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The One Best Way?

Breastfeeding History, Politics, and Policy in Canada

By Tasnim Nathoo & Aleck Ostry
Subjects Social Science, Child Studies, Medical, History Of Medicine, Public Health, History, Canadian History, Women’s Studies
Series Studies in Childhood and Family in Canada Hide Details
Paperback : 9781554581474, 282 pages, July 2009
Ebook (EPUB) : 9781554587582, 282 pages, April 2011


Excerpt from Introduction, The One Best Way? Breastfeeding History, Politics, and Policy in Canada by Tasnim Nathoo and Aleck Ostry

“You will be able to nurse the baby. Never think of anything else. Nursing the baby yourself is the one best way. ”

The Canadian Mother's Book, published by the Department of Health, 1923

Dr. Helen MacMurchy wrote the above words in Canada's first piece of federal government-sponsored child-care advice literature for mothers. As the newly appointed head of the Division of Child Welfare, one of MacMurchy's central goals during her tenure was to establish breastfeeding as “the Canadian way”—in spite of the already dramatic decline in breastfeeding rates observed across the country.

While most of us are familiar with the refrain “breast is best”, few of us have much appreciation for how breastfeeding came to be considered a public policy concern. MacMurchy, as a social reformer and government official, viewed breastfeeding as a solution to the shockingly high rates of infant mortality during the first quarter of the twentieth century. Breastfeeding became a cornerstone of the federal campaign against infant mortality in the 1920s, and it emerged as part of the debates and policies surrounding issues of mothering. MacMurchy suggested that mothers were responsible for the future well-being of the country, and she described breastfeeding as a national duty. While the motivations behind her desire to increase breastfeeding rates are not as relevant in the twenty-first century as they were in the early twentieth century, breastfeeding has remained part of health and social policy debates. And, while the patriotic and moralistic tone of MacMurchy's early messages might make modern-day readers cringe, nuances of her policies continue to linger in current discussions and debates regarding breastfeeding.

Since MacMurchy created and wrote the first editions of The Canadian Mother's Book in the 1920s, the federal government, in all its publications directed at mothers, has officially promoted breastfeeding as “the one best way” to feed infants. However, although breastfeeding has consistently been considered the ideal form of infant feeding, this message has varied somewhat over time. For example, a glance at Canadian federal government publications over the past century demonstrates that the ideal length of exclusive breastfeeding has changed dramatically. In the 1920s, exclusive breastfeeding was recommended for nine months; in the 1950s, it was recommended for three months; and, at present, it is recommended for six months.

As a physician, MacMurchy promoted scientific and medical solutions to child and maternal welfare, and she encouraged women to turn to scientific experts for advice on childrearing. Over the past century, breastfeeding guidelines have consistently been backed by both the state and science. Yet, MacMurchy also cautioned women to be wary of physicians who might prematurely or incorrectly advise them to shift from breastfeeding to bottle-feeding. While, on the one hand, educational materials for mothers have consistently promoted breastfeeding, on the other, scientific knowledge, medical and hospital practices, and a lack of attention to the material conditions of women's lives have often undermined women's ability to successfully breastfeed. As well, throughout the twentieth century, the constancy of “the one best way” message has contrasted sharply with changes in actual breastfeeding patterns.

Choices about infant feeding have implications at both the individual level and the societal level. Consequently, over the twentieth century, physicians, nurses, midwives, government officials, social activists, international organizations, commercial formula manufacturers, psychologists, nutritionists, and, especially, mothers have all become involved in shaping breastfeeding policies and influencing trends in breastfeeding practices. Currently, policy on topics as diverse as early childhood development, nutrition and obesity, environmental sustainability, and childbirth practices emphasizes the importance of promoting breastfeeding. Breastfeeding continues to be inextricably linked with mothering and nutrition policy as well as with public health and health care system policy. Furthermore, it intersects with policy-making not only at provincial and federal levels but also at the international level through initiatives put forward by the World Health Organization and the United Nations.

What is often missing from current discussions about breastfeeding is any knowledge of the historical circumstances that have shaped the major debates and policies. In this book, we describe the history of breastfeeding in Canada from the late nineteenth century to the present, outlining trends in breastfeeding initiation and duration. We contextualize these patterns in relation to breastfeeding policies undertaken between the 1850s and 2000s. In our analysis, we synthesize data from a range of primary and secondary sources, including government reports, medical journals, health and social statistics, food and nutrition policy documents, archival sources, and interviews with policy-makers and advocates in the field of infant feeding. Our inquiry draws upon the disciplines of history, womens studies, anthropology, sociology, and health and social policy analysis.

Table of contents

Table of Contents for
The One Best Way? Breastfeeding History, Politics, and Policy in Canada by Tasnim Nathoo and Aleck Ostry

List of Illustrations

List of Tables

Authors’ Notes

Introduction: The One Best Way

Part 1: Transitions, 1850–1920

1. Infant Mortality, Social Reform, and Milk, 1850–1910

2. Theory and Formulas: Scientific Medicine and Breastfeeding, 1900–1920

3. Nation, Race, and Motherhood: The Political Ideology of Breastfeeding 1910–20

Part 2: Decline, 1920–60

4. Professionals and Government, 1920–30

5. Marketing Infant Feeding, 1930–940

6. Old-Fashioned, Time-Consuming, and a Little Disgusting, 1940–60

Part 3: Resurgence, 1960–2000

7. The Return to Breastfeeding, 1960–80

8. Promoting Breastfeeding, 1980–90

9. Protecting, Promoting, and Supporting? 1990–2000

Part 4: At Equilibrium: Into the Twenty-first Century

10. Continuities and Change: Breastfeeding in Canada at the Turn of the Twenty-first Century

11. Using the Past to Look Forward: Breastfeeding Policy for the Twenty-first Century

Conclusion: The Politics of “Choice”


Appendix A: Timeline of Infant Feeding in Canada

Appendix B: Infant Mortality in Canada

Appendix C: The Canadian Mother’s Book

Appendix D: Percentage of Births Occurring in Hospital, 1926–1974

Appendix E: National Surveys of Breastfeeding Practices

Appendix F: Evolution of Canadian Infant Feeding Guidelines from 1923–2004





In recent years, breastfeeding has been prominently in the public eye in relation to debates on issues ranging from parental leave policies, work−family balance, public decency, the safety of our food supply, and public health concerns such as health care costs and the obesity “epidemic.”

Breastfeeding has officially been considered “the one best way” for feeding infants for the past 150 years of Canadian history. This book examines the history and evolution of breastfeeding policies and practices in Canada from the end of the nineteenth century to the turn of the twenty-first. The authors’ historical approach allows current debates to be situated within a broader social, political, cultural, and economic context.

Breastfeeding shifted from a private matter to a public concern at the end of the nineteenth century. Over the course of the next century, the “best” way to feed infants was often scientifically or politically determined, and guidelines for mothers shifted from one generation to the next. Drawing upon government reports, academic journals, archival sources, and interviews with policy-makers and breastfeeding advocates, the authors trace trends, patterns, ideologies, and policies of breastfeeding in Canada.


``Nathoo and Ostry trace this pendulum swing from breastfeedng to bottle feeding and back again in an illuminating study which examines the scientific background to the development of manufactured baby milks, reviews the latest evidence for breastfeeding's advantages for the baby, and teases out the implications of breastfeeding on gender equality in the workplace. Their analysis of the changing advice given to parents. particularly useful in demonstrating how conflicting and contradictory advice could undermine the confidence of the women it was intended to support. ''

- Linda Knowles, British Journal of Canadian Studies, 23.2

``Although written for a Canadian audience, The One Best Way? has much to offer breastfeeding advocates and politicians worldwide. Consider buying a copy of this book for your deputy minister. ''

- Louise Dumas, ILCA (International Lactation Consultant Association) Print and Media Reviews, March 2010

``The One Best Way? does an admirable job in synthesizing the many disparate works that touch on the history of breastfeeding. ... [p]olicy-makers, analysts, and medical administrators, should they find their way to this book, will be interested in the historical lessons that the book has to offer. Hopefully they will pay attention to its central message of structual change as well as the need for education in all forms of infant feeding in order to give women a truly free choice. ''

- Heather Stanley, H-Net Review, December 2009