Breastfeeding, cognitive dissonance and effort justification


Breast is NOT best.

Sure, all else being equal, fully fed with breastmilk by a well off, mentally healthy mother with access to high quality healthcare and high quality childcare who has freely chosen to breastfeed and has sufficient breastmilk has tiny benefits compared to formula feeding; but all else is rarely equal. Indeed, the scientific research shows that if the many factors in the previous statement are listed in order of importance to infant wellbeing from most important to least important, we get a list that looks like this:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who have expended great effort to breastfeed need to believe that the benefits are large and are hypersensitive to any suggestion that they are not.[/pullquote]

1. Fully fed
2. Access to high quality healthcare
3. Mentally healthy mother who has freely chosen to breastfeed
4. Breastmilk

So if we REALLY cared about infant health, instead of merely pretending that we do, we’d work to ensure that every baby is fully fed, that every baby has high quality healthcare, that we do everything in our power to prevent and treat postpartum depression and only then promote breastfeding. Instead we do the opposite.

Why do we ignore the scientific evidence that the benefits of breastfeeding are tiny? Why do we ignore the growing body of scientific evidence that aggressive promotion of breastfeeding is leading to tens of thousands of neonatal hospital readmissions each year at a cost of hundreds of millions of dollars? Why do we ignore the minor epidemics of infant dehydration, severe jaundice, babies falling from and smothering in their mothers’ hospital beds leading to permanent brain injuries and even deaths? Why do we ignore the harms of aggressive breastfeeding promotion to mothers’ mental health?

The reason: effort justification.

According to Wikipedia:

Effort justification is a person’s tendency to attribute a value to an outcome, which they had to put effort into achieving, greater than the objective value of the outcome.

It’s an attempt to reduce cognitive dissonance:

[T]here is a dissonance between the amount of effort exerted into achieving a goal or completing a task (high effort equalling high “cost”) and the subjective reward for that effort (lower than was expected for such an effort). By adjusting and increasing one’s attitude or subjective value of the goal, this dissonance is resolved.

Simply put, women who have expended great effort to breastfeed — who have endured the screams of a starving baby, cracked and bleeding nipples, multiple episodes of mastitis, sleep deprivation and (in some cases) serious depression — need to believe that the benefits are large and are hypersensitive to any suggestion that they are not. That’s why the Fed Is Best Foundation is excoriated in the loudest possible terms with an endless repetition of lies.

For lactivists, the Fed Is Best Foundation is cognitive dissonance writ large. It’s very name is anathema because it suggests that breast is NOT best for every baby and it only gets worse from there. In order to protect future babies from being harmed by aggressive breastfeeding efforts, the Fed Is Best Foundation reports on existing babies who have been harmed, injured and even died from complications of breastfeeding. How dare they?

In order to protect babies, the Fed Is Best Foundation exposes the lies propounded by lactivists. Such lies include:

  • The claim that insufficient breastmilk is rare (it’s common, affecting up to 15% of first time mothers)
  • The lie that formula supplementation is harmful to breastfeeding (it’s not; judicious formula supplementation in the first few days INCREASES the likelihood of extended breastfeeding)
  • The lie that pacifiers cause nipple confusion (they don’t; they prevent SIDS)
  • The lie that a newborn’s stomach is the size of a marble (it’s not; it’s 4X larger)

In order to support mothers, the Fed Is Best Foundation provides accurate assessments of the tiny benefits and significant risks of breastfeeding. They support breastfeeding in every way they know how, but they aren’t willing to lie to do so. How dare they?

But perhaps most egregious is the fact that the Fed Is Best Foundation supports women who can’t or choose not to breastfeed. That produces unbearable cognitive dissonance for lactivists. If it’s okay not to breastfeed (and it is okay), then the effort that they expended to breastfeed was not heroic; it wasn’t even necessary. When lactivists insist against all evidence that the Fed Is Best Foundation doesn’t support breastfeeding what they mean is that the FIBF doesn’t support their view of themselves as superior mothers. How dare they?

Sadly, cognitive dissonance and effort justification affect breastfeeding professionals nearly as much as lay people. Consider this obnoxious lie tweeted by lactivist Prof. Rafael Perez-Escamilla:


Thank you Baby-Friendly USA for exposing the FIB Foundation which is an organization based on the principles of “Astroturfing” defined [by Wikipedia]

What is Astroturfing?

Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participants… The implication behind the use of the term is that instead of a “true” or “natural” grassroots effort behind the activity in question, there is a “fake” or “artificial” appearance of support.

We have a word for that kind of tweet. The word is libel.

To date, the Fed Is Best Foundation has not chosen to pursue legal action against liars like Dr. Perez-Escamilla, but that doesn’t mean they couldn’t. Like all charitable foundations, FIBF has publicly accessible tax documents. But you don’t even have to look them up; the Foundation has published those documents on the Web. They show that there is NO secret funding source, NO corporate sponsors, nothing but real, grassroots support. Perez-Escamilla and other lactivists who lie have reason to know that they are lying, yet they do it anyway.

Why? Effort justification.

These people have devoted their entire careers to the belief that breast is best for every baby. They’ve raised and spent millions of dollars putting unethical, aggressive breastfeeding promotion efforts like the Baby Friendly Hospital Initiative into practice. Ironically — unlike FIBF founders whom they accuse of profiting from their advocacy — these liars actually DO profit from their advocacy. Their professional raison d’etre is breastfeeding and they need to believe that the effort they have expended, the money they have spent and the money they currently earn are justified by the overwhelming superiority of breastfeeding.

The cognitive dissonance that results from acknowledging that the benefits of breastfeeding are tiny and the risks significant is simply unbearable. The need for effort justification compels otherwise responsible professionals to blatantly lie in order to protect their self-image.

Prof. Perez-Escamilla and the other professional lactivists who have lied about the Fed Is Best Foundation owe them a public apology and an acknowledgement that there is no evidence of corporate sponsorship beyond lactivists’ desperate efforts to avoid confronting the facts.

Breast is NOT best for every baby and I’d be happy to debate Prof. Perez-Escamilla in print or in public on that issue. But I suspect that he, like most professional lactivists, wouldn’t dare.

28 Responses to “Breastfeeding, cognitive dissonance and effort justification”

  1. fiftyfifty1
    September 4, 2018 at 9:01 pm #

    Psychologists can say that lactivism is due to cognitive dissonance or effort justification or whatever. But in my opinion it’s just due to being an asshole. If you suffered to breastfeed, why would you want other woman to have to go through what you went through? You wouldn’t unless you were an asshole.

    • Who?
      September 4, 2018 at 9:29 pm #

      So true. It’s also the frenemy and shaming opportunities, which are also a subset of being an asshole (or arsehole, as we say in Australia).

      I once had someone tell me that I show no respect for myself because I don’t iron my clothes, and also was teaching my children to not respect themselves by not ironing their clothes. The only way she knew I don’t iron (she didn’t believe it at first) is because I mentioned it when she was doing her burning martyr routine about how busy she was.

      (Some) people are the worst.

      • Anj Fabian
        September 4, 2018 at 9:55 pm #

        Modern fabrics are AMAZING!

        You don’t have to iron if you choose clothes that look fine without ironing.

        • Who?
          September 5, 2018 at 1:34 am #

          Choose clothes wisely, and also wash carefully: (choose a machine that gently agitates the clothes after it finishes, so they don’t hold the creases from spinning), shake out, and for shirts and dresses, hang on hangers.

          Done and done. I haven’t ironed regularly since 2002.

          • demodocus
            September 5, 2018 at 2:15 pm #

            i have but only quilt blocks!.

      • MainlyMom
        September 6, 2018 at 6:42 am #

        Sometimes my kids and i wear wrinkled clothing. The horror!!

        • Who?
          September 6, 2018 at 7:10 am #

          I know, right!

          I always ironed as the washing came in-could never bear the tyranny of the full laundry basket-and then one day I couldn’t get to it so I hung it all up in a spare cupboard until I had a moment. When I got to it, I decided it didn’t look so bad after all, so transferred it all to its actual cupboards and moved on with my life.

          The wrinkles fall out of most clothes (old school pure cotton business shirts aside) when you’re wearing them.

    • me
      September 7, 2018 at 8:50 pm #

      They want to believe that their sacrifice was worth something. If other women have formula-fed children that are just as smart and healthy, then all that time and effort meant nothing.

      It’s like John Kerry’s quote when he was trying to end Vietnam, “How do you ask a man to be the last man to die for a mistake?” People arguing to continue the war were saying that ending it would be disrespectful to soldiers who had already died. Of course, that meant more lives were needlessly lost in continuing the war.

      It’s the Sunk Cost Fallacy, and people use it not just on other people, but on themselves. Not only will a woman who let herself and her firstborn suffer because of difficult breastfeeding try to bully other women into breastfeeding, she’ll also go through the same thing with her second child!

      • FormerPhysicist
        September 8, 2018 at 8:22 am #

        This is why I try to say publicly that I regret how long I breastfed my children, even though there were no major challenges. The biggest problems were that I got touched out, and it set up an unhealthy family dynamic of mom vs. dad.

  2. September 4, 2018 at 7:32 pm #

    OT- but I’ve got an inquiry from Illinois from a woman being given a real run around and having difficulty finding a CS by choice friendly doc in iIlionois. Any suggestions of a direction I can point her in? She’s due in December.

    • Madtowngirl
      September 5, 2018 at 1:11 pm #

      If she’s in the Chicago area, Northwestern Prentice Women’s Hospital is supposed to be pretty good. My SIL had no issues with getting a CS there. If that’s an option, I’d point her in that direction to see what providers service the hospital.

  3. The Bofa on the Sofa
    September 4, 2018 at 5:33 pm #

    One of the supposed benefits of breastfeeding is the 3 IQ points.

    I am wondering…what is the relationship between kids IQ and income?

    For that matter, what is the effect of income on illness? Wealthier families (especially 1 income wealth) do not use daycare, which is the main way illness is spread among young kids.

    In your list of priorities for kids, I would say that income is one of the starting points for healthy kids. Kids of wealthier parents end up healthier and all around better off.

    Of course, having families not living in poverty takes a real effort, and can’t just be an issue of shaming women.

    • swbarnes2
      September 4, 2018 at 5:55 pm #

      The relationship between IQ and socioeconomic conditions is way, way, stronger than the relationship between breastfeeding and IQ. The reported differences in good studies max out at about 3 points, which is about how much a person’s score would move taking the test on different day. With a large enough study, you can determine that a small change like that is statistically real, but if the difference is that tiny, who cares?

      We do tell people to give toddlers whole milk, and not reduced fat milk, because of the extra lipids, and I don’t think that the lipid content of breastmilk has been exactly duplicated in any formula, but if that has an effect, it will be very slight. Stuff like reading to kids has a far greater effect.

      • Casual Verbosity
        September 4, 2018 at 6:24 pm #

        All of this. I’m currently training in psychometric assessment and there is no way that I would look at a Fullscale IQ of 105 versus 108 and declare the child with 108 to be superior to the child with 105, even though 108 is technically in the high average range and 105 is average. The problem with IQ is that it’s vastly misunderstood by the majority of the population. That’s why we don’t actually report numbers, we report qualitative ranges e.g. performed in the average to high average range. If there is a difference of three points, the children will have the exact same qualitative range of performance. As swbarnes2 said, a three point difference is the difference between doing the test on Monday versus Wednesday. IQ scores are ESTIMATES of ability, not a true measure of ability. That’s why these measures use ranges; there is error in our estimates. And three points is well within that margin of error. In practical terms it means nothing. I’m not going to declare the child with 108 will do better in life than the child with 105 because while it may be statistically significant, the effect size is practically zero. And on a related note, as part of our assessments we gather data about birth, development, etc., and how a child was fed for the first year of their life is not a factor we consider relevant unless they were underfed (in which case, that would be very relevant to the development of their brain). So when we’re talking about Child-105 and Child-108 we don’t say: “Ahhh you see! Child-108 was breastfed; that’s why they’re so much smarter!”

        • The Bofa on the Sofa
          September 4, 2018 at 7:33 pm #

          But even assuming it mattered, that difference could be made up with, say, $5k extra income instead. As yccp notes, the effect of income is far more important than breastfeeding

          • Casual Verbosity
            September 5, 2018 at 5:21 pm #

            Absolutely. It could even be made up with a little extra effort. Afterall, IQ is an estimate of ability not an estimate of your potential achievement.

    • Young CC Prof
      September 4, 2018 at 7:16 pm #

      Any breastfeeding study that makes any reasonable effort to control for socioeconomic status ends up demonstrating that the effect of wealth is much stronger than the effect of breastfeeding, whether they acknowledge it or not.

  4. The Kids Aren't AltRight
    September 4, 2018 at 5:11 pm #

    FIB and this website also undermine a big source of power for the breastapo. I has my baby a few weeks ago. She left the hospital in good health, but at her 2 week appointment, she was still well below her birth weight and not wetting enough diapers. At her doctors advice, I started supplementing after feeding, and almost every woman I am related to and my in laws have given me endless crap. Thanks to you all, I have had the strength to keep bullies from convincing me to starve a helpless newborn. I think the pseudo feminist bullying is as mich a motivator for sime people as the effort justification.

    • Daleth
      September 4, 2018 at 5:39 pm #

      Yup. I’m so sorry you went through that, and glad you held strong!

    • Sheven
      September 4, 2018 at 6:17 pm #

      Can I recommend that you flat out tell them, “Stop telling me to starve my baby. It’s entirely unethical. If you cut down your food and water consumption to half of what you’d usually consume you’d see that pretty quickly.” Flip the script on them.

    • Cartman36
      September 5, 2018 at 11:13 am #

      I’m so sorry your family is treating you that way. If you haven’t read “Is Breast Best” by Joan Wolf, I highly recommend it. It will give you a TON of information to discount whatever intrusive busybodies feel the need to “share” with you. There is also;jsessionid=42BF00A6EE081C67F0050BF64A5AFE33?sequence=1 to keep in your arsenal. Its a meta-analysis from the WHO which highlights the confounding issue with breast feeding research.

      I wish you the best!

    • demodocus
      September 5, 2018 at 2:23 pm #

      Ugh. Family can be so helpful. And sometimes that is a very sarcastic statement. *hugs* Congrats and I’m glad Her Tinyself is doing better with a little store-bought in her diet.

    • MainlyMom
      September 6, 2018 at 6:49 am #

      Congrats on the new baby, I’m sorry you’re getting crap from family. I hope you can educate your family into Fed is best warriors!

    • PeggySue
      September 8, 2018 at 1:10 pm #

      Congratulations on the new arrival! Enjoy her!

  5. September 4, 2018 at 5:03 pm #

    I find lactivists annoying – but male lactivists really get under my skin.

    Dude, if this is so important, induce lactation in yourself. After all, that guy in Malaysia did that one time – so Dr Whomever should be able to as well.

    • Mimc
      September 5, 2018 at 6:20 am #

      Is there anything more mysogenist than a man telling women what to do with their breasts?

  6. Sheven
    September 4, 2018 at 4:20 pm #

    Sue! Sue! Sue!

  7. demodocus
    September 4, 2018 at 4:11 pm #

    It’s like decluttering. Not really an easy thing for most people, but it has its advantages.

    It being the need to let go of all your effort and accept that something kind of does indeed suck for you.

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