From the time she was young, one Mississippi woman said that if she had kids, she would breastfeed them. A beloved aunt had instilled in her its merits. But when her twins were born, “none of that happened.” At the time, the woman, whom we refer to as Mattie (a pseudonym to conform with academic research standards for anonymity), was 19 years old and the pressure from her mother and the doctors at the hospital gave her little agency over her birth and feeding.
Mattie says that even though she told her providers she wanted to breastfeed, nobody gave her any information—for example, about colostrum, the low-volume, high-nutrient trickle that comes in before a full supply of milk. She assumed her milk wasn’t coming in and that she wasn’t going to be able to keep up with breastfeeding twins, so she quit.
With her third child, Mattie tried breastfeeding again and made it to two months before cluster feeding started—a fairly common occurrence in which some babies want to eat multiple times in a short period and then go long periods without eating. But to Mattie, it just seemed her daughter wanted to eat constantly. Her mom again told her, “You need to feed her formula.” Mattie told her mother that she wanted to breastfeed, but without knowledge to explain her daughter’s feeding pattern, she eventually got scared again. Mattie persisted with breast milk until her daughter was 6 months and then switched to formula at her mother’s and partner’s urging.
With her youngest child, she “went in guns blazing,” determined to breastfeed. She went into research mode, joining online groups and learning that she could get a hospital-grade pump, milk storage bags, and replacement parts through Medicaid. And it worked: When her son was born, he was immediately laid on her chest (a practice called “skin-to-skin” that promotes breastfeeding, among other health outcomes) and she requested the guidance of a lactation consultant in the hospital who helped fix the baby’s latch. Even though her mom was still making discouraging comments about breastfeeding, she listened to the counsel of a good friend: “Don’t freak out. Don’t quit. Keep going.” When I met her eight months later, she was still giving her son breast milk, in part because her employer, an elder health facility, has been very accommodating about her pumping needs.
She has now become an advocate for breastfeeding. She uses her Facebook page as a place to share information about breastfeeding laws and tips for empowerment with other parents. She says that she has even managed to “bring her mom around” on the topic.
Her experience illustrates the stops and starts, dashed dreams, information gaps, and social barriers that women encounter in the face of one of the biggest public health failings in our country. The World Health Organization, UNICEF, the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the surgeon general all agree that exclusive breastfeeding for six months and breastfeeding plus food for one year is the optimal way to nourish new babies. In spite of this, only 22 percent of babies in the United States are exclusively breastfed until 6 months. Many parents are getting the message “Breast is best,” but the postpartum world they must navigate burdens, degrades, and isolates nursing mothers. About 25 percent of mothers in the United States return to work 10 days after giving birth—when those who delivered a child vaginally are often still bleeding.
In the U.S., many factors have rendered breastfeeding a luxury good: Babies from well-off families get it, and other babies do not. The results are both tragic and preventable: Black and brown babies are four times more likely than white babies to die in their first year. And the rate is going up. Statistically, black and brown infants are disproportionately born premature and of low birthweight, making breastmilk a virtual life saver for their underdeveloped systems.
This weekend at the MIT Media Lab, we are convening hundreds of engineers and designers, doulas and doctors, midwives and mamas to make the breast pump not suck as well as hack other barriers to breastfeeding. We did this once already. Back in 2014, the first hackathon resulted in smart pumps, discreet pumps, cuddly pumps, and pump cozies to dampen the infernal wheezing of the motor. We analyzed 1,200 mother-approved ideas for how to improve the breast pump and wrote a research paper about them. Many of these good ideas have now come to market. But they are coming in at a high price point—moms like Mattie can’t afford a $1,000 breast pump, and frankly, neither can we.
This time around, we want to challenge designers to consider inclusive innovation—discreet pumps that work for moms in low-wage jobs, for example, where they don’t have a private office or breaks. We put the call out to the community for their innovation and the responses ranged from an app that helps fight discrimination in maternity care and breastfeeding support to modifying Native American clothing to be more nursing-friendly. We are also hosting a summit on paid family leave, since that is acknowledged as the single-most important policy intervention we could implement to improve the postpartum experience. There will be a breastfeeding art exhibition and a Baby Village, where parents can get much-needed massages. We plan to hack it all at this breastfeeding festival.
But to do all of this, we knew we needed to understand how breastfeeding is made difficult for some mothers far beyond the technological failings of the pump itself. That meant gathering the gritty and raw details of how breastfeeding parents persist in a hostile society.
Between December and February, we interviewed more than 50 parents and care providers living in New England, the Southwest, California, and Mississippi, piecing together how key systems structure individual people’s reproductive journeys. Out of this work, we have gathered their stories in Speaking Our Truths: 27 Stories of What It’s Really Like to Breastfeed and Pump in the United States. The stories are centered on the triumphs and challenges of parents most harmed by societal disparities: parents of color, parents from low-income backgrounds, and parents who identify as LGBTQ.
The main takeaway is clear: While breastfeeding is often framed as a personal choice, we find that parents’ individual agency is grossly limited by the infrastructures of support that should make that choice possible in the first place, but that they are, nonetheless, incredibly persistent. In the book, we tell the story of one woman who left work to pick up a breast pump part she forgot at home at the local medical supply store because the lactation team at the hospital where she works wouldn’t let her borrow one. Another braved through otherwise debilitating depression, anxiety, and insomnia when her newborn arrived because her medications weren’t meant to be used by breastfeeding parents. A third successfully persisted for two months to get her baby to latch correctly, even when the management of the women’s shelter where she was staying was pressuring her to stop her baby’s cries during the night.
The parents facing the difficult decision to breastfeed aren’t the problem. Instead, we need to change the social structures, institutions, and cultural norms that shape our options, mindsets, and experiences. These include a lack of paid leave, workplace hostilities toward breastfeeding, biases in medical care, classist norms of “breast is best,” and the impacts of inadequate support for breastfeeding.
The breastfeeding paradigm we are living under now has a hundred points of failure. That makes it a hard problem to solve, but it also gives us a hundred points of leverage for change. Right now, we are pushing all of that complexity onto parents. But we all have a role to play in catalyzing an inclusive and intersectional movement in breastfeeding innovation, both at this weekend’s hackathon and beyond.