Wednesday, May 7, 2014

Why don't Gypsy and Traveller women breastfeed?

I came very late to the Channel 4 documentary series "My Big Fat Gypsy Wedding," having spent the last couple of months catching up on the two 2011-2012 series. The series itself was largely fluff--in the most literal sense, since it focused on traveler weddings and the enormous, puffy net-crinoline dresses that tend to be worn at these events--and much of the information on the program was wildly inaccurate, but it was still enough to get me interested in Britain's Travelers... and of course, to take a look at these groups through the lens of infant feeding politics.

(By the way, given the controversial nature of both Travelers and breastfeeding in popular culture, I'm wryly amused that I have somehow wound up discussing both issues together in the same article. Good job this post doesn't include discussion about pit bull terriers as well, otherwise it might just explode in an incendiary fireball of its own making....)

Britain's Travelers
The biggest nomadic groups in Britain today are Romani Gypsies and Irish Travelers. Romani gypsies (otherwise known as Romany, Rom or just plain "gypsies") trace their origins back to a group of nomads who left Northern India centuries ago and traveled through Europe, reaching Britain by about 1500. Irish travelers are the result of several waves of emigration from Ireland. Things get complex because the term "gypsy" is often used as a catch-all term covering both groups, while other people use "traveler" to mean Irish Traveler, as opposed to Romani Gypsy. In recent years, a new wave of "Roma" gypsies from Romania and Bulgaria--who come ultimately from the same roots as the English Romani--has arrived in Britain as well. Many people classified as Travelers, by the way, live in houses or other permanent accommodation and do not travel; others live on caravan sites but may travel for part of the year depending on work. Traveler men typically work in areas such as tarmacing, building, and scrap metal dealing. Women generally live within a carefully defined female sphere, marrying young (around 16-20), having quite large families and usually not working outside the home.

Travellers and breastfeeding
The word "gypsy" has a romantically Bohemian image, and indeed, a quick search for "gypsy breastfeeding" threw up a ton of results for whimsically-patterned baby carriers and cloth diapers. You could almost imagine yourself wandering around the hedgerows in a gypsy skirt and a gypsy baby-wearing wrap, breastfeeding your cloth-diapered gypsy baby and generally being at one with nature. All this is of course rather removed from the real lives of modern Romany Gypsies and Irish Travelers, who tend to go in for modern petrol-powered caravans, the swankiest prams they can afford, and cleaning everything with lots of bleach. They also almost always formula feed: in fact, Travelers have the lowest breastfeeding rates of any ethnic group in the UK. In a 2011 survey of Traveler women, breastfeeding rates were "2.7% at birth and 0% at six to eight weeks" (Pinkney, 2011 (*1)) while in "My Big Fat Gypsy Christening" (a babycare special that was broadcast in 2013), a midwife who had worked with Travelers for 30 years said that in that time she had only known a handful of women who nursed their babies. Low breastfeeding rates have been just one of several aspects of Traveller childrearing practices that have come in for criticism, the others including unhealthy diets, unsafe driving practices and the fact that many Traveler groups still remove children from schooling at around puberty. The MBFGW series and christening special certainly sparked off a lot of (mostly negative) online discussion (see here and here), though given the tendency for TV programs to sensationalize it is difficult to know how seriously to take the version of the Traveler lifestyle that the series portrayed.

Cultural taboos
Ethnological studies of Romani Gypsy and Irish Traveller women universally indicate quite negative attitudes towards breastfeeding among both men and women.
"It is viewed with contempt by these women and also by their partners. One traveler woman described it as ‘weird just weird, what would I do that for?’ Another woman claimed that even if she had wanted to, there was no way her husband would have permitted her doing so. Breasts for these women were associated more with ones sexuality rather that performance of breastfeeding. All of the women claim that they were made aware of the benefits of breastfeeding, however none of them expressed any desire to do so, nor to encourage other family members to do so. One woman claims that if she were to have a family member do so –‘she would be an embarrassment and a lot of people wouldn't want her around their families if she was doing that sort of thing’." (*2)
 "The aversion to 'personal' matters may play a part in the very poor breastfeeding rates among Gypsy and Traveller women. Okely [10]  found social taboos to be the main reason women did not breastfeed: "We wouldn't let a man see. That's filthy'"(p208). None of the women interviewed breastfed any of their children and the taboo, perpetuated by oral tradition, impacts greatly on their health at all ages." (*3)
“I don’t like the thought of [breastfeeding] and I was not gonna get my bits [sic] out." (*4)
Why has breastfeeding become so taboo among British Traveler women? Travelers (Romani and Irish) have for centuries observed strict rules about bodily decency--including taboos on premarital sex, elaborate codes of cleanliness in which pets and toilets are kept separately from living quarters, and beliefs about the polluting nature of childbirth and menstruation. Modern British Traveler culture seems to have put breastfeeding into the same sort of category--a shaming and disgraceful display of the breasts.  And yet this can hardly be a truly traditional attitude--if one goes back a couple of generations or more breastfeeding surely must have been the norm among Gypsies and Irish Travelers, because until quite recently rearing a child "by hand" was something close to a death sentence (even without the vagaries of a traveling lifestyle). Indeed, among many Romani-related ethnic groups outside the UK (*5-*8) such as the Eastern European Roma, breastfeeding has remained the norm; in fact, Roma women from these countries are well-known for breastfeeding openly in public, even with toddlers.

I don't know when breastfeeding stopped being the norm among British Gypsies and Irish Travelers. I'm guessing that what happened is at some point in the 20th century, after bottle-feeding had become normalized among white working-class British women (who continue to this day to bottle-feed almost universally), the custom probably spread to Traveler women, and has since come to seen as a social norm and as an ethnic marker--hence the remarks in the ethnological literature about how "we Travelers don't breastfeed." Travelers have their own peer group norms and see themselves as being culturally distinct from settled people--a fact hinted at by the fact that most Irish Travelers retain their Irish accents generations after leaving Ireland.

I just want to emphasize this, because a lot of public conversation about breastfeeding--especially in the United States--tends to focus strongly on the idea of "everyone wants to breastfeed, but economic barriers get in their way, such as inability to afford time off work, lack of maternity leave and pumping rights, and lack of access to healthcare professionals." But Traveler women still generally choose formula even though they do not usually face work/mat. leave-related barriers and the majority (90%) of the women surveyed by Pinkney cheerfully agreed that breastfeeding was cheaper than formula feeding. Poor women and women from disadvantaged ethnic groups (just like relatively privileged women) aren't solely motivated by monetary considerations, nor are socio-economic barriers the only reason why they may not do certain things; cultural identity, desire for status, personal preferences and what their friends do may also be important factors. As the saying goes, "Culture matters."

(By the way, I'm strongly in favor of things like universal access to maternity leave, pumping rights and all the other things, for various reasons--but if US lactivists are under the impression that bringing these things in will result in breastfeeding becoming the norm across America, they are probably in for a big disappointment. Just saying.)

Which is easier--breast or bottle?
Given that most Traveler women don't work outside the home and may sometimes lack access to running water and electricity required for making up bottles, it's somewhat surprising to see that 65% of the women surveyed by Pinkney (strongly) agreed with the statement "Bottle feeding is easier than breastfeeding," while 60% (strongly) disagreed that "Breastfeeding is easier than bottle feeding."

It's still common in many Traveler communities for kids to be removed from schooling at around age 12 or so (having often attended only sporadically before that); girls are expected to take on much of the housework and babysitting work from an early age. Traveler sites where this is still the custom consequently tend to resemble the kind of villages you get everywhere in the world where mass schooling hasn't been developed yet--where kids keep an eye on their siblings and cousins, and every girl seems to have a baby/toddler on her hip. The thing about breastfeeding is, it's only more convenient if you are at home alone with your baby and you are responsible for most of the childcare yourself. If you always have a lot of childcare in the form of older kids, bottle-feeding does tend to be the easier option; you can easily leave the baby with anyone.
We have loads of people come round and the baby would have starved cos I wouldn’t have fed it with people there or husband. That’s wrong.
I just couldn’t try it. I know it's good for the baby but we don’t do things like that and we have so many family coming round... the men would have had to stay out of the house.
Virtually all women who breastfeed are adamant that the first few weeks of breastfeeding, well, suck. You sit there hour after hour, your breasts hurt, and many women find books and web surfing are a lifesaver for getting through this difficult period (I maintain that the arrival of the World Wide Web has been a huge factor behind the increases in breastfeeding rates in most developed countries in the last couple of decades). Conversely, low levels of reading ability among many Traveler women make it harder to use the Net as a place to get advice and encouragement or simply to have someone to talk to when you've been by yourself for hours on end. Combine this with cultural taboos that make women embarrassed to nurse around other people, and it's no wonder the few women in the Pinkney survey who did initiate breastfeeding dropped it after a few weeks.
Health Promotion England (2000) acknowledges that many families initially find breastfeeding difficult however it tends to improve and becomes easier with time, patience and perseverance. It is therefore possible that Gypsy and Traveller women which have historically initiated breastfeeding may have stopped due to early difficulties and then verbalised their problems associated with early breastfeeding to other Gypsy and Traveller women. Research by Dion (2008) highlights that in the Gypsy and Travelling community there is a “strong oral tradition” (p33) and information is readily passed verbally from one generation to the next. This process if negative would therefore reinforce the belief amongst the Gypsy and Traveller community that breastfeeding is difficult. (*1)
It's one of the curious paradoxes of infant feeding culture that breastfeeding (generally seen as "natural") has seen a revival in modern times at least partly as a result of the technological revolution of the internet, while bottle-feeding has most likely remained strongly entrenched among Travelers at least in part because Travelers remain one of the few modern peoples who maintain a strongly oral culture.

A way forward
Pinkney's survey concludes that "In general the attitude scores provided evidence that the community [i.e. Travelers] would benefit from receiving more information on the health benefits of breastfeeding" and suggests that providing more information on this might result in more Traveler women initiating and persisting with breastfeeding. I confess to being a little skeptical about this. For one thing, other discussions about infant feeding among Travelers (see the Bromley paper linked below) suggest Traveler women are already getting plenty of information on this score, with many receiving considerable pressure to breastfeed from National Health Service (NHS) nurses.
"They kept on at you about that. They tried to push you into it. I didn't want to. They kept on about it." (*4)
"I would rather they let you have the choice but they make as if you have to. They made me feel bad and they wouldn't even tell me where the formula was kept." (*4)
Meanwhile, in Pinkney's survey a full 45% of women agreed with the statement that "Breastfed babies are healthier than bottle fed babies," while 50% agreed that "Breast milk is more easily digested than bottle milk."

Thing is, though, there's a big jump between "knowing that XYZ is, all things being equal, a little better," and "being determined to actually do XYZ no matter what it takes." I know perfectly well that (for example) having babies in one's twenties is better than doing so in one's thirties, yet I delayed childbearing till 32 and would do the same again if I had the chance to do things over. I wouldn't have wanted to become a mother in my twenties (I had too much traveling to get out of my system, for a start) and quite honestly, no amount of well-meaning "education" from healthcare workers would have changed my mind about something I felt this strongly about. Culture matters. Of course, the interesting thing is in terms of the age at which they first get pregnant, Traveler women (who typically start their families at around 19 or 20) are actually far closer to the medical ideal and biological norm that the average British woman, who probably doesn't get started till 30 or so. Let's face it though--popular culture and the healthcare profession tend to be a lot more forgiving about "slightly-less-than-100%-optimal" mothering decisions that are popular among educated women (such as delaying motherhood until later in life) while tongue-lashing mothering decisions that are attended with a similar level of risk which happen to be common among young working-class mothers or (shall we say) less-than-popular ethnic groups.

That said, I don't want to be completely gung-ho about Traveler women's preference for bottle-feeding. For one thing, while the benefits of breastfeeding are probably modest in developed country environments, some Traveler women effectively live in the twilight zone between developed and developing world due to intermittent access to running water and electricity (*9). Indeed, it's surprising that things like gastroenteritis are not more of a problem (though Travelers' famously high standards of cleaning are probably helpful in warding off the worst problems). Infant mortality rates among Traveler infants certainly are strikingly high (*10), though it appears that much of this is due to congenital problems caused by high rates of consanguinity. But there is also substantial evidence of sub-optimal bottle-feeding practices in Traveler families, such as feeding young babies cow's milk, or allowing toddlers to walk around sip-feeding off bottles all day long, sometimes filled with sweet drinks and other inappropriate substances, which can cause serious dental and nutritional issues (*11).

It might be more practical for NHS healthcare workers to put their focus on giving young Traveler mothers clearer information about sound bottle-feeding practices (not giving babies cow's milk at too young an age, making up formula correct as per the manufacturer's directions, not filling bottles with sweet drinks or putting children down to sleep with bottles, and bottle-weaning at appropriate ages). Although breastfeeding might in many ways be a more logical choice for women who do not work outside the home and sometimes lack access to the things that make bottle-feeding safe and feasible, the reality is that cultural practices are hard to change, especially when they have become an ethnic marker for a particular group. Putting strong pressure on Traveler women to breastfeed effectively presents them with a choice between maternal guilt and social isolation, increasing the vulnerability of a group of women who already struggle with low social and economic status. Resentment inspired by such pressure could also make Traveler mothers less receptive to taking on advice about more urgent matters such as vaccines, well-baby checks, hearing tests and optimal bottle-feeding practices themselves. Given the sometimes fraught relations that have long existed between Britain's Travelers and the settled community, a pragmatic approach is surely best for safeguarding Traveler children's welfare.

Further reading

*2: Irish Traveller women (Ellen D'Arcy)
*3: Gypsies and travellers: cultural influences on health
*4: The Experience of Maternal Health services by the Bromley Gypsy Traveller Community
*5: Taboo and shame (Ladž) in traditional Roma communities
*6: Social exclusion at the crossroads of gender, ethnicity and class. A view through Roma women's reproductive health
*7: Risk factors for childhood malnutrition in Roma settlements in Serbia
*8: Purity and impurity in the traditional Romani family
Gypsies and Travellers: Their lifestyle, history and culture
*9: The big fat truth about Gypsy life (Guardian)
*10: Traveller infant mortality is persistently higher than the general population in the All Ireland Traveller Birth Cohort study
*11: Child Poverty Relating to Gypsy and Traveller Children and Young People in Sussex 

It didn't seem to fit anywhere into this discussion, but I was interested to stumble across the somewhat random fact that the condition known as galactosemia (where the baby cannot digest lactose and must be fed with a soy formula) is particularly common among Traveler infants, probably as a result of consanguinity. See here:


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