Medical studies show breast is best when it comes to infant feeding. Or do they?

Political scientist Courtney Jung says, “not so fast,” in her book Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy, released by Basic Books in 2015. It questions the science that touts breastfeeding as a universal panacea for a range of childhood ailments from ear infections to asthma. Instead, she argues, the benefits of breastfeeding are modest at best, if one throws out all the small studies and any of the research that cannot control for the confounding fact that breastfeeding mothers often have other healthy behaviors. There have been a number of new studies supporting the long-term, even life-long, benefits of breastfeeding since the book came out.

Jung assigns the moniker “lactivist” to anyone who “firmly believes breastfeeding is the best choice for everyone.” This definition conflicts sharply with the real life experiences of women, many of them breastfeeding advocates, whom I’ve talked with as a part of an in-depth sociological study of breastfeeding in the United States.

With the exception of a few dogmatic advocates—and many La Leche League leaders are much more liberal in their approach—most breastfeeding advocates seem to be all for using formula whenever necessary. They just don’t want it forced down their babies’ throats (often very literally) in hospitals and daycare centers. They aim to normalize breastfeeding because it is, in fact, absolutely normal for humans and we are just coming out of a century-long era of de rigueur formula feeding.

I breastfed one of my adopted sons and not the other. I know firsthand that formula feeding is by no means “easier” than breastfeeding. The two methods have their own challenges. I also know, more than most, since I had to induce lactation with the help of expensive, hard-to-find drugs and a rented hospital-grade pump that I used around the clock, that breastfeeding is not always easy, or even possible, for many women. Nobody should be made to feel inadequate for the way they feed their babies. On this, Jung and I agree.

I am disappointed, however, by Jung’s unfair caricatures of the groups implicated in her subtitle. She skewers breastfeeding advocacy as motivated by identity politics that unwittingly end up serving “big business.” Her evidence that breastfeeding is big business compared to the formula industry, which is at least five times as lucrative, is weak when one considers the little fact that infants have to eat. Parents are either spending their dough on formula or breast pumps; actually, many buy both (and plenty of people borrow pumps). To tip the scale in favor of her argument, she factors unpaid wages into her surprisingly exorbitant estimate of the cost of breastfeeding, while tossing out any potential savings in healthcare costs and sick leave that may result from breastfeeding.

Jung’s math is puzzling. She notes that moms who go to work quit breastfeeding sooner than moms who stay at home and then compares that difference of about 17 percent with the 15 percent disparity in the rate of breastfeeding initiation between African American women and whites. This apples-to-oranges premise underpins her contention that the only real problem of breastfeeding is employment, not race.  Advocates need to back off, she warns, because black women don’t want to breastfeed for cultural reasons: out of modesty and because community child rearing is easier with bottle-feeding (forgetting that bottles and breastfeeding are not mutually exclusive). These are certainly valid concerns for many women but she overlooks the fact that increasing numbers of black women do want to breastfeed and they need considerably more support if it is to be an accessible option. The Centers for Disease Control and Prevention (CDC)—and the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC program—recommend as much in well-researched reports that Jung unconvincingly dismisses as blind public health rhetoric and stingy poor-shaming tactics that aim to keep women in their place.

A handful of anecdotes, as well as Jung’s tone throughout her book, seem to suggest that privileged mothers are out there enforcing the breastfeeding doctrine by patrolling the parks and baby playgroups looking for hapless bottle feeders to shame, or else lording their superior infant feeding choices over the less fortunate. Whereas Jung concedes to her reader, “Maybe you breastfed because you loved it, or because you got that endorphin high some women describe,” she goes on to dismiss these valid benefits, “but still, at some level you were most likely breastfeeding because you believed what you were told: that it would bring ‘significant’ benefits to your children.” Jung insults women by giving little credence to the socioemotional experience of breastfeeding. She also gives no attention whatsoever to the benefits mothers might receive like reduced lifetime risk of breast cancer and stroke, and protection against postpartum depression.

Once Jung has slain the straw men in medical research and public health, she goes after the pump, more ubiquitous than ever thanks to the Affordable Care Act ensuring coverage. Yet, her argument that pumping is no fun and that workplaces fail to adequately support the need to pump actually underscores the need for breastfeeding advocacy.

While the pump serves employers’ interests by allowing breastfeeding parents to return to work, it also allows mothers to stay close to their babies for longer. It frustrates me that Jung portrays the pump as a replacement for direct breastfeeding since most who pump do not stop breastfeeding! The pump also enables all sorts of creative dynamics that help parents and babies. For example, family members and friends share milk and even trade nursing duties, sometimes with the help of a supplemental nursing system, a bag of milk with a tube attached at the nipple.

Normalizing breastfeeding does not require forming a nation of breastfeeding Stepford wives as Jung fears. Instead, it opens up avenues for mixed approaches to infant feeding.

Unsubstantiated claims about milk selling are especially harmful to families working out ways to best nourish their babies. In an unfortunate bit of yellow journalism, Jung indicates that vast numbers of women are selling their (contaminated) surplus pumped milk to the highest bidding stranger on the Internet. Two studies published in 2015, one by anthropologists Aunchalee Palmquist and Kirsten Doehler in Maternal and Child Health and another by Shannon Foster, Beatriz Reyes-Foster, and Tiffany Rogers in Breastfeeding Medicine, confirm that a substantial majority of milk sharing takes place between peers who know and trust each other and that many safeguards are in place such as flash pasteurizing and asking for medical tests and histories from the donors.

Lactivism could have been an important reminder that parents should not be judged negatively for their feeding decisions, that medical evidence supporting breastfeeding should not be accepted uncritically, and that breastfeeding advocacy should not be tyrannical. Sadly, it is instead an ethnocentric screed that fails to connect breastfeeding with “big business and bad policy.”