Breastfeeding Medicine

Physicians blogging about breastfeeding

“Lactivism” and breastfeeding backlash: A second look

with 69 comments

It’s become routine: a big anti-breastfeeding piece comes out in a major publication like the New York Times, or The Atlantic or Time. A mom complains how the benefits of breastfeeding are overrated, how breastfeeding is being forced on people, how moms are feeling shamed into breastfeeding or risk being bad mothers.

Let’s listen to these moms for a minute. Regardless of what we breastfeeding people are actually saying, this is what moms are hearing. We need to ask ourselves, why do they hear this message?

Here’s why: Moms experience the “lactivist.” To the uninitiated, the term “lactivist” equals zealot. Someone who believes that breastfeeding is the answer for every mom in every situation, someone who is inflexible, incapable of listening to a mom’s individual needs and desires.

Any woman who’s just had a baby would probably see a “lactivist” as The Enemy. Imaging yourself as that new mom. You are not thinking the “lactivist” is a savior in a white cape who’s going to defend you from evil hospitals who want to give your baby formula. She’s someone who’s going to push everyone out of the way and make you breastfeed, regardless of your own trials and tribulations, your pain, your exhaustion. She’d not there to help you. She’s there to advance her own agenda of world breastfeeding hegemony.

And, if a mom doesn’t actually encounter a self-described lactivist, she might see the effects. All it takes is a journalist-mom who hears one resentful nurse say “we’re not allowed to teach formula feeding,” and you’ve generated enough anger for a full page New York Times op-ed. This journalist then misrepresents the scientific evidence for the entire world to prove her point that the so-called “Breastfeeding Nazis” are out to get you, and it’s just not worth it, because breastfeeding’s not even all that good for your baby anyway.

We must be careful with our rhetoric, and treat every single mom with compassion and understanding. We must take care in how we train our staff and how that staff communicates to patients. Breastfeeding people all know that it’s required to teach moms how to formula feed, and staff must feel inside that this is valuable information for many moms.

It only takes one “lactivist” to piss off a journalist. You never know who might turn around and write that next full page op-ed for the New York Times.

So please, let’s stop using the word “lactivist.” Better yet, let’s replace zealotry with compassion and understanding, and meet every mom where she is. And if we see zealotry in our colleagues, let’s gently remind them that this may be how we got to that Time magazine cover and New York Times op-ed. That is the only way we will stop this negative press.

Melissa Bartick, MD, MSc is an internist at Cambridge Health Alliance and Assistant Professor at Harvard Medical School. 

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by Melissa Bartick, MD, MSc

October 21, 2015 at 1:15 pm

Posted in Uncategorized

Promotion without Support: A Reply to Editorials that Attack Breastfeeding Advocacy

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I would like to reply to Courtney Jung’s op-ed, and many other similar editorials that attack breastfeeding advocacy as bad for women. This argument posits a false dichotomy, supported by formula advertising, that the true battleground for breastfeeding exists between “lactivists” and mothers who choose to, or must, formula feed their infants. Rather, breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.

It is unclear why discourse on the “minimal” or “moderate” effects of breastfeeding continues; it is likely related to influence from both personal experiences of writers and influence from formula marketing. I will not engage this discourse here, as it is clear from every medical expert panel in every country in the world that the benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established. As breastfeeding is the physiologic norm, high rates of infant formula feeding negatively impacts all of these factors. Also, if what we are discussing is an over-emphasis on the social critique of women’s work, this is beside the point.

I am therefore saddened that media discourse on breastfeeding continues to undermine women by putting forth articles supporting the notion that a battleground exists between mothers. This classic patriarchal technique, of pitting women against each other, keeps the focus away from the systematic factors that undermine women around the world, including unequal access to paid maternity leave, evidence-based birthing practices, postpartum lactation support, breast milk banking, employer support of breastfeeding, and misleading advertising from infant formula companies. It is also the result of insufficient funding for public health infrastructures that therefore focus on breastfeeding promotion, without addressing breastfeeding support.

I urge us to notice that breastfeeding advocacy has moved on. The conflation of negative social experiences of mothers and breastfeeding advocacy is overstated. Advocacy has moved the dialogue, and we are saving our justified anger for the development of much-needed policies, medical practices and community movements that support women to have the real possibility of making choices that support the health and well-being of their families. The social and media conversation needs to move on as well. Editorials like Jung’s in the ‘Times’ only serve to continue the false conflation of advocacy and social blaming, and the false battleground between mothers.

ADDENDUM 10-19-2015 / 3 pm
Let me be clear: No one is saying this isn’t happening to moms. No one is saying that promotion without support is a good idea. Rather, I am criticizing the New York Times for continuing a conversation that pits women against each other and keeps our focus away from the ongoing structural inequities that women face. On both sides of this false battle, we are all agreeing that the battle shouldn’t be between each other, feeling critical or criticized for breastfeeding (or not). We should be joining together to force a conversation about how to create social conditions that actually support women in making choices that support their health and well-being. After all, what kind of choice is it if only one option is possible? As Gandalf would say: “YOU HAVE ONLY ONE CHOICE!” That is just improper diction…

(Also, FYI: research is being done on this, it’s just not getting published in the New York Times… exactly to my point. They are too busy with articles that radicalize breastfeeding advocates and dispute the value of breastfeeding.)

Casey Rosen-Carole, MD, MPH is an Academic General Pediatrics Fellow and Breastfeeding Medicine Fellow at the University of Rochester Medical Center

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by caseyrosencarole

October 18, 2015 at 1:37 pm

Arthur Eidelman deconstructs the latest breastfeeding-and-IQ study

with 5 comments

Would you do a study that “analyzed” the relationship of breastfeeding and IQ based on data obtained from mothers who retrospectively reported at 18 months postpartum if they did or did not breastfeed? Would you conclude anything if the data base was a yes or no answer, with no distinction made if it was exclusive breastfeeding or partial (of any degree) and with absolutely no data provided as to duration of the breastfeeding? Believe or not that was the basis for the “conclusion” by researchers in England that was published in the open access journal PLOS/one, widely reported the lay press and trumpeted gleefully by the disparagers of breastfeeding.

No less than these glaring methodological deficiencies, is the misreading by the “public” of what the authors themselves studied. As they stated, the study was NOT on IQ per se, but rather on IQ growth trajectories. Or to put it simply, if breastfeeding increased a child’s IQ as measured by the initial IQ test and the child maintained that degree of increased IQ as compared to children who did not breastfeed, there would be no increased growth trajectory.

Thus, extrapolating from trajectory data to absolute levels of IQ and concluding that breastfeeding has no impact on IQ is just plain wrong (let alone ignoring the wealth of articles in literature that support the conclusion that breastfeeding does increase IQ : see the most recent review: Effects of Breastfeeding on Obesity and Intelligence: Causal Insights From Different Study Designs. Smithers LG, Kramer MS, Lynch JW. JAMA Pediatr. 2015 Aug)

Given this combination of the basic limitations of methodology coupled with the misinterpretation of the study results, one must conclude that in no way does this study contradict what is a given: breastfeeding is critical quantitative positive variable in the cognitive development of all children. Furthermore, as a measure of the limited value of the study, one should note that authors did not even cite the issue of the lack of data as to the quantity of breast milk that the infants ingested over time in their list of the limitations of the study, let alone, did they indicate the lack of data as to major confounders such as maternal IQ and quality of home environment.

Bottom line is that this study should be discounted in any serious discussion as to the relationship of breastfeeding and IQ!

Dr. Arthur I Eidelman is a Professor of Pediatrics at Shaare Zedek Medical Center, Jerusalem, Israel. He is the Editor-in-Chief of Breastfeeding Medicine, past president of ABM, and a Fellow of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by aeidelmanmd

October 8, 2015 at 5:05 pm

Is it really about sexualizing breasts? Or is it about rape culture?

with 6 comments

A guy friend once informed me that breastfeeding breasts aren’t sexy. Sure, there might be the odd dreamboat (thank you, Brad Pitt) who will publicly announce his preference for the breeding female form, but my friend explains: “Breastfeeding breasts aren’t sexy. No one thinks they are sexy! They are generally overfirm, or oblong, with a giant nipple and a BABY attached to the end!” (He also has lots of very warm and supportive opinions of breastfeeding women) Let’s repeat that: “A baby is attached to it;” and that baby probably just pooped itself.

This struck me as essentially true, so it got me thinking: what’s the deal with the worry that this cultural myth of “breasts are for sex, not feeding” undermines women’s ability to feel comfortable with breastfeeding in public? What’s up with the leagues of women telling us they feel over-sexualized while breastfeeding? Or, at least, the leagues of lactation consultants and breastfeeding advocates worrying about it? In fact, it seems important to point out that breastfeeding women aren’t walking around complaining that they feel too sexy. In fact, one of the main reasons teen moms will give for not breastfeeding is that it isn’t sexy. Not to mention the common misconception that breastfeeding causes one’s breasts to become prematurely saggy. Saggy…real sexy. So, if we, as breastfeeding advocates, are not getting this directly from moms, where does it come from? Read the rest of this entry »

Written by caseyrosencarole

September 10, 2015 at 7:49 am

Posted in Feminism, policy

WBW 2015: Women and Work, Let’s Make it WORK

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Whether you celebrate World Breastfeeding Week (WBW) or National Breastfeeding Month, and whether you choose the first week in August or October, the time to be launching your efforts is NOW!

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The World Alliance for Breastfeeding Action (WABA) is perhaps best known for its global sponsorship of World Breastfeeding Week (WBW), but it is much more: WABA is a global network of individuals and organizations concerned with the protection, promotion & support of breastfeeding worldwide. WABA’s actions are based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the Global Strategy for Infant and Young Child Feeding. WABA is in consultative status with UNICEF and is also an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC). Its Core Partners include ABM, IBFAN, ILCA, LLLI and Wellstart International, with a shared mission: “To protect, promote and support breastfeeding worldwide, in the framework of the Innocenti Declarations (1990 and 2005) and the Global Strategy for Infant and Young Child Feeding, through networking and facilitating collaborative efforts in social mobilisation, advocacy, information dissemination and capacity building.”
World Breastfeeding Week this year occurs on the 25th anniversary of the Innocenti Declaration, signed by more than 30 countries (including the US) that stated the countries’ intention to implement the following by 1995:

  • Create a national multidisciplinary authority for government support and oversight of breastfeeding
  • Ensure all hospitals practice the Ten Steps for Breastfeeding
  • Implement the International Code of Marketing and subsequent WHA resolutions
  • And, last but by no means least, ensure maternity protection, including the ILO guidance of at least 14 weeks paid maternity leave and workplace accommodation.

This year’s theme supports the Innocenti Declaration as well as WABA’s goal to create an enabling environment for mothers and families worldwide to decide to optimally breastfeed and to succeed in that goal Breastfeeding and Work – Let’s make it work! This theme highlights the importance of ongoing support for necessary leave and workplace support.

Now is the time to inspire, empower and educate while we support, protect and promote breastfeeding. Get ready to act now in support of the theme for World Breastfeeding Week 2015. Please visit for information on the theme, materials you can download, a photo contest and WBW 2015 Pledge forms to tell the world about your efforts.

Miriam H Labbok, MD, MPH, IBCLC, FABM, FILCA is Professor and Director of the Carolina Global Breastfeeding Institute in the Department of Maternal and Child Health at the UNC Gillings School of Global School Public Health. She is a Founder, past president and member of the board of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by labbok

August 2, 2015 at 6:51 pm

Posted in Uncategorized

Two lies and a truth: Formula Feeding campaign is off base

with 32 comments

The ad starts by asking “do you ever feel judged?” and shows a woman on a bench outside of a playground, holding her baby in a sling and looking unsure of herself. She is progressively joined by different stereotyped groups of women, including the “breast police,” that start a playground “brawl” of sorts. They argue in shallow derogatory terms that one group has the better form of parenting: breast vs bottle, work vs stay at home, disposable vs cloth diapers, etc… When they finally charge each other, a baby carriage is left hurtling down a hill and all the families join together to chase it. They bond over their concern for saving the baby in the carriage, and the text reads: “Whatever your beliefs, we are all parents first.”…”Sisterhood of Motherhood,” cue to “Similac.” Read the rest of this entry »

Written by caseyrosencarole

June 16, 2015 at 2:54 pm

Posted in In the news

Fallout from IQ study ignores barriers to breastfeeding

with 17 comments

A recent study linking longer breastfeeding with higher IQ in adulthood seems to be pushing some people’s buttons. The study followed several thousand children, recruited in the early 1980s, through adulthood, and assessed years of education, IQ, and income in their early 30s. Compared with those who were not breastfed, individuals who had been breastfed for at least a year earned about $100 more each month, completed an additional year of schooling, and had IQs that were 3.76 points higher. These estimates accounted for multiple sociodemographic founders, increasing the chance that the differences were due to breastfeeding itself, rather than to other confounding factors.

On its face, this study adds to the ample evidence that how babies are fed is an important predictor of health and wellbeing. Yet several in the media have gone the great lengths to pick apart they study and its methods. The Independent’s Matilda Battersby took on the study with a pointed commentary, entitled “So breastfeeding improves your child’s IQ? Try telling that to the women who physically can’t.”

In her commentary, Battersby writes, “What none of these studies or news reports ever seem to acknowledge is quite how difficult breastfeeding actually is.” She goes on to compare her first weeks of breastfeeding to sitting “for hours at a time with a needle sticking in their nipple.” She writes, “Around 69 per cent of mothers breastfeed their babies at birth, but this falls to 23 per cent at six weeks – and for a very good reason. It is tough.”

I suspect that Battersby wanted to assuage the very real feelings of guilt and regret experienced by women who were unable to achieve their feeding goals. But as Shannon Tierney has so eloquently written, “Things can matter, without being the only things that matter. Breastfeeding matters, and it still matters even for women who cannot do it.”

Battersby goes on to write, “while we’d all like to think we’re doing the best for our bambinos we’re stuck between the Earth-motherish pressure to be constantly attached via a teat to our sprogs, versus the “Put it away, dear” mentality – thank you, Nigel Farage – which suggests that breastfeeding is embarrassing and dirty.”

And here, for me, is where her argument falls apart. The “breastfeeding problem” is not that studies have found that breastfeeding is different from formula feeding – rather, the problem is our collective failure to convert those data into a sustained commitment to provide women with the care and support that they need to achieve their infant feeding intentions. It’s the system that did not provide Battersby with help to resolve her pain during the hours of “needles sticking in her nipples.” It is Nigel Farage, and our collective cultural neglect of – and often open hostility toward – mothers and children. Read the rest of this entry »

Written by astuebe

March 22, 2015 at 3:52 pm


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