The moralization of breastfeeding parallels the monetization of breastfeeding

newborn

Courtney Jung is getting great publicity for her forthcoming book Lactivism.

First there was the NYTimes op-ed Overselling Breast-feeding.

Now there’s a piece in the Atlantic The Big, Bad Breastfeeding Industry. As you might guess from the title, the author, Ester Bloom, is dubious of Jung.

Bloom explains Jung’s claims:

The moralization of breastfeeding parallels the monetization of breastfeeding.

People tend to associate the formula faction with corporate profits: It generates, by some accounts, “two million dollars a day.” But, Jung asserts, “some of the research that corroborates the benefits of human milk for infants is funded by companies like Medela, which makes breast pumps, and Prolacta Bioscience, a company that makes infant nutrition supplements from human breast milk.” The breast-pump and nursing-accessory industries, she writes, have market share to gain from an increase in the number of breastfeeding parents.

In other words, self-interest is inescapable, and unbiased information is hard to come by. This echoes an argument put forward in The Federalist by Rebekah Curtis, which came with the subtitle, “Breastfeeding wasn’t just revived by La Leche League but by those who figured out how to profit off it.”

Unfortunately, Bloom gets side tracked condemning the formula industry (which certainly deserves condemnation for past actions):

The commercial history of infant formula is a long and colorful one. In the ‘70s, Nestle was “accused of getting Third World mothers hooked on formula” via misleading promotional campaigns. The results were disastrous: Since many mothers could not afford the stuff they were told they needed, they over-diluted it, often using contaminated water. An in-depth New York Times Magazine investigation from 1981 reported that “the health consequences of the shift to bottle-feeding in the third world have been severe.” A worldwide consumer boycott of Nestle products ensued and lasted seven years.

This view can best be summed up as “who cares what the breastfeeding industry does when the formula industry has done such bad things in the past?”. No doubt Jung is going to hear this a lot but it’s a faulty argument. But the overselling of formula feeding in the developing world is not a justification for the overselling of breastfeeding in industrialized countries.

Bloom also falls for another facile argument in defense of the breastfeeding industry:

It helps no one to draw false equivalences between both sides of this debate when they’re as different, in terms of resources, as PBS and Comcast, or to imply that, when health organizations recommend nursing when possible, as they have done for centuries, they are doing the bidding of profit-hungry corporations.

She’s wrong about that. It helps the millions of women who have been harmed by the moralization of infant feeding. The benefits of breastfeeding have been grossly exaggerated by the organizations that profit from promoting breastfeeding. Being dishonest in counseling women (even for supposedly “good” motivations) deprives them of agency in making the best decisions for themselves and their families.

Moreover, Ms. Bloom’s draws the wrong conclusion from the relative sizes of the formula and breastfeeding industries. Consider: an individual who works for minimum wage is likely to be more aggressive in pursuing an opportunity to an earn an additional $50/week than someone who makes $1,000,000. Furthermore, formula is only one product of many for the large corporations that sell it whereas breastfeeding is the only product of the breastfeeding industry. The breastfeeding industry may not make as much money as the formula industry, but it is every bit as motivated by profit.

La Leche League was founded by women who believed that promoting breastfeeding was a way to keep mothers at home and out of the workplace. It was a volunteer organization providing peer to peer breastfeeding counseling. Then in the 1980’s the folks at LLL began to wonder why they were giving away information for free when they could make money from the same information. They spun off an organization that created the lactation consultant credential; women who previously earned nothing for giving breastfeeding advice at LLL meetings, now were earning $100/hr or more giving the same advice for profit. LLL and lactation consultants themselves began aggressively promoting and lobbying at all levels of government for lactation consultants in hospitals and doctors’ offices. They’ve grossly exaggerated the benefits of breastfeeding and minimized the difficulties for women. Regrettably, they hit upon the best marketing technique of all: they moralized infant feeding and convinced doctors (who should have known better) to moralize it, too.

Breastfeeding in 2015 has no greater or lesser benefits than breastfeeding in 1975, but the urgency around breastfeeding has grown phenomenally, far out of proportion to it’s actual benefits. That has harmed mothers and it hasn’t helped babies. The fact is that approximately 5% of women can’t make enough breastmilk to fully support a growing infant. Those babies are starving and their frantic mothers are admonished to “breastfeed harder,” get more help from lactation consultants, buy pumps and otherwise enrich the breastfeeding industry … and blame themselves for not giving their babies “the best.”

The history of lactivism shows that the moralization of breastfeeding parallels the monetization of breastfeeding. That’s not a coincidence and it needs to stop.

  • D/

    I’m beyond just a little curious what this study (Early Limited Formula for Treating Lactation Concerns) will bear out. https://clinicaltrials.gov/ct2/show/NCT02313181

    Already saw a handful of LCs in an on-line forum up in arms about experimenting on babies with “75% weight loss from birth” … along with a suggestion to notify the Surgeon General of this “unethical” study.

  • demodocus

    OT: my little singleton is coming along nicely. The other embryo disappeared.

    • Daleth

      Yay singleton! I’m sorry to hear the other one went away.

      • demodocus

        Thank you.

    • Megan

      Congrats on the healthy baby growing in there! Sorry if you were hoping for twins.

      • demodocus

        Thank you. My husband was more than half hoping, but me, not so much. Carrying a single at my age (39 in mid-winter) is dangerous enough and the thought of having 2 newborns along with my 2 year old is a bit scary.

        • Sarah

          Best of luck.

  • Fallow

    Dr. Amy, this is OT, but this woman nearly died of HELLP because her birthing center midwives ignored blatant pre-eclampsia symptoms. Her post is chilling.

    http://www.whatthehellp.com/real-stories/kerries-hellp-syndrome-story#.Vjdy7JO36R9

    • Ash

      homebirth midwives always seem to brag about their long prenatal appointments and the fact that they can do urine dipsticks during the appointment (hint: it’s because you don’t need a laboratory to do a dipstick). These prenatal appointments mean nothing if the midwives did not know that she was producing very little urine. Not to mention all the other things.

      I also wish to goodness that ALL HB midwives had a rule that if a patient requests to go to the hospital, NEVER argue with her. Transfer to the hospital immediately, no matter the reason.

      • Fallow

        RIGHT.

        And those midwives stopped even dipsticking her urine at 34 weeks! Which was when her initial pre-eclampsia symptoms began to develop. Isn’t that interesting. If you don’t run the tests, you don’t have to risk someone out, right? I shudder to think of how close that woman came to death.

        And, of course, these birth center fools had no clue the baby was transverse, either.

  • Amy

    Couple of thoughts….

    1) I would guess that, if anything, the benefits of breastfeeding today are smaller in degree than they were 40 years ago, if only because formula companies are continually trying to improve upon their formulas.

    2) Nestle’s a bad company, period, if you look at their positions on issues surrounding the availability of clean drinking water in the developing world and how they’ve taken over the bottled water market (how many labels do they control now?). But they’re not the only formula company out there. One company being horrible doesn’t mean that an entire class of product they sell is automatically to be avoided. After all, do these lactivitsts shun all bottled water, instant coffee, and chocolate? (Maybe some do– we have the luxury of going exclusively with tap water in our home, because our town water supply is excellent and tastes great, and lord knows there are going to be a lot of crunchies who have what they call a “clean diet” that doesn’t include coffee or chocolate. But I don’t see them out there arguing as vociferously against chocolate as a product.)

  • Megan

    Totally OT but I hoped to get some advice: now that I’m almost halfway through this pregnancy (it has flown by so far!) and we are starting to talk about rearranging rooms and getting ready to have two babies. My question is, for those of you with more than one, what is your experience with room sharing? Our oldest daughter will be 18 months old when this little lady arrives. We had planned to have them share a bedroom in order to maximize space in our three-bedroom house but I’m wondering if that’s a good idea. The first 4-6 months the little lady will likely be in our room but after that we’d be moving her in with her sister. My biggest concern is if the younger will keep the older awake at night (or vice versa). Oldest DD is currently a great sleeper and I would hate to mess that up. I do think that there are advantages to them sharing though, especially as they get older. I would love to hear experiences of others in a similar situation.

    • Amy M

      Well, its a little different, but my twins have shared a room since birth. They are almost 7 now. I’d say they adjusted to each other sleeping patterns well. When they were infants, they were pretty much on the same schedule, (and of course still have the same bedtime), but as they got older, if one didn’t fall asleep, he wouldn’t really keep his brother awake. I imagine that if your older one is really out, she won’t even hear her younger sister crying. Is it possible to have a bassinet/pack-n-play elsewhere in the house, in case naps don’t coincide? Maybe have the baby nap there, and the older nap in their room? And eventually, when the baby is a bit older and doesn’t wake in the night to eat anymore (and therefore has an actual bedtime), you can make bedtime the same for them.

      At the age they are now, the biggest issue with my boys is fooling around instead going to sleep. We are trying to combat this with offering a prize they can earn at the end of the week, if they don’t fool around. We used to take away their screen time, but that eventually had very little effect. The ultimate trump card is separation (we have a guest room) which we threaten with and have only had to use a handful of times.

    • Michele

      My boys have separate rooms but when we have had them sleeping in the same room such as when we have guests, they do tend to keep each other up. I found that I have to put the 1 year old to bed and wait until he is completely asleep before I put the 3 year old to bed. Once asleep they don’t bother each other.

    • Dinolindor

      My kids don’t share a room, but love it when traveling – my son is 3.5 years older than my daughter, so not the same age split as your kids. He’s old enough to get some nightmares and find comfort in having a roommate, even a little baby, in an unfamiliar place. One of my friends found that her older daughter’s problems with nightmares got much better once her sister moved into her room, too.

      While I don’t have direct experience, I would suggest comparing nap schedules, if they’ll be napping at home vs daycare. How would your younger one’s multiple nap schedule impact your older one’s afternoon nap? Would they nap at the same time or one after the other?

      My other suggestion is to consider how your older one currently uses her room during the day. Does she play in there a lot, or is it pretty much just for sleep? If she plays in there a lot, suddenly there are going to be a lot of forbidden times in her room during the day while the baby naps. Not to say that’s a reason not to room share, but something that you may want to address in preparing your daughter for the whole new sibling thing.

      Also, just because you don’t start out having them share once baby is ready to leave your room doesn’t mean they can’t start sharing somewhere later down the road. Like just in time for a guest to stay for a long time, or one of their birthdays, or when the younger is ready for a bed instead of a crib, or because “it’s time”, etc. Or the opposite – if you start them out sharing and it’s just not working. Since you have that 3rd bedroom, it’s your house and you can change your mind on how to arrange it as your needs change. It’s not set in stone.

    • Mishimoo

      My girls still willingly share a room at 9 and 6, it’s worked really well for us so far especially since they’re scared of the dark. They’ve been sharing since the younger one was 6 months or so, and were sad that there wasn’t enough room for their little brother to move in once he moved to a cot.

    • Megan

      Thanks everyone for your replies! I really appreciate the advice!! I think we’ll give room sharing a try. Currently I nap with DD in our bed. Not sure what we’ll do with that by the time little lady arrives but I can always have her nap in the bassinet if they need to be separated.

    • guest

      My 2 are 2 1/2 years apart. The baby slept with us for the first few months, then we put them together. We started out putting the baby to sleep in our room, then moving her when our son was asleep. Eventually, we put her to bed in their shared room about an hour before our son’s bedtime and that works well. We still have them nap separately. The baby has a pack n play in our room for that. I think they adjust to each other’s sleep sounds. If one wakes up during the night, the other rarely notices it. Also, agreed that it helped my son with his fear of the dark.

  • StephanieA

    Just wanted to update on a comment I made on another post. I’m pregnant and worried about PPD. I spoke with my OB yesterday and she was totally onboard with me starting Prozac during my third trimester. I’m so relieved, my doctor is very pro breastfeeding but she didn’t even question me about it after we discussed this. I’m so relieved that I will be on medication before delivery, and I’m not going to lie, I’m happy that I won’t feel pressure to breastfeed. Now, if only I could not feel so guilty about the 30 lbs I’ve gained already! 🙂

    • Who?

      Terrific news, well done for raising it, it must have been difficult to make a start on that conversation.

    • Spamamander

      Good on you. I was very reluctant to take my depression medication during my third pregnancy, but the severe PPD I had after baby #2 really didn’t make it an option. I wasn’t eating and finally consented to Prozac during the second trimester. And I did consider not having pressure to BF a plus! I already knew after my first two I didn’t want to attempt it again. Taking care of yourself IS taking care of your baby.

    • lilin

      Sounds like you and your OB came up with a good plan. Be proud.

    • demodocus

      Excellent. Here’s to a not-depressed post-partum phase (or at least not-so-depressed). 🙂

    • Megan

      So glad you and your OB were on the same page. Hopefully this will alleviate some worries for you!

    • Michele

      Yay! Good for you! So glad your OB isn’t pressuring you.

    • Sue

      Mothers with pre-existing depressive illness are definitely at risk for PPD. The best thing for your entire family, including your baby, is for you to be well.

      Since the only good evidence for the (limited) benefit of BF in wealthy societies relates to (mostly minor) respiratory and gastro infections in the first year of life, you can lower that anyway by limited infectious contacts and household smoking. Both of those have a much bigger impact than the type of milk fed.

  • namaste863

    IMO the subtext of the whole by/ncb/app thing is to keep the “Wimmin folk” out of the workplace. Think about it; everything for which they push eats up tons of time and energy. God forbid you need to…..you know……sleep because you have an interview for the big promotion.

    • KarenJJ

      You can’t make motherhood too easy. Otherwise everyone would do it, even those people less worthy…

  • demodocus

    As my best friend’s mom says, First, feed the baby. The only moral problems are if the baby doesn’t have enough or if his/her food is known to be contaminated (and that can be breast milk). Why is this even a question? I don’t get it.