Formula is Feminist!

That’s the title of my latest piece for Slate.

As I’ve written repeatedly over the years: her baby, her body, her breasts, her choice! Therefore, the decision of the British Medical Journal to ban formula advertising is deeply anti-feminist:

Formula is a legitimate solution to what is often a serious health problem (and a feminist solution to an age-old gendered problem). The argument the BMJ has deployed to explain its decision to limit advertisements isn’t justified by the scientific evidence and instead shows its willingness to pressure women to use their bodies in culturally approved ways.

It’s incontrovertible, yet lactivists are are arguing, although the piece has sparked nuanced discussion in at least one forum.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The same people who would be apoplectic if anyone were to mandate the presence of “pregnancy is best” on birth control pills are nonetheless delighted by the exact same restriction on formula.[/pullquote]

The objection to my claim that formula is feminist run the gamut from hypocritical to very hypocritical.

Formula companies have put profits before people!

Sorry, but if you won’t restrict drug advertising because Big Pharma has a history of harming people for profit, don’t tell me you want to restrict formula advertising because Big Formula has a history of harming people for profit.

Formula advertising makes formula more expensive!

If lactivists cared about the price of formula, they’d allow sales, coupons and free samples and yet they don’t.

Corporations have no right to monetize life saving products!

Seriously? Every other lifesaving product is monetized — food, central heating, medical care — yet we are supposed to believe that formula should be uniquely free from profit?

The most powerful argument against efforts to limit not merely formula use but even mention of formula is a very basic truth: women have an unfettered right to control their own bodies and breasts are part of their bodies.

The ugly truth, however, is that lactivists believe a woman’s right to bodily autonomy is expelled with he placenta. Therefore, women must be pressured to breastfeed by any means they can think of — restricting formula advertising, mandating “breast is best” on infant formula packaging, aggressive breastfeeding promotion in hospitals, the closing of well baby nurseries to “promote” breastfeeding, etc.

The same people who would be appalled by restrictions on contraceptive advertising and apoplectic if anyone were to mandate the presence of “pregnancy is best” on birth control pills are nonetheless delighted by the exact same restrictions on formula.

The same people who believe that women can and should participate fully in every possible job and career look askance at the one product — formula — that levels the playing field for mothers and fathers.

The same people who claim to prize gender equity in parenting fail to see the irony of demonizing the only product that allows for gender equity in infant feeding.

The same people who would argue vociferously against forcing women to donate blood or bone marrow without their consent — even if it would save a life — are all in favor of forcing women to donate breast milk (sometimes non-existent breastmilk) for the “benefit” of their children.

The same people who demand every possible form of support for women who want to use their breasts to feed their babies insist that women who don’t want to use their breasts should be penalized and shamed.

The same people who are “pro choice” when it comes to women’s decisions about pregnancy are emphatically anti-choice when it comes to breastfeeding.

Some lactivists have recognized that irony and have sought to portray themselves as “beyond choice.”

The “beyond formula vs breastfeeding debate” position focuses on constraints to successful breastfeeding, addressing breastfeeding and women’s economic, social, and political status. It is assumed that women are constrained by structural factors and that these factors should be addressed instead.

In this view, it is acceptable to ban formula advertising because it “manipulates” women.

But they cannot square the circle because, for them, there is only one acceptable choice: breastfeeding.

Shifting focus to obstacles and support means that women would choose to breastfeed (“all woman will ‘naturally’ adore breastfeeding”), if they get proper support.

Pro-choice feminists (I consider myself to be part of this group) are deeply concerned about the way that women have become invisible within lactivist culture. Women’s pain, frustrations and difficulties are viewed as meaningless when compared to the supposed massive benefits conferred on babies.

We are equally concerned about the biological essentialism that is such as notable feature of contemporary lactivism. Lactivists appear to think that the fact that women are born with breasts means that they are morally obligated to use them. They conveniently ignore the fact that those same women are born with brains and are quite capable of using them to make the choice that is best for their children and themselves.

But most of all we are concerned with women’s right to control their own bodies.

I agree with Philosophy Professor Rebecca Kukla:

We need to think hard about the condescension and even the strategic imprudence involved in throwing our social resources into finding yet more ways of giving women information they already have [or as in this case preventing them from accessing information about formula]. Even more fundamentally, we need to question our assumption that improper education is the cause of low breastfeeding rates.

This is an issue of medical ethics:

…The current strategies and imagery used by American [and British] breastfeeding advocates … are not only inappropriate, but also constitute unethical assaults on new mothers’ autonomy and agency…

It is a violation of women’s bodily autonomy to pressure women to breastfeed.

With respect to breastfeeding, our public health goal should be to make breastfeeding a livable, comfortable, well-informed option for women, and not to cripple women’s ability to find a way of making caring choices for their children.

Women’s right to bodily autonomy is NOT expelled with the placenta and lactivists should not forget it!

It is so vicious as to seem inexplicable.

According to CNN:

Not long ago, a 4-year-old boy died of the flu. His mother, under doctor’s orders, watched his two little brothers like a hawk, terrified they might get sick and die, too.

Grieving and frightened, just days after her son’s death she checked her Facebook page hoping to read messages of comfort from family and friends.

Instead, she found dozens of hateful comments: You’re a terrible mother. You killed your child. You deserved what happened to your son. This is all fake – your child doesn’t exist.

They are not the first family to suffer this additional horror and they won’t be the last:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers experience the death of another person’s child from a vaccine preventable disease as a narcissistic injury and react with narcissistic rage.[/pullquote]

Interviews with mothers who’ve lost children and with those who spy on anti-vaccination groups, reveal a tactic employed by anti-vaxers: When a child dies, members of the group sometimes encourage each other to go on that parent’s Facebook page. The anti-vaxers then post messages telling the parents they’re lying and their child never existed, or that the parent murdered them, or that vaccines killed the child, or some combination of all of those.

What leads anti-vaxxers to such depraved behavior? Their monstrous vanity.

Wait, what? You thought the anti-vaccine lobby was concerned with the health of children? Think again.

The anti-vax movement has never been about children, and it hasn’t even been about vaccines. It’s about privileged parents and how they wish to view themselves.

Privileged

Nothing screams “privilege” louder than ostentatiously refusing something that those less privileged wish to have. In a world where the underprivileged may trudge miles to the nearest clinic, desperate to save their babies from infectious scourges, nothing communicates the unbelievable ease and selfishness of modern American life like refusing the very same vaccines.

Transgressive

Anti-vaxxers are intellectual toddlers having an extended tantrum.

Unreflective acceptance of authority, whether that authority is the government or industry, is a bad thing. BUT unreflective defiance is no different. Oftentimes, the government, or industry, is right about a particular set of claims.

Experts in a particular topic, such as vaccines, really are experts. They really know things that the lay public does not. Moreover, it is not common to get a tremendous consensus among experts from different fields. Experts in immunology, pediatrics, public health and just about everything else you can think of have weighed in on the side of vaccines. Experts in immunology, pediatrics and public health give vaccines to their OWN children, rendering claims that they are engaged in a conspiracy to hide the dangers of vaccines to be nothing short of ludicrous.

Unfortunately, most anti-vax parents, like most toddlers, consider defiance of authority to be a source of pride, whether that defiance is objectively beneficial or not.

“Empowered”

This is what is comes down to for most anti-vax parents: their egos. Anti-vax is a source of self-esteem for them. In their minds, they have “educated” themselves. How do they know they are “educated”? Because they’ve chosen to disregard experts (who appear to them as authority figures) in favor of quacks and charlatans, whom they admire for their own defiance of authority. The combination of self-education and defiance of authority is viewed by anti-vax parents as an empowering form of rugged individualism, marking out their own superiority from those pathetic “sheeple” who aren’t self-educated and who follow authority.

As a result, anti-vaxxers have monstrous egos that are pathetically fragile. Psychologically, they cannot tolerate being wrong about anti-vax ideology on which they have staked their identity and sense of self worth. Shockingly, they experience the death of a child from a vaccine preventable disease — a death their ideology tells them could not possibly have happened — an a narcissistic injury to themselves and react with all the fury that implies.

Anti-vaxxers lash out at the families of children who have died of vaccine preventable diseases in spasms of narcissistic rage.

Why do people with narcissism react so vehemently when threatened by a seemingly minor offense? …

Their grandiose views of themselves are threatened by perceived attacks. These grandiose views of themselves are necessary for their self-preservation. When threatened, they are not merely offended, but their entire sense of self is at stake…

Wikipedia describes it best:

…Narcissistic rage is the uncontrollable and unexpected anger that results from a narcissistic injury – a threat to a narcissist’s self-esteem or worth. Rage comes in many forms, but all pertain to the same important thing, revenge. Narcissistic rages are based on fear and will endure even after the threat is gone.

To the narcissist, the rage is directed towards the person that they feel has slighted them; to other people, the rage is incoherent and unjust… During the rage they are prone to shouting, fact distortion and making groundless accusations… [N]arcissists may even search for conflict to find a way to alleviate pain or suffering …

This narcissistic rage explains why anti-vaxxers will search out parents whose children died of vaccine preventable diseases to vent their terror — and shore up their fragile egos — through harassment, fact distortion and groundless (as well as heartless) accusations.

So when I see anti-vaxxers attacking the family of a child who died of pertussis or flu, my first thought is sympathy for that family, already grappling with unimaginable tragedy, being victimized over and over again by anti-vaxxers.

My second thought is pity for anti-vaxxers. Imagine the abject fear and rage that drives these people; fear that they have been wrong all along and rage that an innocent child dared to die in a way that exposes the hollowness of their ideology and fragility of their egos.

Anti-vaxxers are pathetic and I’m not just talking about their fundamental ignorance of immunology, science and statistics.

One of the most disturbing things about the natural childbirth and lactivists movements is the way they treat our distant foremothers; they treat them the same way we tend to treat all people who are non-white and non-industrialized, as one mass of undifferentiated, never changing animals.

It seems to have never occurred to them that for most of 30+ thousand years prior to the advent of writing, human beings existed in discrete cultures with discrete cultural practices. They had highly advanced civilizations complete with tools, pottery, and art … as well as traditions around birth and breastfeeding.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Exclusive, extended breastfeeding is like the missionary position: just one possible choice among many natural choices.[/perfectpullquote]

Natural childbirth and breastfeeding advocates don’t really pay much attention to what those specific traditions are. Either they behaved like animals relying on their “instinct” (just like contemporary natural childbirth and breastfeeding advocates!) or, to the extent that their traditions differed — think belief that childbearing women were unclean or supplemented their babies with prelacteal feeds — ignorant and “uncivilized.”

Why does it matter? Because both natural childbirth advocates and lactivists are longing for a past that may have never actually existed. Practices like exclusive, extended breastfeeding may exist only in their imaginations and nowhere else.

That’s what Anthropology Prof. Jonathan Wells explains in The Role of Cultural Factors in Human Breastfeeding: Adaptive Behaviour or Biopower?

Referring to the variability of breastfeeding practices among cultures, he notes:

Evidence from a variety of sources, including isotopic analyses of prehistoric skeletons … is consistent with the long-standing primary role of breast-feeding in infant nutrition, but both the historical and ethnographic literatures offer ample evidence that exclusive maternal breast-feeding for the first six months of life cannot be considered either “traditional” or the “natural” norm.

Furthermore, even when exclusive breast-feeding is practised it is not … an “instinctive” or uniform process.

He points out a phenomenon that contemporary lactivists prefer to elide:

Cultural factors therefore pervade breastfeeding at many levels. As the benefits of breastfeeding become clearer to the medical scientific community, those seeking to influence maternal behaviour, with the aim of improving maternal and child health, must develop an improved understanding of the role of cultural factors in infant feeding…

While all mammals suckle their young, there is wide variation in breastfeeding behaviors:

Mother-infant suckling interactions can be considered through a continuum model … At one extreme are altricial infant marsupials and monotremes, born in a premature condition and spending days or even weeks in the maternal pouch attached continuously to the teat. At the other extreme are the precocial ungulates and cetaceans, well developed and fully able to move on their own from birth. Primates lie between these extremes, and have been termed semi-altricial.

In many species, whether altricial or precocial, suckling is a relatively instinctive process. The newborn kangaroo searches out the teat itself, despite its relatively early stage of physical development… Many ungulates can stand very quickly after birth and orient towards the mother to search for the teat. In contrast, primate infants contribute less proactively to the initiation of feeding … The role of offspring instinct appears to be decreased, and there is an increased role of the mother, including learned maternal behaviour, in instigating lactation…

Even among animals, there is a cultural dimension to infant feeding:

In chimpanzees, our closest primate relative, both tradition and learning contribute significantly to the ontogeny of the offspring’s diet. Whiten and colleagues analysed data from a number of relatively discretely distributed populations, and found that groups inhabiting similar ecological environments nevertheless differed in the types of behaviour demonstrated. This scenario extends to diet, with only a selection of all possible foods eaten by any given group. These analyses demonstrated that both innovation of behaviour within populations, and diffusion of behaviour between populations, were important factors in accounting for nutritional intake.

Chimpanzee nutrition in general, including lactation, therefore involves “culture” – the learning of behaviour from others who have also learned it … This role of culture is relevant to our theoretical understanding of instinct in animal behaviour, and the notion of what is “natural” in human behaviour.

Indeed:

Despite the tendency to portray human breastfeeding as a “natural” process, in opposition to supposedly “unnatural” approaches such as bottle feeding, the reality is that there is no single “instinctive “ or “natural” way to breastfeed…

Breastfeeding resembles sex in this way. Labeling exclusive, extended breastfeeding as natural in opposition to any possible variation makes as much sense as labeling the missionary position natural and any other forms or practices of sexuality as “unnatural.”

Both lactivist recommendations and medical recommendations about breastfeeding often ignore this fundamental reality, assuming — despite widespread evidence of a multiplicity of cultural practices around breastfeeding — that exclusive, extended breastfeeding is “natural.” Then, through the use of biopower, they pressure women to conform to a “natural” practice that never existed in nature.

Biopower does not involve overt repression or force, but employs quiet and subtle coercions whose very invisibility enhances their effectiveness. Techniques include normalizing judgements which subtly define the properness of an indivdual’s behaviour, the institutionalisation of knowledge through which individuals are objectified and devalued, and the “panoptic gaze” which subjects individuals to continual surveillance …

That is similar to the way in which biopower is exerted around homosexuality and gender identity. Until very recently, our society objectified and devalued gay and transgender individuals, in some cases going as far as characterizing their behavior as criminal.

The exertion of biopower around breastfeeding has been going on for centuries:

While the literature does not tell us what women actually did in previous generations, it shows that male institutions and interest groups have had a long-standing role in prescribing “optimal” feeding, while also simultaneously containing many normative judgements of acceptable and unacceptable maternal behaviour…

The central role of breastfeeding in the generation of biopower can be attributed to the competing demands on women’s identities and hence behaviour. Women may simultaneously be daughters, sisters, wives or partners, and mothers. Perhaps most importantly, the sexual relationship between women and their partners may conflict with maternal roles, particularly given the relationships between lactational ammenorrhoea and breastfeeding duration. Maher has argued that male control over breastfeeding tends to be stronger in societies emphasising marriage and childbearing as “institutions for the confirmation of wealth and status”. More generally, the nature and duration of breastfeeding are a function of negotiation between the two sexes pursuing different goals …

Of course men are not the only ones who employ biopower around breastfeeding. Lactation professionals consider it an imperative to pressure women into breastfeeding whether they want to do or not, whether they are capable of doing so or not, whether it is in their best interests and the best interests of their babies or not.

They are no different than insitutions and authority figures who consider it imperative to pressure all individuals into heterosexual, penetrative, intravaginal intercourse whether that is what they want to do or not, whether it is in their best interests or not.

The bottom line is that the decision by lactivists to portray exclusive, extended breastfeeding as natural is an example of biopower in action.

It isn’t merely longing for a past that never existed; it can be actively harmful to women and babies.

Women’s biology has always been used against them and to control them.

For example, although pregnancy requires two people — one male, one female — only women get pregnant, carry babies and give birth. Therefore, women can be coerced and manipulated through government and economic policies around access to birth control and pregnancy termination.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding promotion is the exercise of biopower over new mothers, targeting them as objects to be manipulated and trained.[/pullquote]

For what it perceived as legitimate health interests, the government of China enforced a one child policy, forcing women to have abortions they did not want, and punishing women who gave birth to a second or third child.

For what it claims are legitimate health interests, conservative politicians in the US promote ever more burdensome and arcane restrictions on abortion access, forcing women to give birth to children they do not want, risking their lives, health and ambitions for themselves.

Using government and economic policies in this way is an expression of biopower.

As Robyn Lee explains in Ethics and Politics of Breastfeeding: Power, Pleasure, Poetics:

Biopower refers to knowledge and strategies of power that aim at governing a population’s life forces, involving the security of populations, the optimization of their health, and the discipline of their bodies. Governments exert increasing control over variables such as birth and death rates, rates of illness, fertility, rates of sexual activities, life expectancy, migration and nutrition… Through biopower, techniques of population control permeate all levels of life. Under the influence of biopower, the freedom and truth of the individual are defined in economic and biological terms.

It’s easy to understand how China’s one child policy and conservatives’ efforts to restrict abortion access are abuses of biopower. It is perhaps less obvious, but equally true, that contemporary breastfeeding policies are also an abuse of biopower.

As part of the influence of biopower, a technology of population emerged, beginning in the eighteenth century, which had two aspects: (1) the child and the medicalization of the family, and (2) hygiene, and the function of medicine as a form of social control… Breastfeeding became an area of concern because it involved both these aspects…

Contemporary breastfeeding promotion efforts like the Baby Friendly Hospital Initiative are aggressive efforts to exert biopower over women:

The influence of biopower on breastfeeding continues in the contemporary context; it can be seen in ongoing efforts to increase the initiation rates and duration of breastfeeding… [R]ules, norms, and the provision of [breastfeeding] advice represent a form of biopower through control that is exercised over the identity and behavior of women.

Biopower also involves disciplinary power that targets the human body as an object to be manipulated and trained… Conceptions of good mothering as requiring breastfeeding become internalized by individuals who carry out self-policing in relation to these norms.

Biopower is an apparently benevolent, but peculiarly invasive, form of social control.

Biopower relies on process of self-disciplining: individuals are encouraged to become agents of their own subjection through incorporating within themselves external authority structures including dominant cultural ideals and practices.

Though lactation professionals like to bewail the medicalization of infant feeding that occurred with the introduction of formula, they are deeply committed to perpetuating the medicalization of infant feeding. Just as doctors once used the language and authority of science to promote formula feeding as best, lactivists now use the language and authority science to promote breastfeeding as best. The fundamental assumption of lactation professionals everywhere is that science justifies their invasive efforts to control women’s behavior.

By medicalizing infant feeding in this way, they deploy the classic techniques of medicalization: “the expansion of medical jurisdiction and its use as a mechanism of social control through the medical gaze and surveillance.” It’s difficult to come up with a more accurate description of programs like the BFHI than that. It is an expansion of medical jurisdiction (mobilizing medical personnel to achieve its aims); it’s a mechanism of social control of women; and it brings the laser-like focus of the medical gaze on women with its surveillance techniques of constantly measuring rates of exclusive and extended breastfeeding.

The result, ironically, is that infant feeding has never been more medicalized than it has become under the influence of the lactation profession.

Breastfeeding expertise has been transferred away from women as a result of the medicalization of infant feeding, with breastfeeding norms largely determined by expert medical advice to women. Medical researchers assume their recommendations are valuable advice that can significant reduce infant morbidity and mortality… They also assume that they have the right to dispense such advice …

Moreover, while it is easy to understand how making it difficult for women to access to birth control is an unacceptable way of using women’s biology to control them, it is harder for some people to understand that making it difficult for women to access formula is an equally unacceptable way of using women’s biology to control them.

The truth is that current breastfeeding promotion efforts are an abuse of biopower by lactation professionals under the aegis of government and medical authority. It is purportedly justified (as are most uses and abuses of biopower) by the belief that it is “best” for the population of babies and mothers, while simultaneously ignoring the lived experiences of individual babies and mothers.

These breastfeeding promotion efforts are the exercise of disciplinary power over new mothers, targeting them as objects to be manipulated and trained. Women are encouraged by lactation “authorities” to become agents of their own subjugation, surrendering their bodies and lives to a medicalized view of infant feeding. That is unethical, unacceptable and profoundly wrong.

Apparently, the term birthrape didn’t work out so well for the natural childbirth industry.

It was in vogue for several years, but generated not the outrage at obstetricians that midwives and doulas were hoping for, but rather revulsion at their appropriation of the suffering of rape victims to publicize their cause.

The new term is obstetric violence.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Campaigns for normal birth are institutionalized obstetric violence.[/pullquote]

According to Birth Monopoly:

Obstetric violence is normalized mistreatment of women and birthing people in the childbirth setting. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

That’s a definition I strongly support. Sadly, natural childbirth advocates can’t stop sensationalizing all obstetric care as violence.

Amie Newman writes on Medium:

I was born in a snowstorm from a woman whose body was stolen. She was knocked out and drugged up hours after arriving at the hospital where she planned to birth her first child. Her doctor told her to stop screaming as she writhed in pain on a white-sheeted gurney, in a crowded hallway of a New York City hospital. She didn’t oblige his request and was eventually sedated, sighing deep with wet-cheeks. She did not know what she was given.

And:

Whose hand held the scissors that cut us apart? Was it the doctor who delivered babies only on Wednesdays? It’s unlikely it was my father’s. He was not allowed in to the room until much later. My mother still does not know who severed the vessel that kept us connected — that kept me alive while in her womb. But she still wishes she knew.

Although unmedicated childbirth with a midwife is often recommended as the “cure” for obstetric violence, the truth is that midwives are among its leading perpetrators. Midwife led “campaigns for normal birth” are a common form of institutionalized obstetric violence in industrialized countries and denying a laboring woman an epidural is a common manifestation.

How could that be?

Consider Amie Newman’s definition of obstetric violence:

It is an umbrella term that includes disrespectful attitudes, coercion, bullying, and discrimination from care providers, lack of consent for examinations or treatment, forced procedures like C-section by court order, and also physical abuse.

It’s hard to imagine anything more disrespectful than telling a woman how she ought to give birth and ignoring what she might want (pain relief, interventions, maternal request C-section), yet this is precisely what campaigns for normal birth do. By campaigning on behalf of a process instead of for patients themselves, proponents of unmedicated vaginal birth are explicitly ignoring the needs and wishes of those patients.

A good rule of thumb for respectful care is: “Nothing about me without me.”

Declaring that unmedicated vaginal birth is an institutionally supported goal instead of one choice among many possible choices, midwifery organizations are most definitely making policy and determining practice WITHOUT the input of women.

Proponents of “normal birth” insist that it is safest, confusing cause and effect. Sure women who have easy vaginal births have fewer complications than women who have C-sections, but that’s like saying people who spend their hospital stay in regular rooms have fewer complications than those who spend their hospital stay in the ICU.

It isn’t the ICU that is associated complications, it’s the need for the ICU. Similarly, it is often not the C-section that is associated with complications, but the need for the C-section. Campaigns of normal birth are as effective in reducing complications as closing ICUs. Not only do those actions fail to prevent complications, they cause more serious ones.

Even if unmedicated vaginal births were safer, that wouldn’t justify pressuring women to aim for them. Paternalism is never a justification for ignoring the specific needs and desires of an individual woman. It is not a justification for obstetricians to do what they want and it is not a justification for midwives to do what they want. Women do not reclaim their agency from obstetricians by handing it over to midwives.

Denying a woman an epidural, delaying her epidural or trying to chivvy her out of getting an epidural are all forms of obstetric violence. There’s something perverse about an entire industry predicated on the concept that excruciating pain is good for women. And there’s something racist about an entire industry that expropriates the (imagined) experiences of indigenous women — who lack access to pain relief — as “authentic.”

Dr JaneMaree Maher of the Centre for Women’s Studies & Gender Research at Monash University in Australia, offers a way of conceptualizing childbirth pain. In her article The painful truth about childbirth: contemporary discourses of Caesareans, risk and the realities of pain, she observes:

… Pain will potentially push birthing women into a non-rational space where we become other; ‘screaming, yelling, self-centered and demanding drugs’. The fear being articulated is two-fold; that birth will hurt a lot and that birth will somehow undo us as subjects. I consider this fear of pain and loss of subjectivity are vitally important factors in the discussions about risks, choices and decisions that subtend … reproductive debates, but they are little acknowledged…

Denying pain relief to a patient is a human rights violation and just because labor is a natural process doesn’t change that fact.

Pressuring women to breastfeed — mandated visits from lactation consultants, withholding access to formula, withholding pacifiers — is also a form of obstetric violence, a particularly infatilizing form. It is an attempt to control a woman’s body and decisions, violating her autonomy and dignity.

Ironically, the vaunted indigenous women often have greater freedom to choose when and how to start breastfeeding than women in “Baby Friendly” hospitals. Prelacteal supplementation is common in many indigenous cultures.

Closing well baby nurseries in an effort to promote breastfeeding is also obstetric violence. Many cultures have mandated weeks after birth as a time when women’s only task is to rest and recover. Only one culture demands that women begin caring for their babies on their own the moment the placenta is delivered: our culture!

The natural childbirth and breastfeeding industries must STOP trying to control women’s bodies and decisions. They must END violations of women’s autonomy and dignity. NO ONE should be trying to reduce epidural rates. NO ONE should be making it difficult for women to access formula. NO ONE should be mandating rooming in for new mothers and their babies.

The natural childbirth and breastfeeding industries are committing obstetric violence when they fail to heed these admonitions.

Lactation professional Prof. Amy Brown was apprised that one of her slides at a recent conference on “holistic” infant sleep could be construed as racist.

Brown predictably responded as she does to any criticism: with fury. But she’d been called out on a tendency that it is all too common in birth and breastfeeding communities: exoticizing poor indigenous women, particularly women of color.

As Alison Phipps has written in The Politics of the Body: Gender in a Neoliberal and Neoconservative Age:

Complementing [the] focus on the ‘natural’, there is a tendency to search for authenticity and origins in the discussion of alternative birth practices. This … often involves the Orientalizing of ‘traditional’ cultures, whether prehistoric or from developing countries.

Natural childbirth and breastfeeding advocates are channeling Grantly Dick-Read’s notions of “primitive” women, but:

… Like the claims of many contemporary activists, however, Dick-Read’s points were made despite the fact that he had not spent extensive time in non-western countries. The lack of an evidence base to corroborate such assertions is particularly problematic when non-western birthing practices are appropriated in the service of authenticity rather than effectiveness.

Which raises the questions:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Privileged, white natural mothering advocates silence less privileged women who have different experiences.[/pullquote]

Whose experience counts?
Is it appropriate to use the (imagined) experience of others to advocate for oneself?

In a separate paper, Whose personal is more political? Experience in contemporary feminist politics, Phipps attempts to address these questions.

She argues that the way that privileged, white women use experience — their personal experiences as well as the experiences of others — serves to perpetuate their privilege at the expense of others.

…[P]rivileged feminists, speaking for others and sometimes for themselves, use experience to generate emotion and justify particular agendas, silencing critics who are often from more marginalised social positions.

Specifically:

…Rhetorical use of distressing experiences by the powerful and privileged … turns them into a kind of ‘investment capital’ in what Sara Ahmed terms ‘affective economies,’ by mobilising them to generate feeling and create political gain. In the process, structural dynamics are masked; the privileged are able to capitalise on the personal and deflect critique by marginalised groups whose realities are invisibilised or dismissed, even as they are spoken for.

We see this over and over again among natural parenting advocates. Powerful Western, white, well off women ASSUME they speaking for EVERYONE. They use their own personal experiences and hijack the imagined experiences of others to secure what they wish to have. Even worse, they silence less privileged women who have different experiences.

Both the natural childbirth movement and the lactivist movement are made up nearly entirely of white, professional women and their white, privileged acolytes. They seem to believe that their personal experiences are the only experiences that count; their wishes around birth and breastfeeding are the only ones that are legitimate; and that to the extent that other women have different experiences and wishes, they must be silenced if possible and ignored if they dare to speak up anyway.

We are continually treated to the spectacle of white, privileged midwives convening conferences, attended nearly exclusively by white, privileged audiences, telling the birth stories of white, privileged birthing women for the express purpose of ensuring that the entire medical system to cater ONLY to them. In the process, the imagined experiences of black indigenous women (it’s natural!) are mobilized as justification for ignoring the preferences of contemporary non-white and non-privileged women. How dare they want epidurals, interventions of C-sections? They are either ignorant or have been alienated from their natural instinct.

And should any of those less privileged women with different experiences of childbirth and different needs dare to contradict them on social media they are first treated with smug condescension and then shut down entirely by deleting, blocking and banning.

We are continually treated to the spectacle of white, privileged lactation professionals convening conferences, attended nearly exclusively by white, privileged audiences, telling the breastfeeding stories of white, privileged breastfeeding women for the express purpose of ensuring that the entire medical system cater ONLY to them. In the process, the imagined experiences of black indigenous women (it’s natural!) are mobilized (as in Prof. Brown’s slide) as justification for ignoring the preferences of contemporary non-white and non-privileged women. How dare they want formula? They are either ignorant or have been alienated from their natural instinct.

And should any of those less privileged women with different experiences of breastfeeding and different needs dare to contradict them on social media they are first treated with smug condescension and then shut down entirely by deleting, blocking and banning.

What is the Baby Friendly Hospital Iniatitive if not a spectacle of white, privileged lactation professionals ignoring the lives experiences of indigenous women and substituting a mythical “natural” experience that never existed in nature? In reality many indigenous cultures supplement their babies with prelacteal feeds, and mandate days or weeks before new mothers are required to fully care for their babies and themselves. These are the women whose “experiences” are used to support the BFHI policies of avoiding supplementation at all costs and mandated 24 hour rooming in and the closing of well baby nurseries.

Worst of all, as Phipps writes:

This also has a polarising effect which inhibits connections across differing experiences: indeed, we often participate in selective empathies where we discredit the realities of those who articulate opposing politics.

Natural childbirth advocates discredit the reality of women who suffer agonizing pain in labor and severe childbirth injuries. Lactation professionals loudly and obnoxiously discredit the reality of many women who (along with their babies) have suffered from insufficient breastmilk. They have the temerity to sneer that “fed is minimal.”

Phipps analysis is long and complex but the conclusions are straightforward:

…The injuries felt by those who are more privileged, while certainly painful, are not commensurate with the experience of oppression. Ventriloquising another’s personal story is an act of power, especially when the oppression of this Other is wielded against another Other with whom one
disagrees.

In other words, using the (imagined) experiences of indigenous women is an act of power, especially when those stories are used to oppress other less privileged women in one’s own society.

Disclosing one’s experience of violence in a bid to construct and exclude the Other is violence in itself.

There is nothing wrong with privileged natural childbirth advocates discolosing their experience of disappointment at having an epidural, interventions or a C-section. There is something very wrong with privileged women using their disappointment to discredit the reality of women who welcome epidurals, interventions or C-sections. In a very real sense any “campaign for normal birth” is a form of obstetric violence against women who are less privileged.

There is nothing wrong with privileged lactivists disclosing their experience of lack of breastfeeding support. There is something very wrong with privileged lactivists using their disappointment to discredit the reality of women who don’t want to breastfeed, or worse, to discredit the reality of women who had insufficient breastmilk or other serious breastfeeding problems.

It is always an act of power for birth and breastfeeding professionals to use social media to pontificate about AND then silence (through deleting, blocking and banning) women who have different experiences.

The recently revealed college admissions bribery scandal is, of course, a story of money and privilege. But there’s an aspect that’s receiving less attention even though it may be more important. The scheme is the inevitable result of contemporary mothering philosophy — performative mothering — that treats children as maternal props from birth.

According to the Washington Post:

The Justice Department on Tuesday charged 50 people — including two television stars — with participating in a multimillion-dollar bribery scheme that enabled privileged students with lackluster grades to attend prestigious colleges and universities.

The allegations included cheating on entrance exams and bribing college officials to say certain students were athletic recruits when those students were not in fact athletes, officials said…

The public face has become two celebrity mothers, Lori Loughlin and Felicity Huffman.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Raise the child you have, not the one you wish you had.[/pullquote]

Loughlin and her husband, fashion designer Mossimo Giannulli, were accused of paying $500,000 in bribes so their two daughters would be designated as recruits for the University of Southern California rowing team — even though they were not part of the team. That helped the pair get into USC, according to the complaint.

And:

Huffman is accused of paying $15,000 — disguised as a charitable donation — to the Key Worldwide Foundation so her oldest daughter could participate in the scam. A confidential informant told investigators that he advised Huffman that he could arrange for a third party to correct her daughter’s answers on the SAT after she took it. She ended up scoring a 1420 — 400 points higher than she had gotten on a PSAT taken a year earlier, according to court documents.

But for me the detail that is most telling is that there is no evidence that the children actually wanted what the mothers schemed to get them. Unbeknownst to the children, they were being used as props to enhance the women’s image of themselves as mothers.

Loughlin’s daughter Olivia, a social media star in her own right, has made it very clear that she doesn’t care about her education:

In April 2017, she tweeted, “it’s so hard to try in school when you don’t care about anything you’re learning,” but the apathy peaked about a month before she was set to enroll at USC in September. She posted a YouTube video in which she admitted she “didn’t know how much” school she would attend. She told her followers she hoped she would “try and balance it all,” and said she was looking forward to “game days” and “partying,” but didn’t seem all that enthusiastic about the experience.

Which raises the questions:

Why couldn’t Loughlin raise the child she had?
Why did she try to make her into the child she preferred?
Simply put, why did she treat her daughter like a prop instead of a person?

The answer, at least in part, can be found in the rise of performative mothering.

As I recently explained, a mother used to be something you were; now it’s something you do, hence the term “mothering.” And you do it under the gaze of other mothers — you perform it — micro-branding yourself by your choices, and disseminating a carefully curated portrayal through social media, artlessly seeking validation through the “likes” of strangers.

I write about the role of performative mothering in childbirth, breastfeeding, attachment parenting and vaccination, but I’m well aware that it extends throughout childhood, up to college and possibly even after that.

In 2019, we are immersed in a culture that believes there is a best way to give birth, the less medical intervention the better. But birth is not “one size fits all.” Some babies are harmed and some even die because — in an effort to mirror the ideal — their mothers refuse lifesaving medical interventions. The baby is just a prop in the mother’s birth performance.

We are immersed in a culture that believes that there is a best way to feed a baby: breast is best. But infant feeding is not “one size fits all.” Breast is not best for every mother and every baby, yet mothers are pressured into literally starving their babies (sometimes leading to permanent brain injuries and death) to continue to breastfeed. The baby is just a prop in the mother’s performance of breastfeeding.

The performative aspect is particularly prominent in breastfeeding promotion, including the emphasis on enforced breastfeeding in hospitals, enforced rooming in, and the near hysteria surrounding public breastfeeding. Lactivists, professional and lay, are obsessed with the public performance of breastfeeding under the gaze of other women.

In 2019, we are immersed in a culture that believes that there are best places to go to college. But education is not “one size fits all.” A college that may be best for one child, may the wrong place for many others. USC is a great institution for some children, but it can be a disaster for an uninterested child unqualified to attend. No matter. Loughlin viewed her daughter as a prop for her performance of motherhood, not a person with needs and desires of her own.

The mothers, indeed all the parents, in the bribery scheme stand to pay significant legal and financial penalties for their unlawful behavior, but they face another penalty that may have greater long term costs. These mothers will have to explain to their children why they treated them as props, wishing them to be something they were not, and paying people so they could perform their mothering to the rest of the world.

There is a lesson here for mothers of children of all ages: raise the child you have, not the one you wish you had.

I knew this day was coming, but I’m pleased that it has arrived sooner than I expected. Lactation professionals are backpedaling as fast as they can.

I’ve been writing for years that lactation professionals in general, and Baby Friendly USA in particular, have been ignoring scientific evidence in favor of personal biases. Babies and mothers are suffering (and in the case of babies, dying) as a result.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The scientific evidence shows: Fed Is Best![/pullquote]

Along comes Marsha Walker, IBCLC to confirm it.

Walker essentially proves the contention of the JAMA paper that she is commenting upon. That paper found that the World Health Organization reviewed the latest evidence on breastfeeding and then proceeded to IGNORE it.

Specifically, the WHO noted but ignored the scientific evidence that pacifiers reduce the incidence of SIDS, that pacifiers do NOT interfere with breastfeeding and that early judicious formula supplementation does NOT interfere with breastfeeding. In addition, the WHO recommended policies for which there is NO EVIDENCE, including mandatory rooming in of babies and mothers, skin-to-skin beyond the first hour after birth, and the use of donor milk instead of formula for term infants.

The authors conclude that in both cases, stakeholder bias was allowed to take precedence over the actual scientific evidence.

This is a powerful critique (and confirmation of much of what I’ve been writing for years) but Walker tries to justify ignoring the scientific evidence that she doesn’t like. We don’t need high quality evidence for breastfeeding policies because breastfeeding is natural!

The use of the GRADE method and systematic reviews in this synopsis may not necessarily represent the best framework for evaluating interventions for an essentially normal process. Breastfeeding is not a medical problem…

This is so disingenuous that I wonder if Walker actually believes it. I doubt that she would accept scientific evidence that contradicts what she believes about breastfeeding UNLESS it was evidence of the highest quality. So to argue that it can be ignored BECAUSE it is the highest quality is bizarre.

The response by Bass, one of the authors of the original paper, is devastating:

Her statement that the synopsis used the GRADE method is inaccurate because that evidence assessment method was actually used by the World Health Organization (WHO)2 and is widely used and respected because of its rigorous approach to evidence rating. Suggesting that a lower level of evidence was warranted because breastfeeding is not a medical problem reflects confusion concerning the purpose of the BFHI guideline: to analyze the best manner to support breastfeeding, not to judge the value of breastfeeding.

Furthermore:

This resistance to evidence that challenges BFUSA compliance criteria can inadvertently result in unsafe outcomes including sudden unexpected postnatal collapse4 and newborn falls, which have been associated with BF designation…

But Walker is hardly the only lactation professional attempting to backpedal as fast as she can.

Prof. Amy Brown is arguably the fastest backpeddler of them all.

In her latest piece for HuffPo, Brown is shocked, shocked to discover that some women cannot produce enough breastmilk. This represents a complete about face from articles she has written in the past.

In May of 2016, in the cruelly title article Why Fed Will Never Be Best Brown claimed:

Physiologically speaking only around 2% of women should be unable to breastfeed …

[T]he reason why we are struggling so much with breastfeeding is for most not initially a physiological issue…

As recently as December 2018, Brown had the temerity to suggest that women who alert others to the risks of insufficient breastmilk should be ignored:

Try not to pay too much attention to breastfeeding horror stories. People like to share stories – it makes them feel better – without thinking about the consequences for you.

There’s no mention in that piece of what Brown just discovered: some of those horror stories are true.

But give Brown credit for smartly performing an about face. Now not only is insufficient breastmilk much more common that Brown previously acknowledged, it’s the fault of doctors!

Given the breadth and depth of medical knowledge, why do women still not have answers if they can’t breastfeed?

How lovely that after years of repeatedly being informed by women that they weren’t breastfeeding because they had inadequate milk supply, Prof. Brown has suddenly discovered that some women have inadequate milk supply. For years women have struggled with shame, guilt and self-hatred induced by lactation professionals like Brown who refused to listen and berated them instead. I wonder if she plans on apologizing for her years of gaslighting these suffering women and treating them cruelly. Somehow I doubt it.

What’s the take away message from all this lactivist backpedaling?

First, as I and the Fed Is Best founders have been writing for years, contemporary breastfeeding promotion efforts like the Baby Friendly Hospital Iniaitive IGNORE the scientific evidence.

Second, babies and mothers have been harmed by the lactivist insistence on placing their personal biases above the scientific evidence.

Third, lactation professionals aren’t going to back down without a fight.

Whether it’s Marsha Walker pathetically insisting that we can ignore high quality scientific evidence because breastfeeding is natural or Amy Brown brazenly insisting that the problem of insufficient breastmilk — a problem whose existence she denied until yesterday — is both real and the fault of doctors, lactation professionals will maintain breast is best for every baby and every mother. It doesn’t matter to them both scientific evidence and real world experience show that’s a lie. That’s why you should ignore lactation professionals who ignore scientific evidence.

The final take away message is the most important of all:

Fed Is Best!

Lactation professionals don’t think much of women and their ability to make decisions; they are sure that women who choose to formula feed are ignorant dupes.

In Reproductive Health and Maternal Sacrifice, sociologist Pam Lowe offers an excellent description of lactivism in general and the Baby Friendly Hospital Initiative in particular.

And:

The underlying assumption behind BFI, and many other breastfeeding campaigns, is that women who decline breastfeeding only do so through ignorance or as the dupes of formula marketing campaigns. Palmer is typical of this position. She suggests that infant feeding companies as well as ill-informed experts have contributed to a loss of faith in breastfeeding… “[W]hilst women should have a choice, they should all be informed that formula milk is signicantly detrimental to their baby’s health.” This is hardly a neutral position and is not necessarily based on the evidence…

But is that really why some women don’t breastfeed?

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactation professionals resolutely ignore factors beyond women’s control, preferring to blame mothers or society.[/pullquote]

The answer makes a big difference in assessing the ethics of breastfeeding promotion so it’s worth giving serious thought to the way we attribute causes to behavior, known in psychology (not suprisingly) as attribution theory.

Consider Weiner’s attribution theory of controllability. It sounds complicated, but it’s not hard to understand:

Weiner’s achievement attribution has three categories:

stable theory (stable and unstable)
locus of control (internal and external)
controllability (controllable or uncontrollable)

Stability influences individuals’ expectancy about their future; control is related with individuals’ persistence on mission; causality influences emotional responses to the outcome of task.

The theory is often represented graphically like this:

Each factor is vital to the outcome, whether that outcome is a grade on a test or a winner of a race. The key to success for a paticular individual will depend on the mix of controllable vs. uncontrollable factors, but only the controllable factors can be improved by effort or undermined by lack of support.

So, for example, a student’s grade on a particular test can be attributed to intellectual ability, effort at studying, difficulty of the test and luck (not feeling ill on the day of the test, for example).

If a student gets a bad grade on a test and wants to do better next time, he can study harder and get tutoring support, but he cannot change his innate intellectual ability and he cannot control external factors like illness that can impact his performance.

It is perfectly reasonable for a teacher to chide this student for not trying hard enough, or to blame herself for not making the lesson clear enough, but she should not berate the student for inherent lack of intelligence or other factors over which he has no control.

What does this have to do with breastfeeding?

I’ve modified the chart to encompass the factors involved in successful breastfeeding:

A mother who breastfeeds successfully will have adequate milk supply, and extend the effort (and endure the sleeplessness and possible discomfort) to teach the baby how to breastfeed and ensure that he or she is getting enough. She will also have the support she needs and not be swayed by the marketing efforts of formula companies. Finally, she will have a baby that is able to breastfeed and she herself will be healthy enough to breastfeed (no serious childbirth complications, etc).

Each of these factors is essential to ensuring successful breastfeeding and that has important implications for how we attribute “fault” when a woman cannot breastfeed or chooses not to do so.

In my view, the critical (and dangerous) problem with contemporary lactivist efforts, especially the Baby Friendly Hospital Initiative, is that they fail to take into account ALL factors and ascribe outsize influence to only two.

Consider the ability to produce adequate milk supply, the sine qua non of successful breastfeeding. There is a biological limit to what many women can produce. Some women will have inadequate supply in the first few days; some women will always have inadequate supply; some women will develop inadequate supply as the baby’s growth outstrips their ability to produce more milk.

How do lactation professionals deal with this critical factor?

They lie about it to each other and to their patients. Although it is a biological FACT that up to 15% of first time mothers will be UNABLE to produce enough breastmilk, particularly in the early days after birth, lactation professionals insist that insufficient breastmilk is vanishingly rare.

This is the central difference between “Breast Is Best” advocates and “Fed Is Best” advocates. Because they lie to themselves and each other about the non-modifiable factors that are necessary for successful breastfeeding, lactation professionals are left only with blaming mothers and the wider society.

We would consider it both ignorant and insensitive for a teacher to demand that an intellectually challenged student perform as well on a test as a student with an extraordinarily high IQ. We would consider it cruel in the extreme for the teacher to berate the intellectually challenged student by declaring that if he just studied harder, he could have done as well as the genius.

Lactation professionals (most of whom fall squarely in the “Breast Is Best” camp) sadly behave as ignorantly and insensitively as the worst teacher. Because they lie about the true incidence of insufficient breastmilk, they demand that women with insufficient supply provide the same amount of milk as women who have adequate supply. They cruelly insist that those with inadequate supply would have more if they just tried harder or if they were cognizant of the many (mostly debunked) benefits of breastfeeding or if they weren’t gullible dupes of formula companies.

They also ignore the role of other factors beyond women’s control like a baby who is a poor nurser, excruciating nipple pain, or other medical problems that can impact supply. Rather bizarrely, they imagine that all women and all babies face the exact same challenges, all of which they insist could be overcome.

Furthermore, it is almost impossible to overestimate the impact that lactation professionals attribute to maternal effort and social factors. They are obsessed beyond reason with the idea that women who don’t breastfeeding successfully or choose not to breastfeed at all are either personally lazy, lacking in crucial support or under the influence of formula companies.

Whose “fault” is it when a woman doesn’t breastfeed?

According to attribution theory, it can be no one’s fault. It can be the result of factors beyond a woman’s control including simple luck. But in the echo chamber that is lactivism, it MUST be someone’s fault, either the lazy mother or the lack of societal support or the marketing of formula.

As a result, lactation professionals spend most of their efforts on nonsense: “educating” women about breastfeeding, banning formula marketing, and (most importantly for them) promoting greater employment for more lactation professionals to offer more “support.” To my knowledge, not a single one is engaged in investigating the uncontrollable biological factors that have such a critical impact.

When you fail to correctly attribute the cause of a particular behavior, you can’t modify it and you can’t offer real support; you can only produce guilt, shame and self-hatred among new mothers.

In that, lactation professionals have no peer.

There has never been any confusion about the meaning of “infant formula,” but lactation professionals are engaged in a campaign to rebrand it in shaming, ableist language. It started in 1996 with the publication of lactation consultant Diane Weissinger’s “Watch Your Language”:

“Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior.”
This rebranding has been promoted enthusiastically by lactation professionals and their organizations. It has led — as it was intended to do — to feelings of shame, guilt and self-hatred among women who can’t or don’t wish to breastfeed.

We call upon lactation professionals and their organizations to immediately end the use of shaming, ableist language in all their efforts.

Such language has no place in the ethical provision of medical care including breastfeeding support.

Sign the petition HERE.