Why are women being erased from breastfeeding advocacy?

Every year, in the months leading up to World Breastfeeding Week (WBW), the World Alliance for Breastfeeding Action (WABA) announces the theme for the year’s week and releases a series of associated campaign materials for participating individuals and groups. WABA chooses the theme to give a focus to organizing WBW activities and highlight specific dimensions of breastfeeding issues for global action.

This year, WABA chose, “Empower parents, enable breastfeeding” as the theme.

Breastfeeding tends to be overlooked as an issue of women’s rights in reproductive health and bodily autonomy. The development and growth of the infant formula industry, coupled with unfettered neoliberal individualist ideology and liberal feminist choice rhetoric, has seen discussion of breastfeeding in Western settings relegated to sensationalist headlines and inflammatory bait in the “mummy wars.” But breastfeeding is not just a matter of opinion or a maternal ideal — it is a normal event in the trajectory of human reproduction on which the lives of women and infants literally depend.

A 2016 analysis of global breastfeeding levels estimated that “increasing breastfeeding to near-universal levels for infants and young children could save over 800,000 children’s lives a year worldwide, equivalent to 13 per cent of all deaths in children under two, and prevent an extra 20,000 deaths from breast cancer every year.” Low breastfeeding rates worldwide are attributable primarily to poor policy-making, lack of investment, low levels of community support and education, and aggressive marketing of formula. Essentially, though, it is because the lives of women and children are undervalued and under prioritized worldwide. Contrary to the popular narrative of there being “too much pressure to breastfeed,” the real picture of breastfeeding is one in which reproductive disruption and insurmountable barriers prevent women from being able to attain biological norms in caring for their infants.

This is not a newly discovered problem. In 1990, participants in a WHO/UNICEF policymakers meeting on breastfeeding published the “Innocenti Declaration.” This groundbreaking document formally recognized breastfeeding as a fundamental issue of both public health and the human rights of women and children, and formed a foundation for global efforts to promote, protect, and support breastfeeding. In response to the Innocenti Declaration, the World Alliance for Breastfeeding Action was founded in February 1991. WABA is comprised of a network of people and organizations working globally to eliminate obstacles to breastfeeding by tackling problems from a variety of perspectives. Significant campaigns associated with WABA include the Baby-Friendly Hospital Initiative, the International Code of Marketing Breastmilk Substitutes, and the annual World Breastfeeding Week, held each year from August 1 to 7.

But WBW is more than just a public health awareness week — it is also a key opportunity for WABA to consolidate support for their work and mission. The available funding for breastfeeding promotion is a small pool, and even major organizations have to justify their existence for every dollar. It is important to be seen as innovative and taking action, and to continually maintain a sharp narrative hook that will engage maximum participants and funding.

As with an increasing number of health and social justice issues, the current hook in breastfeeding advocacy and promotion is “inclusivity.” The erasure of women and mothers from breastfeeding support has been a slow but steady creep over the past couple of years. Both internally and externally, pressure on peer and professional breastfeeding organizations to update language and imagery in order to centre the experience of individuals and families who identify as transgender and non-binary has increased. “Mother” should become “lactating parent,” “breastfeeding” should become “chestfeeding” or “human milk feeding,” and so on. Rather than expand the terminology to “mothers and _____,” the demands have typically been to eliminate references to women or female bodies in order to demonstrate respect and care. This has also been accompanied by an increasing number of attempts to normalize induced lactation in fathers and trans-identifying males, with total disregard for the impact these interventions have on mothers and babies (including the lack of evidence regarding male milk composition or the safety of the accompanying drug regimens for a baby consuming the resulting milk).

At the 2018 International Lactation Consultant Association (ILCA) conference, tensions about language and “inclusivity” were high. Reports from the conference describe heated discussions, as queer-identified breastfeeding supporters and allies objected to a perceived lack of inclusion and representation on the global stage. The default use of terms like “mother” or “breastfeeding” was strongly challenged. WABA representatives were in attendance.

And so, on February 19, 2019, WABA announced the theme for the upcoming World Breastfeeding Week 2019. On the organization’s Facebook page, the following statement was published:

“The #WBW2019 slogan ‘Empower Parents, Enable Breastfeeding’ was chosen to be inclusive of all types of parents in today’s world. Focusing on supporting both parents to be empowered is vital in order to realize their breastfeeding goals.

Empowerment is a process that requires evidence-based unbiased information and support to create the enabling environment where mothers can breastfeed optimally. Breastfeeding is in the mother’s domain and when fathers, partners, families, workplaces and communities support her, breastfeeding improves.

We can all support this process, as breastfeeding is a team effort. To enable breastfeeding we all need to protect, promote, and support it.”

Despite choosing a seemingly ambiguous theme and logo, WABA was immediately hauled up in comments for being “non-inclusive,” and for using the phrase, “Breastfeeding is in the mother’s domain.” It was inevitable: World Breastfeeding Week 2019 was not allowed to be about mothers.

While WABA has so far retained use of the word “mother” in much of their supporting documents, the promotional materials that were created for use during WBW 2019 confirmed their emerging focus on “parents.” When a series of “message box” memes were created in which participants were invited to describe their contribution to breastfeeding support, WABA changed mothers’ own descriptions of themselves in order to re-label them as “parents” when fitting their statements into the pro-forma text. Not only did this disrespect the women’s own pronoun use, but in all cases this fundamentally altered the meaning of their statements.

While individuals and organizations who maintain a mother-centred focus used the WBW materials despite this being clunky and out of sync with their typical language and approach, many who have been advocating for gender neutrality in breastfeeding embraced it. Social media feeds filled with World Breastfeeding Week word salads so inclusive that they were barely comprehensible.

When questioned about the theme’s erasure of mothers in an open Q&A on Facebook, WABA responded:

“The mother is included in the concept of parents. WABA believes that mothers need to be empowered and that they need the full support of their partners, families and society at large. Thus it could be said that breastfeeding requires a team effort and approach. Research shows that with adequate support from all quarters, breastfeeding improves. In the WBW 2019 action folder we outline the different roles and actions that can be taken to create a supportive environment that empowers parents and enables breastfeeding.”

In the same Q&A session, when challenged by a commenter to justify WABA’s use of the word “mother” and pronoun “her” in supporting information, WABA responded, saying:

“Thank you for pointing this out! It certainly was not WABA’s intention to exclude any parents, including trans, non-binary, or gender non-conforming parents, and we will be more sensitive to this issue in the future. It would be helpful to have more LGBTI parents involved in WABA’s work to help us ensure that the rights and needs of all parents are properly reflected in future WBW materials.”

The message is clear: terminology that accurately describes a female parent and positions her in relationship to her baby, partner, or others is insensitive. Mothers, on the other hand, must accept being subsumed into an amorphous catch-all term regardless of whether this properly reflects their identity or material existence.

There is no question about the importance of partner, family, and social support to a breastfeeding mother. Women who report that their partner is supportive of breastfeeding also report higher levels of confidence and are significantly more likely to meet their breastfeeding goals. But dissolving the identity and reality of mothers into “the concept of parents” erases the unique reproductive experiences of women and denies the economic, social, and biological factors, which impact mothers and fathers in vastly different ways.

It is misleading and dangerous for WABA to present breastfeeding as an issue that impacts “parents” and that can be addressed by “empowerment.” The factors that interfere with women’s decisions surrounding breastfeeding, the ability to achieve their breastfeeding goals, and the physical and mental burdens of not breastfeeding are not things that can happen to any parent, yet nebulously fall on mothers because of their identification as female. Pregnancy discrimination does not happen to parents. Birth trauma and unnecessary medical interventions that interfere with breastfeeding do not happen to parents. Lack of maternity leave provisions does not impact parents’ ability to breastfeed.

Breastfeeding support and advocacy exist specifically because of the patriarchal systems and structures that rule female bodies and that decimated and exploited female bodies to the extent that such support became necessary. Three decades ago, there was no question about which parents were the focus of the Innocenti Declaration or global efforts to protect, promote, and support breastfeeding. WABA’s embrace of gender neutral language during one of the most important weeks in public advocacy for maternal health and rights is an absurd and misogynist betrayal of mothers, simultaneously denying the sex-based oppression of women while removing our ability to name and thereby resist it.

Nicole Jameson holds a Master of International Public Health from the University of Sydney and is a qualified breastfeeding peer supporter. She has combined motherwork with various grassroots volunteer roles and writes about breastfeeding and matricentric feminism at: www.fullcreamweb.blog.

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