Breastfeeding is nearly as contentious as abortion and for the same reason

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Welcome to the thousands of new readers who have visited the blog over the past few days. You’ve been drawn by the posts on breastfeeding in which I’ve attempted to correct the massive amount of misinformation that passes for “education” on the topic.

On Sunday (New US breastfeeding policy, adopted for the wrong reasons, will almost certainly save lives) I wrote about the fact that Trump, though generally wrong about everything, is right to oppose the draconian WHO regulations around infant formula.

On Monday (What the breastfeeding literature REALLY shows) I provided a summary of major papers published in the breastfeeding literature in the past 2 years. Collectively they show that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact leads to babies falling from their mothers’ hospital beds or suffocating while in them. Most importantly, the myriad purported benefits of breastfeeding actually come from the higher socio-economic status of breastfeeding mothers, not breastfeeding itself.

Lactivism, like anti-choice activism, isn’t about babies; it’s about controlling women’s bodies.

On Tuesday (The conventional wisdom about breastfeeding is DEAD wrong!) I wrote about the ways in which the benefits of breastfeeding have become conventional wisdom and how conventional wisdom is often wrong.

Yesterday (Finally, data on lives saved each year by breastfeeding: only 8% of WHO claim!) I showed that the WHO’s central claim about breastfeeding, that it could save more than 800,000 lives each year is based on a faulty mathematical model and is thoroughly undercut by the actual evidence. At its peak, formula use in developing countries resulted in 65,000 deaths per year, ENTIRELY due to contaminated water, not formula itself. That peak occurred in 1981. Since then according to Paul Gertler whose research established the 65,000 peak death toll:

…[T]he annual death toll has dropped to about 25,000, driven by improved access to clean water in the Southern Hemisphere.

That’s only 3% of the total claimed by the WHO.

So why have professional lactivists, including those at the WHO, grossly exaggerated the benefits of breastfeeding, ignored the risks, massively inflated the number of lives that could be saved and clung to the conventional wisdom long after it had been disproven? Their tactics have a lot in common with those of anti-choice activists because neither breastfeeding nor abortion is about babies. This is about controlling women’s bodies.

Although La Leche League, the original and premier lactivist organization has carefully scrubbed their website of the fact, it was a religion inflected organization originally founded by seven traditionalist Catholic women designed to keep other women out of the workforce by convincing them to breastfeed.

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains that the La Leche League was:

…founded in 1956 by a group of Catholic mothers who sought to mediate in a comprehensive way between the family and the world of modern technological medicine…

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative… The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse…

The idealization of motherhood reflects the place of Mary in Catholic popular devotion…

The League’s answer to the question “What should mothers do” is grounded in … the original faith community of its founders.

For those women, the contents of their Catholic faith and the existential question of motherhood are interdependent…

From its very inception lactivism has been about policing women through control of their bodies. The medical justifications were embroidered on later to conceal the religious goal.

From its founding in the late 1950’s through the 1970’s, LLL was an organization that depended entirely on volunteers for peer to peer teaching of breastfeeding. Two things happened in the early 1980’s to propel LLL to its current status as arbiter of and nexus for all things breastfeeding.

First, breastfeeding was monetized. LLL spun off a variety of organizations to create, educate and monitor an entirely new profession: lactation consultant. Though LLL continued to give away breastfeeding information for free, its daughter organizations worked aggressively to install lactation consultants in hospitals, doctors offices and public health organizations. The monetization of breastfeeding led inexorably to the moralization of breastfeeding. In an effort to create ever more employment opportunities for lactation consultants, ever more “benefits” were conjured for breastfeeding and ever more pressure was applied to women culminating in the Baby Friendly Hospital Initiative, a program to aggressively promote breastfeeding to new mothers while they were hospitalized after birth.

Second, these efforts dovetailed with moral outrage over Nestle’s behavior in Africa. In an effort to improve market share Nestle convinced women to abandon breastfeeding for the convenience of formula, deliberately ignoring the fact that many did not have access to clean water. LLL became an advisor to the WHO in creating a response which involved aggressive promotion of breastfeeding. It was at this point that lactivism devolved into a campaign against formula even though there was no evidence that it was formula itself that had caused the problem.

Nestle’s corporate malfeasance is so central to breastfeeding promotion that to this day, more than 30 years after the fact, outrage against Nestle remains front and center in every lactivist effort centered on demonizing formula, which is just about every lactivist effort.

But make no mistake, lactivist organizations have never dropped their original commitment to controlling women by policing their bodies.

Lactivism is not about babies since the benefits of breastfeeding are trivial in countries with access to clean water.

In truth, nearly all the claimed benefits of breastfeeding are based on studies that are weak, conflicting and riddled with confounding variables. When corrected for confounders like maternal education and socio-economic status, the only benefits that remain are an 8% decrease in the risk of colds and an 8% decrease in episodes of diarrheal illness across the entire population of infants in the first year. In other words, the vast majority of infants will experience no demonstrable benefit from breastfeeding.

Lactivism is not about saving babies lives since, with the small exception of extremely premature infants, breastfeeding DOESN’T save lives in industrialized countries.

Lactivism isn’t about following the scientific evidence since most efforts, like the Baby Friendly Hospital Initiative, IGNORE the scientific evidence about the benefits of formula supplementation and pacifiers and ignore the rising number of breastfeeding casualties: the tens of thousands of babies readmitted to the hospital each year for dehydration and other breastfeeding complications.

Lactivism isn’t about saving money since any potential healthcare savings are dwarfed by the hundreds of millions of dollars spent each year to hospitalize babies suffering breastfeeding complications and the hundreds of millions of dollars spent in liability payments for babies’ brain injuries and deaths as a result of those complications.

Lactivism is about controlling women through policing their bodies, imposing a restrictive view of motherhood on women in order force them back into the home. It’s about dictating to women how they should use their bodies, pressuring them to use their bodies in approved ways, and lying to them to convince them to knuckle under.

Is breastfeeding a good thing?

It can be. I breastfed four children (all adults now). They were fat, happy babies and I enjoyed it and was able to combine it with an extremely demanding job. But I have no illusions that it improved the health or intelligence of my children or my relationship to them.

In my view, given the facts about breastfeeding, our approach to breastfeeding ought to be the same as our approach to abortion:

HER baby, HER body, HER choice …

Anything else is an attempt to control women by controlling their bodies.

  • FormerPhysicist

    I will come out and say the horrid thing. I *regret* how long I breastfed. I wish I had weaned much earlier. I don’t regret breastfeeding, but I do regret going past one year, and possibly even past 7 months.

    Most people don’t say they regret not having an abortion, because that’s nasty to a kid that exists. But my daughters know I regret how long I breastfed them, and they really don’t give a flying truck.

    • space_upstairs

      It does seem more acceptable to say that you regret how you raised your kids than to say you regret having had them at all, because the latter is taken as saying you don’t love your kids, even if the reality is more subtle, like, say, you love your kids just fine and don’t blame them for anything but the conditions under which you had and raised them made loving the process another story. It’s good that your kids don’t conflate your regret over an aspect of how you raised them with your not loving them.

      I’ve actually been reading about cases of people regretting having kids (while loving their kids, of course), and it seems a common factor is a sense that they didn’t really choose to have them and think it through with eyes open, but were rather pushed into it, convinced to do it for some inadequate reason that had little to do with kids themselves, or just thought it was something everyone did and never questioned it until it was too late. Is something like that behind your regret over your infant-feeding decisions? Or is that too personal a question?

      • FormerPhysicist

        I believed “breast is best” and wanted to be some sort of earth mother or some such. I did enjoy most of breastfeeding, but (1) I got way ‘touched out’ and that affected my marriage. (2) The kids all got major cavities (baby bottle teeth), ugh. (3) It hurt my career. (4) The kids got so used to mommy is primary and that left dad kind of out in the cold. Mostly balanced now that they are much older, but … bad dynamics. (5) It’s pretty clear now that it just isn’t a big deal to formula-feed and that the whole thing was overblown. And there just seems to be no reason to keep breast-feeding after 1 year. Or even past when introducing solids.

        I should have stopped earlier.

        • space_upstairs

          Ok, so it sounds like you hadn’t anticipated all of the downsides of extended breastfeeding in particular and how and whether you might manage to avoid them. That makes sense. I’m glad I’m getting the opportunity to go into having a kid with the chance to think things through, hear stories like yours, weigh options, and debunk any romanticized popular notions of what motherhood is supposed to be like and make my own sense of it as I go along. So thanks.

          • FormerPhysicist

            BTW, breastfeeding was very easy for me, and pumping was also insanely easy. I *had* to pump regularly to reduce engorgement, and ending up tossing a ton of milk. Yeah, I didn’t have the time to do all the prep work needed to donate (like sterilize every time). I still regret extended breastfeeding. Not like crazy regret, but so few women are willing to say they regret it, especially when it was easy … so I will say it.

          • DothethingZhuLi

            Me too. I pumped until my son was 2 and weaned several months later because I was pregnant and it was too painful. I was lucky to have a job where pumping wasn’t an undue burden, although it absolutely sucked and felt like wasting time. I did donate to several families, which was nice, but with #2, I think I’ll be stopping at a year.

            For a while, I wasn’t sure if I would have another kid, so I didn’t mind the effort as much (I may only have to do this once!), and he didn’t like cow milk. He’s always been a skinny kid (as as his parents) and I worried if I stopped earlier if that would negatively impact his health. I now know that, as he was healthy, that would not have been the case. He drinks milk on occasion now, but still prefers water, which is totally fine. Solids can supplement with dietary good fats if #2 also doesn’t care for cow’s milk.

            The sacrifices I made, scheduling everything around pumping, even dates with my husband, seem kind of silly now. I also agree that with extended breastfeeding, the dad can get left out. It was hard for my husband to comfort our son when he would rather have nursed. It was often easier for me, and so I just did it. And it caused resentment. I was also worried about how to wean. Cold turkey was really unappealing to me (for a number of reasons), and cutting nursing sessions seemed like a drawn out process designed to cause confusion and conflict in the relationship. Ultimately, we weaned over 3 days, as the “:bwee” went to sleep more and more, and my son was totally fine. I had mostly dried up, so I didn’t have any engorgement or clogs. It was almost anticlimactic. I didn’t even know the last time would be the last time. I wish I had quit earlier.

  • RudyTooty

    It almost seems that it can be societally less stigmatizing to have had an abortion that it is not have not breastfed.

    Women can have an abortion, and not have to discuss it with anyone, if she doesn’t want to.

    If a woman chooses to not breastfeed, it seems like she has to defend and explain this decision all the way from pregnancy through when the child enters college.

    Exhausting.

  • AnotherOor

    Exactly how I feel about it, it’s the same as abortion. How pressuring women to breastfeed has become the “feminist” thing I’ll never understand.

  • lawyer jane

    Chapter 2: Then hospitals realized that WHO’s Baby Friendly Hospital Initiative could be a cover-up for reducing maternity care, supposedly in the name of promoting breastfeeding, and adopted it widely. The resulting increase in sudden infant collapse, infant falls, and newborn re-admissions — not to mention rising and widespread consumer dissatisfaction — may result in changed hospital policies.

    • Madtowngirl

      Let’s hope it does result in changed hospital policies. So far, the one I will deliver at has only doubled down.

  • crazy mama, PhD

    Lactivists and anti-choicers both operate on the idea that women are too stupid to make the best decisions for their own families.

    Anti-choicer: ‘Considering terminating a pregnancy? You must not understand that there’s a developing human in your uterus. We’re going to make you look at ultrasounds.’

    Lactivist: ‘Considering formula feeding? You must not understand the benefits of breastfeeding. We’re going to make you listen to them all again.’

    • Who?

      In my experience in the workplace, men (and it is always men that I’ve had this exchange with) will say ‘you would support this idea/project/perspective if you understood it, let me explain (again)’. ‘No need’, say I ‘you need to entertain the possibility that I understand it perfectly and disagree with it.’

      Very trying.

  • Madtowngirl

    Ugh I’ve pointed out the hypocrisy of “my body my choice” applying to abortion rights, but not breastfeeding choices, and the cognitive dissonance I’ve run into is astounding. Apparently once the baby is out of your body, you lose all bodily autonomy. Or something.

  • While working for a women’s health journal, I was asked to come up with some spoof covers for an editorial board meeting. “Efficacy of mifepristone and misoprostol compared with soda and Pop Rocks for first-trimester abortion” was approved (and laughed at). “High school popularity among breastfed vs. formula-fed infants,” however, was rejected on the grounds that someone might be offended.

    Contentious, indeed.