Breastfeeding advocacy and the difference between could, should and would


Breastfeeding or formula feeding?

It’s a choice that provokes strong feelings, particularly among those who identify themselves as breastfeeding professionals. It often seems that there is a huge gulf between organizations like La Leche League, whose avowed goal is to promote breastfeeding and Fed Is Best, whose avowed goal is to promote safe infant feeding whether that it breastmilk or formula.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Our goal: a society where any woman COULD breastfeed; but no woman feels she SHOULD breastfeed and no lactivist insists she WOULD breastfeed if only she knew better.[/pullquote]

I believe that the gulf can be understood by considering just three small words: “could,” “should” and “would.”


We need to create a society in which all women COULD breastfeed if that is their choice.

Despite the myriad disagreements between lactivists and feeding safety advocates, there’s no disagreement on this point. Although lactivists often claim that anyone who disagrees with them “hates” breastfeeding, there’s no evidence that this is the case. In more than two decades of writing about mothering issues, I’ve never come across a single individual who feels that breastfeeding itself is undesirable or substandard.

When we say we want a society where all women COULD breastfeed if they wish, most of us mean:

  • Women should receive any medical and social support they need to successfully breastfeed
  • Hospitals should supply medical professionals for breastfeeding guidance
  • Women should have access to sufficient paid maternity leave to establish breastfeeding
  • Women who return to work should have access to private pumping spaces and time to pump
  • Breastfeeding in public should be welcomed everywhere

Sadly, that’s where the agreement ends.


Breastfeeding advocates believe that we need to create a society in which all women SHOULD exclusively breastfeed, barring rare health issues.

In the view of most lactation professionals, the benefits of breastfeeding are so obvious, so strongly supported by science and so profound that women must be prevented from choosing anything other than breastfeeding.

They reject any empirical claims that the benefits of breastfeeding in industrialized countries are actually trivial, that exclusive breastfeeding has significant safety risks for babies because of the high incidence of insufficient breastmilk, and that it places significant burdens — physical and psychological — on mothers.

But rejecting those claims doesn’t change the fact that they are true. Indeed, the massive popularity of the Fed Is Best movement reflects the experiences of literally hundreds of thousands of women who support it. Those women know that the incidence of insufficient breastmilk is high because they’ve personally experienced it. They know that aggressive promotion of exclusive breastfeeding has significant safety risks for babies because their babies have been hospitalized, suffered brain injuries and even died because of dehydration, low blood sugar or severe jaundice. They know that breastfeeding places significant burdens on women because they’ve struggled with mastitis, pain, exhaustion, difficulty combining breastfeeding and work, as well as the profound shame and guilt of not being able to exclusively breastfeed.

Infant feeding safety advocates, myself included, reject the notion that all women should breastfeed because we recognize that breast is NOT always best for every mother and every baby. Furthermore, we are feminists who believe that women have the right to control their own bodies; to use them in ways that they wish and they must never be forced to use them in ways that ignore their own needs. We reject claims of biological essentialism — that the true fulfillment of women’s purposes lies in reproduction and nurturing of children. We reject the notion that biology is determinative. Just because women are “designed” for penetrative intercourse does not mean that it is wrong for women to be gay or celibate; just because women are “designed” to breastfeed doesn’t mean that it is wrong to formula feed or combination feed.


When faced with feminist arguments about the right to formula feed, breastfeeding advocates respond that all women WOULD breastfeed if only they were properly educated and not subject to the marketing efforts of formula companies.

There’s no scientific evidence to support that claim. The message that breastmilk is best is everywhere, even on formula itself. It is deeply disingenuous, not to mention misogynistic, to claim that women are too stupid to understand it and are in desperate need of greater education about the benefits of breastfeeding. It also implies that women are so gullible that they fail to recognize and are incapable of resisting marketing messages about formula. It denigrates women who choose formula by implying that their choice isn’t free and they have have been manipulated into it.

The existing scientific evidence shows the opposite: that women are well aware that breastfeeding has benefits and is considered best, that women resent being hectored, that language on the “risks” of formula feeding makes them angry, and that they are shamed and traumatized by the intense pressure to breastfeed.

In summary then, the differences between breastfeeding advocates and Fed Is Best advocates is not about “could.” All of us support a society where every woman who wants to breastfeed COULD breastfeed.

The disagreement resides in the words “should” and “would.”

Where does that leave us?

Breastfeeding advocates ought to stop whining that anyone who disagrees with them “hates” breastfeeding or is uneducated or gullible. They ought to stop promoting public breastfeeding as an antidote to formula feeding and recognize that feeding safety advocates don’t oppose public breastfeeding; social conservatives do.

Our goal ought to be creating a society where any woman who wants to breastfeed COULD breastfeed; but no woman feels that she SHOULD breastfeed and no lactivist insists that she WOULD breastfeed if only she knew better.