What sociocultural or health system factors drive the increasing medicalisation and paramedicalisation of common infant care and breastfeeding problems?

"Public health problems without easy solutions are fertile ground for large-scale over-activity in primary care.” Treadwell & McCartney 2016

"Driven by commercialism, direct-to-consumer advertising, and the pursuit of perfect health — a culture of “more is better” — modern medicine has fostered a culture of overdiagnosis and overtreatment. To avoid this harmful approach, clinicians should remain alert to commercial and social influences and practice shared decision-making, balancing patient values with evidence-based disease thresholds." Tikkinen 2025

“Continuously expanding disease criteria can reduce underdiagnosis and increase appropriate care, but often risk over-diagnosis, resulting in overtreatment and low-value care, ultimately threatening health care sustainability.” Tikkenen 2025

Overmedicalisation, paramedicalisation and overtreatment are multi-faceted health system problems

Overmedicalisation, paramedicalisation, and overtreatment are complex and multi-faceted problems, with multiple drivers.8 The following key factors underlie medicalisation and paramedicalisation of common breastfeeding and unsettled infant behaviour problems, in what I judge to be in order of significance, at least in my experience in Australia. As in any complex system, these factors interact together and influence each other.

1. Lack of multi-component, community-based clinical programs developed using principles of implementation science

“Research on de-implementation of low value care has shown that multicomponent interventions hold the greatest potential for success.” Brownlee14 Armstrong?

The proliferation of low value care for breastfeeding and unsettled infant problems results, before all else, from a relative lack of alternative, effective management strategies. Paramedicalised overtreatment can be conceptualised as a backlash against the reductionist or biomedical lenses which have failed to adequately acknowledge the complexity of breastfeeding and unsettled infant problems, and just how profoundly they impact perinatal and infant mental health and family wellbeing.

For example, using a neuroprotective developmental care (NDC) lens, fussy behaviour at the breast is usually either an infant’s way of communicating motoric positional instability or a conditioned hyperarousal at the breast. But fussy behaviour at the breast is regularly inappropriately medicalised (as allergy, reflux, lactose intolerance) or paramedicalised (as neuromuscular sucking and tongue movement deficits secondary to cervical spine subluxations and fascial tightness), resulting in treatments which lack biological plausibility, lack an evidence-base, and constitute low value care.

Relatively little funding is available for community-based, multi-component clinical research

“A major barrier to reforming low-value care is that we have a rigid and only slowly moving mechanism for funding new initiatives, which prevents us from implementing new evidence-based care pathways.”15

There is a relative lack of funding for research into complex primary-care health problems which require, firstly, the development of solid theoretical frames; secondly, translation of these models into multi-lateral clinical strategies; and thirdly, evaluation.

1. Historical lack of research investment in clinical breastfeeding and lactation support, which remains a research frontier.23

2. Dominance of medicalised and first wave behavioural lenses through which research is conducted into clinical support for families with unsettled infants.

3. Dominance of tertiary based and non-generalist medical specialist based research into efficacy of interventions, which has been demonstrated in the UK to only poorly translate into effective community-based care. When there is funding, the research often focusses on a single element or intervention, applying a reductionist or biomedical lens (often preferred by hospital-based or non-generalist medical specialists), ignoring the multiple interacting factors or confounders (more often embraced by generalist doctors and primary care practitioners). This may be why, in the UK, university or hospital-based innovation has been shown to not translate into effective community-based care.

4. Historical lack of coordinated research funding for women’s health issues, clinical breastfeeding support, and non-medical interventions into clinical interventions for breastfeeding problems, combined with lack of allocation of research funding for primary care initiatives. Breastfeeding problems and unsettled infant behaviour are complex presentations, requiring complex, multi-lateral interventions. The medical profession has historically dismissed breastfeeding and cry-fuss problems as of low significance. This historical blind spot has been associated with a lack of research funding to investigate effective, community-based clinical approaches for breastfeeding and unsettled infant problems.

2. Services are increasingly shaped by corporate or business interests, in the absence of political will for investment in long-term health system reform

Commercial powers increasingly penetrate and drive health systems in the absence of political appetite or vision for genuine health system reform. In fee for service health care systems, reimbursement structures drive overmedicalisation, including because of clinician desire to keep patients in their care rather than have patient go elsewhere. Financial incentives reward healthcare overactivity and paramedicalisation.6 Overtreatment is higher when customers are insured and do not bear the residual cost of the recommended service.16

The descriptor “evidence-based” has been co-opted for commercial purposes. Methodologically poor studies are cited to claim ‘evidence-based’, by providers and single-issue breastfeeding support non-profits who are not properly trained to critique research methodologies.

Overtreatment is driven by benevolent provider moral hazard, which occurs when providers do not bear the financial consequences of their treatment recommendations,16 even though they may be a “benevolent provider” who is not driven by profit-making motives themselves. Lagarde et al 2022 hypothesise that provider moral hazard may also be heightened when patients are insured, since the provider knows that patients don’t need to pay or pay less for their treatment when insured.16

In Australia, primary health care is built from a poorly regulated small business model, which supports the proliferation of low value care. Private health care providers are incentivised to fund paramedicalisation and low value care.

Ideological commitment to provision of multi-disciplinary treatments for management of common infant care problems

Multi-disciplinarity is assumed to optimise infant outcomes. In the absence of effective interventions provided by a single primary health care provider, multiple consultations with various providers over long periods of time are implemented, without evidence of benefits and with high associated costs, either to the health system or the family. Although there are many benefits to co-ordinated multi-disciplinarity in the management of chronic disease, the concept has been co-opted in management of breastfeeding and unsettled infant behaviour, as a substitute for effective, multi-component clinical interventions which can usually be delivered by a single clinician who offers holistic primary health care.

3. Commercially driven continuing professional education, based upon speaker popularity rather than research-based credibility, accompanies inadequate tertiary health professional training in clinical lactation support

Health professionals consistently report lack of training in fields of breastfeeding and unsettled infant behaviour. Health professional continuing education in breastfeeding and infant care is driven by private sector conferences and interests, and by breastfeeding non-profits who use the goodwill generated by their non-profit status to silence competitors, applying commercial levers for the financial or reputational benefit or their staff, Board Members, and educators . Private businesses or non-profit organisations which also required to operate as businesses determine what the professional education provided in the field of clinical breastfeeding support.

4. Health professional cognitive bias

Amongst a range of cognitive biases which predispose to low value care decisions, Scott discusses group biases include groupthink and bandwagon effects, where the homogenous views of a closely knit group, often led by influential individuals with authority or charisma, discourage or dismiss opposing views about the limited value of an intervention.17 This problem is particularly prominent in single-issue breastfeeding support organisations. Meta-cognition, or thinking about thinking, is not integrated into health professional educational forums.17

5. Patient expectation

Paediatricians and paediatric registrars report that perceived expectations from family and patients were the most significant driver for medical overactivity. Factors include patients' intolerance of uncertainty patients; patient belief that more care is better; great public enthusiasm in general for more treatments.13 In the field of parent-infant care, one contributory explanatory factor is parental occupational fatigue, exacerbated by the specific sociocultural demands of modern parenting. Research indicates that Finnish parents, for example, are among the most exhausted globally. A recent survey by the Finnish Federation for Family Care revealed that over one-third (36%) of parents in infant families report being frequently or constantly exhausted.19 In studies exploring parental fatigue key contributing factors include performance orientation, the intensity of modern parenting, and the individualistic nature of society.

6. Online information and social media

Internet is changing balance of knowledge between doctors and patients. Research their symptoms and different options (including less conventional approaches). In a study of social media posts about five popular medical tests, most posts were misleading or failed to mention important harms, including overdiagnosis or overuse, demonstrating a need for stronger regulation of misleading healthcare information on social media. 18,19

Greenhalgh et al 2014 have argued that although evidence-based medicine has had many benefits, it has also had negative unintended consequences. The term ‘evidence-base’ is now a powerful marketing tool. Small businesses caring for parents and infants promote their services to parents as ‘evidence-based’, without knowledge about what that might mean.

7. Blacklisting of leading breastfeeding and human milk researchers from education of IBCLCs and breastfeeding medicine doctors

Signfiicant skewing of research-based education available to breastfeeding medicine doctors and International Board Certified Lactation Consultants has occurred over the past decade, due to ideologically-driven blacklisting by lactation non-profits of large numbers of the world's leading lactation and human milk researchers and educators.

Exclusion of genuinely research-based education from lactation medicine and IBCLC education (and the debate and discussion that accompanies it) has enabled the flourishing of overmedicalisation, paramedicalisation, and low value care in the field of breastfeeding medicine internationally. This profoundly silenced problem is dealt with elsewhere.24-26

Related resources

The International Board of Lactation Consultant Examiners pulls commercial levers to 'cancel' the Possums (or NDC) programs' genuinely research-based lactation education

Case study: 'cancelling' an evidence-based primary care innovation which offers alternatives to low value care for management of breastfeeding problems and unsettled infant behaviour

Groundbreaking research is 'cancelled' by single-issue breastfeeding non-profits

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