The Social Context
During the late 1800s and the early 1900s, high infant mortality, even among infants cared for at home, was a major public concern. Physicians and parents recognized that poorly nourished children were more susceptible to illness. Between 1910 and
1915 the newly created United States Children's Bureau sponsored several studies of infant mortality in major cities. Each study showed that babies fed artificial milks (i.e., anything other than mother's milk) were three to five times as likely to die as those who were breastfed. The studies also documented that both the rate of breastfeeding and the rate of infant mortality were linked: each increased steadily as family income decreased. In summarizing these results Williamson (1915) commented that "the disadvantages of a low income were sufficient to offset the greater prevalence of breast feeding among the babies of the poorer families." During this same period, a similar observation was made in England, where high infant mortality prevailed among poor, working-class mothers, 80 percent of whom breastfed their infants (Levenstein, 1983).
As women's aspirations for community service and commercial involvement were rising, Victorian beliefs about modesty discouraged breastfeeding in public. Advertising, which promoted bodily cleanliness, may have led to associating breastmilk with body fluids that were unclean or noxious, a notion that persists to this day, at least in North America (Morse, 1989). Advances in the prevention of disease, largely through public health measures related to sanitation, extended an expanding faith in "modern science" in general to "modern medicine" in particular. Women's magazines developed a wide audience of readers interested in female accomplishments outside the home, in modern attitudes, and in technological innovations; these same magazines reinforced concerns about infant health. An 1880 issue of the Ladies' Home Journal contained this statement (Apple, 1986):
If fed from your breast, be sure that the quantity and quality supply his demands. If you are weak or worn out, your milk cannot contain the nourishment a babe needs.
Between about 1860 and 1910, scientific advances and technological innovations created many new options in infant feeding that appeared to enhance infant survival. The upright feeding bottle and rubber nipple, each of which could be cleaned thoroughly, made artificial feeding easier and safer. New foods to be used with this equipment appeared. Large-scale dairy farming produced abundant supplies of cow milk, which was marketed first as canned evaporated milk and later in condensed (i.e., highly sweetened to retard spoilage) or dried forms.
This technological ferment, fueled both by the need for improved infant health care and by a popular belief in the ability of science and technology to provide answers, attracted analytical chemists. Around 1850 chemists had begun to turn their attention to food products. Early investigations (now viewed as rudimentary) into the composition of human and cow milk convinced them that "the combined efforts of the cow and the ingenuity of man" could construct a food the equal of human milk (Gerrard, 1974). Patented foods, such as Liebig's Food and Nestle's Milk Food, were first marketed in Europe and the United States in the 1860s. The Nestle's product was a mixture of flour, cow milk, and sugar that was to be dissolved in milk or water before feeding. Milk modifiers, such as Mellin's Food, and milk foods, such as Horlick's Malted Milk, were popular in the United States by the 1880s.
Extravagant claims for these foods (Liebig's Food was called "the most perfect substitute for mother's milk") were combined with artful advertising that played on fears for the health of the infant and faith in modern science (Apple, 1986). (See Figure 1-4.) A hundred years later we see these advertising themes played again and again.
In the 1890s, physician Thomas Rotch developed a complex system of modifying cow milk so that it more closely resembled human milk. Rotch observed that the composition of human milk varies, as do digestive capacities in infants. He devised mathematical formulas to denote the proportions of fat, sugar, and protein in cow milk that some infants required at a particular age (Rotch, 1907). The result was an exceedingly complex system of feeding that required constant intervention by the physician, who often changed the "formula" weekly. Supervising infant feeding then became a principal focus of the newly emerging specialty of pediatrics.
Commercial advertising promoted the use of manufactured infant milks to both mothers and physicians. The basic themes-- a mother's concern for her infant's health, the perfection of the manufactured product, and the difficulty of breastfeeding--have persisted over the years (Apple, 1986).
Regulation of Childbirth. During the early part of this century, childbirth moved from home or midwife-attended births largely to hospitals, where a birthing woman was separated from her family and attended by hospital staff. During the middle part of this century, hospital routines and the use of general anesthesia during labor and delivery separated mother and infant much of the time in the early postpartum period. Bottle-feedings by nursery
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For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.