Lactivists’ fear based tactics come back to bite them

Scared shocked woman isolated on gray background

Kimberly Sears Allers is shocked, shocked, that fear is being used in discussions of infant feeding.

Her piece on Lactation Matters, the blog of the International Lactation Consultant Association, is part of the new #FactsNotFear lactivist campaign created to combat the message of the Fed Is Best Foundation that breastfeeding has risks as well as benefits.

Lactivists are bewailing the very tactic that they pioneered, exploited and spent millions of dollars promoting.

Sears writes:

But there is one place where fear should not exist. There is one area, where, as women and
mothers, that we should insist that fear not enter—that is in the precious act of feeding our babies…

That’s why a recent spate of fear-based marketing, particularly from the Fed Is Best Foundation, stoking fears that exclusive breastfeeding kills babies is both erroneous and irresponsible. But it is also the type of insidious marketing that preys on a mother’s existing insecurities that should make all women concerned…

Excuse me while I catch my breath from laughing so hard. Using fear to pressure women into breastfeeding is a deliberate tactic beloved of lactivists. Indeed, lactivists are now bewailing the very tactic that they pioneered, exploited and spent millions of dollars promoting.

Lactivists have been completely upfront about their use of fear to pressure women into breastfeeding. It was first articulated by lactation consultant Diane Weissinger in a seminal paper, Watch Your Language!, in 1996. It’s a blueprint on using fear to pressure women to breastfeed.

Weissinger saw a problem.  For many women, the benefits of breastfeeding simply aren’t great enough to overcome the difficulties and inconvenience:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding …

She proposed that lactivists pressure women to breastfeed by promoting fear of the risks:

The mother having difficulty with breastfeeding may not seek help just to achieve a “special bonus”; but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial baby milk just “to get him used to a bottle” if she knows that the contents of that bottle cause harm.

For example:

…[B]reastfed babies are not “healthier” artificially-fed babies are ill more often and more seriously. Breastfed babies do not “smell better”; artificial feeding results in an abnormal and unpleasant odor that reflects problems in the infant’s gut.

Lactivists fully embraced fear based tactics for 20 years, until it turned out that breastfeeding has risks that women should fear — risks of dehydration, jaundice, starvation and death. In fact, we can point to literally hundreds of term babies injured annually by aggressive breastfeeding promotion, while we can’t find even a single term infant whose health has been substantially improved or whose life was saved by breastfeeding.

That’s why the hypocrisy of Sears Allers is so mind boggling.

Let’s face it, women are sold fear and anxiety as a marketing tool every day. In fact, the strategy, officially known in business circles as FUD—fear, uncertainty and doubt—was designed by an IBM executive decades ago to persuade buyers to feel “safe” with IBM products rather than risk a crash, virus or server disruption.

Let’s face it, women are sold fear and anxiety as a marketing tool by lactation consultants and lactivist organizations every single day. Lactivist tactics are a paean to FUD — fear, uncertainty and doubt. Women are told to fear the “risks” of formula feeding, to replace their conviction that their babies are starving on breastmilk with uncertainty about their own worth as women, and to doubt their ability to be good mothers if they don’t breastfeed.

Even while decrying fear based tactics, Seals Allers can’t stop resorting to fear based tactics:

The truth is, our bodies were uniquely made to feed the infants we create. Decades of scientific research proves that formula is nutritionally inferior to breastmilk.

The truth is that that our bodies were uniquely made to get pregnant, but that doesn’t prevent a nearly 20% infertility rate among couples; we’re uniquely made to carry babies to term, but that doesn’t prevent a natural miscarriage rate of 20%; and while we are uniquely made to breastfeed, that doesn’t prevent a high rate of infant dehydration, jaundice, starvation and death.

Seals Allers doesn’t hesitate to resort to claims contradicted by scientific evidence:

It’s no secret that, especially in the Western world, women already fear they will have insufficient milk. For some, this fear can become a self-fulfilling prophecy because fear and anxiety can literally limit lactation by stifling the letdown reflex that stimulates the milk glands.

There is no scientific evidence that fear of insufficient milk causes insufficient milk. Indeed, research shows that when women believe they have insufficient milk it’s because they do. In fact, new research shows that there may be a biomarker for low supply.

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate.

Another paper, The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern, published in April 2017 noted:

…[T]he observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception. (my emphasis)

Sears Allers concludes her piece with a flourish of hypocrisy:

Ultimately, women deserve facts not fear. Women have a right to guilt-free, confidence-building information and support.

Women have the right to the truth and the truth is that breastfeeding has very real, deadly risks.

#FactsNotFear indeed!

  • Sean Jungian

    YEESH, more of the same, “Oh no if you even THINK you might fail YOU WILL FAIL” and not believing women.

    It’s getting so tiresome, and it’s been this way FOREVER.

    • EmbraceYourInnerCrone

      These people need to read Bright-sided. That book read expressed something I felt but could not articulate. Positive thinking is good to a point, but when it comes to healthcare the whole “you have to have a positive attitude if you want to get well/beat cancer!” is so much BS and way too Calvinist for me, as in if you don’t get better /can’t breastfeed its because you have a bad attitude. Nice victim blaming. I just don’t swallow the Peter Pan(Tinker Bell?) theory of medicine.

      • Sean Jungian

        I’ve said it before and I’ll say it again: bs movements like “The Secret” and “Prosperity Gospel” and other woo play right into this victim-blaming narrative. Cancer quackery didn’t cure you? You didn’t BELIEVE hard enough.

        Its so infuriating.

  • Dr Kitty

    A patient recently told me that when her baby was having difficulty latching (flat nipples) the midwives just left an electric pump by her bed- no advice how to use, no measuring of correct flange size…nothing.
    Just “here you go- pump if you can’t breast feed”.

    Her baby lost 10.5% of BW by day of discharge home, was lethargic and miserable. She gave baby one bottle of formula as soon as they got home- “a different baby” who was happy and suddenly had energy to feed.

    This baby is now thriving- breastfed with EBM top ups and one bottle of formula given by dad in the middle of the night.

    And the MWs and HV were judgemental and sniffy because the BF is with nipple shields and the formula “wouldn’t be necessary you pumped more”. Ignoring the fact that mum is already pumping 5 times a day for the EBM top ups the baby needs and she discovered her supply decreased if she slept less.

    This is a lovely, thriving baby whose mum has got a system that is working for her, but apparently nipple shields and 4oz of formula are so terrible that she has to be “encouraged” to give them up.

    Seriously this is the perfect being the enemy of the good!

    • lawyer jane

      Same exactly thing happened to me. My baby was in the NICU for a few hours, and the LC came by and almost literally threw a pump at me and said “you have to pump.” I had NO idea how to set the thing up – my DH is not mechanically inclinded in the least – so I’m sure I was pumping with the wrong end of the flange or something. They proceeded to ignore us in the hospital for the next 48 hrs, and discharge LO having lost 9% of his weight already … 12% by our first ped appointment the next day. If the pediatrician hadn’t told me to supplement right there in her office, I don’t think I ever would have even known he was hungry.

    • Young CC Prof

      Openness to combination feeding would probably result in a whole lot more breast milk inside of babies, but what do I know?

      • Dr Kitty

        I think from now on I might consider printing something out for my patients which they can laminate and shove under the nose of any annoying busybodies.

        “After a thorough and holistic biopsychosocial assessment of the mother-baby dyad I have devised an individualised optimal feeding regime in collaboration with my patient, and Whig she has been advised to comply with strictly- signed Dr Kitty”

        The busybodies don’t need to know that the assessment and collaboration consists of “so, your baby is thriving- are you happy to keep doing what you’re doing? You are- great!”.

  • lawyer jane

    Off topic: Policy wonks are finally picking up on the issue of bad public health recommendations. R Street is a free-market group and I’m sure I disagree about many of their positions. But really, there’s only so far this no-evidence guidance thing can go before people start objecting.

    http://www.rstreet.org/calendar/oops-sorry-we-were-wrong-how-public-health-guidance-often-harms-the-american-public-health/

  • Mel

    I bet if researchers who were trained in qualitative analysis went into developing nations and asked the right questions they would find that women in non-Western nations fear not producing enough breast milk.

    You can’t just wander into an area, look around and say “Well, all the women holding babies are breastfeeding with or without supplementing with goat’s milk so that’s rate of 100% successful breastfeeding” because you have no way of counting any babies who died from malnutrition or sub-optimal nutrition leading to decreased immune response to diseases.

    Try adding “Sometimes babies die from lack of food even when their mothers are trying very hard to feed them. Have you known of a situation like this?”

    Or try the good old fashion census method of combing all of the women’s memories in a village or tribal group to figure out how many children have been born in the last 20 years and the reason the women think the children who died passed away was.

    I’m willing to bet a lot that the answers would be enlightening.

    • anh

      I don’t claim to have a huge amount of knowledge on this subject but it seems like there are a whole lot of culture out there with their own galactogogues and special recipes for post partum moms, designed to boost milk supply. My dear friend’s mom kept telling me to eat chicken ginger soup and kept sending me papayas when I had low supply.
      It seems like women all over the world fret that their babies won’t get enough food.

      • Mel

        A coworker who was pregnant while working at an adult ESL class got scads of recipes from all over the world for foods that are good for postpartum moms. I’m sure that every culture has their diets that at least theoretically increase milk supplies.

        • Busbus

          Yes! I’m from Europe, and I was told to drink some beer because it would increase my milk supply 😀

          • Tigger_the_Wing

            I was actually offered bottles of stout in hospital when I was in for PPH after my third. I declined (I’m alcohol intolerant) but several mothers on the ward were happily taking theirs.

  • Tori

    The articles about high levels of sodium are fascinating! Thank you for sharing them.

  • lawyer jane

    Ugh!! A large proportion of what passes for breastfeeding “information” presented by breastfeeding advocacy groups would literally be judged to be unfair and deceptive under the current consumer protection legal standards if they were trying to sell a product. I really want this campaign to spell out exactly which facts they think Fed is Best has wrong. Although Fed is Best certainly does emphasize what can go wrong in breastfeeding, they are also very supportive of breastfeeding in general. Their entire focus is how to identify when breastfeeding is UNsafe. Unless 1000 Days is going to deny that breastfeeding can ever be unsafe, I don’t see how they have a shred of integrity here.

    It also REALLY pisses me off that groups like those don’t bother listening to the many, many women who are saying that current breastfeeding advocacy is not working for them; not to mention the serious ethical implications of prioritizing incremental public health gains to leverage extreme pressure on women to use their bodies in a certain way.

    • Chi

      From what I can gather from reading several mommy blogs on why ‘Fed is Best is WRONG!!!!!’ Is that they feel that Fed is Best is pushing for what they consider ‘unnecessary supplementing’.

      It’s all because they’re clinging to the fallacy that ‘just one bottle’ will completely ruin the baby with nipple confusion, tanking mom’s supply, upsetting the gut microbiome etc etc etc.

      They think that FiB is trying to tell mothers that cluster feeding isn’t normal, when FiB is just trying to raise awareness that what mothers are being told is cluster feeding is in fact unsatisfied feedings and basically wanting lactivists to actually recognize the difference and counsel mothers appropriately if their children aren’t getting enough milk.

      I’m with you on the being pissed off at not being listened to. Women are TELLING them that current breastfeeding advocacy is wrecking their mental health only to be snidely told that breastfeeding actually PREVENTS PPD, thank you very much. It also pisses me off that they ‘support’ you through all manner of ridiculous (and potentially dangerous) things to try and establish breastfeeding (tongue-tie clipping, unprescribed meds like domperidone, cranail sacral therapy etc), but as SOON as you cave and give a bottle of formula, they turn their backs on you and essentially shun you.

      How is that ‘supportive’???

      • StephanieJR

        I always figured support is based around what the person you’re supporting needs. Not so with breastfeeding, eh?

      • Tigger_the_Wing

        It isn’t supportive, it’s shaming women for daring to have minds of their own and not to be willing slaves to their ideology.

        BTW, breastfeeding did nothing to prevent my PPD.

    • Cat

      ‘It also REALLY pisses me off that groups like those don’t bother listening to the many, many women who are saying that current breastfeeding advocacy is not working for them’

      Yes, this. It also bugs me that nobody listens to the reasons why exclusive breastfeeding doesn’t work for many women. In my experience, most women who give up breastfeeding do so because of pain and discomfort (the consensus amongst the first-time mums in my postnatal yoga class was “everyone tells you it’s beautiful and easy and better than an orgasm, but it hurts like fuck to start with”), or because it’s very time-consuming (not all women are privileged enough to have the time to spend hours a day with a baby on their breast in the beginning). Yet breastfeeding advocates still seem to hear “women are giving up breastfeeding because it’s not normalised enough and because of evil formula advertising, so the answer is to promote breastfeeding EVEN HARDER!”, not “let’s give women realistic advice about the difficulties that they might experience in breastfeeding so that they come to it knowledgeable and prepared”.

      https://www.theguardian.com/lifeandstyle/2017/mar/23/less-than-half-of-women-breastfeed-after-two-months-survey-finds – Articles like this one piss me off as well: the sub-header trumpets that women are giving up breastfeeding because of embarrassment, yet that appears to have been only the third most popular reason given. But “poll reveals women are giving up breastfeeding because it sometimes hurts like crap” doesn’t fit the narrative as well, does it?

      • Young CC Prof

        Other concerns included “not being able to tell whether baby was getting enough milk.” In the last paragraph. And that one is quite fixable, it’s called an accurate scale and health visitors who tell the truth about baby’s weight even if it’s unpleasant.

        • Cat

          Oh god yes. To be fair, I had a very good health visitor, but I didn’t get to see her until Day 10. By that point, I’d lost all faith that anyone would tell me if I was starving my baby (having had various midwives tell me that non-stop screaming was naughtiness, wet nappies weren’t a big deal and so on), so I told the health visitor that I was sticking with combo feeding. She said that was great, a happy mummy means a happy baby. I could have hugged her.

          (The worst midwife was the one who came to check my latch on Day 6. I confessed that I was exhausted because my baby wouldn’t go in the crib, and she told me to bedshare and just make sure that I followed NHS guidlines to reduce risk. She then went on to suggest bedsharing practices that were about as far from NHS recommendations as you could get: basically making a nest of pillows on the bed and putting the baby to sleep in it all night. After that, I didn’t trust what she said about my latch either).

  • Heidi_storage

    Ugh, this is just like the hypocrisy of anti-vaxxers, who scream “Neurotoxins! Autism!” when trying to convince people that vaccines are harmful, then decry any discussion of the dangers of vaccine-preventable diseases as fearmongering.

    • Petticoat Philosopher

      I am 110% in favor of fearmongering about vaccine preventable diseases. if I had my way, there’d be billboards of children in iron lungs on every highway.

      • Heidi_storage

        Yeah, “fearmongering” is only problematic when the risks being discussed are overblown (or entirely fictional).

      • Roadstergal

        There’s an ongoing anti-smoking campaign on TV in the US that uses fearmongering in a way I approve of. With citations.

        They’ve started to take on vaping lately, too.

  • Emilie Bishop

    Lactivists deliberately withhold facts about potential complications or even current complications to coerce women into breastfeeding. Then when it gets difficult, they come up with things like “triple-feeding” or tell you that your anxiety is causing your supply issues just to lay the blame at your feet. I remember sobbing hysterically that the pain of my son’s latch and the memories of his rehospitalisation made it impossible to relax enough to cause a real let-down of sufficient milk. In other words, I fell right into the trap of self-blame lactivism sets up by design. No wonder they didn’t tell me I didn’t produce more because I have IGT–talk about not fitting their narrative! Now they blame FIB for fear-mongering? Not so much.

  • moto_librarian

    I would love for science to develop a better understanding of why some of us have lactation failure. If sodium could indeed function as a biomarker, that would be incredibly helpful. If I could have had what little milk I produced tested and had found high levels of sodium, I would have been able to let breastfeeding go with much greater ease.

    • Sarah

      Well, she was right about breastfed babies not smelling better, at least. There’s a start.

      • KQ Not Signed In

        THAT is for sure. It was quite a letdown (pun intended!) after all the praise that breastfed babies have sweet smelling poop. NO. THEY. DON’T.

        • Oh my word, my second baby–exclusively breastfed–had the foulest smelling poop ever. Strangers would comment. He was so disgusting. Never did figure it out. Pediatrician couldn’t find anything wrong with him.

        • Nick Sanders
        • Azuran

          My breastfed baby does have sweet smelling poop. But it’s not like ‘Hummmmmmm nice and sweet’ It’s still poop, it still stink, its just poop stink with a weird whiff of foul sweet something in it. More like the smell of changing a sugar bandage on an infected wound.
          It’s not really an improvement.

          • Heidi

            My baby’s poop in the beginning reminded me of movie theatre popcorn gone wrong. It smelled like that yellow stuff they slop on it (I hate that stuff!).

          • AnnaPDE

            Well I thought that was yucky but then I gave bub formula and ewww even worse. And just when I’d accepted tgat smell, we started solids and aaaargh omg it’s awful. And then came a gastro bug.
            I wonder if there’s still room for worse.

          • Sarah

            There’s always room for worse where small children’s arses are concerned.

  • Empress of the Iguana People

    if your anxiety is so high that it interferes with your milk production, perhaps you should be seeking a different type of professional.

    On a related note, the lexipro seems to be helping my pmdd as well as the general ppd. Zoloft was only helping with the latter.

    • moto_librarian

      I’m glad to hear that you’ve found a better medication! I found Zoloft to be underwhelming. It prevented me from totally bottoming out, but it’s just not as effective as Effexor. Now that I’m done having children, I’m glad to be back on it.

    • ArmyChick

      I have been on Lexapro for almost two years now. I was on Zoloft before and it made me paranoid.

      I don’t plan on having a second child but if I did, she would also be formula fed like my first was.

    • attitude devant

      I love Lexapro. It has literally saved my life on at least one occasion.