Wednesday, April 1, 2015

Notes from the Field: When Breastmilk Isn’t Enough

Veronica and 4 month old Paulo
Today's post is a guest article from anthropologist Veronica Miranda. Veronica's "Notes from the Field" appeared in the most recent Council on Anthropology and Reproduction newsletter, and she has kindly allowed its reproduction here. In this post, she reflects on her time spent in the Yucatan while she was breastfeeding and conducting field research.

When Breastmilk Isn’t Enough

It was a hot and humid late July afternoon when I decided to pay a visit to one of the village midwives. I gathered my already-packed research bag and on the way out I said good-bye to my husband (a.k.a. field assistant and nanny) and kissed our three month old son. It was around three o’clock when I left. The heat was still unbearable as I walked through the rural Yucatec Maya pueblo of Saban, located in the southern interior of the peninsula.

When I arrived to the midwife’s house I was hot, sweaty, and thirsty. I was escorted by the midwife’s daughter to the large newly built thatched roof kitchen located behind the house. Elda, the midwife, was cooking lunch when I got there. She invited me to sit down and eat with her family. We had a simple but delicious lunch.

Elda served a thin soup of boiled Chaya (a dark leafy green high in calcium and folic acid) that was mixed with ground-up pumpkin seeds, sea salt, and a generous squeeze of fresh lemon juice. Her son had picked some avocados from the tree outside and made a big bowl of guacamole. And like all meals in the pueblo, our lunch was accompanied by fresh, handmade corn tortillas. It was one of my favorite meals. I ate two servings and savored every bite.

Elda was happy that I liked her cooking and she said I must always be hungry because I am breastfeeding. She told me she ate often when she breastfed her children many years ago. I asked her if she exclusively breastfed her three children—two girls and a boy. She said yes. In fact her son, the youngest, was the largest of all her babies. He was so big that many people thought he was a year old when he was only six months. We had already had many conversations in the past about the importance of breastfeeding for both baby and mother. Yet at that moment, I had to ask her a question that had been bothering me for some time. I asked, “Elda if I am exclusively breastfeeding my infant son and he is visibly a large and healthy baby, why are so many people in the community telling me I needed to supplement with formula? Why are they saying he needs more than breastmilk”?

Elda took a moment to think about what I had just said and then asked if my son cried a lot. As a young first-time mother away from my own familial support system, I was not really sure the average amount a baby cried. My son did cry often throughout the day and night but I was usually able to sooth him by breastfeeding. From the day he was born I nursed my son on demand—even at eight months he was still adamant about having breastmilk every two to four hours. In the end, I answered Elda’s question by saying “Yes, he does cry a little”. Her teenage son was intrigued by our conversation and asked me if my son had air in his belly? Assuming this was similar to colic I explained that this used to be an issue, but not anymore. Elda suggested that he could have mal de ojo. But she was leaning more to the idea that maybe I was not producing enough milk. She asked if my milk was soft or hard when it leaked through my shirt. I paused for a moment—I had never been asked this question before. Was she referring to my milk flow or the thickness of my milk? I probably will never know since I did not ask her to explain. Not completely understanding the question I said I think it comes out soft.  

She said that was it. My son cried a lot because he was hungry, she explained. My milk was too thin and he was not getting his fill. I asked her what I could do to fix this, and she responded by saying, “Usually if the mother has thin milk, about a month after the baby is born, she is told to drink a lot of agua de Chaya and follow a local remedy of placing boiled orange leaves over the her breast and taking a warm bath with the tea water. The mother must stay inside for three days, especially if it is cloudy outside. This will help increase the milk supply and make it thicker”. Unfortunately, I had missed my chance. My son was almost four months old and my best option now was to supplement with formula.

I thought about this conversation with Elda the rest of the time I was in the field. Just a generation ago, women in the community exclusively breastfed. The older and middle aged women who told me I needed to supplement with formula had exclusively breastfed their own children. Women have always breastfed. Breastfeeding continues to be widely practiced throughout the community. As Elda pointed out, local healers and midwives have used traditional remedies passed down from older generations to help a mother increase her milk supply and sooth a crying baby. But times have changed; today, breastmilk is no longer seen as enough. Many women firmly believe that infants need to be supplemented with formula. The idea that traditional medicine is no longer able to help women produce enough milk to feed their babies is relatively new. Formula, for many women, provides the necessary nutrients infants need to thrive. These beliefs are instilled through the advice of local doctors and nurses, and reinforced by widespread media and public health campaigns. Today the majority of new mothers believed that their infants would be healthier and happier if they had both breastmilk and formula.  

There is a wide array of literature that explains why indigenous and/or poor women choose to use infant formula. Some reasons include 1) the belief in corporate media messages proclaiming the superior health benefits of formula; 2) indigenous women’s internalization of the idea that their bodies are inadequate; 3) a rise in social status with the use of expensive formula; and 4) the adoption of the idea by indigenous and/or poor women that they are better mothers by offering formula to their children. I knew all of this going into my fieldwork. I have read the literature, and studied the political economic histories that have affected and shaped rural women’s choices. Yet, it was not until I personally experienced in the field the issue of supplementing with formula that I had a greater appreciation for the many ways in which women address on a daily basis the health of their children. As a young researcher eager to apply the scholarly knowledge I had gained I chose to focus heavily on the issue of breastmilk verses infant formula. But I was wrong. After many conversations with women in the community I was finally able to listen to them and understand that they did not see the two as a binary. It was until much later that I realized the women suggesting I supplement with formula were trying to help me deal with a situation and address a specific symptom—a crying baby. These rural Yucatec Maya women are bombarded with constant messages by doctors and from the media that their bodies are insufficient at meeting the needs of their unborn and infant children. As with childbirth, these women have not addressed their health and that of their children through an either/or dichotomy. Women are trying to make the most of all the resources they have and mixing practices allows them to ensure the wellbeing of their children. It was shocking to see how strong the outside messages of the inadequacy of women’s bodies had affected their beliefs, yes, but even within that these women are trying to find the best ways to raise healthy and happy children.

Veronica Miranda is a doctoral candidate in medical anthropology at the University of Kentucky. Her dissertation research focuses on how rural Yucatec Maya women, midwives, and state health care workers participate in the production of childbirth practices in relation to federal health policies and programs.


  1. i live in nicaragua and am always so perplexed about why so many people give their children powdered milk whether they also breastfeed or not. i have had many conversations about it with the women here and feel llike i am constantly explaining myself again and again as to why i exclusively breastfeed (currently have a 4 month old) and bein given advice to supplement and hear about how shocked someone is that my baby is healthy and has good weight gain. i had come up with my own theories based on what i have seen/heard and finally got around to researching it and came across your article. it was a good read and all of my random thoughts and confusing situations are beginning to make sense. thanks for the informative article. i am going to continue to educate myself about this way of thinking and i hope to be able to better understand and explain and eventually help at least the women i come in direct contact with on a regular basis to make better choices if/when possible about birth and breast feeding. thank you!

  2. This is a great post! Two of my coworkers are breastfeeding right now and one is also doing WeightWatchers. She mentioned that exercising too much could slow down milk production but is still adamant about loosing that extra baby weight by consuming less calories. No judgement on my coworkers (I'm trying to loose weight too!), I'm just glad they're able to breastfeed at work. But my experiences/your post brought up some questions. How do you and the women around you approach eating while breastfeeding? Is it ok to always be hungry and eat more than usual while breastfeeding?


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