NEAL CONAN, host:
If breast is best, why do so many mothers bottle their milk? For the answer to this question and others, Jill Lepore provides some cultural history on motherhood and points us to recent US legislation on the matter. As Facebook stirs controversy by censoring a profile picture of a mother breastfeeding her child, Lepore's article, "Baby Food," in this week's New Yorker shows that debates around the way a mother feeds her child have echoed for centuries.
Meanwhile, moms who make a living outside the home typically head back to work after 12 weeks of unpaid maternity leave if that, and they're turning more and more to breast pumps. As the popularity of these devices soars, Lepore raises another question - is it the mother or her milk that matters more to the baby?
So, parents, we want to hear from you. How do you deal with the issue with work and an infant? Give us a call, 800-989-8255. Email us, firstname.lastname@example.org. And you can join the conversation at our Web site, that's at npr.org, just click on Talk of the Nation.
Jill Lepore joins us now from her office in Cambridge, Massachusetts, where she teaches American history at Harvard University. She's also a staff writer for the New Yorker. Nice to have you on the program today.
Dr. JILL LEPORE (Department of History, Harvard University): Thanks.
CONAN: And it seems like some controversy over breastfeeding erupts every few months, on Facebook, at the airport checkpoint, at the TSA checkpoint there. With the availability of breast pumps, you write in your piece, all of this is so new that people are making up the rules as we go along.
Dr. LEPORE: Well, I think the ability to extract milk from the human body and store it reliably in your kitchen refrigerator is a relatively new thing, and that it's being done so common creates all kinds of problems policy-wise but more familiarly, to most Americans, I think, just at the level of daily decision-making.
CONAN: Daily decision making about - well, the first decision, about how long you breastfeed your child.
Dr. LEPORE: Yeah. You know, doctors will tell you to breastfeed your child for the first year of life, and many women who are interested in breastfeeding would like to listen to that advice, and there's just not a lot of - there aren't many systems set up in place to make that possible.
CONAN: But you are curious about the amount of activity - you introduced me to a new word, lactivist - I've not heard that before - but the amount of activity around issues involving areas for mothers to, well, extract their milk during the day.
Dr. LEPORE: So, there's been a lot of legislation in recent years, really a flurry of it, a lot of it having to do with enforcing exceptions to obscenity clauses for - to allow women to breastfeed in public and expose their breasts in public and not be liable to prosecution. And that seems, you know, to be straightforward and is probably proceeding without much resistance in many places.
But there's another large category of breastfeeding-breast pumping legislation that's being debated at the state and national level as well to include protecting breast pumps and the act of expressing human milk, which is what extracting the milk from your breast and putting it into a container is called, to kind of marry the protection of and promotion of breastfeeding to the protection and promotion of breast pumping. And that is what interested me, the kind of conflation of those two things as if they are one and the same.
CONAN: As if they're one and the same?
Dr. LEPORE: Yeah. And they're - you know, they're not. And there's not a lot of medical evidence to suggest really clearly what the benefits are of feeding your child bottled human milk versus bottled formula, say. There just haven't been a lot of really good studies doing that comparison. There are incredibly rigorous studies comparing feeding your child formula to breastfeeding and all those studies over a long period of time are what lie behind the American Academy of Pediatrics' very forceful endorsement of breastfeeding.
But there's a squeamishness, a political squeamishness, I think, around really thinking about what it means to tell women to breastfeed, but then to actually make it possible only for them to feed their children bottled human milk.
CONAN: Because the issue, as you say it, the real issue is, is it the mother that's important, the act of cuddling and talking to the child and the love, is that what's important, or is it the milk?
Dr. LEPORE: Well, you know, there's not some kind of clear definition on this. And one would be hesitant to hear one since there's a very long history of women being told how to mother and what matters about mothering and women being told that their biology is destiny and women being told that they should work or shouldn't work or should be with their babies this much time, and they should treat them this way or the other way.
So, I'm not making a plea for there to be necessarily clarity but pointing out that we have - and I think in an almost unthinking way - slipped into a set of decisions that have a lot of women making choices that they're quite unhappy with.
CONAN: For example?
Dr. LEPORE: Well, I think it can be very difficult to say - so for instance, WIC mothers now are able to buy breast pumps or rent breast pumps using food stamp funds. And so to be strongly at a policy level encouraging very poor women with other children at home to be going into the workforce or returning to the workforce 12 weeks after giving birth and handing them a breast pump, I'm just not so sure that that is really what the promotion of breastfeeding and the medical argument favoring breastfeeding necessarily was intended to lead to.
CONAN: And what would be the alternative?
Dr. LEPORE: Well, the alternative would be longer maternity leaves.
CONAN: Which is...
Dr. LEPORE: Or on-site infant daycare. I mean, you know, it seems to be there are three ways - if it's really what's important to us medically, if we were to accept the ruling of the American Academy of Pediatrics that children should be breastfed for the first year of life, there are only three ways to make that possible, to either have year-long maternity leaves or to have on-site infant and toddler child care or to sell pumps to women. And that's the place where you can make money, and that's the piece that's cheapest for employers.
CONAN: Let's get some callers in on the conversation. We're talking with Jill Lepore about her piece in this week's issue of The New Yorker called "Baby Food." If you'd like to join us, 800-989-8255. Email us, email@example.com. We'll begin with Elaine, Elaine with us from Grand Rapids.
ELAINE (Caller): Hi. Thanks for taking my call.
CONAN: Go ahead, please.
ELAINE: My son, who's now 12, I kind of bought into that whole notion of breastfeeding. And when he was born, he did not latch on, and after many, you know, wild and wooly things with nurses and hospitals and whatnot, I decided to pump, and I ended up pumping my breasts for an entire year and feeding him breastmilk, you know, in the bottle.
And it was quite a challenge. People told me - the La Leche League told me that I would not be able to keep up with, you know, the demand, but, in fact, I had two freezers full of breastmilk. And during the process, went back to work, back to school, and had principals walk in while I was pumping, and custodians walk in and staff members, even though there was a sign and the door was locked and everything. So, it was quite an experience.
CONAN: Looking back on it, it was necessary in your case.
ELAINE: You know, at that time - at that time I bought into that whole notion that breastmilk was important for an entire year. I don't know that I'd do it today, but, you know, back then, I was there.
CONAN: And - but in order to feed your child breastmilk, this was the only way you could do it.
ELAINE: Yes, that was the only way I could do it.
CONAN: And you do point out in the piece, Jill Lepore, that in some cases, breast pumps save lives.
Dr. LEPORE: Sure. Breast pumps are really important in hospitals, and in cases like Elaine's, they are crucial for women who have difficulty nursing or variety of circumstances could mean that breast pumping was the right solution for them. I think at any individual level, we can come up - I mean, we can just think anecdotally of friends of ours who have had really positive experiences or really negative experiences with pumping or with breastfeeding or with using formula or different outcomes and this and that.
My point, though, is that as a society, we're kind of cobbling together a bunch of individual decisions while not having a real serious conversation about, for instance, what it means to give companies tax breaks to provide what are called non-bathroom lactation rooms, which would have been good for Elaine since most women really - you know, many of us who have pumped have had the experience of, you know, perching yourself on a toilet and trying to find an outlet and then spilling the milk on the floor and being reduced to tears.
It's just a trial. It's a disaster in many instances. And it's nice to know that some companies now provide these rooms. But in a way, asking women to go back to work and giving them the perk of, you know, basically what is a closet with a chair in it and a sink, is I think not asking enough of what it takes to actually make it possible for women and men to raise children.
CONAN: Hmm. Elaine, what do you think?
ELAINE: Well, I know that there are many other countries - I think America's way, way behind in terms of maternity leave. You know, people in Australia and I believe in Canada have almost a year of paid maternity leave. I believe we're way behind in that matter.
CONAN: OK. Thanks very much for the call. Appreciate it.
ELAINE: Thank you. Bye-bye.
CONAN: And let's see if we can get - let's go to Erin(ph). Erin is with us from Port Sanilac in Michigan.
ERIN (Caller): Hi. I was calling because I had a slightly different situation with my second child. My first child I breastfed until she was 14 months old, even though I was pregnant with my second one, because I thought it was important. I finally stopped because I was exhausted. But with my second child, he was later diagnosed with autism, and he had weaned himself by three months. He would not take the breast, so we were forced to put him on the bottle.
So I had to pump, and I pumped for eight months until I lost my milk, but I remember pumping in the airport, for instance. And all the electrical plugs are on the aisleway by the main walkthrough, so you sit there, and you try to cover yourself as best as you can. And it can be very uncomfortable, but I did it because it was what I thought was the right thing to do.
CONAN: Yeah, the outlets are provided for the convenience of people who want to recharge their laptops.
(Soundbite of laughter)
ERIN: Not for those of us who are pumping our breast milk.
CONAN: I wonder, Jill Lepore, you didn't say this in the article, but I think you just said it on the air here, that you've had this experience yourself?
Dr. LEPORE: Yeah, you know, I went back to work with each of my kids. I breastfed each of them, and I didn't always - I didn't pump for each of them. I grew somewhat frustrated with the strenuousness and the kind of - the artificiality of the situation. Unlike Erin, who had this, you know, pressing medical circumstance that dictated the need for pumping, I was just unable to do my job and be with my kids.
And that was a very, I think, as for many women, a very, very painful situation to be in, and, you know, the pump in some ways seems to make it possible. But in another way, it seems like a very simple solution to a much harder problem. And failing to attend to the bigger problem by accommodating in some ways the cheap way out for an employer is, I think, a problem that has a long history.
And in women's history, that's kind of been richly documented by scholars who have looked at the history of women's relationship to the private and public sphere, and is something I think we need to wrestle with. Again not at the level - we all wrestle with it individually and most of us who have children wrestle with very - with this choice, with every other kind of choice you make about raising your kids, but I think we'd do well to think about it in a broader, community kind of way.
CONAN: Erin, you were trying to say something?
ERIN: I'm sorry. I was going to say, it's also a very - it's a personal emotional battle. I know how heartbreaking it is for women who want to breastfeed their children and are unable to, especially when it's something as simple as needing a place to be able to do it. That it's not reasonable that we put that burden on women on top of all the other difficulties of being a new mother.
CONAN: Erin, thanks for the call. Appreciate it.
ERIN: Thank you.
CONAN: Bye-bye. We're talking with Jill Lepore of the New Yorker magazine about her article called "Baby Food" in this week's issue of the magazine. You're listening to Talk of the Nation from NPR News. And this is Shannon, Shannon with us from Cincinnati.
SHANNON (Caller): Yeah, hi. I was just calling to make a comment. I breastfed my three-year-old until he was two, and I'm nursing now. And I'm back at work already, and my employer is really good because they give me an office to pump in, and I haven't had any break-ins or, you know, exposures or anything like that.
But I have to say that while I want to breastfeed, and I'm glad that I am, that it's a real pain to be able to get all of my work done in the day and stop and do it all, and I really salute countries that give women more maternity leave and places of business that help women to be able to bring their kids to work and be more productive in that way and have their kids with them. I just think that it's a real hardship to do it.
CONAN: Yeah. And one of the points Jill Lepore raises in her piece is, for a lot of women, the choice comes down to, do you spend 20 minutes three times a day to pump your breast or skip that and feed the baby formula, but get home an hour earlier to spend more time with him or her?
SHANNON: That's an interesting solution that, you know, that I hadn't really thought of before, but you have to think, if you have a solution like that, that, you know, most women need to pump to be able to produce milk. The more you take out, the more you produce. So, if you wait all day and don't pump, then your milk production decreases, and then you have the situation where I'm not making enough milk for my baby.
CONAN: So, these - Jill Lepore, as you say, these are agonizing individual questions, but still, that overarching public question that you leave us with.
Dr. LEPORE: Yeah, and I think, you know, it's important to remember that, you know, there was a lot of marketing of breast milk substitutes over the last century, so that by the middle of the 20th century, more women were feeding their babies formula than were breastfeeding. And the second half of the 20th century has witnessed a great rise in the return, especially since the 1980s, of breastfeeding.
And formula companies are making less money, and there's less money - there's not a lot of money if you think about it to be made off of women breastfeeding their infants until pump comes - and the pump companies come along and offer this solution which allows them to sell services to corporations.
There are all these corporate lactation programs, these consulting services which allow employers to get tax breaks for providing, you know, these tiny rooms with a chair and a sink in them and therefore to win kind of working women's magazines awards for being good employers. And so we have a kind of a marketing of a whole different solution to the problem of infant feeding as if infant feeding is inherently a problem.
CONAN: And do you find that women's groups are on the side of, we ought to find a lot more - a lot more time for maternity leave, or are they arguing for more lactation rooms?
Dr. LEPORE: Yes, so I think we've had a real diminished set of expectations as the, you know, women - I think women's groups have certainly had a diminished set of expectations about what's possible within a women's movement. There was a time when people really were arguing rather vociferously and stridently and making the comparison with other industrialized nations that a year's maternity leave is a reasonable solution, and it's a goal to be fought for.
That's not, for instance, what the National Organization of Women is fighting for. They want companies to provide lactation rooms. That's a very different and I think a much lesser and much less ambitious goal and not one that speaks to many women's experiences.
I mean, I, you know, this article just came out a couple of days ago, and I've gotten flooded with emails from women saying, I am so unhappy that I spent my child's infancy pumping. And I look back on it, and I have regrets about that, and I wonder why I was so convinced that pumping was the right solution for me and what it was about this kind of moment in history that got us to this point.
CONAN: Shannon, thanks very much for the call.
SHANNON: Oh, no problem.
CONAN: OK, we've got to go. We're out of time. Appreciate the phone call. And I'd like to thank Jill Lepore for her time today.
Dr. LEPORE: Thank you.
CONAN: Jill Lepore's article, "Baby Food," in this week's issue of the New Yorker. We have a link to it at npr.org, just click on Talk of the Nation. She was with us from her office in Cambridge, Massachusetts. This is Talk of the Nation from NPR News. I'm Neal Conan in Washington.