Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policyby Courtney Jung Published 24 Nov 2015
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Social scientist and mother Courtney Jung explores the ever-expanding world of breastfeeding advocacy, shining a new light on the diverse communities who compose it, the dubious science behind it, and the pernicious public policies to which it has given rise
Is breast really best? Breastfeeding is widely assumed to be the healthiest choice, yet growing evidence suggests that its benefits have been greatly exaggerated. New moms are pressured by doctors, health officials, and friends to avoid the bottle at all costs-often at the expense of their jobs, their pocketbooks, and their well-being.
In Lactivism, political scientist Courtney Jung offers the most deeply researched and far-reaching critique of breastfeeding advocacy to date. Drawing on her own experience as a devoted mother who breastfed her two children and her expertise as a social scientist, Jung investigates the benefits of breastfeeding and asks why so many people across the political spectrum are passionately invested in promoting it, even as its health benefits have been persuasively challenged. What emerges is an eye-opening story about class and race in America, the big business of breastfeeding, and the fraught politics of contemporary motherhood.
"Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy" Reviews
I have four children, and there was never a question of whether I would breastfeed them. I had read about all the benefits of breastfeeding, and with all the uncertainty surrounding parenting, breastfeeding was on a very short list of things I knew I could do right. But when I had my first child, it was not that simple. Nursing hurt. Her feeding schedule was unpredictable. I felt tied down in all sorts of ways, physical and emotional, by the need to be on call for her and the pressure of being the only thing standing between her and starvation. When I returned to school and work after two and a half months, I had the added pressures of pumping to contend with at a time when there was far less awareness of the needs of nursing mothers in the work environment.
It was a stressful and anxiety-provoking period, and although I believed I was doing the right thing I struggled with a great deal of ambivalence. What made things even harder was being surrounded by family members who were militant advocates of breastfeeding. Of course, they were all stay-at-home mothers who had no clue about the challenges I was experiencing and didn't especially sympathize given that I had made different lifestyle choices. "Call La Leche League!" one of my relatives urged when I told her I was struggling. But I didn't want to call La Leche League. This same relative had blithely described La Leche League as an organization that would support my nursing by insisting I do it no matter what. That wasn't the answer I wanted to hear. I didn't want someone pushing a nursing agenda on me. In this, as in so many other areas, it felt as if my personal needs no longer counted now that I had an infant.
Thankfully, I got through that period okay. I ended up nursing my daughter, and my subsequent three children, for fourteen months each and have no regrets about having done so. Part of me feels that the pressure surrounding me, unpleasant though it was, helped strengthen my resolve to continue nursing and ultimately I'm grateful that I kept it up. But I do remember the resentment and anxiety I felt, and have wondered at times whether it was truly warranted. Naturally, I was extremely curious when I heard about this book and it did not disappoint.
Courtney Jung reports that she breastfed both of her children. She tells us that she's happy she did it. She also acknowledges that, for a variety of reasons, her breastfeeding experience was easier than that of many mothers. And she adds that the pressure many mothers feel to breastfeed may be unwarranted, coming from a conflation of societal agendas of varying origin and validity.
According to Jung, La Leche League was founded in 1956, when formula feeding was far more popular than breastfeeding in the U.S., out of an interesting combination of feminist and conservative agendas. From a feminist perspective, La Leche League wanted to empower women to wrest control of their bodies and childrearing practices away from the (largely male) medical establishment. At the same time, La Leche advocated for an agenda of full-time mothering and prioritizing childcare above all else, including housework and appearances. What further separated La Leche League from the feminists was the issue of whether to take a stand against abortion in the early 1970s.
Although La Leche League was a marginal organization for a while, breastfeeding got another boost in the 1970s when people became aware of high infant mortality rates in developing countries. These rates were attributed in part to the increasing popularity of baby formula in these countries, where conditions for preparing the formula were frequently unsanitary and poor mothers couldn't afford sufficient formula to nourish their babies. Idealistic Americans began boycotting baby formula companies and viewing breastfeeding as an act of social consciousness.
Feminists, too, jumped on the breastfeeding bandwagon as an issue of female empowerment. And as Dr. Sears and his books promoted attachment parenting in the 1980s, our culture of hyperparenting lent more support to breastfeeding. Hipsters embraced breastfeeding as part of a larger movement toward socially conscious consumption practices that includes fair trade coffee, locally grown produce, etc. Fundamentalist Christians embraced breastfeeding as part of God's plan. Politicians claimed that breastfeeding would reduce nationwide medical costs. And businesses, such as breast pump manufacturers, stood only to gain by enhancing breastfeeding's popularity.
But is breastfeeding truly superior? Maybe a little, but not nearly as much as people would have you believe. According to Jung's investigation, the benefits of breastfeeding are highly overstated. Much of the research is mixed or inconclusive. While there is some legitimate research supporting certain benefits of breastfeeding, the list is far shorter than people think and the benefits are modest at best. Further, it remains to be clarified whether the benefits are due to breastmilk itself or due to other aspects of breastfeeding, i.e., the bonding that mother and infant experience during the process. Notwithstanding the marketing efforts of breast pump manufacturers and government regulations to make the workplace friendlier to mothers who need to pump, the milk itself may not be the issue here (this was particularly disheartening for me to read, although I do believe that my efforts to pump were worthwhile because they helped maintain my milk supply at a time when I was out of the house a lot).
In what may be the most damning chapter, Jung discusses La Leche League's alignment with AIDS denialists and dangerous support for breastfeeding by mothers who are HIV positive. I was so horrified I had to google this. Sure enough, consistent with Jung's book, La Leche states that "it is no longer necessary for HIV positive women to give up all hope of breastfeeding." According to Jung's research, although the risk of transmitting HIV to infants through breastfeeding can be somewhat reduced under very particular conditions, reaching these conditions is not always realistic; formula feeding, on the other hand, would eliminate the risk altogether. This type of fanaticism is akin to bombing abortion clinics out of an ostensible concern for human life; if the goal of La Leche League is to protect the health of infants, why would they promote breastfeeding in a situation that could only increase the danger to an infant's health?
As I struggled in my early days of nursing, I remember one relative's dogmatic insistence that there is absolutely no such thing as a woman not having sufficient milk, a position which is likely espoused by La Leche League. Jung debunks this myth as well. Although it's certainly far from the majority, a small percentage of women are in fact unable to nurse for physical reasons. To deny this possibility is highly irresponsible and does a terrible disservice to mothers and infants. Although I do think that nursing is a struggle for many mothers initially and, in my experience, is most often is due to a learning curve rather than to physical factors, it's important to explore all the possibilities rather than unnecessarily torturing yourself and your infant because of misguided propaganda.
Having said all that, I'm still a fan of nursing. The research has in fact firmly established some health benefits, even if they're not quite as far-reaching as we would like to believe. I'm happy that I got through my initial adjustment period and feel that both I and my children benefited from my breastfeeding in tangible and intangible ways. But I believe it's a personal choice, especially since the margin of benefit is not nearly as wide as is popularly believed. Aside from my interest in nursing itself, this book was a fascinating look at the way various societal agendas can converge to promote a trend with great emotional urgency at the expense of intellectual honesty.
Pretty good serious non-fiction. The author does a nice job of explaining how breastfeeding is nice but not the super-important duty it's made out to be by some. She makes the distinction between breastfeeding and breast milk and otherwise gets into details that turn out to be important. The supposedly "endless" benefits of breastfeeding are based on appallingly weak studies, which are contradicted by the stronger research. Unfortunately, these stories of stupid policy based on dogma and sloppy science are too common to be shocking.
I went to a conference on human lactation in 2001. There are two talks that still stick in my mind. The first was a woman working in a maternity hospital in Ghana. One out of five of new mothers were HIV positive. Despite the risk of them passing it on to their babies via breastfeeding, most of these women did it. Many did not have access to clean drinking water to make up the formula and there was also the stigma of using formula - it meant you were HIV positive.
The second talk was giving by a scientist showing that asthmatic women who breastfed their children were more likely to have asthmatic children than asthmatic women who formula fed their children. The lactivists came out and fiercely attacked the woman's data. My boss and I looked at each other - WTF?
This book is great at showing how the movement to more breast feeding has now turned into backlash against women who choose not to breast feed or are unable to breast feed. Women who get WIC benefits get better benefits if they breast feed regardless if they have lactation failure or are on anti depressants that could harm a breast fed infant. Women are pressured by doctors and the general public to breast feed.
This pressure to breast feed has created a huge industry in breast pumps. Since the US does not have the maternity leave program most countries have, women are back to work 6 weeks or less after the baby is born. Many use breast pumps, but are given broom closets or rooms with large windows to pump in. Some women get their paychecks docked for the time they take to pump at work. Many women resort to pumping in the car during their commutes. Doesn't that sound safe?
The breast feeding trend has come from many flawed studies regarding the health benefits of breast milk. The vast majorities of these health benefits only occur in developing nations without access to clean water. The benefits in the developed world are very modest. The best study is the PROBIT study which showed some cognitive benefits to breast feeding. One thing that was pointed out is that this study was done in Belarus where very few women use breast pumps. There have been no good studies on the benefits of breast milk on cognitive abilities between those babies that get milk straight from the breast or those who drink pumped milk.
The one problems I had with the book was she states, "....there has never been a time when women didn't breastfeed." Duh, we're mammals.
Bottom line, don't harass a woman who doesn't breast feed her baby. She may have very valid reasons that are none of your business.
This is an incredibly thoughtful and fascinating book. First, a few thoughts about the structure and then I’ll go into more detail about the actual content. Structurally, it’s repetitive. I read the same anecdotes or statements or research conclusions at least several times throughout. I know this was likely done to keep reminding the reader about the thesis statements presented earlier–but it could also feel like filler. I struggled with the book’s tendency to file moms into very specific stereotypes to describe that particular group’s breastfeeding agenda. You can see those stereotypes on the cover: feminists, fundamentalists, hippies, and yuppies. For clarity’s sake, yeah, it’s easier to just say “hippies advocate breastfeeding because of X” and “yuppies advocate breastfeeding because of Y,” but I think (hope) we are smart enough to talk about the variety of reasons women choose and advocate breastfeeding without having to categorize them into just four groups. Small qualms here and there, but let’s get into the content. I can tell you honestly that I’ve read very few books on parenting or modern motherhood that were so convincing or eye-opening as this. It changed my perspective on so many things.
The book first establishes the rise and fall of breastfeeding over the past century or so, giving some broad context to where we find ourselves today. And that place is, of course, one where breastfeeding reigns supreme, where it has become a marker of good and responsible parenting, where it defines the kind of mother you are and the kind of person you want your baby to become.
The writing is very surgical, wasting nothing on fluff, with Jung really drilling down and questioning some of the modern reasons women choose to breastfeed. She tears apart breastfeeding research, talking to the most respected doctors and researchers in the field. If you’ve ever read that breastfeeding affects IQ, or prevents certain diseases, well–Jung finds out the research to support those claims is virtually non-existent or the sample pool is too small or distorted to be taken seriously.
She also discusses the history of formula, the contemporary feminist discourse on a woman’s right to breastfeed, the shame of being unable to breastfeed, the privilege and racial disparity that goes hand-in-hand with the ability to breastfeed exclusively for at least 6 months, the folly of treating a lack of breastfeeding like a national health crisis or necessitating public health interventions, the astonishing differences between the benefits breastfeeding and non-breastfeeding WIC recipients receive, the HIV-through-breastmilk deniers that are still affecting transmission rates today…this book covers so much. And most of it is infuriating and frustrating.
The part that I want to call out in a bit more detail is the thoughtful and methodical attention Jung pays to how American society and modern mothers equate breastfeeding benefits with pumping. Somehow we’ve radically redefined and accepted this new definition of breastfeeding. And pumping is not feeding–it’s lactation, Jung points out. Is there a woman alive who likes to pump her breastmilk? Who enjoys it? (I personally found the experience frustrating, uncomfortable, occasionally painful, demeaning, and time-consuming.) But I did it, and most women do it or try to do it because we believe we are providing the same benefits to our babies that they would receive feeding from the breast, despite no evidence to support that belief. The reason, Jung says, that we do this is multi-layered. Most women who pump have jobs, and those women want to provide for their infants in a tangible way even if they can’t be with them every hour of every day for the formative months of their baby’s life. We, American women generally, also pump because it’s in the best interest of politicians and the companies we work for if we keep pumping. Breast pump manufacturers, hospitals, insurance companies, lactation consultants–they all just get in line too. I just read an article this morning that talked about the Affordable Care Act “breastfeeding rights.” (Sidenote: some of the research in that article is more or less eviscerated in Jung’s book too.) But most of the provisions in the ACA didn’t give us breastfeeding rights. They gave us the right to go back to work and pump at our leisure. Jung brings this back to–guess what? Mandatory, paid maternity leave. So long as we believe that breastfeeding = pumping, and we are, maybe 6 weeks after giving birth to another human, celebrating our right to be stuck in a supply closet for 45 minutes of milk production 3x a day, there is no incentive for politicians to seek paid maternity legislation. Jung could find only 3 articles on employment and breastfeeding in the United States, but found hundreds describing and analyzing the problem of racial disparities in breastfeeding. She notes: “It’s hard to resist the conclusion that the reason public health initiatives and policy makers don’t discuss the effect of maternal employment on breastfeeding rates is that doing so would focus attention squarely on America’s famously skimpy maternity leave.”
So, I love this book. It made me think critically about issues I’d never had to think about or had never considered and I appreciate that. It’s available for pre-order now and will be released on November 24. Thanks to Perseus Books and Basic Books Group for the opportunity to read this book in exchange for a review.
I love nonfiction. I really love nonfiction where I get to learn about something I have zero personal experience with, and breastfeeding definitely falls under that category.
Lactivism was fascinating and infuriating, like most good nonfiction. It was incredibly frustrating to learn that the standards for breastfeeding research have been very low. Most studies do not allow control for the differences that also come from socioeconomic status, which is a serious problem since middle- and upper-class woman are far more likely to be able to breastfeed than low income women.
I was particularly drawn in by Jung's chapters on breastfeeding at work and HIV transmission. That we've allowed breastfeeding to be equated with breast pumping and bottle feeding has weakened the argument for federal mandated maternity leave. If women can just pump and send their baby with bottles, she only needs time to recover! If a woman needs to be actually breastfeeding for the length the government recommends (6 months), then that is a serious problem that can only be fixed with longer paid maternity leave.
Overall, Lactivism is a fascinating history of the breastfeeding movement and provides a compelling interpretation of our current stance on breastfeeding. Anyway you slice it right now, women lose. Women who want to breastfeed are limited by a lack of support in the workplace (pumping policies with zero ways to enforce them, lack of paid leave) and women who don't or can't are shamed and even punished (women who formula feed can accept WIC for HALF the time as women who breastfeed and get fewer food vouchers) by a society that increasingly paints breastfeeding as an issue of good mom vs bad mom.
This book is really important and deserves a proper review, but I think I need a couple of days to sort out my thoughts. Review to follow!