Knowing the type of reactions this topic elicits, I have mulled over whether or not to write this post for a long time. But World Breastfeeding Week is a time for health practitioners and health advocates to reflect, and as someone who hails from the world of science rather than clinical, and as someone who is not a parent, I think I have some unique thoughts on this subject.
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In July of last year, I attended a science conference. Conferences often come with lots of coffee, and was feeling a little self-conscious about how enthusiastically I had gushed about my scientific field of interest, the anthropology of infancy–which I’m sure will come as no surprise to you largely involves breastfeeding. During the closing proceedings on the last day, I felt several eyes flit in my direction when the plenary speaker brought up news that had broke that day: Donald Trump attacked breastfeeding on Twitter, prompting the New York Times editorial board to take a rare step of publishing an editorial on their own behalf. And that was the day the non-parent world found out that the breastfeeding science backlash movement was a thing.
When I chose to study anthropology, I knew I would encounter science denialism, dismissal, or rejection at some point; I just expected it to be about human evolution, not breastfeeding! Sometimes I get pretty frustrated at having chosen a subfield that has turned out to be so controversial. I just want to say “Hey, I just came here for the science, leave me alone.” So I don’t really want to write this. What I really want to write about is weird animals that make milk and that crazy new video that came out in May showing what a letdown looks on the cellular level. But I’m starting to realize that this amazing science only gets done because the public believes in its value, and this science–the science I love and have dedicated the past decade of my intellectual life to–is currently being questioned on its validity, not by people with a scientific background in this area, but by people with huge platforms. People who parents look up to and respect.
Things like cultural resistance to breastfeeding and false advertising claims on formula labels have been around for as long as the formula industry has existed. But active dismissal or denial of the science itself has gained traction just in the past 5 years or so. This movement as managed to sew doubt in the minds of the public, journalists, and even some medical practitioners, in established science on a major public health issue that costs Americans literally tens of billions of dollars every year.
Before I move on, let’s just get this out of the way: The breastfeeding “debate” is socially constructed. There is no debate, in the scientific community, over the idea that the optimal nutrition for human infants is the milk of our own species. The WHO, UNICEF, the American Academy of Pediatrics (AAP), the American College of Gynecologists and Obstetricians (ACOG), and the corresponding pediatric and OB organizations in the UK and Canada all hold breastfeeding as the optimal form of nutrition for human infants. Yes, even for infants in wealthy countries like the U.S. In response to recent pushbacks against this area of science, both ACOG and the AAP released position papers doubling down on their support for breastfeeding, and for important initiatives designed to increase breastfeeding rates.
The idea that in order to achieve optimal health, infants require the milk of their own species: Sooo controversial, right? But it makes total sense to someone who is familiar with this area of science, and with its sociopolitical components, that some people would have a hard time with this. Let me explain.
The breastfeeding backlash movement is tapping into a serious–and very real–problem. As a society, we are badly failing families. Most women start out wanting to breastfeed, but don’t make their goals. Our entire reproductive health system reflects the fact that we value fetuses and babies over mothers, without understanding that the two are inextricably linked. We tell women to breastfeed, but we don’t provide the structural support, information, and cultural acceptance necessary for it to work. They’re tossed into water and left to sink or swim. We are one of only two countries in the entire world that offers no form of paid parental leave. Breastfeeding parents have to navigate, with no real guidance, unfamiliar challenges like social stigma and the completely disorienting experience of nighttime breastfeeding. Having internalized our individualist culture, mothers are overcome with deep, painful feelings of personal failure and shame if bonding or breastfeeding doesn’t go as they had hoped. These feelings are only exacerbated by maternal mental illness.
Parents got the message on breastfeeding loud and clear, but they never got the structural support. A backlash against breastfeeding seems practically inevitable in a society that tells women to breastfeed if they want to be a “good” mother, then punishes them for trying.
Science denialism is as old as science itself, and today is as prevalent, clever, and creative as ever. One of the most persistent targets of science denialism and doubt-casting involves evolution by natural selection, appearing in various iterations, from legitimate competing scientific theories (at least for the time), to religious ideologies masquerading as a scientific theory, as with so-called “Intelligent Design.” Others, such as the anti-vaccine movement, are rooted in both legitimate social concerns (accountability and transparency for pharmaceutical companies, for example) and complex cultural issues (fear surrounding the mysterious nature of autism, and strained relationships between mothers and the medical community). Sometimes, science denialism manifests in the form of astroturfing and lobbyists pushing politicians to suppress or perpetuate particular messages about health, a strategy mastered by the tobacco industry.
Science denialism or rejection isn’t always obvious when it’s happening, so it’s important to be aware of their tactics. Most of the tactics used by those who wish to cast doubt on breastfeeding science, in some way or another, take advantage of the emotional trauma of parents who’ve been failed by the system, and as a result did not meet their breastfeeding goals. For example, they might tell stories of “starving” babies that tug at your heartstrings.
They also cherrypick and misrepresent research and use sciencey-sounding language in order to convince mothers that, actually, the science is overblown and it doesn’t really matter what you feed your baby after all! It’s comforting, but it also sounds like a reasonable, middle-ground position. It has a familiar bouquet, similar to the extreme wing of the body positivity movement, which actively denies that excess adipose tissue (an endocrine organ) is associated with a higher risk of noncommunicable diseases. It sounds nice, and is comforting in a kind of ephemeral way, but it isn’t the truth. In both cases, the truth hurts, but the solutions hurt governments and corporations, of course, so the individual takes the hit.
Rather than helping parents understand the complex sociopolitical and structural causes of breastfeeding difficulties, they demonize clinicians, scientists, and health advocates by referring to them with terms like “breastfeeding Nazis” (You can thank Tina Fey for popularizing that one. God, I wish celebrities would quit commenting on health issues. And joking about Nazis.) and “lactivists”—a term that used to be used among health advocates to refer to themselves, and had a positive connotation. They claim that breastfeeding promotion is anti-feminist and oppresses mothers, while conveniently ignoring the ways in which systemic oppression of all mothers results in racial and economic disparities in breastfeeding rates. Most recently, one of their organizations fraudulently reported a lactation consultant to her state’s board of nursing for “practicing without a license.” It later turned out they’d done so in error because they spelled her name incorrectly.
I’ll go into more detail on their tactics in a future post.
Beyond a few internal warnings and strongly worded letters to the editor, there hasn’t been much of a substantial response to this messaging from the clinical and scientific communities–largely because, like me, many of them were caught off guard by this recent surge in attacks on breastfeeding science, and it kind of has them scratching their heads. When I talk about it with them, some of them tell me they don’t have the publicity skills or budget to respond. Many are busy trying to stay afloat in a “publish or perish” academic culture, and just don’t have time. Others have been targeted with personal attacks, and are afraid to be too vocal. Those who have dipped their toes in the social media waters have found managing the flamewars and trolls that inevitably follow to be way beyond their bandwidth.
This movement has been gaining traction in the media over the past few years, landing a New York Times oped and a whole segment on popular skeptic comedy Adam Ruins Everything. It’s being perpetuated by some of my favorite shows, podcasts, and personalities in skepticism, science education, and science writing. Despite this, I continue to have an abiding respect and admiration for a lot of these folks, and have faith that at least most of them are open to exploring this issue in the spirit of mutual curiosity that drives us all.
In the coming days, I will go into more depth about the tactics employed by those who seek to cast doubt on established breastfeeding science and offer some solutions and advice for people who share this concern. In the coming weeks and months, I hope to get down and dirty with the science on breastfeeding, why this issue is so complicated, and skills parents can use to critically evaluate scientific information.
This is a very. long. conversation. Let’s do this.
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