“Breastfeeding: Supporting Women vs. Lactivism” – with Courtney Jung PART 1

Courtney Jung and Dr. Fox discuss the potential downsides of breastfeeding advocacy and the fine line between promoting breastfeeding and shaming women who can’t breastfeed. They also discuss choice regarding breastfeeding and how race and class factor in.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, I’m really excited to be joined today by Professor Courtney Jung, who is a Ph.D. and a professor of political science at the University of Toronto, our neighbors up north. You did, it looks like most of your education in the U.S., including your Ph.D. from Yale and you are the author of the book “Lactivism: How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy.” Dr. Jung, thank you so much for coming on. I really appreciate it. 


Prof. Jung: Oh, it’s a pleasure. Nice to meet you. 


Dr. Fox: Nice to meet you, too. So, yes, we’ve never met. I cold-called Courtney saying, “Hey, I read your book. I love your book. Can you please come on the podcast?” And you were gracious enough to agree to do so. How’s life up in Canada? How are you doing over there? 


Prof. Jung: Life in Canada, you know, it’s peaceful. It’s easy. Living the dream up here. I’m from New York, so it’s different but… 


Dr. Fox: It is different. 


Prof. Jung: …it’s fun. We’re weathering the pandemic a lot better up here than we are in the U.S., unfortunately. 


Dr. Fox: People will say there’s a lot of things going on better up there than in the U.S., but that’s okay. I’m originally from the Midwest, I’m from Chicago and I always found that for whatever reason Canadians and particularly people from Toronto and Chicagoans had a real strong kinship. There’s something, like, similar about those two places. And I don’t really know why, maybe it’s just a little more relaxed or laid back, that could be it, compared to New York, certainly. 


Prof. Jung: Well, yeah. Moving here from New York, I did find Toronto had much more of a Midwestern vibe than I realized. I didn’t really realize how far west Toronto is. I mean, it’s actually really close to Detroit. 


Dr. Fox: Yeah, yeah, absolutely. When we used to, yeah, you can…to go to Toronto, you basically drive to Detroit and turn left. And you end up in Toronto, at least from Chicago. If you’re from New York, you’d have to turn right, for those of you who are geographically not inclined. So, how does a professor of political science enter the world of writing about breastfeeding? 


Pro. Jung: Well, the first thing she does is she gets pregnant and has a baby. And then everyone starts to talk to her about breastfeeding. So, that’s really how it happened to me, it was a very personal digression. I guess the first thing that happened, the first thing that made me think, “Oh, this is weird,” was I was pregnant and I was in New York, and I happened to be at a party. And a woman who I didn’t know very well sort of made a beeline toward me. And it turned out she had just become affiliated with La Leche League in some capacity, I don’t remember what. But she started talking to me, she realized I was pregnant so she started talking to me about the importance of breastfeeding. She was going on and on, I was sort of backing up and she was advancing. And then at some point in her, sort of, you know, explanation of why it was so important that I breastfeed, she started talking about how awful it was that so many black and poor people were not breastfeeding and were, you know, not doing right by their children. 


And I had spent, you know, the last sort of 15 years before that, mostly writing about race and class and racism. And so, I immediately was sort of focused on the ways in which she was using breastfeeding as a way of disparaging the parenting practices of people who were not white like she and I were. And so, that was my first sort of moment of thinking, wow, breastfeeding is doing this kind of racial boundary work in the United States. And that’s what really sort of grabbed my attention. And that was before my first child was born. I did not write the book then, I kept on thinking, “I need to write a book like this,” but I was writing another book at the time, so I didn’t have time. And then I had my second child and after he was born, I was like, all right, breastfeeding advocacy, I found had only grown more extreme in the time between when my first and second children were born. And so then I thought, “Okay, now I really have to write this book.” 


And then once I started looking into it, every time anybody would ask me about the book, I would say, “This book is writing itself. It’s unbelievable what I’m finding.” It was pouring out, you know, it was incredible. So, yeah, it really was. I mean, I’ve written two books before, but this book I wrote so quickly. And as I said, you know, it wrote itself because the evidence and the interesting stuff I found was just constant. 


Dr. Fox: Was this done sort of as a part of your work in political science or a totally, like, side hobby that had nothing to do with your, you know, “academic pursuits:”? How did you integrate that? 


Prof. Jung: Yeah, yes and no. I would say there’s a lot of politics in the book, I would definitely say that my training as a political scientist, you know, the things I saw about how breastfeeding became part of, you know, people’s identities and sort of stood in for who they were and what they believed in. Those are very sort of political sciency kind of ideas. The links between breastfeeding and race and class, and then, you know, policymaking around breastfeeding. All of that is sort of straightforward political science. But of course, there was a lot of stuff in the book, you know, like an entire chapter on the medical research on breastfeeding that is not actually the kind of stuff political scientists do. So, I guess I would say it was a departure, it was an absolute departure for me in terms of kind of research and things I work on, and also the fact, you know, that it was not a book that was published by an academic press. So, you know, the publishing process for a non-academic book is just completely, completely different from the process for an academic book. I had to get an agent, for example. 


Dr. Fox: Okay. And in your current teaching and research and mentoring, it’s not related to this topic, correct? 


Prof. Jung: That’s right. I have graduate students, you know, who I’m supervising, none of whom are writing on politics of breastfeeding. 


Dr. Fox: Right. It’s so interesting. There’s another professor who’s been on this podcast several times, her name is Emily Oster. I guess if you read her books, or her articles, it’s almost like the exact same story. So, she’s a professor of economics, has nothing to do with, you know, this world and then she got pregnant, and her doctors are giving her this advice and she’s reading about it. And she’s like, “This data just seems off.” And she’s, her expertise is in data analysis. And so, she starts pulling all the data and decides this book is writing itself. It’s almost the exact same story, obviously, in a different, you know, angle or a different part of pregnancy. But it’s the same thing, you know, she’s an academic, and she teaches economics and data and, you know, and she’s also the person who writes books on pregnancy, but that’s not really her day job, so to speak. You two should have lunch together. That’s all I got to say. When this pandemic is over, you two should talk. 


It’s so interesting to me. And I guess, I don’t know, I guess I’m drawn to these, yeah, these types of books. I also find them so interesting because so much of what’s written on these topics are written by physicians. And we are so boring when we write stuff. It’s, like, awful to try to read this, you know, when it’s a medical book. But when it comes from, like, a real human who’s writing, you know, as an angle, both as an academic and as, you know, someone who went through this as a parent, it’s just so much more interesting. And so, that’s why I love and I recommend it. 


Prof. Jung: Well, thank you for doing that. 


Dr. Fox: Just to clear the air for anyone who’s listening, you as, from what I, again, we’ve never met but from reading your book, you and I are both very supportive of breastfeeding, policies to support breastfeeding, and to support women who breastfeed. We’re not opposed to it in any way whatsoever, correct? 


Prof. Jung: Yes, I am not opposed to breastfeeding. Absolutely not. 


Dr. Fox: And you breastfed your children. 


Prof. Jung: As I say in the book…I did, I did. I spent hundreds of hours breastfeeding my two children. 


Dr. Fox: And what you wrote in the book, one of the quotes is you wrote, “I’m not against breastfeeding, I’m against lactivism,” and, which is the title of your book, “Lactivism.” So, can you explain to our listeners, what exactly is lactivism? 


Prof. Jung: Lactivism is a word that was coined by breastfeeding activists and advocates. It was not coined by me and it’s breastfeeding advocacy. So, it’s basically zealotry around breastfeeding as a good in and of itself. And it’s elevating the idea that you have to breastfeed in order to be a good parent, a good mother, a good citizen, and shaming mothers who don’t breastfeed. So, it’s basically an attitude around breastfeeding rather than breastfeeding itself. And I do find that in our contemporary world, breastfeeding advocacy often crosses the line from being supportive of women who choose to breastfeed to shaming women who choose not to breastfeed and elevating breastfeeding to a moral behavior. 


Dr. Fox: Right. It’s so interesting, because when you read some of the stuff that you write in your book, and some of it’s been quoted, it’s written in articles and “The New York Times” had an article, and you write how, you know, breastfeeding advocacy, it’s a positive way to protect women’s ability to choose how, when, where to feed their children, fine. And then you write that this advocacy can cross the line or too often crosses the line into lactivism. And then you refer to it as, you know, compulsory breastfeeding, you know, breastfeeding as a moral crusade, and a means of distinguishing good from bad parents. And I think when people read that, they’re like, “Well, yeah, that sounds like, that sounds terrible, you know, like, that’s not what it should be.” But it’s really, really common. 


Prof. Jung: Yeah, it’s very common. 


Dr. Fox: Was that something that surprised you when you were doing the research, meaning how common it was? 


Prof. Jung: By the time I was doing research on this, I had already had two children. And so, I was familiar with how common it was because lots of people had engaged me in conversations about breastfeeding. And people would congratulate me for breastfeeding for as long as I had or something like that. And I would think, that’s weird to be congratulated for feeding your kid. So, I think that mothers who do it, they feel, and they would tell me, like, “I was very proud of myself for,” you know, they’re quite smug about having breastfed for X number of months. Well, what really did surprise me, in fact, what shocked the heck out of me was discovering, you know, that organizations like WIC, the Women, Infants and Children’s feeding program, actually do things like provide breastfeeding mothers with food for longer, and, you know, better quality food, and for longer periods of time than non-breastfeeding mothers. That there would actually be public policies in place that punish people who don’t breastfeed. So, I was already aware of this sort of the social stigma involved, but I didn’t know about actual government policies that punish people for not breastfeeding. 


Dr. Fox: I mean, it’s odd for many reasons. But also, you would think that there’s this attitude in this country that, you know, no one’s breastfeeding, you have to get everyone to breastfeed. But in the U.S., I mean, most women are breastfeeding, they choose to, right, you know, like 80% basically start breastfeeding and about 50% are still doing it at six months, which is, you know, really good. Those are high rates, and they actually meet the goals set by whoever set these goals, you know, nationally. And so, it doesn’t seem like we have a massive lack of breastfeeding in this country that would require such harsh interventions. 


Prof. Jung: Absolutely. So, when I wrote my book, I think we’re at about, 79% was the latest numbers I had, but I’ve found more recent numbers. So, in 2017, which is the most recent year we have data for, it was actually 84% of women who are breastfeeding at birth. And even by 28 days, one month, it goes down to 80%. So, still a month, we’ve got 80% of women in the United States who are breastfeeding, and this is in a country where most women don’t have any maternity leave. And so, these numbers are incredibly high, given the incredible, you know, high personal cost of breastfeeding for most women in the United States because of the absence of maternity leave. You know, we’ve only got, what, 16% of the population that is not breastfeeding at birth, not breastfeeding when they leave the hospital. 


Dr. Fox: Yeah, and it’s not fair to compare us to, you know, Scandinavian countries where women get, they’re off for a year or so after they deliver with paid leave and, you know, which is wonderful. And so, it’s not that it’s therefore easy for them to breastfeed, but some of the hurdles are removed in terms of going back to work and, you know, whatever it might be. And to have these high numbers in the U.S. just shows there’s already strong support for it. 


Prof. Jung: Yeah, absolutely. So, I completely agree. You know, I think that the breastfeeding advocacy and raising breastfeeding to a standard of being a public health issue like, you know, smoking and unsafe sex, that’s what we’ve elevated formula feeding to, is the equivalent of smoking in the United States. And it’s just beating people over the head with something that we really don’t need to be beating anybody over the head with. I also found in doing research for the book that experts, researchers, medical professionals estimate that about 15% of women cannot produce enough milk to feed their babies. So, they’ll be physically unable to produce enough milk to feed their babies. And there are a whole range of reasons for this, having to do with thyroid imbalances, there’s, like, 10 different things that could affect a woman’s capacity to produce enough milk to feed her baby. And so, if it’s the case that 15% of people cannot produce enough milk to feed their baby, then 84% is just about as high as we should expect. 


Dr. Fox: Right. That is interesting. And another thing you’re right about, which is so poignant and sharp is often these women who can’t produce enough breast milk are told by “experts,” “Everyone can produce enough breast milk, you can do it, you know, we’ve been doing it forever. You know, women have always done this.” And you wrote, we’d never say that to a diabetic about their pancreas not making enough insulin, you know, “We could all make enough insulin if you just try harder.” It’s just, it sounds crazy. I mean, it’ll literally be crazy talk. And so, to start, you know, pushing this message on women that they’re failing because they can’t produce enough breast milk is just so horrible. 


Prof. Jung: Yeah, “All women can breastfeed,” is one of the lactivist slogans. You hear that all the time, “All women can breastfeed.” Yeah, and so that is something that I point out in the book, you know, that it’s never been the case. Never in the history of human beings has it been the case that all women could breastfeed. There have been… What do they call…? 


Dr. Fox: Wet nurses. 


Prof. Jung: Wet nurses, thank you. There’s been wet nurses, you know… 


Dr. Fox: There’s not a lot of them out there anymore. So, you know, their website doesn’t have a lot of hits anymore. 


Prof. Jung: Well, and that’s because wet nurses have been replaced with breast pumps. And also with, you know, people sending their breast milk across the country for, you know, people buy other people’s breast milk. So, now you don’t have wet nurses who are providing a service, you have a product, they produce a product, and then they’ll sell you the product. Because, you know, now that we have pumps, they don’t actually have to provide the service, they can just deliver the product. That is essentially wet nursing with a middle step involved. 


Dr. Fox: Right. It’s wet nursing with Amazon in between. What’s also so interesting about that is when people, sort of, on the surface of it look at, you know, breastfeeding as a, let’s say, an industry, they’ll say, “Oh, it’s the formula companies are, you know, they’re big business, they have, you know, shareholders they’re answering to or they’re not interested, you know, in women’s health or an infant’s health and, you know, they’re bad because they’re business.” And that’s sort of, like, if you look at the surface, but what you get into in your book a lot, which is so true, is the breastfeeding industry is also big business, it’s huge business. I mean, these pumps are expensive, and all the equipment that goes with it, and all the breastfeeding, you know, the gear, and there’s just so much that goes into it on that end also, it would be unfair to just say that there’s a financial interest on the formula side when there’s a as great or even greater interest on the breastfeeding side. 


Prof. Jung: Right. So, one of the really interesting things that I found is, you know, the Affordable Care Act, Obama’s Affordable Care Act passed into law that all women who give birth to a baby get a free pump from their insurance company. All the breast pump companies, you know, made a fortune off of that. But one of the things I found was that during the time, you know, a lot of healthcare special interest groups were involved in lobbying around the Affordable Care Act and making sure that particular things got into that act. And one of the very big advocacy groups that was involved in drafting the Affordable Care Act was the breast pump industry. So, Medela had people in Washington who were making sure that breast pumps got into the Affordable Care Act. And after that part of the act was passed, after, you know, mothers were required to get free breast pumps from their insurance companies, the breast pump industry jumped by 50% in the United States between 2015 and 2018. So it was a massive, massive boon to those breastfeeding, breast pump companies. 


Dr. Fox: Right. I mean, pretty much, you know, 80% to 85% women who are nursing or starting to, almost 100% of them buy a pump, or get a pump from their insurance company “for free.” I mean, someone’s paying for it, it’s just not, you know, it’s part of…we’re, society’s paying for it. And that’s, the people making the money off of it are the ones who sell the pumps. And doesn’t mean they’re bad people, but just whatever, it is a lot of money. There is definite interest in this continuing. 


Prof. Jung: Absolutely. And, you know, the concern there is that what the United States is doing is it’s not really promoting breastfeeding when it’s getting the Affordable Care Act to offer pumps to women who have babies, it’s promoting breast pumping. Now, whether or not pumping breast milk to feed your baby breast milk from a bottle is the same as breastfeeding, the jury is out on that. You know, nobody really knows that the benefit from breastfeeding comes from the properties inside breast milk which is what, you know, the breast pump logic would imply or if it comes from, you know, actually feeding your baby at the breast, etc., etc. Nevertheless, it’s also clear that the reason we focus so much on breast pumping in the United States is that we have no maternity leave. So, we’re trying to square the circle between, you know, government recommendations that women should breastfeed exclusively for six months, and the fact that most women, most new mothers work and don’t have maternity leave. With breast pumps, there’s the solution. And so breast pumping breast milk is just, it’s the cheap substitute for maternity leave in the United States. 


Dr. Fox: I think that’s such a huge point. And it’s so important because people don’t often realize the big picture of this, that, you know, number one, there is this, you know, governmental recommendation that women breastfeed exclusively for six months. And like we said, and we’re gonna continue to say, it’s really pushed on people, and in many different ways we’ll go into, but it’s really, really pushed. But they’re not at the same time paying for a way for them to do it in the way that it was intended, right, breastfeeding. So, instead of saying, “Okay, we’re not gonna give you maternity leave, you still have to go back to work, so we’re gonna do all these pumps.” And the pumps are, they’re definitely useful for women who are nursing, they’re breastfeeding, and they can’t be with their baby 24/7. So, in the times that they’re not, they can, you know, pump and they can continue to breastfeed at home. But what ends up happening for a lot of people is you’re basically promoting breast milk, not breastfeeding, like you said, and those are different. 


And people don’t always understand it, that’s not the same thing. Feeding a baby exclusively breast milk is not the same thing as exclusively breastfeeding, because there’s so much benefit to that, you know, the touching, the bonding, the skin to skin, the warmth, you know, that has effect on babies as well. And when you remove that from the equation, it’s unclear what the benefits are. 


Prof. Jung: Right. And in fact, you know, one of the things that I found that was super interesting is, it’s not just that we’re implying that breast milk is the same as breastfeeding, that’s actually also elevated to an ideological position. So, for example, when my book came out, I was asked by the “L.A. Times” to write an op-ed about it. And I mentioned the fact that, you know, just this exact fact, what we’re talking about, about the fact that the United States was actually promoting breast pumping and not breastfeeding, and it was promoting breast milk as a product rather than breastfeeding as, you know, an act. When the article was published, the comments that started coming up in response to the article, there were a lot of mothers, I assume mothers, who said, “Don’t you dare say that breast pumping is not every bit exactly the same as breastfeeding, do not denigrate my breast pumping,” and so on and so forth. And I realized that, you know, there was a real fervor about absolutely insisting that those mothers who were pumping were doing everything exact, you know, they were doing the exact same thing, offering their babies the exact same benefits as mothers who are breastfeeding, 


Dr. Fox: When you tie people’s, you know, worth and their value as parents into that equation, you can see why people will get very emotional about that. 


Prof. Jung: Right, which hasn’t been, you know, my point at all, I wasn’t meaning to denigrate the actual mothers who were pumping. I was looking at this as a public policy and saying our policies are messed up and we shouldn’t be talking about promoting purchase of breast pumps as an instance of Obama promoting breastfeeding, right? We should look at it as a clear-eyed instance of Obama promoting the purchase of breast pumps as a way of avoiding changing our maternity leave policy. 


Dr. Fox: Right. And I think that also was sort of the backbone of all of this, which is really the claims about the benefits of breastfeeding and exactly what they are. Because if you ask someone, either someone on the street or you ask even a doctor or you ask a public policymaker, you know, why is breastfeeding better? Right? What is it that’s better? And you’re basically gonna hear essentially, every single, you know, ailment in the history of mankind is improved by breastfeeding. You know, we’re essentially talking about reducing the risk of ear infections, gastrointestinal infections, respiratory infections, enterocolitis, blood pressure, obesity, heart disease, diabetes, asthma, allergies, cancer, celiac, Crohn’s, eczema, death, SIDS, and they’re gonna have higher IQs, and have better mental health if they’re breastfed. And there’s nothing in the world that reduces the risk of all those at the same time. But that’s what you’re gonna read and what you’re gonna hear. What’s the data even to support those claims? 


Prof. Jung: There’s so much data out there and it, you know, it varies in quality. I guess the first thing would be to talk about the research on breastfeeding and… 


Dr. Fox: We’re gonna spend some time on this, so everyone can hunker down and hear about data for a while. 


Prof. Jung: So, the most important part of this, this sort of background information that you need is that all of the studies on the benefits of breastfeeding are observational. So, there are no randomized controlled studies on breastfeeding and health outcomes. And randomized control studies are what, you know, we mostly have in science and in medical research, because of the problem of confounding factors. So, if you have randomized control studies, you can control for confounding factors. And most people are gonna understand this clearly, but let me just give you an example. So, it turns out that most women who breastfeed also do not smoke. If babies of mothers who breastfeed have a lower chance of respiratory infection, so they get fewer respiratory infections, we can’t tell if it’s because their mothers breastfed, or if because, it’s because their mothers don’t smoke. Right? It’s possible that mothers who smoke tend to give their baby, you know, their babies have a greater chance of respiratory infections. 


So, because we don’t have randomized controlled studies, we cannot control for those confounding factors. And so, that makes all of the research on breastfeeding and health outcomes less robust, less scientifically sound than it otherwise would be because they’re all observational studies. That is, we’re looking at women who breastfeed and women who don’t breastfeed, but they also tend to have a lot of differences between them. In the United States, one of the big differences is that the women who breastfeed longer, those women’s children also tend not to go to daycare. And daycare is the leading cause of most illnesses that babies have in the first, you know, two or three years of life. 


Dr. Fox: Right, like infections, like minor infections. 


Prof. Jung: Exactly, exactly. So, diarrhea, you know, runny noses, ear infections, all of those things, babies basically don’t get any of those things until they start daycare. And every parent listening to me right now is going to say, “Oh, yeah, no kidding.” For example, one very famous study of breastfeeding outcomes was conducted in Belarus. And that study found that, you know, children in Belarus actually don’t get ear infections at all, and they don’t get diarrhea almost at all. You know, very, very low percentage of babies, something like 15%, whereas in the United States, it’s more like 60%. And that’s because women in Belarus get very, very long maternity leaves and there basically are no daycares there, right? So, you’re starting with totally different numbers. Back to the research. So, after, you know, wading through, I mean, probably hundreds of articles on, you know, studies on the benefits of breastfeeding, I decided that breastfeeding has an effect on four different types of infection. 


It has an effect on ear infection, lung infections, respiratory infection, gastrointestinal infection, and it seems to have an impact on something that preterm infants have, which is called necrotizing enterocolitis. And then there’s a whole range of things, you know, among the list that you mentioned, where the bottom line is that we simply don’t know. That there’s a lot of research out there, it’s contradictory or it’s unclear. So, I’m looking now at my book. So, the evidence that breastfeeding protects against…this is stuff in the middle range, right? Where the evidence is inconclusive or the evidence is mixed. That’s with eczema, asthma, allergies, SIDS, type two diabetes, leukemia, cardiovascular disease, Crohn’s disease, celiac disease, behavioral disorders, and increasing intelligence. So, in the case of those health outcomes and intelligence outcomes, we just don’t know, there are studies that go either way. Good studies that show both an impact and no impact at all. 


Dr. Fox: As you were saying before, it’s so hard to really do this. I mean, again, just for, you know, for our listeners, that the only way to really know is literally to take, let’s say, you know, 10,000 women and randomly tell half of them, you know, just randomly divide them in two groups and say, “Okay, you 5,000, I want you to breastfeed exclusively for six months, and you 5,000 don’t, you know, do formula feeding.” And that hasn’t been done. I don’t think anyone’s planning to do that. There’s a lot of reasons that’s not gonna get done, it’s very difficult. But that would be the only way because if you look back on women who breastfed, you know, other than smoking, there’s so many reasons they may be different and you can’t figure it out. You know, the researchers know this, it’s not like this is, you know, foreign to them. But the way you tease it out is you look at, you know, people are breastfed longer versus shorter, and sort of the same groups, but that’s also biased. 


Or sometimes one of the, some of the better studies are able to tease out within a certain family, who have, you know, multiple children, some of whom are breastfed, and some of whom are not. You know, things like intelligence which, you know, and most of the studies have not shown any great benefit to the children within a family who are breastfed versus not, which would sort of imply that it’s not so much the breastfeeding, but rather your family, your parents, your genetics, you know, those types of things. And so, it’s very tough. And the other thing which you mentioned in the book but so important for people to realize is when we say there is a benefit, how much of a benefit, right? Because in papers, when we say there’s a significant benefit, what we mean when we’re writing it is, it’s not due to chance, it seems to be real. But when people hear that, they think, “Oh, it’s a huge benefit,” but, like, lowering something from 10% to 7% might be significant but you’re like, “Well, that’s a pretty small drop.” And that’s the numbers we’re talking about here for these improvements, so to speak. 


Prof. Jung: So I talk about that as the difference between, you know, what significant means in statistics, and what it means in real life. So, in statistics, that just means this is actually a real difference. It’s not just a result of statistical manipulation. That’s all it means. It just means “real” whereas, you know, as we know, in real life, “significant” means significant, important, big. So, yeah, that’s possible, but that’s the problem. You know, it’s also the case that a lot of what public health officials are talking about is they’re looking at the difference at a population-wide level, whereas we as individuals would be making decisions with regard to our own baby’s health outcomes. And so, if you’re a public health official, looking from the perspective of, “Does this matter, you know, for our population of 330 million people?” the answer could be yes. But that would not translate into the same kind of logic that an individual person would be making when they make their own decision to breastfeed their baby. 


So, the example I have of this is there was a former director of the U.S. government’s Agency for Healthcare Research and Quality, an organization called AHRQ. So, this guy’s named Dr. David Meyers. And he gave a speech where he was intending to drive home how critical breastfeeding is to children’s health. So, he’s making the point that it makes a big difference. In his speech, he said the evidence suggests that for every six children who are exclusively breastfed for six months of life, one of them will not have an ear infection that he or she otherwise would have had. And then he goes on to say at least 26 infants will have to breastfeed exclusively for four or more months to prevent one incident from pneumonia, from getting pneumonia. So, he is looking at six women breastfeeding exclusively for six months to prevent one ear infection. So, that’s like 5,400 hours of breastfeeding to prevent an ear infection. So, if you’re looking at population-wide data, you might think that that 5,400 hours of breastfeeding is definitely worth it to prevent one ear infection. 


Because if you multiply that across all of the women, you know, all of the babies who are born in any particular year, that’s a fairly large number of ear infections that you’re preventing. I can’t do the math right now, I don’t know how many ear infections you’d be preventing. But if you’re a parent, and you realize that the difference between…that, you know, you’re investing 5,400 hours of breastfeeding in order to prevent one ear infection among those six, you know, children, so that ear infection is likely not even going to be your own child’s ear infection. You might do a really, really different calculation about what your time is worth and how important breastfeeding is. That’s part of the reason that what public health officials say about the benefits of breastfeeding is different. They have a different calculus of what the benefits of breastfeeding are than we would have if we were to make those same decisions on our own family level. 


Dr. Fox: When I hear, again, from either public health or medical, either individuals or organizations that talk about the benefits of breastfeeding, I find that there’s really two sort of categories of what I’m listening to. Because I rarely will hear anyone be, like, very blunt and say like, “The benefits are not huge and we’re not 100% sure about them.” Like, you don’t hear that. What you basically hear is one of two things, either, they just don’t seem to understand the data themselves. And they’ll just say, “Oh, breastfeeding, well, you know, it’s so good, it’s associated with lower rates of this, and this and this,” and they start quoting all these things that if you actually look at the data, like we said, we were like, “Well, no, it really doesn’t.” Data doesn’t show those, it does not prove those things. Or they’ll sort of state it more truthfully but I’m not gonna say intentionally, but it’s sort of misleading, right? Because you can say, like you said, breastfeeding, there’s multiple studies, and it seems to be associated with the lower rate of ear infections. 


And so, a parent hears that and says, “Oh, well, that’s good. Like, I don’t want my baby to get an ear infection, like, you know, I don’t want them to have pain and let’s go to the doctor and give antibiotics and, you know.” All right, fine. But when you sort of hear the numbers about, well, it’s lowering it from a low number to a slightly lower number, you’re like, “Well, that’s not a huge benefit and there’s so many other things we can do to, you know, to promote our kids’ health aside from just breastfeeding.” And when you put into context, it may not be as robust in that sense. And I just don’t think that that messaging is clear to people who are making this decision about how to feed their babies. 


Prof. Jung: No, I mean, in fact, the opposite. That messaging would be frowned on. I mean, I think you almost cannot give people that information. 


Dr. Fox: Right. Because it’s almost just too, you mean, you can’t give them information that it’s not as beneficial as we think it is or others think it is. 


Prof. Jung: Yeah, you just can’t say that. 


Dr. Fox: Did you get a lot of pushback on your book? I assume you did. You must have had a lot of angry people. 


Prof. Jung: You know what, so when I was writing the book, everybody I knew said to me, “I can’t believe you’re writing this book, you’re gonna get, you know, drawn and quartered. People are gonna go crazy about this.” And strangely enough, that did not happen. I feel like this book sort of caught a wave of people who had had trouble breastfeeding or had just, you know, there was sort of a backlash against this kind of rabid breastfeeding advocacy. And so, most of the press that the book got was very sympathetic, shockingly sympathetic, I thought. And I did a lot of live radio interviews. I mean, a lot of live radio interviews where, you know, people would call in, and almost always the people who were calling in were mothers who had had trouble breastfeeding, and they wanted to tell their story. And they were saying, “I’m so glad you wrote this book. You’ve saved my life, I was so depressed, I felt so guilty, I felt so ashamed. And this is making me feel so much better,” and so on and so forth. There was one really negative review of the book in maybe “The Washington Post” and then something funny happened. 


On, I think it was either Christmas Eve or Christmas Day, there was an NPR interview in Boston with the director of the Massachusetts Breastfeeding Coalition, a woman named Melissa Bartick, who said that I was the Donald Trump of breastfeeding. And that was strange to me, because I didn’t realize, it had never occurred to me the book would be identified as a right-wing backlash against breastfeeding as something that was PC or something like that, do you know what I mean? 


Dr. Fox: Yeah. 


Prof. Jung: So, she was basically saying, like, imagining that I was coming from a very conservative anti-breastfeeding perspective. Whereas, in fact, what I was saying was almost categorically the opposite, right? That this breastfeeding advocacy gone wild was, in fact, a very conservative, and it’s not, but it is, right, sort of requiring that every woman breastfeed and eliminating choice, eliminating women’s choice. Whether it’s coming from the left, you know, from the position of being, you know, sort of a hippie hipster or, you know, feminist breastfeeding advocate, or from the perspective of, you know, the Christian right or something like that. And by the way, you know, that’s what the title of the book implies is that from all over the political spectrum, you’ve got breastfeeding advocacy convergence or a consensus on the importance of breastfeeding. But the book definitely was not meant to sort of wade in on the side of anti-breastfeeding as a conservative sort of intervention into the discussion. 


Dr. Fox: Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.