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Good Breast-Feeding Keeps Children Alive and Well


Historian Anne Løkke has just published her doctoral thesis Death in Childhood about infant mortality and modernization processes in Denmark 1800-1920.

This interview was originally brought in the print version of FORUM in 1997 as she was completing her thesis.

FORUM/6.11.99 Fortunately the historian Anne Løkke comes to meet me at the front entrance of the Historical Institute at Copenhagen University. As always, I have almost lost my way out there. The physical layout of the University is perhaps meant to be a metaphor for the tortuous paths of academia and the iron will needed to succeed: The ground floor is named the first floor, the first floor is named the second floor, and there are rumours that staircase no. 16 doesn't even exist.

Anne Løkke is a petite woman who wears her dark hair pulled back from her face. Today she seems quite excited, probably because she will soon be handing in her thesis. I have come to hear about breast-feeding and children. Strange as it may seem, however, her thesis is entitled Death in Childhood (Døden i Barndommen, Gyldendal, 1998). I didn't think this was particularly pertinent to breast-feeding, but I was about to find out that it was. As Anne Løkke points out herself:

- Today we think it is unnatural to mention death and children in the same breath. But this was not the case just two or three generations ago.

Anne Løkke has worked on her thesis for six years.

- You need to be predisposed for this kind of marathon by having lots of muscles with long fibres to be able to cope, she says.
- Originally my thesis was meant to be about infant care and the view of infancy, but when you examine infancy prior to 1930, then death predominates. The literature about infant care from the period around 1900 consistently deals with the prevention of infant mortality. If one goes further back in time, a lot of thought has been given to the considerable risk of children dying on you. You hardly knew which side of the life line infants were on."

It is my impression that whatever Anne Løkke doesn't know about breast-feeding and infancy in a historical perspective is not worth knowing. Much of the fight against infant mortality was centred on the breast-feeding of infants: how they should be breast-fed, how women used to do this, and how the doctors wanted them to do it during the campaign to curb infant mortality around the turn of the century.

I am curious to find out what - in Anne Løkke's opinion - is the most exciting and surprising fact about breast-feeding that she has uncovered. Without hesitation she replies: - The women on Funen and Bornholm were able to keep their infants alive without the aid of doctors and scientific knowledge to an extent that was not surpassed until around 1940. For legitimate and illegitimate children, rich and poor alike, the rate of infant mortality was under 10%. In contrast, women in the Randers region in Jutland, lost 20-25% of their children.

Anne Løkke was made aware of the regional differences in infant mortality by reviewing a large amount of statistical material from the 19th century.

- I became aware of the line of reasoning used by the 19th century statisticians: Wherever there are differences, there has to be a reason. In other words, it cannot be God's intention that infants should die if more children die in Randers than on Funen. Hence they catalogued some of these differences. By spending a long time at the National Record Archive copying out reports on births and deaths made by priests, a student and I were able to map the mortality rate.

The causes for these differences, however, were much more difficult to uncover.

- A very, very, very long time went by indeed. But I consulted two kinds of sources. One was reports by health inspectors. Already in 1800 Denmark was covered by a network of health inspectors, whose job it was to send in reports on mortality and epidemics to the Department of Health. I have plowed through heaps of their material and have also looked at folklore accounts."

- I have compared these two sources for small localities to see if there could be a connection between the folklore accounts and the doctors' reports. According to historians, doctors have a tendency to view anything the common folk do as just wrong, bad and die-hard habit, and they should stop doing it. Folklorists have the opposite tendency. They believe that everything in the old days was beautiful, romantic, and in harmony with nature. But when you look at the concrete facts, there are systematic coincidences which paint the following picture: Women on Funen and Bornholm breast-fed their children for a long time, they did not 'cook' for their childen - that is feed them solid food - and they continued to breast-feed their children until they were two-three years old.

So the main reason why mothers from Funen and Bornholm were particularly good at keeping their infants alive was the way in which they breast-fed them.

They breast-fed their children according to demand, as we would say today. They let their children have what they wanted and with no restrictions. And they did not prepare any other kinds of food for them, that is. Children were breast-fed until they could sit at the table during meals. In the region around Randers, as well as other places, it was thought that breast milk was good for the infant, but not quite sufficient. Hence children were fed other kinds of food immediately after birth. In the worst areas children were given peas, cabbage, pork, and porridge with a dollop butter. No only did cooked food contain bacteria, but the intestines of an infant are not able to cope with this kind of solid food.

In a lyric passage from his memoirs My Funen Childhood (Min Fynske Barndom), the composer Carl Nielsen (1865-1931) writes about his breast-feeding mother on Funen: "We children were allowed to nurse until we were a couple of years old, and I clearly remember the sensation of her skin (....) When my mother sat with the youngest child at her breast, she was usually happy and almost jolly. It might then take the little one away, play a little with her breast, and then put it into the mouth of one of the older children, and say: 'Do you want some, too, my little one?' I have stood in my clogs in front of my mother and partaken in the delight."

The women on Funen did not seem to be in doubt about their milk being good enough and being the best thing their children could be given.

- Breast-feeding is something which is enjoyable, something one can play with. Something which is sensual and pleasurable, says Anne Løkke.
- Yet during the course of the campaign to reduce the rate of infant mortality, breast-feeding became an obligation. It was something women had to do for their children to survive. Breast-feeding became equated with meals at fixed times, food, and nutrition. The pleasure of breast-feeding disappeared.

In the period around the turn of the century, women and doctors formed a kind of alliance to reduce the rate of infant mortality in "The Medical Infant Care Programme". The key was breast-feeding, and the method was rest, cleanliness, and regularity, as the physician Sven Monrad prescribed in The Mother's Book (Moderens bog, 1916):

- Femininity was equated with maternity. Being a real woman meant being a mother. And a real mother nursed her children for six months, otherwise she was not a good mother.

The mother became the most important person in her children's lives. She was supposed to breast-feed them, take care of them emotionally, and keep an eye on all aspects of their childhood. Motherhood as we know it today developed at this time, and women have made huge investments to bring down the rate of infant mortality.

Although breast-feeding and improved hygiene were two of the main causes for the great reduction in infant mortality, the doctors' recommendations about very regular breast-feeding brought about a slow, but steady, decrease in the frequency of breast-feeding during our century. A decrease that culminated in the late 60's and early 70's.

- This philosophy of regularity is in stark contrast to the physiology of breast-feeding, says Anne Løkke.

The amount of breast milk is determined by supply and demand, so to speak. If the infant wants more milk, then more milk is supplied. If mother and child cannot adapt to this, then there are many mothers who experience a kind of collapse in breast-feeding. They do not have enough milk. The same books that state that we should breast-feed regularly, also tell us that it is every woman's duty to nurse her child for at least six months. But when the mechanism of supply and demand is suspended, then one will automatically experience a breast-feeding collapse when the child reaches 2-3 months, since there will be a sudden surge in the child's appetite. And then the only solution is breast milk substitutes.

- Today I am completely convinced that if the doctors had simply asked the mothers on Funen and Bornholm, instead on relying on autopsies of dead children, then the infant mortality would have decreased more rapidly.

This is quite a claim. But breastfeeding and mother's milk is also a cause of healthier children today.

- Today it is not a matter of the children's survival, but it is clearly a matter of how many allergies, middle ear infections, and bouts of pneumonia children suffer from.

- Nowadays, because so many mothers from so many different social classes nurse their children, it is possible to prove that their children are in fact healthier. This is fascinating for scientists, who turn out scores of results. The more questions that are asked, the more complicated feedback mechanisms are revealed. The mother creates antibodies against the particular pollutants in her environment, and this immediately benefits her child, etc., etc.

Recently in the daily newspaper Det Fri Aktuelt one could read about precisely this kind of study. In her Ph.D. thesis, the doctor Marianne Hørby has shown that children who are breast-fed have better vision than children who are not breast-fed.

Anne Løkke has researched this subject for six years. The results will soon be available in the form of a thesis. Who might be interested in her results?

- It is very relevant for the experts in this field, who will be advising future fathers and mothers. It is not merely people from other cultures who take a different view of breast-feeding, we have also had a different view. My results demonstate an historical perspecive on the issue. Much has changed in this country in the course of the last few generations."

- My results will of concrete value to doctors, midwives, nurses, and health care facilitators and teachers. And for ordinary women, it is certainly interesting to see that there is history in this, too. That one actually takes part in creating the society one lives in, by living the way one does. For me it is interesting to see that what we interpret as biology or nature is also a part of history.

Before I leave, Anne Løkke adds a postscript to the story about the mothers from Funen:

- When a child was taken to church to be baptised, it was custom to bring another woman along to church, a woman who had milk in her breasts and could nurse the baby. As in other parts of Denmark, the mother of the child was seen as unclean and remained at home. There was a special word for this kind of wetnurse, "suckle mother" (pattemor). Wetnurses were very rare in Denmark, but when the mothers on Funen went to town, they would rather leave their babies with a neighbour with milk in her breasts than with a servant.

Translation Britt Keson

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