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Thu, 04 Jun 2009 08:26
Gabrielle Palmer is a nutritionist and a campaigner. She was a breastfeeding counsellor in the 1970s and helped establish the UK pressure group Baby Milk Action. In the early 1980s she lived and worked as a volunteer in Mozambique. She has written, taught and campaigned on infant feeding issues, particularly the unethical marketing of baby foods. In the 1990s she co-directed the International Breastfeeding: Practice and Policy course at The Institute of Child Health in London until she went to live in China for two years. She has worked independently for various health and development agencies, including serving as HIV and Infant Feeding Officer for UNICEF New York. She recently worked at The London School of Hygiene and Tropical Medicine where she had originally studied nutrition.
Mark Thwaite: What first gave you the idea for writing The Politics of Breastfeeding?
Gabrielle Palmer: In 1986, birth and breastfeeding guru Sheila Kitzinger phoned me up and asked me to write a book on The Politics of Breastfeeding for a book series called, 'Issues in Women's Health' for Pandora Press (owned by Routledge at the time) Sheila was series editor and she knew about my work as a campaigner against the unethical promotion of baby milk. I had with others, established the pressure group, Baby Milk Action and Sheila was a patron. The book and the title was her idea. I said yes.
Mark Thwaite: You contend that "breastfeeding is not best, it's normal" -- can you explain this a little more?
Gabrielle Palmer: It is not just me who says this. Other researchers and writers have also pointed this out. I dislike the phrase 'breast is best'. It is such a platitude. It's like saying 'walking is the best way of getting from your desk to the other side of the room' or 'kidneys are best for filtering waste products from your body'. Not breastfeeding is the odd, unusual practice and 99% of human beings who have walked this earth were breastfed. It is only comparatively recently that human beings have been able to survive artificial feeding. In 19th century Dublin the orphanage was closed when 99.6% of babies died because they were not breastfed. Breastfeeding has been the normal way of feeding babies since humans first evolved. In many societies the concept of 'not being able to breastfeed' does not exist'. Today in our very odd society (which may be on the brink of collapse) we have made breastfeeding so difficult that vast numbers of women believe they cannot do it or don't want to because they have heard how difficult it is. But still today most babies are at risk of death if they are not breastfed; 80% of humans live in poverty and artificial feeding kills babies who live in the normal conditions of most people. Of course like any biological process, there are occasional 'failures'. There are also some people who cannot walk, but we don't think it is normal for the majority of healthy people to use wheelchairs or crutches... yet. In the UK the majority of babies are not breastfed for more than about six weeks and we think infant infections are normal. Antibiotic effectiveness is fast declining and we cannot be complacent about this. Babies die all over the world from infections that breastfeeding could prevent. Just read my book for a fuller explanation.
Mark Thwaite: Your book is subtitled "when breasts are bad for business" -- is baby-milk formula simply a con? Are there no women who need it?
Gabrielle Palmer: Artificial milk (or infant formula as many people call it) for babies is not a con. It is a necessary product. There are always orphans. Also there are women who have had mastectomies due to breast cancer or HIV women who decide to avoid breastfeeding. The common problems that lead so many women to abandon breastfeeding are mostly due to incompetent health professionals and misinformation from the companies and the culture. Also there are women who do not want to breastfeed. Every woman has the right not to breastfeed, but she also has the right to be informed about the risks to her baby. She must know that her baby will need more medical treatment and she must be able to afford excellent healthcare or live in a country where it is free. Ideally when babies are not breastfed by their mothers they would be wet-nursed or fed with donated human milk but that is not possible at the moment. What is a con is the baby food product marketing. There is far too little scrutiny and inspection of the milks and the bottles and teats. Many milks do not contain the proportions of ingredients they claim on the tin and they can contain lethal bacteria within the powdered milk. The preservatives used in them have not been proven safe for babies and they are not named in the labels. Our UK government (and many others) do nothing to check their safety and many adult foods are inspected far more regularly and carefully. We know that up to 14% of tins can contain enterobacter sakazakii, a heat resistant pathogen that causes a brain-damaging or fatal meningitis. Babies have died from this but it is rarely publicised. Bottles and teats do not have to conform to rigorous standards and many are manufactured from suspect materials. Parents and carers are not told these facts on the labels or in information about the products. The WHO Code of Marketing (which our government has agreed to) restricts the marketing of milks and bottles. It states that governments have the responsibility for providing impartial information.
Mark Thwaite: How long did it take you to write and research your book Gabrielle?
Gabrielle Palmer: I published the first edition in 1988, it took two years to write, the second edition (1993) took six months and this third edition about four years. But this is because I have had to earn my living and do other voluntary work at the same time.
Mark Thwaite: This is a substantially revised version of your book -- what has changed since the last edition?
Gabrielle Palmer: I have developed ideas from the first edition with new detail about ecology and economics. I have now written a chapter about infant feeding in disasters such as earthquakes and one about HIV/AIDS. These are important topics because many people do not understand how vital breastfeeding is in the worst of circumstances. It truly is a matter of life and death. Many western people are unaware that if a woman stops breastfeeding in an emergency, she is likely to get pregnant and may die as a result. I have also included sections about the effects of childbirth both in the rich and the poor world. I feel very passionate about the latter. Every day 1370 women die from causes related to pregnancy and childbirth, equivalent to a jumbo jet crashing every four hours, yet the media rarely report this daily tragedy. Dead women cannot breastfeed. Politicians never make speeches about these preventable deaths. Globally the contraceptive effect of breastfeeding prevents more pregnancies than all other forms of modern contraception. Women, toddlers and babies are more likely to die if pregnancies are closely spaced. When companies promote their milks and foods they may not only cause a baby's death but his mother's. All these topics have been expanded in this new edition.
Mark Thwaite: What was the most difficult aspect of writing The Politics of Breastfeeding? How did you overcome it?
Gabrielle Palmer: The most difficult part of writing the book is that I would get extremely depressed about the state of the world and this would paralyse me and make me unable to work. I would overcome it by meeting, talking to or just thinking about friends I have made around the world. I have always been bowled over by the resilient cheerfulness and optimism of people in poor countries who work in such difficult conditions. Last year I visited friends in Guatemala, the poorest country in Latin America. I stayed in the mud-floored hut of an illiterate woman, mother of eight healthy children, all born at home with only her husband's help. She had been chosen by her community to do a government training to be a birth attendant. She was so knowledgeable and so responsible. By our terms she would be viewed as desperately poor but her tranquillity, wisdom and good relations with her community were greater than anything I have come across in my own country. She owns nothing but she enjoys her life and gets satisfaction from her work and her family. I have written about her in my book. I have known people from Nigeria, South Africa, Bangladesh and many other places who remain positive in the worst of situations, never give up and really enjoy the small pleasures of life. These friends give me hope, the most valuable gift of all.
Mark Thwaite: How do you write? Longhand or directly onto a computer, straight off or with lots and lots of editing?
Gabrielle Palmer: On a computer with loads of errors (I cannot touch type). I write far too much and spend more time editing and cutting than actually writing. I sometimes wish I did write by hand because when I do the ideas flow more coherently (something to do with the brain working differently with the hand movements of writing). However I would then have to copy type it out which would be a nightmare.
Mark Thwaite: In what way do hospital practices sabotage breastfeeding?
Gabrielle Palmer: It's all in the book. Or look up UNICEF Baby Friendly Hospital Initiative (BFHI) on the internet. Despite BFHI making some improvements, hospital practices still make breastfeeding difficult. Mothers and babies need unhurried, uninterrupted skin contact after birth. This not only affects breastfeeding hormones but changes the digestive hormones of both mother and baby. Many of the drugs used in childbirth damage babies' suckling reflexes so they don't feed well at first and mothers lose confidence. Babies are still removed from their mothers and even put in nurseries in some countries. Many hospitals forbid mothers and babies to bed share. Any separation impedes the 'getting to know each other' phase which is vital for easy breastfeeding. Many health staff are still disgracefully unskilled at knowing how to help a mother get her baby attached (important to prevent sore nipples) and to be emotionally supportive. The noisy, stressed, over-lit atmosphere makes mothers tense and anxious. Hospitals still give unnecessary feeds of glucose water or infant formula which stop the baby stimulating the right amount of breastmilk. The baby needs to suckle immediately after birth when her reflexes are at their strongest and suckle freely whenever she wants. Feeding within the first hour would prevent thousands of infant deaths in poor countries. This post-natal period is called the 'calibration' phase when a baby's suckling communicates to her mother's body how much breastmilk she is going to need long-term. If given other fluids, the baby loses thirst and appetite and is reluctant to suckle so the mother's body gets the message it does not need to make much breastmilk. Bad hospital practices cause poor breastmilk supply. Also many hospitals (especially in the USA) still promote infant formula and hand out free samples of these products. Hospital maternity wards have been major saboteurs of breastfeeding. During the 20th century, across the world, the more hospital births increased, the more breastfeeding declined. It is a great shame on the medical, nursing and midwifery professions that this is still going on. Many health professionals and academics have sold out to the baby food companies. These companies exploit inadequate health worker training and sell more products as a result. Profit is more desirable than infant health.
Mark Thwaite: Why, as a society, have we become so phobic of women breastfeeding in public?
Gabrielle Palmer: I don't think we are quite so phobic in Europe; it is the USA which has the big terror of naked nipples and bare breasts. It's quite amusing and astonishing how so many US citizens are scared, yet obsessed by breasts. It always baffles me that so many US women have cosmetic surgery to make their breasts all look alike and conform to some ridiculous norm, yet they don't even go topless on beaches to show off their expensive artificial breasts. What's the point? I think some of this nipple and breast phobia comes from general misogyny. Remember it is not even 100 years since British women got the vote and some in Switzerland only did in the 1990s. Women could not even get degrees from Cambridge University until 1948. Equal employment and anti-discrimination laws are relatively new even in the most advanced countries. Women are still only grudgingly allowed to be full members of society. The condition is that you can join the male power structures on condition you are not too female. I sense that men do not want to be reminded of how multi-talented women are. I also think many women are very uptight about their breasts and had bad breastfeeding experiences (as most 20th century women did) so any public breastfeeding reminds them of a negative experience. In the USA there is plain old Puritanism and fear of the body. They may not kill witches in Salem anymore but there is still fear of the female. Breastfeeding stayed so hidden that people forgot how to do it. It was also quashed by the WIC programme that stopped poor women breastfeeding in the 1960s by providing free infant formula. There are loads of other different reasons but I certainly know that where public breastfeeding is accepted no one bats an eyelid and then more people find it easier. This might be Scandinavia or Swaziland. This also includes countries where women have to be much more modest and even veiled. There are societies where public breastfeeding is taken for granted yet a woman could not go bare-headed. Culture is so fickle that what is shocking today is totally acceptable tomorrow. Women wearing trousers, drinking or eating in the street, not wearing a hat: these were all shocking to most British people when I was a small child. These taboos have disappeared completely. Public breastfeeding is actually very important. You only learn to breastfeed by watching it being done, just like dancing. Women who have never seen breastfeeding and try to do it by reading a book can get techniques wrong. In societies where everyone breastfeeds in public (such as Amazonian Indians) you simply do not get breastfeeding problems or failure.
Mark Thwaite: Do you read the critics? Have you been pleased with the responses to your book? Have you learned anything from them?
Gabrielle Palmer: I do read the critics but have not read reviews of this third edition yet. When the first edition of my book was published in 1988 I got consistent praise from all quarters and was touched at how widely my message was understood. No one ever said anything unkind or unfair. But some people looked at the topic from a different point of view. In 1991, the delightfully thuggish Richard Littlejohn saw someone reading my book in the London tube. He wrote a piece saying he couldn't understand why she was reading it because she was so ugly that no one could ever be desperate enough to fertilise her so she would never breastfeed anyway. I learned something from this 'review'. Did I mention something about misogyny in the paragraph above? I always hope I learn something from all feedback. I belong to a writers' group. None of the other authors have anything to do with my subject. They have been hugely helpful in commenting on this edition as I wrote it. As outsiders to the topic of breastfeeding they challenged me and made me strive to be clearer and explain things.
Mark Thwaite: What do you do when you are not writing?
Gabrielle Palmer: In no order of priority: teaching and giving talks; answering emails; writing about other related subjects; working on my allotment which I've done for 30 years; gardening; visiting and entertaining family and friends; looking after our grandchild; playing tennis; walking; housework; cooking; doing cryptic crosswords; playing scrabble and/or cards; reading; going to the cinema or theatre; bird-watching; talking; listening to the radio; going to a pub; punting. I used to travel a lot especially for work and I loved the feeling of adventure when I arrived in a new strange place. I once totted up that I had been to over 50 countries (some very briefly): these included North Korea and Libya during the air embargo. I felt very privileged that I could go off the beaten track and work with people and not just be a tourist. However I have nothing against tourism. I now try to minimise air travel because of global warming. However I do shift my priorities. My son and his Basque wife live in Northern Spain and I had never visited them since they married nearly two years ago. I did not have the time or money to go overland so I flew. My husband has also had to travel a lot with work and we both now want to stay home more and to explore Britain which has so many beautiful areas. I love trains and have travelled in them in India and China as well as in Europe and the USA. Incidentally whenever we go on holiday I vow that I will have nothing to do with the baby food issue. Inevitably the first shop I pass has some terrible advertisement which is breaking the WHO Code. I sigh and take a photo to send to IBFAN. I long for the day when the world comes to its senses on this resolvable issue.
Mark Thwaite: What are you working on now Gabrielle?
Gabrielle Palmer: I am working on an internal advisory document about complementary feeding of older infants and young children. I cannot tell you any more about it because it is a confidential commission. A lot of my work has been helping organisations make decisions about infant feeding policies.
Mark Thwaite: Who is your favourite writer? What is/are your favourite book(s)?
Gabrielle Palmer: I admire the journalist Ryszard Kapuscinski and feel sad that he has now died and will never write again. I also love Bill Bryson. I would read anything by these two authors whatever it was about. I have produced a list of my ten favourite books for you and the difficulty was leaving so many authors out. I also love 19th century writers like Charles Dickens and George Elliot. I relish Mark Twain. I read lots of non-fiction and get very engaged. I've just finished The Spirit Level by Richard Wilkinson and Kate Pickett. I think this the most important book of the decade and want everyone to read it. It's a good job I only read it after my book had gone to press otherwise I would have delayed publication to include its remarkable evidence and ideas and my publisher would have wanted to kill me. I love psychological novels and murder mysteries. I enjoyed Zoe Heller's Notes on a Scandal which converted into such a good film. I am someone who will read or re-read the book after seeing a film adaptation. I must admit that I waste time reading newspapers and ration myself. I resist buying one because I can idle away the day with ephemeral journalism, especially when I have an urgent deadline.
Mark Thwaite: Do you have any tips for the aspiring writer!?
Gabrielle Palmer: My first reaction to this question is to say: 'don't do it, there is no money in it and you will suffer too much'. Apparently some people really enjoy writing but most writers I know suffer. The good times are good but the bad times are dreadful. But it is a type of compulsion. Like many writers I sometimes don't know what I really think until I've written it down. I suppose if I have any advice, it is the well known adage that Jane Austen followed: 'write about what you know'. So many people have incredible life stories and they don't think they are special because they are humble and modest but writing it down gives so much to others. My other advice would be to find a good editor or join a writers' group. Writing is a lonely business and you can get carried away with too many words. Everyone needs a kind but ruthless friend who will tell you when you are too boring or long-winded. A good editor is a true friend. If the publisher does not provide one find your own. Even if you ignore their advice, their comments still help.
Mark Thwaite: Anything else you would like to say?
Gabrielle Palmer: I suppose I would say do please read my book because I have put my heart and soul into it and the explanations here are inadequate. I fret about the environment and what the world will be like for my grandson and his peers. My experience from poorer societies is that people do not need loads of stuff to be happy and our rampant materialism has done harm. Everyone needs food, shelter and healthcare but after that it is the human contact that makes life fun. I have seen laughing, barefoot children playing with homemade cricket bats in a Dhaka slum and people dancing their hearts out to a local band. My own children played outdoors for two years when we lived in Mozambique and were quite happy without TV or loads of toys. Fresh air, imagination and a sense of fun was all they and the other children in the street needed. In my own society people moan and children whinge. The Spirit Level proves that equality is better for everyone on every score. My vision is that no child suffers from malnutrition (which includes obesity) and that no adult is so sad and disconnected from life that they need private jets or extra cars and houses to prove their worth.
Tue, 12 May 2009 02:31
Gabrielle Palmer, author of The Politics of Breastfeeding, is a nutritionist and a campaigner. She was a breastfeeding counsellor in the 1970s and helped establish the UK pressure group Baby Milk Action. In the early 1980s she lived and worked as a volunteer in Mozambique. She has written, taught and campaigned on infant feeding issues, particularly the unethical marketing of baby foods.
The Ragged-trousered Philanthropists by Robert Tressell
I find this book unbearably poignant because it was only published after Tressell's death. He died feeling rejected. He tells a story of the life of a house painter and decorator and describes the humiliations and suffering of underpaid urban working class life in the early 20th century. His political stance is that the purpose of all this exploitation and endurance is to make life comfortable for the rich who benefit from the workers' low waged existence. It is a novel but we know that Tressell speaks from his own experience and that reality shines through. His message is relevant today on a global scale. I based the title of my section on the US state-subsidised infant formula system ('the wet-diapered philanthropists') in my own book (The Politics of Breastfeeding) on his brilliant title. This book is essential reading for anyone who (like me) finds much intellectual political writing a bit turgid.
The Female Eunuch by Germaine Greer
This book changed my life. It gave me the confidence to think I could transcend the spoken and unspoken messages from my parents, education and culture which told me that women came second to men.
Poverty and Famine by Amartya Sen
Sen is a Professor of Economics and a Nobel Prize winner. Anyone could read this book and understand it. He describes famines (Irish, Ethiopia, Bengal) and shows how that people die not because there is no food to feed them but because they are not entitled to that food. Like most great ideas, this one is astonishingly simple and robust; when you analyse any famine you see that certain people (like aid workers, journalist and rulers) still eat while people are dying of starvation. His writings and views on economics are brilliant, wise and energised by a true caring for humanity.
On Liberty by John Stuart Mill
I was surprised how much I enjoyed this book. John Stuart Mill (born in 1806) is completely open about the fact that his ideas either came from or were inspired by his close friend Harriet Taylor. Their friendship thrived over 20 years while she was married to Mr Taylor. Everyone loves to speculate about whether JSM and HT were lovers (they later married after Mr Taylor died) but to me that is irrelevant. They had the most amazing intellectual intimacy and obviously sparked each other off to great emotional and intellectual benefit to themselves and to us. This book (and his other writings) has a wonderful emotional, as well as intellectual, integrity. JSM proclaims that he could never have done his work without her. They were a team. His ideas about, for example, freedom of speech, women's rights and education are all as relevant today as in the 19th century.
Long walk to freedom by Nelson Mandela
I took this on a long journey to read, almost out of duty, because I admired Mandela and wanted to know his story. I couldn't put it down because it was so well written, so entertaining and so human. I was working overseas and I used to make excuses to avoid the socialising (and I am very sociable) and race back to my hotel room so that I could eat up more of this delicious book.
Good behaviour by Molly Keane
A magnificent and under-rated novel, told in the first person with immense skill. The reader sees what is happening but the narrator is too innocent to notice the horrible reality. The tale reveals the hypocrisy and brutality towards women behind attitudes to sex. It conjures up the stifling 'blind eye-turning' of Anglo-Irish life in the first part of the 20th century and deals with issues that were never spoken about. Brilliant.
Notes from a Small Island by Bill Bryson
I am a devoted fan of everything Bill Bryson writes but this was the first book I read. He was talking about my country and my era with absolute accuracy, shredding the British to pieces but with great affection. I read this on a plane and shook with laughter so much that my fellow passengers gave me strange looks.
The Emperor by Ryszard Kapuscinski
RK was a Polish journalist who died in 2007. Everything he ever wrote was like mother of pearl. His writing is so simple, so clear and so easy that it is effortless to read and yet he writes about big things: death, war, power-crazed leaders. I picked this book because it describes all the little details of political collapse and the stranglehold of human habits and relationships on power struggles. It's about the collapse of the rule of Emperor Haile Selassie of Ethiopia in the 1970s. Whenever you read something by RK you think, 'Ah at last I understand why that place is in such a mess.' For me he is the best non-African writer on Africa ever.
Schindler's Ark Thomas Keneally
Now made famous by the Spielberg film Schindler's List, the book is a far greater testament to the characters involved. Keneally presents the paradox that some unpleasant people do good and some seemingly pleasant ones do evil.
Obedience to Authority by Stanley Milgram
A very important account of why humans do what they do to each other. Very relevant for our time. This book was reissued just when the abuses in the Abu Ghraib prison in Iraq were exposed. This book should be standard reading in all secondary schools.
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