On the face of it, there’s no reason why breastfeeding, which in industrialized countries has only trivial benefits, has become a public health cause celebre.
There are so many, many issues that have a much greater impact on child health that are being ignored, while breastfeeding advocacy benefits from millions of dollars of public and private funds, extensive public health campaigns, and redesign of hospital policies. We have public health campaigns against smoking because that costs millions of lives; we have public health campaigns to promote vaccination because vaccines save millions of lives; we have public health campaigns to promote breastfeeding … which has never been shown to save even a single term baby.
If you want to see how trivial the impact of breastfeeding is on public health you need only look at the impact of breastfeeding on infant mortality in the US during the 20th Century when breastfeeding rates fluctuated dramatically from a high of over 75% to a low of 25% and back up to 75%. Breastfeeding rates had ZERO impact on infant mortality.
While breastfeeding advocates breathlessly promote studies that show trivial benefits within tiny groups of carefully selected individuals, we’ve already done the largest public health experiment possible and it shows that breastfeeding is NOT a public health issue since it has no impact on public health.
How then can we explain a multimillion dollar effort to promote breastfeeding rates in the absence of public health benefits?
There are several reasons that I have detailed many times in the past.
1. The science of breastfeeding has been subverted. The truth is that the scientific literature on the benefits of breastfeeding is weak, conflicting and compromised by confounding variables.
2. Breastfeeding advocacy is a huge business. While individual professional breastfeeding advocates don’t make large sums of money, 100% of the income of lactation consultant derives from breastfeeding promotion, and 100% of the income of lactivist organizations like the Orwellian-named Baby Friendly Hospital Initiative comes from the more than $10,000 they charge each hospital for the privilege of being designated lactivist baby friendly.
3. Breastfeeding promotion, which has its modern incarnation in La Leche League as an effort to keep women in the home and out of the workforce, is a response to the profound social disclocation of women’s emancipation. The political right has retreated into religious fundamentalism and the political left has retreated into mindless worship of “nature.” Simply put, aggressive promotion of breastfeeding is deeply retrograde and anti-feminist.
There is a fourth reason:
Breastfeeding advocacy dovetails perfectly with our contemporary “blame the mother” culture.
Blaming the mother for how a child turns out is hardly new. For most of human history mothers were blamed if a child was not a desired son (even though it is actually the father who is responsible for a baby’s gender); congenital anomalies were blamed on a mother’s dreams and fears; and severe mental illness in a child was blamed on emotionally cold “refrigerator mothers,” while homosexuality was blamed on inappropriately close relationships between mothers and sons.
No matter what it is, if it is bad, it’s always the mother’s fault.
This fits in perfectly with a contemporary political culture that denies government any role in dealing with vast social inequality within the population. American society has shifted violently to the political right, which takes as axiomatic the belief that government cannot and should not have any role beyond national defense.
We could look at the deficiencies in health, educational level, and income of Americans at the lowest end of the socio-economic spectrum and seek to correct the structural inequities within our society. But that would require a strong, well funded central government, anathema to conservatives. How much easier, cheaper, and politically reassuring then to blame these differences on the mother and insist, without any evidence at all, that her children would be more successful if only she had breastfed.
As Phyllis Rippeyoung explained in a recent position paper, Governing Motherhood: Who Pays and Who Profits? published by the Canadian Centre for Policy Alternatives:
This individualizing of responsibility for child welfare has also been seen among breastfeeding proponents, as most explicitly illustrated in an editorial by Dr. Ruth Lawrence, a founder of the Academy of Breastfeeding Medicine. In her essay, “The Elimination of Poverty One Child at a Time,” she argues that breastfeeding is the panacea for health and cognitive inequalities between poor and non-poor children. She ends the piece by writing that breastfeeding may be the only gift that poor mothers have to offer their children.
… I have been unable to find any research assessing whether breastfeeding … will actually reduce either poverty or the consequences of growing up poor, one child at a time or otherwise. In research I have recently completed (Rippeyoung forthcoming), I assessed the relative impact of breastfeeding versus the family educational environment on reducing gaps in child verbal IQ between the poor, the near poor, and the non-poor … This research indicates that individual solutions to low test scores will not solve the problems of inequalities in school readiness.
It is hardly a coincidence that the women who are targets for shaming by breastfeeding advocates are more likely to be poor, non-white and under-educated. It’s so much easier (and cheaper, not to mention politically gratifying) to chastise these mothers for not breastfeeding than to address the terrible environments in which many are forced to raise their children.
The ugly truth is that money spent on breastfeeding advocacy benefits only the advocates and not mothers or children.
We should stop spending money on public health campaigns to promote breastfeeding, both inside and outside hospitals. Instead we should divert that wasted money to initiatives that we know will help ameliorate social inequities: better public school funding, easy access to doctors for all children, and debt forgiveness for student loans. But that presupposes a beneficial role for government.
It is ever so much easier (and delightfully satisfying) to simply blame the mother for not breastfeeding.
