Milk run … formula-feeding was widely promoted in the 1950s. Photo: Getty Images
Revolutionaries aren't supposed to look like this. People who change the world have chiselled jaws, steely eyes and an elusive air of power revved up by generous servings of conviction. Lisa Watson's eyes could not be described as steely. They are sparkly and welcoming, and crinkle when she laughs, which she does a lot. She has soft curves and a perma-tan from a life spent chasing three children outdoors. She's not an Oxbridge graduate but a stay-at-home mum, who worked in marketing before having her first baby at 24. But from her bedroom in Curra on Queensland's Sunshine Coast, Watson is quietly working away at spreading a radical message that could change the world for millions of women. Her belief? That it is okay not to breastfeed your child.
For anyone who hasn't had children in the past 30 years, the significance of such a statement may not be obvious. Yet in a society where the one thing all new parents know by heart is that "breast is best", suggesting there is nothing wrong with bottle-feeding is about as socially acceptable as giving cigarettes to your kids.
I was so upset about having to bottle-feed that, the first couple of times, my partner had to give the bottle to my baby.
Breastfeeding has made a spectacular comeback from the dark days of the 1950s, when mothers were told the best start for their baby was to be found in a tin of formula. More than 19 in every 20 Australian women now try breastfeeding at least once, twice the number of 50 years ago. And it is no surprise they do - the breast-is-best message is driven home from the moment a woman conceives. "The push comes from everywhere," laughs Watson.
Hitting the bottle … Los Angeles-based Suzanne Barston, creator of the Fearless Formula Feeder blog. Photo: Hugh Hamilton
At her first antenatal visit, a pregnant woman will be told of the benefits - fewer ear, chest and tummy infections, a lower risk of SIDS, diabetes and obesity, plus a higher IQ. After she gives birth, nurses will encourage her to breastfeed and lactation consultants will be on hand to help with those first difficult fumbles until a successful "latch-on" is achieved. Once at home, she will have the number of a 24-hour breastfeeding hotline, and her much-thumbed copy of What to Expect When You're Expecting will inform her that nursing will burn about 2100 kilojoules a day, help prevent breast and ovarian cancer and develop that all-important bond with her baby. If she Googles "breastfeeding support", she will find 41,900,000 sites that validate her choice, and thousands of support groups and blogs dedicated to nursing at the breast. At every well-baby check-up, posters on the wall will remind her that "breast is best".
According to Dr Nicole Highet, the manager of Beyond Blue's perinatal mental health program, the well-intentioned message has now become a pressure on new mothers. She recently led ground-breaking research which found this pressure has become a significant contributing factor to postnatal depression.
"The women studied talked about the portrayal of perfect mothers in the media who are all breastfeeding, and how it made them feel like a failure when they were having troubles," she says. "An inability to breastfeed would be seen as another indication that you are not a 'natural' or a 'good' mother, because breastfeeding has become synonymous with being a 'good' mother in our culture."
The new radical … Queensland-based Lisa Watson, founder of Bottle Babies. Photo: Naz Mulla
By default, if not by design, the act of breastfeeding has become a key marker of good mothering; what all mothers measure themselves and others by. The alternative - using formula - is characterised by one overarching emotion: guilt.
It is against this backdrop that, last year, Lisa Watson launched Bottlebabies.org, the first not-for-profit organisation in the world dedicated to providing support and information to bottle-feeding parents. Although, globally, the majority of parents will use formula at some stage, Bottle Babies runs one of only two independent websites dedicated to giving support and information to bottle-feeding mothers. "That really just shows the lack of support," Watson says.
Yet Bottle Babies is capturing a tide of change that has started to lap at the edge of the public discourse around infant feeding. In publications from The Spectator ("I choose to bottle-feed my baby. Get over it"), The Atlantic ("A father's case against breastfeeding") and the Fairfax Media website dailylife.com.au ("I hated breastfeeding"), commentators are daring to suggest that while breast milk is undoubtedly better than formula, perhaps breastfeeding is not always best for mother and baby.
Feminists such as Jessica Valenti and Elisabeth Badinter want the needs of women to count for more in the breastfeeding debate. Even US comedian Tiny Fey has weighed in, slamming women she calls "Teat Nazis" in her memoir, Bossypants. Add to that the growing number of Facebook support groups for bottle-feeding, and the result is what can only be described as a backlash, not against breastfeeding but against what some see as the dogma of "breast is best".
Backlash isn't a word that Watson likes to use. "I just really want to make sure that other mums don't have to struggle like I did," she says. Having always planned on breastfeeding, she was devastated when she simply couldn't produce enough milk because of a previous breast reduction.
"I was so upset about having to bottle-feed that, the first couple of times, my partner had to give the bottle to my baby," she remembers. Feeling a gaping need for support, she set to work. Seven years and hundreds of late nights of research later, Bottle Babies was born. At its heart is a belief that good parenting doesn't come from breasts or bottles: "It comes from the heart, and we need to be supporting each other as mums, no matter how we mother our children.”
In her home in a down-at-heel neighbourhood in Los Angeles, the woman who, for the past three years, has been almost single-handedly "standing up for formula feeders, without being a boob about it", as her blog's subtitle proclaims, is struggling to find a quiet place to talk. Suzanne Barston, a small, vegan mother of two, is the other leader of the pushback against "breast is best". From its debut three years ago, her Fearless Formula Feeder blog now gets up to 3000 visits a day from dozens of countries and has spawned a recently published book, Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why it Shouldn't.
For now though, this mommy-blog powerbroker is hunting a space where her four-year-old son, Leo, who is defying bedtime, will not distract her from this Skype interview. It was, she explains, Leo's refusal to latch on that first sent Barston into the world of formula. ("Latching on" is medical-speak for the seal a baby's mouth forms around the nipple. A good seal is essential for good breastfeeding.) Like the vast majority of mothers, she had always intended to breastfeed, but when Leo simply wouldn't suckle, she ended up pumping for months to give him her breast milk. Even then he had rashes, bloody nappies and was sick "22 out of 24 hours a day".
After Leo was finally diagnosed with a dairy allergy, Barston's only option was to move him to a hypoallergenic formula. "Within 12 hours, we had a different child," she says. "But when I switched, I found absolutely no support out there. I was really frustrated with the limited nature of the discourse." Like many 21st-century mothers with something to say, she started blogging. Thus began the Fearless Formula Feeder (FFF). With posts such as "Formula feeding tips - since you'll be hard pressed to find them elsewhere", her blog is a mixture of sceptical science, angry polemic, public confessional and cheerleader. Women posting on both FFF and Bottle Babies frequently profess to be crying with relief at finding an online haven for those who can't or don't want to breastfeed. "THANK YOU THANK YOU THANK YOU" is a typical comment on FFF.
But there are also plenty of detractors, particularly of Barston and her more confrontational style. "I've been called stupid, the c-word, the b-word," she says matter-of-factly. "But for every piece of hate mail, I get 10 emails from people who have been helped by hearing the stories of other women who are on the blog, too.”
For many, the road to the bottle is a traumatic one, littered with cracked nipples, sleepless nights and lactation consultants. Perhaps wary of the charge that bottle-feeding mothers are lazy and ignorant, women often seek to justify the decision rather than simply explain it.
But Kimberly Morgan, 36, a frequent poster on Bottle Babies' Facebook page, did not attempt to breastfeed 11-month-old Madeline even once. To drive the point home, she bound her breasts with two sports bras after she gave birth, much to the astonishment of her obstetrician. Morgan explains, in a Facebook interview from her home in Japan, that as a survivor of sexual assault, breastfeeding would have triggered a horde of unwelcome memories.
"In order to be the healthiest mother possible for my child, I knew that I needed to bottle-feed her. Bodily autonomy is a huge thing to me, as is retaining control over choices involving my body. I think there are many women who feel this way, but are too embarrassed to speak up. There is such pressure with the 'breast is best' message, but what about the mother? What about what's best for her mental health?"
There were no traumatic events that led Sasha Orhan, 28, to bottle-feed her three children: she simply says it wasn't for her. "I wanted my body back and I just didn't like the feeling of it," she says over the phone from her home in the Gold Coast.
Giving birth to her first baby at 24, Orhan fits the demographic for bottle-feeders: younger women are less likely to breastfeed than older mothers. Unlike many women who describe troubles with breastfeeding as their reason for using formula, she was easily able to nurse her first son. "It was all fine, I could feed, I had plenty of milk, but it was just something I didn't want to do."
She says she kept it up for five weeks because of pressure from breastfeeding counsellors, but felt immediately better when she stopped, and didn't attempt to breastfeed either of her subsequent children. "I've been ridiculed by friends for not doing it, but I've stood my ground the whole time," she says. "I definitely think the whole experience has made me a stronger person.”
"I have been told I am a horrible person, that I feed my child dog food and that I am very selfish," says Kimberly Morgan. "One of my Japanese friends saw me upset after a woman made the dog-food comment to me and said, 'Don't worry about them. They are as inconsequential as radishes.' So, now I imagine a bunch of talking radishes when people make crazy comments or judgments.”
Breastfeeding was on life support in the middle of last century. A paternalistic medical system, predatory formula advertising and the growing numbers of women joining the workforce meant that, according to statistics from the Australian Breastfeeding Association (ABA), by the 1970s, fewer than half of all Australian mothers breastfed after leaving hospital. Its resurgence is thanks to an international campaign led by the World Health Organisation, UNICEF, governments and breastfeeding advocacy groups.
At the drive's heart are literally thousands of studies showing that breastfed babies are healthier, smarter and leaner than their bottle-fed counterparts. But according to the leaders of the breast-is-best backlash, the evidence isn't as concrete as first glances would lead us to believe. "We have a very large body of research which shows that babies who are breastfed have less of a chance of a number of illnesses, less chance of childhood obesity, better chance of a higher IQ. However, none of the studies can show us whether it is the breast milk that is doing this, the act of breastfeeding or merely the association of being a child ... who is breastfed exclusively [by its mother]," says Barston.
It is the argument made by journalist Hanna Rosin, whose infamous 2009 article for The Atlantic, "The Case Against Breast-feeding", first questioned the quality of the evidence and planted the seed of the current push-back against "breast is best". Her essay argued that while women are told of a rock-solid mountain of evidence in favour of breastfeeding, "the medical literature looks nothing like the popular literature. It shows that breast-feeding is probably, maybe, a little better ... A couple of studies will show fewer allergies, and then the next one will turn up no difference. Same with mother-infant bonding, IQ, leukaemia, cholesterol, diabetes."
At the core of Rosin's argument, as well as that of Barston and the American academic Joan Wolf, whose book Is Breast Best? raised the ire of "lactivists" everywhere, is that breastfeeding mothers are fundamentally different from bottle-feeding mothers. Researchers try to account for the known demographic differences - breastfeeding mums tend to be richer, better-educated and healthier - but they can't account for what could be the biggest confounding factor of all, which is that a woman's decision to breastfeed, and continue breastfeeding in the face of difficulties, may show a supreme commitment to her child's well-being that could trickle down to all aspects of her baby's health and development. In other words, breastfeeding is a symptom of better mothering, rather than a healthier baby being an outcome of breastfeeding.
It's a highly controversial idea, and one that receives short shrift from breastfeeding experts around the world. One is Dr Karleen Gribble, an adjunct fellow at the School of Nursing and Midwifery at the University of Western Sydney, who believes that questioning breastfeeding's benefits is a coping mechanism for women struggling with the guilt of using formula. "And I think that this is completely fine. It's a decent coping mechanism. The problem is that others have picked up on this, people like Joan Wolf and Hanna Rosin and now Suzanne Barston who have fed on it, looked at the research in a superficial way with a non-expert eye and lent legitimacy to the idea that there is no real difference in health outcomes between breastfed and formula-fed infants."
When she first began her blog, Barston frequently picked apart research in the belief that showing some of the shortfalls might convince mothers that infant feeding is not an uncontested area of study. Now, she's not sure that it's worth the trouble. "I just don't feel that it gets anywhere because people just refuse to see it, and it is really frustrating. But the other side of that is ... breastfeeding can be an extremely pleasurable, rewarding, awesome experience. I'm afraid that by focusing so much on 'Is breast really best?' that we are giving society and companies a reason not to support breastfeeding. And I do think it is extremely important to promote and protect it; it's just the way that we go about it.”
In Australia, women frequently encounter moments of zealotry when it comes to breastfeeding versus formula-feeding. For example, one Australian Breastfeeding Association educator was secretly recorded in an antenatal class likening formula to AIDS. The unnamed counsellor reportedly told a class, "AIDS destroys your immune system and then you just die of anything and that's what happens with formula ... Every 30 seconds, a baby dies from infections due to a lack of breastfeeding and the use of bottles." (The ABA made it clear those were not its views, and sent the counsellor for retraining.)
For Lisa Watson and the Bottle Babies team, the most worrying issue is a bid to beef up the labelling on formula tins to include warnings about the health risks of not breastfeeding. Tins already carry the mandatory statement "breast milk is best for babies" and Food Standards Australia New Zealand, the national food safety body, is taking submissions on whether to add more explicit warnings.
"We feel that putting warning labels on tins just causes emotional distress and doesn't help breastfeeding rates at all," says Watson. "One of the respondents in a survey we put out said simply having a statement on there isn't going to make her boobs work any better.”
But ever the optimist, she also sees breakthroughs in Australia for bottle-feeding parents. One is a newly announced pilot study by the Queensland University of Technology and Cambridge University to give mothers who are already using formula free consultations with a paediatric dietitian. According to the 2010 Australian National Infant Feeding Survey, by the age of just one month, 40 per cent of newborns will have had at least some formula, and nearly 80 per cent will have it by 12 months. Despite its prevalence, there is very little information and support about how to do it safely. When formula is made up incorrectly, possible risks include infection, malnutrition and, in extreme cases, death. "The advice on the tin really isn't sufficient," says QUT researcher Dr Kimberley Mallan. Lisa Watson estimates that 90 per cent of women who visit Bottle Babies have never been taught how to bottle-feed, despite the potential risks.
So, does breastfeeding promotion in Australia need a revamp? Renee Kam, spokeswoman for the Victorian branch of the ABA, believes not: "Why would the Australian government fund our breastfeeding helpline, why would they fund a national breastfeeding strategy, why would they put money into promoting breastfeeding if it wasn't in the nation's best interests? If we don't ever talk about the risks of not breastfeeding, then we are depriving mothers of important decision-making information.”
In Watson's view, the polarised version of the breast-versus-bottle debate, like the rest of the media-driven "mummy wars", isn't borne out in real life: "I think the majority of people want to see mums happy and healthy and babies happy and healthy. There is a small minority of people who are pushing for one particular way."
Above her desk, there are two frames. In one is a photo of her first child, Jakob, when he was three days old. In the other, the certificate of incorporation for Bottle Babies. The photo is to remind her of her struggle with breastfeeding and the overpowering guilt of having to use formula. The certificate is to remind her of how far she has come. "It's embarrassing, but before my own breastfeeding troubles I definitely had that judgmental attitude of, 'If you just try hard enough.' That's why I don't blame people who are passionate ... because that's how I felt." She giggles when asked what her 24-year-old self, who only ever wanted to be a stay-at-home breastfeeding mum, would think of 31-year-old Lisa, the bottle-feeding activist. "You never know where your life is going to lead you. At that time when I was going through all this self-doubt and feeling like a failure, I never thought it would lead me to where we are now.”
- From Good Weekend.