I’ve been mulling over this one for a while, trying to get to the bottom of just why it is that Ireland has the lowest, or at least one of the lowest, breastfeeding rates in the world. Why Ireland? What is so different about us that we managed to be the holders of such an ignominious statistic? We know that Ireland is a big manufacturer of infant formula. Maybe that has something to do with it, but it doesn’t explain everything. So I’m going to endeavour to dig a little deeper in this blog and explore some of the background to why we are where we are today. The short answer is: patriarchy and Catholic church interference in Government policy. Let me explain…. (please note, I’m not a historian! This blog is a mix of information I’ve cobbled together and both my mother and mother-in-law’s accounts of having their babies. Feel free to correct me if you think anything I’m writing here is incorrect!).
A little bit of context first. Ireland is a former colony of the United Kingdom and was officially declared a republic in 1949, a mere 74 years ago. This declaration was preceded by the war of independence, the civil war and the second world war. Although Ireland was neutral during the second world war, the country was undoubtedly affected – there were rations in place and people in living in poverty would have been most adversely affected. So, in the aftermath of several decades of turmoil, Ireland at this time was relatively poor and both maternal and child mortality rates were high. The rates of anaemia and tuberculosis among postnatal mothers were high. However, breastfeeding rates were higher than they are now and infant formula was not widely available.
In 1948, Dr Noel Browne, a socialist, became Minister for Health. He was tasked with the job of modernising Ireland’s healthcare system, and one of his key aims was to reduce maternal and infant mortality rates. The long story short is this – Dr Browne proposed a healthcare scheme for mothers and their babies called the ‘The Mother and Child Scheme’ in 1951, but the Catholic Church archbishop John McQuaid (patriarchy) objected, and the scheme never saw the light of day. The Catholic Church feared that providing ‘socialised medicine’ to women would endanger the morals of women and children and pave the way for abortion and freely available contraception (anathema to Catholic teachings). At the time in Ireland, the Catholic Church had huge influence on the government and it ran most primary and secondary schools. GPs were also against the scheme as they perceived it as a potential a threat to their incomes.
In the wake of the failed Mother and Child Scheme, the government introduced ‘The Maternity and Infant Care Scheme’ in 1954. This scheme provided free healthcare for women during their pregnancy and for 6 weeks postpartum, and for an additional charge, women could give birth in a maternity hospital. According to Patricia Kennedy (2012) the scheme was
“…the beginning of the division between home and maternity unit, creating a distinction between those who could and could not pay and as a result home births came to be perceived as the poor woman’s option and thus worth less cultural capital.”
Following the introduction of the Maternity and Infant Care scheme, the Government messaging to parents was that antenatal GP-led, obstetrician-led and hospital-based care was better and safer. Midwife-led care was not factored in to this new scheme, and the result was (in my reading of it) that antenatal and postnatal care and education shifted in a big way from being the realm of women and midwives, to being medically-led and in the domain of men (because most GPs and obstetricians at the time were men – patriarchy). Maybe this is too simplistic a characterisation of what happened, but it’s certainly true to some extent – women were excluded, maybe not intentionally, but this is the very definition of patriarchy. Mothers, who prior to the scheme would have birthed at home, and perhaps been surrounded by women in their extended family and community who would have been able to provide breastfeeding support, were now having their babies in hospitals, where they stayed for one to two weeks, apart from the people who heretofore would have been helping them
My Mother-in-law May, now 92, gave birth to four babies in The National Maternity Hospital between 1958 and 1970. She did not breastfeed, but was nevertheless always a great supporter of me as a breastfeeding mother. I was curious about her about her experiences of having her babies and feeding them. So when I talked to her about them, this is what she told me:
“The system then at the time of my first baby’s birth, that would be 65 years ago, was that it would be breastfeeding. All the women in the ward were crying, including myself. The babies were howling and this Sister, a dragon of a Sister was making life miserable for absolutely everybody. So, I continued breastfeeding for two days after I came out of hospital and then my husband said it couldn’t go non any longer. I was in such a state of pain, and that was how we went on the bottle.”
So, May was one of the mothers who would have received care under the new scheme. This meant having her baby in hospital, but it is clear from her account that no provisions were made to give the mothers support to establish breastfeeding. She went on to say
“My first episode with breastfeeding was a total and absolute disaster and it put me off for the rest of my life. And of course nowadays you’re given these choices and you can make up your own mind. But in those days things were very strictly regulated. I was a week in hospital after my baby was born and I cried for that week, and the baby cried for that week, and other women’s babies cried for that week. It was hell on earth. That’s all I can describe it to you as. It really was a terrible experience.”
“Hell on earth.” May is a tough, pragmatic lady. She would not use those words lightly. Can you just imagine how awful it was for these new mothers? And is it any wonder that they were put off breastfeeding for life?
“Two days after I stopped feeding him, my husband got up on a Sunday morning and knocked up a Chemist in the days when the chemist lived over the shop. And he just said ‘give me something to feed the baby’, and the chemist gave him something called Sister Laura’s food*. That was the name of it but I can’t remember anything else about it. He came home with two cans and made up a bottle and brought it up and said ‘give it to that child’. So, I put the bottle in his mouth and he sucked the hell out of it. And we never heard another word from him ever after, in regards to whinging and crying. It was pure bliss, but my breast was very sore. That was painful enough for some time afterwards.”
When May had her second baby in a few years later, she was given tablets to suppress her milk, as her baby was one month premature and had to go to the NICU. At that time, parents were “not allowed” (yep, patriarchy) into the NICU. In 1965 May had Ronan (my husband) and this is how she described that experience:
“With Ronan there was no bother at all because a new master had come into the hospital and he said mothers were to be made comfortable and that was his only objective besides the babies. So, everybody went for the bottle then.”
It appears that sometime between 1958 and 1965 bottle feeding replaced breastfeeding as the norm in our maternity hospitals. The goal was not to support the health of the mothers and babies, but to make things easier for everyone (mothers, babies, staff and the master). Certainly by the time I was born in 1971 (in The Rotunda Private), there was no question of breastfeeding. It wasn’t even mentioned. The assumption was that you’d feed your baby formula. For the brave and determined mothers who did try to establish breastfeeding, there was very little help or support available to them, and the attitude of very many people would have been “Sure why would you bother? Why make life difficult for yourself.” Bear in mind that at this time in Ireland, just over twenty years after the country officially became a republic, there was an emerging middle class. And one of the ways this middle class may have sought to distinguish themselves from the less well-off was to formula feed their babies. My mother said she believed growing up that “breastfeeding was for poor people.” Another contributory factor was early second wave feminism, and the idea expressed by feminists such as Simone de Beauvoir and Betty Freidan that motherhood and its trappings served to subjugate and oppress women. Breastfeeding fell into this category – regarded by many second wave feminists as an onerous task that modern, liberated mothers were no longer obliged to perform. In contrast, formula feeding was embraced as freeing and as a means to return to the workplace and avoid the constraints placed on mothers by a patriarchal society.
Another factor in Ireland’s low breastfeeding rates was the introduction of Active Management of Labour (AML) in 1969. This was an approach to ‘managing’ the Labour and birth process devised by male obstetricians in The National Maternity Hospital (men telling women how to give birth – patriarchy). By putting women ‘on the clock’ – they were expected to labour and birth within a 12-hr time frame. And when they didn’t, interventions were used to speed things up. This of course led to more inductions and more caesarean sections, and less breastfeeding.
Breastfeeding rates were probably at their lowest during the early seventies, but they have been growing slowly but steadily since then thanks to a number of initiatives such as the WHO Code on the Marketing of Breastmilk Substitutes, The Innocenti Declaration, The Baby Friendly Hospital Initiative, and strategic government plans to increase breastfeeding rates. The last few decades have also seen the development of greater breastfeeding supports for women – La Leche League, Cuidiu, Friends of Breastfeeding – and greater efforts among late second-wave and third wave feminists to to reclaim breastfeeding as a women’s health issue.
To sum up – it’s complicated. But it may be that a unique set of post-colonial, political, societal, historical, religious, sociological and demographic factors contrived to almost decimate breastfeeding in Ireland. Things are getting better but we still have a way to go. Smash the patriarchy.
*‘Sister Laura’s Food’ was a tinned powder that was added to cow’s milk to break down the caesins in it and made it more readily digested by babies. Powered infant formula was not widely available in Ireland until sometime in the late 1960’s. It was actually common practice at the time to feed babies a mixture of cow’s milk and sugar.
Further reading:
Kennedy P. Change in maternity provision in Ireland:“elephants on the move”. The Economic and Social Review. 2012;43(3, Autumn):377-95.
Becker G. Baby Friendly Health Initiative in Ireland: History and Future. 2016. http://www.babyfriendly.ie/images/History%20BFHI%20Ireland%20for%20UNICEF%2025%20year%20review.pdf
Bender A. Shame and the breastfeeding mother in Ireland. Éire-Ireland. 2021;56(3):104-29.
Millar M. Institutionalism’old’and new: exploring the Mother and Child scheme. Public Administration and Public Policy in Ireland, Theory and Methods. London: Routledge. 2003 Sep 2.
Friedan, B. (1971) The feminine mystique. London: Victor Gollancz.
De Beauvoir S. The second sex. In Social Theory Re-Wired 2023 Jun 22 (pp. 346-354). Routledge.
Regarding the opposition to the Mother and Child Scheme, many historians now attribute the failure of Noel Browne’s efforts to the medics, who whispered into McQuaid’s ear that it was communism, and he duly took on the task. Diarmuid Ferriter is one of those.
For many years I’ve asked people what was it in Dev’s 1954 watered-down version that got it across the line.
This detail I’ve only seen discussed once, and not by a historian.
Apparently the 1954 version stipulated that an obstetrician had to be involved in every birth, so those foolish muscular midwives were sidelined.
Accurate? I think so.
Relevant? It merits discussion. It shouldn’t be a detail that’s hidden away.