Most cultures are fixated on women’s bodies and the things those bodies do. ^{Footnote 1} We subject them to strict personal status laws; commercialize and sensationalize them in film, advertising, and the internet; and regulate their rhythms and treat their failures with medicines and surgeries. The desire to improve women’s lives is only one motivation driving such activity. All too often, the codified laws, social norms, and dominant discourses that inform how women perceive, and how others treat, their bodies serve other agendas. States, religious groups, capitalist enterprises, and social movements frequently use women’s bodies as instruments to support the glory of the nation, the expansion of state power, the growth of profit, and the honor of a particular family.

Even breastfeeding, one of the ways that women’s bodies have sustained the human race, has been coopted. As Courtney Jung shows in her terrific new book called Lactivism, breastfeeding in the contemporary United States has been captured by diverse constituencies including the Christian Right, environmentalists, feminists, experts working in public health and global development, the government, and for-profit corporations. Thanks to these groups, breastfeeding has come to mean much more than merely holding an infant to suckle at your breast. Today, it is an indicator of class status, evidence-based parenting, and a “moral marker” to identify good parents and punish bad ones. Jung argues that these trends shame women and limit their choices.

Lactivism is directed at a large audience. It is brilliantly written, insightfully argued, and often hilarious. Jung draws on historical narratives, interviews with key figures, government documents, medical research, and her own life experiences to expose the passions, hypocrisy, sexism, and denial that runs through national discourse on breastfeeding.

Jung explains that she is not against breastfeeding (indeed, she testifies that she breastfed both of her children for years, and that it was easy for her). Rather, she opposes the zealotry of “lactivism.” Lactivism, which includes “compulsory breastfeeding” and “breastfeeding as a moral crusade” (p. 7), has come to characterize much of breastfeeding advocacy. Lactivists, who believe that “breastfeeding is the best choice for everyone,” have bolstered racial and class hierarchies in the contemporary United States and have legitimized coercive interventions into the lives of poor and minority women (p. 209).

The consensus around breastfeeding is less than a generation old. Most people born in the 1960s and 1970s, like I was, were fed by formula. It was seen as the “modern” and “scientific” thing to do. But today, people who otherwise disagree about almost everything come together to endorse breastfeeding. Jung remarks that “for feminists it is an act of female empowerment; for Christians a symbol of womanly submission; for yuppies an affirmation of class status; and for hipsters a way to reduce the carbon footprint” (p. 71).

She observes that Americans across the political spectrum love breastfeeding so much, that “to be against [it] is almost sacrilegious” (p. 50).

Jung is concerned that many of us are forced to breastfeed, and that we beat ourselves up trying to do it, even when we aren’t good at breastfeeding or when circumstances make it difficult. She claims that we have been intimidated by pamphlets, websites, and advice from doctors and nurses, all of which exaggerate the “proven” benefits of breastfeeding on a range of diseases, conditions, and characteristics (like IQ). These medical studies, Jung contends, are frequently deployed to justify “heavy-handed policies” to promote breastfeeding.

For middle- and upper-class women, it is one thing to suffer public criticism and personal torment once the formula and the bottle come out: usually, we can just turn away, or compensate our babies by reading them an extra story that night. But for disadvantaged women, punishment for not breastfeeding is more pernicious, for it can affect the shape of our welfare benefits and our relationship with government personnel. Jung blasts guidelines of the U.S. government’s Supplemental Nutrition Program for Women, Infants, and Children (WIC), which offer breastfeeding mothers “enhanced food packages” denied to non-breastfeeders, and allow them to stay on the program for a longer period of time. ^{Footnote 2} Breastfeeding campaigns focusing on African-American women, she reports, have the effect of reinforcing racial stereotypes and the idea that white people make better parents.

Many women who have felt like failures because breastfeeding was difficult for them, or because they had to stop earlier than they had hoped, have been grateful for Jung’s book. By questioning the scientific and ethical basis of lactivism, she has legitimized these women’s own struggles and choices. But the important question is: Is it breastfeeding per se that inspires efforts to demean and criticize women? Or is breastfeeding merely a tool, in the context of sustained gender inequality, that groups use to put women in their place? More on this later.

Lactivism charts the important but largely unacknowledged shift from breastfeeding to breast pumping. In the contemporary United States, breastfeeding no longer means holding a baby to nurse at your breast. Rather, it has come to mean pumping milk from your breast and storing it, so that another person can feed it to your baby from a bottle. Though we lack precise data on the prevalence of this form of breastfeeding (which we should more accurately call breastmilk feeding), Jung argues that it amounts to a large share of the practice today.

The push for breastmilk feeding is state-sponsored. The Affordable Care Act (ACA) revised U.S. labor law to require employers to give women break time and space to pump milk during their child’s first 12 months (but also contained numerous accommodations to employers; see p. 136). Later, the ACA required health insurance plans and Medicaid to cover the cost of breast pumps and accessories. Noting that “the US government’s initiatives to promote breastfeeding have focused almost exclusively on breast pumping,” Jung observes that pumping constitutes a uniquely American method of breastfeeding. In no other culture, “do women use breast pumps as much as they do in the United States.”

For some feminists, the pump advances gender equality. Nothing poses more of a challenge to liberal notions of equality than pregnancy and breastfeeding, since only women can do these things. Like the birth control pill, the pump offers women greater control over their bodily functions. Like hiring a nanny or paying a day care center, the pump enables women to subcontract reproductive labor.

Jung argues that the pump’s availability helps deflect demands for publicly-paid and longer parental leave. If the benefits of breastfeeding can be gained by women pumping at work, why do employers need to give women time off to be with their babies? If nannies and day care workers can feed babies pumped milk, who needs parental leave? Pumps enable women to get back to work right away while minimizing guilt and entertaining the belief that they are still benefiting their babies by breastmilk feeding.

In her recent work, Nancy Fraser contends that the spread of the pump may reflect (and contribute to) a broader crisis of social reproduction. ^{Footnote 3} Certainly, the pump signals a marginalization and alienation from these processes: it separates women, bodily and geographically, from their breast-milk dependent infants. The pump also supports a social order that continues to hide and devalue the work of caregiving. Instead of helping women to combine caregiving with paid work through publicly financed parental leave and flexible working hours, U.S. policymakers support breast pumping.

The pump has upsides too: it helps women and babies in crisis circumstances. When my third child was in the NICU and unable to take any food by mouth, I pumped for the first two weeks of her life. She took my colostrum and milk through a repogle descending the length of her reconstructed esophagus. Pumping exclusively was hard work. But I was glad to do it: lactating, even with a machine, helped me feel less alienated as a mother, and helped set up a good breastfeeding relationship with my daughter later on.

In her most powerful indictment of extremist lactivists, Jung reveals that the desire to promote breastfeeding led organizations such as La Leche League, the World Health Organization, and UNICEF to withhold information that HIV could be transmitted from mothers to infants through breast milk. Having won a prolonged battle against Nestlé and other formula companies, and having convinced international organizations to recommend breastfeeding as a matter of policy, lactivists were reluctant to jeopardize these gains by admitting the connection between breastfeeding and HIV. On the contrary, as evidence mounted in the 1980s and early 1990s, UNICEF and WHO continued to insist that breastfeeding carried a low risk, and to recommend it regardless of a mother’s HIV status. This unstinting lactivism aroused scattered protests by sub-Saharan activists, some of whom accused global health officials of inflicting a double standard on mothers and babies from the Global South. Not until 1998, Jung reports, did world health organizations change course and acknowledge that, to eliminate the risk of transmission, HIV positive mothers should feed their babies with breast milk replacements (p. 187).

La Leche League’s response to the WHO policy undermined the group’s credibility. Inspired by a Canadian AIDS denialist, La Leche co-founder Marian Tompson formed a non-profit organization to question the science linking breast feeding and HIV transmission. Tompson’s new NGO received the blessing of other La Leche founders, according to the group’s spokesperson (p. 193). Jung concludes that the group ended up prioritizing breastfeeding over the very lives of the babies they had sworn to protect (p. 200).

Jung does a terrific job identifying the dangers of lactivism. While she claims to oppose lactivism and not breastfeeding, the text tends to conflate lactivism as social movement and political position with the humanly practice of breastfeeding. Perhaps as a consequence, Jung has a tendency to blame breastfeeding for trends and experiences that have other causes. In one section, Jung tells the story of a glass factory worker who suffered harassment, insults, and intimidation at work because of her determination to pump milk for her infant (pp. 137–138). Yet later in the book, rather than condemn the misogyny motivating this treatment, Jung lists “ribbing, harassment, and discrimination” as yet another “less tangible cost” of breastfeeding (p. 208). Other stories include women who felt like failures because they couldn’t breastfeed, or women who were insulted in public due to a perception that they weren’t breastfeeding. Rather than attributing such episodes to lactivism, sexism, or competitive parenting, she singles out breastfeeding: “experiences such as Maya’s offer a glimpse of the zealotry and social shaming that breastfeeding sometimes elicits—and, sometimes, even encourages” (p. 98). Finally, at the end of the book, Jung laments that women who conform to societal pressure to breastfeed for six months “pay a significant price … [including] giving up jobs and careers that will be very hard to re-enter years later” (p. 208).

By holding breastfeeding—or even lactivism—accountable for workplace harassment, public insults, and women’s disadvantaged position in the labor market, Jung mischaracterizes the source of the problem. She implies that if lactivists stopped forcing women to breastfeed, these conditions would improve. Yet the end of breastfeeding would do almost nothing to combat the big problems alluded to by Jung, which include enduring sexism in the workplace and other organizations, the neglect of families by U.S. public policy, and the ways that groups in all cultures have manipulated the meanings of women’s bodies as weapons in other struggles, and gotten away with it.

At times, Jung runs the risk of abandoning breastfeeding to the same dustbin of history as the racist, classist, and sexist agendas she divulges. This would be a mistake. Breastfeeding does not have to be “a substitute for maternity leave” (p. 210); rather, it complements the extended parental leave, high-quality child care, health care, and other family supports necessary to reverse the trend toward greater class inequality in this country. Breastfeeding is not just “the particular infant feeding practices of one privileged demographic” (p. 22), but the way humans survived for millennia, and even today an important way to teach people that being a parent requires relinquishing control, demands patience, attentiveness to a child’s needs, and is unpredictable.

Lactivism’s consequences must be seen within the broader cultural context. In a society characterized by pervasive gender inequality, the things women do—including breastfeeding but also walking, earning money, speaking up, or standing out—are held to a double standard. The righteousness of public debate over breastfeeding, in which the pain, joy, ambivalence, confusion, and fear experienced by actual women occupies only a marginal place, is a symptom of women’s relatively precarious position. Can we imagine an equally impassioned and entitled examination of men’s urination? Salivation? Sweating? Ejaculation? We should contemplate the background conditions that enable scientists, feminists, Christians, environmentalists, and capitalists to use breastfeeding—and the women and infant bodies involved—as instruments to promote their agendas.

Jung’s outstanding book demonstrates how breastfeeding, in a context of gender inequality, can be pitted against women’s interests. The solution to this predicament is not to reject breastfeeding. Rather, it is to build political will and public support for policy changes to make breastfeeding—and whatever else women need to do to take care of their children—compatible with working to support a family and ascending to positions of public leadership. Women should not have to conform to the rules of the masculinist workplace; rather, we should change these rules. Breastfeeding can serve as a crucial reminder of the ties of human dependency that enmesh us all, ties that merit greater recognition and protection in the public sphere. Breastfeeding doesn’t need to lead to lactivism.