Doctors: the original lactivists

Lactivists, like many purveyors of “natural” health, love to rewrite history. Just like the vaccine rejectionists love to pretend that vaccines were invented to treat diseases that “weren’t dangerous” or “were disappearing by themselves,” lactivists like to pretend that infant formula was invented despite the fact that there was no need for it, and an unholy alliance of formula makers and physicians subsequently tricked women believing in non-existent benefits.

As Rima Apple explains in Mothers and medicine: a social history of infant feeding:

… In attempting to uncover the roots of our present circumstances, historical studies often portray women as passive in the face of medicine expertise, (male) physicians as engaged in conscious manipulation of (female) patients, or both. Although such analyses illuminate certain aspects of today’s situation, they ignore many important dynamics. This is especially the case for an issue of historical and contemporary importance — infant feeding.

That’s because the real history of infant formula belies the lactivist fantasy that breastfeeding is easy, and that women unsullied by formula advertisements want to breastfeed and are “empowered” by doing so. The development of formula was not precipitated by pharmaceutical companies, rather it was precipitated by the reality that substantial numbers of women couldn’t or wouldn’t breastfeed their babies. Far from “creating” a need for formula, physicians, having failed to convince women that breastfeeding was a matter of life and death, were desperate to find a safe, nutritious substitute food for infants who were dying in droves. In other words, lactivists have it precisely backwards.

In fact, the first true lactivists were physicians. As Jacqueline Wolf explains in the chapter Saving Babies and Mothers: Pioneering Efforts to Decrease Infant and Maternal Mortality, in the book Silent Victories: The History and Practice of Public Health in Twentieth Century:

The custom of feeding cows’ milk via rags, bottles, cans and jars to babies rather than putting them to the breast became increasingly common in the last quarter of the nineteenth century progressed… In 1912, disconcerted physicians complained bitterly that the breastfeeding duration rate had declined steadily since the mid-nineteenth century “and now it is largely a question as to whether the mother will nurse her baby at all. A 1912 survey in Chicago … corroborated the allegation. Sixty-one percent of those women fed their infants at least some cows’ milk within weeks of giving birth.

The unwillingness of mothers to breastfeed crossed every strata of society:

This custom of artificial feeding crossed class lines as upper-, middle-, and working-class women alike- prompted by different social. economic, and cultural pressures- all participated in the practice. Upper-class women relied heavily on servants for infant care and that dependence often precluded breastfeeding… New expectations for marriage based on companionship rather than economics shaped middle-class women’s infant feeding practices as the bond with their husbands became more important than their relationship with their children… Working-class mothers found their infant feeding practices dictated by economics. Women who worked outside the home often had to leave their infants with grade-school daughters and artificial food. The burgeoning number of Little Mothers’ Clubs. after-school organizations that trained thousands of young girls to better care for the infant siblings left in their charge, reflected this growing practice…

This refusal to breastfeed, or to breastfeed exclusively, let to soaring rates of infant mortality because cows’ milk was contaminated.

… The late.nineteenth.century urban milk supply killed tens of thousands of infants each year. Unpasteurized and unrefrigerated as it journeyed from rural dairy farmer to urban consumer for up to 72 hours. cows’ milk was commonly spoiled and bacteria-laden. Public health officials dramatically charged that in most U.S. cities, milk contained more bacteria than raw sewage…

In an effort to save infant lives, physicians and public health officials embarked on two parallel campaigns, the first designed to increase rates of exclusive breastfeeding, the second aimed at teaching women to pasteurize milk. The emphasis was placed on breastfeeding:

The medical community deemed human milk so vital to infants’ health that doctors even feared that providing clean cows’ milk to babies might be counterproductive since it tended to exacerbate low breastfeeding rates. At a 1910 meeting of the Chicago Milk Commission. a medical charity that provided certified/pasteurized milk at no cost to consumers via dozens of neighborhood milk stations, one doctor complained that the Commission’s widely advertised milk made it easy for a mother “to shirk her obligations” and avoid breastfeeding. An exasperated Chicago Medical Society. which managed its own certified milk operation. likewise decried plummeting breastfeeding rates and editorialized in 1909. “We even incline to the opinion that the babies and children would get along very nicely if the entire [cows’] milk supply, whether pasteurized or not, were shut off entirely and permanently.’

But women did not want to go back to breastfeeding. Public health campaigns to increase breastfeeding rates were dismal failures; only one major city, Minneapolis, managed to increase breastfeeding rates enough to have an impact on infant mortality. Everywhere else, infant mortality due to contaminated cows’ milk did not begin to decrease until a substantial proportion of the milk supply was pasteurized.

Ultimately, cows’ milk was replaced by infant formula, which more closely matches the composition of human milk, is sterilized and is very convenient to buy, store and use. The bottom line, though is that breastfeeding rates did not decline in response to the availability of breast milk substitutes. Breastfeeding rates declined substantially long before the advent of formula and even before the advent of safe breastmilk substitutes.

The efforts of contemporary lactivists to raise breastfeeding rates are doomed to failure for the same reason that the efforts of the original lactivists, doctors, were doomed to failure. For many women, breastfeeding is difficult, uncomfortable and inconvenient. Instead of finding breastfeeding to be empowering, most women find bottle feeding to be both empowering and liberating.