History and culture of breastfeeding

Old-Babylonian plaque of a sitting woman breastfeeding her infant, from Southern Mesopotamia, Iraq

Moche ceramic vessel showing a woman breastfeeding. Larco Museum Collection. Lima-Perú

Princess Sobeknakht Suckling a Prince, ca. 1700-after 1630 B.C.E Brooklyn Museum

In the Egyptian, Greek and Roman empires, women usually fed only their own children. However, breastfeeding began to be seen as something too common to be done by royalty, and wet nurses were employed to breastfeed the children of the royal families. This was extended over the ages, particularly in western Europe, where noble women often made use of wet nurses.[1] The Moche artisans of Peru (1–800 A.D.) represented women breastfeeding their children in ceramic vessels.[3]

Shared breastfeeding is still practised in many developing countries when mothers need help to feed their children.

Painting of a woman breastfeeding at home, Netherlands

In the 18th century male medical practitioners started to work on the areas of pregnancy, birth and babies, areas traditionally dominated by women.[7] Also in the 18th century the emerging natural sciences argued that women should stay at home to nurse and raise their children, like animals also do.[8] Governments in Europe started to worry about the decline of the workforce because of the high mortality rates among newborns. Wet nursing was considered one of the main problems. Campaigns were launched against the custom among the higher class to use a wet nurse. Women were advised or even forced by law to nurse their own children.[9] The biologist and physician Linnaeus, the English doctor Cadogan,[10] Rousseau, and the midwife Anel le Rebours described in their writings the advantages and necessity of women breastfeeding their own children and discouraged the practice of wet nursing. Sir Hans Sloane noted the value of breast-feeding in reducing infant mortality in 1748. His Chelsea manor which was later converted to a botanic garden was visited by Carl Linnaeus in 1736.[11] In 1752 Linnaeus wrote a pamphlet against the use of wet nurses. Linnaeus considered this against the law of nature. A baby not nursed by the mother was deprived of the laxative colostrum. Linnaeus thought that the lower class wet nurse ate too much fat, drank alcohol and had contagious (venereal) diseases, therefore producing lethal milk.[12]

Cover of Linnaeus' Nutrix Noverca (1752)

Mother's milk was considered a miracle fluid which could cure people and give wisdom. The mythical figure Philosophia-Sapientia, the personification of wisdom, suckled philosophers at her breast and by this way they absorbed wisdom and moral virtue.[13] On the other hand, lactation was what connected humans with animals. Linnaeus – who classified the realm of animals – did not by accident rename the category 'quadrupedia' (four footed) in 'mammalia' (mammals). With this act he made the lactating female breast the icon of this class of animals in which humans were classified.[14][15]

Historian Rima D. Apple writes in her book Mothers and Medicine. A Social History of Infant Feeding, 1890–1950 that in the United States of America most babies received breastmilk.[16] Dutch historian Van Eekelen researched the small amount of available evidence of breastfeeding practices in The Netherlands. Around 1860 in the Dutch province of Zeeland about 67% of babies were nursed, but there were big differences within the region.[17] Women were obliged to nurse their babies: "Every mother ought to nurse her own child, if she is fit to do it (...) no woman is fit to have a child who is not fit to nurse it."[18]

Mother's milk was considered best for babies, but the quality of the breastmilk was found to be varied. The quality of breastmilk was considered good only if the mother had a good diet, had physical exercise and was mentally in balance.[19] In Europe (especially in France) and less in the USA it was a practice among the higher and middle class to hire a wet nurse. If it was too difficult to find a wet nurse, people used formula to feed their babies, but this was considered very dangerous for the health and life of the baby.[20]

Breastfeeding in the Western world declined significantly from the late 1800s to the 1960s.[21] By the 1950s, the predominant attitude to breastfeeding was that it was something practiced by the uneducated and those of lower classes. The practice was considered old-fashioned and "a little disgusting" for those who could not afford infant formula and discouraged by medical practitioners and media of the time.[2] Letters and editorials to Chatelaine from 1945 to as late as 1995 regarding breastfeeding were predominantly negative.[2] However, since the middle 1960s there has been a steady resurgence in the practice of breastfeeding in Canada and the US, especially among more educated, affluent women.[2]

In 2018, Transgender Health reported that a transgender woman in the United States breastfed her adopted baby; this was the first known case of a transgender woman breastfeeding.[22][23]

In response to public pressure, the health departments of various governments have recognised the importance of encouraging mothers to breastfeed. The required provision of baby-changing facilities was a large step towards making public places more accessible for parents and in many countries there are now laws in place to protect the rights of a breastfeeding mother when feeding her child in public.

The World Health Organization (WHO), along with grassroots non-governmental organisations like the International Baby Food Action Network (IBFAN) have played a large role in encouraging these governmental departments to promote breastfeeding. Under this advice they have developed national breastfeeding strategies, including the promotion of its benefits and attempts to encourage mothers, particularly those under the age of 25, to choose to feed their child with breast milk.

Government campaigns and strategies around the world include:

• National Breastfeeding Week in the United Kingdom
• The Department of Health and Ageing Breastfeeding Strategy in Australia
• The National Women's Health Information Center in the United States
• World Breastfeeding Week

However, there has been a long, ongoing struggle between corporations promoting artificial substitutes and grassroots organisations and WHO promoting breastfeeding. The International Code of Marketing of Breast-milk Substitutes was developed in 1981 by WHO, but violations have been reported by organisations, including those networked in IBFAN. In particular, Nestlé took three years before it initially implemented the code, and in the late 1990s and early 2000s was again found in violation. Nestlé had previously faced a boycott, beginning in the U.S. but soon spreading through the rest of the world, for marketing practices in the third world (see Nestlé boycott).

United States

WPA poster, 1938

A United States House of Representatives appropriations bill (HR 2490) with a breastfeeding amendment was signed into law on September 29, 1999. It stipulated that no government funds may be used to enforce any prohibition on women breastfeeding their children in Federal buildings or on Federal property. Further, U.S. Public Law 106-58 Sec. 647 enacted in 1999, specifically provides that "a woman may breastfeed her child at any location in a Federal building or on Federal property, if the woman and her child are otherwise authorized to be present at the location." A majority of states have enacted state statutes specifically permitting the exposure of the female breast by women breastfeeding infants, or exempting such women from prosecution under applicable statutes,[38][39] such as those regarding indecent exposure.

Most, but not all, state laws have affirmed the same right in their public places. By June 2006, 36 states had enacted legislation to protect breastfeeding mothers and their children. Laws protecting the right to nurse aim to change attitudes and promote increased incidence and duration of breastfeeding.[39] Recent attempts to codify a child's right to nurse were unsuccessful in West Virginia and other states.[40] Breastfeeding in public is legal in all 50 U.S. states and the District of Columbia.[38]

The following table shows the uptake of exclusive breastfeeding.[44][45]

Direct udder nursing 1895

If a mother cannot feed her baby herself, and no wet nurse is available, then other alternatives have to be found, usually animal milk. In addition, once the mother begins to wean her child, the first food is very important.

Feeding vessels dating from about 2000 BC have been found in Egypt. A mother holding a very modern-looking nursing bottle in one hand and a stick, presumably to mix the food, in the other is depicted in a relief found in the ruins of the palace of King Ashurbanipal of Nineveh, who died in 888 BC.[47] Clay feeding vessels were found in graves with infants from the first to fifth centuries AD in Rome.[48]

Valerie Fildes writes in her book Breasts, bottles and babies. A history of Infant Feeding about examples from the 9th to 15th centuries of children getting animal's milk. In the 17th and 18th century Icelandic babies got cow's milk with cream and butter.[49] Human–animal breastfeeding shows that many babies were fed more or less directly from animals, particularly goats.

In 1582, the Italian physician Geronimo Mercuriali wrote in De morbis mulieribus (On the diseases of women) that women generally finished breastfeeding an infant exclusively after the third month and entirely around 13 months of age.[50]

The feeding of flour or cereal mixed with broth or water became the next alternative in the 19th century, but once again quickly faded. Around this time there became an obvious disparity in the feeding habits of those living in rural areas and those in urban areas. Most likely due to the availability of alternative foods, babies in urban areas were breastfed for a much shorter length of time, supplementing the feeds earlier than those in rural areas.

Though first developed by Henri Nestlé in the 1860s, infant formula received a huge boost during the post–World War II baby boom. When business and births decreased, and government strategies in industrialised countries attempted to highlight the benefits of breastfeeding, Nestlé and other such companies focused their aggressive marketing campaigns on developing countries. In 1979 the International Baby Food Action Network (IBFAN) was formed to help raise awareness of such practices as supplementary feeding of new babies with formula and the inappropriate promotion of baby formula, and to help change attitudes that discourage or inhibit mothers from breastfeeding their babies.

• Nursing chair
• Weaning
• Human milk banking in North America
• Postpartum confinement, a system of recovery from childbirth that allows for mother and baby to learn how to nurse