Why is contemporary American society so profoundly invested in breastfeeding? In many ways, Lactivism is a standard work of critical social theory. Whereas breastfeeding is the relatively straightforward practice of nursing an infant at the breast, lactivism is an ideology. It's a set of ideas, held in common especially by members of certain social circles, with the power to guide people's understanding, action, and judgment. The book exposes the existence of an ideology around breastfeeding, traces its roots and emergence, demonstrates how it has taken hold in our society, and shows how it works to shore up and entrench many of the prejudices and hierarchies that already structure American social life.

Of course, as Htun points out, breastfeeding does not have to lead to lactivism. Breastfeeding is as old as humankind, whereas lactivism has crept up on us in the last decade or so. Lactivism is not breastfeeding, but it derives from two commonly held beliefs about breastfeeding. The first is that breastfeeding is crucial to child health and development; the second is that “all women can breastfeed.” Held together, these twin convictions lead almost inevitably to the verdict that all women should breastfeed, and that women who don’t breastfeed are bad parents. That, in a nutshell, is lactivism.

I devote a chapter to evaluating the medical research that supports these convictions. The evidence that breastfed children are healthier is mostly weak and inconclusive. It may make a difference at the margins, especially when it comes to infections, but it probably doesn’t have much impact on most other outcomes. Experts estimate that about 15% of women cannot breastfeed, for a wide range of reasons.

This is where critical theory comes in. If lactivism is not driven by scientific evidence, then where does it come from, and why is it so powerful in contemporary social life? As Htun points out, Lactivism tells a familiar story about society’s interest in regulating women’s bodies and bodily functions. Although breastfeeding has been embraced by many feminists, an imperative to breastfeed that eliminates a mother’s choice is hardly liberating. As lactivism takes hold in our collective consciousness, it performs the role of the panopticon, practically eliminating the need for a watchman as women discipline themselves—and each other. If good parenting necessarily involves breastfeeding, lactivism also polices the boundaries of gender, and sexuality.

Surprisingly, though, lactivism also works to shore up the hierarchies of race and class that structure American life. In the U.S., breastfeeding statistics that are routinely recorded according to race and socio-economic status show that wealthy and middle class white women have the highest rates of breastfeeding. Those statistics justify a range of interventions—which I catalogue in my book—specifically aimed at changing the infant feeding choices of women who are African American, or poor. Against a backdrop in which breastfeeding is equated with good parenting, those statistics also reinforce insidious tropes about the “pathology” of black families, in circulation since at least the Moynihan Report.

Htun claims that I hold breastfeeding “accountable for workplace harassment, public insults, and women’s disadvantaged position in the labor market,” and that I imply that “that if lactivists stopped forcing women to breastfeed, these conditions would improve.” That is a wrong-headed argument, and she is right to remind me to be clear that it is not the one I make in the book. For the record, breastfeeding is also not responsible for racism, or for enduring class inequality. But just because lactivism has not caused those problems, doesn’t mean it isn’t constituted by them. Htun and I agree that lactivism’s consequences exist in a broader cultural (and political, and economic) context.

Nevertheless, there are still important differences between us. I took up breastfeeding without much thought, as a way to feed my babies. If it hadn’t worked, I would have switched to formula, fast. I don’t believe breastfeeding made my children smarter or healthier, or that it produced a stronger attachment between us. Although breastfeeding may teach us that being a parent is unpredictable and demands patience, I think most parents learn those lessons, even if they don’t breastfeed.

Htun concludes by calling on women to take up breastfeeding as a weapon against misogyny, in order to challenge the masculinist workplace and public sphere. Here she proposes that, even though lactivism doesn’t cause misogyny, it may help to eliminate it. In fact, however, lactivists have been instrumental in adapting breastfeeding to the masculinist workplace, by embracing breast pumps and regulations that allow women to pump breast milk at work during unpaid breaks. In collusion with corporate and government interests, lactivists propagate the idea that human milk is “liquid gold,” a valuable commodity that supports not only the $1.2 billion pump market, but a burgeoning market in human milk. As Htun points out, pumps can be convenient, but pumping three or four times a day on the job, during unpaid breaks, so that someone else can feed our babies breast milk from a bottle, adds enormously to the burden of working mothers. While there is nothing inherently anti-feminist about breastfeeding, lactivists have advanced the cause of breast milk not only against the interests of children, as Htun notes, but against the interests of the women who produce it.

The call to take up our breasts, so to speak, in the fight against sexism, is one that appeals to many women. We now read routinely about nurse-ins to protest against stores and restaurants that have policies against nursing in public. It’s my sense that they have been successful at raising awareness about laws that allow women to breastfeed in public, which makes breastfeeding a lot easier. But it is also true that this type of activism has been embraced primarily by middle and upper middle class white women, and that it does not necessarily speak to the issues that concern women outside that demographic. Not only that, but more than one third of women will never breastfeed. Feminists have learned before the dangers of deploying essentialized conceptions of womanhood, that divide and exclude many women, in the fight for women’s rights. As we were reminded painfully on November 8, it’s going to be a longer battle than we realized. We’re going to need all the solidarity we can muster.