Insisting that “breast is best” is like insisting that “heterosexual is best”

64277031 - hands holding cardboard on bokeh background with text: love wins

I’ve written many times that I consider lactivism in general and the Baby Friendly Hospital Initiative to be unscientific, harmful and often unethical. Why? Because insisting that “breast is best” is no different than insisting that “heterosexual is best.” Both reflect prejudice, not science.

Although lactivists like to invoke “science” to support their claim that breast is best, their reasoning has much more in common with religion than science.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Both imply that a choice was made when there was never any choice at all.[/pullquote]


1. Lactivists claim that women are “designed” to breastfeed. Science tells us that women aren’t “designed” at all; they are products of evolution. It is religion that insists on a designer and a design.

2. Lactivists claim that breastfeeding is nearly always perfect because it is natural. If science teaches us anything, it is that ‘natural’ is not a synonym for perfection. Hurricanes and earthquakes are entirely natural and generally quite harmful.

3. Lactivists claim that the fact that “we are still here” means that breastfeeding always works. That’s just a riff on the claim that breastfeeding is perfect, implying that our survival depends on perfection. Science teaches us that only the fittest survive, not everyone; and that survival is perfectly compatible with failure, imperfection and variation.

It’s easier to see the religious nature of these arguments when you realize that they are the exact same arguments that are often made to justify discrimation against gay people.

1. Homophobes insist that people are “designed” to have sexual relations with the opposite sex.

2. Homophobes insist that heterosexuality is best because it is natural.

3. Homophobes insist that heterosexuality is perfect because “we are still here,” implying that we wouldn’t be here if homosexuality were also natural. Science teaches us that population growth does not require that every individual have offspring.

Homophobia is rooted in a religious belief that homosexuality violates God’s “design.” Lactivism is rooted in the near religious belief that formula feeding violates nature’s “design.”

For many homophobes, their antipathy to gay people is rooted in the religious belief that sexuality is a choice. For many lactivists, their antipathy to women who don’t breastfeed is rooted in their belief that there are no women who are unable to breastfeed, only those who are unwilling. In other words, it’s a choice.

Many homophobes are advocates of gay conversion therapy, based on the idea that with enough “support,” gay people would become heterosexual. It is axiomatic for lactivists that women who can’t or don’t breastfeed are suffering from lack of support. According to their reasoning, if only women were only supported more, they would always be able to breastfeed.

Many homophobes blame contemporary culture for promoting homosexuality. Loose sexual morals, acceptance of difference, and the injunction against discriminating against gay people combine to make homosexuality an acceptable and therefore attractive choice. In the absence of a permissive culture, homosexuality would be non-existent. Nearly all lactivists blame contemporary culture for promoting formula feeding. In their view, acknowledging that insufficient breastmilk is common, pain is common, inconvenience is common combine to make formula feeding an attractive choice. In the absence of formula industry marketing, formula feeding would be non-existent.

It is easy to recognize the self-serving moralism of homophobes. It is harder to recognize the self-serving moralism of lactivists, but it is no less serious and harmful. The difference is that, through education, we have become sensitized to the ugly reasoning behind homophobia. Homophobia is inevitably about some people feeling superior to others.

Unfortunately, because of relentless efforts to promote breastfeeding as an unmitigated — and always perfect — good, we can’t always appreciate the ugly reasoning behind lactivism. It is inevitably about some mothers feeling superior to others.

Claiming that “breast is best” is like insisting that “heterosexual is best.” It implies that what is common must therefore be superior; it refuses to acknowledge individual variation; and most egregiously it invokes choice where there is often no choice.

Hopefully most of us recognize that claiming that “heterosexual is best” is nothing more than prejudice. It is love that makes a relationship, not corresponding sexual organs.

It’s time to recognize that “breast is best” also reflects prejudice. Motherhood is powered by love, not breastmilk.

64 Responses to “Insisting that “breast is best” is like insisting that “heterosexual is best””

  1. swbarnes2
    April 4, 2017 at 2:46 am #

    OT: Irish breastfeeding paper, 8000 kids, focusing on cognitive development.

    “RESULTS: Before matching, breastfeeding was associated with better development on almost every outcome. After matching and adjustment for multiple testing, only 1 of the 13 outcomes remained statistically significant: children’s hyperactivity (difference score, –0.84; 95% confidence interval, –1.33 to –0.35) at age 3 years for children who were breastfed for at least 6 months. No statistically significant differences were observed postmatching on any outcome at age 5 years.”

    They seem to be rather excited about that one significant result out of their 26 tests, even though that’s kind of the hallmark of a spurious result, and they have absolutely zippo improvement lasting the full 5 years.

    Note that they didn’t correct for maternal IQ, which is known to be a significant confounder and they still found bupkis lasting 5 years.

    And their conclusions? Since there only blips were in the 6+ month breastfed category, they claim their data supports benefits encouraging MOAR BREASTFEEDING LONGER.

  2. Platos_Redhaired_Stepchild
    April 2, 2017 at 5:44 pm #

    Actually, I’d go so far to say that BIB is more than just “similar” to saying heterosexual is best. It actually is saying that bio mothers are only good parents because the unlikelihood of an adoptive parent / male parent being able to breast feed.

  3. myrewyn
    April 2, 2017 at 3:42 pm #

    OT because you guys are my favorite bank of knowledge right now. My MIL is in poor health and we will need to travel to Tucson ASAP to visit her after our baby is born to make sure she gets a chance to meet the baby named after her. At what point would you say it is feasible to fly with a newborn?

    • Empress of the Iguana People
      April 2, 2017 at 4:03 pm #

      Ugh. I’m sorry about MIL, that’s rough.
      If it were feasible, I’d prefer to drive with a newborn, (regular stops, fewer people’s germs, baby doesn’t have to deal with changes in cabin pressure) but if flying is a must and soon, then I don’t suppose it much matters. (bearing in mind I know darn little.) I’d prefer not to fly until at least 2 months and their first DTap.

      • myrewyn
        April 2, 2017 at 4:23 pm #

        I’ll see what my guy thinks of a roadtrip. He usually hates driving (he’s one of those gazillion mile frequent flyers) but he may be open to it to protect the baby.

        • April 3, 2017 at 3:10 am #

          Because my mother was terminally ill, I flew from Israel to the US when my son was 10 days old. No problems at all. Airline provided carrycot, and the motor vibrations kept him sleeping almost the entire trip. The stewardesses were most solicititous.

          • myrewyn
            April 3, 2017 at 1:04 pm #

            I bet the flight attendants were thrilled to see such a tiny baby! Aww!

        • Dr Kitty
          April 3, 2017 at 5:54 am #

          Would you consider taking 2 days each way and stopping at a motel for the night?

          Newborns sleep so much that flying with a baby under 3 months is much, much easier than flying with a toddler or older baby, but international airports and recycled cabin air are not good for unvaccinated infants.

          • myrewyn
            April 3, 2017 at 1:04 pm #

            Yeah if we drive it would have to be split into two days each way.

            Pertussis would be my main fear on an airplane but I did just get a booster and incidentally The Pediatric Insider just wrote today about how effective that is for protecting babies too young for their own vaccines.

            The situation isn’t ideal either way but I appreciate everyone’s input so much! Thanks!

          • Dr Kitty
            April 3, 2017 at 2:33 pm #

            Whatever you decide to do, I would make the decision after the baby has arrived and you have had a few days to adjust to parenthood (a 20hr drive might be unworkable if you’re recovering from a 3rd degree tear, or have a baby who feeds 45 minutes at a time every 90 minutes for example).

            You’ll have an idea yourself what you can do once you’re through L&D and know what kind of baby you have.

            However you decide to get there, most likely everything will be fine, it’s more important you make the trip if possible and have no regrets in that regard.

    • Aine
      April 2, 2017 at 4:37 pm #

      I know in Europe the minimum age for most airlines is 8 days if the baby wasn’t premature. No idea what the medical view on that is though. You should also check with your airlines whether you will need photo ID for the baby (passport?) to board a flight and this takes time to organise even after the delay while birth certificate is issued.

      Pesonally though, I’d prefer the risks of a reasonable length flight to those of a lengthy road trip for a newborn. In Europe, the recommendations are for babies to spend no longer than one hour at a time in a car seat. Add in time for feeds and you can easily at least double the expected journey time. I think with a bit of care, the chance of catching something on the flight are pretty minimal. No scientific basis for this though.

      Hope your MIL gets to meet your baby.

      • myrewyn
        April 2, 2017 at 4:45 pm #

        Looks like two flights of about two hours each with a one hour stop, vs 20+ hours to drive. I have no idea about ID, I didn’t even think of that! I’ll have to look into it.

        • guest
          April 2, 2017 at 9:02 pm #

          For a US domestic flight, you do NOT need a photo ID for a baby, just a proof of age. They often don’t even check it, especially if the baby is clearly under two. The most common documents for babies are the birth certificate or an official vaccination record. I believe other types of medical records showing the date of birth and name would be acceptable.

    • Aine
      April 3, 2017 at 3:52 am #

      One other thing to consider – your risk of DVT is massively elevated in the first six weeks after birth, even if you didn’t have a c-section (nobody ever mentioned it to me and I learned it the hard way, not even travelling but sitting under my baby cluster-feeding for hours as the lactivists insisted I should). So make sure to take all possible precautions whichever way you travel, particularly on the drive. You would need to allow extra time for regular walking breaks for you and be disciplined about taking them. A 20 hour drive sounds intolerable to me even at the best of times; add a newborn and your own comfort needs and it could be really challenging. I really think the flights would be best. If it helps, most airlines I am familiar with allow you to purchase an extra seat for the infant and use a car seat to strap them in there.

      What a difficult situation and how lovely of you to be trying so hard to allow your baby meet her grandmother.

    • SporkParade
      April 3, 2017 at 5:44 am #

      Our pediatrician advised waiting until 2 months, not because of the flying but because of the being in a close space with a bunch of people (you do not want a baby under 2 months with a fever). That said, flu season is basically over, which would be my big fear about flying on an airplane.

  4. SporkParade
    April 2, 2017 at 6:34 am #

    I got into a scary discussion with some people I went to college with about why wet nursing has fallen out of fashion. Scary because I was the only person who seemed to think there was anything wrong sharing breast milk between close friends. Everyone in this discussion was old enough to remember when the first effective antiretroviral therapy for HIV came out. And privileged enough to easily afford formula and prepare it safely.

    • Sarah
      April 3, 2017 at 3:41 pm #

      HIV, awareness of blood borne diseases, basic employment rights putting domestic help beyond the reach of most people didn’t compute, then?

      • SporkParade
        April 4, 2017 at 11:56 am #

        I think they’ve decided that, if having unprotected sex with one’s spouse is okay, giving unscreened body fluids to one’s baby is also okay, especially because pregnant women are tested for HIV in many places. The FDA, AAP, and equivalent bodies in every other developed country disagree with them, but that didn’t seem to compute. Nor did the fact that over 3% of women seeking to donate breast milk end up being positive for milk-borne illnesses that can kill a baby, and clearly this are women who are assuming they are healthy.

        • kilda
          April 4, 2017 at 2:03 pm #

          not to mention that giving a friend’s unscreened body fluids to your baby isn’t analogous to having unprotected sex with your spouse. It’s like having unprotected sex with your friend. And their spouse.

          • Sarah
            April 5, 2017 at 5:41 am #

            And anyone they or their spouse might have had unprotected sex with since the friend was last tested for HIV.

          • SporkParade
            April 6, 2017 at 4:03 am #

            Their argument was that pregnant women are tested for all these diseases, so the risk a lactating woman has contracted them in the meantime is low. Also, in all fairness, the first HIV+ guest speaker I ever heard had been infected by her fiance.

  5. Allie
    March 31, 2017 at 9:59 pm #

    “For many homophobes, their antipathy to gay people is rooted in the religious belief that sexuality is a choice.”
    Gee, and here I thought it was fear of their own latent homosexuality.

    • SporkParade
      April 2, 2017 at 5:51 am #

      I think a lot of homophobia is actually rooted in toxic masculinity, and religion is just a convenient excuse. Like, if you need women to be subservient to men, a relationship between equals is inherently threatening to your self-worth as a man.

  6. AA
    March 31, 2017 at 6:03 pm #

    Some folks might find this discussion interesting–FYI, this subreddit is intended for medical professionals, so it may fall into the category of “read only” for many commenters (including me).

    I had to cringe at user Shenaniganz08’s that hating the sensation of breastfeeding is not a strong reason not to breastfeed, or having repeated bouts of thrush is not a contraindication because there are antifungals.

    • Merrie
      March 31, 2017 at 8:43 pm #

      Most of those commenters sound like jerks.

      • March 31, 2017 at 9:14 pm #

        It’s Reddit. You have to expect that…

        • Merrie
          April 1, 2017 at 11:48 am #

          Probably. I have spent extremely little time on Reddit and the few subreddits I have frequented are pretty tightly moderated.

    • sighs
      April 1, 2017 at 8:45 am #

      It’s horrifying to hear pediatricians blithely agreeing that “of course
      breast is best. They then go on to argue about just how much it’s ok to bully women. Even the saner voices feel the need to kowtow to the “breast is best” philosophy before saying that they don’t feel comfortable bullying weeping, guilt-ridden new mothers.

      Don’t these doctors have enough training in science to be at least a little skeptical/curious?!?!?

      • Empress of the Iguana People
        April 1, 2017 at 9:52 am #

        a lot of them have to answer to upper management.

  7. Cat10
    March 31, 2017 at 5:56 pm #

    OT: In my opinion, this confirms what Dr. Amy has been saying all along, namely that the natural birth and breast feeding discourse is one of privilege. Imagine, women in the West exploiting Third World women just so that their precious little babies can have breast milk (when perfectly good formula is readily available):

  8. BeatriceC
    March 31, 2017 at 5:28 pm #

    OT: We did another round of tests, including some tests that had come back negative before, but we redid them. Leo has Avian Bornavirus. There’s no cure. All I can do is manage the symptoms and make him comfortable until he dies. That could be anywhere from days to months. Right now he’s not eating and I’m syringe feeding him, which is torture on him. I don’t know if that’s still the right thing to do. ABV doesn’t transmit easily between birds, so chances are the rest of my flock is safe, but Goofy (The Evil Attack Parrto ™) has had a recent change in aggressiveness, so we’re going to take him in to be tested this afternoon. None of the other birds show symptoms for now.

    • Dr Kitty
      March 31, 2017 at 5:43 pm #

      I’m so sorry.
      Pets can be like family, and I know Leo means a lot to you.

      • BeatriceC
        March 31, 2017 at 7:33 pm #

        Thank you. After a long discussion with the vet, we’ve decided the most humane thing to do is let him go. We have an appointment tomorrow afternoon. I’m heartbroken.

        • mabelcruet
          April 1, 2017 at 2:34 am #

          I’m so sorry you’re losing Leo. Pets add so much to our lives and losing them is always hard. Ensuring that they have a peaceful and pain free passing is a gift we can give them for all the love they give us.

        • Empliau
          April 1, 2017 at 1:14 pm #

          I am so terribly sorry. I know what it is to lose a pet who is so loved. Good on you to find the strength to give him an easy passing.

        • FormerPhysicist
          April 1, 2017 at 1:32 pm #


        • The Computer Ate My Nym
          April 1, 2017 at 2:22 pm #

          I’m sorry for your loss!

          • BeatriceC
            April 1, 2017 at 2:56 pm #

            Replying to you just because I can’t reply to everybody. Thank you. Right now we are hanging out outside in my back yard. Birds belong outside. He should spend his last hours in the fresh air. We have to leave in 30 minutes.

          • BeatriceC
            April 1, 2017 at 5:06 pm #

            He’s gone.

          • Merrie
            April 1, 2017 at 8:33 pm #

            I’m so sorry… poor birdie.

          • SporkParade
            April 2, 2017 at 5:52 am #

            <3 <3 <3 <3

          • Christy
            April 4, 2017 at 1:10 pm #

            I’m so sorry.

          • kilda
            April 4, 2017 at 1:21 pm #

            I’m so sorry. The decision to let a loved pet go is always so hard. I know your heart is breaking right now. Rest in peace, Leo.

        • MI Dawn
          April 1, 2017 at 6:30 pm #

          So sorry to read this, BeatriceC! Sending love and lots of hugs to you. It hurts so much to say good bye to a pet.

    • Heidi_storage
      April 2, 2017 at 8:14 am #

      I’m very sorry. I hope you have good support to help you through this difficult time.

  9. myrewyn
    March 31, 2017 at 2:49 pm #

    OT — ARRGH Portland! I’m researching pediatricians this morning for my baby due in May. I started on my insurance site, picked one in my network, highly rated and convenient to my location, made a call to get some info, and then looked up his website after everything sounded good over the phone. It comes right up with his new book about an alternative vaccine schedule he’s come up with (that’s shaking the nation!). There’s a link to Vaxxed and info on their new homeopathic doctor. The website hits autism, toxins, aluminum, and with a little more digging, he’s collaborated with Jennifer Margulis on articles and videos. I almost walked right into this and in fact I probably wouldn’t have googled him if the receptionist hadn’t told me to check out their website which made me curious. I weep for the future of my city. Luckily now I’m set up with a pediatric practice that’s associated with our local big teaching hospital. Hopefully I can find a provider in that clinic with common sense.

    • Roadstergal
      March 31, 2017 at 2:53 pm #

      🙁 Such a beautiful place to be so full of woo.

    • The Bofa on the Sofa
      March 31, 2017 at 3:38 pm #

      That the receptionist would have you check out the website in the first place is already a concern.

      Are you sure they aren’t naturopaths?

      • myrewyn
        March 31, 2017 at 3:47 pm #

        That comment was what first set off my spidey senses. Up until then she and the clinic seemed totally normal. And no, the main guy is an MD. Looks like a few other MDs, a DO, some nurse practitioners, and the homeopath lady.

        • Dr Kitty
          March 31, 2017 at 4:37 pm #

          Integrative is a red flag.
          Because it means “integrating” CAM with allopathic (I.e normal) medicine.

          • myrewyn
            March 31, 2017 at 4:43 pm #

            Yep. I didn’t have the clinic name until I googled, just the name of the MD, or I would have stayed away from the beginning.

  10. mabelcruet
    March 31, 2017 at 1:05 pm #

    Quite frankly I’m too concerned about the parlous state of my own love life and sex life to give a damn about anybody else’s! I don’t care who does what with whom, as long as it’s done with consent. Same with feeding a baby-as long as the calories get in there, the delivery system should be nobody else’s business.

    • Guest
      March 31, 2017 at 1:15 pm #

      Right? I have too many of my own problems to give a shit who other people end up between the sheets with.

  11. EmbraceYourInnerCrone
    March 31, 2017 at 12:37 pm #

    OT, sorry but as today is supposedly the AnitVax march in Washington DC, I’ll just leave this here:

    3400 cases so far and 17 deaths

    Their uptake rate for MMR has gone from 97% in 2007 to 86% in 2015

    • Steph858
      April 2, 2017 at 1:18 pm #

      I was shocked when an open day at a local nursery I was interested in nosing around was cancelled due to a confirmed case of German Measles in one of the nursery’s current attendees. My first thought was, “Where did THAT come from?” I thought MMR was supposed to protect against German Measles. I know no vaccine is 100% effective and there will also be a small percentage of children who can’t be vaccinated due to genuine medical reasons, but with herd immunity shouldn’t coverage still effectively be 100%?

      I did some googling and the most recent vaccination rates for my area I could find refer to 2015. According to those stats ( only 88% of 2 y/os receive their initial dose of MMR and only 85% of 5 y/os receive all their MMR doses; the target rates are 95% and 90% respectively. I don’t know why those targets are as low as they are – I find it hard to believe that 5-10% of children suffer from severe reactions and/or compromised immune systems which would prevent them from getting vaccinated.

      I can’t understand why the rates are so low. I don’t live in a woo-infested area like Oregon and all vaccines are free on the NHS so it can’t be because some people can’t afford the vaccines.

  12. Amy M
    March 31, 2017 at 12:23 pm #

    It could be argued that the “near-religious” (actually religious in some cases) lactivist belief is that women should be tied to the home and kept subservient. Not so much that formula feeding violates nature’s design, but that women doing anything other than child-rearing violates nature’s design.

  13. Empress of the Iguana People
    March 31, 2017 at 12:11 pm #

    Penis-in-vagina and only for creation is best!

    • LaMont
      March 31, 2017 at 12:23 pm #

      And it’s tricky to limit yourself to that when the mere presence of a person of the opposite sex results in wild, sweaty sex immediately. My work lunch with the head of the Ops department at my last job got WEIRD. 😉

      • sdsures
        April 3, 2017 at 7:40 am #

        Am I out of line when my spidey sense tells me that that guy has likely gotten away with sexual crimes in the past?

    • Gæst
      March 31, 2017 at 1:09 pm #

      So, logically, nipple-in-mouth and only for infant feeding! Disgusting.

      • sdsures
        April 3, 2017 at 7:39 am #

        They kinda forget that similar activities in a far pleasanter circumstance often assist in the creation of infants to begin with.

    • Steph858
      April 2, 2017 at 9:33 am #

      Great. Now I’ve got that Monty Python song stuck in my head.

      #Every sperm is sacred ….

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