Before reading Courtney Jung’s groundbreaking new book Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy, I thought I knew something about overzealous breast-feeding evangelism and just how terrible it can be.
One of the worst moments of my first year with my first child was a visit from a well-regarded lactation consultant. She told me that both my son’s sucking skills and my milk production were B-grade; to improve, she instructed me to pump after every feeding and to guzzle an awful bespoke herbal tea. If you’ve ever nursed a newborn, you know they eat about every two hours, and that those two hours are measured from the beginning of a feeding, not the end; in practice, you get about 90 minutes between each one. She was telling me to spend 20 of those precious minutes hooked up to a hellish machine. I was vulnerable, and rather than throwing her out of my house and giving my hungry baby some supplementary formula, I tried to comply. Until she showed up, I’d been thinking that the whole having-a-newborn thing wasn’t quite as bad as I’d feared. Afterward, I was ashamed, overwhelmed, and unsure I could handle parenthood.
I got off easy. I’ve since read about women in so-called baby-friendly hospitals who, instructed to breast-feed around the clock, fell asleep on their newborns and killed them. I’ve read about women who were so tormented when breast-feeding went badly that they spiraled into postpartum depression. I read Jung’s October New York Times op-ed, with its revelation that the Women, Infants, and Children nutrition program rewards breast-feeding mothers and their kids with better, healthier food than their bottle-feeding peers.
“Unlike formula-fed babies, who are eligible only for infant cereal and fruit and vegetable-based baby food, breast-feeding babies also receive meat-based baby food, which is richer in iron,” Jung wrote. “The difference in benefits is intended to create incentives for poor mothers to breast-feed, but withholding food from mothers at nutritional risk, and from their babies, seems more like punishment to me.” Besides being cruel and coercive, it’s illogical. If breast milk is such a magical elixir, don’t those benighted babies who are denied it deserve more nutrition, not less?
Yet even after all this, I had no idea how much damage “lactivism” has done to women and children. To be clear, we’re not talking about simply encouraging breast-feeding—everyone agrees that breast-feeding is great when it works, even if it’s not the divine cure-all that its more ardent promoters claim it to be. Jung’s subject in Lactivism isn’t nursing itself, but a strain of advocacy that prizes feeding babies breast milk above all else, no matter the cost to their mothers or, in some cases, the babies themselves. “I am not against breastfeeding,” writes Jung, who reports that she happily nursed her own babies. “I am against lactivism. I am against using the particular infant-feeding practices of one privileged demographic to measure people who lack the resources to breastfeed—or prefer not to. I am against using a selective reading of medical literature to justify a public health issue. I am against using that public health issue to compel women to breastfeed and to punish those who don’t.”
Lactivism emerged partly in reaction to the scandal of Nestlé promoting formula in developing countries. In places where families lacked access to clean water, formula easily became contaminated; it was also punishingly expensive for the poor, who, once dependent on it, would sometimes dilute it to make it last. In the 1970s, it became clear that countless babies were dying from malnutrition and diarrhea due to watered-down or polluted formula. “Americans’ growing awareness of Nestlé’s reckless and cynical promotion of formula in the developing world made them more sympathetic to breastfeeding in general,” Jung writes.
Yet in a horrifying irony, lactivism itself soon emerged as a profound threat to women and babies in poor countries, particularly in sub-Saharan Africa. In Jung’s most revelatory chapter, she explains how, thanks to the work of Western breast-feeding activists, major health agencies encouraged African women to breast-feed even though doing so could transmit HIV. Throughout the 1980s, writes Jung, “World health organizations … routinely pitted the risk of HIV transmission against the risks of formula feeding in a way that made the former seem almost trivial by comparison.” Somewhere between 4.9 million and 7.35 million babies have been infected with HIV through breast-feeding since the start of the epidemic.
In 1987, Jung writes, African delegates to the World Health Assembly criticized the World Health Organization and UNICEF for failing to disseminate information about the risks of breast-feeding for HIV-positive mothers, lest it interfere with their pro–breast-feeding agenda. “Are we to accept that our children’s survival should be compromised by the risk of infant AIDS in the cruelest sense through the promotion of unlimited, unmodified, and unchallenged breastfeeding policies?” their statement asked. Not until 1998 did the big health organizations revise their guidelines.
Even then, however, many lactivists were unbowed. Indeed, Jung shows how leading figures in La Leche League, America’s original lactivist organization, have hopped into bed with AIDS denialists rather than admit that breast isn’t always best. One of the founders of La Leche League started the organization AnotherLook, devoted to challenging mainstream medical opinion on breast-feeding and HIV. “The Advisory Council of AnotherLook is made up of known AIDS denialists, an alternative-medicine health guru, and a prominent antivaccine doctor,” Jung writes.
La Leche League has done nothing to distance itself from AnotherLook. Indeed, speaking to Jung for Lactivism, a La Leche League spokeswoman praises AnotherLook as “the only organization pointing out that there is no evidence supporting the policies that prohibit breastfeeding when a woman is HIV positive.” The spokeswoman then provides Jung with a list of other lactivist organizations that also support AnotherLook. “Even after all I had learned about how impassioned lactivists can be, I was completely floored,” writes Jung. Anyone who reads her important book will be as well.