“What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesn’t require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes?” Nicolas Kristof begins his Sunday New York Times column. “Impossible, you say? Actually, this miracle cure exists. It’s breast milk.”

Traveling through the desperately poor West African nation of Niger, Kristof can’t help but see the tragedy of so many babies dying of hunger- and food-related illnesses, and only 9% of mothers taking the “cheap,” “obvious,” “instinctual,” “simple,” “low-tech” high road of exclusive breastfeeding.

His thesis – that breastfeeding is a net positive for both babies and mothers – is inarguably correct. Studies have shown, again and again, that exclusive breastfeeding for the first six months of a baby’s life is the firmest foundation for future health and wellbeing. According to a 2008 study published in The Lancet, reliance on breastfeeding could save the lives of 1.4 million babies per year. “That’s one child dying unnecessarily every 22 seconds,” Kristof notes.

But Kristof and the exclusive-breastfeeding lobby miss the larger point that, while cheap and low-tech, breastfeeding is neither simple nor purely instinctual. Instead, it is a complex interaction that is as much a function of culture as it is biology. The prevalence of breastfeeding has changed across time and across cultures, and it can only be understood in context.

Niger is a great example. On the fringes of the Sahara, it is among the world’s poorest nations, second to the bottom of the UN Human Development Index. Women bear a tremendous burden. An estimates 84% of girls marry by the age of 15; it is not uncommon for girls as young as 9 to be wed. Fifty percent have borne their first baby by age 16. Only 11% have access to contraception. Not surprisingly, Niger has the highest fertility rate in the world, with 7.8 children born per woman. Given that only 46% of women have even a single prenatal checkup and only 33% have a skilled birth attendant for their many, many labors, it is equally unsurprising that 12 out of every 1,000 Nigerien women die in childbirth. One in four of their children die by the age of 5.

Between 85 and 90% of females are illiterate. They have few legal rights and little representation in the government. A 2007 survey found that 70% of women believed domestic beatings and rapes were “normal.” During a 2005 famine, Unicef had to reach out with emergency microloans when it became clear that a high proportion of men were hoarding the family food stores, leaving their wives and children to go hungry.

So these women, who marry and birth too young, who have no bodily autonomy or control over their destinies, who have no access to information other than the advice of other women in exactly the same situation, who are accustomed to watching their peers or their children die, who are themselves often perpetually malnourished, can perhaps be forgiven for not wholeheartedly embracing The Womanly Art of Breastfeeding. They’re busy just trying to survive.

Yes, exclusive breastfeeding should be promoted in the developing world. But it is not a “miracle cure.” We need to create a healthy population of mothers, who marry well after puberty and have access to the full range of family planning choices. We need to increase access to clean water sources, so if women do choose to formula-feed, they can do so safely.  We need to assure that women in the developing world have access to education, to legal rights, to micro-credit, to food. If we want to save 1.4 million babies a year, we first have to assured that they’re born into a world worth living in.