It’s not the end of the breastfeeding wars, but it’s the end of the beginning

baby milk bottle

Hallelujah!

According to The Independent, Midwives told they must respect mothers who decide not to breastfeed:

Mothers who decide not to breastfeed their child must be respected for their choice, midwives are being told.

New advice from the Royal College of Midwives (RCM) stresses new mothers should be given appropriate support if they make an informed decision to bottle feed…

[T]he RCM acknowledges some mothers struggle to start or carry on breastfeeding, breastfeeding, and says the decision is a woman’s right.

Think about that for a minute:

The RCM has just publicly acknowledged what Joan Wolf, Courtney Jung, Suzanne Barston, Christie del Castillo-Hegyi, Jody Segrave Daly, and I have been writing for the past decade.

• The physiology of breastfeeding has not changed. A significant proportion of women have ALWAYS struggled to breastfeed.

• Women’s right to control their own bodies has not changed. Bottle feeding has ALWAYS been a women’s right.

• Midwives’ ethical obligations have not changed. Midwives were ALWAYS ethically required to respect women’s feeding choices.

This is an admission that they and the rest of the breastfeeding lobby — La Leche League, the Baby Friendly Hospital Initiative, professional lactivists in the World Health Organization — have spent the past decade IGNORING and DENYING women’s struggles and babies’ suffering, IGNORING and DENYING women’s rights, IGNORING and DENYING their ethical obligation to respect women’s choices.

Gill Walton, new head of the RCM essentially acknowledges their woeful behavior:

“…[S]ome women cannot or do not wish to breastfeed”.

“They must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby,” Ms Walton added.

We know that every woman wants the best for her baby, and we want to be able to empower our members to support women to be the best they can be and enable them to make decisions that are right for themselves and their babies.”

This is EXACTLY what Joan Wolf, Courtney Jung, Suzanne Barston, Christie del Castillo-Hegyi, Jody Segrave Daly, and I have been writing for the past decade.

Why is the RCM suddenly acknowleding what everyone has known for years? I suspect it’s because the power of the breastfeeding lobby has come up against the tremendous suffering and massive amount of healthcare spending their unethical behavior has caused. Babies are injured and dying from dehydration, jaundice and falling from or being smothered in their mothers’ hospital beds. Breastfed babies are being admitted to the hospital at twice the rate of their formula fed peers, costing hundreds of millions of healthcare dollars per year. Moreover, women are vocally opposing both the scientific claims and the unethical tactics of the breastfeeding lobby.

As I have noted in the past, the unethical behavior of the breastfeeding lobby can be traced to a seminal 1996 paper by lactation consultant Diane Weissinger who set out a roadmap of lactivist behavior. She proposed the use of shaming language to pressure women into breastfeeding.

Why?

She couldn’t have made it clearer:

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, REGARDLESS OF OTHER CIRCUMSTANCES. (my emphasis)

Regardless of the fact that up to 15% of first time mothers cannot produce enough breastmilk; regardless of the fact that many women don’t want to breastfeed; regardless of women’s right to control their own bodies and midwives’ ethical obligation to support women’s choices.

The breastfeeding lobby — despite endlessly whining of victimhood — has controlled the infant feeding discourse with an iron fist for the past decade and more.

Sociologists Sunna Símonardóttir and Ingólfur V. Gíslason explain that women have been challenging the power of the breastfeeding lobby.

How?

Mothers pointed out that formula fed children are healthy.

The most uncontested and culturally accepted type of medical discourse on breastfeeding is the long list of the assumed benefits on the health and wellbeing of children…

Even though the women do not directly challenge this overall assumption, or make claims that breastmilk has no health benefits over formula, some of them do contest certain aspects of the hegemony of the medical breastfeeding discourse. The women who challenge the medical discourse on breastfeeding do so from a personal standpoint, contrasting their own happy and healthy children with the image of formula fed children as deprived and less healthy.

Their formula fed children are smart:

For some of the women, the worst aspect of this medical discourse on the benefits of breastfeeding is the notion that breastfeeding has a positive effect on a child’s intelligence. The women stress the academic achievements of their children and how in fact their formula fed child is ‘top of the class’.

They and their children have bonded fiercely to each other:

Breastfeeding … has been constructed as a vital aspect of mother–child bonding, reflecting the ideology of intensive mothering and ‘the need for mothers to manage risk by heeding expert warnings and advice.’ A number of women reject this idea that bonding takes place through breastfeeding by discussing the effects that breastfeeding (or trying to breastfeed) had on their mental and psychological wellbeing. Those women had usually been trying to establish breastfeeding with a lot of difficulty and severe pain, and they describe trying to breastfeed as an ‘emotional roller-coaster’ that has had serious consequences and often made them feel depressed and anxious. Breastfeeding is therefore not constructed as helpful when it comes to bonding, but directly harmful to the bonding process.

Women found that most of the ostensibly scientific claims made about breastfeeding were not true in their circumstances. That’s hardly surprising since, as I and others have detailed repeatedly, most of the scientific claims made about breastfeeding were made as part of the Panglossian paradigm beloved of both lactivists and anti-vaxxers that nature is perfect and technology cannot improve upon it.

The scientific evidence about breastfeeding has always been weak, conflicting and riddled with confounding variables. Early claims about the benefits of breastfeeding have not been borne out by later, larger studies. Most importantly, none of the predicted public health benefits of breastfeeding (based on mathematical modeling) have occurred; there have been no measurable changes in the mortality and morbidity rates of term infants and no healthcare dollars saved. To the contrary, the results of the power of the lactivist lobby are best measured in infant deaths and disabilities, maternal anguish, and hundreds of millions of dollars spent each year treating breastfeeding complications.

What the findings of this study do is to make visible certain discursive constructions and power relations that have remained hidden or simply taken for granted. Once they have been identified, we are much better equipped to disrupt and untangle these constructions and power relations and critically engage with the normalizing discourses on infant feeding …

Is this, as Guardian columnist Zoe Williams asks, the end of the breastfeeding wars?

I doubt it for the reason that Williams herself details: privilege.

The underlying issue was class-based: breastfeeding, the middle-class choice, gave middle-class parenting a superior status that would otherwise have been difficult to assert… [T]he First Three Years became a key policy area, with improbable and unpleasant assertions about what non-U parents were like. They fed their babies formula, then they left them all day strapped into a buggy, pointed at a wall; they didn’t give them the right vocabulary because they weren’t interested in talking to them. Bottles became a key signifier of parental neglect …

It’s was never about babies, but always about mothers:

This has been a culture war, and quite an exhausting one, where nothing meant exactly what it said: the pro-breastfeeding line originated with second-wave feminism, asserting a woman’s choice to feed with her baby as she saw fit, without medical or corporate interference. That liberation became an oppression; if it’s the only thing you’re allowed to choose, that’s not a choice. It fed into a set of ideas that located the source of childhood disadvantage not in hardship but in their parents’ sub-optimal behaviour, so that poverty would indicate, literally, that if you weren’t a bad person then probably your mother was. And this political notion was mediated not just through women’s bodies but through our actual tits. It was faintly chilling for all women, mothers or not. It would be wonderful if the RCM’s humane, good sense intervention marked the end of it.

It would be wonderful, but I predict that the breastfeeding lobby is not going down without a fight. There will be wailing and gnashing of teeth: about Nestle, about victimhood and about “The Science.” There will be no mention of the fact that breastfeeding is a big business, bringing in billions of dollars of revenue in breastfeeding products, and probably much more in lactation consultant fees and salaries.

Winston Churchill’s words about actual war may apply to the breastfeeding wars.

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.

  • Just had a lovely playdate. As the other mom was bottlefeeding her baby, and I was breastfeeding mine, she said she never made enough to breastfeed her babies. I said I hoped no one ever tried to make her feel bad about it, and she said she used to make herself feel bad, but then she saw her kids were healthy and growing, so now…she just shrugged and smiled.

    I’m very glad she feels that way about formula feeding now, but I’m sorry she went through suffering at first–pumping and fenugreek–and also that her tone was a bit apologetic when she said she couldn’t breastfeed. But at any rate, the essential thing was that we two were sitting amicably, feeding our babies, who got nice happy full tummies. Fed is best.

    • The Bofa on the Sofa

      As the other mom was bottlefeeding her baby, and I was breastfeeding mine, she said she never made enough to breastfeed her babies.

      How about the fact that she felt a need to justify her use of formula in the first place?

      In a sane world, there is no reason that this discussion even comes up. “She was bottlefeeding. I was breastfeeding. We talked about art we saw at the museum.”

      • AnnaPDE

        You wouldn’t believe just how much two eating babies inspire a conversation about feeding babies. At least among mums. Every time I did it the topic came up right away. Regardless of the method of feeding. 🙂

        • JDM

          Your infant eats peas? Mine hates peas.

  • qiaraau

    Breastfeeding is not always easy but this is the best for your baby to provide sufficient nutrients and also it is good for your health.

    • HailieJade

      You must be new here…

    • Who?

      Even if mum doesn’t make enough?

    • Sarah

      Oh dear…

    • Amazed

      What do you hope to achieve by posting this here? I doubt you found this page by chance, so you already know our attitude to garbage like yours. Surely you can’t hope you’ll find the adoration your boobs deserve here, of all places?

    • MaineJen

      Maybe it was the best for YOUR baby. It is not the best for a baby whose mother cannot make enough milk. 200 years ago that baby would have died or would have to be fed by someone else. Shall we go back to that?

      Why do you think prelacteal feedings are so common in so many cultures? Is it because those poor women haven’t been “educated” enough? Or could it be that a mother’s milk (particularly a first time mother) doesn’t always come in immediately, and the baby gets hungry, and it’s inhumane and cruel not to feed a hungry baby?

    • momofone

      Unless it doesn’t provide sufficient nutrients. Or isn’t good for one’s health.

    • Daleth

      Did you know exclusive breastfeeding puts babies at risk of rickets (vitamin D deficiency), which affects bone growth? Here’s an article:

      https://www.nytimes.com/2008/08/26/health/research/26rick.html

      And the official recommendation to supplement breastfed infants with Vitamin D:

      “Do infants get enough vitamin D from breast milk?

      No. Breast milk alone does not provide infants with
      an adequate amount of vitamin D, even if mothers are taking vitamins
      containing vitamin D. Shortly after birth, most infants will need an
      additional source of vitamin D.”

      https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-d.html

    • demodocus

      Glad you found bf’ing satisfactory. I found it violating and fantasized about cutting off my boobs. It got worse with my 2nd, so she’s mostly formula fed.

    • Dabbledash

      No. It’s a very good way of feeding your baby, just like formula.

  • HailieJade

    Even long before I discovered you Dr Amy, I used to laugh so hard at lactivists who played “victim” and acted as if breastfeeding women were some persecuted minority. Maybe it’s just because I grew up with breastfeeding propaganda shoved down my throat (and a mother who literally cried when I told her I found the thought of BF distasteful and had no intention of ever doing it) but to me, as a Millennial, breastfeeding was THE norm. It was everywhere. Apart from the occasional story about some grumpy old man complaining about a woman breastfeeding on a bus, I saw far, far more judgement directed at bottle feeding mums.

    Lactivists just remind me of American Evangelicals claiming to be a victimised minority. Who do they really think they’re fooling?

    • Russell Jones

      That’s a good analogy. Both groups use an idiosyncratic definition of “persecution,” something along the lines of “failure to confer upon my world view the force and effect of law [or at least social orthodoxy].”

      • HailieJade

        Pretty much. Bully crying victim.

      • MaineJen

        And both groups think everyone else would come around to their point of view, if only they get enough “education.”

  • J.B.
    • Amy Tuteur, MD

      Hideous!

    • attitude devant

      This is despicable. I’m ashamed of my government.

      • fiftyfifty1

        Can you imagine if this happened to a US family abroad? Americans live in other countries illegally all the time. I lived in a Central American country for awhile, and tons of US citizens were living there on overstayed visas. Published expat guides go so far as to endorse it: “Well, LEGALLY you can only stay for 3 months on a tourist Visa, but people go for years without being challenged, if anyone ever does cite you, then just call the Counsulate, blah blah blah.” It happens all the time in Europe, too. I belong to a study abroad forum and students are forever posting “Oh whoops, I just realized my student Visa expired last month, I thought I had until the end of the summer LOL.” Can you IMAGINE if these countries jailed American citizens when they found us there illegally?! If they ripped families apart and put the children in cages while their parents were held in jails? Holy shit.

    • Russell Jones

      Jesus. That’s some pretty epic outrage porn right there.

      Also, you’ve gotta love the whole “we’re gonna punish you for entering the country unlawfully by … uh … keeping you here! That’s it, we’re keeping you here” thing. The pull of the prison labor system on which so many putatively “private” industries depend is strong indeed, but that’s a whole ‘nother tirade.

    • Amazed

      What the hell!

  • Sarah

    Zoe Williams work on the subject is worth a read generally. In her book, she wrote about emails she sent to researchers asking for clarity on certain dodgy claims etc, and one of them accidentally sent an email not meant for her but about her, basically calling her a trouble causer. I think it was ‘What Not To Expect When You’re Expecting’.

  • Amy Tuteur, MD

    Here comes the lactivist backlash! The BFHI starts things off by gaslighting womenwho have suffered from aggressive breastfeeding promotion: https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/guidance-for-health-professionals/statements/

    • Sarah

      In the UK, infant feeding is an emotive subject because so many families have not breastfed, or tried and not succeeded. Yes. That’s why it’s emotive. Fuck all to do with any of Unicef’s dodgy contributions to the discussion. And as for the food bank policy, words fail me. Unicef UK won’t be getting any more money from me until they drop that one.

      • attitude devant

        I mean, if I’m bottle-feeding for whatever reason and I need an emergency food supply….my baby should starve?

        • Young CC Prof

          Apparently, yes. They’d rather your baby go hungry, or get fed some makeshift, possibly for days.

        • swbarnes2

          According to UNICEF, formula fed infants aren’t family.

        • Sarah

          It would appear so.

          They cite the existence of Healthy Start vouchers, £6.20 a week, which are given to low income families and can be used towards formula. However, there are a several problems with relying on these:

          1. £6.20 is not enough to cover an infant’s supply of formula for a week. The cheapest formula is from Aldi, £7 a tub, and they aren’t even in all of the UK.

          2. You can be in sufficient crisis to need a food bank but not be low income enough to qualify for Healthy Start, which is an income based benefit.

          3. You could have a change of circumstances that leads you to qualify for Healthy Start but experience a delay in receiving vouchers. They backdate, but meanwhile what are you meant to do if your claim doesn’t come through for a few weeks? This happens often enough.

          • Steph858

            Plus, even if you have enough of those vouchers to buy a tub of formula, you still have to go to the time and expense of finding and travelling to an establishment which will accept them. From the retailer’s side, they need to be registered BEFORE they can accept the vouchers. There’s all sorts of red tape involved in registering and reclaiming the value of the vouchers, so retailers who’ll take them are few and far between, especially in rural areas.

      • Mimc

        Wow I see what you mean. The “formula may not be the right type” thing is such BS. Are the going to stop offering any food people might be allergic to? Most babies just need the regular type with a few needing soy or hypoallergenic. If there babies need special formula then mom’s can just refuse the other kind.

    • Young CC Prof

      That’s an interesting document. “There was never any problem, let’s talk about breastfeeding support again.”

  • guest

    “They must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby,” Ms Walton added.

    Oh, thank goodness. When I gave birth at a BFHI hospital in the United States, the nurses refused to answer any questions on bottle feeding (even with pumped breast milk). Just flat out refused. I was given many hours of breastfeeding education. It seemed like a major oversight.

    • Megan

      But they need to educate us FF moms to “responsively feed” our babies?? Excuse my language (since I usually don’t get this mad) but fuck them. I know they still have to find some way to feel superior to FF moms but it’s wretched to suggest FF moms can’t respond to or bond with their babies without their education. FFS. Frankly, my postpartum depression worsened from breastfeeding my first made me less responsive. I will refrain from calling these people the names going through my head right now.

      • EmbraceYourInnerCrone

        I had kind of the same thought, “Oh gee, my baby and I loved the snuggle time of bottle feedings and her daddy loved feeding her the night bottles and telling her stories at the same time when she was a new born” I guess it’s dumb luck we figured out how to respond to our baby without the magic knowledge that comes breastfeeding /@@ <—- This is my eyes rolling onto the floor

  • fiftyfifty1

    “The physiology of breastfeeding has not changed. A significant proportion of women have ALWAYS struggled to breastfeed.”
    I agree with this, and would add that the proportion, always significant, has only increased. Advanced maternal age at first birth has always been a physiologic risk factor for poor supply/lactation failure, and women are now older than ever when they give birth the first time. (But of course a woman doesn’t need to have a physiologic reason to choose to bottle feed instead. Formula is a healthy and valid choice for personal preference alone.)

    • Sarah

      As indeed has the number of women conceiving after hormone related fertility issues, for example. And fertility issues generally. We know that women with PCOS may have supply issues, for hormonal reasons. We also know that there’s now medical technology to assist such women in conceiving. There’s thus a group of mothers of new babies who didn’t exist in anything like the same way until recently.

  • Anj Fabian

    I smirked at midwives having to respect women’s choices.

    It’s the rule in the NHS that midwives must respect women’s choices when it comes to birth. Why should breastfeeding be any different?

    • Sarah

      I mean, they don’t always do the best job at respecting either set of choices…