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Abstract

Women living in abusive relationships who choose to breastfeed their infants may do so for many reasons: bonding, health benefits for the infant and themselves, economics, and so on. Along with these benefits they are also choosing to engage in an activity that is often perceived as deeply gender performative. This study examines the gender performativity through breastfeeding of mothers living with intimate partner violence (IPV) and the ways in which these mothers use breastfeeding successfully (and unsuccessfully) to achieve what Butler (2004) terms a “livable life.” Semi-structured qualitative interviews were conducted with thirteen mothers who lived with abusive partners while breastfeeding. Content analysis was used to examine the women’s accounts for gender performativity around breastfeeding. Gender performativity was used by these mothers successfully and unsuccessfully to attempt to stem the violence and chaos in their relationships. Mothers attempted to fulfill traditional female roles to appease abusive partners, used breastfeeding to protect themselves and their infants, and also drew strength from family, friends and medical/support professionals by fulfilling the ‘good mother’ role through breastfeeding.

Keywords

gender-based violence gender/sex mothering

Introduction

Women living in abusive relationships who choose to breastfeed their infants may do so for many reasons such as bonding, health benefits for the infant and themselves, and economics. They are also choosing to engage in an activity often perceived to be deeply gender performative. Breastfeeding is physically limited to a body assigned female at birth, or the female partner in a heterosexual couple; male partners can play a supportive role if they choose but cannot physically perform the same function¹.

The breastfeeding period, when a new child is brought into a family, is a time of transition when family roles may bend and shift to create space for breastfeeding, which may initially be time consuming. The shift into parenthood is also a time of change in gender roles, with women often forced into more feminine roles because of how American society and families within it are structured; one researcher termed motherhood as the ‘most gender-enforcing experience in the lives of many women’ (Fox, 2001). In abusive heterosexual relationships gender roles tend to be more rigid, with abusive male partners using male privilege to assert control and authority over their female partners (Heise, 1998; Stark, 2009; Morris, 2009; Kelly & Westmarland, 2015).

This study examines the gender performativity through breastfeeding of mothers living with intimate partner abuse (IPA) and the ways in which these mothers use breastfeeding successfully (and unsuccessfully) to achieve what Butler (2004) terms a “livable life.” What is ‘livable’ for one mother living with abuse (perhaps a low-level of emotional and physical abuse for herself and her children) might not be livable for another mother. Butler's “livable life” references a subjective standard where each individual has the basic needs for survival, but also some level of stability, joy and social connection needed to achieve more than basic survival.

IPA and Male Hegemony

Western society is generally accepted to be a patriarchy, with men privileged over women “structurally and ideologically” (Hunnicutt, 2009). These societal level patterns are reflected in individual relationships, with many relationships featuring some aspect of male privilege though not all are violent, suggesting that “degrees of patriarchy” may exist (Hunnicutt, 2009).

IPA affects nearly one in three US women in their lifetime (Breiding, 2014), and takes many forms, including physical assault, sexual assault, control, coercion, economic abuse, isolation, and the use of children to harm a partner (Stark, 2009). The use of male privilege is another form of abuse; a deep belief the man in a heterosexual relationship has the innate right to dominate and control the woman in the relationship (DAIP, 2018). In relationships where physical violence and other types of intimate partner abuse exist, a greater belief in, and adherence to, gender roles frequently occurs (Morris, 2009; Walker, 2016; Heise, 1998). Indeed, belief in traditional gender roles is predictive of higher levels of violence in dating relationships even among teens (Lichter & McCloskey, 2004).

Women have been seen as “bargaining with patriarchy” (Kandiyoti, 1988) in trying to negotiate an existence in patriarchal societies that deny them resources and authority. The patriarchy can also be seen to protect women in some circumstances, at the price of cooperation with patriarchal structures and powers, and women who violate norms of female behavior “may no longer benefit from the ‘privilege’ of male protection” (Hunnicutt, 2009). Women living in violent and coercive relationships walk a finer line in seeking protection not only from abusive macro-level patriarchal structures, but abusive micro-patriarchal currents in their homes (Hunnicutt, 2009; Dobash & Dobash, 1998; Connell, 2013; Kandiyoti, 1988).

Adhering to traditional female gender roles may be one way women in abusive relationships seek protection from violence, but it is important to note women in these relationships hold little power and even highly traditional performance of their feminine role is no guarantee of protection; the power in the relationship – the power to choose to abuse or not – rests, literally, in the hands of the male partner. However, women are not without some choices; even within the context of the patriarchy and an abusive relationship, women may make choices to increase the ‘livability’ of their situation (Sanyal, 2014) and exercise a kind of ‘burdened agency’ (Lentz, 2018) in strategically making choices of how and when and to what extent to perform their gender roles.

Breastfeeding

From a purely biomedical perspective breastfeeding benefits both infants and mothers in a myriad of ways. Breastfeeding lowers the risk for all causes of infant mortality (Chen & Rogan, 2004) and can reduce a baby girl's lifetime risk of cancer by up to 25% (Freudenheim et al., 1994). Breastfed babies have stomach linings that are 15 times thicker than non-breastfed babies (Koletzko, Sherman, Corey, Griffiths & Smith, 1989). For mothers, breastfeeding reduces a woman's risk of more than nine types of cancer (Stuebe, 2009), offers protection from cardio-vascular disease, diabetes and post-natal depression (Mezzacappa, 2004; CDC, 2021).

Breastfeeding also appears to have benefits for mothers living with trauma. One study looking at sleep and post-partum depression (PPD) found that exclusively breastfeeding mothers got more sleep and had lower levels of PPD than mothers mixing breastfeeding and breast milk alternatives² or mothers who exclusively used breast milk alternatives (Kendall-Tackett, Cong & Hale, 2011). Kendall-Tackett and her co-authors then focused on sexual abuse survivors and found mothers with a history of sexual abuse who breastfed exclusively had better sleep and lower rates of PPD than survivors who mixed breastfeeding and breast milk alternatives or exclusively used breast milk alternatives (Kendall-Tackett, Cong & Hale, 2013). Kendall-Tackett and colleagues theorize that some of the hormones released via breastfeeding may be beneficial to survivors of violence (Kendall-Tackett, Cong & Hale, 2013).

Beyond the biomedical perspective, it is important to note that although 83.2% of US mothers initiated breastfeeding in 2015, only 24.9% of mothers breastfed exclusively for the recommended six months (CDC, 2018). For many mothers the breastfeeding phase is a chaotic time filled with competing demands, potentially requiring them to balance a desire to breastfeed with other equally important priorities. There has been little effort to address the many barriers breastfeeding mothers encounter, such as the need to return to work, the lack of access to breastfeeding assistance, and breastfeeding-supportive workplaces (Gonzalez-Nahm, Grossman & Benjamin-Neelon, 2019; Christopher & Krell, 2014; Slusser & Lange, 2002).

Breastfeeding in the US involves confronting many opposed societal messages. On one hand, breastfeeding is viewed as the ‘best’ source of nutrition for an infant (American Academy of Pediatrics, 2012) and a breastfeeding mother therefore performs a culturally heralded task (Stearns, 1999). On the other hand, there are many sexual and societal taboos against breastfeeding (Tomori, Palmquist & Dowling, 2016; Young, 1992; Stearns, 1999) and a tendency to be disgusted at human bodily fluids, including breast milk (Bramwell, 2001). Breastfeeding is often considered a gender performative act garnering women positive regard in the early months of an infant's life, if the mother breastfeeds privately or at least discreetly, covering any evidence of the act itself (Stearns, 1999). Done within these limits, breastfeeding is seen as part of performing the “good mother” role and embodying the “good maternal body,” (Stearns, 1999) allowing a mother to provide optimal nutrition to her infant, at the sacrifice of her own body and time, while bonding deeply with her infant and showing conformance to the culture of intensive mothering (Hays, 1996; Lee, 2008).

Indeed, breastfeeding is so strongly tied to ‘good mothering’ that women who use non-breastmilk alternatives may feel like a ‘failure’ or experience guilt and a loss of their sense of themselves as ‘good mothers,’ while others who feel more confident in using non-breastmilk alternatives may still feel the need to justify their decision to employ what is perceived to be a more ‘risky’ feeding method (Lee, 2008).

IPA and Mothering

IPA impacts how women mother as abusers often target the mother-child bond to isolate a woman from sources of self-esteem and support, not allowing women to see themselves as ‘good mothers’ (Buchanan, 2019; Peled & Gil, 2011). Women adapt their mothering in a variety of ways, many of which are focused on protecting their children (Buchanan, 2019).

Women who have children while living with abuse are often vilified as ‘bad mothers’ for failing to leave the relationship and move their children to safer circumstances (McDonald-Harker, 2016). This, of course, is a very simplistic stance, not taking into consideration the many barriers women face in leaving an abuser, including financial issues, custody issues and the fact that women are often in greater danger when they leave a relationship (Long et al., 2018; Campbell et al., 2003).

IPA and Breastfeeding

IPA occurs across women's life spans, from dating violence among youth (Bonomi et al., 2012) and into the elder years (Roberto, McPherson & Brossoie, 2013). Prenatal violence, defined as physical violence toward a pregnant woman, is estimated to affect an estimated 3% to 8% of pregnant women (DeVries et al., 2010). There is no data on how many women who experience IPA are breastfeeding, but IPA is disproportionately common among women of childbearing (and therefore, breastfeeding) age, with women from 18 to 34 years typically facing the highest rates of IPA (Catalano, 2012).

Limited research has been done to examine the conjunction of IPA and breastfeeding, despite rising breastfeeding rates in the US over the past decade. One quantitative study (Wallenborn, Cha & Masho, 2018) using a nationwide sample found women reporting physical violence had an 18% greater risk of discontinuing breastfeeding prior to eight weeks. A similar study from India (Metheny & Stephenson, 2020) showed severe physical violence related to risk of discontinuing breastfeeding prior to six months. Outside of these quantitative studies, few projects have sought the voice of actual breastfeeding mothers living with IPA.

Gender Performativity in IPA

In recent decades gender has been recognized as a “routine, methodical and recurring accomplishment” (West & Zimmerman, 1987). “Doing gender” then is the act of people performing gender-appropriate acts, as defined by the patriarchy (society), that then places these people within the gender binary, thereby reproducing the binary and reinforcing it (West & Zimmerman, 1987).

Even as gender performances act to place people within the patriarchy – in roles of dominance or subservience – there is an element of agency. Humans do perform gender, but not mechanically; they often do so in pursuit of a “livable life” (Butler, 2004). The pressure to conform to a certain gender norm can create friction within a person and at the same time confer some level of protection by placing the performer within the tightly drawn bounds of the gender binary and the patriarchy (Butler, 2004). In this way, a woman in an abusive relationship may dislike being confined to performing her gender through the mastery of household chores and children, but also find some level of protection from violence within the household if she performs the role in such a way that the male partner approves; however, the ultimate choice to confer protection always resides with the male abuser.

Breastfeeding, similarly, may have its challenges for women, but also provide opportunities for gender performance that give women access to positive regard in some circumstances, such as praise from healthcare professionals, family and friends. Indeed, examining ways – small and large – in which women can empower themselves in the face of abuse is an important issue in social science research into IPA. Chaudhuri and Morash (2019) found that women living with IPA who were more involved with external sources of empowerment (such as women-centered groups) were able to access more support and exercise greater agency within their family.

It is important to note that gender performativity is not done alone, but always in relationship to society and to others (Butler, 2004). Father or partner support of breastfeeding has been found to increase a mother's self-efficacy around breastfeeding and potentially increase her ability to breastfeed past the immediate post-partum period and achieve the recommended six months of exclusive breastfeeding (Mannion, Hobbs, McDonald & Tough, 2013; Tohotoa et al., 2009). The dichotomy in attitudes toward breastfeeding then leaves women to negotiate the intricacies of how and when breastfeeding is sanctioned by society, her partner, their families, healthcare professionals, etc., and when it crosses invisible lines and becomes performatively taboo (Stearns, 1999).

Despite the acknowledged fact that male-female gender roles, and therefore gender performativity, are frequently a part of abusive intimate relationships, there has been little research on gender performativity in this context. To date the analysis of gender performativity in abusive relationships has been confined to examining male gender performativity. Anderson and Umberson (2001) interviewed 33 men recruited through a domestic violence agency and analyzed their discourses about their violence toward their female partners. The men's discourses gendered their violence as rational and necessary, while portraying any female violence toward them as weak, illogical and ineffectual (Anderson & Umberson, 2001).

The Current Study

The focus of this project was to explore the intersection of breastfeeding and IPA by directly engaging survivors to discuss their experiences of living with a violent/coercive partner while breastfeeding. A better understanding of mothers’ experiences of breastfeeding while living with abuse, and how they deploy gender roles to negotiate for greater safety for themselves and their infants can help advocates and healthcare providers better understand this phase and, hopefully devise better support systems for mothers who live with abuse.

Semi-structured qualitative interviews were used to engage survivors to explore how IPA changes with breastfeeding, how mothers use breastfeeding to protect themselves and/or their infants, how abusers manipulate breastfeeding to control women and how IPA dynamics affect breastfeeding mothers.

Method

Population

The population of interest for this pilot project was mothers over the age of 18 who spoke English, had a child under one year of age whom they breastfed for some period of time while living in a violent/coercive relationship and who had sought services from a domestic violence program. The breastfeeding period coincides with the earliest years of an infant's life. This is often a busy time for a breastfeeding mother who may be adding breastfeeding to work, caring for other children and managing a difficult intimate relationship. To minimize memory issues, we sought women whose latest breastfed baby was under one year old. Women could breastfeed the child for any length of time or still be breastfeeding but had to have lived with their abusive/coercive partner for some length of time while breastfeeding. These strict eligibility requirements limited sample size by excluding women with abusers who were not chosen intimate partners or whose children were more than a year old.

Recruitment

I partnered with seven IPA service agencies in a Midwestern state, after obtaining Institutional Review Board approval for this project in December 2017. Staff from each of the participating IPA agencies agreed to invite eligible clients to hear more about participating in this study. I personally contacted all survivors referred for the study, ensured they were eligible, provided detailed information about the study and walked each participant through an IRB-approved consent statement.

Interviews

A semi-structured interview guide with some general questions was designed to start a conversation and begin to understand the ‘lived experience’ of these women while living with an abusive partner and breastfeeding. Such interviews allow for flexibility – questions are not necessarily asked in a particular order – while maintaining a modicum of control over the topics covered (Leavy & Hesse-Biber, 2006). Feminist scholars frequently employ semi-structured interviews as a format that allows women to tell their story in their way, with fewer interruptions from the researcher (Leavy & Hesse-Biber, 2006). Questions explored the mother's breastfeeding experience, challenges, her partner's behaviors toward her and how these behaviors impacted her, her infant and her decisions around breastfeeding and mothering.

This project utilized basic principles of feminist interviewing. The dignity and comfort of the interviewees was put above research goals. Interviews were conducted in spaces chosen by survivors – including meeting them in their homes. All interviews were conducted in person. Survivors were informed of their right to skip questions they were uncomfortable with (though none chose to) and reminded that they could reply to their level of comfort – providing whatever level of detail they chose. Finally, interviews were paused when survivors needed time to reflect, cry or simply breathe.

Thirteen survivors were interviewed once for an average of 108 min and were paid $40 each. Interview incentives were designed to be high enough to express appreciation for participants’ time and expertise, and to defray any costs they might incur as a result of participating, while not being so high as to be coercive.

Data Analysis

Qualitative analysis followed principles established by Miles et al. (2014). This methodology falls under the category of thematic content analysis and begins with the writing of notes and memos during the interview process. Interviews were recorded and transcribed to facilitate analysis. I then followed a semi-deductive approach, with codes emerging organically in reading transcripts, but also drawn from my experience conducting all the interviews and from jots and memos I wrote during the interview period. These materials were used to develop an initial set of codes. I coded an initial set of interviews, adding codes as needed. Once I felt I had a more comprehensive set of codes I recoded the entire set of interviews. I then reviewed the codebook looking for areas of redundancy and areas where more detailed, or granular, coding would enhance understanding; I then recoded all interviews a second time. After coding was complete, I began to look for themes across multiple interviews and identify commonalities.

Results

Demographics

Thirteen mothers were recruited through IPA agencies, ranging in age from 19 to 38, with an average age of 29. These mothers represented a wide range of racial/ethnic backgrounds; African American (n = 5, 38%), Latina (n = 4, 31%), White (n = 3, 23%) and Asian (n = 1, 8%). These women had an average of 2.5 children, ranging from four children to just one infant.

In terms of breastfeeding, only three of the mothers experienced breastfeeding for the first time with their most recent child; the majority (77%) of these women had breastfed previous children for some amount of time. Seven mothers were still breastfeeding at the time of the interview (54%). Most mothers mixed breastfeeding and use of breastmilk alternatives at times during the breastfeeding phase, but almost half breastfed exclusively for some period of time.

At the time of the interviews, six mothers had discontinued breastfeeding after breastfeeding for an average of three months (ranging from 1.5 months to eight months). Mothers discontinued breastfeeding for a variety of reasons including resuming a depression medication³, restarting a smoking habit to help with anxiety, and quitting due to the difficulty of balancing work and needs of older children. Several mothers linked their discontinuation of breastfeeding directly to the abuse and chaos in their lives. Two mothers described situations where the stress of the abuse caused diminished milk supply, leading them to eventually discontinue. Another mother felt her milk supply was insufficient and had breastfed largely at the request of her abusive partner; when they separated – following a physical assault – she discontinued breastfeeding.

Themes

Acquiescing to male privilege to meet male requirements for gender performativity in the hope that adequate performance of the subservient female role will provide protection from violence.

In these abusive, often gender-role-rigid relationships, the women often spoke of gender roles being forced upon them or spoke of performing the role in hope that they could satisfy their partner's need to feel ‘like a man’ and therefore avoid conflict and violence.

Normal was me biting my tongue most of the time, not saying anything because… it's just easier to have the stability and calmness, than to have a fight about this. And then when I did say things, they would lead to a fight that was screaming, and, you know, name calling, and stomping around maybe throwing stuff, slamming doors, umm… and then on occasion grabbing, holding down, forcing, you know, but not like punching or slapping or you know that sort of thing. And that would happen about once a week. (Kyanite⁴)

Many of the mothers interviewed here spoke of picking up their traditional female gender roles – including cleaning and cooking and being the primary caregiver for children – very shortly after returning home following the birth of their children. These mothers tried hard to go back to their traditional roles immediately after birth, despite exhaustion, birth injuries and the often initially time-consuming task of breastfeeding a new infant. Many women spoke about how the pressure to resume these domestic gender roles impacted breastfeeding through stress and time pressure. One new mother told of her challenges trying to meet her abusive partner's expectations in the first days after giving birth:

On the fifth day of us all being home I was in the bathroom crying because I was bleeding heavily, my breasts were tender and sore, and my stitches had broken. [Abuser] came into the bathroom and told me to shut up and stop acting like a baby, that all women go through this and that I shouldn't cry and to suck it up. He then told me we needed food and sent me off to the supermarket to do the grocery shopping. By the time I got home from shopping my feet and legs had swollen so much I couldn't see my ankles. But I didn't have time to rest as he was tired and wanted dinner made so he could go to bed. (Opal)

Several moms in this small sample did not want to breastfeed – preferring instead to return to work – but experienced pressure from their partner to perform the traditional female role. One mother did not wish to breastfeed, but her partner kept asking about it while she was pregnant, and she acquiesced to his demands until her doctor recommended breastmilk alternatives. Another mother described pressure to breastfeed, with her abusive partner using guilt about her not wanting to breastfeed this child.

I didn't wanna breastfeed him ‘cause I just wanted to get back to work. But [the abuser] said no, and that he felt like I didn't care about my son because I breastfed my other kids, but I didn't wanna breastfeed him. So, then I ended up just breastfeeding him anyways. (Garnet)

Some of the abusive partners did help care for other children in the early days when the mothers returned home from birthing their infants. However, the male partners often performed these caretaking roles in performatively male ways – such as buying fast food for children, rather than actually cooking. “He does do his best to try to care for the kids, like they ate [fast food restaurant name]… because I wasn't able to cook.” (Rose Gold) In many cases, the mothers were uncomfortable with these parenting shortcuts and viewed them as acceptable for only a short period of time; mothers felt a need to return to their female gender performances of the “good mother” and provide quality meals and attentive childcare rather than rely on the male parenting performances their partners offered. With limited time, mothers talked of trade-offs between the time to perform these gendered tasks and time dedicated to breastfeeding and infant care.

Many of the mothers talked about how trying to perform their traditional female gender roles within the household impacted their ability to breastfeed their infants. “I’m more like, ‘Okay, I need to feed you so I can go and get more housework done.’” (Pearl)

Many of these women said their partners approved of their breastfeeding in the sense that it provided superior nutrition to their infants. However, tacit support of breastfeeding did not ensure safety for these women or mean that partners did not attempt to manipulate breastfeeding in other abusive ways.

Many mothers spoke about their partners’ attempts to control them via breastfeeding, especially in regard to breastfeeding in public. One man verbally berated his partner over the phone for breastfeeding with a cover on a front porch with only close family members present. This mother initially hung up on his tirade, but later found herself reconsidering his claims that her breastfeeding in public was disrespectful of him.

But during the process of me checkin’ myself and really processin’ what he had told me and tryin’ to validate his feelins’ - throughout that, you know, I came to a conclusion that, okay, to be a good woman and a good mother and listenin’ to his opinion wit’ his son I can take into consideration his feelins’ about things… You know just tryin’ to give him that fair shot that this is his kid, as well and I am his woman, you know what I mean? Just to try to make things comfortable, respectable, so there ain't no reason for any nonsense. (Topaz)

This mother subsequently began breastfeeding privately to meet her partner's expectations and avoid “nonsense.”

He made me feel a way… some type of way about myself… morals, you know what I’m sayin’? …How are you lookin’ at me? So, once I realized that it possibly was, I started to do that. Like goin’ in the car, you know what I’m sayin’, goin’ in the room… a room or somethin’ just not right where people at. (Topaz)

For this mother (and others) avoiding breastfeeding around others was an attempt to gain positive male regard from her partner. Breastfeeding in private and curtailing her movements and social interactions when her infant needed to be fed was part of her ‘bargain with the patriarchy,’ but increased her isolation and unfortunately did not result in protection from her male partner's abuse.

Pumping to please. Most of the mothers in this sample had a breast pump and pumped milk at some point. However, several of the mothers in this sample moved to pumping milk not out of personal preference, but as part of a strategy. Referring to old cultural tropes of a father feeding an infant with a bottle, several moms moved to pumping hoping to involve the father in feeding to improve their safety and the safety of their infants. Moms also mentioned partners being jealous of the time they spent with their infant; they hoped greater involvement of fathers in infant feeding might increase the father's bond to the child, rather than viewing infants as a competitor for the mother's attention.

One abusive partner repeatedly pulled a nursing baby out of a mother's arms and targeted her breasts, squeezing them to the point she found nursing painful. She strategically thought through her options to protect her child and decided to try pumping milk so the infant could still get breast milk, hoping the infant's feedings might be less interrupted by the abuser.

[I was thinking] that maybe he could not be so mean and grow attached to the baby if I just pumped, and then I’d let him feed the baby instead of me. And then I wouldn't get hurt. And it worked for about a month. (Garnet)

For some mothers playing to a somewhat more modern gender role – where mothers provide milk and fathers share in the physical feeding of infants – seemed to work for a period of time, but gradually new problems arose. Several abusers made derisive and negative comments while their partners pumped, while others stared and treated pumping as a sexually arousing activity – which often made mothers uncomfortable. One mother disliked how her partner would corner her when she was attached to the pump and relatively immobile; she took her pump to work and no longer pumped at home.

Several mothers said their partners pushed them to pump, but provided little to no support, leaving them to undertake pumping, childcare, work, etc.

So, he’d sort of be like, ‘Yes, yes, you must pump’ but there would be no support. Like I’d be like, ‘Can you take care of [baby]?” and he’d be like, “No, I’m sleep deprived.” So, like so what am I supposed to do? How do I pump with [the baby] on me? (Ametrine)

Some moms reverted to breastfeeding when pumping was made untenable, some continued to pump (strategically choosing the time and place), while a few gradually switched to non-breastmilk alternatives.

Women's use of breastfeeding to protect themselves and their infants.

Mothers used breastfeeding performatively to protect themselves in a range of ways. Some simply hoped that breastfeeding would provide some level of protection as they worked to embody the ‘good mother.’ Others actively used breastfeeding to attempt to protect themselves or their infants during volatile situations.

De-escalation. Several mothers used breastfeeding performatively to attempt to step away from their abusive partners when situations seemed to be deteriorating. Abusers did not always grant mothers privacy for nursing, but several mothers, at times, were able to use breastfeeding to gain distance from an abuser. Some mothers admitted to pretending to nurse their infant or coaxing the infant to nurse before the infant itself expressed any interest in nursing. “If [abusive partner] was just being like rude, or if I felt like, umm, uncomfortable I would just leave and go feed [baby].” (Eudialyte)

Many mothers sought the privacy of another room when using breastfeeding this way, either citing the desire for privacy or the need to get away from distractions (such as other children and TV, etc.).

Sometimes, you know, if I would say “Oh, I have to feed [baby's name]” and I would go to feed [baby] and [abusive partner] would try to follow me in there, and bother me still, and yell at me. So, one day when [abusive partner] was sleepin’ I put a lock on the door. (Onyx)

Food stability. Another mother used breastfeeding as a source of security for always having a stable food source for her baby, despite being housing insecure due to abuse. “One of the perks to breastfeeding is… that is no matter where I go, whatever happens, I’m always gonna be able to feed my baby.” (Rose Gold)

Physical safety for children and self. Another mother said she often picked up her infant and breastfed him as arguments escalated. This performative use of breastfeeding did not stop the arguments and abuse directed toward her and the children, but she felt safer knowing she had her infant in her arms if she needed to quickly exit the home for safety.

One mother used breastfeeding performatively to avoid situations where her abusive partner might try to traffic her for sex. Her abuser pushed her to pump breastmilk so she could spend more time away from the baby, but she resisted pumping exclusively and primarily breastfed as an excuse to stay home and closer to her infant. After she stopped breastfeeding, she worried that her abuser might try to separate her from the baby and force her back into sex work. “I kind of feared that one of those times going out, since my son wasn't breastfeeding then, that he might possibly drive me… out of town or something and like force me back into that lifestyle.” (Jade)

Breastfeeding as a way of embodying the “Good Mother” and achieving a sense of self-esteem amid violence.

Breastfeeding performativity and positive regard from others. IPA often involves isolation from support and an emotional tearing down of the victim. Women in abusive relationships often suffer from low self-esteem (Cascardi & O; eary, 1992). In these interviews breastfeeding was a source of self-esteem that abusers attempted to target but not always successfully. Women spoke of positive feedback for breastfeeding from doctors, nurses, lactation consultants and WIC (Women, Infants and Children; a US government food and nutrition support program) counselors.

Breastfeeding also sometimes garnered positive reactions from friends and family members. One woman described her abuser's family's fascination with her breastfeeding, saying they wanted to watch her breastfeed and pump; she regarded this as violation of her privacy, but it also put in her a position of generally positive attention. Another participant received positive feedback from her boss for breastfeeding. One mother felt positive about her breastfeeding's impact on her teenage daughter, “she says if she ever has a kid she wants to breastfeed, so I think that that's really positive.” (Ruby)

Overcoming breastfeeding challenges enhanced confidence and self-esteem. Breastfeeding presented difficulties for these mothers at different points – difficulties with violent partners, unstable housing, plugged ducts and the need to address other priorities (work, school, care of older children and relatives, etc.). Often troubling comments from abusive partners targeted how moms breastfed, but several mothers said those comments did not hold true to them.

He convinced me that getting my [degree] was a bad idea, that having kids was a bad idea, that you know that my job choices were a bad idea, that my clothing choices were a bad idea, that I was stupid, that people didn't like me, that I didn't… you know, he convinced me of all this stuff, but he could not convince me that breastfeeding was the wrong thing to be doing or that I was doing it incorrectly. (Kyanite)

Most of these mothers said they had considered discontinuing breastfeeding before reaching their goals, but then found ways to overcome challenges. Despite stress, mothers often expressed a sense of accomplishment for overcoming obstacles.

I stuck with [breastfeeding] through things that most mothers would not do … the bruises? I stuck with it. Trying to take care of three kids alone, for three months, juggling court dates and anti-violence classes and all sorts of everything just piled up? I mean life… I stuck with it… It felt like a huge, beautiful victory. (Onyx)

Impact of IPA on Breastfeeding

At the time of the interviews just over half of the mothers (n = 7) were still breastfeeding. The mothers who were no longer breastfeeding (n = 6) had breastfed their infants for an average of just under four months, two months short of the minimum six months of exclusive breastfeeding recommended by the American Academy of Pediatrics (AAP, 2012) and a year and eight months short of the minimum two years of non-exclusive breastfeeding (supplemented by foods and other liquids after six months) recommended by the World Health Organization (WHO, 2001).

Several mothers who stopped breastfeeding at three to four months cited abuse as the primary factor in their decision to discontinue breastfeeding. They blamed the abuse for stress and felt the stress impacted their milk supply. Two of these mothers cited stress as a factor in returning to the use of supportive medications/substances they felt were not compatible with breastfeeding. Most mothers said they would have breastfed longer if not for the impact their abusive partner had on their breastfeeding via stress.

I would have breastfed longer if it wasn't for bein’ in that relationship. Like I said with my oldest son, he breastfed for over a year. I… I would’ve been able to do it for over a year, if it wasn't for the stress of the relationship. (Jade)

Mothers who were not successful at meeting their own breastfeeding goals often expressed a sense of anger at their partner's abuse and the impact it had on their ability to breastfeed, a sense of grief at what they felt was taken from them (the ability to achieve their breastfeeding goals) and a level of guilt about the kind of mothering they had been able to provide their infant.

It's hard enough doing what you’re doing, but constantly worrying about how my husband's gonna react, what he's gonna do next, when's it gonna happen, what's gonna happen… You know, I couldn't fully enjoy the first year of my babies’ lives and I grieve for that. (Opal, who quit breastfeeding before she wanted to due to low milk supply which she tied directly to her husband's abuse.)

Discussion

This study confirms female use of gender roles during the breastfeeding stage. Mothers use breastfeeding to embody the ‘good mother,’ and to seek positive regard from sources of support including friends, family and healthcare providers.

Women in abusive relationships use gender roles during the breastfeeding phase to attempt to enact the ‘good mother’ to improve their safety and the safety of their infants. Prior to this study, only male use of gender roles in abusive relationships had been examined (Anderson & Umberson, 2001).

While attempts to use gender roles around breastfeeding were often unsuccessful in the short run (and universally unsuccessful over a longer time period as all participants had left their abusive partner at the time of their interviews), they do demonstrate agency (Lentz, 2018) on the part of mothers living with abuse. Participants used multiple strategies, including gender performance, to try to accomplish their breastfeeding goals as a means of protecting themselves and their infants.

This study also supports findings that breastfeeding is strongly promoted and seen as a mark of ‘good’ mothering (Lee, 2008; Hays, 1996). As mothers living with abuse are often labeled as ‘bad mothers’ for living with abuse (Buchanan, 2019; McDonald-Harker, 2016), it makes sense that many would search for ways to compensate and see themselves as ‘good mothers.’ I theorize that breastfeeding to many of these mothers was one way of attempting to embody the ‘good mother’ in the face of their abuser's attempts to tear them down, and in this way is a culturally sanctioned form of resistance. Additionally, providing ‘optimal’ nutrition for their infants is another way of signaling positively about their mothering. Most of the mothers in this study assigned a high priority to breastfeeding their infants, despite many conflicting priorities, such as paid work, housework, care for other children and the need to attempt to manage the abuse in their relationships. Many spoke of feeling guilty if they moved wholly to the use of non-breastmilk alternatives or did not achieve their breastfeeding goals – moving away from breastfeeding clearly impacted their sense of themselves as capable mothers.

Two mothers in the sample initially did not wish to breastfeed their most recent infant. They experienced pressure from their male partners and changed their minds; in both cases the male partners used guilt, implying the woman did not care enough about this infant to breastfeed and provide optimal nutrition. This may represent male use of the ‘good mother’ paradigm around breastfeeding and certainly represents male control over a female body.

Abusers also target the mother-child relationship, a source of positive regard and support for mothers. Breastfeeding, culturally and scientifically acknowledged as the ‘gold standard’ of infant feeding, is one thing these mothers can try to do to win respect not only from their abuser, but from family, friends, healthcare providers and (sometimes, in the right circumstances) the public. Programs and providers serving breastfeeding mothers need to understand the potential importance of breastfeeding to a woman's self-esteem and sense of herself as a competent or ‘good mother.’ Breastfeeding is often seen as a choice, as optional, but for some of these mothers, breastfeeding was important in their self-perceptions, and a lifeline to support and praise. While breastfeeding should never be used to shame women who cannot or choose not to breastfeed, it should be seen by advocates, healthcare providers and policymakers as an opportunity for positive self-regard, especially among mothers who have experienced abuse or trauma. Advocates who serve women impacted by IPA should also recognize the creativity, determination and perseverance of these mothers and, in counseling them, seek to help them see how hard they tried to care for their infants, whether they ultimately met their breastfeeding goals or not.

Additionally, this study advances the literature around IPA and breastfeeding by adding qualitative, first-person accounts of mothers who lived with abuse during the breastfeeding period. Recent quantitative studies confirm IPA impacts breastfeeding, but only from hearing mothers’ lived experiences can we build a picture of the complex lives these women lead and the many strategies and tools they employ to attempt to build a more ‘livable life’ (Butler, 2004).

Currently, government programs (WIC and others), hospitals and healthcare providers push women to breastfeed citing the biomedical benefits, but with seemingly little appreciation for the barriers and difficulties many mothers face in the breastfeeding phase (Christopher & Krell, 2014). Breastfeeding promotion and support must take into account these lived realities and demonstrate an appreciation for the complexity that is part of breastfeeding for many mothers. Pushing breastfeeding without understanding a mother's individual situation will only increase resistance to seeking help. This study can help to inform policy makers and healthcare providers about a segment of mothers who face greater challenges to successful breastfeeding and can perhaps help build breastfeeding support and information campaigns that are more responsive to the complexity all mothers face post-partum. Additionally, while all breastfeeding mothers need access to good quality breastfeeding support, strong policies around paid maternity leave and breastfeeding-supportive workplaces, mothers who live in challenging circumstances (such as coping with an abusive partner or living in poverty) need these supports urgently. Indeed, infants born into challenging circumstances need all the advantages our society can provide to give them the best chance to thrive and cope and hopefully develop beyond those initial challenges. Breastfeeding provides optimal nutrition and social development and should be supported by quality programs, not simply a recitation of biomedical advantages.

Strengths

This study seeks to bring the voices of women to the forefront – to add to the quantitative data around breastfeeding and IPA. Organizations serving IPA survivors, healthcare professionals, and policy makers need to better understand the lived experiences of the breastfeeding mothers they serve, the negative impact of abuse and the countervailing strong societal pressures to embody the ‘good mother’ and breastfeed for a minimum of six months.

Limitations

The sample size for this study is small (n = 13) and geographically situated in the Midwest of the United States. The study has strong diversity for a small sample, both racial/ethnic diversity and a diversity of breastfeeding durations.

Funds to interview women who speak languages other than English were lacking. Future projects should seek to include these women and layer into the research the impact of these women's identities as non-native English speakers, immigrants, and/or refugees – deepening the intersectional perspective.

The eligibility criteria for this study asked for women who had ‘ever breastfed, no matter how long’ but may not have reached women who breastfed for only a brief time and who may not self-identify as having breastfed. This study also cannot speak for women who decided not to even attempt breastfeeding out of fear of or concern about repercussions from an abusive partner. More research should be done to examine abuse as a factor in the decision not to breastfeed.

Finally, this article does not examine use of gender roles by men, but there are indications abusive partners in this sample also used gender roles. Several mothers complained that though the children's fathers would attempt to care for their infants at times they often did such a poor job of it or asked so many questions or wouldn't care for the child without the mother present – a variety of tactics to make the man appear to be incapable of providing simple infant care – that most mothers gave up and took on more childcare, got less sleep and were more isolated and stressed. The man's act of incompetence may be a male gender performance; future research should speak to abusive men to understand how they perform gender in the breastfeeding period.

Future research should also seek to expand on this exploratory effort. A community-based sample of mothers might include greater diversity in social class and other demographic aspects. Exploring the intersection of abuse, breastfeeding and race/ethnicity also deserves attention, as many cultures have different expectations for and attitudes toward breastfeeding mothers; samples of non-English-speaking mothers should be prioritized.

Conclusion

This study confirms that mothers living with IPA are active in seeking ways to stem the violence toward themselves and their children. They strategically and repeatedly use what agency they have within the patriarchy and within their relationships – a burdened agency – to move toward a more livable existence. For mothers of infants, breastfeeding may have provided them with additional gender performative options that they used, successfully and unsuccessfully, in the search for peace, safety and a sense of self-esteem. While their attempts to provide optimal nutrition to their children in the face of violence are laudable, these mothers deserve more than praise for their agency in using gender performativity. These mothers need concrete resources to support their breastfeeding and to make them feel that they have real options outside an abusive relationship. These resources include long-term (not just short-term emergency) housing options, educational programs, high-quality childcare and breastfeeding-supportive employment opportunities that would allow them to support themselves and their children at a level above the poverty line.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this research was received by a Michigan State University.

ORCID iD

Heather Bomsta

Notes

References

American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827−e841. https://doi.org/10.1542/peds.2011-3552

Anderson

K. L.

Umberson

. (2001). Gendering violence: Masculinity and power in men’s accounts of domestic violence. Gender & Society, 15(3), 358–380. https://doi.org/10.1177/089124301015003003

Bonomi

A. E.

Anderson

M. L.

Nemeth

Bartle-Haring

Buettner

Schipper

. (2012). Dating violence victimization across the teen years: Abuse frequency, number of abusive partners, and age at first occurrence. BMC Public Health, 12(1), 1–10. https://doi.org/10.1186/1471-2458-12-637

Bramwell

. (2001). Blood and milk: Constructions of female bodily fluids in western society. Women & Health, 34(4), 85–96. https://doi.org/10.1300/J013v34n04_06

Breiding

M. J

. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—national intimate partner and sexual violence survey, United States, 2011. Morbidity and Mortality Weekly Report. Surveillance summaries (Washington, DC: 2002), 63(8), 1. https://doi.org/10.2105/ajph.2015.302634

Buchanan

(2019). Current mothering discourses and domestic violence: A double whammy. In Intersections of mothering (pp. 156–167). Routledge.

Butler

(2004). Undoing gender. Psychology Press.

Campbell

J. C.

Webster

Koziol-McLain

Block

Campbell

Curry

M. A.

Gary

Glass

McFarlane

Sachs

Sharps

Ulrich

Wilt

S. A.

Manganello

Schollenberger

Frye

Laughon

. (2003). Risk factors for femicide in abusive relationships: Results from a multisite case control study. American Journal of Public Health, 93(7), 1089–1097. https://doi.org/10.2105/ajph.93.7.1089

Cascardi

O’Leary

K. D

. (1992). Depressive symptomatology, self-esteem, and self-blame in battered women. Journal of Family Violence, 7(4), 249–259. https://doi.org/10.1007/BF00994617

10.

Catalano

S. M

. (2012). Intimate partner violence, 1993–2010. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

11.

Centers for Disease Control and Prevention (2018). National Immunization Survey (NIS) website. http://www.cdc.gov/breastfeeding/data/nis_data/index.htm. (Accessed August 1, 2018).

12.

Centers for Disease Control and Prevention (2021). Why It Matters. Retrieved 12 January 2022, from https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html

13.

Chaudhuri

Morash

. (2019). Building empowerment, resisting patriarchy: Understanding intervention against domestic violence among grassroots women in gujarat, India. Sociology of Development, 5(4), 360–380. https://doi.org/10.1525/sod.2019.5.4.360

14.

Chen

Rogan

W. J

. (2004). Breastfeeding and the risk of postneonatal death in the United States. Pediatrics, 113(5), e435–e439. https://doi.org/10.1542/peds.113.5.e435

15.

Christopher

G. C.

Krell

J. K

. (2014). Changing the breastfeeding conversation and our culture. Breastfeeding Medicine, 9(2), 53–55. https://doi.org/10.1089/bfm.2014.9994

16.

Connell

(2013). Gender and power: Society, the person and sexual politics. John Wiley & Sons.

17.

Devries

K. M.

Kishor

Johnson

Stöckl

Bacchus

L. J.

Garcia-Moreno

Watts

. (2010). Intimate partner violence during pregnancy: Analysis of prevalence data from 19 countries. Reproductive Health Matters, 18(36), 158–170. https://doi.org/10.1016/S0968-8080(10)36533-5

18.

Dobash

R. E.

Dobash

R. P

. (Eds.). (1998). Rethinking violence against women. Sage Publications.

19.

Domestic Abuse Intervention Programs (November 1, 2018). Understanding the Power and Control Wheel. Retrieved from https://www.theduluthmodel.org/wheels/understanding-power-control-wheel/#male-privilege

20.

Fox

. (2001). The formative years: How parenthood creates gender. Canadian Review of Sociology/Revue Canadienne de Sociologie, 38(4), 373–390. https://doi.org/10.1111/j.1755-618X.2001.tb00978.x

21.

Freudenheim

J. L.

Marshall

J. R.

Graham

Laughlin

Vena

J. E.

Bandera

E.,

Muti

, Swanson, M.,

P.,

Nemoto,

. (1994). Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology (Cambridge, Mass.), 5(3), 324–331. https://doi.org/10.1097/00001648-199405000-00011

22.

Gonzalez-Nahm

Grossman

E. R.

Benjamin-Neelon

S. E

. (2019). The role of equity in US States’ breastfeeding policies. JAMA Pediatrics, 173(10), 908–910. https://doi.org/10.1001/jamapediatrics.2019.2582

23.

Hays

(1996). The cultural contradictions of motherhood. Yale University Press.

24.

Heise

L. L

. (1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4(3), 262–290. https://doi.org/10.1177/1077801298004003002

25.

Hunnicutt

. (2009). Varieties of patriarchy and violence against women: Resurrecting “patriarchy” as a theoretical tool. Violence Against Women, 15(5), 553–573. https://doi.org/10.1177/1077801208331246

26.

Kandiyoti

. (1988). Bargaining with patriarchy. Gender & Society, 2(3), 274–290. https://doi.org/10.1177/089124388002003004

27.

Kelly

Westmarland

. (2015). Domestic violence perpetrator programmes: Steps towards change. Project Mirabal final report.

28.

Kendall-Tackett

Cong

Hale

T. W

. (2011). The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation, 2(2), 22–26. https://doi.org/10.1891/215805311807011593

29.

Kendall-Tackett

Cong

Hale

T. W

. (2013). Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: A comparison of breastfeeding, mixed-feeding, and formula-feeding mothers. Breastfeeding Medicine, 8(1), 16–22. https://doi.org/10.1089/bfm.2012.0024

30.

Koletzko

Sherman

Corey

Griffiths

Smith

. (1989). Role of infant feeding practices in development of crohn’s disease in childhood. BMJ: British Medical Journal, 298(6688), 1617. https://doi.org/10.1136/bmj.298.6688.1617

31.

Lee

E. J

. (2008). Living with risk in the age of ‘intensive motherhood’: Maternal identity and infant feeding. Health, Risk & Society, 10(5), 467–477. https://doi.org/10.1080/13698570802383432

32.

Lentz

E. C.

(2018). Complicating narratives of women’s food and nutrition insecurity: Domestic violence in rural Bangladesh. World Development, 104, 271–280.

33.

Lichter

E. L.

McCloskey

L. A

. (2004). The effects of childhood exposure to marital violence on adolescent gender-role beliefs and dating violence. Psychology of Women Quarterly, 28(4), 344–357. https://doi.org/10.1111/j.1471-6402.2004.00151.x

34.

Long

Harper

Harvey

Ingala-Smith

. (2018). The Femicide census: 2017 findings. Annual report on UK Femicides 2017. Femicide Census.

35.

Mannion

C. A.

Hobbs

A. J.

McDonald

S. W.

Tough

S. C

. (2013). Maternal perceptions of partner support during breastfeeding. International Breastfeeding Journal, 8(1), 1–7. https://doi.org/10.1186/1746-4358-8-4

36.

McDonald-Harker

(2016). Mothering in marginalized contents: Narratives of women Who mother In domestic violence. Demeter Press.

37.

Metheny

Stephenson

. (2020). Is intimate partner violence a barrier to breastfeeding? An analysis of the 2015 Indian national family health survey. Journal of Family Violence, 35(1), 53–64. https://doi.org/10.1007/s10896-019-00077-9

38.

Mezzacappa

E. S

. (2004). Breastfeeding and maternal stress response and health. Nutrition Reviews, 62(7), 261–268. https://doi.org/10.1111/j.1753-4887.2004.tb00050.x

39.

Miles

M. B.

Huberman

A. M.

Saldaña

(2014). Qualitative data analysis: A methods sourcebook. Sage publications.

40.

Morris

. (2009). Gendered dynamics of abuse and violence in families: Considering the abusive household gender regime. Child Abuse Review: Journal of the British Association for the Study and Prevention of Child Abuse and Neglect, 18(6), 414–427. https://doi.org/10.1002/car.1098

41.

Peled

Gil

I. B

. (2011). The mothering perceptions of women abused by their partner. Violence Against Women, 17(4), 457–479. https://doi.org/10.1177/1077801211404676

42.

Roberto

K. A.

McPherson

M. C.

Brossoie

. (2013). Intimate partner violence in late life: A review of the empirical literature. Violence Against Women, 19(12), 1538–1558. https://doi.org/10.1177/1077801213517564

43.

Sanyal

(2014). Credit to capabilities: A sociological study of microcredit groups in India. Cambridge University Press.

44.

Slusser

W. M.

Lange

(2002). Breastfeeding in the United States today: Are families prepared. In N. Halfon, K. McLearn, & M. Schuster (Eds.), Childrearing in America: Challenges Facing Parents with Young Children , (pp. 178–216). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511499753.007

45.

Stark

(2009). Coercive control: The entrapment of women in personal life. Oxford University Press.

46.

Stearns

C. A

. (1999). Breastfeeding and the good maternal body. Gender & Society, 13(3), 308–325. https://doi.org/10.1177/089124399013003003

47.

Stuebe

. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics and Gynecology, 2(4), 222. PMCID: PMC2812877 PMID: 20111658.

48.

Tohotoa

Maycock

Hauck

Y. L.

Howat

Burns

Binns

C. W

. (2009). Dads make a difference: An exploratory study of paternal support for breastfeeding in perth, western Australia. International Breastfeeding Journal, 4(1), 1–9. https://doi.org/10.1186/1746-4358-4-15

49.

Tomori

Palmquist

A. E.

Dowling

. (2016). Contested moral landscapes: Negotiating breastfeeding stigma in breastmilk sharing, nighttime breastfeeding, and long-term breastfeeding in the US and the UK. Social Science & Medicine, 168, 178–185. https://doi.org/10.1016/j.socscimed.2016.09.014

50.

Walker

L. E.

(2016). The battered woman syndrome. Springer publishing company. (1st edition - 1983).

51.

Wallenborn

J. T.

Cha

Masho

S. W

. (2018). Association between intimate partner violence and breastfeeding duration: Results from the 2004–2014 pregnancy risk assessment monitoring system. Journal of Human Lactation, 34(2), 233–241. https://doi.org/10.1177/0890334418757447

52.

West

Zimmerman

D. H

. (1987). Doing gender. Gender & Society, 1(2), 125–151. https://doi.org/10.1177/0891243287001002002

53.

World Health Organization. (2001). The world health organization’s infant feeding recommendation. Retrieved October 8, 2018, from: http://www.who.int/nutrition/topics/infantfeeding_recommendation/en/index.htmln

54.

Young

I. M.

(1992). Breasted experience: The look and the feeling. In The body in medical thought and practice (pp. 215–230). Springer, Dordrecht.

Female Gender Performativity Around Breastfeeding in Abusive Relationships