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Q&A With Award-Winning Author and Journalist Kimberly Seals Allers on Her Recent Book, The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding

May 23, 2017Kimberly Seals Allers is an award-winning journalist and founder of www.MochaManual.com, a pregnancy and parenting blog specifically geared toward Black parents. Her new book, The Big Letdown: How Medicine, Big Business, and Feminism Undermine Breastfeeding, is an in-depth analysis of the social, economic, and political influences of the American breastfeeding culture. 

Below are Kimberly’s thoughts about her book and how women’s health and wellness impacts our nation, particularly in the workplace. 

1. What inspired you to begin exploring the topic of breastfeeding and ultimately write "The Big Letdown"?

I was mostly inspired by my own struggles. As a first-time mom I really wanted to breastfeed but found it incredibly difficult. I was a first-generation breast-feeder, so I didn’t have any multi-generational support, and the experience was far different from what I had read in any magazine or book. As a writer I started sharing my story, and I realized so many women were having similar struggles. I thought, “Hmm, something is not right here. Why are so many women having challenges to fulfill their biological norm?” I mean breastfeeding has sustained humankind for millions of years, and now it is becoming an endangered activity. And I wanted to know why. Why in a country where we boast of American exceptionalism, do we literally suck at breastfeeding? If there is some collective failure among women, is it biological or psychological? Or biological because of a psychological trigger? Why has breastfeeding become so politicized and polarizing? There were so many questions about something that women uniquely do and that impacts the health of our nation, so I wanted to know more. The Big Letdown is the result of five years of reporting and research to reveal the systems and interests that often set women up to fail at breastfeeding before they even begin. It’s an eye-opener and a wakeup call. 

2. Breast milk contains essential nutrients for a growing infant—how did a simple act like feeding our children become so controversial? What are some of the stereotypes and stigmas surrounding women and breastfeeding?

So much shifted for women when companies figured out that there was money to be made by substituting mother’s milk with formula—which began as a necessary product for the relatively few infants whose mothers could not breastfeed. Formula grew into a highly profitable, commercial product to replace breastmilk as often as possible. The profit-driven model of infant formula companies flies in the face of what every medical association says is the optimal nutrition for infants. And what companies do to maintain those profits—from engaging everyone around the mother, including doctors and nurses, to funding the American Academy of Pediatrics—is part of how many of those stigmas survive. 

Another powerful stigma is around nursing in public. In this country women’s breasts are used every day as marketing tools, for example to sell chicken wings or beer, but when women use them for their biological purpose in public they are shamed, told to cover up, or asked to leave public places. This is a cultural problem that is mostly unique to the United States. On top of that, we live in the only developed country that does not offer a paid maternity leave, therefore mothers are returning to work two to three weeks after birth. There’s so much pressure on women, it makes lactation really hard.   

3. What can examining different cultures’ relationships to breastfeeding tell us?
If we take a historical look at different cultural relationships to breastfeeding, we can see starkly different experiences that have contributed to the disparities we see today. For example, during slavery Black women were forced to stop breastfeeding their own children in order to feed the children of their slave owners. Many historical records show that often the slaves’ own children grew sick or died because the mother had to feed the master’s children. This disrupted breastfeeding experience has often led to a negative association of breastfeeding with something Black women did for other people or were forced to do. Today, there remains a 40-year-old racial disparity in breastfeeding rates between white women and Black women. Either way, we know that social acceptance and cultural acceptance of breastfeeding does not happen in a vacuum—it is shaped by historical events, women’s work patterns, evolving feminist ideals, and even women’s perceptions of their own bodies. 

4. In what ways—both obvious and insidious—are big businesses influencing women when it comes to breastfeeding?

There are so many ways. Throughout history, big business has insinuated itself into disrupting breastfeeding. For years, infant formula companies paid big money to hospitals around the world for the rights to design or renovate their newborn facilities. Of course, these designs included centrally located nurseries that placed mothers far away from babies, a practice that disrupts the natural rhythm of breastfeeding. They have courted physicians with direct payments or invitations to fancy “ski and learn” conferences, or funded scientific research to skew outcomes. Much like the tobacco companies, they create “institutes” that sound reputable, and then fund faux science that supports their agenda.

The obvious way is that they peddle fear and doubt. They are willing to concede breastmilk is best, but offer you formula “just in case,” planting a seed of doubt in the minds of mothers. They use physicians as marketing ambassadors and make multi-million dollar, back-door deals with hospitals to buy the right to market their formula to every mom who delivers there. Moms have no say-so and no cut of the deal.

Ultimately, public health and private profit are at odds because the formula industry profits from the failure of breastfeeding. And the failure of breastfeeding among a generation of women is a fatal blow to the health and wellness of future generations. 

5. As you did research for your book, what surprised you most? 

I think I was most surprised by listening to many of the calls the infant formula company CEOs have with Wall Street analysts where they openly discuss their business strategy. There’s very little talk of improving the nutritional quality of formula but much talk about new marketing angles —tweaking a product to claim it can help with colic, allergies, etc. At the end of the day, these companies are accountable to shareholders and are not champions of infant health. The CEO of Mead Johnson Nutritian (the maker of Enfamil) openly stated that he didn’t see any difference in marketing strategies at a consumer products company, “whether you sell infant formula or you sell beer.” I’d like to think those strategies should be very different. 

I was also surprised and saddened by how much women have accepted in this area of our lives—the pumping experience still feels dehumanizing, and we accept that our physicians don’t receive much lactation training in medical school but get “educated” by the infant formula companies. We’ve allowed marketing campaigns to create the so-called “mommy wars” that divide women just to sell us products. We haven’t fought for a feminist movement to include protections for all the roles and identities women choose to play in their lives—including motherhood—which leaves birth and breastfeeding without much feminist support. The fact is, we deserve better.

6. What are "first food deserts," and how do they impact breastfeeding trends across the country? 

Just as we have come to understand the concept of “food deserts”—that is, that there are some places where there are no easily accessible fresh fruits and vegetables—we also know there are “first food deserts,” places where mothers struggle to get the support and resources they need to effectively feed their babies the healthiest first food—breastmilk. The same way that we believe everyone should have easily accessible healthy food, infants have the same rights and need the same protections, and that means making sure mothers have hyper-local support in their communities. We know there are places in the country where there is a great environment for supporting breastfeeding and lots of resources to do it well, but in many other places, women report receiving little to no breastfeeding information. These desert-like areas also have some of the highest rates of infant mortality, childhood obesity, and other diet-related diseases, so there is a correlation between decreased breastfeeding and infant and child health outcomes. For the past three years, I’ve been leading a pilot project in Detroit and Philadelphia, funded by the W.K. Kellogg Foundation, to help create a national accreditation for breastfeeding-supportive communities, to make sure communities create and maintain a standard commitment to their youngest residents. We hope this, and other efforts, will help level the playing field for all mothers across the country. 

7. You talk about “shifting the culture”—are there any ways in which you are already seeing this happen? Please tell us how your work is making waves toward shifting the discourse surrounding women, motherhood, and breastfeeding.

One of the things I have been passionately working on is removing the individualistic approach of breastfeeding. I often say, women don’t breastfeed, cultures do. So we have to start talking about cultural shifts. We have allowed breastfeeding to remain an individual issue when it is really a structural issue, a community issue, and a public health issue. Instead, the burden is on the mother, and if she fails she feels tremendous personal guilt, when in fact there is a system designed to set her up for failure before she even begins. We have to start attacking the structural barriers and bad policies that don’t allow women to have true choice in infant feeding, and see those issues as the “enemy” —not battling each other. This is all so much bigger than any one of us. 

We are also shifting the discourse by telling the truth. We have to dispel the image of breastfeeding as idyllic and comparable to running through a meadow of daisies. We have to tell women the truth about breastfeeding—that the act may be biologically natural, but the experience is very difficult when you live in a country where women are returning to work too soon, are under economic pressures, don’t have physicians who are knowledgeable about lactation science, or are being shamed and forced out of public places simply for nursing. When we focus on the experience women are having while breastfeeding instead of talking about the act or the benefits of breastmilk, we can transform the experience for all women. That is my dream. And then I will be obsolete in this work and will find a new dream to chase.

8. How has your experience as a journalist contributed to your work in supporting families and infant health?

I think being a journalist is a wonderful foundation for research and intellectual rigor, and I try to always bring that to my work. Many of my book reviews speak to the research and storytelling in The Big Letdown, and this is important because supporting families and infant health must be rooted in facts—especially when covering such an emotional issue and even more so at a time when facts are under attack. Being a journalist also allows me to step outside of the story and honestly discuss how even breastfeeding advocates have had missteps and failed mothers along the way. Many people were surprised by that candor because I am also an advocate, but being able to shine a light on all the traps is what any good journalist would do. Personally, I feel extremely honored and blessed to use the craft that I love in service of a cause that I love. To me, this is my dream life. 

9. What is the most important message you hope readers will take away from your book?

Whether you are a formula feeder or a breast feeder, women deserve a level playing field for decision-making that hasn’t been corrupted by commercial interests and upside down social norms. We don’t have that. And as women, we should all be concerned, whether we have children or not. 

10. Where can interested readers or mothers go to learn more and get support around breastfeeding? Particularly mothers of color, such as Blacks, Latinas, and Asian Americans?

There are so many great organizations providing on-the-ground breastfeeding support, such as Breastfeeding USA, La Leche League International, and the United States Breastfeeding Committee. Specifically for women of color there are great resources online and on social media, including the Black Mothers Breastfeeding Association, Black Breastfeeding Week, Latina Breastfeeding Coalition, and the Asian and Pacific Islander American Health Forum.

The views expressed herein are solely those of the guest blogger and do not necessarily reflect those of Catalyst. Catalyst does not endorse any political candidates. The post and the comments are presented only for the purpose of informing the public.