Breastfeeding Medicine

Physicians blogging about breastfeeding

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

with 48 comments

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

48 Responses

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  1. Here here! I was saddened by a blog post I recently read, written by a BF mother, where she stated that Formula Feeding is the “norm” in England, and that we should just realize that and move on… sigh..
    I feel that today people are more afraid of even mentioning breast feeding in fear of being criticized for advocating it and have your head bitten off because you dare question how a mother feeds her baby.
    But I prefer to look at things as whole perspective – which is that it *does* seriously matter how you feed your baby. That is a fact. And the fact that formula feeding is the “norm” in England is *nothing* to be proud of it is rather something to be ashamed of if nothing else. It’s not a positive thing, it’s a very dangerous thing.

    ERF Mama

    October 18, 2015 at 2:07 pm

    • If you’re “having your head bitten off because you dare question how a mother feeds her baby,” it’s because you are butting into something that’s just none of your business at all.

      As long as a mother is using breastmilk and/or formula (as opposed to, say, goat’s milk or Coca Cola) and is providing enough of it for the baby to grow, she’s doing just fine. It is SO ABSOLUTELY none of your business which of those two choices she’s making, that I’m not at all surprised if people get angry at you for voicing your personal judgment of their choices.


      October 21, 2015 at 8:48 am

      • It is my firm belief that comments like this does nothing to help. I was not speaking about me personally. 🙂 And I am sorry, but I truly disagree. It *is* actually a major public health issue – so it IS something that should be discussed.
        Good day to you. 🙂

        ERF Mama

        October 21, 2015 at 10:06 am

      • Comments that point out that you’re being judgmental and putting your nose in other people’s business “do nothing to help”? Why? Because you’re not going to stop bothering people about their private business regardless of what comments you get? Ok then.

        Also, whether something is or is not a public health issue is not a matter of opinion. Whatever that thing is, it either makes X number of people sick, makes X number of people healthy… or is simply NOT a public health issue. Those things are facts, not opinions. So what are the facts? How many people are made healthy by breastfeeding who would have been unhealthy on formula? How many people are made sick on formula who wouldn’t have been sick on breast milk? And by the way, I’ll give you this fact: very premature infants do better on breastmilk than on formula (at least until they’re at or near full term in age). And by “better” I’m referring to the fact that they have lower rates of necrotizing enterocolitis, a not uncommon complication of extreme prematurity. (Oh, and since I like facts, here’s a legit link on that:

        But aside from protecting preemies? I await your facts…


        October 21, 2015 at 3:15 pm

    • Please provide a link to an original research study that uses high-quality data and an appropriate causal identification strategy to demonstrate that breastfeeding is “dangerous.”


      October 21, 2015 at 10:22 am

      • Are you responding to me liz? 🙂 Because I have never said breast feeding is dangerous, quite the contrary. 🙂

        ERF Mama

        October 21, 2015 at 10:32 am

      • My mistake. Left out a word. Please provide a link to an original research study that uses high-quality data and an appropriate causal identification strategy to demonstrate that NOT breastfeeding is “dangerous.”


        October 21, 2015 at 2:43 pm

      • I don’t think anyone says artificially feeding is “dangerous.” Rather, artificially feeding is a factor in greater risk for various illnesses and chronic health conditions (ear infections, childhood leukemia, lower IQ, NEC, leaky gut, breast cancer, high cholesterol, asthma, neonatal death, etc.). The time to artificially feed is when breastfeeding is unavailable, insufficient, or contraindicated due to medical conditions. The lack of cultural support for breastfeeding is appalling, given the costs to the society paying for the higher rate of illnesses.


        October 25, 2015 at 7:44 pm

  2. Yes – advocacy has moved on….my own organisation, NCT, in the UK, has a clear policy on this, that we promote and support the social, structural and other conditions that are needed to enable breastfeeding. I do see and hear from mothers who feel personally judged, battered and bruised by encounters with advocates, nevertheless, so the advocacy world still has work to do. But the ‘mummy wars’??? Ridiculous, misogynist notion:(


    October 19, 2015 at 3:39 am

  3. I kind of think that if a woman claims she felt excessive pressure to breastfeed, it’s not my place to tell her it didn’t happen. And an awful lot of women have reported excessive pressure.

    I really don’t think American mothers who want to breastfeed are getting very good support. On the political side, we’ve still got bupkis. The right to nurse in public, which is basically a polite gesture, but no paid leave, and job protections which may look good on paper but are really weak in practice.

    On the scientific side, I think the research into breastfeeding over the past few decades has been really lacking. Oh, we’ve got plenty of studies on the benefits, but not enough honest research into the problems that nursing dyads encounter and how to fix them.

    We don’t know what the true incidence of primary insufficiency actually is. We don’t much know much how to predict it in advance, or whether anything can really be done to treat it, instead we have rumors and tiny studies decades old.

    We don’t know enough about delayed lactogenesis II, and how to manage it in a way that guarantees the baby’s safety while maximizing the chances of long-term breastfeeding success. What is known by science isn’t getting to the mothers who need to know.

    Dealing with latch issues should mean relying on a reasonably large and tested toolkit, instead, individual LCs have a handful of techniques that may be completely unrelated to what another LC offers. How can we best identify and fix latch issues? This shouldn’t be an area for rumors to rule.

    These are all questions that should be relatively simple to answer, but we don’t know, because no one is doing the right sort of research. Research into the benefits of breastfeeding is beside the point when up to a third of nursing mothers experience substantial problems of one kind or another, and they can’t get science-based help.

    Brooke Orosz

    October 19, 2015 at 1:02 pm

    • Thank you. This has got to be one of the most level-headed and reasonable comments I have seen on this issue. I ultimately couldn’t breastfeed, and while I was struggling, I was incredibly disheartened to see the poor amount of research out there.

      Anecdotally, I had a lactation consultant actually admonish me when my milk hadn’t come in 3 days after my pre-term baby was delivered. She was also unnessesarily rough with my baby when we tried to get her to latch. It isn’t her fault that breastfeeding didn’t work out for us, but she did not help.


      October 20, 2015 at 7:29 am

    • You hit the nail on the head. You cannot push breastfeeding until you fix one of the major reasons woman don’t breastfeed – the fact that they get no paid maternal leave and cannot afford to leave their jobs. All this “breastfeed or else” does is depress women because they are now stuck in a situation where either they leave their job and have not enough or no income, or work and think that their child is now going to die at an early age because they gave formula.

      All I have seen from breastfeeding advocates is telling women to do something without bothering to find out why. And when they do, they just brush it off like the LLL did to a friend of mine who was asking about pumping at work – they told her to quit her job. She was the main breadwinner and her work is how they had health insurance. Even after explaining that they STILL told her to quit her job and to on public assistance. How is that better for anyone?


      October 20, 2015 at 5:39 pm

  4. This is a shockingly weak rebuttal. Professional lactivists have spent years grossly exaggerating the benefits of breastfeeding and moralizing infant feeding to boost business. Babies and mothers have been harmed as a result.

    Amy Tuteur, MD

    October 19, 2015 at 1:43 pm

    • This is a shockingly negative comment on a topic that has such an important impact on public health. The fact that a medical professional felt compelled to post something so inflammatory is especially disappointing. To imply that there are ‘professional lactavistis’ who moralize infant feeding to ‘boost business’ in a way that ‘harms’ mothers and babies is insulting to HCPs who support women and babies is shameful. I’d like to remind Dr. Tuteur that the business being boosted in this situation is the formula industry, not the ‘lactavists’. I don’t know anyone getting rich in the field of breastfeeding support.

      There is nearly universal agreement regarding the myriad benefits of breastfeeding, and comments like this do nothing except spread fear and distrust. Anne Smith, IBCLC

      Anne Smith, IBCLC

      October 20, 2015 at 5:24 pm

      • “Such an important impact,” Anne? What impact are you talking about, exactly? What well designed studies show any significant impact whatsoever of breastfeeding in first-world/developed countries?

        And by well-designed studies, I mean ones that eliminate confounders such as socioeconomic differences between the mothers who breastfeed and those who don’t.


        October 21, 2015 at 3:17 pm

    • I’m afraid you have it the wrong way around in my opinion. It is the Formula industry that is boosting business on women’s lack of self confidence to feed their own child.

      Are you suggesting that the World Health Organisation, who actively recommend breast feeding to 2 years old in the western world, is a bunch of professional lactivists who have spent years exaggerating the benefits of breastfeeding?

      ERF Mama

      October 21, 2015 at 10:18 am

      • With all due respect, I really think that lactation advocates as well as Medela and Ameda do tend to stretch the benefits of breastfeeding a lot more than the formula companies.

        I know that some formula ads say that their formula helps with brain and eye development, (which is misleading–) but they don’t say that their product formula can help prevent chronic disease like many advocates (1) and breastfeeding equipment companies (2)

        And the formula companies certainly do not say anywhere that their product is better than breastmilk—–
        or women are doing their children some great disservice by breastfeeding and not giving them formula.

        P.S> I think that Liz was asking for well done studies that find that formula is dangerous, (not breastfeeding). I would be kind of interested in seeing some of those as well. Most of the research I have seen does not find that breastfeeding can reduce the risk of conditions like allergies, asthma, obesity, diabetes, etc.


        Here is my idea for another blog post –How about “breastfeeding promotion without propaganda”

        Anne Risch

        October 21, 2015 at 1:22 pm

      • I had no lack of self confidence that I could not feed my child. I just didn’t see the point. I was formula fed, my husband was formula fed, most of my generation was. None of us have health issues. Why should I be the only one who can feed, stuck being away for days straight when I can give formula and my husband can help? And I was returning to work, why should I take precious time from my baby by pumping?

        I have seen both breastfed and formula fed babies that have horrible health, I have seem formula fed and breastfed babies that have never even had a sniffle. It’s called genetics, it has nothing to do with how you feed your baby.

        And funny, people laud health organizations when it fits *their* agenda. How many people scream about how the AAP encourages breastfeeding so we should listen and do it, but then puts their fingers in their ears when it recommends *against* co-sleeping. Suddenly they are wrong wrong wrong. I hear this all the time from lactivists and I just want to slap them over the heads and I’m a pacifist who abhors violence!


        October 21, 2015 at 9:40 pm

  5. I fail to see how it is fomenting the mommy wars to point out that there are costs to breastfeeding as well as benefits, something which I notice your article completely fails to mention. I also fail to see how reassuring formula-feeding mothers that they are not poisoning their babies somehow undermines women’s rights. In fact, most of those who are fighting back against the breast-is-best onslaught are strong feminists, which means they support any kind of reforms that would make the experience of all working mothers (breastfeeding, formula-feeding or otherwise) more pleasant and productive.


    October 19, 2015 at 2:31 pm

    • Liz – I hope you might consider bringing these concerns to the upcoming 2016 Breastfeeding and Feminism International Conference, For more than a decade, this Interdisciplinary meeting has been grappling with the social constraints that affect women’s ability to choose how to feed their babies. Here is an excerpt from a recent book of conference proceedings:

      “Current public health promotion of breastfeeding per force relies heavily on health messaging and individual behavior change, often failing to take into account the myriad constraints on women’s choices and practices. The result is a perceived pressure on women to breastfeed without necessary social and cultural support. The reality of women’s lives is diverse and constrained by structural factors outside of their personal control. Our volume focuses attention on the multiple contexts that affect women’s behaviors, beliefs, and practices, exploring ways to refocus public debate about infant feeding decisions in the United States and elsewhere.”

      This book ( ), and a large body of work from breastfeeding and feminism, is tackling the issues that you raise. I hope you might be willing to join this effort to determine the structural changes that will enable women to achieve their infant feeding goals.


      October 19, 2015 at 8:26 pm

      • Dr Steube, you talk of constraints on women’s lives and the decisions that they make. .

        Don’t you feel that to have mothers under the impression that breastfeeding can prevent long term health problems like asthma, diabetes, and obesity can constrain women from feeling as though they could choose to formula feed, combination feed, or fail at breastfeeding and not be a horrible mother?

        Anne Risch

        October 19, 2015 at 9:06 pm

      • The best way to influence policy is not to publish conference proceedings, but to contact a state or federal lawmaker. If you don’t want to be a lone letter-writer in the wilderness, you can join one of the many established, professionally-staffed organizations that are already pushing for these changes, such as the National Women’s Law Center or even NOW. The difference between these organizations and yours, of course, is that they are lobbying for reforms that benefit ALL women, not just the ones who can or want to breastfeed.


        October 20, 2015 at 7:59 am

      • Also, while we’re at it, if what you want is to help women “choose how to feed their babies” or “achieve their infant feeding goals” then why are running a *breastfeeding* conference and publishing the proceeds in a *breastfeeding* journal? Which is it? Are you promoting breastfeeding or are you empowering women to make whatever choice is right for them?


        October 20, 2015 at 8:37 am

  6. P.S. Many of the people involved in debunking breastfeeding hype are professional researchers or statisticians. When these people argue that the research shows minimal causal effects from exclusive breastfeeding, they are not relying on what gets published in the NY Times.


    October 19, 2015 at 2:45 pm

    • Thes researchers mentioned in the previous comment apparently aren’t able to read and critique a study with academic rigor. Jung, for example did not correctly report the results of the PROBIT study. Scary to know, because many will believe that her credentials imply otherwise. This is more evidence that the author intends to inflame and to avoid the real problems of young families in this society.

      Susan Crump

      October 19, 2015 at 5:08 pm

      • So, Susan, How would you interpret the PROBIT study? Here are some results I found:
        “we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior.”
        ,”…. yet it (breastfeeding) did not reduce the measures of adiposity, increase stature, or reduce blood pressure at age 6.5 y in the experimental group”
        “These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy”
        “intervention to promote breastfeeding slightly widened socioeconomic inequalities in breastfeeding but not those in child cognitive ability”
        “provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age.
        ‘strong evidence that prolonged and exclusive breastfeeding improves children’s cognitive development.”

        (I really don’t agree with the last result, but the PROBIT trial did conclude the BF improved IQ.)

        Anne Risch

        October 19, 2015 at 8:43 pm

      • What would an academically rigorous critique of the PROBIT study look like?


        October 20, 2015 at 8:06 am

    • Your logical fallacy is: Appeal to Authority.

      “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.”

      In other words: Scientific consensus. A few researchers/statisticians do not a scientific consensus make.


      October 20, 2015 at 8:35 am

      • Wait…are you are accusing me of appeal to authority? Or warning me that you are about to commit such a fallacy? Neither you nor Dr. Rosen-Carole provide anything other than an assertion that “every medical expert in every country” agrees (which, by the way, simply cannot literally be true). So your evidence for the claim that there is a scientific consensus comes from what…the doctor’s say-so?


        October 21, 2015 at 2:53 pm

  7. I would like to invite everyone here to watch MILK. A documentary that I wrote, produced and directed that deals with all of these topics. In making this film, I learned that the issues surrounding breastfeeding are universal. In the USA, there is a need to raise awareness and increase debate in order to provoke change. I hope that together, we can make that change so mothers are supported in their decision, as long as they are informed properly. It is about women’s choices and societies at large must understand that. We need more education at all levels in order to achieve that. Please join us in our discourse in all social media platforms and in bringing MILK to your communities in the USA. #Milkthefilm

    Noemi Weis

    October 19, 2015 at 3:48 pm

  8. Liz perfectly and eloquently summed up my exact feelings on this topic, so I won’t regurgitate them here. I am however compelled to point out that it was not Gandalf but Elrond that stated “You have only one choice.” A statement that he made very calmly no less, so the all caps were completely unnecessary. Whatever expertise the author may have re: breast feeding, certainly doesn’t extend to their nerd cred.


    October 19, 2015 at 4:45 pm

    • To be fair, Gandalf said, “We now have but one choice” when in the Mines of Moria. I think we can agree, from a nerd cred perspective, that this critique is splitting hairs. Otherwise, I could not agree more with Dr. Rosen-Carole. I also agree that we should be empowering women to make the best personal choice possible. It is inauthentic and scientifically unfounded, however, to equate formula feeding and breast feeding in the decision-making process. In fact, I think that breastfeeding advocacy serves to benefit all women through the normalization of infant feeding in society.

      Sean Frey, MD

      October 21, 2015 at 9:00 am

      • Dr. Frey, assuming we’re talking about full-term infants here (as opposed to extreme preemies, who indeed do significantly better if given breast milk in those first weeks), in what measurable way do you think breastfeeding and formula feeding are NOT equivalent? I mean apart from the fact that formula always has enough vitamin D and iron while breast milk does not… haha.


        October 21, 2015 at 3:19 pm

  9. It is with my own experience in mind that I encourage women everywhere to consider the nurturing benefits of breastfeeding and the very personal close time with baby that can assist in establishing an everlasting bond between mother and child. Though there is sufficient evidence-based research to support this, the ever reminder that there is only one person who can bring a child into the world is a key! The journey that can go on for a Mum is then to offer their bubby the most comforting and secure start to life possible……mothers have that privilege! Where possible, it is also important to consider that the opportunity to breast feed your own child is an extremely deep and personal path towards a child’s sustenance, establishing and security – knowing that ‘Mummy actually wanted to spend that close and comforting time with her child and made every effort to offer such an start for her baby’. Not always possible we know…but so very much worth pursuing! We need to encourage our lactation experts, consultants and supporters in their efforts to see women…not only allowed this option …but enjoying this pathway for themselves and their children! So worthwhile…….! We truly must consider and support those who simply are not given the opportunity to breast feed their own bubs due to their own physical health or their cultural, health or circumstantial conditions. …. it is important that they are given such a significant personal choice…….

    Julie Gall

    October 20, 2015 at 4:09 am

    • So…are you willing to say outright what you are implying here: that women who formula feed don’t care as much about their children as breastfeeding mothers do?


      October 20, 2015 at 8:08 am

    • And I can give that exact same experience formula feeding. Not only did I formula feed BY CHOICE, I went back to work AND Ferberized (I know, call CPS on me) and at four my daughter is 100% Mommy’s girl and comes to me for any and all comfort. Daddy she plays with, Mommy she wants to cuddle and rock with. While my husband shared quite equally in the feeding, diaper changing and putting to sleep, it’s still Mommy she goes to when she skins her knee or that boy down the street pulls her hair.

      So…I’m guessing you’ll come back with my daughter being some exception to the rule.


      October 20, 2015 at 5:32 pm

    • And what about the mothers who have their babies attached to their breast 40 out of every 60 minutes of every day because the baby is struggling to get what they need? What about the mothers whose mental health is in serious jeopardy because they have lost complete body autonomy and have NO time to look after themselves? The women who start to resent their baby because they are slipping closer and closer to postpartum depression. I’m pretty sure when that happens, mother isn’t ‘bonding’ with their baby but wishing desperately for them to finish feeding and go to sleep.

      If breastfeeding works for a woman, great. Power to her. But people like you ignore the fact that there’s a number of women who struggle and struggle to breastfeed and their babies fail to thrive. Lactation consultants can only help so much.

      You say it’s a ‘significant personal choice’. True. It’s VERY personal. But it’s only significant because people like you and the La Leche League over-inflate the benefits of breastfeeding in first world countries, to the point where, to vulnerable new mums it is the ‘only’ choice. Formula is evil and to be avoided at all costs. Which shames women who HAVE to turn to it because their bodies ‘failed’ at what they were supposed to do – nourish their babies.

      I’m all for better laws to protect jobs for women who have children. For laws that give them paid maternity leave so that they CAN establish a good breastfeeding relationship. But shaming women because their choice may differ to yours? Shaming them because they may not WANT to breastfeed?

      That’s not choice. That’s bullying and it needs to stop.


      October 21, 2015 at 12:14 am

  10. […] Read more here at Academy of Breastfeeding Medicine… […]

  11. […] that seek to challenge or contextualize the data surrounding the proven benefits of nursing as vilifying the practice itself. The uproar raises an interesting question: What do we actually lose as breastfeeding mothers once […]

  12. I have just one question for the folks here who seem to genuinely believe that breastfeeding makes a big difference. If you go into any classroom in America, can you tell which kids were breastfed?

    That’s a rhetorical question, because no, you can’t… and if you can’t look at a bunch of kindergartners or sixth-graders or high school students and tell who was breastfed and who wasn’t, just from looking at them or their school records or their medical records… then on what possible basis do you claim that breastfeeding makes a significant difference?


    October 21, 2015 at 3:22 pm

  13. […] Promotion without Support: A Reply to Editorials that Attack Breastfeeding Advocacy […]

  14. I believe the main reason for the Breast vs Bottle ‘Mommy Wars’ is that our feeding culture is changing, after spending nearly a century in the bottle camp. While the bulk of medical research overwhelmingly supports breastfeeding as the healthiest feeding choice, there are still those few studies that are inconclusive or show the opposite of what was expected. Unfortunately, those are the articles that send people like Ms Jung and some commenters here in the wrong direction. The author of Over-Selling Breastfeeding is not really saying that breastfeeding isn’t worth it, she is merely saying that some of these studies don’t correlate with the exuberance of some people that try to cram breastfeeding down mother’s throats. While I have seen that occur, it is certainly not the norm in my circles, especially lately. We are beginning to become a breastfeeding culture but we do need to be gentle when change is occurring.

    Let’s not forget that breastfeeding was here first. The bottle came of age during the 1920’s, when women began working outside of the home. Mothers were taught to mix their own formula and the new ‘scientific’ way to feed became the rage. Even stay at home mothers, like my grandmother in the 1930’s, were persuaded to use this ‘state of the art’ feeding method. In the middle of the last century, women who breastfed were considered pariahs. When my own mother told her doctor she wanted to breastfeed me in the 1950’s, he screwed up his face and exclaimed “Why would you want to do THAT?” Ridicule has no place in health care or in civilized society, yet it has been used both for and against breastfeeding over the years. It is unfortunate that some people believe that browbeating a person is an effective communication tool. Women (or anyone) should never be subjected to embarrassment and shame for their choices. Of course, my mother wasn’t discouraged and managed to nurse me for 3 months before she ran out of milk, due in part to the rigid doctor-prescribed 4-hour feeding schedules of the time. Mothers know their capabilities and are acutely aware of what feeding methods would fit them and their babies best. Providing information and education (without intimidation) to make an informed decision is the most effective way to empower a woman.

    This discussion should not be about whether breast or bottle is best; that is already clear. It really is indisputable that when all studies ever done on breastfeeding stand together, human milk’s combined health effects come out on top of every other feeding option. Even if there is only a marginal effect of breastmilk over formula, like for full term babies in developed countries, it is only ethical that parents should be informed of that advantage. Instead, this discussion should be about how to assist women in making an informed decision and supporting them in their choice. Health care providers, lactation advocates and the public alike should not resort to coercion of a mother who is trying to find her own way, especially when we are slacking in the support arena, as Alison Stuebe so accurately pointed out. Who are we to know whether a formula feeding baby had a challenging suck dysfunction, or a mother with a history of mental illness or prior sexual abuse? If we persuade that mother to nurse without the proper resources, she will almost surely crash and burn.

    If I have learned anything from being a La Leche League leader for over 20 years, it is that if you really listen and treat people the way you’d like to be treated, they will respond in kind. In our meetings, we announce at the beginning that mothers are free to bottle feed during the meetings if needed. We recognize out loud that they are there to learn more about breastfeeding, even if they are not nursing in the moment. It sets the tone and prevents judgmental actions by other attendees. I am always inspired when years later they show up with their next child who is exclusively breastfed, saying that they felt empowered to nurse after experiencing the support and encouragement from our accepting environment.

    So let’s take off the boxing gloves and really listen to what each other has to say. Think about your delivery and how the other person would be most open to hearing it. Then, unite and work toward keeping informed parental choice, and its corresponding support systems, in this conversation.

    Anne Brown, Family Nurse Practitioner, IBCLC, LLL Leader

    October 22, 2015 at 3:14 pm

    • So—the women should be informed of the benefits of breastfeed –I totally agree.

      The thing many of us are complaining about is that they are exaggerated all the time.

      According to Dr Mellisa Bartick, in her latest post— are that breastfeeding cuts down (but does not for sure prevent):
      NEC approx. (1/10,000)
      SIDS, approx (4/10,000)
      ALL approx (1/10,000)
      GI infections.

      With the top three being so rare, and the chances a women cannot breastfeed is at best 5% (or one in 20) does the lactation community really need to focus on this?? And truthfully, the research is mixed on SIDS and ALL–there is an association, but both are associated with poverty and poor living conditions which is also associated with not breastfeeding.

      Dr Bartick also stated:, “in our review, we chose to omit pediatric type 1 diabetes, asthma, and atopic dermatitis after including them in my 2010 study with Reinhold because we did not feel the current state of the evidence supported their inclusion.”

      So –no more asthma, diabetes or eczema— This should be made public knowledge so that women are aware that failing to breastfeed does not put their children at excess risk for these conditions.

      I really think that if the lactation community focused on providing accurate, evidence based information about the risks and benefits of breastfeeding as well as a ‘heads up’ that it can be difficult and not every one can do it, a lot of the pressure women feel to breastfeed and succeed at all costs would ease quite a bit.

      Anne Risch

      October 22, 2015 at 5:55 pm

  15. Hi Anne (nice name, by the way),

    I am glad that you agree that women should be informed of the benefits of breastfeeding or, if we use breastfeeding as the biological norm, the disadvantages of formula feeding. My point is the same as Ms Jung’s, that it should not be shoved down people’s throats. It is not an exaggeration to say that formula fed babies have increased incidences of NEC, SIDS, GI infections and the others. Those are the facts that mothers-to-be need to know, especially if they deliver prematurely. It DOESN’T need to be presented in a way that threatens, pressures, intimidates or coerces. A good health care provider should also include information about the common difficulties experienced by nursing mothers and the resources available if help is needed. Ideally, as with any decision, the pros and cons of BOTH feeding options should be explored…that is truly informed choice.

    As I said before and I’m sure you will agree: present the information in a respectful manner, let the parents decide, and support them in their choice. If a mother chooses to formula feed, she should not ever be shamed for her decision. Never think you can walk in her shoes, only she knows what she has to give. Give her the information needed to be successful with formula feeding and you will be respected in return.

    My objection to Ms Jung’s article is that, in an effort to call off the pushy breastfeeding advocates, she made it sound like breastfeeding was the same as formula feeding, which is not true.

    So here’s my plea to the self-proclaimed ‘lactivists’ (and formula advocates) out there:
    and maybe we can end the mommy wars.

    Anne Brown, Family Nurse Practitioner, IBCLC, LLL Leader

    October 22, 2015 at 10:19 pm

    • Thank you —

      I think that a PROVIDING ACCURATE INFORMATION ON THE BENFITS should be added to your list.

      I do think that an acknowledgment that breastsfeeding’s benefits are overstated is in order. I worked at WIC for several years and although the LC’s and the Peer counselors (and everyone else there) were perfectly nice, compassionate etc. ,but our handouts, materials, and trainings exaggerated the benefits as well as the ease and sucess rates— (which we all–except me) pretty much took as gospel.

      So–of course mothers and health care providers are going to push the exclusive BF agenda if they think that breastmilk can prevent every diseases and condition under the sun as well as help bond with babies and make them much smarter.

      While working at WIC I saw many women (some very young, some unhealthy themselves–some with a whole lot of stresses and problems) go to extremes to make breastfeeding work, of ten to the detriment of themselves and the rest of their families. I also saw many women pump exclusively for months on end when there was no latch or they were uncomfortable with having a baby at the breast.

      Would these women be doing this if they knew that formula really didn’t put their children at risk for diabetes, asthma obesity and the the research on cancers was mixed at best (and the chances of getting it were pretty darn slim) ?

      bleow are tow pamphlets and a website that stretch it. Breastfeeding Handout from Denver WIC (used in MI) for African Americans AAP (calims unequivocal evidence)

      None of these pamphlets even mentions the fact that breastfeeding might not work, and many women do have trouble with supply — Usually the mantra is –just breastfeed more

      Anne Risch

      October 23, 2015 at 8:08 am

      • Anne, I think you are noble to want to protect mothers who are struggling with nursing from comments from those who push the breastfeeding agenda without regard for their mental or physical health. It sounds like you have experienced some judgement by others. All mothers need to be respected. There are many reasons why women choose not to breastfeed. Making an informed decision should always be a part of the picture.

        All of the documents you shared are pretty accurate so I am not sure why you would not want mothers to know that information. The evidence is overwhelming that NOT breastfeeding increases many health risks in both mother and baby. It does no good to isolate one or two diseases (where a couple of studies found equivocal results) when the vast majority of medical research shows an overall beneficial effect. You really have to look at the big picture, whole body health, not just a couple of illnesses. If you use breastfeeding as the biological norm, then yes, there would be more illness and disease associated with formula feeding. Breastfeeding is only ‘better’ if you use formula feeding as the norm. While formula feeding may be the social norm, it is not the biological one. Missing from these pages, though, is the recognition that breastfeeding can be pretty tough for some mothers. I think that is what you are trying to say…not that formula feeding is equivalent to breastfeeding when it comes to, let’s say childhood cancers, but that breastfeeding articles, documents and websites need to identify the challenges mothers can face so they are more balanced.

        I do agree with you that there should be information presented on these documents that acknowledges the difficulties that some mothers experience, and offers referrals for those who need it. When your nipples are sore or your baby won’t latch, the last thing you want to hear is “but breastfeeding is the best way to feed your baby.” You want someone to identify and solve your breastfeeding problems, provide concrete answers and create a plan that can bring you to the next level. So many of my clients put up with pain and other problems because they think it is ‘normal.’ Pain is never normal. By the time I see them, they are a mess and often ready to quit. I cannot boast 100% success but I get pretty close. Most moms just need the right treatment plan, support and encouragement to turn things around. The information on these documents can be the impetus to aid in that change.

        The percentage of women who are truly unable to breastfeed is rather small. In my experience, the large majority of mothers who did not have enough milk had been given erroneous information that led to early weaning. Most others who struggle either have other physical or emotional barriers, or do not have access to competent clinical lactation care. As many commenters have written, we are moving past the point of making people feel guilty and on to the greater challenge: making skilled lactation care universally accessible, which will give every mother and baby the best chance to succeed. Support and encouragement are important ingredients of good care.

        Individualizing care, taking into consideration the physical and emotional health of each mother-baby dyad, is ideal. If a mother has access to good lactation care and she has done everything that she can muster (different for every woman) to breastfeed and does not succeed, she should never be made to feel inadequate. The decision she makes is the best for herself and her family.

        So while I am an avid breastfeeding supporter, I am also a women’s advocate. I implore my fellow health care providers, WIC counselors, La Leche Leaguers, and the general public to avoid making judgements on women who use bottles. You never know what fierce battles she may have waged to arrive where she is now. When presenting information (in person or in written documents) about breastfeeding, remember to acknowledge that it is not fool-proof. Women can and do experience difficulties. Inform her of the pros and cons of each feeding method. Be prepared with the appropriate referrals and realize that every woman has her own threshold for coping with adversity. Support her when she makes a decision and please, please, do not make her feel like she is any less of a mother if she chooses not to nurse. Help her to be the best mother she can be, with or without the bottle. Think of how you would like to be treated if you were unable or chose not to breastfeed. It’s time we all just respected each other and formed a united front for women’s and baby’s health and wellness.

        Anne Brown, Family Nurse Practitioner, IBCLC, LLL Leader

        December 29, 2015 at 12:31 am

    • Hey Annie! Just wanted to thank you for your great comments. I couldn’t agree more with all you’ve written, including your plea. I’ll add one more: Let’s all be kind and understanding to one another, no matter what our background, perspective, history, personal biases, choices and experiences. I am a woman who was lovingly parented without being breastfed, who enjoyed breastfeeding my own children and who is fortunate to assist mothers as they enjoy their own babies including, but certainly not limited to, breastfeeding.

      Sue Iwinski

      October 23, 2015 at 11:34 pm

  16. […] can talk all day about how and why breastfeeding should be promoted. But it does no good unless we support it. There is not one formula company who would do this. We have to do it in our homes, […]

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