Medical Examiner

WHO’s Language on Breastfeeding Really Is Flawed

That doesn’t mean Trump’s reasons for rejecting it were correct, but for women like me who suffered as a result of the uncompromising promotion of breastfeeding, the rejection was a relief.

A newborn lies on its mother's chest.
gaiamoments/Getty Images

The United States’ refusal to endorse the breastfeeding resolution at the U.N.’s World Health Assembly is another ugly example of this administration acting like a bully on the world stage, as well as yet another transparent decision to put corporate interests before the health and well-being of individuals. The proposal called for governments to “protect, promote and support breastfeeding” and to limit the marketing of formula, seemingly innocuous steps to free women in the developing world of harmful messaging from the industry.

But it was also an oddly welcome move, to me and other women like me who have been harmed by the effects of prior pro-breastfeeding resolutions.

Since 1981, the World Health Organization has promulgated a series of resolutions aimed at increasing breastfeeding rates. This work was focused on combating appalling practices of misleading marketing by formula companies, which had aggressively marketed their product in areas without clean water, leading to thousands of unnecessary infant deaths. But these initiatives have had huge ramifications for women everywhere: Ten years after the first of these resolutions, WHO enacted the “Baby-Friendly Hospital Initiative,” which mandates, among many other requirements, that formula in such hospitals be kept “out of sight unless in use” and that hospitals “provide parents with written and verbal information about breastfeeding.” These policies sound fine on paper, but the way they are put into action at hospitals across this country would likely give pause to many breastfeeding advocates who also believe that women have a fundamental right to autonomy over their bodies and should not be subjected to coercion.

Ten months ago, I gave birth in a “baby-friendly” Brooklyn hospital where most of the patients are minorities and poor. Black women’s low breastfeeding rates, in particular, have been seen as a problem by the pro-breastfeeding community—and, like many complex societal ills, “education” has been deemed the solution. Less than 24 hours after my daughter was born, I found myself in a hospital room filled with aching, slowly shuffling women, wheeling swaddled newborns in portable bassinets. We lowered ourselves into hard plastic chairs to face a video screen. We had been told that if we didn’t attend this class, we wouldn’t be allowed to leave the hospital. We watched videos that described the wonders of breastfeeding and learned that it wasn’t supposed to hurt. Babies knew what to do. And anything less than exclusive breastfeeding was compromising your child’s start in life and her health.

I sat in that room, delirious with exhaustion, with my daughter at my breast. I fed her for the entirety of the hourlong class, grimacing in pain the whole time. I counted down every minute. I was not in a state to be “educated” about much of anything. I had been up for 40 hours straight giving birth, and I wanted to feed her, then hand her off to my husband so I could catch a little sleep. (Babies also “room in” at “baby-friendly” hospitals, giving new mothers very little time to rest.)

But shortly after I left the “class”—really, mandatory video watching that could have just as easily happened in our own rooms—the pediatrician came around to look at my baby. She pulled her up by the arms, and my baby’s whole body trembled. “That’s happening because she’s hungry,” the pediatrician declared. “Low blood sugar.” My eyes immediately filled with tears—I had been feeding her, I had thought, for an entire hour. I dutifully tried to put her back to my breast, but she proceeded to arch away and scream. With her every cry, I grew more and more hysterical, sobbing louder than she was. In my hormone-filled, sleep-deprived brain, a siren was blaring: “WARNING! WARNING! YOUR BABY IS HUNGRY.” And yet, she wouldn’t latch.

My baby-friendly hospital, like many, kept formula not just out of sight but under lock and key, as if it could be stolen and sold on the streets. My husband went to try to get formula from a nurse but was turned away. “She’s not latching,” he said. “She is latching,” the nurse declared. “Formula will ruin that.”

After a shift change, he eventually managed to get a bottle from a different nurse, which I kept squirreled away. I knew that I wasn’t supposed to feed her from a formula bottle that was unrefrigerated for too long, but in my addled state, I felt like a cornered animal who needed to outwit these people who were not going to let my baby survive. I knew nothing then about New York City’s extremely aggressive pro-breastfeeding initiative or about the fact that staff at baby-friendly hospitals were behaving the same way to women across the country—because they were trained to do so. I had not yet learned, as I would in the materials given to me when I was discharged, that women who qualify for Women, Infants, and Children assistance will receive better quality food for a longer period of time if they agree to “exclusively breastfeed,” a practice that I think most women who believe deeply in the power and health benefits of breastfeeding would find as icky and coercive as I do. All I knew during my hospital stay was that I felt very small, very scared, too devastated by my own failure at feeding to feel much joy about my daughter.

The woman in the curtained partition next to me had given birth to her baby three weeks early. When she joined my room after midnight, I heard a doctor instruct her to give her baby some formula because of crystals in her baby’s urine, a sign of dehydration. The next day, I heard a different doctor ask her, apparently gesturing to the empty formula bottle in the bassinet, in a disgusted tone, “You say you’re going to breastfeed? What, then, is this?” I learned, since I could hear every one of her private conversations through the curtain, that this was her third child; she had breastfed all of them. And yet, she was treated contemptuously as one more “undereducated” woman.

I went on to breastfeed my daughter for several months—never easily, never without complication—and to resent more and more the way I had been treated at the hospital. I did not have postpartum depression, but during that hospital stay, I felt like I was losing my mind.

Despite breastfeeding versus bottle being painted as another battle in the mom wars, most women can agree that mothers need to be able to make choices—including choices about how to feed their babies—without judgment, guilt, and shame. While the mother is also a patient at these “baby-friendly” hospitals, there is no language in the guidelines about how to account for the mother’s mental health. Not every mother can breastfeed immediately, and some never can—a commonly cited statistic is that the “failure rate” for breastfeeding is approximately 15 percent. The exact percentage is hotly debated, but if you accept the premise that some women physically cannot breastfeed, you must also realize that all the “education” or browbeating in the world will not change that fact. The talking points that the Department of Health and Human Services gave to the New York Times regarding why it declined to support this resolution are lifted straight from feminist and pro-choice language. HHS spoke of all women, including those who cannot breastfeeding, as needing “choice” and “options” rather than “stigma.” This is reflective of the conversations I’ve had with women since the birth of my daughter—and it is language that women all over the world deserve to hear.

Of course, in the mouths of anyone from this administration, those talking points ring hollow. The Trump administration does not care about women—not about me, or my neighbor on the other side of the curtain, or the other women who watched that video with me, or about any woman or child in this country. But I do think that the people who promoted the most recent breastfeeding resolution, and others before it, mostly do genuinely care about both women and babies. They have fought hard to have the importance of breastfeeding recognized and promoted. I do not disagree that their project is worthwhile. But I also think that the language in WHO’s resolution is overdue for some re-examination and additional nuance.

What is perhaps most frustrating is that the context of this rejection, that it was made by the Trump administration and seems to simply bolster industry, will likely hinder the complex discussion we need to have about why the language was flawed and how it could be improved. And the U.S.’s rejection of this resolution may even galvanize the most extreme of these groups to double down on the aggressive promotion of breastfeeding. Breastfeeding is a wonderful thing for both mothers and children, but it is a means to an end—a healthy child, a healthy mother.  

The overly aggressive promotion of breastfeeding to women who have just given birth can border on coercive cruelty, and harms more than it helps mothers, and we should recognize that and ensure that our efforts to increase the practice don’t inadvertently backfire.