In recent years, the black maternal and fetal health crisis has been front page news, and for good reason. Black women die from pregnancy complications at three times the rate of white women, and the black infant mortality rate is more than double that of all other ethnic groups. Due to racism in the medical industry, environmental stressors and the impact of poverty, black babies are almost 50 percent more likely to be born prematurely than white infants. As medical professionals and activists seek causes and solutions for this health crisis, scholars have begun to weigh in on the history of race, childbirth and childrearing. Some activists have begun examining the connection between breastfeeding rates and infant mortality in the black community, but until Andrea Freeman’s new book, little scholarly work has been published on the subject.
Andrea Freeman’s Skimmed: Breastfeeding, Race, and Injustice (Stanford University Press, 2020) tells a compelling story of the use and abuse of the Fultz quadruplets by dairy corporation Pet Milk in the early twentieth century. The four sisters, born to a black Cherokee mother in 1909, were subjected to experimental vitamin injections and contracted to Pet Milk as spokes-babies for their infant formula in the black community. Their mother wasn’t even given the right to name her own children. The girls’ names, Ann, Louise, Alice and Catherine, were given to them by Dr. Klenner, the physician who delivered them and experimented on them. Klenner put the girls on a regimen of high dose vitamin C injections beginning at birth, a treatment he thought would lead to greater health (19). The contract with Pet Milk, which their parents were pressured into signing, eventually led to the girls being taken from their parents and placed with a foster family. Throughout their childhood, the Fultz girls were routinely paraded as evidence of the safety and efficacy of formula at black cultural events around the south. Their work for Pet Milk interfered with their education — none of the girls finished college — and had long lasting impacts on their success as adults. Mysteriously, all four died from cancer at relatively young ages.
Freeman’s study of the Fultz sisters tells the story of the lives of four women who were both ordinary and extraordinary. The sisters were born to an ordinary black family of tenant farmers in rural North Carolina who had several children already. Unusually for 1909, they were born in a hospital. The sisters, though born early like most multiples, were healthy and did not suffer complications from prematurity. Fed on formula from their first day, the sisters grew quickly and were soon discharged from the hospital. They went home to the new farm, purchased for their family by Pet Milk, in the company of their mother, siblings and the nurse hired to help their mother and keep an eye on the girls for their sponsors. Reporters visited regularly to view the girls through the special window into their nursery, and interviews with their parents and nurses were published regularly. Publicity became the center of their lives from infancy onward. Freeman follows their lives throughout the first half of the book, and then shifts to her broader analysis of marketing.
Freeman, a white law professor at the University of Hawai’i, is known for her work on food deserts. She approaches her study of the marketing of formula to black mothers and the subsequent decline in breastfeeding rates from this framework, or as she calls it, the “first food desert.” This interpretation, as well as an (over) emphasis on the benefits of breastmilk for infants, permeates the book. Although Freeman opens the book with the caveat that she does not want to push the idea that “Breast is Best,” judgment pervades the text in her discussions of formula feeding vs. breastfeeding and her analysis of black women’s substantially lower breastfeeding rates. Freeman analyzes the ways in which the American welfare system, including the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), generates incentives to feed formula while offering few real alternatives for working mothers. Lack of paid maternity leave, pumping breaks and appropriate space for expressing milk, as well as strict daycare regulations around the handling of breastmilk create much larger barriers for women working in the service sector than for women with their own offices or control over their own schedules.
Freeman’s account of the Fultz girls’ upbringing is a fascinating story that illuminates how celebrity shaped their childhoods as well as how the entertainment industry and the legal system were complicit in the breakup of the Fultz family. The connection between Freeman’s argument about the causes of low rates of breastfeeding is only loosely tied to her biography of the Fultz quadruplets. Once Skimmed moves beyond the story of the Fultz sisters, the argument breaks down. It becomes clear by the middle of the book that the author was uncertain about the intended audience for the text. The opening chapters give a nuanced and well-cited narrative that would be a strong opening for any text in history, Africana, or women’s studies. After telling the majority of the quadruplets’ life story, the book becomes more pointed in its analysis of the systemic barriers to black breastfeeding, and more theoretical and less grounded in the real-life experiences of black women. Freeman spends an entire chapter laying out basic theoretical outlines of the stereotypes of black women and drawing connections between the stereotypes and the treatment of black mothers in high profile cases of child neglect, something likely unnecessary for a scholarly audience of humanists, but perhaps illuminating for legal scholars.
The second half of the book is where Freeman reveals her own privilege as she attempts to make her larger argument about the impact of formula marketing in the black community. Although she positions herself as an ally, her position as a white mother who lives in a predominately upper-middle class white community shows through her analysis. Freeman’s analysis of the structural and cultural systems that encourage black women to feed their infants formula covers ground that makes sense: medical racism and hospital policies, the lack of maternity leave beyond 8 or 12 weeks, little workplace support, less familial support, and pressure from formula companies and other media. But rather than challenging the systems that encourage black women to use formula, Freeman’s analysis focuses on the personal decisions black women make. While Freeman expresses sympathy in her discussion of “first food deserts,” her discussion at times takes on a judgmental tone. She seems to argue that if only black women breastfed their children, obesity, diabetes, asthma, and a host of other health problems would not be rampant in the black community, ignoring the other environmental and socio-economic factors that predispose African Americans to those health issues. In addition, Freeman pays little attention to the high numbers of black infants who are born prematurely or via cesarean section, both factors that are much more likely to impede milk production in mothers.
As she asserts early in the book, breastfeeding is a very personal decision, and it’s hard to determine why any particular woman might choose to breastfeed or formula feed. It is doubly difficult to parse this decision for black women, who already face discrimination on many levels and who also, as Freeman herself illustrates, struggle against predetermined bias against them as mothers. Stories of black breastfeeding that cast black mothers in a positive light make up only a small portion of the book. Outside of a few stories of celebrities who breastfed their babies, there are stories only of women whose babies died, were taken from them, or women who were otherwise deemed unfit mothers. This book provides an interesting starting point for additional scholarly work on the history of breastfeeding and marketing to mothers, but fails to fully connect a fascinating history of early formula marketing to black women to the causes of the current low rate of breastfeeding among black mothers.