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Breastfeeding Biocultuful perspectives. Edited by Patricia Stuart-Macadam and Katherine A. Dettwyler. New York Aldine de Gruyter. 1995. 430 pp. ISBN 0-202-01191-7 $31.95 (paper)

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In sum, this is an interesting if sometimes
frustrating book to read. Cavalli-Sforza has
had ideas about a wide diversity of subjects
relevant to human diversity and evolution.
As a “popular”book presenting these ideas,
the book does a good job (although occasionally suffering from oversimplification).
Readers with more background will often enjoy following the historical development of
Cavalli’s views but will miss references and
the systematic development of the arguments. Indeed, some might wish that Cavalli
had paid more attention to criticisms and
ideas of others on a number of these issues.
Department of Anthropology
University of California, Riverside
Riverside, California
BIOCULTUFULPERSPEC-early human cultural adaptation” (p. 63).
TIVES. Edited by Patricia Stuart-Mac- She reminds us that even the lower end of
adam and Katherine A. Dettwyler. New the range, 2.5 years, is far longer than most
York: Aldine de Gruyter. 1995. 430 pp. pediatricians in the US recommend for nursISBN 0-202-01191-7 $31.95 (paper).
ing and than most people in the US regard
as “normal.”
This book has a clear and unambiguous
Patricia Stuart-Macadam provides an
message: breast is best. In his preface, obste- overview of breastfeeding in prehistory;
trician Edward Newton makes this clear: drawing from studies of human skeletal
“the decline in the initiation and duration of remains she discusses the potential of
breastfeeding reflects a profound biocultural bone chemistry analysis for evidence of
crisis.”The succeeding 15 chapters and com- breastfeeding practices in the past. Other
mentaries take on the task of supporting and sources of information on nursing in prehisdocumenting that claim.
tory include ethnographic analogy, genetics
Patricia Stuart-Macadam lays the founda- (e.g., lactose intolerance), and demography.
tion for the book in the first chapter, “BioculValerie Fildes reviews the history of
tural Perspectives on Breastfeeding.” She breastfeeding in Western Europe with emclaims that this volume may be unique in phasis on artificial feeding practices, timing
explicitly linking biological and cultural per- of weaning, use of supplemental foods, and
spectives throughout the contributions.
appropriate infant foods, once the child was
Katherine Dettwyler outlines the “homi- weaned. Sara Quandt discusses sociocultunid blueprint” for weaning, using three ral aspects of lactation, emphasizing that
sources of evidence for her proposal that hu- breastfeeding is a much larger phenomenon
man infants be weaned sometime between than simple feeding behavior. She intro2.5 and 7 years of age. Comparing primate duces the concept of “breastfeeding style” to
life history data yields ways of predicting highlight the impact of breastfeeding on maweaning age based on tripling or quadru- ternal fertility, women’s work habits, and
pling of birth weight, attainment of one- other aspects of women’s lives as well as the
third of adult body weight, an equation impact of these factors on breastfeeding style
based on adult female body weight, six times itself. She closes her chapter with a review
the length of gestation, and timing of erup- of the culture-specific disorder known as “intion of the first permanent molar. Although sufficient milk syndrome,” one caused in althe predictions do not yield consistent wean- most all cases by sociocultural rather than
ing ages, Dettwyler argues that a wide range physiological factors.
in predicted weaning ages in humans is enAs noted, the book takes a position on
tirely consistent with the wide range of envi- breastfeeding, a stance well illustrated by
ronments in which mothers and infants live. Penny Van Esterik’s chapter, ‘“ThePolitics
In other words, “Flexibility in deciding when of Breastfeeding: An Advocacy Perspective.”
to wean may well have been a hallmark of Most of this chapter deals with the contro-
versies over the marketing of breast milk
substitutes, the Nestle’s boycott, and the
WHO Code on marketing of infant formula.
It provides a useful history and update on
these issues.
In her second contribution to this book,
Katherine Dettwyler reviews the arguments
about breasts as sex objects presented by
scholars of human evolution and reflected in
advertising, pornography, demand for breast
implants, and everyday conversation in the
United States. This cultural ideal that
breasts are for sex, not for babies, is responsible for many of the difficulties that women
encounter in attempting t o nurse their infants in public and in private in the US.
Dettwyler also discusses the “culture of misinformation” that surrounds breastfeeding
in the US.
Michael Woodridge directs our attention
to the meaning of signalling (i.e., crying) by
the breastfed infant. Usually a crying infant
is interpreted as desiring more quantity of
breastmilk. On the contrary, the infant’s dissatisfaction may more often be due to inadequate quality of the milk. Because the caloric
and fat content of breastmilk increase toward the end of a feed, an infant who is
removed from the breast because of an externally imposed schedule may not be getting
sufficient calories, despite the appearance of
adequate volume intake. Furthermore, the
positioning of the baby at the breast influences the amount of fat consumed. Woodridge’s final point is that the infant is entirely capable of self-regulating feeds, and
that societal concepts of appropriate feeding
style and pattern are often out of synch will
individual infant needs.
In his chapter, Allan Cunningham dispels
the notion that breastfeeding is no longer
important in developed nations because infant mortality is so low and artificial formula
is easily and appropriately used. He catalogues the evidence that breastfed infants
suffer less from gastrointestinal illness, respiratory illness, otitis media, bacteremia
and meningitis, and SIDS. He notes that in
North America, breastfeeding decreases infant mortality by four per 1,000. Long-term
effects of bottle-feeding include disorders of
the immune system, celiac disease, diabetes,
breast cancer, allergies, and heart disease.
The only potential negative effect of
breastfeeding that is of much importance is
the fact that the AIDS virus can be transmitted in human milk.
McKenna and Bernshaw discuss the interrelationships among mother-infant co-sleeping, breastfeeding, and SIDS, placing these
behaviors in an evolutionary perspective.
They review lab studies that support the notion of the physiological effects on infants
sleeping with their mothers. Among these
effects is a mechanism that may protect
some infants from SIDS.
Peter Ellison’s chapter, “Breastfeeding,
Fertility, and Maternal Condition,”turns the
focus to the effects of breastfeeding on the
mother. He provides a thorough review of
the effects of breastfeeding on reproductive
hormones (and thus on fecundity), based on
studies conducted in a number of populations. Marc Micozzi continues this focus with
a review of the evidence concerning the effects of breastfeeding on breast cancer. Recognizing that the “causes” of breast cancer
are multifactorial, Micozzi proposes two factors related to breastfeeding that may lower
a woman’s risk of breast cancer: if she was
breastfed as a child and if she breastfed her
own children. These mechanisms are reviewed further, demonstrating the links to
overnutrition, excess body fat, early menarche, and circulating estrogens, all of which
are themselves implicated in breast cancer
In the final chapters of the book, commentaries are provided by Sheila Kitzinger, Ruth
Lawrence, and Doren Fredrickson. All in all,
this book represents a thorough and up-todate review of current thinking and research
on breastfeeding. As noted above, it is definitely pro-breastfeeding and thus may be regarded as unbalanced by some. But for anyone who is searching for evidence that
“breast is best,” this book has it.
Department of Sociology and Anthropology
New Mexico State University
Las Cruces, New Mexico
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paper, patricia, gruyter, aldine, katherine, isbn, breastfeeding, new, dettwyler, 1995, 01191, macadam, york, 430, 202, edited, perspectives, stuart, biocultuful
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