Understanding women’s rights is fundamental in the development sector. However, these rights entities have been widely followed by the crisis of universality (Mutua, 2015). The universality of entitlement is not only about Northern versus Southern practices but also forces the idea that women-related concerns are seen as universal for all women, despite being in the same regions. The inability to understand this complexity has many things to do with slowing the advance of women’s rights as human rights and a manifestation of deeper pathologies of the power (Meekosha & Soldatic, 2011). If that language confuses you, let me take you to a real example of how mothers find themselves in a dilemma when it comes to prioritising their rights or their children, particularly on exclusive breastfeeding.
WHO suggests that exclusive breastfeeding is the foremost solution for maternal and child health problems, but it comes with many tensions around reproductive health and rights issues, specifically among feminist scholars. Some women’s groups argue that breastfeeding is a women’s issue and confirms a female power on bodily authority (Van Esterik, 1994). Breastfeeding is considered empowerment because it expands biological determination in which breast is often associated with sexuality. Additionally, it fights against global capitalism, such as multinational infant formula companies, which repeatedly frame women as consumers. On the contrary, other feminist groups challenge that narrative and claim that (exclusively) breastfeeding leads to the essentialist constructions of womanhood and their bodies which ultimately have impacts on the capacity of women as an agency to proliferate (Alburo-Cañete, 2022) — highlighting the power of women’s bodies in providing nourishment results in oppressing women’s voices on their struggles. Furthermore, the celebration of exclusive breastfeeding reifies the stigma towards women who do not exclusively breastfeed and silence the underlying problems of breastfeeding.
Therefore, let us deconstruct the knowledge and practice around motherhood and breastfeeding. Here, I discuss the nuisance within the Indonesian setting as the country has legalised regulations to support the implementation of exclusive breastfeeding in the last two decades. In doing so, firstly, I describe the contextual background of this initiative in Indonesia. Secondly, I examine social norms around breastfeeding in the country, including the assumptions of body natural circumstances and the mother-children relationship. Thirdly, I assess the structural force in ignoring women’s disabilities in breastfeeding, and fourthly, I scrutinise the tension among feminist movements on this programme. Lastly, I conclude by calling the need for a re-examination of exclusive breastfeeding policies and norms from a comprehensive feminist lens.
Contextual background
WHO (2014) defines exclusive breastfeeding as providing only breastmilk (no other food or water) as nourishment for infants for the first six months. Medically, it has been proven that exclusive breastfeeding has a huge potential impact on child mortality prevention (World Health Organization, 2014). Additionally, it has broadly acknowledged that breastmilk has the rich nutrition infants need and giving other food and water during the first six months is harmful to babies. Looking at the importance of exclusive breastfeeding, the Indonesian government took severe steps by stipulating exclusive breastfeeding (or Program ASI Ekslusif in Bahasa Indonesia) in National Health Law in 2009. This legal action illustrates that health services are obligated to promote exclusive breastfeeding, including early initiation of breastfeeding. Also, the government expects all public places to support this programme through the designated spaces for breastfeeding. What is more, the law explicitly requires all infants to be breastfed for the first six months, and any party who prevents a mother from breastfeeding is sentenced to a year in jail or AUD 10,000 in fines (Wise, 2011).
Through this strict legislation, the exclusive breastfeeding practice in Indonesia exceeds the national target (45%) in 2021, accounting for 69,7% of infants in the country being exclusively breastfed (Ministry of Health in Indonesia, 2021). However, from a public health perspective, this achievement needs to be improved as the case of stunting due to malnutrition in Indonesia is the five highest number in the world, accounting for 30,8% in 2020 (UNICEF, 2020). Therefore, there is urgent action to accelerate the implementation of this exclusive program throughout the country and ensure that all born infants are exclusively breastfed (Beatty et al., 2017). The urgency of this initiative holds a critical position in the knowledge production of breastfeeding practices. The main message is clear: breastmilk is the best food for an infant, and therefore, nothing is more significant than nurturing children directly from the mother’s bosom (Pearson, 2017). This campaign is followed by three other messages: exclusive breastfeeding is cheaper, healthier, and will make children smarter1. What is more, the ASI Ekslusif programme focuses on three essential interventions, namely 1) giving only breastmilk for up to six months, 2) continuing to breastfeed until two years, and 3) providing complementary food after six months (MPASI2).
Notwithstanding the growing progress in promoting this initiative in Indonesia, there is an apparent silence on Indonesian women’s struggles with their private domain. Obvious silence means that there is limited acknowledgement, especially from Indonesian feminist perspectives, of the struggles experienced by women who have difficulties in producing breastmilk, lack social support and experience uneven distribution of domestic work. Most of the research that has been conducted is purely descriptive of mothers’ behaviour, knowledge, and breastfeeding barriers which is done from the public health point of view and disregards the women’s struggles. In fact, when talking about breastmilk being the best, there should be a critical sociological examination of this policy as it affects mothers and children. Hence, a valid question that should be asked is best for whom.
Breastfeeding: “The natural thing women can do”
Many Indonesian people believe that breastfeeding is a natural thing women can do for their children. In Indonesian community-based breastfeeding intervention, it is very often that female health workers score that practically all women can breastfeed and encourage them to avoid using formula. Also, health promoters claim that if women live healthily, they can produce enough breastmilk for their infants (Spagnoletti et al., 2018). What is more, to encourage young fathers to support their wives, recently, some interventions state that breastfeeding can also slim their wives’ bodies faster as breastfeeding consumes extra energy. Here, breastfeeding is constructed from a patriarchal perspective as a natural thing women can do, and society seems to have control over women’s bodies. As a result, breastfeeding for women tends to be socially accepted ‘by design’ because of their biological bodies.
While it may be verifiable that women physically can produce breastmilk, formulating such narratives will underplay the actual disabilities experienced by women in breastfeeding their newborns. Spagnoletti (2018), in her research in an urban area in Indonesia, argues that when Indonesian women are physically unable to breastfeed their babies exclusively, they find themselves in guilt, sadness, and failure feelings.
The real difficulties for women in breastfeeding range from uneven distribution of domestic work with their partners to limited breast milk supply. What is even worse, some infants, in certain circumstances, stop wanting or rejecting breastmilk. As a result, mothers are often taking many traditional and modern treatments to ensure that they produce enough breastmilk supply and that their infants are willing to consume it (Spagnoletti et al., 2018). These efforts cause women depression and anxiety due to social pressure from family and society. When women fail to breastfeed their babies, society interprets it as a failure to be a good mother. All of these authentic experiences illustrate that exclusive breastfeeding does not work out for all women. Unfortunately, the government and breastmilk advocates barely highlight women’s struggles and keep using naturalness narratives to achieve the breastfeeding target in the nation and indirectly generalise women’s abilities in breastfeeding.
Breastfeeding: Mother and child bonding
Breastfeeding advocates in Indonesia, including public health researchers and development agencies, tend to use child-centred messages as ultimate attentiveness rather than the physical and mental health of the mothers. The concerns for women in sacrificing their bodies and taking a strict diet (such as eating moringa leaves and bitter melon3 to produce qualified breastmilk are often neglected because ‘naturally’ it is a women’s sense to fight for their children and have a responsibility to be a good source of breastmilk. While such messages are culturally suitable for understanding mother and child bonding, it constructs the idea that women are the primary caregiver.
Some cultural feminists in Indonesia support such an idea because breastfeeding is embraced as a remarkable female role and a manifested experience of motherhood. Additionally, exclusive breastfeeding develops relationships between mothers and children (Law, 2000). As it is crucial for children’s development, Indonesian feminist breastfeeding advocates attempt to improve special indemnity for breastfeeding by reconstructing social and economic structures to accommodate the programme without bringing biological determinism into service.
However, revamping social and economic structures is not as easy as turning one’s hand over. If the idea of breastfeeding is to develop the relationship between mothers and their infants, then the mother’s physical presence is mandatory. Meanwhile, there is another struggle women face when doing public chores (McCarter-Spaulding, 2008). Even though the Indonesian government requires workplace lactation support, the number of such facilities is still limited. The struggle is also exacerbated by narrow maternity leaves. While exclusive breastfeeding requires six months duration, the maternity leaves recommended by Indonesian Labour Law is only up to three months. Consequently, women tend (and are socially expected) to quit their work to prioritise their babies.
While there is nothing wrong with staying at home to take care of their children and develop maternal love, I point out that not all women have the privilege of being able to choose between work and family, especially those living in low-income families. For that reason, exclusive motherhood through exclusive breastfeeding needs to be challenged.
A structural force in ignoring women’s difficulties in breastfeeding
The unwillingness to acknowledge women’s struggles in breastfeeding has something to do with the discomposure of placing breastfeeding on a pessimistic side which formula manufacturers have used to promote their products as a solution for women and children when it comes to breastfeeding barriers (Wall, 2001). Therefore, the Indonesian government has developed a strict policy to close the opportunity for formula firms to frame the barriers of exclusive breastfeeding in their marketing messages. For instance, the government bans formula campaigns by depicting healthy infants, providing free formula products and marketing formula products in mass media4. This hesitancy results in a tendency to shrink women’s difficulties which are considered minor and manageable at a personal level. Reiterate the previous section, when it comes to the promotional key message such as “all women can breastfeed”, it interprets that women have to deal with the barriers personally.
Limited space to openly discuss the struggles demonstrates that such an issue is a private thing that women do as a coping mechanism for being mothers. Examples of coping mechanisms that Indonesian women take include taking traditional diets, buying breast pumps, and consuming lactation supplements. Some women with a lack of support from family and community may deal with those difficulties silently, resulting in baby blues syndromes and other postpartum mental health issues (Spagnoletti et al., 2018). It is interesting to note that while an exclusive breastfeeding policy is a must for all mothers, it seems that it goes beyond personal choice over women’s bodies. However, when it comes to women’s difficulties, it is seen as individual matters of time, emotions and the body. Ultimately, the denial of this repression becomes ‘normal’ with the help of the discourse of naturalness, maternal love, and personal option.
Even after two decades of exclusive breastfeeding implementation in Indonesia, the government and development agencies still focus on overcoming women’s barriers to breastfeeding rather than providing spaces for women to negotiate regarding their own bodies without any judgement as good or bad mothers. Therefore, drawing from the feminist perspective that the ‘personal is political’ (Alburo-Cañete, 2022), the notion of breastfeeding should go beyond the child-centred to women’s sexual reproductive health and rights.
The tensions in the feminist movement
The problem of breastfeeding arises because it is sex-specific and challenges the feminist essence of gender-neutral childrearing. Until recently, most public health research focuses on biological reproduction (lactation) rather than social reproduction, which creates the process of breastfeeding (McCarter-Spaulding, 2008). When it comes to tension around the feminism of breastfeeding, health promoters engage with cultural feminists to accelerate the programme implementation. Using public health perspective, some women’s groups narrate that breastfeeding protects women’s health as it reduces the risk of ovarian cancer, heart disease and diabetes (Global Breastfeeding Collective, 2016).
Furthermore, those advocates emphasise the value of being females and mothers while embracing social interaction in the Indonesian community. In this sense, feminist breastfeeding advocates encourage women to claim their power by breastfeeding their infants because it is considered women’s earliest option after delivery (Law, 2000). Combined with adequate reproductive health services and information, women are empowered to decide to breastfeed their infants. Additionally, as mothers, it gives them the means to protect their children with their powerful bodies (Global Breastfeeding Collective, 2016).
Nevertheless, those narratives have not profoundly considered the social reproduction of breastfeeding. It is accurate that breast milk lactation is vital for infants’ growth. Yet, the discourse of exclusive breastfeeding is beyond nutritional facts and not only about the lactation produced by women versus formula milk produced by factories. Exclusive breastfeeding is more about technical, social and domestic engagements because biologically, breast milk is generated once the baby is delivered outside the women’s physical body (Law, 2000).
While reproductive rights, women empowerment and motherhood are central issues in feminist breastfeeding advocacy, exclusive breastfeeding in Indonesia has contributed mainly to the construction of womanhood, which has been linked with a patriarchal structure. It has been adequately explained in the previous sections that exclusive breastfeeding creates patriarchal expectations of childrearing and becoming mothers. Health promoters and Indonesian society often step into moral police who judge women who cannot or cannot breastfeed (Spagnoletti et al., 2018). Spagnoletti (2018), in her study, also emphasises that exclusive breastfeeding messages reinforce gender stereotypes and create a heavy burden for women.
All of this tension and progressive promotion of exclusive breastfeeding results in a relatively small analysis of the feminist literature on breastfeeding. What is even worse, some critiques around exclusive breastfeeding are currently assumed to be a liberal movement that contradicts national goals in the maternal and child health sector. Also, this movement is threatened with imprisonment or a fine based on National Law on the ASI Eksklusif Program.
All of these facts support my conclusion that the exclusive breastfeeding programme has been institutionalised in the public sphere and individual’s moral reality. This causes women’s decision to breastfeed or not to breastfeed exclusively to become subject to collective investigation on what is ‘ideal’ for them. And the discourse of morality has transformed into everyday practices due to normalisation within society, including among feminist breastfeeding activities. As a result, women’s experiences and struggles are ignored, unheard and diminished.
This situation, of course, appeals to a profound re-examination of the definition of women’s rights on reproductive health and rights. Disregarding this circumstance obscures the meaning of empowerment and gender equality. As exclusive breastfeeding is indeed feminist and women’s issue, it needs further scrutiny through a comprehensive feminist lens.
Therefore, I hope there will be a feminist re-writing and re-reading of breastfeeding public intervention, practices and discourse by listening more to what is actually felt by women that shape exclusive breastfeeding practices. Thus, the domination of future literature would be around the narrative of how motherhood is shaped by the sociocultural and structural forces that perform in breastfeeding.
Notes:
[1] This is translated from Bahasa Indonesia version of promotion material for exclusive breastfeeding developed by the Ministry of Health in Indonesia, referring to ‘ASI adalah makanan terbaik bagi bayi. Lebih Hemat. Lebih Sehat. Anak Cerdas’ (Breastfeeding is the best food for infants. Cheaper. Healthier. Children will be smart). Source: https://promkes.kemkes.go.id/poster–asi-eksklusif70x100cmaccessed on 3 October 2022 at 11.38 am.
[2] MPASI is makanan pendamping ASI or complementary food given to infants after 6 months old to fulfil the nutrients need by the infants (https://health.detik.com/berita-detikhealth/d-5101467/apa-itu-mpasi-berikut-menu-mpasi-6-bulan-menurut-who, accessed on 3 October 2022 at 11.46 am).
[3] Traditionally, moringa leaves and bitter melon are acknowledged to increase breastmilk production after delivery in Indonesian setting (https://health.kompas.com/read/2020/04/18/133000268/8-jenis-tanaman-untuk-pelancar-asi-yang-mudah-ditemui-?page=all) accessed on 4 October 2022 at 3.13 pm.
[4] Peraturan Pemerintah No 33 tahun 2012 tentang Pemberian Air Susu Ibu Eklusif (National Regulation No 33 in 2022 regarding Exclusive Breastfeeding in Indonesia)
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