Helping women with their milk and the cruelty of the pure

Lactation non-profits and a purity of mission

The lactation non-profits around the English-speaking world, which aim to help a woman breastfeed her baby, remain in the thrall of deeply rooted Western beliefs about the purity and rightness of breastfeeding. These beliefs are entangled with damaging ideas of maternal naturalness and buried in the structural orientations of lactation non-profits, most particularly in rigid or over-extended interpretations of the WHO International Code of Marketing of Breast-milk Substitutions. (This outdated ideological orientation remains the case, I argue, despite the lactation non-profits use of progressive and inclusive terms such as breast/chestfeeding and breastfeeding person.)

Belief in maternal naturalness fuelled the sentimentalisation of Motherhood in the emergent 19th century Western Europe middle class – a 'naturalness' which served the patriarchal social order and which social scientists and feminist philosophers have spent decades deconstructing. It’s a naturalness that never really existed from an evolutionary perspective, given the highly social nature of infant care in pre-industrial societies, the diversity of infant care practices world wide, and the profound entanglement of biology and culture which uniquely characterises our most extraordinary of species, Homo sapiens.

My early research focussed on unsettled infants. By the 2000s, I was still reeling from the infant gastro-oesophageal reflux epidemic which had started in my home city in the early 1990s then spread down south and around the world, right before my GP-IBCLC eyes. I had formed the view that we would only improve breastfeeding rates if we integrated management of breastfeeding problems with management of unsettled infant behaviour, since so many breastfeeding problems were misdiagnosed as signs of infant GORD or allergy. At the International Infant Cry Research Workshops I attended in those years, I was viewed as an oddity, an anomaly (and, to be frank, an irrelevance). One of the most senior infant cry researchers in the world at that time, with whom I'd struck up a friendship, told me this over a glass of wine at the table with his wife late one evening after one of the workshops, in their elegant home outside London. Don't come any more, he said to my face, trying to be kind, you really don't belong. Mine were the first publications which drew on the research to propose a multi-domain approach to clinical management of unsettled infants and breastfeeding problems, at both a local and international level.

When I wrote that last sentence I'd put in a parenthesis: mine were the first publications (if modest and low impact) - and then I pulled myself up. Cover articles in both the BMJ and Archives of Disease in Childhood in the same year are not low impact, I remind myself. They actually changed clinical practice, and there were others of mine like that, too. And instantly, on changing the sentence, I hear the old voices in my own head which warn against boasting, which shout out 'imposter'!

Maybe I have been excluded from belonging to BMNANZ, too, because my lactation medicine colleagues think me guilty of hubris, or worse, narcissism? I stopped submitting to Australian journals and only published internationally when an anonymous Australian lactation medicine doctor reviewer – a gatekeeper for years on what can get through concerning education of GPs in breastfeeding management in Australia - labelled the gestalt method of fit and hold ‘divisive’. Divisive? There is the permissible, and the impermissible, in science-based considerations of fit and hold? To introduce something new is divisive?

But an unfunded independent clinical primary care researcher publishing reviews which propose paradigm shift can't hold her ground against big university research teams.

It's true that my efforts to include the field of unsettled infant behaviour as part of lactation medicine, and the inclusion of lactation medicine in considerations of unsettled infant behaviour, was a radical reframe, and seemed to be a reason for incomprehension by my breastfeeding medicine colleagues back then in the 2000s and 2010s, of whom there were only two or three publishing in Australia. It seemed clear that they didn’t agree my work on unsettled infant behaviour was before all else about breastfeeding. I remember how disheartening attempts to discuss this with one of these medical colleagues was for me, back then: her incomprehension and lack of interest, sitting there in a foyer at a conference as I tried to explain.

Lactation non-profits and authoritative knowledge or rightness

Lactation non-profits and their leaders remain structurally embedded in a historical purity, a certain righteousness. A tone of authoritative knowledge or rightness or definiteness widely characterises lactation medicine and clinical breastfeeding and lactation education and support. Those who stand outside the world of lactation medicine often comment to me on this when they hear of my special interest in breastfeeding. Those inside just think this is how you educate, or how you evoke confidence in your colleagues and in women. The well-known American lactation medicine doctor Professor Alison Stuebe once commented in an email that perhaps we’ve spent so long defending breastfeeding from detractors that we’ve normalised a strident tone. I'm not convinced. That strident tone mirrors the tone of the medical patriarchs in my training and early days of medical practice, and is a tone that Australian general practice is increasingly abandoning.

I watch the next generations of GPs stand with humility before the great unknowns in the way they educate, stand with humility before the complexities of our patients’ stories. This old-fashioned, authoritative, medicalised tone is adopted in lactation medicine even as theoretical models are being taught as scientific or clinical facts, since clinical breastfeeding and lactation support remains a research frontier. Someone like me, who might ask questions and dissent out of my knowledge of the research, risks judgement and exclusion as a trouble-maker. The world of lactation medicine is frightened of dissent, or at least wants to control who can and can't dissent.

Lactation medicine is still emerging out of the reductionist mindset that has characterised medical practice in industrialised societies: a mechanistic perspective that fails to take into account embodiment, or the intimate mind-body connection fundamental to the human condition. For this reason, although you’d also think it was fundamental, mechanosensing (the way mechanical forces act upon living cells and tissues) is still ignored in breastfeeding medicine, and yet is radically foundational in my own work across multiple areas of breastfeeding management.

When the European Academy of Breastfeeding Medicine invited me to talk in 2023 about my reframes of mastitis and its management using mechanosensing as a foundational theoretical model (publications which are linked with my work on nipple pain, too), the organisers explained that they were arranging the panel to avoid direct discussion or argument amongst the panellists. I’m grateful that the EABM invited me. At the time IBLCE was communicating to conference organisers in various countries who’d reached out to me that I was in violation of the WHO Code, so that multiple invitations were then withdrawn. The EABM did not seem to be intimidated by this, confident their conference would succeed even if some presenters like myself, an outsider, or the esteemed Professor Thomas Hale, highly respected within lactation medicine circles, weren’t able to be attributed CERPs. This demonstrated to me how narrowly my Asia Pacific colleagues choose to interpret alleged violations of the WHO Code, how selectively the sanctions are applied - and weoponised, if unconsciously.

Dissent, respectful disagreement, debate, is utterly fundamental to the evolution of science. Dissent and debate is at the creative edge of scientific and clinical advance. The flattening or silencing of dissent and disagreement helps explain why so much of the clinical support breastfeeding women receive doesn’t help, at a time when collective scientific and clinical knowledge is most fields of health are in stunning global acceleration. It helps explain the rapid rise in overmedicalisation, paramedicalisation, and overtreatments of breastfeeding women and their babies, with all the attendant risks of other unintended outcomes (documented in the research and which I see, over and over, in the clinic).

Historical perspective-taking helps us understand why lactation non-profits operate structurally from the righteo belief, not supported by the evidence in high income countries, that predatory marketing practices of formula companies are the main cause of breastfeeding problems. I have even heard Australian doctors claim recently that the allergy diagnosis was driven by formula companies – again, a misrepresentation which compensates for government failure to invest in lactation research and milk banks, and for lactation non-profits' failure to engage with (those awkward, uncomfortable, disruptive) voices of dissent.

Calling for change

There’s something cruel about purity.

There’s something cruel about excluding women (it is mostly women researchers and educators who are affected) from educating alongside colleagues in a field that they are passionate about, in which they are courageously attempting to make a contribution – at the same time as their work is extracted without appropriate acknowledgement and often without recognition of where the work even comes from since this has been going on for so many years.

There’s something cruel about excluding women who decide, in the face of shocking nipple pain or damage, in the face of the exhaustion of long-term triple feeding (that’s direct breastfeeding, pumping, then bottle feeding routines) and baby weight gain concerns, in the face of a little one who fusses endlessly at the breast, that they need to use formula.

This is the cruelty to the pure.

Related resources

Possums Breastfeeding & Lactation articles which address lactation non-profits, ideology, and harm

Selected references

Azad MB, C NN, Bode L. Breastfeeding and the origins of health: interdisciplinary perspectives and priorities. Maternal and Child Nutrition. 2020;17:e13109.

Chetwynd E. From censorship to conversation: agnotology, market influence, and the ethics of breastfeeding research. Journal of Human Lactation. 2025;4(3):303-305.

Chetwynd E. The 4-year question: optics, ethical clarity, and the future of lactation research in times of upheaval. Journal of Human Lactation. 2025;41(4):451-453 doi:410.1177/08903344251387116.

Frances, Nic & Cuskelly, Mary Rose. The end of charity: time for social enterprise. Allen & Unwin 2008.

Kendall-Tackett K. Have we returned to the Dark Ages: Excommunication and its chilling effect on science. Clinical Lactation. 2020;November:DOI: 10.1891/CLINLACT-D-1820-00024.