CHILDREN / The campaign for real milk: Breastfeeding, Dinah Hall argues, has become a middle-class fringe activity. Next week, enthusiasts will begin to fight back

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The Independent Culture
WE HAVE grinned for National Smile Day, stubbed out for No Smoking Day - now let us all unbutton our blouses for National Breastfeeding Week, which starts tomorrow. Around the country a few stalwart middle-class women, recruited from local branches of the National Childbirth Trust, will lift up their flowery sweatshirts in McDonald's or department store restaurants to predictable headlines of 'No Breast Please, We're British'.

Meanwhile, the rest of British motherhood will carry on as normal - removing the dummy from baby's mouth and replacing it with a rubber teat. For behind these government-inspired jollies there always lies a darker truth (as in, thousands of people die from lung cancer each year and we are a nation of miserable sods). Behind National Breastfeeding Week is a serious concern about the decline of breastfeeding in this country.

In England nearly 65 per cent of women breastfeed their babies at birth, but after six weeks only 40 per cent are soldiering on; in Northern Ireland the start-off figure is already below 40 per cent, with about 12 per cent continuing. Far more revealing, though, are the figures relating to social class. At the bottom end of the British socio-economic scale only 34 per cent start breastfeeding. In Norway, by comparison, 99 per cent of mothers continue after six weeks. Broadly speaking, in Britain breastfeeding is regarded as a middle-class fringe activity: the upper and working classes share a common distaste for it.

Breastfeeding in public is viewed as at best socially unacceptable, at worst an act of deliberate subversion. Alison Waters remembers breastfeeding her six-week-old son Martin in Mothercare, that citadel of babyhood. Having rejected the idea of feeding him in the room set aside for the purpose because it was overflowing with the day's takings in dirty nappies, she sat on a bench in the shoe section with her back turned and fed him underneath her heavy winter coat, only to be halted by a horrified sales assistant who told her: 'You can't do that here, it might offend the customers.'

Nowadays, midwives and health visitors - and baby milk manufacturers - are under pressure to acknowledge that 'breast is best'. At the same time they feel an obligation not to make women feel guilty about bottle feeding. This sensitivity to the feelings of non-breastfeeding mothers, which protects the interests and boosts the profits of the formula milk manufacturers such as Farley, Cow & Gate, Milupa and Wyeth (baby milk sales total pounds 180m per year), may have gone too far. It should not be allowed to obscure the benefits of breastfeeding for the majority of mothers.

As well as providing the valuable antibodies which protect against infection in the first few months of life, human milk contains essential fatty acids which promote optimum physical and mental development. Human milk is particularly good for brain and blood vessel growth, whereas cow's milk promotes rapid physical growth: in comparison to body weight, the bovine brain is extremely small. This may well have some relevance to the finding that children who were breastfed as babies tend to have higher IQs than those who were bottle fed. Other tests, however, have shown that even the intention to breastfeed is associated with higher IQs in children. Dr Mike Woolridge of the Breastfeeding Clinical Support Service in Bristol believes this indicates an intrinsic difference in attitudes to parenting between breast and bottle feeders. This should be of some comfort to mothers who feel guilty when they do not succeed in breastfeeding.

Patty Rundle of Baby Milk Action, which campaigns against the marketing and promotion tactics of the baby milk companies, believes that any guilt lies firmly in the camp of the manufacturers, who 'put across the message that you should breastfeed if you can, creating an atmosphere of doubt. Why do they make us feel that our bodies won't function?'

Seventy-five per cent of the women who give up breastfeeding after six weeks cite as their reason insufficient milk. But of the women referred to the Breastfeeding Clinical Support Service, 85 per cent are helped simply by correction of their feeding technique. It is important to recognise, however, that some women do have real and distressing physical and psychological problems with breastfeeding.

For most mothers who 'fail', the problem starts in the early days, very often in the maternity ward itself, when well-intentioned but ill-informed staff give breastfed babies a bottle of formula. In the first few weeks the breasts are going through a 'calibration process', explains Dr Woolridge. The baby's needs are calculated by how much he or she sucks. If a bottle is given the baby sucks less and the breasts miscalibrate, thus producing insufficient milk. Also a young baby's stomach is the size of a walnut, points out Rosemary Thompson of the Health Visitors Association: just one bottle of formula will stretch it and make it dissatisfied with the breast, which delivers quality over quantity.

Next month a law banning the advertising of formula milk comes into force. But, says Rosemary Thompson, the manufacturers really don't need to advertise any more. We live in a bottle-fed culture. Mother and baby rooms in shops and airports are graphically depicted with a bottle. Babies on television are bottle fed. Education at primary and secondary school is vital, yet in a series of three BBC videos intended for sex education at primary level, the first image you see of a baby is one with a bottle stuck in its mouth.

The benefits of breastfeeding could have been tailor-made to address some of the problems of low-income mothers in deprived areas. It can act as a natural contraceptive - most women breastfeeding on demand will not menstruate for up to a year; it seems to protect against cot death; breastfed babies tend to cry less because their needs can be immediately satisfied; and, of course, it is free.

Many women cannot cope, however, with the duality of their breasts being sex objects one minute and feeding vessels the next. More crucially, nor can their partners. 'Many husbands consider breasts their own,' says psychotherapist Pat Thomas, 'and they don't want to see them out on loan.' She also believes that, where women have low self-esteem and no sense of worth, 'they simply cannot believe that something of value can come from them. The working classes in Britain, and increasingly people in the third world, believe they are giving the best because they have paid. If they are spending money on milk, it has a concrete value, as opposed to breast milk which has an inner value.'

There is one other crucial but little researched element, one which is often left out of the breast versus bottle equation. Breastfeeding is the natural end to a hormonal cycle which begins with pregnancy. In rats and mice, Dr Woolridge points out, two hormones - prolactin and oxytocin - drive their maternal behaviour: when deprived of these, the animals neglect their offspring. The same hormones are present in lactating mothers. Oxytocin, which is produced while breastfeeding - and during orgasm (hence the similarity of feeling between sex and breastfeeding reported by some women) - is one of nature's tranquillisers, while prolactin, dubbed by some doctors 'the hormone of mother love', may be of immense benefit during the sometimes stressful months of early motherhood. 'Any human mother who elects to bottle feed can kiss goodbye to those hormones,' says Dr Woolridge.

Having trained as a zoologist and spent the last 15 years researching breastfeeding in humans, Dr Woolridge must have a perspective on the likely effect that denying part of our mammalian nature could have on society. From a scientific point of view, he says, this is difficult to evaluate. 'But my personal feeling is that the emotional health of a society is affected by whether it is bottle fed or breastfed. Of course there is a whole set of social concerns which may be involved in dysfunctional or aberrant parenting - poverty, housing, deprivation, overcrowding, poor access to education. But within those factors, if 95 per cent of women breastfed I am sure there would be better mother/child cohesion, and that it would be a contributing factor in diminishing the parenting mishaps that we see today.'-

(Photograph omitted)