How lactation professionals de-legitimize mothers

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Every complex problem has a simple solution … and it is wrong.

According to lactation professionals, the “problem” of low breastfeeding rates has a simple solution. Just end formula advertising and societal pressure to bottlefeed and all women would breastfeed successfully, exclusively and for extended periods. They’re wrong. But even worse, they’ve leveraged their “simple solution” to disempower mothers.

Lactation professionals arrogate authority over breastfeeding to themselves by de-legitimizing doctors and mothers.

That’s what sociologist Emma Head explains in Understanding Mothers’ Infant Feeding Decisions and Practices.

The first part of this paper discusses the development of social research that focuses on the promotion of breastfeeding in public health campaigns and by health professionals. I argue that this work tends to conceptualize the choices of women as constrained by overbearing public health messages which need to be ‘rolled back’ to enable women to make feeding decisions according to their own wishes.

But that’s wrong.

The broad exploration of infant feeding found in social research—one that recognizes its temporal, embodied, and emotional dimensions and that it takes place in the wider context of specific health and policy regimes—is thus a challenge for more simplistic accounts which focus on changing attitudes or behaviors in an individualist way.

I can hear lactivists now: “But, but the SCIENCE!”

Critiques of the way that ideas of risk and science have dominated debates around infant feeding are based around two main arguments. The first of these questions the validity of the scientific evidence that supports the promotion of breastfeeding. Following on from this, the second is concerned with the restrictions placed on women’s abilities to make meaningful choices around infant feeding that the current formulation of health promotion supports.

Specifically:

[T]he promotion of breastfeeding on scientific grounds can be understood “… as the outcome of a cultural process in which the authority of science and medicine is borrowed by lobbyists and campaigners”, resulting in the diminishing of other forms of authority and the “de-authorization” of the parent.

Lactation professionals de-legitimize doctors by claiming they “don’t understand” breastfeeding and de-legitimize mothers by claiming they cannot resist formula advertising and cultural messaging. It’s not a coincidence that lactation professionals imagine that ONLY they have a clear-eyed understanding of infant feeding choices.

Curiously, lactation professionals ignore the pressure that they bring to bear on women.

…[O]ver time the constraints on choice around infant feeding have increased so the presentation of breastfeeding has become more of a directive than a choice. Knaak identifies how the ‘choice’ to breastfeed has become increasingly pressured as it is not just physical health outcomes that are linked to breastfeeding but “increasingly strong interconnections” are made with mother-infant bonding. This adds an additional pressure for women negotiating infant feeding and means their choices are constrained because formula feeding is represented negatively.

Moreover, in contrast to lactation professionals’ simplistic representation of infant feeding decisions, there is far more involved than formula advertising and the presence or absence of cultural support.

The gap between public health promotion and women’s experiences adds weight to the recommendation that those promoting breastfeeding should try to roll back the moralization of infant feeding and, more broadly, that the politicization of parenting needs to be undone.

That such a gap exists is largely the result of lactation professionals’ efforts to de-legitimize women’s experiences of and feelings about breastfeeding. Because lactation professionals have chosen to pretend that breastfeeding is perfect, any less than perfect breastfeeding experience must be ascribed to the failure of women to try hard enough, their failure to resist formula advertising and their failure to reject cultural support for formula feeding. Perhaps the most egregious example of the disempowering and de-legitimization of mothers is the entity of “perceived insufficient milk supply” as if women can’t be trusted to tell that their beloved babies are starving.

Lactation professionals arrogate authority over breastfeeding to themselves by claiming that neither doctors nor mothers can be trusted to understand breastfeeding. The result has been a disaster for babies — exclusive breastfeeding is now the leading risk factor for newborn hospital readmission — and a source of soul searing guilt for mothers — who are evaluated by lactation professionals only on their willingness to knuckle under.

The bottom line is that public promotion of breastfeeding, particularly within hospitals and by government agencies, has NOT been shown to be beneficial to babies and mothers and has actually been shown to be harmful. But this has never been about babies and it certainly isn’t about mothers. Breastfeeding promotion is about building the authority of lactation professionals by de-legimitizing doctors and mothers. The babies who are harmed are just acceptable collateral damage.

That has to end. It’s time for mothers to take back their authority from lactation professionals. Only then will women be truly empowered to make the infant feeding decisions that are right for their babies and themselves.

  • Shawna Mathieu

    I really felt the public health pushing on breastfeeding. My son was never able to latch, and I pretty much felt like a failure, especially after an LC told me my only problem was that I needed to “calm down.” Yeah, calming down didn’t help the flat nipples, lady. So I spent months feeling like a failure, which contributed to bad PPD, which didn’t get treated properly b/c I did what the books said and refused to wean.

    A few years later, even though I’d decided before my daughter was born to formula feed only, going to the WIC office made me wince, because EVERYTHING posted on the walls was for breastfeeding, not a mention of formula. Other WIC offices were the same – I remember seeing all the health department’s display about how breastfeeding was easier in a natural disaster, with the implication if you were formula-feeding, your baby was screwed!

    I straight up told the WIC nurses what seeing all that made me feel like, without seeing a single mention of formula feeding. No one had ever brought it up before, and the nurses had never even considered it.

    They agreed it was pretty crappy ,and it was hypocritical of them to do it, seeing as WIC paid for formula! They were under enormous pressure to push breastfeeding, which was less about all the “benefits” of BFing, and more if they got more moms to BF, they’d have to pay for less formula.

  • MainlyMom

    Dr. Amy, once again you’re one of few voices taking up this important topic. I’m sure the greater skeptic community will continue to ignore breastfeeding woo just like they ignored homebirth woo. Your voice and leadership here are so important.

    Thank you!!

    • MaineJen

      I’ve noticed that too. There is a subtle streak of misogyny in the skeptic community sometimes, and they often disdain ‘womens issues.’

  • Montserrat Blanco

    I have not seen a single formula commercial since decades ago. The lactivists had messages all over the GP practice, the hospital, etc when I was pregnant.

  • rational thinker

    Maybe a bit OT but we have talked about this before and a lot of us have been personally affected by this. The second half of the video talks about how too many black women are dying in childbirth. https://www.youtube.com/watch?v=TATSAHJKRd8

  • Anna

    A squillion percent, and this is not just opinion – there is a growing body of evidence saying the same things.

  • alongpursuit

    Thank you, dear Dr. Amy, for this. It summarizes my experience so well.