Book Review! Gabrielle Palmer: Complementary Feeding: Nutrition, Culture and Politics, London: Pinter & Martin (128p., £9.99)

2 Mar

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Having helped established Baby Milk Action, co-directed the International Breastfeeding: Practice and Policy Course at the Institute of Child Health in London, and served as HIV and Infant Feeding Officer for UNICEF New York, Gabrielle Palmer can speak with authority on infant feeding. At just 128 pages (including appendices and references) her 2011 book is much briefer than the impressive Politics of Breastfeeding (Pinter & Martin 2009; originally Pandora Press 1988), but no less thought-provoking.

The book is divided into three sections. Part one, ‘The Big Picture’, covers aspects such as entitlement to food and water, as well as an explanation of what Palmer means by ‘Complementary Feeding’: she decided against the use of the word ‘weaning’ as this suggests that food replaces breastmilk in the baby’s diet – ideally, babies continue to receive breastmilk while trying out their first foods.

Part two, ‘A Closer Look’, gives an overview of the industrialisation of food systems: how brand power exploits consumers’ trust, and de-skilling and poor access to healthy food leads to dependency on processed products.

Part three, ‘Processes For Change’, discusses the importance of clearly-worded legislation (‘fresh’ and ‘natural’ can be used in surprising ways) and the benefits of eating primarily locally grown food. This section also contains a brief overview of Great Britain’s food distribution policy during the Second World War which led to remarkable improvements in mother and child health. The success of this policy is contrasted with the US Special Supplemental Programme for Women and Children (WIC) which despite preventing undernutrition in economically disadvantaged people, Palmer states, is likely to have had a negative effect on breastfeeding rates and contributed to obesity problems in the US.

Particularly fascinating was how Palmer neatly linked a discussion of the complexities of Ready-to-Use Therapeutic Foods in developing countries with children’s malnutrition in richer countries due to marketing and misinformation: in developing countries babies starve when breastmilk is replaced with substitutes which cannot be prepared safely because of inadequate water supply or watering down; in developed countries babies are overfed when breastmilk or formula are replaced too early with baby rice or mashed food.

Palmer repeatedly highlights the fact that healthy and adequate nutrition is not simply achieved through the provision of food: complementary feeding is also a learning process for the child during which she becomes part of the community, forms taste preferences and learns appetite control. An astonishing fact mentioned by Palmer is that our oxytocin levels increase and the digestion and metabolism of food becomes more efficient when we eat together with others.

Palmer states several times throughout the book that her aim is not to be prescriptive, but rather to stimulate thought. In this she is certainly successful. At no point does she admonish parents for their feeding choices; instead she places blame for both starvation and obesity on political decisions and companies’ unethical behaviour. The tone of the book is factual: it is for information purposes rather than an attempt to make mothers feel good about their choices, thus I would imagine that, for example, puree-feeding mothers would be uncomfortable with hard-hitting facts such as “[p]ureed, semi-liquid and diluted foods are unnecessary, because if a child cannot chew, he is not ready to have anything other than breastmilk (or the best possible breastmilk substitute)” (49).

I was pleased to see Palmer repeatedly mention the benefits of delayed cord-clamping as this is a rare practice whose benefits do not seem to be widely known outside ‘earth mother’ circles. The volume of blood a baby receives when the cord is cut only once it has stopped pulsating provides a vital amount of iron. While babies are born with sufficient iron stores to see them through ca. the first six months of their life and breastmilk provides a large percentage of a baby’s micronutrient requirements throughout the first and even second year of her life, delayed cord clamping makes a significant difference to the baby’s long-term iron stores: Palmer notes that 100ml of blood from a newborn is the equivalent of taking over a litre from an adult.

All of Palmer’s statements are backed up by a solid grounding in research, details of which can be found at the end of the book, together with an index. This makes Complementary Feeding a good choice for readers who have a special interest in nutrition and its politics.

One aspect of the book about which I’m not quite sure is its structure. First, the purpose of the appendices is not clear: they are written in the same style as the main part of the book and contain information which simply could have been included in the chapter to which they pertain. Similarly, the inclusion of both an introduction and a foreword is confusing, especially as they are separated by the acknowledgements.

Second, although Palmer’s arguments in general are very clear, I find that in some instances the chapters’ internal structure is not strict enough for my taste which makes it difficult to understand the particular chapter’s aim (e.g. why are the benefits of fermented milk products included in the chapter on cereal?). I suppose the book’s great strength, the wealth of information it contains, means that it is sometimes difficult to separate interlinked facts in favour of structure.

I can’t help the impression that most of the book consists of the paper which Palmer wrote for the International Baby Food Action Network mentioned in the introduction with added black and white photos of eating children to make it marketable to the average reader. This is not necessarily a bad thing though, as thanks to Pinter and Martin we can have access to this information too. It is worth having a look at the other books by this publisher, by the way, as they include influential works by Grantley Dick-Read, Sheila Kitzinger and Ina May Gaskin.

All in all, then, in my opinion Complementary Feeding is a great book: Palmer’s accessible style, as well as the short chapters and lists of key points at the end of each of the three sections (both presumably leftovers of the book’s original purpose), make it easy to read in short bursts while Palmer’s arguments and the way in which she questions public policy makes it particularly satisfying.

Although the style of Complementary Feeding is very matter-of-fact, Palmer occasionally uses humour in a way which reminds us that, despite being fact-heavy, this is not a book about dry biological processes, but about children – small vulnerable people with funny quirks who need our protection to let them develop into strong adults with healthy attitudes and access to good food.

Disclaimer: I was sent this book for free by the publisher as part of their reviewers’ book club. (But I probably would have bought it myself at some point anyway as I enjoyed The Politics of Breastfeeding!)

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