BREASTFEEDING

Breastfeeding: New Anthropological Approaches unites sociocultural, biological, and archae-

ological anthropological scholarship to spark new conversations and research about
breastfeeding. While breastfeeding has become the subject of intense debate in many
settings, anthropological perspectives have played a limited role in these conversations.
The present volume seeks to broaden discussions around breastfeeding by showcas-
ing fresh insights gleaned from an array of theoretical and methodological approaches,
which are grounded in the close study of people across the globe.
Drawing on case studies and analyses of key issues in the field, the book high-
lights the power of anthropological research to illuminate the evolutionary, historical,
biological, and sociocultural context of the complex, lived experience of breastfeeding.
By bringing together researchers across three anthropological subfields, the volume
seeks to produce transformative knowledge about human lactation, breastfeeding, and
human milk.
This book is a key resource for scholars of medical and biological anthropology, evo-
lutionary biology, bioarchaeology, sociocultural anthropology, and human development.
Lactation professionals and peer supporters, midwives, and others who support infant
feeding will find the book an essential read.

Cecília Tomori is Assistant Professor of Anthropology, Durham University, UK.

Aunchalee E. L. Palmquist is Assistant Professor of Maternal and Child Health at the
Carolina Global Breastfeeding Institute, in the Gillings School of Global Public Health,
University of North Carolina-Chapel Hill, USA.

EA Quinn is Associate Professor of Anthropology at Washington University in St.

Louis, USA.
BREASTFEEDING
New Anthropological Approaches

Edited by Cecília Tomori,

Aunchalee E. L. Palmquist
and EA Quinn
First published 2018
by Routledge
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© 2018 selection and editorial matter, Cecília Tomori, Aunchalee E. L.
Palmquist, and EA Quinn; individual chapters, the contributors
The right of Cecília Tomori, Aunchalee E. L. Palmquist, and EA Quinn to
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CONTENTS

List of  illustrations vii

Notes on contributors viii
Acknowledgementsxiii

Foreword: Translating conversations: bridging biological

and social approaches to breastfeeding xv
Penny Van Esterik

  1 Introduction: towards new anthropologies

of breastfeeding 1
Cecília Tomori, Aunchalee E. L. Palmquist, and EA Quinn

  2 Beyond passive immunity: breastfeeding, milk and

collaborative mother-infant immune systems 26
Elizabeth M. Miller

  3 Consuming immunities: milk sharing and the social life of

passive immunity 40
Aunchalee E. L. Palmquist

  4 Breastsleeping in four cultures: comparative analysis of a

biocultural body technique 55
Cecília Tomori

  5 “Natural, like my hair”: conceptualizations of breastfeeding

among African American women 69
Sarah Sobonya
vi Contents

  6 Breastfeeding and body size 83

Nicola L. Hawley and Pavane Gorrepati

  7 Mothers, milk, and morals: peer milk sharing as moral

motherwork in Central Florida 97
Beatriz M. Reyes-Foster and Shannon K. Carter

  8 Milk medium chain fatty acids and human evolution 112

EA Quinn

  9 Chestfeeding as gender fluid practice 127

Michelle Walks

10 Mixed-feeding in humans: evolution and current implications 140

Melanie Martin

11 Out of the mouth of babes and sucklings: breastfeeding

and weaning in the past 155
Siân E. Halcrow*, Charlotte L. King*, Andrew R. Millard,
Anne Marie E. Snoddy, Rachel M. Scott, Gail E. Elliott, Darren
R. Gröcke, Hallie R. Buckley,Vivien G. Standen, and Bernardo
T. Arriaza
*Joint first authors

12 Shifting weanling’s optimum: breastfeeding ecology and

infant health in Yucatán 170
Amanda Veile and Karen L. Kramer

13 New mothers’ breastfeeding expectations, challenges, and

the return to employment 185
Carrie Hough, Erica Prussing, and Kayleigh Applegate

14 Understanding and enabling breastfeeding in the context

of maternal-infant needs 199
Kristin P.Tully and Helen L. Ball

Afterword: Breastfeeding: in search of the right questions 212

James J. McKenna

Index219
ILLUSTRATIONS

Tables
  2.1 Selected immunologically bioactive factors in human milk 30
  8.1 Global comparative data for the nine most common fatty acids,
plus essential fatty acids and DHA and ARA 115
  8.2 Descriptive characteristics of the case study sample from Cebu, Philippines 121
  9.1 Interview participants who experienced a successful pregnancy 128
12.1 Summary of maternal costs of breastfeeding in the Yucatec Maya,
traditional versus contemporary setting 178

Figures
  2.1 Model of passive immunity via breast milk 27
  3.1 A mother breastfeeding with a supplemental nursing system 47
  6.1 Infant body size scale for Samoa 90
  8.1 Comparison of percentage of MCFA relative to total fatty acids 116
11.1 Schematic showing expected changes to isotopic ratios during
the transition from exclusive breastfeeding to the adult diet 157
11.2 Map giving the location of the northern Atacama Desert, and
modern-day city of Arica from which individual Morro1 T17c4 derives 161
11.3 Isotopic profile for left deciduous first molar from Morro1 T17c4.
White squares represent δ15N values and dark circles represent δ13C values 162
11.4 Long bone length vs. dental age for individuals from Morro1.
The black diamond represents Morro1 T17c4. 163
14.1 Theoretical mother-infant breastfeeding trade-offs over a specific
period of time 201

Box
10.1 Mixed-feeding 142
NOTES ON CONTRIBUTORS

Kayleigh Applegate is a Masters in Health Administration graduate student at Saint

Louis University. She graduated from the University of Iowa with a BA in Anthro-
pology for Health Professionals. She was invited to be a student research assistant
for Carrie Hough and Erica Prussing through the Iowa Center for Research by
Undergraduates (ICRU) after she expressed interest in their research project on
new mothers and the return to employment.

Bernardo T. Arriaza is a Professor and researcher at the Universidad de Tarapacá,

Arica, Chile. His work focuses on bioarchaeology and the study of eco-contaminants
in ancient Andean populations.

Helen L. Ball is Professor of Anthropology at Durham University, UK, where she

founded and directs the Parent-Infant Sleep Lab and the Infant Sleep Info Source
website. Her research examines parent-infant sleep, infant feeding, and infant mor-
tality. She serves as Chair of the Scientific Committee for the Lullaby Trust, UK.

Hallie R. Buckley is Professor in the Department of Anatomy at the University of

Otago, New Zealand. Her work focusses on biocultural adaptations to the island
environment in early colonising populations in the Pacific islands and has high-
lighted the vulnerability of mothers and infants in these colonising situations. Her
work on later more established Pacific populations has also investigated early life
stress, particularly in areas where malaria was endemic.

Shannon K. Carter is Associate Professor of Sociology at the University of Cen-

tral Florida, USA. Her research focuses on social inequalities, reproduction, and
mothering. She is currently conducting research on African American mothers’
breastfeeding experiences and peer breast milk sharing in Central Florida. Her col-
laborative research with Beatriz Reyes-Foster on peer milk sharing is published in
 Notes on contributors  ix

several outlets, including articles in Breastfeeding Medicine and the Journal of Human
Lactation.

Gail E. Elliott is a PhD Candidate in biological anthropology at the University of

Otago, New Zealand, researching human growth as an indicator of physiologi-
cal stress in past populations. She also has a research interest in gross anatomy and
forensic anthropology.

Pavane Gorrepati is a Research Assistant in the Department of Chronic Disease

Epidemiology at the Yale School of Public Health, USA. Her interests are on the
roles that gender gaps play in improving maternal and child health. She has pub-
lished a children’s book entitled Girls Can! Do Anything as part of her work to
inspire young girls about the endless possibilities they have.

Darren R. Gröcke is Associate Professor (Reader) in Stable Isotope Geochemistry

at Durham University, UK, and is the director of the Stable Isotope Biogeochem-
istry Laboratory (SIBL), located in the Department of Archaeology at Durham
University.

Siân E. Halcrow is Associate Professor in the Department of Anatomy at the Uni-

versity of Otago, New Zealand. She assesses infant and child health in the past to
answer central archaeological questions of subsistence, fertility, and health change
with the intensification of agriculture. She does this by applying a range of methods
including bone growth, dental and skeletal pathology, and indicators of diet and
weaning within a biocultural framework.

Nicola L. Hawley is Assistant Professor of Epidemiology and Anthropology at the

Yale School of Public Health, USA. Her research focuses on maternal obesity dur-
ing pregnancy and the challenges it presents for long-term maternal and child
health. Her work on breastfeeding has been primarily conducted in the Pacific
Islands of Samoa and American Samoa.

Carrie Hough is Associate Professor of Anthropology and chair of the Public

Health Program at Augustana College, USA. Her current research examines new
mothers’ prenatal expectations of parenting and their postnatal realities, particularly
around the return to employment. This work on the intersections of reproduc-
tive and productive labor coupled with her own experiences as a breastfeeding
employed mother catalyzed her engagement with the anthropology of lactation
and breastfeeding.

Charlotte L. King is a Postdoctoral Research Fellow at the University of Otago,

New Zealand. Her work focusses on the use of tissue chemistry to trace changes
to human diet over the life course. She is currently particularly interested in how
breastfeeding, weaning, and nutritional stress interact, and how these interactions
may be visible in archaeological skeletal and dental tissues.
x  Notes on contributors

Karen L. Kramer is Professor of Anthropology at the University of Utah, USA. Her

research interests span behavioral ecology, demography, comparative life history,
reproductive ecology, the interaction between economic and demographic transi-
tions, and the evolution of childhood and cooperative breeding.

Melanie Martin is Assistant Professor in the Department of Anthropology at the

University of Washington, USA. Her research has examined maternal and infant
factors associated with variation in breastfeeding and complementary feeding prac-
tices, and how this variation influences subsequent infant growth and development
and maternal energy and reproductive outcomes.

James J. McKenna is the Rev. Edmund P. Joyce, CSC, Professor of Anthropology

and Director of Mother-Baby Behavioral Sleep Lab at the University of Notre
Dame, USA. His research addresses the relationship between mother-child sleeping
arrangements, feeding method, and risk factors for Sudden Infant Death Syndrome
(SIDS).

Andrew R. Millard is Senior Lecturer in Archaeology at the University of Durham,

UK, specialising in dating, chemical analysis of bone, and quantitative methods in
archaeology. He has worked on estimating the duration and tempo of weaning from
archaeological isotope data for nearly 20 years.

Elizabeth M. Miller is Assistant Professor of Anthropology at the University of

South Florida, USA. Her work focuses on breastfeeding, immune function, and
maternal and infant health in Kenya and the United States.

Aunchalee E. L. Palmquist is Assistant Professor in the Department of Mater-

nal and Child Health, Carolina Global Breastfeeding Institute, Gillings School
of Global Public Health, University of North Carolina-Chapel Hill, USA. Her
current research focuses on critical biocultural contexts of breastfeeding, global
maternal-child health disparities, human milk sharing, and infant and young child
feeding in emergencies.

Erica Prussing is Associate Professor of Anthropology and Community & Behav-

ioral Health at the University of Iowa. Her research and teaching focus on the cul-
tural politics of indigenous health, in the broader context of social justice (including
feminist) activism for health. She became specifically interested in the cultural and
political challenges that breastfeeding mothers in the U.S. face as she reflected
anthropologically on her own experiences with childbirth and lactation.

Elizabeth (EA) Quinn is Associate Professor of Anthropology at Washington Uni-

versity in St. Louis, USA. Her research focuses on human milk and infant develop-
ment in an evolutionary context; she also researches high-altitude adaptation.
 Notes on contributors  xi

Beatriz M. Reyes-Foster is Associate Professor of Anthropology at the University

of Central Florida, USA. A medical anthropologist, she has conducted research on
mental health in Mexico and peer milk sharing and vaginal birth after C-section
(VBAC) in Central Florida. She and collaborator sociologist Shannon Carter have
published several articles on their work on milk sharing.

Rachel M. Scott is an Assistant Research Fellow at the University of Otago, New

Zealand. Her work incorporates dental microwear texture analysis to investigate diet
in the past, including the introduction of complementary foods to infants and children.

Anne Marie E. Snoddy is a PhD Candidate at the University of Otago, New Zealand.
Her research interests are metabolic and infectious diseases in past populations and
the epidemiological relationship between micronutrient status and infectious disease.

Sarah Sobonya is a Research Associate at Washington University in Saint Louis,

USA. Her work explores the ways racial and socioeconomic disparities are mani-
fested in breastfeeding praxis.

Vivien G. Standen is an Associate Professor and researcher at the Universidad de

Tarapacá, Arica, Chile. Her work focusses on bioarchaeology and the study of vio-
lence in ancient Andean populations.

Cecília Tomori is Assistant Professor of Anthropology and member of the Parent-

Infant Sleep Lab at Durham University, UK. Her research combines sociocultural
and biological anthropological, and multidisciplinary approaches to examine health,
illness, and inequality, with a focus on the intersection of breastfeeding and infant
sleep. She is the author of Nighttime Breastfeeding: An American Cultural Dilemma
(Berghahn Books, 2014).

Kristin P. Tully is a Research Associate with the Carolina Global Breastfeeding

Institute at the University of North Carolina at Chapel Hill, USA. Her research
focuses on the factors underlying maternal-infant health outcomes such as child-
birth mode, breastfeeding rates, and parent-infant sleep practices. She examines
mother-infant interactions and contexts that enable the realization of women’s
health priorities.

Penny Van Esterik is Professor Emerita of Anthropology, York University, Toronto,

Canada, where she taught nutritional anthropology, advocacy anthropology, and
feminist theory. Her fieldwork was primarily in Southeast Asia. She is a founding
member of WABA (World Alliance for Breastfeeding Action) and has developed
advocacy materials on breastfeeding and women’s work, breastfeeding and femi-
nism, environmental contaminants and infant feeding, and breastfeeding as infant
food security.
xii  Notes on contributors

Amanda Veile is Assistant Professor of Biological Anthropology at Purdue Uni-

versity, USA. Her research focuses broadly on the evolution of the human life
course, human reproductive and behavioral ecology, and the developmental biology
of modern humans.

Michelle Walks is a sessional instructor who regularly teaches anthropology, soci-

ology, and gender, sexuality, and women’s studies at five different post-secondary
institutions in British Columbia and Yukon Territory, Canada. Her passion is queer
reproduction, with a particular focus on infertility, pregnancy, surrogacy, parenting,
and breastfeeding.
ACKNOWLEDGEMENTS

Developing this project from a double panel at the 2014 American Anthropological
Association Annual Meeting in Washington, DC, to this book has been an incred-
ibly rewarding journey, filled with learning opportunities. Throughout this pro-
cess, we (the three editors) have had the pleasure of exploring a wealth of diverse
approaches to anthropological research on breastfeeding and human lactation and
finding ways to put them in dialogue with one another, and to use these conver-
sations as platforms for developing novel research questions and approaches, and
plans for future cross-subfield collaborations. We would like to thank our panelists,
many of whom became authors in this volume, for giving excellent papers that
motivated us to pursue the project further. We have been fortunate to be joined by
some additional authors along the way, who have expanded the breadth of research
featured in this volume. We are very thankful to each of our contributing authors,
who have brought a wealth of anthropological expertise and insight from across the
discipline to the chapters.We appreciate the many hours of work each author spent
preparing and revising chapters to bring this project to fruition. We owe special
thanks to our panel discussants, Penny Van Esterik and James McKenna, who have
generously commented on our papers, read the chapters as they evolved, and writ-
ten a foreword and afterword to this volume. We have been inspired by their work
and leadership in the anthropology of breastfeeding and are very fortunate to have
benefited from their wisdom in this volume.
We wish to thank Katherine Ong, anthropology editor at Routledge, who first
took interest in the project, encouraged us to submit a proposal, and oversaw the
development of the book. We would also like to thank Louisa Vahtrick, who over-
saw our proposal submission and initial review process.We are grateful to the anon-
ymous reviewers who have generously provided feedback on our project.
We wish to thank our mentors who have set us on the path to anthropology,
our research funding support for making our individual projects possible, and most
xiv Acknowledgements

importantly, our research participants who have generously shared their lives with
us so that we can develop our own insights about breastfeeding.
We would like to thank our families for supporting us in our work. Cecília
would like to thank her husband, Kerry, and their children, Jakob and Adrian, who
have been active participants in Cecília’s embodied experience and professional
interest in breastfeeding. She would also like to thank her mother, Zsófia, and late
grandmother, Ella, who have passed on the family legacy of breastfeeding despite
challenges in their own lactation journeys. Aunchalee would like to thank Owen
for his enduring support, along with their children, Aunchalee, Isra, and Arun, who
not only taught her how to breastfeed, but also accompanied her into the field. EA
would like to thank her husband Brad. Finally, we would like to first express our
thanks to one another – we are each grateful for the knowledge, incisiveness, gen-
erosity, and kindness that our editorial team brought to this project. We could not
have asked for a better team.
FOREWORD
Translating conversations: bridging
biological and social approaches
to breastfeeding

Penny Van Esterik

Confession time! When I discussed some of these papers from the American
Anthropological Association meetings back in 2014, I did not fully understand
them. I couldn’t tell a fatty acid from a skinny acid. In preparation for making dis-
cussant remarks, I found myself sneaking into the back of a biological anthropology
panel, listening to how they spoke about each other’s work. I was afraid to expose
my ignorance by asking a question, fearing I would begin speaking in metaphor.To
me, the subfields of anthropology – particularly biological anthropology and lin-
guistic anthropology – have become dummy reference categories. That is, I know
what they are about and when I need an anthropologist with that expertise; but
I know that I don’t know what they know. I have learned to live with my naïve
reading of these fields, just as I hope others can live with my relaxed feminism; but
are such casual encounters across the subfields enough to usher in the new genera-
tion of what Agustin Fuentes (2016) calls integrated anthropology?
Consider the impressive research record of the three editors of this book. I could
easily picture myself going to the field with Aunchalee Palmquist and Cecília
Tomori, observing and talking to others about shared breastfeeding or breastfeeding
at night, leaning on my own past fieldwork in Southeast Asia as a point of reference.
But I am less sure about venturing into the lab with EA Quinn, which for me is
unfamiliar territory. Why? Is it because our work styles are different? The socio-
cultural anthropologist usually works alone doing observational work that oth-
ers cannot replicate. We become our own research instruments, producing unique
ethnographies that cannot easily be compared. Both biological and archaeological
anthropologists are more used to working in teams doing work with measurable
outcomes that can be replicated and validated by others. I respect, admire, and
recognize the need for the work of biological anthropologists. I am humbled by it,
but my ignorance about the kind of quantitative evidence they produce in the lab
prevents me from asking questions that are appropriate in their subfield, and even
xvi Foreword

from asking for the translation work necessary to know what questions to ask. As a
sociocultural anthropologist, I need to know what questions to ask of my colleagues
in biological anthropology. And this requires skilled translation.
Translation is a critical step in order to work together more effectively. Who
will risk making these translations? Have prior attempts at cross-subfield training in
anthropology, such as the four-field approach in the U.S., been eroded along with
the growing separation between the anthropological sciences and more humanis-
tic approaches? Do we need to oversimplify in order to talk across subdisciplines?
Before we can answer these questions, we need to tell each other how we under-
stand the work of the less familiar field. We need to tell each other when we get it
wrong or when we start from the wrong assumptions. What are the implications of
oversimplifying or overgeneralizing the work of the other subfield? How can we
keep the highest standards of evidence while at the same time ensure that others
can use the evidence by providing simpler translations for others?
Take confounding variables, for example. A biological anthropologist must con-
trol for them in order for their work to be replicable and for the results to be
published in reputable research journals. On the other hand, sociocultural anthro-
pologists describe these confounding variables as context, and it is here where they
begin their work. Does this mean we operate with different logics? And even if
we do, do these differences lead to insurmountable barriers between the subfields?
All the authors in this book share the same fascination with the human capac-
ity to lactate, both with the product, human milk, and the process of breastfeeding.
They use diverse mixed methods to explore the subject. But how do we talk to
each other about this one human trait across the methodological and theoretical
differences that divide us? As the chapters in this book indicate, we have moved well
beyond the point of sociocultural anthropologists telling biological anthropologists
that culture is important, or of biological anthropologists reminding sociocultural
anthropologists that not everything about reproductive biology is culturally con-
structed. Phenotypic responsiveness of human milk and discourses of the natural
are both important aspects of breastfeeding in their own right. The task this book
has undertaken goes beyond acknowledging their importance; it aims to somehow
place them both in the same analytical frame. As a result, the discussion is focused
less on disciplinary differences and more on how and why the social becomes bio-
logical and the biological becomes social, setting up key questions for the next
generation of anthropologists to answer.
After hearing these papers and reading the chapters that the contributors devel-
oped from them, I would like to suggest three steps to bridge some existing gaps
between the subdisciplines to make this integration more productive.

Step one: greater overlap in conceptual tools to make

translation easier
Looking back over my own work, I can see occasions when my conceptual tools
have been too specialized or appropriate to only one region of the world – usually
 Foreword  xvii

Southeast Asia. My use of the term style (breastfeeding style) owes much to my
training in archaeology. The term did not translate well across public health and
biological anthropology. Words can be bridges or dividers, as Sobonya warns us of
the varied interpretations of the natural. What conceptual tools cross the subfields
best? Consider terms like nurturing practices or the life cycle. The latter draws atten-
tion to what passes across the generations and evokes aspects of life history models
in evolutionary biology, where milk acts as signal across the generations. A concept
such as maternal quality of life could have both biological and cultural indicators.
Both biological and sociocultural anthropologists study body boundaries and
embodiment, as several chapters demonstrate. The dynamic interaction between
maternal and infant bodies is illustrated by Miller’s reframing of passive immunity as
a more representative collaborative immunity, Palmquist’s work on sharing human
milk, and Tomori’s research on breastsleeping. As the editors note in their intro-
duction, my product/process distinction emphasizes a duality that breaks down in
the face of what we are learning about breastfeeding and the signalling capacity
of breastfeeding and human milk. Yet the tension between product and process
may still be effective in research and advocacy discourses, to draw attention to the
dangers of putting so much emphasis on the qualities of human milk that milk
becomes decontextualized from breastfeeding and breastfeeding’s sociocultural,
ecological, and evolutionary complexities. This distinction is particularly apparent
in scientific studies that hone in on milk components without consideration of the
person who produces the milk, as well as in the practices of some North American
families who provide only expressed milk to their infants without breastfeeding.
The value of both ethnographic contributions and the biological anthropological
approaches is that they aim to situate the practices and processes of lactation in
fuller context, forcing us to create new ways of conceptualizing these complexities.
Noticeably missing from this list is culture. In my view, removing it as a key
conceptual tool in the analysis of breastfeeding and infant feeding sidesteps divisive
debates about nature versus culture. In fact, culture may not be the best concep-
tual tool to share across the subfields, as it can draw analysts to make assumptions
about cultural coherence and breastfeeding as culturally constructed. We need to be
paying attention to how breastfeeding works bioculturally, not just what it means
culturally (O’Connor and Van Esterik 2012: 12). A term like custom, for instance,
may draw us more into nurturing practices that support breastfeeding and down-
play conflicts between traditional and modern practices (see Veile and Kramer, this
volume).

Step two: productive comparisons that downplay

WEIRD breastfeeding
I would rather be accused of exoticizing breastfeeding by drawing too much
attention to breastfeeding elsewhere than of using WEIRD (Western, Educated,
Industrial, Rich, Democratic) Euro-American mothers as the standard for normal
breastfeeding (Henrich, Heine, and Norenzayan 2010). Unfortunately, WEIRD
xviii Foreword

cultural assumptions influence policy decisions that affect the rest of the world.
Anthropologists provide the evidence for the importance of cultural, ethnic, gender,
and class differences in our incredibly diverse world.
Broader comparative work might protect against representing breastfeeding as
a marker of privilege or a lifestyle choice that only fits with intensive mother-
ing (see Reyes-Foster and Carter, this volume), as illustrated by continued lengthy
breastfeeding across many cultural groups (see Martin, this volume), including the
Yucatec Maya who face rapidly transitioning economies (see Veile and Kramer, this
volume), and by historical populations who may have faced numerous environmen-
tal stressors (see Halcrow et al., this volume). Similarly, comparative evidence can
help diffuse the hype around breastfeeding practices that are deemed “controversial”
in WEIRD settings, like breastsleeping or peer milk sharing (see Tomori, Palmquist,
and Reyes-Foster and Carter, all this volume), which may turn out not quite so
strange after all. Likewise, Walks’s discussion of masculine/queer breastfeeding and
chestfeeding adds a comparative perspective that draws attention to diversity within
gender frames in a WEIRD setting (see Walks, this volume).This comparative work
can also avoid cultural assumptions about human milk that draw universalizing
conclusions based on milk samples from WEIRD populations. As Quinn’s work
shows, while there are many shared characteristics of human milk across our species,
specific qualities of milk also dynamically respond to local environments, thereby
facilitating the survival of the infants who consume this milk.
Anthropologists remind us of how easily knowledge coded as postpartum
customs passed from mothers and grandmothers to daughters can disappear (see
Sobonya, Tomori, this volume). Many customs support breastfeeding; others, such
as discarding colostrum, may not be helpful. Health educators may celebrate the
loss of traditional knowledge because it is often couched in the language of spirits
or pollution or embedded in ideologies incompatible with lab logic. But many of
these postpartum customs provided new mothers with time together with their
infants, facilitated rest and recovery, and supplied relief from some domestic work.
Indeed, the custom of breastfeeding and related practices, such as breastsleeping, can
be erased, forgotten, or rediscovered, depending on cultural and political economic
forces (see Tomori, Sobonya, this volume).The resilience of these customs and their
persistence in the future may depend on local contexts and only be seen over the
arc of historical time (see Veile and Kramer, Halcrow et al., this volume).

Step three: generate sharable research questions

The chapters in this volume raise many important research questions concerning
variation in human milk (Quinn), the duration of exclusive breastfeeding (Halcrow
et al.,Veile and Kramer), the age for introducing complementary foods (Martin, Haw-
ley and Gorrepati), mixed feeding trajectories (Martin, Veile and Kramer), and the
process of weaning (Halcrow et al.,Veile and Kramer), as well as postpartum customs
(Veile and Kramer, Sobonya, Tomori) and the ideologies that shape them (Hawley
and Gorrepati, Sobonya, Miller, Palmquist, Reyes-Foster and Carter, Walks, Tomori,
Hough, Prussing, and Applegate). The chapters on immunity (Miller, Palmquist)
 Foreword  xix

remind us of the importance of the linkages created through time, stimulated by

new developments in epigenetics and how nurturing practices coded as postpartum
customs could alter long-term multigenerational biological programming.
Questions about infant feeding could usefully be integrated into food studies
by paying more attention to how breastfeeding fits with meal formats, custom-
ary methods of food preparation such as fermentation, and taste transfer through
human milk. Feminist anthropologists might also help us work out how to address
maternal agency in those cases where women experience disempowerment, not
empowerment, when breastfeeding.
Many questions require joint exploration by sociocultural and biological anthro-
pologists and those researchers who comfortably wear multiple hats. The rhythm of
days and nights, seasons, critical periods in infant development, and the fit between
reproductive and productive work all present challenges for scheduling time to nur-
ture. That is, of course, what makes combining breastfeeding and employment so
difficult in states and institutions that do not provide even basic maternal accommo-
dations. Without adequate leave for recovery after birth, women struggle with the
constant need for a back-up plan, anticipating problems even before they develop, as
Hough, Prussing, and Applegate’s research demonstrates.The most important part of
back-up plans for breastfeeding mothers used to be early supplementation with for-
mula, presented as “the best of both worlds.” Health professionals and new mothers
often treat infant formula as the back-up solution, when the needs of breastfeeding
mothers for problem solving or support are not met. Formula marketing actively
encourages parents to depend on formula for when breastfeeding inevitably “fails,”
or better yet, avoid all problems by using their products from birth.
Today in North America, pumps also play an important part in breastfeeding
mothers’ plans. New hands-free electric or battery-operated pumps as wearable
technology act like a prosthesis for the breast-mouth link. How does pumping as
a process differ from breastfeeding as a process? How does expressed human milk
differ from maternal milk consumed by a breastfed baby? Does this difference mat-
ter? Questions about how technology disrupts or creates relation between bodies
inform Palmquist’s and Reyes-Foster and Carter’s work on sharing human milk
and breastfeeding. Such questions also fit well with the trend to commoditize breast
milk and breastfeeding. Perhaps the broader question might be whether formula
supplementation and pumping are the best ways to meet the needs of mothers in
the contemporary workforce and how changing patterns of maternal work, paid
access to leave, and political rhetoric influence feeding practice.

How can we widen our audiences and expand the

conversations?
If we can bridge the gap between biological and sociocultural anthropology, can
we also open broader conversations? I have suggested some ways to expand the
conversations within anthropology. Breastfeeding researchers and advocates, includ-
ing anthropologists, have often found themselves talking only to each other about
insufficient milk, low birth weight babies, and exclusive breastfeeding. It is time we
xx Foreword

step outside our comfort zones to take on breastfeeding’s many critics – some bla-
tant, some insidious and subtle. These conversations need to take place with health
care providers, policy makers, activists, and the media, among others. Many of the
chapters in this book will stimulate such discussions.

Conversations with health care providers

Medical and nursing education needs to provide more education around the
complexities of breastfeeding and how to avoid or solve breastfeeding problems.
These chapters suggest that some health professionals are better at following rules
than acknowledging the uniqueness of every breastfeeding mother-infant dyad.
Tully and Ball’s chapter provides practical suggestions for supporting new moth-
ers, including acknowledging the reality of mother-infant conflicts. How can we
ensure that research on subjects such as autism, anorexia, obesity, allergies, and
chronic diseases always include questions around breastfeeding and infant feeding?

Conversations with policy makers

Policy makers are people who make decisions that determine budget priorities
and implement regulations at the national and international levels. Universal health
policy from UN institutions like the WHO (World Health Organization) can have
a profound effect when local groups take on implementation. The Code for the
Marketing of Breastmilk Substitutes has been a useful tool to limit the promotional
practices of formula companies in many parts of the world, but it has never been
implemented in North America where direct-to-consumer advertising is rampant
and effective. They convince new parents that their specialized milk products will
increase their baby’s IQ or help them sleep through the night.
It is easy to dismiss breastfeeding policy because it deals with universal guidelines
that always need to be translated into the vernacular to meet local conditions. No
policy maker I have ever met expects that all women everywhere will breastfeed
their infants exclusively for six months, but they must operate as if they all do. It
is a challenge to provide evidence for the benefits of exclusive breastfeeding, for
example, while at the same time arguing for a nuanced evolutionary understanding
of flexibility in timing for adding complementary foods (see Martin, this volume).
Anthropologists excel as naysayers, reminding others to be sensitive to cultural con-
text and warning of unintended consequences of outside interference in local situations.
These practices do not always endear us to policy makers. Consider the complexities of
how Mayan mothers negotiate between traditional and more medicalized practices in
the context of rapid change, for instance (see Veile and Kramer, this volume).

Conversations with activists

These conversations can be more difficult, since there is a long tradition in the
social sciences of accusing academics who take on advocacy causes of losing their
 Foreword  xxi

objectivity. But as these chapters demonstrate, there are social justice implications
built into questions about infant feeding. Both sociocultural and biological anthro-
pologists use informed political economy frames to draw attention to the justice
implications of their research work. Anthropologists have no ethical responsibility
to be activists around their research topics, including infant feeding. But they do
need to be sensitive to how their research can be used to further different agendas.
Anthropologists often produce evidence that can be of use to activists. When that
evidence is made public, it is equally of use to business interests who hope to profit
from encouraging women to use their products, such as formula, baby foods, supple-
ments, or breast pumps.
Conversations with activists draw us into greater awareness of conflicts of inter-
est and sensitivity to the appearance of conflicts. Particularly in the political context
of public-private partnerships, where food and pharmaceutical companies sit at
policy-making tables, transparency around who benefits and who loses by answer-
ing certain research questions should be part of the conversation. Anthropologists
can help insure that advocacy groups get the science right and can respond to
reports of “alternative facts” about breastfeeding.

Conversations with the media and the general public

Our publics often learn about anthropological research through the media. The
media spotlight has been on breastfeeding for some years now. Not in a good
way; it sensationalizes the exotic, bizarre, and tragic and ignores the power of the
everyday nurturing practices of mothers and emerging revelations about what
human milk accomplishes in newborns. Instead, media highlights the controversies,
making advocacy on behalf of breastfeeding and breastfeeding parents more diffi-
cult. Every time the media reports on positive research findings about the power of
breastfeeding and human milk, they are countered almost immediately by reports
on studies that try to minimize the impact of the new work, particularly around
World Breastfeeding Week.
While preparing this introduction (April 2017), the media repeatedly reported
on research in Ireland confirming that there are no differences in cognitive devel-
opment between formula-fed and breastfed infants (Girard, Doyle, and Tremblay
2017), “proving” that breastfeeding does not matter. That report was repeated over
several news cycles and circulated on social media. For example, an adviser to the
Fed Is Best Foundation, Dr. Brooke Oroz, concluded on a news report that the
“long-term benefits of breastfeeding look a whole lot smaller or non-existent if
you control properly for your confounding variables” (Kounang 2017).
When the media perpetuates such dangerous myths about infant feeding, is it
partly our fault if we complain among ourselves or fail to correct and counter such
reports? Biological anthropologists who work with large data sets might be able
to critique the methodology and put these studies in a broader perspective. Socio-
cultural anthropologists who work in media studies might also help us understand
whose research is reported, whose is ignored, and why.
xxii Foreword

Celebrating contributions: it’s about time

Mothers make do; so do academics, as we all move forward acting as if we know the
specialized techniques of our colleagues. As anthropologists, we have a shared tradi-
tion that has diverged so much in the last few decades that many feel a disconnect
across the discipline’s subfields. It is clear from these chapters that anthropologists
have made important contributions to research on breastfeeding over the last few
decades, but it is less clear how much this research has impacted anthropology as a
whole. Questions about breastfeeding are not a narrow or marginalized specialty
but speak to the human condition, the core of anthropology. They draw atten-
tion to the tensions between the universal and the particular, the trajectories of
human development, and the trade-offs inherent in adapting to our rapidly chang-
ing environments.
Breastfeeding is entangled with many domains of life and is one important
means for understanding the human condition. It is a local, historically contin-
gent, biocultural hybrid at the intersection of the social and the biological. It is
about time we celebrated these advances in knowledge about our formative stage.
There are dangers in not working together and celebrating new research on breast-
feeding. The popular press delights in pitting breastfeeding mothers against non-
breastfeeding mothers. Often their weapons come from lactation science. There is
also a clear anti-science bias in the backlash about breastfeeding. As a sociocultural
anthropologist, I often walk into a hornet’s nest because I do not always know
how to talk effectively about the evidence from lactation science. Sociocultural
anthropologists face accusations of being anti-science if they cannot articulate the
details of lab results. In turn, biological anthropologists who draw attention to the
physiology of women’s reproductive bodies face accusations of being anti-feminist,
acting as if women are wombs and breasts on legs, without active agency about
their own bodies.
A subject like breastfeeding is living proof of the importance of maintaining a
broad, four- or five-field anthropology. Breastfeeding is so basic to the human con-
dition that we need all the tools of the field to unravel its mysteries and to explore
its place in the full complexity of human development. I thank the editors for gen-
erously acknowledging my past work on this topic. I would love to think that my
work played a role in inspiring some of the authors in this book who saw potentials
for furthering my work; like human milk, ideas flow across the generations.

References
Fuentes, Agustin. 2016. “The extended evolutionary synthesis, ethnography, and the human
niche: Toward an integrated anthropology.” Current Anthropology 57 (S13): 13–26.
Girard, Lisa-Christine, Orla Doyle, and Richard E. Tremblay. 2017. “Breastfeeding, cognitive
and noncognitive development in early childhood: A population study.” Pediatrics 139 (4):
e20161848.
 Foreword  xxiii

Henrich, Joseph, Steven J. Heine, and Ara Norenzayan. 2010. “Beyond WEIRD: Towards a
broad-based behavioral science.” Behavioral and Brain Sciences 33 (2–3): 111–35.
Kounang, Nadia. 2017. “Study shows no long-term cognitive benefit to breastfeeding.” Accessed
April 30, 2017. http://edition.cnn.com/2017/03/27/health/breastfeeding-hyperactivity/
index.html
O’Connor, Richard A., and Penny Van Esterik. 2012. “Breastfeeding as custom not culture:
Cutting meaning down to size.” Anthropology Today 28 (5): 13–16.
1
INTRODUCTION
Towards new anthropologies
of breastfeeding

Cecília Tomori, Aunchalee E. L. Palmquist,

and EA Quinn

This book seeks to spark new research and theoretical innovation that bridges
anthropological subfields around breastfeeding. The volume is particularly timely
since breastfeeding has become a focal point of attention and debate in the Western
media. After many decades of decline and disinterest driven by historical, political,
economic, and sociocultural transformations, breastfeeding and human milk are
increasingly valued in biomedicine, public health, and society at large. The recent
Lancet series of breastfeeding has summarized a vast, and rapidly expanding, body
of breastfeeding research and has highlighted these impacts for both low- and
middle-income as well as high-income settings (Victora et al. 2016; Rollins et al.
2016). With over 800,000 child deaths and 20,000 breast cancer deaths averted if
breastfeeding was practiced according to current global health recommendations,
and a multitude of other health implications, breastfeeding not only has a tremen-
dous effect on the health of infants and mothers, but on the health and wellbeing
of entire communities (Victora et al. 2016; Rollins et al. 2016). The recent waves
of public health breastfeeding advocacy, however, have also led to controversy and
backlash in many settings, where infant feeding with artificial breast milk substi-
tutes has been the infant feeding norm. Across the U.S. and (Western) Europe, for
instance, critics routinely question the scientific evidence used to support breast-
feeding advocacy, often depicting breastfeeding as limiting women’s autonomy
and promoting unequal gender norms. Some critics have raised concerns about
the undue pressure placed on mothers for breastfeeding (Jung 2015; Oster 2015;
Wolf 2011; Badinter 2012). Moreover, breastfeeding (e.g. breastfeeding in public)
and the use of human milk (e.g. in human milk sharing) remain controversial in
many contexts, and structural policies often offer only limited support (Tomori
2014; Palmquist and Doehler 2014; Carter, Reyes-Foster, and Rogers 2015; Rollins
et al. 2016; Palmquist and Doehler 2015; Tomori, Palmquist, and Dowling 2016).
These controversies point to gaps between the idealized values and social realities
2  Cecília Tomori et al.

attributed to breastfeeding and human milk, as well as to the complex ways in

which the physiological process of breastfeeding is part and parcel of the social,
cultural, and political economic environment.
To date anthropological research has played a relatively minor role in pub-
lic discourses about breastfeeding, yet anthropology is essential to understanding
breastfeeding in this complex and polarized global landscape. Unlike media debates
that are often based on a narrow set of arguments from wealthy, Western settings,
anthropology’s disciplinary traditions are rooted in close studies of local populations
examined in the context of comparative cross-cultural, historical, and evolutionary
perspectives. Anthropological research can provide insight into epidemiological data
that currently forms the evidence-base for breastfeeding research and can transform
the very assumptions and questions asked. Moreover, anthropological approaches
can play a key role in addressing the roots of contemporary debates, shedding light
on how breastfeeding became controversial in the first place and offering criti-
cal evidence on the interplay of the biological and social role of breastfeeding.
Indeed, partly stimulated by growing popular interest in the topic, the discipline
of anthropology has experienced renewed interest in breastfeeding research across
its subfields. Despite significant efforts by some scholars to incorporate knowledge
and approaches from across the discipline, substantive dialogue and collaborative
research among these breastfeeding scholars has been limited due to epistemologi-
cal and methodological differences.
This volume draws together leading-edge research across anthropological sub-
fields that pertain to breastfeeding, human lactation, and human milk, with the pur-
pose of stimulating intellectual exchange and new thinking about ways to approach
their measures and meanings.We highlight work from biological, bioarchaeological,
and sociocultural anthropology, where the majority of anthropological research has
been carried out in recent decades. Featuring studies from geographically diverse
settings and populations, this book offers examples of the rich insights anthropolog-
ical studies have produced, sometimes blurring conventional boundaries between
subfields. Finally, the book highlights paths toward future work that integrates
research across these areas of anthropology to produce transformative knowledge
and theory that are timely and relevant for informing policies that aim to support
breastfeeding.

Disciplinary traditions and approaches to breastfeeding

Biological and bioarchaeological anthropological perspectives

on breastfeeding
Biological anthropologists have played a key role in anthropological studies of
breastfeeding. In this tradition, breastfeeding has been investigated as one of many
biocultural processes in which biology, ecology, sociocultural influences, and evo-
lutionary significance are inextricably linked. Biocultural studies have also greatly
contributed to broader breastfeeding discourses in their attention to cross-cultural
 Introduction  3

variation in breastfeeding ideologies and practices (cf. Stuart-Macadam and

Dettwyler 1995).
Biological anthropologists studying breastfeeding and human lactation strive for
a nuanced, dynamic portrait of breastfeeding and human milk as critical adapta-
tions for human survival. The foundation of the subfield is rooted in key scientific
approaches to and concepts of evolution, which recognizes the unique features
of the human species, but examines humans in the web of a much broader con-
text of life on Earth, both past and present. The sources of data on breastfeeding
and human milk are primarily measurable biological outcomes and features that
can be compared within and across contemporary human populations, as well as
among non-human primates, other mammals, and fossil remains of Hominid ances-
tors and other animals. Within this broad evolutionary approach, which considers
breastfeeding in the comparative context of a fundamental mammalian adaptation,
breastfeeding is a flexible process situated within the nexus of multiple, interrelated
physiological processes (e.g. development of the immune system, sleep, brain devel-
opment, weaning) and ecological contexts for humans in particular but mammals
(including primates) more generally.
Many of the evolutionary theories regarding breastfeeding in humans are
grounded not only in the study of breastfeeding in contemporary human popula-
tions, but in comparative primatological studies. Ongoing studies of mothers and
infants have identified considerable variability in feeding practices, weaning behav-
iors, and milk composition across primate species (Hinde and Milligan 2011; Power
and Schulkin 2016). For example, early work showed that maternal carrying strate-
gies predicted milk composition among prosimians, with species that cache their
young having higher fat milk compared to species that carry offspring (Tilden and
Oftedal 1997). Important early work among baboons identified maternal strategies
to balance reproductive costs, with maternal body weight loss predicting weaning
age (Altmann 1980). More recently, studies of captive and wild living primates have
challenged existing ideas linking weaning to molar eruption (Smith et al. 2013), and
shown increasing evidence for postnatal programming of infant behavior (Hinde
et al. 2015).  Anthropologists examining human nutrition and growth have also gen-
erated a robust literature in breastfeeding practices, which have informed theorizing
contemporary human variation and population differences in human infant growth
and development trajectories globally (Jenkins, Orr-Ewing, and Heywood 1984;
Allen and Pelto 1985; Quandt 1985, 1998; Pelto 1987; Pelto, Levitt, and Thairu
2003; Dettwyler 1988; Dettwyler 2004; Dettwyler and Fishman 1992; Little 1989;
Casiday et al. 2004; Castle 1996; Pelto and Armar-Klemesu 2011).
The wide variability in breastfeeding practices documented cross-culturally and
understanding the factors that explain these differences has long been a focal point
of biological anthropology. Such investigations were situated within larger theoreti-
cal frameworks of human ecology, life history theory, and studies of human adapta-
tion (Solien de González 1964; Goodman et al. 1985; Hill 1993; Vitzthum 1994,
2008; Dufour and Sauther 2002; Robson 2004; Ellison 2009). Work ranged from
studies of breastfeeding and infant and young child feeding in foraging groups
4  Cecília Tomori et al.

(Hewlett et al. 1998; Kramer and Greaves 2010; Meehan and Roulette 2013) and
small scale horticultural or pastoralist societies (Fink et al. 1992; Fouts, Hewlett, and
Lamb 2005, 2012; Piperata and Mattern 2011; Meehan and Roulette 2013; Miller
2014) to urbanized or rapidly urbanizing societies (Konner and Worthman 1980;
Martin et al. 2012; Quinn et al. 2015; Panter-Brick 1991, 1996; Ellison et al. 1993;
Quandt 1998; Stallings, Worthman, and Panter-Brick 1998; Thairu and Pelto 2008;
Veile and Kramer 2014; Tumilowicz et al. 2015; Sellen 2001a). More recently, such
investigations into human lactation by biological anthropologists include collection
and analysis of milk samples (from both human and non-human primates), which
further allow for investigation into biological adaptation through milk and breast-
feeding. Milk is, as Quinn (2016) has argued, “both a phenotype and the producer
of subsequent phenotypes.” For example, there is a growing body of evidence sug-
gesting that infant growth and development in human and non-human primates is
correlated with milk-born hormones (Quinn and Childs 2017; Hinde et al. 2015;
Fields and Demerath 2012; Hinde et al. 2014; Hinde 2013; Bernstein and Hinde
2016) but external evidence suggests that the act of breastfeeding, and not merely
the consumption of human milk, may be important in long term development
(DiSantis et al. 2011; Galán-Gónzalez et al. 2014).
Examination of the effects of breastfeeding and human milk on health across
the life course continues to fuel groundbreaking research that may elucidate the
evolutionary, biocultural, and ecological significance of breastfeeding in humans.
Biological anthropologists at the forefront of this research have emphasized the
complex interplay between mothers and infants in this research and are playing
an important role in broadening the scope of investigation to include the evo-
lutionary context and dynamic relationships between mothers, infants, and their
environment (McDade and Worthman 1998; Vitzthum and Aguayo 1998; Treva-
than 2010; Quinn 2013, 2014; Fujita et al. 2012, 2011; Rudzik, Breakey, and
Bribiescas 2014; Thompson 2012; Thompson and Bentley 2013; Mattison, Wander,
and Hinde 2015; Thompson et al. 2015; Miller 2016; Quinn, Diki Bista, and Childs
2016; Rudzik 2012; Miller and McConnell 2015; Sellen 2007, 2001b; Breakey
et al. 2015). Biological anthropologists have also been instrumental in challeng-
ing biomedical assumptions about the process and physiology of breastfeeding, as
in the case of examining the interrelationships between nighttime breastfeeding
and maternal-infant sleep, pioneered by McKenna, Ball and colleagues (Gettler
and McKenna 2011; Ball et al. 2016; McKenna and Gettler 2016; Volpe, Ball, and
McKenna 2013) as well as situating human milk sharing and other cooperative
breastfeeding practices in cross-cultural and evolutionary perspective (Hewlett and
Winn 2014). Although there are a growing number of scholars who seek a fuller
integration of culture and history into biocultural studies of breastfeeding, much of
this research has had limited interaction with sociocultural anthropology.
Archaeological investigations into infant feeding behaviors in the past have relied
on both the archaeological record and research using bioarchaeological techniques.
One of the primary means for investigating breastfeeding in past populations has
been through the analysis of stable isotope ratios in the body. Such investigations
 Introduction  5

rely on trophic-level differences in the ratios of carbon, nitrogen, and oxygen in the
body and allow researchers to use shifts in these ratios to estimate population trends
in weaning age or uses of supplemental foods (Tsutaya and Yoneda 2015; Hum-
phrey 2014) and how economic and social shifts may have impacted breastfeeding
practices in populations (Nitsch, Humphrey, and Hedges 2011; Turner et al. 2007).
These reconstructions are typically made from immature skeletal remains, but some
techniques use isotope ratios in adult teeth as well (Burt 2013) and have been vali-
dated using hair and nails from living individuals with known histories (Fuller et al.
2006). In the archaeological record, preserved feeding vessels may illustrate alterna-
tive feeding methods, although the historical record suggests such efforts met with
limited success.

Sociocultural anthropological perspectives on breastfeeding

Sociocultural anthropologists have integrated anthropological theory with ethno-
graphic research to show that breastfeeding can provide a powerful lens for illumi-
nating central aspects of human relationships. Nevertheless, while breastfeeding was
certainly noted in early anthropological studies, it has not been a locus of intensive
inquiry within the subfield. As with childbirth and other areas of reproduction,
this was partly due to men’s dominance of early anthropology and their lack of
interest in these areas, as well as men’s lack of access to aspects of women’s lives.
Margaret Mead played a critical role in drawing attention to cross-cultural practices
of childrearing, including infant feeding practices, highlighting differences between
cultural norms in the U.S. and those in Samoa. This included Mead’s attention to
the normative practice of breastfeeding as a response to the infant in Samoa versus
the dominant white middle-class practices of feeding infants with artificial milk
substitutes on a schedule in the U.S. Mead’s research sparked sustained comparative
studies of child development and parenting practices, including infant feeding prac-
tices (Harkness and Super 2006; Super and Harkness 1982; Small 1998; Gottlieb
2004; Morelli et al. 1992; Harkness and Super 1996, 1983) and greater interest in
women’s roles and experiences in society (Scheper-Hughes 1984).
Scholars turned to investigating childbirth, which also encompassed attention
to breastfeeding, and used historical and cross-cultural comparison to challenge
the medicalized approaches to birth, which also undermined breastfeeding and
encouraged replacement feeding. Brigitte Jordan’s cross-cultural studies of child-
birth (Jordan [1978] 1993) generated a substantial literature on comparative stud-
ies of childbirth (Davis-Floyd and Sargent 1997) and played a key role in igniting
further interest in the anthropology of reproduction (Ginsburg and Rapp 1995b).
Ginsburg and Rapp’s seminal 1995 volume Conceiving the New World Order, which
aimed to “drag . . . reproduction to the center of social analysis” (2) consolidated
this interest in the anthropology of reproduction and brought multiple theoretical
directions together, combining feminist theory with studies of science and bio-
medicine, political economy, and kinship. Still, only a limited number of articles
in anthropology journals and even fewer ethnographic monographs have devoted
6  Cecília Tomori et al.

significant attention to breastfeeding through the mid-2000s (Maher 1992a; Van

Esterik 2002; Mabilia 2005; Scheper-Hughes 1993; Gottlieb 2004;Yovsi and Keller
2003; Obermeyer and Castle 1996; Moffat 2002; Dykes 2006; Gottschang 2001,
2007; Millard 1990; Zeitlyn and Rowshan 1997; Whittemore and Beverly 1996;
Farmer 1988; Whitaker 2000).
Penny Van Esterik’s (foreword to this volume) work stands out in this history
because of its sustained focus on infant feeding within sociocultural anthropology
and her participation in inter-subfield and interdisciplinary conversations about
breastfeeding (Van Esterik 1989, 2002, 2010, 2012, 2015; Moland et al. 2010; Van
Esterik 1995). In her 2002 comprehensive review, Van Esterik identified several key
areas of research in the sociocultural literature on breastfeeding, including sexu-
ality, reproduction, embodiment, and subjective experience and also highlighted
the importance of historical studies of breastfeeding (Van Esterik 2002). She then
addressed these themes in the context of the difficulties of breastfeeding in “bottle-
feeding cultures,” where artificial milk substitutes have become the cultural norm.
The review also addressed issues of exclusive and complementary feeding, and
breastfeeding advocacy and policy in light of the HIV epidemic and global capital-
ist efforts to market human milk substitutes and commodify human milk. At the
end of her review, Van Esterik argued that anthropological perspectives on infant
feeding provide unique insight into key issues in the discipline:

Anthropology has the potential to make explicit the interconnections

between social relations, resources, sexuality, embodiment, power, nurturance,
and commensality implicated in the challenge of feeding a newborn infant.
No other discipline is positioned to ask and answer such fundamental ques-
tions about what makes us human.
(273)

Van Esterik’s wide-ranging synthesis was pivotal in launching further inquiry

into breastfeeding, and the themes she discussed remain relevant for contemporary
thinking about breastfeeding in sociocultural anthropology. Reflecting a growing
literature on breastfeeding in the social sciences and the humanities, the last few
years have seen a significant number of anthropological conference sessions, articles
and book chapters, and several new volumes that specifically address breastfeed-
ing and explicitly incorporate sociocultural anthropological perspectives (Faircloth
2013; Tomori 2014; Cassidy and El Tom 2015; Liamputtong 2011b; McCourt 2013;
Dykes and Hall-Moran 2009; Flacking and Dykes 2015; Ryan, Bissell, and Alex-
ander 2010; Ryan, Team, and Alexander 2013). This body of work is influenced by
multiple theoretical directions, particularly in the areas of historical, feminist, and
critical medical anthropology, addressing a variety of aspects of breastfeeding and
human lactation. Here, we want to briefly highlight some key themes that have
influenced recent work on breastfeeding.
There is growing interest in the historical transformations that produced con-
temporary infant feeding norms. While historians have been at the forefront of
 Introduction  7

exploring the social and economic shifts, including industrialization, the medi-
calization of childbirth, urban migration, factory labor, and changing family rela-
tionships, which propelled these changes (Apple 1987; Golden 1996; Parkes 2001;
Wolf 2001; Hunt 1999, 1988; Fildes 1998), some anthropologists have also taken a
historical approach in framing their work (Scheper-Hughes 1993;Van Esterik 1989;
Tomori 2014; Cassidy 2015;Whitaker 2000).The use of commercial infant formula
became widespread amid these changes, and its association with modernity, scien-
tific knowledge, and privileged social status played a key role in its success (Palmer
2009). Aggressive marketing and medical support for this emerging product, as
evidenced by practices such as the so-called ‘Nestlé nurses’ and long-term sponsor-
ship of medical associations such as the American Academy of Pediatrics (AAP) by
several formula manufacturers, firmly entrenched the use of the commercial infant
formulas and led to the replacement of breastfeeding and other practices, such as
wet-nursing, cross-nursing, and the use of other milks/paps, as the cultural norm
for infant feeding in wealthy industrial settings in the 20th century.  These norms of
infant feeding were also taken across the globe, often as part of colonial and post-
colonial health system reforms and reinforced by commercial interests (Hunt 1988,
1999; Scheper-Hughes 1993). At the same time, colonialism and expanding global
capitalist, industrial production initiated significant changes in labor practices that
often made women’s work less compatible with breastfeeding, further encourag-
ing the use of human milk substitutes (King and Ashworth 1987; Jelliffe and Jelliffe
1979; Palmer 2009; Gottschang 2007; Moffat 2002).
Efforts to increase breastfeeding in the past few decades reflect grassroots move-
ments, as well as growing scientific interest in breastfeeding and human milk. The
latter of these efforts – themselves a product of the historical transformation that
led to the medicalization and fragmentation of childbirth and infant care under the
purview of separate medical experts – positioned biomedical doctors and scientific
researchers as possessing authoritative knowledge on breastfeeding and led to the
formation of international agencies for creating and implementing global health
policies (Tomori 2014; Van Esterik 1989, 1995). These efforts have been gaining
ground in recent decades, stimulating contemporary breastfeeding controversies
and new scholarship on breastfeeding.
Penny Van Esterik has pioneered the anthropological analysis of these transfor-
mations and the ways in which the process of breastfeeding has been systematically
undermined by the interests of multinational corporations that aggressively pro-
mote infant feeding products, which are incorporated into governmental policies
(Van Esterik 1989, 1995). She has also highlighted the double-edged role of medical
research on breastfeeding. On the one hand, scientific evidence on breastfeeding
has been pivotal in spurring global public health efforts that promote breastfeed-
ing and aim to restore it as the norm. On the other hand, V   an Esterik has shown
that scientific interest in breastfeeding has often emphasized the product of breast-
feeding – human milk – over the process of breastfeeding, leading to policies and
practices that only value the delivery of this substance (or products based on this
substance) to infants, but do not facilitate breastfeeding itself.  This emphasis on the
8  Cecília Tomori et al.

“product” over process remains relevant in contemporary breastfeeding promotion

efforts that emphasize the components of human milk, such as in Brazil (Rudzik
2015). Research on medicalization and breastfeeding continued to emphasize the
paradoxical treatment of breastfeeding that, on the one hand, increasingly promotes
it, while, on the other hand, aims to control, regulate, and monetize it (Palmquist
2015;  Tomori 2014).
Contemporary anthropological work on breastfeeding within and beyond the
discipline has been heavily influenced by feminist theories and science and tech-
nology studies as well.  This work from its inception has challenged cultural ide-
ologies that equated breastfeeding with “nature” and reinforced gendered division
of labor, unequal gender roles, and power relations (Maher 1992a; Faircloth 2013;
Tomori 2014; Hausman 2003, 2011; Stearns 1999, 2009, 2010; Haraway 2013).
This theme continues to be salient in contemporary scholarship and has often been
linked to critiques of breastfeeding promotion, including the use of the term “natu-
ral” in breastfeeding campaigns (see Sobonya, this volume). Emerging research has
also challenged the equation of breastfeeding with women and mothers, through
transgender breastfeeding and chestfeeding (see Walks, this volume) and through
adoptive breastfeeding and milk sharing communities (see Palmquist; Reyes-Foster
and Carter, this volume). While many sociocultural anthropologists share concerns
about the (mis)use of breastfeeding to perpetuate gender-based inequalities, there
are significant differences in how these insights are applied – some propose restruc-
turing promotion messages, while others propose to end breastfeeding promotion
altogether. Anthropologists have also critiqued some of the feminist scholarship
for ethnocentrism and the lack of recognition that breastfeeding can be a feminist
act that can contribute to attaining greater recognition of women’s diverse roles
in society and contribute to greater equality by nurturing social connections and
family and community health (Van Esterik 2015; Palmquist 2015;  Tomori 2014).
Anthropologists have highlighted the authoritative use of science to legitimate
and promote or undercut breastfeeding practices. These state-sponsored efforts that
equate breastfeeding with “good motherhood” can have the effect of stigmatizing
those who do not breastfeed or who face breastfeeding difficulties (Faircloth 2013;
Tomori 2014; Liamputtong and Kitisriworapan 2011; Ryan, Bissell, and Alexander
2010). Science can also be used to lend authority to justify breastfeeding in the face
of considerable social stigma, as in the case of full-term breastfeeding in the U.K.,
for instance, even when decision-making about breastfeeding may be based on
emotions originating from the “heart” (Faircloth 2011, 2010).
In cultures where breastfeeding with early complementary feeding remains
the norm, not breastfeeding and exclusive breastfeeding without early comple-
mentary feeding can also be a sign that a woman has HIV, which can further
compound the stigma associated with the virus (Van Hollen 2011a; Desclaux
and Alfieri 2011, 2015; Moland and Blystad 2009; Koricho, Moland, and Blystad
2010; Desclaux and Alfieri 2009;Van Hollen 2011b; Levy, Webb, and Sellen 2010).
The medical recommendation to discontinue breastfeeding for HIV positive
women has now been reversed and replaced with exclusive breastfeeding with
 Introduction  9

antiretroviral medications in low- and middle-income nations. Both the imple-

mentation of the initial recommendation and its reversal and replacement have
been surrounded by controversy and confusion and continue to have implications
for women, since exclusive breastfeeding for the first six months is usually not
the cultural norm in these settings and may be stigmatized, and many continue
to worry about the possibility of HIV transmission (Desclaux and Alfieri 2015;
Desclaux 2014; Odeny et al. 2016). In turn, those migrating from the global
South to high-income settings may be surprised and saddened when confronted
with the opposite medical guidance for women living with HIV, prohibiting
breastfeeding (Tariq et al. 2016).
Hospital and other medical practices that ostensibly encourage breastfeeding
may fail to provide support for it in practice, leaving mothers to question of the
adequacy of their breastfeeding and milk (Dykes 2006; Millard 1990; Rudzik 2015).
Moreover, some breastfeeding practices are portrayed as highly dangerous, as in the
case of peer milk sharing (Palmquist and Doehler 2014; Carter, Reyes-Foster, and
Rogers 2015) or bed sharing to facilitate breastfeeding (Tomori 2014; McKenna
and McDade 2005). This work has highlighted the degree to which medical rec-
ommendations can reflect larger concerns about the cultural status of breastfeeding
in settings where infant formula use was the norm for much of the 20th century.
In these contexts, breastfeeding and the use of human milk can be positioned as a
social and moral ideal, while many aspects of the everyday experience of breast-
feeding remain stigmatized (Tomori, Palmquist, and Dowling 2016). Extensions of
this paradox can be seen in the growing emphasis on breast pumps and the wide-
spread use of expressed human milk, which acts to separate the stigmatized process
of breastfeeding from its highly valued product – the substance of human milk
(Ryan, Team, and Alexander 2013).
Medicalization has often been studied in tandem with the role of political eco-
nomic forces that shape infant feeding practices (along with other aspects of repro-
duction). A key area of focus has been the significant detrimental influence of the
commercial infant formula industry on breastfeeding and the increasing commodi-
fication of human milk by companies that aim to harvest and market human milk
products (Palmquist 2015). The intersections of the partitioning of breastfeeding
as process and human milk as substance with biomedical and commercial interests
are discussed in this volume (see Palmquist, Reyes-Foster and Carter, this volume).
These analyses also highlight the wide-reaching scale and scope of capitalist eco-
nomic systems and the role of human bodily products in these networks, which
some have termed “biocapitalism” (see Tomori 2014: 43–7). Ethnographies have
shown that capitalist regimes are incorporated into hospital routines as well as into
cultural ideologies about parenting, which are fully embodied (Dykes 2005, 2006,
2009; Millard 1990; Tomori 2014). At the same time, this research has also shown
that parents can challenge some aspects of these ideologies. For instance, Palmquist’s
research shows that gift economies around milk sharing based in reciprocity can
run counter to these commercial economies (Palmquist 2015), and Tomori’s (2014,
this volume) work illustrates how breastfeeding families who sleep close to their
10  Cecília Tomori et al.

infants rework capitalist regimes of nighttime spatiotemporal parent-child separa-

tion linked to ideologies of independence and self-sufficiency.
Political economic analyses also highlight the effects of capitalist labor on wom-
en’s work conditions that discount the work of breastfeeding and raising children,
separate mothers and infants, and undermine breastfeeding. These conditions often
make the use of human milk substitutes the only viable option for families, and
even when ostensibly supportive workplace policies often only encourage milk
expression via a pump, not breastfeeding itself (Ryan, Team, and Alexander 2013);
see also Hough, Prussing, and Applegate, this volume). These conditions perpetu-
ate and deepen existing inequalities along socioeconomic, racial, ethnic, and other
divides, ultimately contributing to stratified reproduction (Ginsburg and Rapp 1995a:
3), whereby some are supported in their reproduction, while others are hindered or
prevented from reproducing.
Anthropologists have also raised concern about the role of public health pro-
motion efforts in perpetuating these inequalities as part of neoliberal regimes that
lay responsibility for health on individuals and place undue pressure on women to
breastfeed in the face of difficult political economic conditions (Faircloth 2013;
Tomori 2014; Gottschang 2007; Liamputtong 2011a). While most anthropologists
agree that political economic conditions must be addressed to facilitate breastfeed-
ing, they sharply differ in their emphasis on discussing different aspects of political
economy (e.g. the formula industry) and their vision for the future (e.g. the role of
the government in breastfeeding promotion and legal protections for breastfeeding).
Van Esterik has encouraged scholars to broaden their focus beyond human milk
as a product and pay close attention to the process of breastfeeding and the impor-
tant role it plays in creating and participating in social relationships (Van Esterik
2012). New research into the full range of lactation and human milk practices
(including several chapters here) has highlighted the complex social relationships
that they entail (Cassidy and El Tom 2015). This work has recently led V   an Esterik
to reconsider the process/product dichotomy and to see these practices as “two
inseparable sides of the same coin, intertwined like the two sides of the Mobius
strip”(Van Esterik 2015: xvi). Theories of gift exchange in building social rela-
tionships, including kin and kin-like ties, provide a particularly fertile area of new
research on breastfeeding and human milk.
This emphasis also aligns with a transformation in kinship studies, sparked in
part by interest in new reproductive technologies, which has revitalized interest
in this classic area within anthropology (Franklin and McKinnon 2001). Kinship
scholars had noted the importance of breastfeeding in forging kin ties in numerous
earlier ethnographic works (Parkes 2001; Carsten 1997; Dettwyler 1988), but per-
haps because breastfeeding was an “old reproductive technology” (Tomori 2014),
it has taken longer to generate sustained inquiry using this theoretical framework.
Now, however, there is substantial new research exploring the ways in which breast-
feeding helps construct persons and kin relationships, especially in the realm of milk
sharing (El Tom 2015; Cevese 2015; Palmquist 2015) and in nighttime breastfeeding
and sleep practices (Tomori 2014). Studies of kinship also intersect with research
 Introduction  11

on embodied aspects of breastfeeding. While the majority of this work has focused
on mother’s subjective experiences, some have proposed a relational, interembodied
approach to breastfeeding (Tomori 2014; see also Palmquist; Tomori, this volume).

Working across anthropological subfields

Challenges
As they build bridges across the subfields, the chapters of this volume touch on cen-
tral concepts within anthropology that have often divided scholars in the discipline.
These questions concern the orientation of anthropology towards the sciences and
the humanities and key disciplinary aims and methods. Since these debates have
been discussed in great detail, here we highlight key issues with specific relevance
to anthropological research on breastfeeding.
A key debate threading through decades of breastfeeding research concerns the
role of “nature” and “culture,” often presented as dichotomous and oppositional
categories in the sociocultural anthropological literature. Maher’s introduction to
her 1992 edited volume on breastfeeding, for instance, sets up a dichotomy of
“natural law” or “social construct” as it wrestles with this question (Maher 1992b).
Sociocultural anthropologists, drawing on cross-cultural and historical compara-
tive data, have argued that the concept of “nature” itself as a cultural construct has
been used to achieve various ideological ends, usually in the service of biological
determinism (Yanagisako and Delaney 1995). Discourses of the “natural” in rela-
tion to breastfeeding in the U.S. historically have been often paired with moral
overtones that use women’s physiological differences to reinforce white, middle-
class, heteronormative, patriarchal gender norms and religious ideologies (Haus-
man 2003, 2011; see also McKenna 2016; Sobonya; Walks, this volume). Some are
highly skeptical of scientific breastfeeding research and have dismissed it as the basis
of policy altogether, at least in wealthy settings (Faircloth 2015). A related concern
addresses the study of culture. Sociocultural anthropologists are concerned that
biological anthropologists lack training in theoretical approaches and their use in
ethnographic fieldwork and do not adequately appreciate contributions of the sub-
field. Furthermore, there is worry that in biocultural research, culture is reduced to
a variable or limited to outdated concepts of culture.
For biological anthropologists, the above concept of “nature,” and the dichotomy
between “nature” and “culture,” are equally problematic and inaccurate, albeit in dif-
ferent ways. Both breastfeeding and human milk, considered a living, dynamic sub-
stance, are viewed in the context of human variation and as important aspects of
human biology. Culture does not stand apart from but rather is an integral part of
the environment that shapes these processes (see Martin; Miller; Quinn; Veile and
Kramer, this volume). At the same time, many biological anthropologists remain skep-
tical about sociocultural approaches to ethnographic fieldwork because of its reliance
on highly subjective engagement, as well as insights drawn from novel theoretical
concepts, which are sometimes perceived as merely fashionable rhetorical trends.
12  Cecília Tomori et al.

Biological anthropologists are also concerned that sociocultural anthropologists lack

adequate training in (or may entirely reject) the process of scientific inquiry, do not
appreciate the significance of evolutionary theories, and have little knowledge of the
environmental challenges and biological realities of human populations.

Building bridges
Because of the history of divisive relationships between the subfields and the above
concerns, many anthropologists have been reluctant to engage with colleagues
across the subfields. At the same time, there have been persistent efforts (cf. Leath-
erman and Goodman 2011) and recent emerging movements within the discipline
towards challenging these divides and re-envisioning the relationship between the
biological and the social/cultural, which may foster more interaction across the
subfields (Ingold and Palsson 2013; Fuentes 2015). A recent Wenner-Gren sympo-
sium, which resulted in a Supplement in Current Anthropology, was devoted entirely
to this issue and provides examples of integrated biocultural work (Fuentes and
Wiessner 2016; Fuentes 2016). Social anthropologists Ingold and Palsson (2013)
encourage us to “think of ourselves not as beings but as becomings – that is, not
as discrete and pre-formed entities but as trajectories of movement and growth”
(8). They wish to move past ideological dichotomies to examine the dynamic, rela-
tional processes entailed in these “biosocial becomings” (9). Biological anthropologists
Fuentes and Wiessner (2016) similarly argue,

We need to dismantle the conceptualization of the biological and social as

distinct domains in the human and see them as intertwined processes that are
not wholly separable in our models and analyses. We need to adopt an inte-
grative approach that has as its basal assumption a system of entangled agents
and processes involved in the human experience.
(S13–14)

These efforts, even as they pursue different directions for how these boundaries are to
be reconfigured, provide useful starting points for working together on breastfeeding.
The last major attempt to construct an inter-subfield approach to breastfeeding
is the now over twenty-year-old volume, Breastfeeding: Biocultural Perspectives (Stuart-
Macadam and Dettwyler 1995), which featured contributions from biological and
sociocultural anthropologists, a social historian, and several physician-public health
researchers. Stuart-Macadam in her introduction called “Breastfeeding . . . the ulti-
mate biocultural phenomenon” because “in humans breastfeeding is not only a bio-
logical process but also a culturally determined behavior” (Stuart-Macadam 1995:
7). She cautioned readers not to ignore our evolutionary history or to assume that
contemporary cultural concerns about breastfeeding reflect cross-cultural norms.
Despite the agenda set out in that volume, biological anthropology and socio-
cultural anthropology have largely continued to pursue separate research trajecto-
ries. Until recently, biological anthropologists have been generally more open to
 Introduction  13

integrating cultural approaches in their work than vice versa. Medical anthropol-
ogy, which itself is an intersectional discipline (Inhorn 2007), has provided some
opportunities for biocultural research. Since interest in lactation, breastfeeding, and
human milk is rising across anthropology, there is also a growing body of literature
that builds on cross-subfield perspectives and collaborations, such as on breastfeed-
ing interactions in central Africa (Fouts, Hewlett, and Lamb 2012), milk sharing in
the U.S. (Palmquist and Doehler 2014), and research on nighttime breastfeeding
and infant sleep in the U.S. and the U.K. (Tomori 2014; McKenna, Ball, and Gettler
2007; McKenna and Gettler 2016; Rudzik and Ball 2016), to name a few exam-
ples of the many lines of inquiry currently underway. We believe that the current
momentum offers opportunities for asking new interdisciplinary research ques-
tions that can galvanize anthropological research on breastfeeding. We hope that
the present volume lays the groundwork for some of this new work, which will not
only make an important contribution to our own discipline, but also highlight the
importance of anthropological approaches to broader audiences, including health
professionals, policy makers, and parents.

Rethinking anthropological approaches to breastfeeding

Although the divisions between the subfields are deep, the process of breastfeeding
itself generates the potential for boundary-crossing conversations. The authors of
this volume strive for an understanding of breastfeeding that recognizes and values
its significance in anthropology and in human life. Drawing on their diverse train-
ing, experience, and methodologies, the contributors provide rich insight into the
manifold biocultural processes and relationships that constitute and are constituted
by breastfeeding across an array of environmental, historical, sociocultural, and
political economic contexts. Our objective is to highlight the scope of breastfeed-
ing research in anthropology and to facilitate discussion and potential collaborations
across the subfields.  We see different epistemological roots and methodological
approaches not as inherent barriers, but as opportunities for enriching our inquiry
and conceptualization of breastfeeding. Consequently, we do not advocate for a sin-
gle, integrative biocultural model in this book, but rather offer some cross-cutting
themes that can engage different authors’ work in new, productive conversations.
The chapters of the volume are organized around four key themes: (1) rela-
tionality and interembodiment; (2) cultural ideologies and biocultural practices;
(3) variability and adaptability; and (4) ecological and political economic consid-
erations. While nearly all chapters touch on each of these four themes, we have
loosely grouped the chapters according to a primary theme to foster inter-subfield
dialogue.

Breastfeeding as a relational, interembodied practice

The first chapters emphasize the complex embodied relationship of mothers and
infants in breastfeeding within the context of evolutionary, ecological, physiological,
14  Cecília Tomori et al.

and cultural concerns. Miller’s chapter revisits literature on “passive immunity” to

argue for a much more dynamic, interactive model of collaborative immunity, in
which mothers and babies communicate with one another to shape the immu-
nological composition of human milk. Palmquist’s chapter examines cultural per-
ceptions of passive immunity, which reflect a dynamic model of immunity that
encompasses not only relationships between biological mothers and babies, but also
those that may be formed through sharing breast milk and breastfeeding. Finally,
Tomori unites Mauss’s classic concept of body techniques with McKenna and Get-
tler’s recent biocultural construct of breastsleeping – the integrated combination of
breastfeeding and shared sleep – as an analytical lens for examining the intercorpo-
real bodily habit (habitus) of breastsleeping across cultural settings.

Cultural ideologies and biocultural lactation practices

This group of chapters highlights the role of cultural ideologies in shaping percep-
tions of breastfeeding, which have significant implications for lactation practices
as well as for health, wellbeing, and inequality. Sobonya’s chapter explores how
African American women in the St. Louis area of the U.S. engage with, appropri-
ate, and problematize public health advocacy messages of the “natural” in ways
that may facilitate or hinder successful breastfeeding practices. These public health
advocacy discourses have significant implications for reinforcing or alleviating racial
breastfeeding disparities in the United States. Hawley and Gorrepati review the
complex biocultural relationship of breastfeeding and maternal and infant body
size, which have significant implications for human health. The authors use a case
study from American Samoa to demonstrate how cultural preferences for a larger
infant body size shape breastfeeding practices, ultimately leading to the shorter
duration of exclusive breastfeeding and increasing the vulnerability of this popula-
tion to obesity and its health consequences. Finally, Reyes-Foster and Carter show
how U.S. women in Central Florida draw on cultural ideologies to carry out moral
motherwork by engaging in sharing human milk and providing what they perceive
as the best alternative means to feed their infants, in spite of negative public health
perceptions. In this process, they may reinforce existing inequalities in breastfeeding
across racial and socioeconomic lines.

Variability and adaptability in breastfeeding

The next set of chapters highlights variation and adaptability as a key feature of
human lactation and infant feeding. Quinn’s chapter examines variability and its
potential evolutionary significance in an understudied aspect of human milk –
medium chain fatty acids – across populations and in a case study from Cebu in
the Philippines. She proposes that the ability to synthesize relatively high levels
of medium chain fatty acids has adaptive significance in ensuring the delivery of
necessary fat for infants under conditions of low dietary fat intake. Walks’s chap-
ter describes the experiences of masculine/queer breastfeeding and chestfeeding
 Introduction  15

experiences in Canada, which challenge cultural ideologies that associate breast-

feeding with the “feminine” and demonstrate the variability of breastfeeding, this
time in specific cultural contexts. Finally, Martin’s chapter explores the variability
of mixed feeding trajectories – the timeline for the introduction of complementary
foods to full weaning – across human populations. Martin examines this evidence
in relation to comparative evidence from other primates and ecological pressures to
argue for an evolutionary understanding of this variability.

Ecological and political economic perspectives

on breastfeeding
Finally, our volume highlights the considerable overlap in ecological modes of
inquiry in biological anthropology, and political economic approaches in sociocul-
tural anthropology. Both of these approaches investigate women’s pragmatic decisions
about breastfeeding within the context of their lives and local challenges on different
levels. First, Halcrow, King, and colleagues’ chapter offers an integrative bioarchaeo-
logical perspective on the role of breastfeeding and weaning in early life histories of
stress, maternal health, subsistence, and disease in past natural and social environments.
Veile and Kramer’s chapter follows a similar theoretical approach with a different set
of methods from biological and sociocultural anthropology to explore the changing
ecology of breastfeeding and weaning practices among a contemporary population of
Yucatán mothers in light of rapidly changing social conditions, including less physi-
cally demanding labor practices and growing access to medical care. Hough, Prussing,
and Applegate’s chapter highlights the structural barriers that shape how first-time
midwestern U.S. mothers negotiate breastfeeding and the return to paid employ-
ment in the context of dominant cultural ideologies of motherhood and individual
responsibility among middle-class white families. Finally, Tully and Ball offer a bio-
cultural approach that accounts for the biological and social costs and benefits that
shape breastfeeding decisions in settings with varying levels of structural and cultural
support. They describe how such an approach can be combined with public health
approaches to reduce barriers to breastfeeding and breastfeeding inequities by enhanc-
ing support and limiting iatrogenic interference with mother-infant interactions.
Together these chapters, complemented by commentary from Penny Van Esterik
and James McKenna, offer new directions for integrating biological and sociocul-
tural perspectives that enrich our understanding and offer avenues for developing
better support for breastfeeding and human lactation practices.

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nia Dominguez-Reyes. 2014. “Do breastfeeding and bottle feeding influence occlusal
parameters?” Breastfeeding Medicine 9 (1): 24–8.
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 Introduction  19

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