Dr. Alison Stuebe of the Academy of Breastfeeding Medicine has had something of an epiphany.
Six years ago, I wrote a blog reflecting on Diane Wiessinger’s seminal essay, “Watch your language.” “There are no benefits of breastfeeding,” I wrote. “There are risks of formula feeding.”
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]For years the breastfeeding industry has insisted that all women will make enough breastmilk and all along they’ve known it was a lie.[/pullquote]
That post remains the most-viewed piece I’ve ever written, with more than 74,000 views as of this writing. I’ve taken the lesson to heart. I’ve published a peer-reviewed study on the increased risk of hypertension among women with curtailed breastfeeding, and I’ve flipped odds ratios in teaching slides and review articles to frame associations as the “risk of not breastfeeding” or the “risk of formula,” rather than the “benefits of breastfeeding.”
…[W]hen we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.
Weissinger’s piece is a paean to viciousness and inadvertently revealing. Weissinger writes:
All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, REGARDLESS OF OTHER CIRCUMSTANCES. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is … watch our language.(my emphasis)
“We want,” “cultural norm,” “regardless of other circumstances.” This is language beloved of tobacco companies and other industries seeking to manipulate the public into buying their products. It is the language of business, not the language of healthcare.
Stuebe was impressed nonetheless:
It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done.
What caused Stuebe’s change of heart? It wasn’t just that shaming language is ineffective at increasing breastfeeding rates. Stuebe was confronted by the inherent racism and classism of lactivism that elevates the personal preferences of upper middle class white women to norms that are used to criticize poor women and women of color.
… In her spectacular keynote address at Breastfeeding and Feminism, Kimberly Seals Allers used a baby bottle with the head of Darth Vader to frame a discussion about how “risks of formula” might be perceived among women of color. For a mother worried that her teenage son might be gunned down for walking down the street wearing a hoodie, “risks of formula” seem pretty trivial…
You don’t say.
In a breastfeeding context, messaging that formula feeding increases childhood leukemia risk is unhelpful for the 22% of employed women who return to the workforce by 10 days postpartum, or for the mother who lives 3 hours from the nearest lactation consultant. If the purpose of risk-based language is to motivate mothers to clamor for help, there has to be help within clamoring distance.
And that doesn’t even take into account that the claim about leukemia is almost certainly untrue.
Then there is an inconvenient fact that Stuebe and colleagues have been deliberately ignoring for years. Stuebe now acknowleges:
… a substantial proportion of infants born in the US require supplementation. Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation. If we counsel women prenatally that Just One Bottle will permanently alter the infant gut, then we set up 1 in 7 mothers to believe the horse is out of the barn in the first week of life. A mother might even conclude that the damage has been done, so she might was well wean altogether.
This is a stunning, ugly admission. For years the breastfeeding industry has insisted that all women will make enough breastmilk and all along they’ve known it was a lie.
If that weren’t bad enough, Stuebe and colleagues have deliberately condemned 1 in 7 infants to starve for days by pretending that “Just One Bottle” of formula will damage the infant gut when we have yet to determine the normal state of the infant gut let alone harmful variations.
Stuebe is reassessing her efforts to promote shaming language in light of its ineffectiveness, inherent racism and classism, and its basis in a spectacular lie. Those are good reasons to reassess, but shaming language around breastfeeding should never have been promoted for a very simple reason: it is UNETHICAL. If patient autonomy means anything it means that all people have the right to ignore healthcare providers’ recommendations without fear of bullying and crude attempts at manipulation.
The fundamental problem with shaming language around breastfeeding is that it is CRUEL and cruelty has no place in healthcare.
Stuebe ends her piece with this:
And until we have evidence that risk-based language improves the wellbeing of mothers and children, we might do well to reconsider our rhetoric. It’s past time to conduct the research that’s needed to sort the real risks and benefits of risk-based language.
But she should have ended it with an apology.
Stuebe and her colleagues should beg forgiveness for the suffering they have caused to starving infants. They should beg forgiveness for the suffering they have caused women with their deliberate lie that all women make enough breastmilk. They should beg forgiveness for the suffering they have caused by placing the needs of the breastfeeding industry above the needs of their patients.
In other words, Stuebe and colleagues should beg forgiveness for their unspeakable, unethical cruelty.
