“Formula feeding is the longest lasting uncontrolled experiment lacking informed consent in the history of medicine.”
—Frank Oski, MD
Lactivism is a term used to describe breastfeeding advocacy. Lactivists are those who support breastfeeding, advocate for the rights of breastfeeding mothers, ensure that breastfeeding mothers are not discriminated against, and aim to inform the general public regarding the health benefits of breastfeeding. Lactivism can occur in many ways, but the act that receives the most media attention is the “nurse-in.” At a nurse-in, mothers gather in public places to breastfeed their children.
Why Advocate for Breastfeeding?
Breastfeeding is the preferred form of nutrition for all infants. The health benefits of breastfeeding are so significant that virtually every professional organization including the American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding for the first 6 months after birth followed by supplementary foods and continued breastfeeding for 1 to 2 years or more as mutually desirable by mother and child (Figure 99-1). The Agency for Health Care Quality and Research (AHRQ) (2007) conducted an extensive metaanalysis on the benefits of breastfeeding for both mother and child. Breastfed full-term infants receive the following health benefits: reduction in the risk of acute otitis media by 27% to 50%, a 42% reduction in the risk of atopic dermatitis, and a 27% reduction in the risk of asthma (Ip et al., 2007). Even more significant are the 64% risk reduction for gastrointestinal infections and the 72% risk reduction for respiratory infections (Ip et al., 2007). Breastfeeding may also help protect the child from type I and type II diabetes (19% to 27%, and 39% risk reductions, respectively). Chen and Rogan (2004) report that infant mortality in the United States could be decreased by 21% if all infants received the recommended 6 months of human milk. The AHRQ also concluded that there is clear evidence to suggest an association between breastfeeding and a reduced maternal risk of breast cancer, ovarian cancer, and type II diabetes (Ip et al., 2007). Mothers who do not breastfeed or who have a short duration of breastfeeding are at higher risk for postpartum depression (Ip et al., 2007).
The Historic Decline in Breastfeeding in The U.S.
What has led to the need for lactivism in the U.S.? Until the mid-1800s, almost all infants in the U.S. were breastfed. In the 1890s and early 1900s, a shift began that essentially transformed the culture to one in which bottle feeding became the cultural norm. Increasingly in the 1900s, baby formula manufacturers advertised their products in women’s magazines and mothers had increasing doubts about being able to successfully breastfeed. As childbirth moved from the home into the hospital, medical practice began to interfere with successful establishment of lactation and breastfeeding. By 1948, only 38% of infants were receiving exclusively human milk feeds at 1 week of age, and by 1957, only 21% of infants were exclusively breastfed at the time of hospital discharge after birth (Apple, 1994).The culture of breastfeeding in the U.S. has eroded over the past 100 years, and, despite the fact that more women now “try” breastfeeding, preference for bottle feeding persists.
The federal government has tracked breastfeeding trends only since 1999. Prior to this, the earliest, and now the longest, ongoing survey of breastfeeding initiation rates in the U.S. was produced by the baby formula industry (the Ross Mothers Survey). According to the Centers for Disease Control and Prevention, breastfeeding initiation and duration rates have risen since 1999, however the increases have been modest at best. In 1999, approximately 68% of U.S. women initiated breastfeeding, and in 2006, 74% of women initiated breastfeeding—only a 6% increase. This includes mothers who may have only breastfed one time or just in the hospital before discharge. In 2006, only 13.6% of infants received human milk exclusively for 6 months, with any breastfeeding at 6 months increasing from 32.6% in 1999 to 43.4% in 2006 (Centers for Disease Control and Prevention [CDC], 2010).
A sociocultural issue that appears to underlie resistance to breastfeeding is the dual roles breasts have. Wolf (2008) wrote a commentary on why public breastfeeding remains so controversial in the U.S. Wolf asserted that American culture focuses on breasts for their sexual appeal—not for their primary function, which is to provide nourishment. The view that breastfeeding should be a private act, like sex, can make it challenging for some women to feel comfortable breastfeeding outside their homes (Wolf, 2008). Because of these conflicting views, breastfeeding mothers have been met with discrimination in public areas, stores, and restaurants. At a Toys ‘R Us at Times Square in New York, an employee asked a mother to move to a basement to breastfeed because there were children present. This resulted in a “nurse-in” at the Times Square location in 2006 (New York Civil Liberties Union, 2006). In 2004, Lori Charkoudian was asked by a Starbucks store employee in Silver Spring, Maryland, to cover up or use the women’s restroom when she attempted to breastfeed her 15-month-old daughter. This led to a “nurse-in” involving 30 mothers and their babies as well as other family members and friends (Helderman, 2004). Similarly, a mother was ticketed for breastfeeding her son in Colorado at a beach, despite the fact that Colorado passed a law protecting breastfeeding in 2004 (The Denver Channel News, 2005). Table 99-1 provides a summary of breastfeeding incidents and lactivism events.
|Description of Breastfeeding Incident||Response||Source|
|Brooke Ryan was asked to cover the head of her infant while breastfeeding by a waitress and then the manager of an Applebee’s restaurant in Lexington, Kentucky, in 2007. Both employees claimed that other customers were complaining about her breastfeeding in the restaurant.||A nurse-in was held on September 8, 2007. Jonathan R. Weatherby, Jr., Associate General Counsel for Applebee’s attorney wrote “We regret that Ms. Ryan left without being served and would like the opportunity to personally invite her to return … we are also considering keeping blankets in the restaurants for use by breast-feeding mothers that may not have them readily available as a result of this incident.”||www.mothering.com/discussions/showthread.php?t=739358|
|Danielle Glanvill was harassed twice by a female security guard for breastfeeding in the children’s section of a New York library in 2009.||A written apology was granted, and the security guard was transferred to another branch.||www.nypost.com/seven/03242009/news/regionalnews/mom_wins_booby_prize_library_oks_breast__161094.htm|
|A mother was asked to cover up while breastfeeding at a Denny’s restaurant in North Carolina.||A nurse-in was held in protest on February 22, 2009.||blogs.babiesonline.com/baby/nationwide-dennys-nurse-in-february-22/|
|Emily Gillette was asked to leave her Freedom Airlines flight if she would not cover her breasts while feeding her child.||News of the event spurred public “nurse-ins” at airports around the country, and Gillette filed a complaint with the Vermont Human Rights Commission.||www.msnbc.msn.com/id/16773617/wid/11915773/|
|A lifeguard told Laurie Waldherr to leave a public pool in Washington state when she was breastfeeding at the pool’s edge for risk of bodily fluids getting into the pool.||Waldherr sued the city and reached a settlement out of court.||www.msnbc.msn.com/id/16773617/wid/11915773/|
|Julie Wheelan was asked to leave a shopping mall food court in Providence, Rhode Island, by a security guard when she was breastfeeding.||Wheelan suggested that the guard call the police, as she knew she was protected by law to breastfeed her child.||www.msnbc.msn.com/id/16773617/wid/11915773/|
|Dorian Ryan was ticketed for indecent exposure on July 14, 2005, at the Carter Lake Swimming beach in Larimer County, Colorado.||Ryan requested an apology, and Colorado lawmakers agreed. A law passed that gives women the right to breastfeed anywhere she’s allowed to be in public.||www.thedenverchannel.com/news/4785183/detail.html|
|Lori Charkoudian was asked by a Silver Spring, Maryland, Starbucks store employee to cover up or use the women’s restroom when she attempted to breastfeed her 15-month-old daughter in 2004.||A nurse-in was held in protest.|
A Starbucks spokesperson wrote “We will instruct our Maryland store partners to inform any concerned customer that by Maryland law, mothers have the right to breastfeed in public and to suggest to the customer that they either avert their eyes or move to a different location within the store.”
|Chelsi Meyerson was harassed for breastfeeding her infant at the Times Square, New York, Toys “R” Us store. An employee asked her to move to the basement to breastfeed. Chelsi refused. Four other female employees also pressed her to move to the basement.||A nurse-in was held at Toys “R” Us Times Square on September 21, 2006.|
The New York Civil Liberties Union informed Toys “R” Us that it had violated civil rights law when employees told Meyerson she was not allowed to breastfeed in the store because her breastfeeding was inappropriate because there were children around. Toys “R” Us has apologized to Meyerson and informed stores of its nursing policy, which specifies that nursing women may breastfeed their children in the place “of their choice” at Toys “R” Us stores.
|Cheryl Cruz was asked to cover-up when breastfeeding at Universal Studios in Florida.||Cruz was permitted to breastfeed.|
A spokesman for the park said, “We’re going to have the specific team members involved in this incident apologize to her, and we’re going to make sure that our team members know how to proceed in these kinds of situations, moving forward.”
|Lori Rueger asked if she could breastfeed her baby in a Victoria’s Secret dressing room in Charleston, South Carolina. An employee told her no, it was against store policy, and suggested she go to the mall bathroom.||Anthony Hebron, spokesperson for The Limited Brands in Columbus, Ohio, said, “There was an unfortunate misunderstanding in the incident involving us, but you know what, if it’s brought forth even greater things, that’s fine.”||abcnews.go.com/US/Health/story?id=1378087|
|Heather Silvis was confronted in 2008 by a Walmart employee when she attempted to breastfeed. Her shopping cart and infant were taken from her and moved to a dressing room.||Two years earlier, Governor Mark Sanford signed an act protecting and promoting breastfeeding throughout the state. Walmart store management apologized to Silvis.||www.midlandsconnect.com/news/news_story.aspx?id=221405|