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


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.


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.