| Discussion Paper
Risks, Rights and Regulation
Communicating about Risks
and Infant Feeding
Reaching a consensus about contaminants and breastfeeding will not be easy. Acting and communicating in the face of scientific uncertainty and highly charged emotions is particularly challenging. The unknowns of immediate relevance concern both breastfeeding and toxins. There is no agreement on how exposure to toxins affects infants, breastfed infants, and adults (Jensen and Slorach 1997:274). All agree that the effects may be very subtle and hard to measure. If breastfeeding in a polluted world were more dangerous than bottle feeding in a polluted world, one would expect to see increased incidence of cancers among adults who were breastfed as infants. In fact, the opposite may be true. Breastfeeding appears to mitigate affects of prenatal toxic exposure. How? By what mechanisms? Even medical researchers do not agree on how breastmilk actually protects infants. "Although many components of breast milk have been identified, the honest answer is that we do not fully know" (Schreiber 1997:136; cf Cunningham et al 1991). While the toxicologists and medical researchers work out the biological mechanisms and establish standards of acceptable risk, there is a great need for gender-sensitive social science research on the application of the scientific knowledge produced. Three inter-related topics emerging from this review require particular attention from social scientists: the interpretation of risk, time, and embodiment.
The Meaning of Risk
Risk, according to the experimental sciences, is an estimation of the chance that undesirable effects may occur and it is assessed from past experience, based on the familiarity principle (Nottingham 1998:175). Risk may also be interpreted as opportunity or recklessness, and risk-taking as bravery (Steingraber 1997:227). Thai men refusing to use condoms when they visit prostitutes in the context of HIV/AIDS is an example of risk-taking interpreted as bravery. Others consider hazards as basic to human/environment systems, rather than as extreme and unpredictable events. Risk and uncertainty are integral to the human condition, The distinction between risk and uncertainty is often blurred. Policy makers are concerned with risk management involving cost-benefit tradeoffs. But risk management is only possible when the consequences are already known and measurable. Risk-benefit analyses offer no solutions and imply that as long as breastfeeding is less dangerous than failure to breastfeed, we should take that option. The narrow duality of risk-benefit analysis ".leaves no room for the proposition that feeding our infants industrial poisons is unacceptable" (Steingraber 2001:274).
Risk assessments are often presented as if they were objective and quantitative statistical constructs based on measurable characteristics, ignoring the subjective and political side to risk assessment. "Scientific" risk assessment is followed by risk management or policy making. Some argue that risk assessment cannot be separated from risk management (Shrader-Frechette 1993:32). But even the most sophisticated systems of risk assessment and risk management cannot determine the probability of certain events occurring. Generally, the media fails to place risks in a broad ecological context and time frame. Nowhere is that more obvious than with reporting on breastmilk and environmental toxins. The role of media in risk amplification also needs further study, particularly since measures (and reports of measures) taken to prevent hypothetical consequences to infants (such as recommendations to stop breastfeeding) may do more harm than good. Thus, interventions also carry with them an element of risk.
Disciplines approach risk from different perspectives. In a review of disaster research in anthropology, Oliver-Smith (1996) recognizes three interconnected perspectives: the behavioural response approach, the social change approach, and the political economic/environmental approach. These theoretical perspectives require different definitions of risk. For example, breastfed infants could be conceptualized as a vulnerable natural resource dependent community whose existence is based on the utilization of a renewable natural resource - breastmilk. This resource is threatened by increasing environmental pollution, since some chemical contaminants interfere with milk production and thus directly threaten breastfeeding.
To anthropologists, the necessary scientific research concerning risk assessment needs to be combined with analyses of risk perception. Individuals and groups hold different perceptions about what is harmful and what harm matters. According to Douglas and Wildavsky, people make a distinction between risks they undertake knowingly and risks that are imposed on them, and they have a greater sense of outrage at involuntary risks (1983: 16-17). Whenever information on toxins in breastmilk is deliberately withheld from the public, then breastfeeding has the potential for being interpreted as presenting an involuntary risk for an infant. But it is important to remember that it is not just
information about toxins in breastmilk that may be withheld; Steingraber notes that environmental threats to pregnancy are also ignored. "There is some kind of disconnect between what we knowscientifically and what is presented to pregnant women seeking knowledge about prenatal life" (2001:105). Risk and perception of risk need to be considered in the context of power. Broadening the approach to risk might encourage asking different kinds of questions. Are risks associated with bottle feeding and breastfeeding undertaken knowingly, or is the distinction between voluntary and involuntary a constantly shifting boundary? To what extent is the focus on toxins and breastmilk a response to "objective"physical/biological/environmental threats, and to what extent is it a crystallisation of more complex forces and realities" (Wynne 1996:44)? As Beck notes, there is a pervasive sense of risk gripping industrial society, when even eating is high-risk behaviour (1992b).
The question of who should bear the burden of proof is addressed by the concept of the precautionary principle - always err on the side of caution regardless of complete scientific evidence if there is potential for harm, or in ignorance, abstain. Industries demand 'proof of harm' before agreeing to regulation, but often 'scientific' levels of proof are not available. Activists cannot wait for full scientific evidence to be assessed before calling for better regulations. Consider the Minamata case where scientific proof was available but ignored until citizen activism demanded action against the companies who were dumping methylmercury into Minamata Bay (Steingraber 2001:46). Nash and Kirsch point out that ".the ability to direct scientific inquiry toward proving that materials such as PCBs are hazardous, rather than that they are safe for human ecosystems, places the onus on the people affected by the hazard."(1988:170). Fortunately, the Stockholm Convention signed in May 2001 uses the precautionary principle when selecting new chemicals to the list of banned substances. Environmental groups should not have to prove that pollutants are hazardous before protective legislation can be put in place; mothers should not have to prove that their breastmilk is safe. How did the burden of proof shift from corporations and governments that allow contamination, to breastfeeding mothers who worry whether they should have their breastmilk tested for contaminants?
Time and Toxins
Risk cannot be considered apart from time frames. Three temporal dimensions are particularly important to consider when discussing toxins and breastfeeding. The first is the chronological order in which chemical contaminants were developed, used, researched, and regulated. The second is the intergenerational effects of toxins. Third and most important is the time in the life cycle when the individual was exposed to toxins, prenatally, postnatally, or as an adult.
New technology continually reveals new contaminants. Some contaminants like DDT were discovered early, researched, and eventually regulated in North America. Products like DDT were then marketed in countries with much less stringent regulations, but with a need for cheap products. As these contaminants were researched and reported in the scientific literature, information about them entered public discourse. Meanwhile, tests for recognizing minute quantities of new contaminants were perfected. Regulations may indeed be enforced, products phased out, and the risks reduced. However, the culprits are by now well known to the public. To communicate to the public, researchers may make reference to substances most widely known to be toxic, such as DDT, first found in breastmilk in 1950. When chemical contaminants are found to be declining in foods or in breastmilk, for example, it is not reported because it is no longer news. For example, the WWF-UK report noted that the levels of organochlorine pesticides and dioxin compounds in breastmilk were declining in the UK; other reports confirm the decline in contaminants in Canada.
New contaminats may be in more minute quantities and may or may not be as lethal as those revealed by earlier methods. Their effects may be less understood and more subtle; they are harder to test for and regulate; and they may require rethinking causality and bio-accumulated risk. Standards and regulations may have been set at a time when measurement techniques were less sensitive. Products such as endocrine disrupters, for example, may be interpreted by the public by analogy with earlier generations of contaminants such as DDT which are now on the decline. Similarly, dioxins such as Agent Orange tend to "stand for" all POPs in media reports. By analogy, the public may assume that all POPs are as toxic as dioxins.
The need to consider the chronology of scientific discoveries is further complicated by the time lag between exposure and outcome. Causes in one generation may produce results in the next. We need to explore new ways to measure and assess cross-generational effects of contaminants. This would be facilitated by the possibility of tracking exclusive breastfeeding across generations and perhaps by a sensitive breastmilk monitoring program. Stockholm monitors breastmilk and can show that when persistant organic pollutants are banned, their levels in breastmilk fall dramatically (Steingraber 2001:265). Are we prepared to use breastmilk monitoring as a scientific and political tool to protect the health and well-being of our infants and our community?
More attention also needs to be paid to the differential susceptibility to contaminants of infants and children compared to adults. For example, pregnancy, childbirth, and lactation provide different environmental contexts. Prenatal exposure, breastfeeding, and complementary foods offer different routes for contamination. Time of conception may even be important. In Minnesota, children conceived in spring when pesticide use was highest were more likely to have birth defects than children conceived at other times of the year (Steingraber 2001:265). Information about contaminants has not discouraged Swedish women from breastfeeding. Breastmilk monitoring as a scientific and political tool can provide useful information to protect the health and well-being of our infants and our communities, particularly when combined with the political will to act on the information.
Woman as Canary: The Sentinel Gender
Time and risk are also relevant to the social science literature on embodiment. The body as a focus of research has not figured prominently in discussions of breastfeeding and pollution. Nevertheless the unspoken discourse in much of this literature on contaminants in breastmilk is premised on the body as a source of pollution and
impurity. Pollution, defilement, contagion, and impurity implies some harmful interference with natural processes, or the abnormal intrusion of foreign elements (Douglas and Wildavsky 1983: 36), matter out of place. But as suggested by the story of the Eastern European shopkeeper who believed that women were no longer pure enough to breastfeed, impurity and pollution are easily interpreted as moral transgression.
Breastfeeding is accomplished by a gendered body; women's bodies are seen as risky environments, places where problematic processes occur, where too much or too little food is consumed, where too much or too little estrogen regulates hormonal function. And breasts are a particularly problematic site on these bodies. Too big, too small, diseased or healthy, capable of producing life-giving or life-taking fluids. Women's breasts are conceptualized as risk-laden sites of virtual pathology in need of risk management (Morgan 1991:90) (or as expressed by a reporter for the Toronto Star, September 29, 2000, "breasts as disease-disaster areas"). Instead of the metaphor of a strong body battling the invaders, the literature on contaminants and breastmilk assumes a woman's body is taken over by poisons and dangerous substances, her immune system broken down and useless against the invaders; more destructively still, she passes these poisons into the even purer body of her newborn child - an act of perfidy, evil personified. It is particularly difficult for feminists and breastfeeding advocates to hear about breasts, markers of female identity, referred to as toxic waste dumps. Similarly, the idea of "pump and dump" breastmilk, or non-stop closely spaced pregnancies from an early age (Steingraber 2001:277-8) or accepting the trade-off of miscarriages as a means to deplete women's bodies of contaminants is miscogenist and obscene. Although the literature on body burdens and chemical contaminants is gender-neutral, there is generally less focus on male-mediated developmental toxicity (cf Sever 1995).
Emily Martin's 1994 book, Flexible Bodies, explores the complexity of defending the self against the non-self. The boundaries become more blurred when another self - the fetus - is growing inside the maternal self, or when "self" becomes food for the "other" in the form of breastmilk. What would a feminist model of contamination look like without the sharp divisions between self and other, without the war metaphors, without the fetus as tumour that the maternal body attempts to destroy or tolerates, without technological metaphors of downloading contaminants from mothers' bodies into children's bodies (cf Martin 1994:61)? Clearly, this research topic requires searching for new metaphors, new images of breastfeeding, based on models of flexible adaptation, and a political economy of nurture and care.
Martin cites a pamphlet that describes complex systems held together by communication and feedback, not divided by category and hierarchy (1994:61). Lactation is a complex process sensitive to fluctuation and change, both in the external environment and the internal environment. The father-in-law who thinks breastfeeding belongs in the bathroom can devastate a system by an ill-timed frown. And yet breastfeeding survives under adverse conditions including emergencies and industrial accidents.
Imagine a person who has learned to feel at least partially responsible for her own health, who feels that personal habits like eating and exercise are things that directly affect her health and are entirely within her control. Now imagine such a person gradually coming to believe that wider and wider circles of her existence - her family relationships, community activities, work situation - are also directly related to personal health. (Martin 1994:122)
The belief that individuals are responsible for their personal health is particularly disturbing in the case of breastfeeding and chemical contaminants. Breastfeeding does not exist in isolation from the whole reproductive cycle of men and women, nor from the processes of globalization that tolerate, or even encourage industrial pollution. This is why the issue is so disturbing and emotional to discuss. Messages that warn about breastfeeding and toxins suggest the horror of total system breakdown, the horror of a system turning toxic to itself (Martin 1994:134). To understand why science and media focus particular attention on breasts and breastfeeding as sources of contamination, the concept of risky environments and the fear of total system breakdown must be explored in more detail. Women are blamed for exposing their children to contaminants, poisoning themselves and their children, downloading contaminants from their bodies to their children's bodies, in a dangerous slippage between contaminated mothers and contaminated milk. The blame is understandable because we so desperately want a simple solution to the problem of environmental pollution and human health. The solution will not be simple, but will take the concerted efforts of environmentalists and health activists applying political and economic pressure, including
DDT style bans, tighter regulations, incinerator closings, emission reductions, permit denials, right-to-know laws, recycling initiatives, and tough environmental enforcement at both local and national levels. (Steingraber 2001:278)
The search for a solution should enable breastfeeding advocates
to reposition breastfeeding as both metaphor and practice more
securely within the environmental movement.