in·ad·e·quate –adjective – 1. not adequate or sufficient; inept or unsuitable
-accessed October 15, 2008
Poor Mother (def.)
1. A woman who is rearing children without adequate resources.
2. A woman who is rearing children without adequate parenting skills.
3. A woman who deserves our sympathy.
-Fine and Weiss, page 186, 1998 10
In 2007, Solomonik conducted interviews with WIC mothers at a western New York site about their reasons for switching from breastfeeding to bottle feeding; responses included: “Unfortunately, I did not have enough milk”; “My baby was still hungry”; and “I dried up shortly after birth”. Often their answers took this form, “I know breastfeeding is really good but, - [personal failure] - and I ended up formula feeding”. Women endorsed breastfeeding as the best option while asserting that their decision to discontinue breastfeeding was unfortunate, anomalous, and out of their direct control; it was rooted in biological, not social circumstances.
The mothers in Solomonik’s study are not unusual. An insufficient milk supply is the most common reason women give for discontinuing breastfeeding, 4–9
and yet physical problems that inhibit milk production are very rare with only about 4% of women thought to have this condition.8
A number of investigators refer to this as Inadequate Milk Syndrome (IMS), a condition that spans a biopsychosocial continuum from a rare physiological situation to a condition embedded in psychological and social circumstances. 4–7,10
Most analysts have traced social circumstances of too little time and not enough support to physiological responses that would reduce milk supply. Here we argue ‘inadequate’ is an oblique reference to their lives as low-income women in US society, not just a physiological response.
In what ways are the lives of low-income women inadequate and how might this be related to their decisions to formula feed? The question of inadequacy has dual significance for social life. On the one hand we can ask if the lives of low-income women are inadequate in terms of material items we as US citizens deem minimal for negotiating daily life, such as housing, safe neighborhoods, transportation, health care, training, and employment. On the other hand we can ask if low-income women feel inadequate in fulfilling the multiple social roles that are demanded of them as workers, mothers, partners, and family members. The goal here is not to come to definitive conclusions, but to generate hypotheses to be tested in later studies.
We know that low-income women in the US do not have adequate material resources. Studies have documented inadequate preventive health services; inadequate health insurance; inadequate childcare; and inadequate food security. What was unexpected in the literature about the lives of low-income women, however, is that across a number of ethnographic studies, low-income women report inadequate safety, with a high frequency of violence in their lives.11–14
The quantitative literature supports this. A 2005 study by McDonnell and colleagues, for example, surveyed 455 low-income women in Baltimore looking for correlations between experiences of interpersonal violence (IPV) and health related quality of life. 15
of the women had experienced IPV either in the past year or over their life-time. There was a high negative correlation between their experiences of violence and decreased health related quality of life.
Violence, or inadequate safety, emerged in the ethnographic literature on three different levels: at the level of the household as domestic violence both witnessed and experienced; at the level of the community as street violence; and at the institutional level of law enforcement and of health and human service agencies. One research team, reporting on the lives of the low-income women in Jersey City, NJ and Buffalo, NY, noted that women’s lives were “saturated with domestic terror”.10
(p Community level violence may consist of shootings, stabbings, gang warfare, drug houses, and vandalism. Institutional violence can include police brutality and corruption; and health and human services organizations that are seen as not as mechanisms of social support but as mechanisms of social control, continually monitoring the activities of low-income women with the implicit threat of taking their children from them should they be deemed inadequate mothers. Low-income women, Fine and Weiss argue, live in fear.
Can these repeated instances of violence and punitive surveillance be construed as constant reminders to women that they are inadequate in fulfilling (unrealistic) role expectations under conditions of inadequate resources? With the constant threat of violence, is a sense of inadequacy inculcated into women, making formula feeding just one small way to reassure them that they are fulfilling the role of mothering? Within this context of inadequate safety and constant fear, do women feel too vulnerable to uncover themselves enough to breastfeed even in the privacy of their own homes? Does it make uncovering in public to breastfeed untenable? Does an unsafe environment and sense of inadequacy push women to stop breastfeeding as soon as they encounter difficulties while learning how to breastfeed?
What we are outlining here is a research agenda that asks if there is a relationship between women’s experiences of violence and the decision to formula feed their infants. Are women who report violence in their lives more likely to use formula than those who do not and if so, why? Are neighborhoods with high homicide rates sites of lower breastfeeding rates? Are mothers’ impressions of social service agencies as supportive or hostile related to their ability to breastfeed?
Paul Farmer has written eloquently of structural violence – the large scale social forces that become embodied
within the lives of the poor.16
He calls for research that focuses on the “gritty biographical details of life” as a way to better understand the how violence is manifested in the lives of the poor and what its consequences are. We do not have that level of detail about the lives of poor US mothers who choose formula feeding over breastfeeding. Both Farmer and Scheper-Hughes, however, offer similar structural insights that call on us to look beyond an American focus on the individual woman as the social agent who can choose what is best for her child, i.e., breastfeeding, divorced from the rest of her reality. Women’s infant feeding decisions must be understood within the higher order social structures which constrain their ability to breastfeed and which in circumstances of violence may make formula feeding the most logical choice. (1,830 words)