Rebecca Leeney is a 43-year-old mother of three who lives just outside Sudbury, Ont. She was an avid proponent of breastfeeding before and during her first pregnancy. Then, her baby was born unable to feed directly from the breast. So, Leeney did what many new mothers do when they are desperate to do right by their babies: She expressed her breast milk with a mechanical pump several times a day and fed it to her baby from a bottle.
If that sounds like twice as much work, think again. After washing and disinfecting bottles, nipples and breast pump parts, and spending the time pumping while also caring for a baby, pumping is easily three or four times as much work as breastfeeding.
"It was horrible," said Leeney, who did not get more than two hours of consecutive sleep for six months. "I had unrelenting postpartum depression. It was very, very hard."
She said she consulted many health-care professionals but they encouraged her to continue trying in spite of the difficulty.
"At no point did anyone say to me, this isn't working and you should switch to formula, which is what should have been said," said Leeney, who successfully breastfed her two other children. Looking back, Leeney feels like she was so preoccupied with feeding her infant daughter that she missed out on cherishing those early months.
I have breastfed three babies, and it was a wonderful experience – one I would highly recommend, assuming that everything comes together nicely. But breast milk is still just food. In recent years, I have noticed an unnerving uptick in what University of Toronto professor Courtney Jung has dubbed "lactivism" in her new book. By that, she means an increasing sentiment that what a woman feeds her baby is everybody's business and that the assumed superiority of breast milk over formula justifies intense shaming exactly when a new mother is at her most vulnerable.
Jung's book is a bold challenge to the prevailing parenting orthodoxy. There are lots of studies on breastfeeding but they do not all account for factors such as smoking, household income, education and so on. In Lactivism, Jung looked at large, well-respected studies and meta-analyses of smaller studies. She agrees that exclusive breastfeeding seems to offer some protection against respiratory, gastrointestinal and ear infections for as long as a baby continues to nurse. What advocates and health organizations, such as the American Academy of Pediatrics and the World Health Organization, have oversold are the long-term benefits, she said.
"All of the research on the long-term benefits of breastfeeding is … observational. A lot of it is older. It doesn't control for confounding factors and it swings in both directions," Jung said of her analysis. She could find only conflicting and dubious evidence for claims that breastfeeding continues to offer a protection against a slew of other conditions: obesity, diabetes, cardiovascular disease and SIDS, among others.
Medical evidence is only part of the story: Jung also zeroes in on breastfeeding advocacy. Its history is rooted in claims from activists that it is a radical act that countered the mainstream conventions of the 1950s and 1960s, when medically managed childbirth and quantifiable formula feeding were the standard. "Breastfeeding advocates do consider themselves to be a beleaguered minority and they do believe that formula companies represent a real threat to best feeding practices," Jung said.
Even though the past several decades have seen breastfeeding widely embraced by everyone from eco-feminist hipsters to the Christian right, the same strident undercurrent of subversiveness remains. (Breastfeeding mothers still gather at nurse-ins to protest against unfriendly breastfeeding policies, for example.) Many early advocates are now in positions to enact public policies that encourage breastfeeding over the alternatives.
Jung is especially bothered by pro-breastfeeding policies targeted at low-income communities of visible minority women. "Breastfeeding becomes not only the lifestyle choice of wealthy white women, but also a requirement of good parenting and a condition of good citizenship through public health initiatives," she said.
She added that a byproduct of this way of thinking is the belief that women who do not breastfeed produce unhealthy babies who become burdens on the health-care system. "In Canada, it's women who are poor and who are aboriginal. In the U.S., it's women who are poor and African-American," she said.
At best, she said, these policies come across as rich white women telling other communities how best to feed their babies. At worst, they are actually harmful and discriminatory. Jung said that one U.S. government program gives less in food vouchers to women who formula feed than to those who breastfeed to encourage them to switch to breast milk.
Leeney, the Sudbury mom, echoed Jung's distaste for breastfeeding initiatives that target low-income women. "We were very young and super poor and I think this played into it," she says of the pressure she felt as a new mom at a time when she and her husband could not afford to replace their broken-down car, or even their shoes. "There was a lot of emphasis from our pediatrician about breastfeeding that friends of mine later on did not have."
The reality is that a great many women cannot (or choose not to) breastfeed exclusively. Some babies, such as Leeney's, just do not latch. Working mothers (especially in the United States, which has no paid maternity leave) often need to head back to work well before the six, 12 or 24 recommended months of breastfeeding (depending on who you ask) are up. This results in advice to feed babies breast milk rather than at the breast.
"Research has not been done on the distinctions between feeding a baby human milk from a bottle and breastfeeding, and so we really don't know if they're the same thing," said Jung, pointing out that the manufacturing of breast pumps and accessories is a big business.
Ottawa pediatrician Catherine Pound disagrees strongly with Jung on a number of counts.
"There's an overwhelming body of evidence that breastfeeding has quite clear benefits," said Pound, who writes information on feeding babies for the Canadian Paediatric Society. "There are clear benefits that come from the breast milk that will be there in the bottle, so, yes, breast milk from a bottle is still a viable option." Pound also believes that there is still good observational evidence for the long-term benefits of breastfeeding.
What Jung and Pound agree on is that the pressure to breastfeed is often an unfair burden on the mother. "While health-care professionals are aware that breastfeeding is wonderful, very few programs are providing physicians in training the skills to actually support it," Pound said.
She said that no matter how a newborn gets fed, the overall mental well-being of the mother needs to be the priority.
"I am not anti-breastfeeding," Jung said. "I simply want policies that are supportive of women's choices so they can make real decisions."