Breastfeeding advocacy and the difference between could, should and would

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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.”

COULD

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.

SHOULD

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.

WOULD

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.

  • fiftyfifty1

    Lactivists are never going to get behind the idea of stopping at “could”, rather than pressing for “should” and “would.” Lactivists are never going to be ok with Fed is Best. They know that if women learn the truth about breastfeeding–that for term infants in countries with clean water, breastmilk has only trivial benefits–that few women will choose to breastfeed. If we told women the truth and stopped all the social pressure, I think rates would fall to what they were in the 70’s or close. Certainly *exclusive* breastfeeding would fall to near zero. It’s like epidurals: when they are freely available, the vast majority of women choose them. If your agenda is to keep women away from formula or epidurals, the only effective way is to either make them unavailable, or demonize them with lies.

  • Aniko Szabo

    I would realy like to see more discussion on what does it actually mean for the medical community and society to support breastfeeding, and more generally feeding a child the way it works for its parents – your COULD section. I agree with all the points there, but there is so much more to it. My youngest child is almost 20, so hopefully my experiences are out of date, but I really felt unsupported in many things that made possible to fit breastfeeding into my life. I was lucky enough to have no difficulties in initiating it, but got little to no advice or support on other aspects.
    – Pumping to give me some flexibility. I only figured that out properly by my 3rd kid.
    – Mixed breast and bottle feeding and weaning when I wanted/needed to. I was just making it up by myself and my mother/mother-in-law’s advice. With my first child nobody told me that I should probably be weaning a 6 month old to formula and not cow’s milk – he was just fine, no harm done, but still.
    – Recognition by other medical professionals that a mother of a young baby might be breastfeeding and thus be aware of what medications might be used. I had a fun experience with a dentist, for example
    – etc, etc, I am sure others have much more current examples of what is needed and what is missing.

    • fiftyfifty1

      I think one thing that is missing is more info on how to combo feed. But first we need to get rid of the idea that anything other than exclusive breastfeeding is a failure.

      • Mama Politic

        SO much this! Even my friends who DID BF ended up combo feeding for one reason or another (low supply, sickness, hospitalization, time away, quit pumping at work, etc.). We got tons of education on pumping and EBF straight from the breast but nothing on formula or combo feeding. I didn’t have the slightest clue how to make a bottle before my husband showed me (I have older bonus kids).

    • The Kids Aren’t AltRight

      I am due in about a month, so I lack real world experience, but I would say that for professional women anyway, huge strides have been made for flexibility and pumping education and acceess; however, combo feeding is basically forbidden knowledge and weening questions are kind of dismissed besides “as long as you want, even for toddlers!” I often wonder if one of the reasons for the disparities in outcomes for formula fed babies is due to lack of support and education for proper formula/combo feeding.

    • Mimc

      I think the information that cow’s milk should wait until one is fairly well known now. I agree with others combo feeding is not talked about in any books or classes I had even though most of the women I know did it at some point.

    • Mama Politic

      So, my kid is 19 mo old. There is SO much breastfeeding support and information. I chose a mom-friendly (ie non-Baby-Friendly) hospital because I would not be breastfeeding for medical reasons and refused to sign a waiver saying I was harming my child after being browbeaten about why I was taking psychotropic meds I needed vs. breastfeeding. We still had more than 1 day out of 4 days of childbirth education devoted to breastfeeding. I ended up having to sit through it regardless of my plans so I could be “educated”. We learned about pumping and such but nothing about combo feeding with formula, I will say (which is obnoxious because almost everyone does that at some point even if they try to EBF). When I asked about formula, not knowing ANYTHING about making a bottle on my own, I got crickets. So, the pendulum has swung in the other direction.

      I had a baby Brezza, so I didn’t mix a bottle myself until we were on the road with a newborn at the holidays. It was dizzying. If my husband didn’t have two older kids, I would have had little faith in my ability to get it right (and it’s not that complicated). I have a PhD and consider myself pretty competent but I was so tired and run down that it felt awful not knowing enough. So, I’m sorry you had that experience with BF’ing because I can imagine it’s very disorienting and lonely to feel that way. But I think in today’s day and age, you would have MUCH more support. And, on top of it, you wouldn’t have to lose a lot of your friends! I lost a lot friends “choosing” not to breastfeed. It’s that big of a deal now days.

  • BeatriceC

    Typo in this sentence: “Infant feeding safety advocates, myself included, reject the notion that all women should breastfeed because we recognize that breast is NOT aways best for every “. The L is missing in “always”.

    • Amy Tuteur, MD

      Thanks! Fixed it.

  • Danielle G

    I totally agree with this. I’m so so tired of the breastfeeding brigade. My situation was different. I had breast milk but my baby just wasn’t a talented latcher, and I wasn’t a good student of the technique. I suffered through two bouts of mastitis and was encouraged to keep nursing (pumping in reality bc she couldn’t latch) through the pain by health professionals. How twisted and evil is that? I decided that my health and sanity was worth more than “liquid gold” and I said enough at 8 weeks. I just wanted to enjoy my baby and bond with her. But I had all the support and “education” I needed to keep going. It just didn’t matter enough to me. So I guess I’m one of those lazy moms who just didn’t try hard enough. Also, having formula fed, I’m not sure I could ever breast feed future kids. I appreciated splitting parenting duties and night feedings too much. I guess that is taboo to admit!

    I take serious offense to the suggestions that Formula moms don’t have the proper support or education. Why is it so hard for these zealots to acknowledge:

    1. After 40 weeks on average of pregnancy some moms don’t want to be the sole source of nutrition for their child and need their body back from a psychological standpoint. They want to share the responsibility that had mostly been theirs for the whole pregnancy.

    2. Not all women/babies take to it right away, and the effort to make something work when your heart isn’t fully in it just doesn’t seem worth it in a developed country with access to clean water. Especially wen a mom has limited time off and prefers to spend it happy rather than stressed.

    3. The more they exaggerated about breast milk, the harder it is to take anything they suggest seriously.

    4. Not all moms experience euphoria when they try to nurse so making that claim is a joke.

    It’s very Handmaid’s Tale.

    • demodocus

      god, that number 4 is true enough for me. My best days bf’ing were neutral. Other times I barely got through it and despite having weaned that child nearly 4 years ago, I still cannot stand anyone touching my chest. It’s even interfering with my enjoyment of the spouse’s affection.

    • guest

      # 1 was me. It was hard on me psychologically during pregnancy to be the sole person responsible. I was more than ready to split with my husband by the time the kid was born. That and sleep are the main reasons I didn’t breastfeed.

    • Anna

      All of this!!! Great post. I breastfed two babies, was in ABA, read all the books, was in the groups etc. I wasnt lacking education or support with baby three. I was lacking a baby that could efrectively transfer milk. Im expecting in Dec and also worry, after formula feeding, could I go back? My 3rd was sleeping through by 4months! Sleep is essential at 39 with three other kids, including a toddler.
      I tried way harder with my 3rd than I did with the first two where it came naturally and I didnt have school runs, huge grocery runs, soccer, ballet, band, assemblies etc to go to.