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The War Over Breastfeeding

Nursing has become a status symbol and new mothers are feeling the pressure to conform.

Fiona Goodall / Getty Images

A dozen or so years since the emergence of the feminist blogosphere, it’s no surprise that a book about “lactivists”—the most fervent of breastfeeding advocates—contains a preponderance of stories from the “mommy wars.” A New York City cocktail party where an aggressive member of La Leche League literally backs an expectant mother (our insufficiently enthusiastic author) into a corner? Check. A new mom so distraught over her lactation failure that she preemptively defends herself to strangers in a pediatric waiting room? That too. A woman bottle-feeding her baby on a subway (under a “breast is best” campaign poster, no less) who hears a fellow traveler mutter that people like her shouldn’t be allowed to have kids? Yep. One of the daughters of folk-singing trio Peter, Paul and Mary responding to Hurricane Sandy by calling for a lactation consultant to visit housing projects in the Rockaways? Why not!

These are the type of stories we’ve come to expect, after years of debate about competitive middle-class parenting that has made breastfeeding—and the backlash against it—a central issue. Courtney Jung, a University of Toronto political science professor, has catalogued these incidents thoroughly in her new book, Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy, along with a host of bourgie excesses worthy of the last days of Rome. There are $20 cookies intended to help women produce milk, and $20 scoops of breast milk ice cream, made from the milk of women who have pumped more than they can use. If you want to roll your eyes at upper-middle class consumer culture, and the one-upmanship of people who can’t leave each other’s parenting choices alone, Jung has you covered.

But Jung’s more interesting findings relate to what the decision between nursing and formula has become in contemporary U.S. society, where, she writes, “Breastfeeding is never just breastfeeding.” It’s also a moral marker, distinguishing good parents from bad, and it’s a status symbol that, unconsciously in some cases, lionizes the choices of white college-educated parents. And it’s a “consensus issue” that unites left, right and middle in shared support of breastfeeding, even if for different reasons (empowerment for feminists, submission and faithfulness for conservative Christians, and global-mindedness for environmentalists). “The truth is that in the United States,” Jung writes, “breastfeeding has become much more than simply a way to feed a baby. It is a way of showing the world who you are and what you believe in.”

Decisions about how to feed and care for infants have long been informed by class dynamics. When Victorian-era women sent their children to wet-nurses, it was because breastfeeding was seen as the province of the lower classes. When 1950s housewives turned to formula, it was a signal that they’d embraced a form of advanced, scientific motherhood, casting mothers who continued to breastfeed as backwards and unsophisticated. 

“One of the striking features of breastfeeding history is that this longstanding demographic trend has now been almost completely reversed,” Jung writes, as it’s now predominantly wealthy, white, college-educated women who breastfeed, while poorer women, and women of color, rely in greater numbers on formula. What has stayed the same is that one version of parenting is viewed as better. And as the CDC, the American Academy of Pediatrics and the U.S. Surgeon General have all come forward to declare that breastfeeding is not just a matter of preference, but something that concerns the entire country—since the health benefits said to be associated with breastfeeding would ultimately result in fewer health problems for children, and greater productivity for their working parents—Jung writes that formula feeding has become equated “with smoking and unsafe sex as a form of risky behavior that threatens not only individual health but American society at large.”

The scientific guidelines have meant that the contours of the debates around breastfeeding have altered radically. The return to breastfeeding was once championed by both feminists and traditionalists (like La Leche League), who saw it as an empowering challenge to the medical establishment. But increasingly the relentless advocacy of breastfeeding has led some “lactivists” to repudiate the language of “choice,” and even to suggest compulsory global breastfeeding laws (like those that exist in United Arab Emirates). As one doctor, the coauthor of a 2012 breastfeeding statement released by the American Academy of Pediatrics, put it, now that breastfeeding is a public health concern, “why are we just leaving it up to the whim of the family to do whatever they feel like?”

What’s come with such escalated language are a number of stories of breastfeeding coercion that don’t tend to get featured in confessional essays written by and for aspirational urbanites. There are the hospitals in New York City where formula is kept under lock and key, and doled out to mothers who refuse to breastfeed as though it were a restricted narcotic. There’s the “loving support” of breastfeeding exemplified in how the Women, Infants and Children (WIC) program gives mothers who breastfeed better quality food, for twice as long, compared to mothers who use formula. (As a matter of policy, WIC prioritizes breastfeeding mothers as the first recipients of its finite funds, even if some formula-using mothers are medically unable to breastfeed.) And there’s the patronizing treatment of black women, who are known to breastfeed at lower rates than white women, and who meet a barrage of dumbed-down educational materials that assume their choice is the result of ignorance, and not because they’ve made an informed decision based on their life circumstances. (One public service campaign took this to such an extreme that it featured a heavily-pregnant black woman riding a mechanical bull in a bar—apparently an equivalent risk to using formula.)

In reality, Jung writes, black women most often choose formula because of a work environment that is incompatible with breastfeeding. Although black women’s supposed failure to breastfeed has remained a consistent talking point, the larger demographic gap in breastfeeding is between working and non-working mothers. And there’s ample reason for that. Despite several national initiatives, supported by President Obama, to ensure that working mothers receive adequate support in balancing breastfeeding and their careers, the reality is that the workplace is still deeply inhospitable to new mothers. Jung tells the stories of women whose colleagues denigrate their professionalism when they take time to pump, or who show physical signs of needing to do so, like leaking milk. Even though new laws require access to adequate breastfeeding rooms at work, many employees reported being offered spaces that are obviously unfit, from bathroom stalls to exposed conference rooms to closets. Some employers are exempt from complying, and others are permitted to make working mothers come in early or stay late to make up for the time they spend pumping. When employees complain, some are pushed into resigning; the laws laying out what mothers are entitled to have so far proven to be unenforceable. 

And that’s just at the white-collar level. In a blood-boiling anecdote about a working-class mother who returned to her factory job, Jung describes how that woman was first offered an all-glass communal employee room to breastfeed in (which her male coworkers promptly christened “the Pump Room”), then a shower stall, and then a filthy locker room covered with dead bugs. When the mother complained to her supervisor that her coworkers banged on the door while she was pumping, and covered the door handle in grease and metal shards, her own union rep made a lunchtime announcement that her colleagues should watch out for her, because she was accusing people of sexual harassment. For working mothers, Jung writes, treating breastfeeding as a matter of public health and civic duty has translated into intense societal pressure to do something they’ll end up being punished for as individuals.

And all of this, Jung argues, rests on questionable science. While the Department of Health and Human Services has described the benefits of breastfeeding as “endless,” and nursing has been touted as the panacea for everything from SIDS to raising a child’s IQ, most of those claims rest on observational studies, which are incapable of distinguishing between effects caused solely by breastfeeding and the host of other “confounding variables” that go along with it: that mothers who do breastfeed are also already likely to be healthier, wealthier, better-educated and married, all of which could account for their children’s health outcomes. More rigorous research—studies that use randomized controlled testing, for instance—shows far more modest benefits, mostly related to a reduced risk of several discrete types of infection.

This inconclusive science, and the shaky way it’s represented in popular media, has led not just to shaming U.S. mothers into making a choice that may not fit their lives, but, in developing nations, to some truly astounding choices to continue promoting breastfeeding even in countries where HIV rates are at epidemic levels, and mothers may not have access to antiretroviral treatments.  

In the U.S., it’s also led to one of Jung’s most interesting findings: the conflation of the benefits of breastfeeding, the practice, with its product, breast milk. All the talk around breastfeeding’s benefits has led to the almost fetishistic celebration of human milk as a commodity unto itself, a “magical elixir,” or “liquid gold,” Jung writes. (Increasingly it’s also an unregulated one, as contaminated or adulterated breast milk is sold online, either to mothers struggling with low supply or one of the bevy of new consumer demographics who have latched onto human milk as a new super-food.)

Because nearly all working mothers who breastfeed are also pumping breast milk at work, and the pumping industry has grown to several billion dollars per year, Jung notes that there’s a built-in commercial reason to treat human milk—which has to be expressed, stored, and sometimes frozen and defrosted, so that a child-care provider can feed it to a baby while their mother works—as though it’s synonymous with nursing. But that, she says, is not what any of the research has studied. The science behind breastfeeding’s benefits is already inconclusive enough, without divorcing the product of lactation from the delivery system of intimate mother-child bonding.

That “apparently subtle shift” has big implications though; the lead scientist of the most reputable breastfeeding study told Jung that the question of whether breast milk’s benefits carry over outside the context of nursing desperately needs it own research. But the call for that is unlikely to get much support, since another built-in reason that breastfeeding has been able to become such a consensus issue, drawing together political figures who agree on little else, is that demanding that women breastfeed exclusively for six months places almost no real burden on anyone besides the mother.

In a country with notoriously abysmal family leave policies, where some 30 percent of new mothers take no maternity break whatsoever, suggesting that pumping and breastfeeding are equivalent helps to maintain the status quo. But, despite how much feminists groaned to hear Democratic candidate Bernie Sanders specify that women need the option to stay home with their newborn infants, in reality, that is the more common practice in countries where there are higher rates of breastfeeding. In the U.S., Jung argues, real support for breastfeeding—and not just human milk—would make a powerful argument for federally-mandated six-month maternity leaves, or workplace changes that allow mothers consistent access to their infants. But, as the architect of New York City’s 2012 “Latch On NYC” breastfeeding campaign told her, those sort of proposals are just “too big a change to the workplace.”

Where that leaves many women is squeezed from both sides. Now that women have won the “right” to pump at work—however poorly enforced, and under however degrading and unfair circumstances—the expectation that they’ll do so has become the “substitute for maternity leave.” “Who needs a lavish European-style maternity leave when a mother’s body is no longer the only vehicle through which the magic elixir, mother’s milk, can be delivered?” Jung writes.

All of this, Jung argues, is part of a broader problem in the U.S.: our tendency to treat broad social issues as though they’re just a matter of personal responsibility, which a little bootstrapping can fix, and as though continued lack of access to adequate and affordable health care, day care and maternity leave can be ignored as long as women breastfeed. Mothers bear a lot, but they shouldn’t have to bear this.