Get government’s hands off women’s breasts!

47676651 - female controlling breast for cancer, isolated on white

Under the guise of what is “best for babies,” the government has wrongly brought its considerable power to bear on promoting breastfeeding. In a fascinating paper entitled State power and breastfeeding promotion: A critique, political philosophers Balint et al. advance a compelling political argument against government promotion of breastfeeding. Simply put, the government misuses its power when it aggressively promotes breastfeeding.

The government misuses its power when it aggressively promotes breastfeeding.

State-sponsored breastfeeding promotion campaigns have become increasingly common in developed countries. In this article, by using the tools of liberal political theory, as well as public health and health promotion ethics, we argue that such campaigns are not justified. They ignore important costs for women, including undermining autonomy, fail to distribute burdens fairly, cannot be justified neutrally and fail a basic efficacy test… (my emphasis)

I’ve been making these arguments for years: breastfeeding promotion campaigns like the Baby Friendly Hospital Initiative (BFHI) violate women’s autonomy, re-inscribe privilege and are not justified by the trivial benefits of breastfeeding.

Why does the government need to justify itself? This goes to the heart of what we believe about the proper role of government.

One of the roles of liberal institutions is to make it possible for people to pursue their ends; and not to define their ends for them, nor favour some conceptions of the good over others, nor avoidably favour one way of life over others. In relation to breastfeeding promotion, this means that the burden must be carried by the health and welfare argument, and not any view about the goodness of any particular type of motherhood or the natural role of women. That is, only if breastfeeding provides significant welfare benefits for infants or mothers could such promotion be neutrally justifiable.

Breastfeeding promotion programs like the BFHI are unabashedly manipulative. They force women to undergo mandated “education”; they limit women’s feeding choices within the hospital; and they interfere with the free speech rights of medical professionals who believe that aggressive breastfeeding promotion is harmful to mothers and potentially deadly to babies. Manipulation violates women’s autonomy and autonomy ought to be valued very highly by government.

… [M]anipulation, like coercion, bends the will of one to that of another. This invasion of autonomy is severe even when the distortion it causes in a person’s decision making is relatively minor. Here we will argue that in the case of breastfeeding campaigns the quality of the information and the nature of the messages used at a time of particular emotional vulnerability can constitute a form of manipulation and can thus be autonomy-undermining for women …

The government is of course justified in promoting public health but that is subject to limiting principles:

(i) When there is more than one possible way to achieve a goal, we should always choose the least restrictive (i.e. least liberty-infringing) alternative.
(ii) Liberty-infringing interventions should be used in a non-discriminatory way, and we should be particularly cautious about using such interventions when those singled out by it come from the worst-off groups of society.
(iii) The burdens should be as minimal as possible.
(iv) Those who bear the burdens should be compensated.
(v) If a public health intervention is warranted (i.e. it meets the above conditions), an individual should be helped and supported to discharge her duties as much as possible (‘reciprocity’)…
(vi) Respect autonomy as well as doing good…
(vii) Do not cause fear, anxiety and vulnerability unnecessarily…
(viii) A campaign should be efficient in achieving its goals.

How do the BFHI and other breastfeeding programs violate these principles? Let me count the ways:

  • It affects only women and is more burdensome for poor women than for rich women.
  • The burdens are considerable.
  • In the absence of a comprehensive maternity leave policy, the government is imposing the burden without helping the affected women discharge it.
  • Fear mongering about the “risks” of formula is central to these campaigns.
  • Breastfeeding campaigns don’t actually work and produce only minimal health benefits even when they do (except in the case of prematurity).

The authors are justifiably scathing in their assessment of lactation professionals’ response:

While many of the physical problems … are acknowledged by breastfeeding advocates, the response is usually one of perseverance. The problem – whether it be postnatal depression, multiple births, or severely cracked nipples – can almost always be surmounted with appropriate counselling, management and determination. This is the case even when the problem is one of insufficient milk and the infant itself is not thriving as well as their peers. Hausman, for example, writes that ‘no one disputes that cases of true (or primary) insufficient milk syndrome exist – breastfeeding advocates simply tend to question the idea that there are large numbers of women who physically cannot make enough milk’. And, in response to a woman who, while unsuccessfully trying to breastfeed her infant, had ‘blood dripping down her chest and tears streaming down her face’, the advice was that the issue could be resolved by proper ‘lactation management’…

Perseverance, counselling and management, and not choice, context and individual circumstances, seem to be an all too common response from many public and/or publicly funded health professionals and institutions to those struggling. (my emphasis)

What about the health benefits of breastfeeding? The evidence is weak, conflicting and riddled with confounding variables.

As we argued, if this is true, there remain the problems of autonomy and fairness. And moreover, as we demonstrated, such a claim seems empirically suspect: (a) much of the empirical evidence for breastfeeding is beset with methodological problems, and (b) where positive health effects seem well demonstrated, they are often very small, in non- serious areas, or very rare. Thus, because the scientific evidence for the infant health benefits of breastfeeding is much weaker than is usually claimed, the ethical principle of efficacy (viii) is challenged. It seems then that there is no neutral justification for such a policy given that exclusive breastfeeding is associated with a particular view of child-rearing and motherhood. This means that promoting breastfeeding appears to unjustifiably privilege one conception of the good over others.

In summary, government breastfeeding promotion violates important political principles:

Because of the special role of the state, our argument focused on state power, rather than private organisations. This special role, however, enables the state to act in this sphere. It should provide accurate factual information, and legislate and agitate for more family-friendly workplaces, including for women who want to breastfeed… This is quite different from actively and strongly encouraging, often with quite manipulative and autonomy-undermining messages, a practice, the benefits of which for infants are marginal at best, and under current conditions, the negative effects of which on women’s welfare and autonomy can be strong and long-lasting, and certainly not equally or fairly distributed… Perhaps, breastfeeding is better for a child’s health, but it is certainly not always better, all things considered, particularly when one of the considerations is the health, welfare and autonomy of the woman who is being asked to do the breastfeeding.

Therefore, we should get government’s hands off women’s breasts!

  • Kq

    https://youtu.be/DwVfdX56gL8

    OT

    Part one is amazing also but holy hell. This is almost too on the nose.

    • Sue

      Samantha Bee is brilliant !!

    • Empress of the Iguana People

      snort.

  • mostlyclueless
    • PeggySue

      Good news that they are suspending operations. Given what the article reported, I wonder if 4 since opening is really accurate. 3 in six months sounds ghastly.

    • DaisyGrrl

      Yikes. Went to their website, and this is the page on their “outcomes”: http://www.babyandcompany.com/center/cary/our-outcomes/

      Strange…it’s all about their low rates of c-sections and epidurals and not a word about deaths or injuries…

    • Mel

      The company’s statement that low-risk births can devolve into emergencies “at hospitals and at birthing centers” is stunning in its attempt to link hospitals and out-of-hospital birth centers as equal in some way.

      The main difference is that a hospital would not have lost 4 babies out of 1,200 low-risk infants whose mothers were not suffering from diabetes, obesity, hypertension, other unlisted chronic conditions and not trying for a VBAC.

      • Wow. One in 300? That’s like homebirth-bad.

      • mabelcruet

        A standalone midwife unit opened in my area a few years ago (UK, so staffed by the equivalent of USA certified nurse Midwives). We offered to come and do the training that we provide to all the local hospitals about stillbirth, post mortem, consent to autopsy training and placental pathology. The response was ‘oh, there’s no need for that. Nothing like that will happen here.’

        And so far they are right-no babies have died there, but it’s only because they are so risk averse that everyone gets shipped out-in their first year they delivered 20 babies. How on earth can that be considered cost effective? And how are they managing to keep their skills up delivering 2 babies a month?

        • maidmarian555

          The nearest MLU to me has had at least one avoidable baby death (it was in the local papers- they didn’t know how to effectively make an emergency call, the ambulance stopped for a toilet break, by the time they got mum and baby to hospital it was about an hour too late to save him). All the mums round here know about it and I don’t know a single person who has used that unit. I have no idea how they are staying open, particularly when there are a couple other MLUs and an alongside at the other large hospital in the area. It seems such a waste of resources when the main labour wards are understaffed.

          • Sarah

            Ideology. That’s the only explanation for why a resource that is underused both relative to other options and sometimes absolutely is persisted with, whilst hospital MLUs and CLUs regularly have to temporarily close. It’s no wonder they have better stats than hospital MLUs and CLUs for low risk multip women: the ratios are loads better!

  • Wow. I’ve never disagreed with a blogger more in my life. I found you because of your Times article that someone posted today on FB. Why not take the stance that mothers should do what is best for their family? Breastfeeding is best for us, and the main reason… cheaper than formula. I’m supportive of my friends who bottle feed, because that’s what works for them. But wow at the outright hate towards nursing your baby. To say it isn’t beneficial to the baby, or that it barely is… my milk was never recalled.

    • The Bofa on the Sofa

      Breastfeeding is best for us

      Who is “us”?

    • Cartman36

      Did you actually read Dr. Amy’s article or the original article she is quoting, the entire article? The whole premise is that the current approach to promoting breastfeeding by the government is inappropriate specifically because it doesn’t encourage women to figure out what works for them but assumes breast feeding is best for everyone.

      No offense, you should read things thoroughly before you comment, otherwise you just look ignorant.

      • fiftyfifty1

        Wow, wouldn’t that be amazing? Encouraging women to find out what works best for them and their families and supporting them in that, instead of trying to shame and manipulate them.

    • The Bofa on the Sofa

      To say it isn’t beneficial to the baby, or that it barely is… my milk was never recalled.

      BTW, my wife quit breastfeeding our younger son when she realized that her milk was GREEN. As in, shamrock shake green, like this (without the whipped cream)

      https://uploads.disquscdn.com/images/89784d031838fe1bfef03dd97003930f01a96e7e47d11bcc3c523eef56f453a4.jpg

      • Gene

        Heh. A friend of mine loved changing her diet to see what colour her breast milk would turn. Green was the only color she couldn’t achieve. Go figure…

        • The Bofa on the Sofa

          The change in the color of my wife’s milk cannot be attributed to anything diet. She ate nothing different.

        • mabelcruet

          Did she try beetroot? I get spectacularly red pee with beetroot (beeturia), I wonder if it does the same to breast milk?

          • Gene

            Beets made red and carrots made orange. I can’t remember others. Maybe it was blueberries and blackberries for purple/blue?

      • Mel

        I recalled my own for faulty advertising.

        The loony lactation consultant kept insisting that FTMs of micro-preemies could and totally did produce enough milk to EBF their infant once they had reached term size.

        Personally, I’ve never met one IRL or online – but for me, I barely could produce enough for my son as a newborn. It would be like buying a box of cereal that said it had 64oz of cereal – but the box only contained 12 oz…..

        • Empress of the Iguana People

          I’ve only heard of Bea, and she wasn’t a first time mom with her micro preemie

          • BeatriceC

            I had oversupply with all of them, but even my first surviving child, who was a barely preemie at 36 weeks, wasn’t my first baby, and while the twins were very, very early, lactation still happened to a minor extent. The oversupply just kept getting worse with each baby, and my micro was no exception. I did avoid pumping at the NICU because in the pumping room moms were getting an ounce or less out of both breasts after 15 minutes and I’d come out with 30-40 ounces after 10 minutes. I actually had quart jars rigged as collection bottles because once letdown happened it was just like the Niagara falls of boobs. And I could see other moms being extremely disheartened by that.

          • Merrie

            Wow, holy crap. I assume after you finished pumping you had to go eat 6 hamburgers and a quart of ice cream and down half a gallon of water?

          • BeatriceC

            Perhaps a bit more water. I still drink about a gallon and a half of water per day as a habit gained while nursing. I had to drink so much more that this honestly doesn’t seem like much, but it’s a lot compared to normal people.

        • Merrie

          I have met one! IRL friend of mine whose daughter was born at 26+6. But she quit pumping at around 3 months because her daughter never really latched and she was over it, and also she had to use milk fortifier. She had enough milk stored up for her daughter to get breast milk until 7 months.

          • Mel

            Oh, the joys of fortified formula! My little guy was a double-whammy since research has found that babies under 1.5kg and male babies both do better with fortified formula than on breastmilk alone.

            I don’t know if the crazy LC realized how close she came to being whacked upside the head when I had reached about 4 months of pumping and had a question to ask about how much more milk I could realistically expect to increase in production now that I was in established supply.

            I had waved her down and she smiles and asks how I’m doing.

            I say that I’m fine, the kid’s great blah, blah, blah – but that I had a question about increasing production after established production.

            She stopped dead and said “You’re still pumping?!?!”

            I replied coolly, “Yes” and bite back “and regretting calling you over already.”

            She blurts “Almost no one from the Small Baby Unit pumps for this long!”

            Me: (thinking: If I smack her now, I’ll be in jail when Spawn comes home. Is it worth it? Hmmm. Time to sacrifice one for the bub ) “Interesting how you left that tidbit out when you told me that pumping was critical for my son’s survival the first day I met you.”

            She turned red – and then regurgitated the spiel that I would have a massive bump up in supply when Spawn came home from….um….lack of stress.

            Me: “Huh. Even when he’s oxygen dependent and on a feeding tube at home? That’s less stressful? ”

            Her: “Yes!” with a level of confidence that was strangely misplaced…..

          • Merrie

            Oh boy. As if preemie moms don’t have enough to worry about.

        • Ozlsn

          I know a couple of mums who were able to fully breastfeed babies once they were term corrected and home, including one with twins. To be honest I quite possibly would have been in that category myself were it not for my son’s respiratory issues. Given he still would have had TPN and fortified EBM before that it was never going to be an exclusively breastfed situation though.

      • MaineJen

        Don’t know about breast milk, but I can confirm that eating too much chocolate will turn the baby’s poop green. 🙂 (One of the drawbacks of having a newborn during the holiday season…)

    • Cartman36

      None of the formula that I bought for my kids was ever subject to a recall. You’re comment just provides a nice example of what Suzanne Barston calls the “stupefying dismissal of relative risk” that occurs in BF promotion.

    • swbarnes2

      Dum dum, the author breastfed 4 kids. She doesn’t hate breastfeeding. And if you have large well-controlled studies (no shit where the breastfeeding cohort is richer and better educated than the formula feeders), by all means, provide them.

    • Casual Verbosity

      If you read more of Dr Amy’s work, you’ll see that she is not actually against breastfeeding at all. She even breastfed her own children. What she is against is using misinformation to manipulate women into breastfeeding when they can’t or don’t want to do it. She’s written a slew of helpful articles detailing exactly why the purported benefits of breastfeeding to healthy full-term infants are grossly exaggerated with links to the original research. But here’s the short version:
      The number one predictor of whether a child will be breastfed is socio-economic status. And the number one predictor of good health outcomes is also socio-economic status. Because we can’t ethically randomly allocate some women to breastfeed and some to formula feed, we can only run correlational studies. This means that we can only look at the outcomes for babies whose mothers chose to breastfeed/formula feed. Having participants choose their own group is a major issue for drawing meaningful conclusions in science because there’s the possibility that something about the people who choose a particular group might be inherently different from the people who choose the other group. These correlational studies show a relationship between breastfeeding and positive health outcomes. However, this does not mean that the breastfeeding causes the positive health outcomes. Because socio-economic status predicts both likelihood of breastfeeding and positive health outcomes, it (SES) confounds the results. For some reason, the majority of studies in the breastfeeding literature don’t do the right thing and statistically control for socio-economic status. However, the few studies that do control for SES show that in healthy term infants, the differences between formula and breast milk are negligible.
      Think of it this way: When the weather is hot, more people drown than when the weather is cold. This is not because there’s something about heat that makes us poorer swimmers. It’s because there are more people swimming in hot weather than in cold weather, and the more people who are swimming, the more people will drown.
      And as for the claim that your breastmilk was never recalled, that’s because no one tests breastmilk for quality in the way that formula is tested on a routine basis. This doesn’t mean that breastmilk is inherently safer than formula; it simply means no one is testing it. Because breastmilk is made from the mother’s own bodily fluids, it can (and does) contain anything that reaches the mother’s bloodstream. Part of the AIDS crisis in Africa was driven by the lies of breastfeeding advocates who claimed that breastmilk cannot transmit AIDS, when in fact it very much can. Believing them, HIV positive mothers breastfed their babies and many of the babies contracted HIV through the breastmilk. I’m not saying that your breastmilk contains HIV. I’m simply saying that breastmilk can and often does contain some pretty terrible things, but you’d never know about it since it’s not tested.

    • Amy Tuteur, MD

      Why are you so defensive about your personal choice? It’s great that it worked for you but you that doesn’t change the fact that the benefits are trivial.

      • What are the benefits to formula then, why should I use that instead of breast milk? To say I’m so defensive, I said I disagreed with your stance on the topic. Defensive is what your blog followers appear to be to someone disagreeing with you.

        • MaineJen

          The benefits of formula are: your baby has something just as good to eat when you can’t/don’t want to provide breast milk. It really is that simple.

          No one cares what YOU feed your kid.

          • Sarah

            Plus, more vitamin D and vitamin K…

          • seenthelight

            And iron 🙂

          • Cat

            Ah, but breastmilk is the perfect food, so being deficient in iron must be the ideal state for babies and toddlers! (Yeah, seriously, I’ve read that line of argument several times recently. And for Vitamin K too: a common line of argument for refusing Vitamin K for newborns seems to be “Breastmilk is the best source of Vitamin K. Oh wait, it isn’t? Then babies must have evolved to be deficient in Vitamin K for good reason and we mustn’t meddle with that”. I only had a mediocre science education up to age 16 and even I can see through that argument!)

        • Charybdis

          Benefits of formula in no particular order:
          1. You can easily see how much your baby is eating, without having to resort to counting diapers, weighted feeds, etc.

          2. Other people can feed the baby and have that close bonding time with the baby.

          3. You don’t have to worry about taking medications that may be necessary for your health.

          4. You can eat and drink what you like, whenever you like.

          5. A veritable cornucopia of varieties to try if there is a problem with the baby digesting a certain type.

          6. Babies with galactosemia or PKU cannot breastfeed, so formula is their only option.

          7. Formula is fortified with iron and Vitamin D, so supplements are not necessary.

          8. You don’t run the risk of mastitis if you use formula.

          9. Using formula is not triggering to the mother if she has a history of sexual abuse/rape/trauma.

          10. Formula is nutritionally balanced and contains the appropriate amount of vitamins, minerals, fat, etc and breastmilk can be deficient in some of those things. And you won’t know unless you have it tested.

          11. The baby can hold their own bottle while feeding as they get older.

          12. Bodily autonomy for the mother.

          13. Doesn’t treat the mother as is she is nothing but a pair of lactating breasts whose only purpose is to feed the baby.

          Now, if breastfeeding is easy for you, your baby is thriving,you have adequate to abundant milk and you can tolerate it, even enjoy it, then yay for you. Get on with your bad self.

          I, however, hated, loathed and despised breastfeeding. It made my skin crawl and it was a contributing factor to my PPD. I also hated pumping; I am not a cow to be hooked up to a milking machine. My mental health was not worth the very trivial “advantages” of breastmilk.

          There are only two things you can feed a baby; breastmilk and formula, either in combination or exclusively one or the other. Choosing formula (and yes, it IS a choice, even if you can’t comprehend it) does not make anyone a bad mother, nor does it mean that we need more “support” or “education” about breastfeeding. Really.

          Feed your babies the way you want and let others feed theirs how they want,

        • Mariana

          For me the biggest benefit was keeping both my children alive. Even being a SAHM, pumping and nursing round the clock both my kids would have starved to death with my breastmilk alone. So yeah, for us breast was not best. I prefer my kids alive then ebf.

    • Empress of the Iguana People

      My sister’s was, but that’s neither here nor there. Stage IV cancer is not extra yummy.

      The point is there are a lot of women who cannot breastfeed and are regularly belittled for it by the medical community and by bloggers like milk meg. Do you understand how devastating it is to hear the breast is best mantra when you are physically or mentally incapable of it? I don’t care one whit if every woman in this forum breastfed their babies. Hell, I bf’d my first. I’m still “touched out” and he’s been weaned for 3 years. The thought of bf’ing again when I was expecting my second triggered suicidal ideation. Every damn time. I find myself still making my excuses, like there’s something -wrong- with formula. There’s nothing wrong with nursing your baby. What is wrong is when someone implies or even straight out says like some on social media say, that I am harming my child for keeping that last fraying thread of my sanity.

    • But is it cheaper? You’re assuming that a woman’s time has no value. If I could get paid $20/hr at work, and I lose 2 hours due to pumping every day … that adds up. Fast. I think formula is a lot cheaper than that.

      • Christine O’Hare

        Exactly! If you just look at the price of the liquid itself, yes breastmilk is cheaper. However, if you account for a breastpump, pump parts, materials for storing and transporting milk, bottles, and bottle-related supplies, that difference shrinks dramatically. And once you account for time and opportunity costs, then its no contest that formula is the ‘cheaper’ option. If I weren’t salaried and had to clock out everytime I pumped at work I would be losing $45 a day, 5 days a week and say I do this for a year, 52 weeks, that’s $11,700. Not so cheap anymore.

        • Except, insurance now covers pumps and parts. Even after paying for it out of pocket it’s cheaper than formula. 30 bucks a can isn’t cheap. Flange replacements are nothing.

          • momofone

            I know many people who bought formula for much less that $30 a can, and in fact, who formula fed for $500/year or less. It cost me considerably more than that to breastfeed.

          • Heidi

            Your insurance covered that. Yours. Many others don’t have your insurance plan! My insurance covered a pump, but not correct fitting breast shields, not replacement hoses or flanges, not a storage set or freezer bags. Our formula cost $24 for a 48 oz. canister that lasted 10 days. I’ve mostly been paid minimum wage but even $7.25, if I could get away with an hour of pumping during a shift, is more than $2.40 (the cost for one day). I had to pump every 3 or so hours though to make 8 oz. a day so obviously I mostly formula fed.

          • Sarah

            Shush, women who earn minimum wage aren’t real. To say nothing of insecurely employed women. They don’t exist either.

          • Heidi

            Right? I also think we are just go and get a higher paying job, too, if we aren’t happy or can’t survive on that wage. Evidently it’s super easy to do!

          • Christine O’Hare

            Also many people don’t have insurance.

          • Sarah

            Don’t expect lactivists to have any insight into their own levels of privilege.

          • Sarah

            30 dollars a can wouldn’t be cheap, no, but since only a tiny minority of formula costs that, you should probably use something closer to average costs. I wonder how many people in the US need to buy the $30 stuff as opposed to how many people don’t have insurance that would cover the parts…

          • I’ve never seen a can less than $25. And Obama’s changes to insurance are what’s allowing free pumps and supplies. It’s cheaper for someone on Medicade to get formula bc they get it for free. My sister could have had free formula but chose to breastfeed. Not so for middle class America. Either way. Acting like formula isn’t expensive for families is a joke. Suddenly you’re purchasing pricey diapers and if you have formula then that too, and good grief if you child needs special formula. That’s insanely expensive. You can’t pretend that formula is just so cheap for families. Easy to use, maybe. Cheap, no.

          • momofone

            Oh, ok. Since you’ve never seen it, it must not exist. Especially since you, as a dedicated breastfeeder, must have done a lot of looking at formula for bargains?

            Acting like formula is more costly to families just because that is your presumption indicates a serious lack of awareness of situations other than your own.

          • Heidi

            Yeah, you gotta love how an EBFer knows all about the cost of formula, more than actual formula feeders. I also like how she dismisses the fact those who need expensive speciality formulas either won’t be able to breastfeed or breastfeeding would require a lot of effort such as eliminating all dairy and soy.

          • Gæst

            Here ya go, now you’ve seen a whole tub for less than $25: https://www.walmart.com/ip/Parent-s-Choice-Advantage-Non-GMO-Infant-Formula-w-Iron-23-2-oz/49933687

            Walmart even breaks it down for you: It’s 10 cents and ounce. For a baby that drinks 24 ounces of formula a day, that’s a whopping $2.40. The majority of the time, that’s less than the cost of eating the extra calories it takes to produce breastmilk.

          • Heidi

            That was my estimate for what formula cost us at most in a day, before introducing solids. I know a 48 oz tub from Sam’s lasted about 10 days. It cost $24.

          • Gæst

            Yeah, I picked 24 ounces as a sort of average amount a baby would eat before starting solids. Feeding formula to a newborn would be much, much cheaper (unless you use RTF or specialty formula).

          • Sarah

            If you’ve never seen formula for less than $25 a can, you need to look a bit harder rather than try to weaponise your ignorance. You’re using an internet device: five minutes research would’ve solved that one for you.

            And the reality is that for some people, formula will be the cheaper option. This is not any kind of matter of opinion: your choices are to accept this or be wrong. There are women in the US whose insurance isn’t as good as yours. There are women who need to work and who aren’t able to avail themselves of their legal rights to pump because they’re afraid of not getting any more shifts if they do, or who can’t afford the unpaid time to do it. There are women in countries other than yours who use healthcare systems that don’t offer the range of pumps your healthcare does. Just because you’re not one of them and don’t know any, doesn’t stop them from existing.

            Try and at least have some modicum of insight into your own privilege before making vast generalisations.

          • The Bofa on the Sofa

            Exclusive breast feeding would have cost us more than $10K for our two kids compared to exclusive formula feeding. Ultimately, combo feeding was optimal, probably $1K better than eff.

            But the formula made tbe differenxe

          • Mel

            You’ve got the details of last comment a bit tangled. Let me straighten it out for you.

            Obamacare did require pumps to be covered by private insurance in states that did not previously require pumps to be covered. Certain states like the one I live in required breast pumps to be covered. Most required pump accessories like flanges and valves are covered as well, but can be charged through reimbursement procedures which will likely keep most women from jumping through the massive amount of paperwork and rejections to get the money.

            Some on Medicaid is making 133% of the federal poverty line or less. For a family of 4, that’s $33,000 a year or $4,018 dollars a month. That’s not a lot of money for four people to live on.

            Formula is not covered by Medicaid.

            If a person qualifies for Medicaid (or Medicare), they automatically qualify for WIC which does cover a certain amount of formula a month based on the age of the infant, a certain amount of formula a month and food for a partially breastfeeding mother, or a certain amount of food a month for a breastfeeding mother.

            So…yeah, your sister probably qualified for formula through WIC. Or she qualified for food. Or she qualified for both. It depended on which of three options she chose. In terms of straight money value, the formula only choice has the highest money value per month and the food only has the lowest – but the food only package is still well over $200 a month that families that are making more money don’t have access to – but I’m not sure why you brought that up in the first place.

            If the infant does not tolerate the standard formula that WIC has contracted through either Enfamil or Similac, the doctor of the infant can write a prescription for a different formula. My formerly-micro-preemie snippet of a baby needed to use Alimentum which cost around $28 dollars for the smaller can. That’s twice as expensive as the basic infant formula offered by Similac and Enfamil. Based on the fact that most stores have a very small on-hand stock of Similac’s Alimentum and the Enfamil version Nutragen, it implies that those formulas are not flying off the shelf compared to the basic baby formula.

            Is it cheap? It depends. My $28 dollar can of formula lasts around 3 days when my son was guzzling formula before he started on solids. My son couldn’t directly breastfeed because of oxygen demand issues so I needed to exclusively pump. Once I had an established milk supply, I needed to pump 5x a day for 20 minutes plus 5 minutes of prep/clean up to keep my supply going. That’s a total of right around 2 hours a day of pumping time or six hours every three days. That means that each hour I pumped “earned” me a savings of $4.67 cents. (Prior to an established milk supply, the savings was around $1.98 per hour because of the increased amount of time I spent pumping.)

            My freelance hourly rate is about $20.00 per hour. Childcare for me runs between $0 (when my husband and I can work the schedules right) and $8.00 per hour when I need a sitter plus….let’s assume $2.00 per hour for gasoline, business casual clothing, and wear on my car. Working an hour pays me a net $10.00 before taxes and around $6.43 after tax.

            So, for us it’s cheaper to formula feed than breastfeed because of the wages I can bring in (despite using a very expensive formula). The answer varies depending on the cost of formula, the potential earnings of the primary caregiver that are missed due to breast feeding, the costs of childcare, and the costs associated with working.

          • I didn’t say a word about pumps or parts. I literally just counted the cost of lost hours. $40/day lost is much more expensive than $30 every week or two. Hell, even if formula was $30 per day (it isn’t), it’d still be cheaper than pumping.

          • Gæst

            I never once paid $30 a can.

    • Sarah

      Your milk never having been recalled isn’t evidence that the benefits of breastmilk aren’t minimal. It’s just evidence that governments can’t really recall tits. Which I expect is something we were all aware or not. And whether it’s cheaper or not depends on a number of factors. Check your privilege.

      This is the problem with you lactivist types though. Strong on idiot generalisations, weak on actual evidence.

    • Mel

      But could your milk pass milk donor testing standards for the entire time you lactated?

      After all, that’s the standard that formula is held to – required nutrition level, no transmittable diseases, and no OTC or prescription medications.

      • Gæst

        I know my breastmilk didn’t pass those standards at *any* point.

    • BeatriceC

      Did you know that when there are feeding related issues in NICU’s one of the first things they do is test Mom’s breastmilk? During my combined 10 months in NICU’s I saw a dozen moms find out that their breastmilk contained inadequate calories, inadequate fat, lack of various other nutrients, too much of various nutrients, and a whole host of other issues. This doesn’t even begin to address supply issues. That was just moms who produced adequate volume. When human milk is tested, it does, in fact, get “recalled”. Human milk, like any other bodily fluid, is inconsistent from person to person, and lactation, like any other bodily function, has a failure rate. Nature doesn’t do perfect. It does good enough. And on the species level, it’s good enough to only have a portion of the population survive to reproductive maturity, since the only goal is to perpetuate the species, not 100% individual survival.

    • Clearly we don’t agree with each other. But here area few insights for the people who seem to ask. 1) Yes my breast milk would have passed donor standards, I wouldn’t have given my child less. I ate extremely clean while nursing. 2) Yes, when I say us I mean my own family. Just like when you say us you mean yours. 3) I was extremely lucky to have a hospital that supported breastfeeding. In my hometown that is not the case and even if you say you wanted to nurse your baby they’d give them formula behind your back. Super thankful to find a facility that supported how I wanted to do things. 4) Right now I’m loving the government overreach on breastfeeding. For one I do value my time as a woman… since a man is who questioned that one… Federal law allows me to pump at work and it doesn’t cost me money. Also, thanks to new breastfeeding laws and support in insurance I was able to get a pump for my second child absolutely free and they will send new parts every two months. Hence pumping and breastfeeding are cheaper because what I’ve spent on a pump in the past isn’t a shot in the dark to what my formula mama friends have spent. I can’t afford to give my child formula, it’s too expensive.

      Is nursing easy? No. But it is rewarding to be able to help out my family by providing nutrients for my child for over a year as well as financially help out by saving money by pumping for our child.

      • MaineJen

        It’s great that everything is working out so well for you. Here’s your cookie.

        Things might not be going so swimmingly for other women. They might not be able to produce enough milk. They might have a workplace that’s not as amenable to frequent breaks (yes, I know, “it’s the law,” but in practice, it doesn’t always happen). They might not have health insurance. *They might not want to breastfeed.* For these and many other circumstances, formula continues to be a perfectly good option.

        And before you start with me, YES, I breastfed both of my kids and I even pumped at work. Many women on this blog breastfed their kids. We just recognize that it doesn’t work out for everyone, and we don’t feel the need to browbeat people who make different choices.

      • Heidi

        No, pumping does cost money at work. If you read the law, they have to provide **un**paid breaks. But really no one here wants you to formula feed your child if breastfeeding works for you.

      • Sarah

        None of this addresses the points in the article though…

      • *ahem* I questioned your time value. I am a woman. But okay, you do you with dismissing it.

    • Merrie

      The health benefits of breastmilk over formula are negligible for term infants. That doesn’t mean that breastmilk is not perfectly serviceable food or that a particular family might not value certain advantages of breastmilk over advantages of formula. If breastfeeding works for your family, great. But there’s no reason for another mom to be worried that her infant will have adverse outcomes if she can’t breastfeed or decides she doesn’t want to.

      I’m all for breastfeeding. I EBFed my first two children. However, trying to keep up with the enormous intake of this current baby while working a demanding job and caring for three little kids was just a little much for me and I decided to stop pumping at work and combo feed. He is thriving. I’ve gotten formula for $15-20 a canister using store brands or coupons. My husband wants to try the Costco house brand next which will be even cheaper. I do like to be able to breastfeed in the evening/morning and overnight so I don’t have to fix bottles.

    • Amazed

      Poor you! I am so sympathetic! It must be absolutely HORRIBLE to be such an underachiever that your time is worth nothing and formula is so costly compared to your wages. I can’t imagine what it feels like when your only contribution to your family is to be a milking cow for your kids. I am not surprised that you think nursing is SO beneficial. You seem just the kind of woman Big Lacta can easily sell their bullshit to.

      Oh wait. You think formula costs 30 bucks or so. Now, it makes sense. Oh wait again. It proves you’re still an idiot. Stop pretending that you’re supportive of your friends who bottle feed because it works for them. After all that praying at the altar of your own milk-based awesomeness, as seen by your comments downthread, it’s clear that you’re supportive of them so you can further enjoy your own superiority.

      Your cheering on any overreach is disgusting. BTW, Dr Amy has the lead in the breastfeeding department. She breastfed four kids and she did it because she wanted to, not because she was a loser married to another loser who couldn’t afford the minimal expenses for formula even with joint efforts.

      I hope you now appreciate just how nice the other commenters were with you. Your ilk loves to come here and whine how they have been attacked, just like you did. And then, they get the really nasty ones. Like me.

  • Cartman36

    I just wish they would have ended with “mic drop”. I think my favorite line is “it seems strange to show concern for the future welfare of children, yet then disregard welfare concerns for around half of these children (the female ones) when they then have children themselves”. It reminds me of how some narrow minded people admonish working mothers for harming their children by having them in daycare and yet when half of marriages end in divorce, it seems to me that my children’s welfare is pretty damn dependent on my ability to remain in the workforce with current and marketable skills.

  • Emilie Bishop

    Also, why are governments promoting something so ableist? Plenty of women just can’t make milk! Why is it any different than a government promoting 20/20 vision, saying only those not needing glasses are good parents and those of us who need glasses don’t really, we just need to try harder for the sake of our babies? Not a public health issue; let’s all move on!

    • Cartman36

      My opinion is that the government promotes breastfeeding and especially EBF for two main reasons:

      1. it is easy for them because it puts the workload squarely on mothers rather than the government having to address issues that contribute to poor outcomes in children like poverty, poorly funded public schools, drug abuse, incarceration rates, etc.

      2. its a relatively safe position. If they say anything negative about breastfeeding, they will incur the wrath of lactivists but they can rail against formula and most people nod in agreement.

      • The Kids Aren’t AltRight

        I think your #1 above is why so many people cling so hard to breastfeeding as a magic talisman for middle class values. If your white, middle class kid does well, it is not unearned privilege, but your awesome sacrifice. When poor children do less well, it isn’t their lack of privilege, but their own failure to sacrifice in the right way.

        • Roadstergal

          THIS.

      • Casual Verbosity

        Breastfeeding is also a topic that unites both liberals and conservatives. Crunchy liberals love breastfeeding as the cure to all ills. And conservatives, particularly of the religious variety, love breastfeeding because it’s the way we’ve always done things. There’s also very much a general sentiment in society that natural = better, even amongst usually very rational people. So pro-breastfeeding policy is a sure-fire way to get people from the whole political spectrum on your side.

        • seenthelight

          Religious conservatives cling to it because it keeps women at home with the babies 😉

      • PeggySue

        I believe there is a third, though less important, reason: health care and government operate under the assumption that making things easy to measure makes life lovely and full of unicorns. So setting a goal of EBF–how much easier could it be to measure? Any protocol that becomes a metric upon which money depends is subject to abuse. So, even saying it would be nice if OB patients were supported to try BF can become translated into: we need 100% compliance with EBF.

        Saw a patient in a hospital where the cardiac metric was 100% of patients with suggestive ECG tracings were in a cath lab within 1 hour of arriving at the hospital. Patient came in, had not seen a doctor in 40 years, scared out of his life. They tried to consent him for the procedure, when they started with the description and risks he just went into overwhelm mode and shut down. No, no, no, he kept saying. So they didn’t proceed, but also didn’t take any more time with him. He’d declined the procedure within the hour, apparently, so their metric wasn’t damaged. He was admitted for medical management. No one explained to him what was happening to him or how the procedure they wanted to do would help him because, one hour. Amazingly enough, he had a nice big fat stroke overnight, not big enough to kill him, but big enough to disable him permanently. The protocol and metric failed this patient utterly. I only wish someone could have said, well, we need to give this more than an hour, and settled down in a chair next to him, and drew pictures of his heart, and actually explained things. He might well have consented, but they would have been at under 100% “one hour door to flow.” Follow the money, follow the numbers. I liked him; he was so scared, and who could blame him?

        • Sue

          EXACTLY, PeggySue.

          I work in a health service dominated by time-based metrics – it matters less whether the decision made was the best decision, than whether it was made within the taarget time.

          Then there’s another phenomenon – once a patient has “breached” the time metric, they can potentially wait forever, because they already haven’t contributed to “good” data.

          Time-based targets are intende to reduce delays to time-critical care, and also to reduce delays, but too often they are subject to gaming and become an end unto themselves.

  • fiftyfifty1

    Great to see what you have been saying for years get published in a formal, academic manner. The more it gets said, in more different ways, by more different people the better. Terrific.

  • lawyer jane

    I LOVE THIS SO MUCH!!