The American Breastfeeding Crisis of 2027

Eyes close-up little boy

This post is speculative fiction.

A thesis submitted

in partial fulfillment of the requirements for the degree of

Master of Public Health

May 2052

INTRODUCTION

From the vantage point of May 2052, the American Breastfeeding Crisis of 2027 seems impossible to fathom. As early as 2020, elementary school teachers had been pointing to the rising rate of learning and conduct issues — previously seen most commonly among poor children deprived of adequate early nutrition — in an otherwise privileged cohort of Western, white children of high socio-economic status. This was initially thought to be evidence of a harmful exposure to an environmental toxin and throughout the early 2020’s vigorous investigative efforts were made to identify the source.

It was gradually realized that although the crisis was indeed of our making, the environmental “toxin” was not a substance but rather the relentless effort to promote breastfeeding that had been underway for decades but reached a peak in the first quarter of the 21st Century. Simply put, an entire generation of children was demonstrating the insidious effects of early infant starvation and resulting brain injuries. American policy makers and health officials had inadvertently created an artificial “famine” among the very young by refusing to acknowledge the limitations of exclusive breastfeeding and making infant formula expensive and difficult to obtain.

Why did Americans unwittingly starve their youngest, most vulnerable citizens? The artificial breastfeeding famine resembles other much larger artificial famines — The Irish Potato Famine, the Stalinist Famine of 1932, and the Great Chinese Famine of 1959-1961 in that the causes were ideological, not natural.

When the potato blight destroyed the crop repeatedly in Ireland of the late 1840’s, the island was still producing substantial amounts of grain that could have fed the majority Catholic population living at a subsistence level. Instead the grain was shipped to England by Protestant land owners for outsize profits, a result of the British Corn Laws that kept the price of grain artificially high. British politicians justified the suffering that the famine produced with economic and moral arguments. They argued that the natural laws of economics meant that providing aid to the population would destroy the economy and they insisted that that Irish Catholics were in part responsible for the tragedy due to their lazy, shiftless ways.

The Great Stalinist and Chinese Famines also had their roots in government policy, in this case the collectivization of farming and the spread of agricultural pseudoscience like Lysenkoism. Millions died but they were seen as deserving of their misfortune because they opposed government efforts.

As this thesis will explain, the American Breastfeeding Crisis was the result of a tragic mix of ideology, pseudoscience and economics. The ideology was lactivism, the pseudoscience was the tremendous exaggeration of breastfeeding’s benefits while simultaneously hiding its risks, and the economics was the rise of a group of medical paraprofessionals — lactation consultants — whose income was entirely dependent on promoting breastfeeding regardless of the consequences.

During the 2010’s a growing body of research findings documented the pernicious effects of aggressive breastfeeding promotion:

The incidence of newborn hypernatremic dehydration rose dramatically
Over 90% of cases of jaundice induced brain damage (kernicterus) were the result of breastfeeding
Breastfeeding was found to double the risk of newborn hospital readmissions
Many cases sudden unexplained infant collapse was related to babies being smothered in their mothers’ beds
A rise in skull fractures and deaths of infants falling from maternal hospital beds.

In response, the breastfeeding industry blamed everything but breastfeeding. Just as British politicians insisted that the Irish Potato Famine was the result of the laziness and sloth of the Irish themselves, the lactation industry insisted that insufficient breastmilk was the result of the laziness and sloth of breastfeeding mothers themselves.

Just as British politicians introduced draconian policies meant to discourage access to soup kitchens, the breastfeeding industry introduced draconian policies meant to discourage access to formula: banning it in hospitals, requiring women sign shaming consent forms for access, refusing to allow formula to be advertised, etc.

Just as British politicians invoked the “natural” laws of economics, the breastfeeding industry invoked nature itself, conveniently ignoring the fact that all natural processes have failure rates. Indeed, there is nothing more natural than a dead baby.

What changed in 2027? White, well off Americans of the 2020’s were obsessed with the educational achievements of their children. Indeed, one of the favored exaggerations of the breastfeeding industry was that breastfeeding increased IQ. Research ultimately conclusively demonstrated not merely that breastfeeding does not increase IQ, but that insufficient breastmilk, particularly in the early days of infancy, decreases IQ and leads to disorders of executive functioning.

How could the breastfeeding industry itself as well as the public at large fail to see the damage that aggressive breastfeeding promotion was causing? How could they turn away from the suffering that resulted? Cultural beliefs provided complete justification. Lactivists and lactation consultants believed with every fiber of their being that breastfeeding was always good, never failed, and anyone who claimed otherwise was either lazy or under the sway of formula manufacturers. But then British politicians believed with every fiber of their being that the “natural” laws of economics were immutable, never failed and anyone who claimed otherwise was either lazy or under the sway of radicals.

And in both cases, children suffered terribly as a result.

This post is speculative fiction.

  • mabelcruet

    I wish you’d change the photograph at the top of this piece-that kid is really freaking me out!

  • It would be fascinating if someone would do some research about the past 3 or 4 generations of US/UK women to discover how many were breast or bottle fed, and how [if it does] it impacted on life expectancies, levels of education, chronic illness in later life, obesity, etc.

    I know I was completely bottle fed. My mother, in 1946, was as convinced that it was the “modern” way as today’s lactivist fanatics are convinced that the breast, and ONLY the breast [no EBM in bottles!] is suitable infant nutrition. I suspect I am far from alone. Formula feeding really got going in the 30s as the “scientific” way, even though back then there were no powdered prepared formulas but you had to make up a day’s supply, with a recipe [in the 40s, usually Dr. Spock’s] in front of you. The life expectancy of “baby boomers” is probably the longest in recorded history, but whether the frequency of, say, type 2 diabetes in middle or old age, has increased significantly among those who were fed by a particular method, is, AFAIK, unknown.

    • Tigger_the_Wing

      Interesting. I was breast fed (I’m sixty) and I have type two. But they aren’t linked – my diabetes is a result of liver damage due to the medications for my congenital health issues.

    • Who?

      I’m 55 in a minute, and was fed on watered down evap. Fit, healthy (so far as I know), lower end of BMI range. And I just got zero on my calcium storage test-which I know isn’t a big deal, and would be a worry if I hadn’t-but it’s the only time in living memory zero is a good score, so I’m dining out on it.

    • mabelcruet

      Breast fed for 2 weeks, then bottle fed. My parents had 3 kids under 3 by the time they were 20 and 21, so I get the impression feeding was a matter of scavenging and survival of the fittest-I am the world’s clumsiest eater and forever dribbling food onto my chest, I think its because by the time I was at the solid eating stage, my mother had the 3rd one so she was tied up with younger sib and I never learnt how to eat neatly.

      Anyway, bottle fed. 50, fat, normotensive, normal bloods, normal lipids, normal everything. Anytime I go to the GP surgery they keep insisting on re-doing my blood pressure because being fat it’s supposed to be high, but its not. I was invited in for a fasting blood sugar (they were doing an audit and everyone over a certain BMI was invited) and it was normal. Other than well upholstered, fairly good state of health generally, once I got my gallbladder out, that was a bit of a bugger.

    • not quite kidding

      I could see it looping back around to homemade formula in a few years, if the recipe is time-consuming and difficult to make. Expensive, rare ingredients and hours of stirring could do it, though if you could find a way to make it physically painful for the woman, that would clinch it.

  • yentavegan

    Breastfeeding is a method of transferring nutrition to a baby. Like many other human biological functions, sometimes the system functions flawlessly , other times, no matter what a mother does , the body is unable to meet the needs of the baby. I have alwaysed counselled mothers to feed the baby…feeding the baby is never the wrong answer. A well fed newborn can transition to the breast , if that is the mother’s desire. An underfed infant will be unable to suckle with gusto …and a strong lusty latch is key to building and maintaining a milk supply.

  • Emilie Bishop

    All good speculative fiction is rooted in real-world issues looked at through a different lense. In this case, sadly, you didn’t have to stretch very far. I wouldn’t be surprised if this is the conclusion eventually drawn a few years down the line. Hopefully sooner than 9 years. A lot of babies could suffer in 9 years…

  • fiftyfifty1

    Wow. I am ashamed to admit how little I knew of the Irish Potato Famine. A million people dead, my god. No wonder The Troubles.

    • Rather worse than that. According to Cecil Woodham-Smith, whose book “The Great Hunger” is regarded as one of the best histories of the Irish Potato Famine, between the deaths caused by starvation, and the deaths from disease on the “coffin ships”, the ultimate toll was even higher. And, by the 1850s, Ireland’s population had shrunk from 8 million to about 4 million, as everyone who could emigrate, did so.

      • mabelcruet

        The population has never really recovered either, its still about 4.5 million. Everywhere you go in rural Ireland you see ghost villages, ruined walls, tumbledown sheds, ridged fields that used to be potato beds.

    • maidmarian555

      I didn’t know much about it until long after I’d left school. In England (certainly during my school days) you get taught history that skirts around our shameful colonial past. So basically up to Elizabeth 1st, then a big old gap that starts again with WW1 and ends with WW2 (hooray we are the good guys). I honestly didn’t know the American Independance Day was a celebration of kicking out the English until I was in my twenties. This is part of why our politicians can talk about the British Empire like it’s a good thing, fanning the flames of populism. The vast majority of people in England have this idea that we once upon a time ruled the world and were brilliant and powerful but have no idea how shameful our past actually is.

      • Megan

        My education on the Irish Potato Famine was courtesy of Victoria on PBS and subsequent googling. 🙂

      • Sarah

        I’m English and I knew all about it, but I’m a Catholic from the north west and Irish was arguably the greater cultural influence on us growing up.

        • maidmarian555

          I’m in the SE and we were keenly aware of the Troubles due to proximity to London and regular bomb threats but the history of Ireland was pretty much a mystery. My Dad was a Glaswegian Protestant so I knew a little bit more about Scottish history, that the problems in Ireland were also somehow linked to the same schism between Catholics and Protestants that he had grown up with, and also that the other parts of the UK felt rather differently about England/Britain than we were lead to believe but my actual education on the topic was woeful. I’ve only really learned more as an adult because I was interested and watch a lot of documentaries and read a lot of books. I’d imagine plenty of my peers are totally oblivious to all of it.

          • Sarah

            Oh we were pretty aware of the Troubles too, especially in Manchester! I wasn’t aware of the causes or anything like that until they were over, but then I was only 13 when GFA was signed. Fortunately where I am, my parents generation were the last where the Catholic/Protestant thing meaningfully existed. How old are you? I was reading your post upthread again and I must say, we did do the slave trade and they told us about how Britain participated.

            I agree about obliviousness. If you listen to the number of pro Brexit people airily saying it’ll all be fine, people in NI will just have to do x to make things work… yeah, they won’t actually have to.

          • maidmarian555

            I’m 37 so at a guess only a little bit older than you if you were 13 when the GFA was signed. I did do a little bit about the British role in the slave trade but that was during A-Levels and in relation to studying Heart of Darkness (the book Apocalypse Now is based on), I think that’s when I started to realise I had massive gaps in my knowledge. Even studying WW2 as part of my GCSE, we mostly focused on how awful the Nazis were and the rise of Stalin, neatly glossing over all the fighting in North Africa and any uncomfortable information we might have picked up about what British fighters were actually doing in North Africa in the first place. My mum was at school in the 50s and said she was taught about the British Empire but in really jingoistic terms that would probably be described today as ‘horribly racist’. I would hope education on these things is getting better but I have doubts.

          • Sarah

            Oh yes, Stalin. That and Hitler’s rise to power. I did history to A-level and we did one or both of those every year from Year 9 upwards. I do understand hammering Hitler’s rise to power into kids, since it’s a very important lesson to be able to recognise, but the pair of them got bloody boring by the end.

          • maidmarian555

            Yeah I was done with it by the end of my GCSEs and switched to Classics for my A-Level. I also agree that part of history has some really important lessons to teach us but I’m not sure it was entirely necessary to spend a good three years on just that and nothing else.

    • StephanieJR

      I’m Scottish. Most of our history lessons was ‘fuck the English’.

      There were the Highland Clearances up here, which wasn’t as bad as the Potato Famine, but still screwed over a lot of people.

      • Both countries were essentially depopulated, but for different reasons.

        At the time of the Famine, it was strongly felt by the British government that aid would “promote dependency” on welfare, and that the Irish should have been so prescient as to diversify agriculture instead of relying exclusively on the potato, and have had smaller families [!]. It was very much a case of “blame the victim”.

        The Scots and the British overlords simply wanted to have the land for grazing which was far more profitable than leasing it to crofters, so they made life as untenable as possible to rid themselves of unwanted residents. And the failure of the ’45 rebellion, followed by the draconian actions of the British, caused widespread poverty and devastation.

        • StephanieJR

          Interesting, I didn’t know that, thank you.

        • Sarah

          I’m reminded of Alan Partridge’s marvellous skit on the potato reliance argument.

      • Who?

        History is all about context. My Spanish friend learnt at school that Christopher Columbus was a pirate.

        • MI Dawn

          We had a German exchange student who was taught that WWII was started by the English and French.

          • If you look at it sideways and say that WWII was started (or at least rendered inevitable) by the Treaty of Versailles and how badly it treated Germany, I guess you could make that argument? It’s not right, it’s not entirely wrong either. There is actual historical veracity to it.

          • MI Dawn

            True. But she knew nothing about that, and the Holocaust wasn’t really taught, either. From what she said, they were taught that France was attacking Germany so Germany *had* to defend itself. She was also unaware that they went east into Poland and Russia.

            Now, I’m not saying that was a common situation. She was from a very small town in Northern Germany. But she was so shocked and upset when she learned about it in US History (a required class for the exchange students no matter what grade they were in ) that she cried for days.

          • Oh, that is unusual.

    • Sarah

      The Troubles weren’t particularly a consequence of the Famine. The area that later became NI was affected but not quite as badly as some other parts of Ireland were. What caused the Troubles is the way in which the Catholics of Ulster were treated after partition.

      There isn’t really a strong causal link between the Famine and the Troubles except insofaras the Famine changed everything that came later in Ireland. And Britain to a lesser degree, since the migrations of the Irish to England and Scotland in the 19th century are a big part of our history and many millions of us owe at least some of our descent to that time.

    • Eater of Worlds

      All of Europe had the same blight on their potatoes. They knew for 40 years prior that Ireland was fucked in terms of starvation. They were mostly Catholic and because they were Catholic they were poor and only recently were they able to own land. Most of the landowners lived in England and the money they made was sent to England (no trickle down economics there!). Landowners let middlemen handle their taxes/estates, they rented out the land to tenant farmers who were basically subsistence farmers, they subletted the land further. Families rented land to grow food to feed themselves while also working for the landlords. Potatoes were the only thing they could grow in enough quantities to prevent starvation on that bit of land they could afford to rent.

      Prices and taxes increased, landlords wanted that bit of land to be for something else so the family was booted, couldn’t rent the same size for the same amount of money, people bankrupted left and right. Not only were they growing only potatoes they grew only one kind of potato, which meant Ireland was hit particularly hard by the blight (they didnt have other potatoes which could handle the blight better). That and 2/5 of the population is eating potatoes only for food.

      When the British took over the land ownership in Ireland they used it for grazing, leaving crappy little bits of land for the Irish which also ecouraged only potatoes to be grown because only potatoes could be grown on that quality of land in enough quantity to prevent starvation (going in circles now, we are). Blight didn’t naturally happen in Ireland, it was brought into Ireland. Because of how Britain treated Ireland they dithered on taking action. They had grain tariffs the hiked the price of grain so people couldn’t make bread (sound familiar, trump? we have issues with his steel tariff already for stuff as simple as making and exporting sinks). Over a million people left the country, laws were made and laws abandoned for dealing with the poor, they weren’t allowed to export food (and make money) b/c they were keeping the food in Ireland to feed people (that worked out really well for those who starved). Money was donated, that’s how the famous Choctaw donation came about even though it was just a little more than 15 years since the Trail of Tears. Because of more stupid laws mass evictions of the tenants from land happened, so now they really had no options for food. With the people that emigrated they sent back more money and got more family members to emigrate (that horrid chain migration that Trump fears and that his family and his wife’s family are guilty of).

      And that’s my terrible rendition of the Irish Potato Famine:It wasn’t just the potatoes.

      • Who?

        Thanks for that. Disasters never happen in isolation.

        The Irish diaspora is huge and widespread. My dad had an Irish grandmother-tiny, fierce, bright blue eyes. Back in the forties, at the hot dusty corner of no and where in the far back end of Queensland, the catholics and protestants were dressing their children up in the orange and the green.

    • Mishimoo

      My eldest learned about it at school last year, which was somewhat shocking to me because of exactly how bad the Irish Potato Famine was. It was handled pretty well too – the kids all had to write some self-insert historical fiction about it after doing some basic research, which promoted some empathy for the people involved.

      • MaineJen

        I wish more teachers did this. I remember writing historical fiction in social studies class, from the perspective of a girl living in Germany between the two world wars.

    • MaineJen

      I grew up in a very Irish-American town in New England…when we studied ancestry/immigration, fully half the kids in my class were all “My great-great grandparents immigrated during the Potato Famine…”