Look – there are racial and economic disparities in a ton of areas in our society – take education for example. People who are trying to reform education do so in part because of these disparities. By a similar argument to Dr. Jung’s (and many, many others), this is akin to “shaming” those who have to attend poor quality schools and thus we should be angry with those who promote access to better education. In short, it’s ridiculous. The fact that racial and economic disparities exist is not a reason to censor discussion over the risks of formula feeding or non-biological breastfeeding. Just as they are not a reason to censor discussion on education or later dietary and health choices.

Moreover, recent research that was presented at the annual meeting for the Academy of Breastfeeding Medicine found that breastfeeding may actually be something that evens the playing field based on socio-economic differences. That is, exclusive breastfeeding was found to moderate differences in cognitive development based related to lower SES; those who were exclusively breastfeed did not show the same effect of SES on cognitive development than those who were not. This research is preliminary, but if it holds up in long-term studies, this has huge public health implications and should provide our politicians with even more of a push to create policies that support women’s rights to breastfeed and breastfeed exclusively.

(To read up on the highlights of the recent research mentioned at the ABM 2015 conference, here is a great summary from an attendee.)

In fact, lactivists have attempted to end this disparity by pushing for better education and support for minority and lower SES groups, yet even these attempts are being called out by those against any form of breastfeeding advocacy. It’s almost as if they want things to stay in this segregated manner and ignore the other issues facing lower SES families who formula feed.

Yes, that’s right, there’s inequality in formula feeding as well with lower SES families facing serious problems such as access to safe water (even in the United States), enough money to afford enough formula for the month, the proper preparation of formula and sterilization of bottles to avoid disease, and the early introduction of solids or even watering down formula. These are all issues that face too many families in the USA, yet in the privileged discussion of “choice” this is all happily ignored.

Oh Those Policies!

Dr. Jung takes much offense to policies in the USA that she feels shame formula-feeding mothers. Here is where I’d like to say that she raises some good points about the policies in place (some, not all), but where her anger is misdirected. Instead of blaming inept politicians, she decides to go after lactivists, which is woefully ignorant and unfair.

Where I find Dr. Jung to be wrong in her assessment of policy is her idea that labeling breastfeeding as a public health issue portrays mothers who don’t as bad parents and irresponsible citizens as it blatantly ignores that it is a public health issue. It has nothing to do with shaming individual mothers, but rather acknowledges that the societal effects – financially and health-wise – of breastfeeding are too important to ignore. By labeling it as such, the American Academy of Pediatrics and surgeon general have brought the issue to the forefront of politics where it had previously been swept under the rug. Only with this type of awareness can we make real progress in terms of policies that need to be implemented to help women. (Though because of the ineptness of politicians, this is not actually happening in ways anyone appreciates.)

The discussion of WIC policies in her article has many people – rightfully – up in arms, but they are up in arms at the wrong people. Yes, WIC wants to promote breastfeeding because, as previously mentioned, it is a public health issue, but Dr. Jung forgets that there are financial and practical realities of a public subsidy program that need to be mentioned as well. People seem to forget that WIC pays for a large portion of the formula provided to moms who do not breastfeed, money that is used for the extended food package for moms who do. For example, in the first six months, an exclusive formula WIC package costs 25% more than an exclusive breastfeeding package. (Interestingly, the cheapest option for WIC would be to have every mother-infant dyad on the partial breastfeeding package for the entire first year of a baby’s life.)

Should all moms have access to good, healthy foods? Abso-freaking-lutely, but when someone else is paying for it, you can bet they’re going to be pretty stringent with the money they spend and when it’s the government, that pesky issue of public health is also going to play into it (remember the numbers for infections and hospital visits?).

Is this right or fair?

Not really, for a few reasons. First, although formula is supplemented with vitamins and minerals, hopefully no one actually believes that this replaces high-quality whole food in terms of the health benefits. Second, it ignores the varied reasons women make the choices they do with respect to infant feeding; until other policies are in place that support women’s right to make an actual choice (*cough* paid leave *cough*), it does come across as punishment for some women. Third, given the racial and economic disparity that already exists in infant feeding practices, it does, as Dr. Jung states, serve to create greater health disparities between the haves and have nots (for even within those who use WIC, there are differences). But none of this was instituted by breastfeeding advocates. These were instituted by inept politicians. Let’s be clear that breastfeeding advocates aren’t out celebrating these disparities. More often than not, they are equally disparaging of policies that put the best interests of moms and babies behind the dollar bill.

I agree completely with Dr. Jung that the USA needs better policies in place such as paid maternity leave, flexible work schedules, on-site daycare, and so on. These are things breastfeeding advocates have been pushing for far longer than the anti-breastfeeding brigade. The entire basis of this past year’s World Breastfeeding Week was on working mothers and pushing for changes that enabled working moms to reach their breastfeeding goals. Yet even that week, we were all treated to an endless barrage of how horrible lactivists are and how we just need to say “formula is just as good”. Yet in no world does that attitude help foster change for anyone.

Choice