The Breastfeeding Instinct

It was another interesting day on NPR Morning Edition for human evolutionary biology. Here’s the story:

Here’s the key thesis of the story: “It’s almost like in the U.S. we’ve lost the breast-feeding instinct. That Western society has somehow messed it up. [Professor Brooke] Scelza wanted to figure out why: What are we doing wrong?”

The reporter’s evidence that Western women have “lost the instinct” is through comparison with dogs (who apparently have no problem whatsoever with nursing). The scientist on whose research this story is based, Prof. Scelza posed the same hypothesis through comparison with “the best breastfeeders in the world”, the Himba in Namibia, who don’t use bottles or formula. Because all Himba mothers nurse their babies, the hypothesis is that they don’t find it challenging to teach the baby to latch on properly or suffer from sore nipples or infections (mastitis) or other such complications that Western women experience. What is the reason they don’t have such complications? Nursing comes so easily to them because their culture doesn’t stigmatize it.

Prof. Scelza is suprised to find that in actuality, Himba women do find it hard to breastfeed and that they need support from more experienced women in their society to help them figure it out. Dr. Scleza’s conclusion is that grandmothers are essential for teaching new moms how to nurse, an extension of Professor Kristen Hawkes’ grandmothering hypothesis.

This story was on national news. It was listened to by likely millions of people. This was a significant opportunity to show the strength of anthropology, and yet, it fails on four levels as I see it. Let me share these with you, and then propose an alternative frame that would have been so much better IMHO.

First, the biological research is so lacking that I am embarrassed. I get that scientists need to be a little bit streamlined in how we present scientific research to a general audience, but geez, from my 5 minute search on PubMed, there is a huge amount of scientific evidence that all mammals have trouble nursing. There are numerous papers on mastitis and other breestfeeding complications in cows, dogs, cats, camels, and marsupials  (just to list a few). There is even a whole literature on pain management for lactating cats and dogs. Based on my quick dive into the literature, the supposition that breastfeeding is super easy for dogs is not supported by the evidence. The lesson here is that personal experience shouldn’t suffice for scientific research. Scientists and science journalists should consult the scientific literature before asserting that animals don’t have any breastfeeding complications.

At this point in the news report, every single veterinarian or person who has had pet with one of these complications just decided this story is scientifically unsound.

Second, the transition from dogs-as-ideal-breastfeeders to the Himba as “the best breast feeders in the world” comes across as somewhat offensive to my ears. We have already ascertained that the claims for dog breastfeeding are facile. Extending this perception to a group of people is similarly naive, and almost sounds like the journalist and the researcher first assumed that Himba women are more like dogs than Western women because they make breastfeeding look easy to the people who don’t know them well. This makes me cringe.

Anyone who caught that these women are from a country in the south west part of Africa just cringed with me at the apparent equivalency of Himba women to dogs, and both of them being distinct from women living in wealthy western countries. 

The third reason this story bothers me is that nowhere in the story did anyone make the point that the Himba are poor and therefore cannot afford bottles or infant formula even if they wanted or desperately needed them. The whole story comes across as though 100% of these women nurse because they prefer it to other options. These people live in traditional grass/mud huts and practice pastoralism and some subsistence farming. They face very real human rights issues. Does anyone really think that if these women had a choice, that the women who really struggled with latching or mastitis wouldn’t have taken the infant formula option if that existed for them? Glorifying the only option that poverty provides is, at least to me, rather offensive. If these women didn’t tough it out, their babies just wouldn’t survive. There is no other option. And for the women who ultimately can’t make it work, well, they lose the child.

Anyone sensitive to global health issues just deemed the story naive and tuned out.

The last reason this story bothers me as an example of human evolutionary biology is that it evokes grandmothers as the essential element to successful nursing. In reality, Prof. Scelza demonstrated that the essential element is culture, the transfer of knowledge from an experienced person to a novice. There isn’t anything magical about grandmothers other than that they might be the most proximate person to you. But it could be a lot of other people who transfer knowledge about breastfeeding. As Professor Alma Gottleib notes from her research that is quoted in the text version of the NPR story, “During the first few weeks, a newly delivered woman — especially a first-time mother … has a constant stream of visitors, particularly women… Most have breast-fed many babies themselves, and they spontaneously share their nursing wisdom. Through them, a new mother is quickly socialized into accepting an almost continual round of breast-feeding suggestions dispensed by more experienced women.”

At least the story concludes with the key point: lactation consultants are wonderful. I just wish they could have framed the story a bit differently. How about:

Breast feeding is something all mammals do and it is universally hard. Complications abound. But humans have a special trick that makes it a little easier. No, not formula and bottles, although those are wonderful when you really need them. The special trick is culture. All women around the world, rich and poor, have the same difficulty learning to nurse their babies as do women in Western societies. The one thing that all cultures have in common is that new moms are mentored by people who have a lot of experience nursing babies. In more traditional societies, these mentors are often grandmothers or aunts or sisters or mothers-in-law. But, there are lots of ways to find mentors. In the NPR listeners’ world, one sure bet is to lean on a lactation consultant. A universal human trait is that we use our culture to transfer knowledge about how to breastfeed new babies, from one generation of mothers to the next. Now, we just need to embrace it here.