Wet nurse

From Wikipedia, the free encyclopedia

 

Louis XIV as an infant with his nurse Longuet de la Giraudière

 

Statuette of a parclose representing a woman who presses her breast to collect milk in a bowl. – Stalls (16th century) of the Basilica of Saint Materne [fr] (11th century) – Walcourt (Belgium).

 

A wet nurse is a woman who breast feeds and cares for another's child. Wet nurses are employed if the mother dies, or if she is unable or elects not to nurse the child herself. Wet-nursed children may be known as "milk-siblings", and in some cultures the families are linked by a special relationship of milk kinship. Mothers who nurse each other's babies are engaging in a reciprocal act known as cross-nursing or co-nursing. Wetnursing existed in cultures around the world until the invention of reliable formula milk in the 20th century.

Reasons

A wet nurse can help when a mother is unable or unwilling to feed her baby. Before the development of infant formula in the 20th century, when a mother was unable to breastfeed, a wetnurse was the only way to save the baby's life.

There are many reasons why a mother is unable to produce sufficient breast milk, or in some cases to lactate at all. Reasons include the serious or chronic illness of the mother and her treatment which creates a temporary difficulty to nursing. Additionally, a mother's taking drugs (prescription or recreational) may necessitate a wet nurse if a drug in any way changes the content of the mother's milk.

There was also an increased need for wetnurses when the rates of infant abandonment by mothers, and maternal death during childbirth, were high.

Some women choose not to breastfeed for social reasons. Many of these women were found to be of the upper class. For them, breastfeeding was considered unfashionable, in the sense that it not only prevented these women from being able to wear the fashionable clothing of their time but it was also thought to ruin their figures. Mothers also lacked the support of their husbands to breastfeed their children, since hiring a wet nurse was less expensive than having to hire someone else to help run the family business and/or take care of the family household duties in their place. Some women chose to hire wet nurses purely to escape from the confining and time-consuming chore of breastfeeding. Wet nurses have also been used when a mother cannot produce sufficient breast milk, i.e., the mother feels incapable of adequately nursing her child, especially following multiple births.

Eliciting milk

A woman can only act as a wet-nurse if she is lactating (producing milk). It was once believed that a wet-nurse must have recently undergone childbirth. This is not necessarily the case, as regular breast suckling can elicit lactation via a neural reflex of prolactin production and secretion. Some adoptive mothers have been able to establish lactation using a breast pump so that they could feed an adopted infant.

Dr Gabrielle Palmer states:

There is no medical reason why women should not lactate indefinitely or feed more than one child simultaneously (known as 'tandem feeding')... some women could theoretically be able to feed up to five babies.

Historical and cultural practices

Wet nursing is an ancient practice, common to many cultures. It has been linked to social class, where monarchies, the aristocracy, nobility or upper classes had their children wet-nursed for the benefit of the child's health, and sometimes in the hope of becoming pregnant again quickly. Exclusive breastfeeding inhibits ovulation in some women (Lactational amenorrhea). Poor women, especially those who suffered the stigma of giving birth to an illegitimate child, sometimes had to give their baby up temporarily to a wet nurse, or permanently to another family. The woman herself might in turn become wet nurse to a wealthier family, while using part of her wages to pay her own child's wet nurse. From Roman times and into the present day, philosophers and thinkers alike have held the view that the important emotional bond between mother and child is threatened by the presence of a wet nurse.

Mythology

Many cultures feature stories, historical or mythological, involving superhuman, supernatural, human and in some instances animal wet-nurses.

The Bible refers to Deborah, a nurse to Rebekah wife of Isaac and mother of Jacob (Israel) and Esau, who appears to have lived as a member of the household all her days. (Genesis 35:8.) Midrashic commentaries on the Torah hold that the Egyptian princess Bithiah (Pharaoh's wife Asiya in the Islamic Hadith and Qur'an) attempted to wet-nurse Moses, but he would take only his biological mother's milk. (Exodus 2:6–9) 

In Greek mythology, Eurycleia is the wet-nurse of Odysseus. In Roman mythology, Caieta was the wet-nurse of Aeneas. In Burmese mythology, Myaukhpet Shinma is the nat (spirit) representation of the wet nurse of King Tabinshwehti. In Hawaiian mythology, Nuakea is a beneficent goddess of lactation; her name became the title for a royal wetnurse, according to David Malo.

Ancient Rome

A funerary stele (akin to a gravestone) erected by Roman citizen Lucius Nutrius Gallus in the 2nd half of 1st century AD for himself, his wetnurse, and other members of his family and household

 

In ancient Rome, well-to-do households would have had wet-nurses (Latin nutrices, singular nutrix) among their slaves and freedwomen, but some Roman women were wet-nurses by profession, and the Digest of Roman law even refers to a wage dispute for wet-nursing services (nutricia). The landmark known as the Columna Lactaria ("Milk Column") may have been a place where wet-nurses could be hired. It was considered admirable for upperclass women to breastfeed their own children, but unusual and old-fashioned in the Imperial era. Even women of the working classes or slaves might have their babies nursed, and the Roman-era Greek gynecologist Soranus offers detailed advice on how to choose a wet-nurse. Inscriptions such as religious dedications and epitaphs indicate that a nutrix would be proud of her profession. One even records a nutritor lactaneus, a male "milk nurse" who presumably used a bottle. Greek nurses were preferred, and the Romans believed that a baby who had a Greek nutrix could imbibe the language and grow up speaking Greek as fluently as Latin.

The importance of the wet nurse to ancient Roman culture is indicated by the founding myth of Romulus and Remus, who were abandoned as infants but nursed by the she-wolf, as portrayed in the famous Capitoline Wolf bronze sculpture. The goddess Rumina was invoked among other birth and child development deities to promote the flow of breast milk.

England

Catherine Willoughby, formerly Duchess of Suffolk, and her later husband Richard Bertie, are forced into exile, taking their baby and wetnurse. Wet nursing was commonplace in England.

Wet-nursing was a well-paid, respectable and popular job for many lower class women in England. In 17th- and 18th-century England, a woman would earn more money as a wet nurse than her husband could as a labourer. Up until the 19th century, most wet-nursed infants were sent far from their families to live with their wet nurse for up to the first three years of their life. As many as 80% of wet-nursed babies who lived with their wet nurses died during infancy, which led to a change in living conditions.

Women took in babies for money in Victorian Britain, and nursed them themselves or fed them with whatever was cheapest. This was known as baby-farming; poor care sometimes resulted in high infant death rates. The wet nurse at this period was most likely a single woman who previously had given birth to an illegitimate child. There were two types of wet nurses in Victorian England. There were those on poor relief, who struggled to provide sufficiently for themselves or their charges, and there were professional wet nurses who were well paid and respected.

It was common for upper-class women to hire wet nurses to breastfeed their children. English women tended to work within their employers' homes to take care of their charge, as well as working at foundling hospitals for abandoned children. The wet nurse's own child would likely be sent out to nurse, normally brought up by the bottle rather than being breastfed. Valerie Fildes, author of Breasts, Bottle and Babies: A History of Infant Feeding, argues that "In effect, wealthy parents frequently 'bought' the life of their infant for the life of another."

Wet nursing in England decreased in popularity during the mid-19th century due to the writings of medical journalists concerning the undocumented dangers of wet nursing. Valerie Fildes argued that "Britain has been lumped together with the rest of Europe in any discussion of the qualities, terms of employment and conditions of the wet nurse, and particularly the abuses of which she was supposedly guilty." C. H. F. Routh, a medical journalist writing in the late 1850s in England, argued that there were many evils of wet-nursing, such as that wet-nurses were more likely to abandon their own children, there was increased mortality for children under the charge of a wet-nurse, and an increased physical and moral risk to a nursed child. While this argument was not founded in any sort of proof, the emotional arguments of medical researchers, coupled with the protests of critics of the practice slowly increased public knowledge and brought wet-nursing into obscurity, replaced by maternal breastfeeding and bottle-feeding.

France

The bureau of wet nurses in Paris

 

Wet nursing was reported in France in the time of Louis XIV, the mid 17th century. In 18th century France, approximately 90% of infants were wet nursed, mostly sent away to live with their wet nurses. In Paris in 1780, only 1000 of the 21,000 babies born that year were nursed by their own mother. The high demand for wet nurses coincided with the low wages and high rent prices of this era, which forced many women to have to work soon after childbirth. This meant that many mothers had to send their infants away to be breastfed and cared for by wet nurses even poorer than themselves. With the high demand for wet nurses, the price to hire one increased as the standard of care decreased. This led to many infant deaths. In response, rather than nursing their own children, upper class women turned to hiring wet nurses to come live with them instead. In entering into their employers home to care for their charges, these wet nurses had to leave their own infants to be nursed and cared for by women far worse off than themselves, and who likely lived at a relatively far distance away. 

The Bureau of Wet Nurses was created in Paris, 1769, to serve two main purposes; it supplied parents with wet nurses, as well as helped lessen the neglect of charges by controlling monthly salary payments to wet nurses. In order to become a wet nurse, women had to meet a few qualifications including a good physical body with a good moral character, they were often judged on their age, their health, the number of children they had, as well as their breast shape, breast size, breast texture, nipple shape and nipple size, since all these aspects were believed to affect the quality of a woman's milk. In 1874, the French government introduced the Roussel Law, which "mandated that every infant placed with a paid guardian outside the parents' home be registered with the state so that the French government is able to monitor how many children are placed with wet nurses and how many wet nursed children have died".

Wet nurses were often hired to work in hospitals so that they could nurse premature babies, babies who were ill, or babies who had been abandoned. During the 18th and 19th centuries, congenital syphilis was a common cause of infant mortality in France. The Vaugirard hospital in Paris began to use mercury as a treatment for syphilis; however, it could not be safely administered to infants. In 1780, began the process of giving mercury to wet nurses who could then transmit the treatment to the infants with syphilis through their milk in the act of breastfeeding.

The practice of wetnursing was still widespread during World War I, according to the American Red Cross. Working class women would leave their babies with wetnurses so they could get jobs in factories.

United States

Enslaved Black woman wet-nursing White infant

 

English colonists brought the practice of wet nursing with them to North America. Since the arrangement of sending infants away to live with wet nurses was the cause of so many infant deaths, by the 19th century, Americans adopted the practice of having wet nurses live with the employers in order to nurse and care for their charges. This practice had the effect of increasing the death rate for wet nurses' own babies. Many employers would have only kept a wet nurse for a few months at a time since it was believed that the quality of a woman's breast milk would lessen over time.

Since there were no official records kept pertaining to wet nurses or wet nursed children in the United States, historians lack the knowledge of precisely how many infants were wet-nursed, for how long they were wet-nursed, whether they lived at home or else where while they wet-nursed, as well as how many wet-nursed babies lived or died. The only evidence which exists pertaining to wet-nursing in the United States is found in the help wanted ads of newspapers, through complaints about wet nurses in magazines, and through medical journals which acted as employment agencies for wet-nurses.

In the Southern United States, it was common practice for enslaved black women to be forced to be wet nurses to their owner's children. In some instances, the enslaved child and the white child would be raised together in their younger years. Visual representations of wet-nursing practices in enslaved communities are most prevalent in representations of the Mammy archetype caricature. Images such as the one in this section represent both a historically accurate practice of enslaved Black women wet-nursing their owner's white children as well as sometimes an exaggerated racist caricaturization of a stereotype of enslaved Black women as "Mammy" characters.

Relationships

"Visite Chez la Nourrice" ("Visit to the Wetnurse") by Victor Adam

 

An infant who has been living with a wet-nurse being taken away from its foster-parents by its natural mother. By Étienne Aubry

 

Sometimes the infant is placed in the home of the wetnurse for several months, as was the case for Jane Austen and her siblings. The Papyrus Oxyrhynchus 91, a receipt from 187 AD, attests to the ancient nature of this practice. Sometimes the wetnurse came to live with the infant's family, filling a position between the monthly nurse (for the immediate post-partum period) and the nanny. 

In some cultures the wetnurse is simply hired as any other employee. In others, however, she has a special relationship with the family, which may incur kinship rights. In Vietnamese family structure, for example, the wetnurse is known as Nhũ mẫu, mẫu meaning "mother". Islam has a highly codified system of milk kinship known as rada. George III of the United Kingdom, born two months premature, had a wet nurse whom he so valued all his life that her daughter was appointed laundress to the Royal Household, "a sinecure place of great emolument".

Current attitudes in Western countries

In contemporary affluent Western societies such as the United States, the act of nursing a baby other than one's own often provokes cultural discomfort. When a mother is unable to nurse her own infant, an acceptable mediated substitute is expressed milk (or especially colostrum) which is donated to milk banks, analogous to blood banks, and processed there by being screened, pasteurized, and usually frozen. Infant formula is also widely available, which its makers claim can be a reliable source of infant nutrition when prepared properly. Dr Rhonda Shaw notes that Western objections to wet-nurses are cultural:

The exchange of body fluids between different women and children, and the exposure of intimate bodily parts make some people uncomfortable. The hidden subtext of these debates has to do with perceptions of moral decency. Cultures with breast fetishes tend to conflate the sexual and erotic breast with the functional and lactating breast.

In addition, the legacy of wet-nursing for African-American women is inherently linked to slavery, and the physical, emotional, and mental abuse that enslaved African-American women endured. While other populations in the United States may be more open to wet-nursing, the cultural attitude within African-American communities towards wet-nursing remains one deeply affected by the generational trauma of wet-nursing during slavery.

For some Americans, the subject of wet-nursing is becoming increasingly open for discussion. During a UNICEF goodwill trip to Sierra Leone in 2008, Mexican actress Salma Hayek decided to breast-feed a local infant in front of the accompanying film crew. The sick one-week-old baby had been born the same day but a year later than her daughter, who had not yet been weaned. Hayek later discussed on camera an anecdote of her Mexican great-grandmother spontaneously breast-feeding a hungry baby in a village.

Current situation elsewhere

Wet nurses are still common in many developing countries, although the practice poses a risk of infections such as HIV. In China, Indonesia, and the Philippines, a wet-nurse may be employed in addition to a nanny as a mark of aristocracy, wealth, and high status. Following the 2008 Chinese milk scandal, in which contaminated infant formula poisoned thousands of babies, the salaries of wet-nurses there increased dramatically. The use of a wet-nurse is seen as a status symbol in some parts of modern China.

Additionally, a woman who is difficult to get pregnant may wet-nurse and rear a relative (especially a poorer one's) new-born as a mancing (Javanese language for "lure").

Notable wetnurses

Royal wetnurses are more likely than most to reach the historical record.

In Ancient Egypt, Maia was the wetnurse of King Tutankhamun. Sitre In, the nurse of Hatshepsut, was not a member of the royal family, but received the honour of a burial in the royal necropolis in the Valley of the Kings in tomb KV60. Her coffin has the inscription sdt nfrw nsw in m3‘t ḥrw, meaning Royal Wet Nurse. Lady Kasuga was the wet nurse of the third Tokugawa shōgun Iemitsu. Lu Lingxuan was a lady in waiting who served as wetnurse to the emperor Gao Wei; she became exceedingly powerful during his reign, and was often criticized by historians for her corruption and treachery. Chinese emperors honoured the Nurse Empress Dowager. Dai Anga was the wetnurse of the Mughal Emperor, Shah Jahan. Shin Myo Myat was the mother of King Bayinnaung of Toungoo Dynasty of Burma (Myanmar), and the wetnurse of King Tabinshwehti. In England, Hodierna of St Albans was the mother of Alexander Neckam and wet nurse of Richard I of England, and Mrs. Pack was a wet nurse to William, Duke of Gloucester (1689–1700).

Some non-royal wetnurses have been written about. Halimah bint Abi Dhuayb was the foster-mother and wetnurse of the Islamic prophet Muhammad. Petronella Muns was, with her employer, the first Western woman to visit Japan. Naomi Baumslag, author of Milk, Money and Madness, described the legendary capacity of Judith Waterford: "In 1831, on her 81st birthday, she could still produce breast milk. In her prime she unfailingly produced two quarts (four pints or 1.9 litres) of breast milk a day."

History and culture of breastfeeding

From Wikipedia, the free encyclopedia

 

Two early 20th century Korean women breastfeeding their babies while working

 

The history and culture of breastfeeding traces changing social, medical and legal attitudes to breastfeeding, the act of feeding a child breast milk directly from breast to mouth. Breastfeeding may be performed by the infant's mother or by a surrogate, typically called a wet nurse.

Ilkhanate prince Ghazan being breastfed.

 

Breastfeeding is the natural means by which a baby receives nourishment. In most societies women usually nurse their own babies, this being the most natural, convenient and cost effective method of feeding a baby. However there are situations when a mother cannot suckle her own baby. For example, she may have died, become unwell or otherwise cannot produce breast milk. Before the availability of infant formula, in those situations, unless a wet nurse was found promptly, the baby might die, and infant mortality rates were high. Wet nurses were a normal part of the social order, though social attitudes to wet nursing varied, as well as to the social status of the wet nurse. Breastfeeding itself began to be seen as common; too common to be done by royalty, even in ancient societies, and wet nurses were employed to breastfeed the children of royal families. This attitude extended over time, particularly in western Europe, where babies of noble women were often nursed by wet nurses. Lower-class women breastfed their infants and used a wet nurse only if they were unable to feed their own infant.

Attempts were made in 15th-century Europe to use cow or goat milk, but these attempts were not successful. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this was also unsuccessful. Improved infant formulas appeared in the mid-19th century, providing an alternative to wet nursing, and even breastfeeding itself.

During the early 20th century, breastfeeding started to be viewed negatively, especially in Canada and the United States, where it was regarded as a low class and uncultured practice. The use of infant formulas increased, which accelerated after World War II. From the 1960s onwards, breastfeeding experienced a revival which continued into the 2000s, though negative attitudes towards breastfeeding were still entrenched up to 1990s.

Early history

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. The Moche artisans of Peru (1–800 A.D.) represented women breastfeeding their children in ceramic vessels.

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

Japan

Traditionally, Japanese women gave birth at home and breastfed with the help of breast massage. Weaning was often late, with breastfeeding in rare cases continuing until early adolescence. After World War II Western medicine was taken to Japan and the women began giving birth in hospitals, where the baby was usually taken to the nursery and given formula milk. In 1974 a new breastfeeding promotional campaign by the government helped to boost the awareness of its benefits and its prevalence has sharply increased. Japan became the first developed country to have a baby-friendly hospital, and as of 2006 has another 24 such facilities.

Islam

In the Qur'an it is stated that a child should be breastfed if both parents agree:

Mothers may breastfeed their children two complete years for whoever wishes to complete the nursing ... And if you wish to have your children nursed by a substitute, there is no blame upon you as long as you give payment according to what is acceptable. (parts of Surat al-Baqarah 2:233) ... and his gestation and weaning [period] is thirty months ... (part of Surat al-Ahqaf 46:15)

Islam has recommended breastfeeding for two years till 30 months, either by the mother or a wet nurse. Even in pre-Islamic Arabia children were breastfed, commonly by wet nurses.

18th century

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. 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. 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. The biologist and physician Linnaeus, the English doctor Cadogan, 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. 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.

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. 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.

19th century

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 got breastmilk. 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. 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.”

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. 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.

Decline and resurgence in the 20th and 21st centuries

Breastfeeding in the Western world declined significantly from the late 1800s to the 1960s. 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. Letters and editorials to Chatelaine from 1945 to as late as 1995 regarding breastfeeding were predominantly negative. 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.

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.

Canada

A 1994 Canadian government health survey found that 73% of Canadian mothers initiated breastfeeding, up from 38% in 1963. It has been speculated that the gap between breastfeeding generations in Canada contributes to the lack of success of those who do attempt it: new parents cannot look to older family members for help with breastfeeding since they are also ignorant on the topic. Indigenous women in Canada are particularly affected by their loss of traditional breastfeeding knowledge, which taught mothers to breastfeed for at least 2 years and up to 4-5 years after birth, as a result of settler colonialism; Indigenous mothers now initiate breastfeeding and exclusively breastfeed for at least 6 months at significantly lower rates than non-Indigenous mothers in Canada. Western Canadians are more likely to breastfeed; just 53% of Atlantic province mothers breastfeed, compared to 87% in British Columbia. More than 90% of women surveyed said they breastfeed because it provides more benefits for the baby than does formula. Of women who did not breastfeed, 40% said formula feeding was easier (the most prevalent answer). Women who were older, more educated, had higher income, and were married were the most likely to breastfeed. Immigrant women were also more likely to breastfeed. About 40% of mothers who breastfeed do so for less than three months. Women were most likely to discontinue breastfeeding if they perceived themselves to have insufficient milk. However, among women who breastfed for more than three months, returning to work or a previous decision to stop at that time were the top reasons.

A 2003 La Leche League International study found that 72% of Canadian mothers initiate breastfeeding and that 31% continue to do so past four to five months.

A 1996 article in the Canadian Journal of Public Health found that, in Vancouver, 82.9% of mothers initiated breastfeeding, but that this differed by Caucasian (91.6%) and non-Caucasian (56.8%) women. Just 18.2% of mothers breastfeed at nine months; breastfeeding practices were significantly associated with the mothers' marital status, education and family income.

Cuba

Since 1940, Cuba's constitution has contained a provision officially recognising and supporting breastfeeding. Article 68 of the 1975 constitution reads, in part: During the six weeks immediately preceding childbirth and the six weeks following, a woman shall enjoy obligatory vacation from work on pay at the same rate, retaining her employment and all the rights pertaining to such employment and to her labour contract. During the nursing period, two extraordinary daily rest periods of a half hour each shall be allowed her to feed her child.

Developing nations

In many countries, particularly those with a generally poor level of health, malnutrition is the major cause of death in children under 5, with 50% of all those cases being within the first year of life. International organisations such as Plan International and La Leche League have helped to promote breastfeeding around the world, educating new mothers and helping the governments to develop strategies to increase the number of women exclusively breastfeeding.

Traditional beliefs in many developing countries give different advice to women raising their newborn child. In Ghana babies are still frequently fed with tea alongside breastfeeding, reducing the benefits of breastfeeding and inhibiting the absorption of iron, important in the prevention of anaemia.

Publicity, promotion and law

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).

Breastfeeding in public

A breastfeeding mother in public with her baby will often need to breastfeed her child. A baby's need to feed cannot be determined by a set schedule, so legal and social rules about indecent exposure and dress code are often adapted to meet this need. Many laws around the world make public breastfeeding legal and disallow companies from prohibiting it in the workplace, but the reaction of some people to the sight of breastfeeding can make things uncomfortable for those involved. Some breastfeeding mothers feel reluctant to breastfeed in public.

USA

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, 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. Recent attempts to codify a child's right to nurse were unsuccessful in West Virginia and other states. Breastfeeding in public is legal in all 50 U.S. states and the District of Columbia.

UK

A UK Department of Health survey found that 84% find breastfeeding in public acceptable if done discreetly; however, 67% mothers are worried about general opinion being against public breastfeeding. In Scotland, a bill safeguarding the freedom of women to breastfeed in public was passed in 2005 by the Scottish Parliament. The legislation allows for fines of up to £2500 for preventing breastfeeding in legally permitted places.

Canada

In Canada, the Canadian Charter of Rights and Freedoms gives some protection under sex equality. Although Canadian human rights protection does not explicitly include breastfeeding, a 1989 Supreme Court of Canada decision (Brooks v. Safeway Canada) set the precedent for pregnancy as a condition unique to women and that thus discrimination on the basis of pregnancy is a form of sex discrimination. Canadian legal precedent also allows women the right to bare their breasts, just as men may. In British Columbia, the British Columbia Human Rights Commission Policy and Procedures Manual protects the rights of female workers who wish to breastfeed.

Recent global uptake

The following table shows the uptake of exclusive breastfeeding.

Country	Percentage	Year	Type of feeding
Armenia	0.7%	1993	Exclusive
	20.8%	1997	Exclusive
Benin	13%	1996	Exclusive
	16%	1997	Exclusive
Bolivia	59%	1989	Exclusive
	53%	1994	Exclusive
Central African Republic	4%	1995	Exclusive
Chile	97%	1993	Predominant
Colombia	19%	1993	Exclusive
	95% (16%)	1995	Predominant (exclusive)
Dominican Republic	14%	1986	Exclusive
	10%	1991	Exclusive
Ecuador	96%	1994	Predominant
Egypt	68%	1995	Exclusive
Ethiopia	78%	2000	Exclusive
Mali	8%	1987	Exclusive
	12%	1996	Exclusive
Mexico	37.5%	1987	Exclusive
Niger	4%	1992	Exclusive
Nigeria	2%	1992	Exclusive
Pakistan	12%	1988	Exclusive
	25%	1992	Exclusive
Poland	1.5%	1988	Exclusive
	17%	1995	Exclusive
Saudi Arabia	55%	1991	Exclusive
Senegal	7%	1993	Exclusive
South Africa	10.4%	1998	Exclusive
Sweden	55%	1992	Exclusive
	98%	1990	Predominant
	61%	1993	Exclusive
Thailand	90%	1987	Predominant
	99% (0.2%)	1993	Predominant (exclusive)
	4%	1996	Exclusive
United Kingdom	62%	1990
	66%	1995
Zambia	13%	1992	Exclusive
	23%	1996	Exclusive
Zimbabwe	12%	1988	Exclusive
	17%	1994	Exclusive
	38.9%	1999	Exclusive

Alternatives

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. Clay feeding vessels were found in graves with infants from the first to fifth centuries AD in Rome.

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. 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.

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.