Lactation non-profits and the ethical lactation medicine of the future
This article explains why I decided just a few weeks back that I could not attend the BMNANZ Conference. I'd already made that decision when I learnt that a colleague visiting from the UK was available to visit Minjerribah (Stradbroke Island) with me that same weekend, so we've booked a weeekend by the sea instead.
"This life is full of hurts and heals, we bruise off each other just by living, but the hope is some days we realise it." Niall Williams, This is happiness. Bloomsbury Publishing 2019
I wake at nights and grieve being excluded by medical colleagues
I wake some nights or mornings with a dull ache of grief and shame in the centre of my chest. In my heart. I have known the co-chairs and other members of the Breastfeeding Medicine Network of Australia and New Zealand (BMNANZ) Board of Directors for many years - but they haven’t picked up the phone to call me. They often sign off from the impersonal safety of “The BMNANZ Board”.
For months I’ve been hurting like this, using all the strategies I know to manage the pain, even as I continue to live well and enjoy this one wild and precious life as best I can. I practice experiential acceptance and cognitive defusion. I use the imagery and voices of self-compassion. I practice the different kinds of somatic therapy I’ve drawn on for much of my life. What old wounds of abandonment or scapegoating are roughened up and bleeding inside me yet again as a result of my colleagues’ rejection? I talk it over with friends, who are appalled. “How small!” my friends say, shaking their heads. Day by day, night after night, my heart continues to ache and I apply all the medicines I know.
I go down to the river most days, to Maiwa here in Brisbane, our great tidal estuary. I'm 65 years old now and I'm experienced in the navigation of tides, in the ebb and flow of grief. I know it has something to teach me. I know it will pass.
But it's been extremely painful to find myself excluded from an organisation that I had imagined, not so long ago, would be a natural professional home. I had learnt to expect exclusion from the International Board of Lactation Consultant Examiners (IBLCE) representatives, but it hurts to receive the same from my local medical colleagues, Australian GPs who share my passion to make a difference for families at the beginning of their little one’s life.
The shame needs to switch sides if lactation medicine is to meet the urgent challenges of our times
I refuse to be shamed by the leadership of BMNANZ though. A recent analysis by the Possums team shows that 74% of the doctors on the BMNANZ website, who publicly identify as Australian breastfeeding medicine physicians, have been upskilled in breastfeeding medicine by me – more, if we were to include those who only completed the Possums introductory courses in 2015-2016, for which we no longer have records. Forty-nine of the 89 doctors listed on the BMNANZ site are current members of The NDC Institute.
The shame needs to switch sides. Something has to change in the world of lactation medicine, if we are to best serve breastfeeding and lactating women and help them prepare their babies, body and soul, for the most resilient possible future on our ravishingly beautiful and catastrophically threatened planet. I believe that these most extraordinary times demand from each of us an urgent and ethical response, drawing on whatever skillset and passion we have developed.
The mental health crisis is one huge factor driving unsustainable costs within health systems, world-wide, and our health systems now accept that neural templates which either promote or undermine psychological and physical resilience are laid down during the exquisitely neuroplastic first months of life.1 This is why the research which shows that ‘breast is best’ messaging worsens maternal mental health should give those of us who are passionate about lactation medicine great pause.2
The physical and mental health of breastfed babies in high income countries today, and the length of their lives, are threatened by market powers far more predatory and powerful than formula companies. Predatory market powers lie at the root of the destruction of our environment, and in large part drive the escalating unsustainability of our health systems; structural change and regulation is urgently required by governments. These times demand nothing less less than the most brilliant, creative, and interdisciplinary responses possible, across multiple fields of endeavour, as we work together towards a flourishing future for humanity and all other lifeforms on this Earth. Every ounce of our breathtaking collective intelligence is called upon, right now.
Our lactation non-profits including BMNANZ are structured globally upon the ideological belief (which is tragically simplistic, even anti-science) that more women will be able to breastfeed if they punish companies who sell formula and punish companies who sell breast milk pumps and bottles and teats for expressed breast milk and punish individuals who have a range of associations with these companies - without discriminating between countries and contexts.
Formula companies, for all their documented predatory capacity, are just one small cog in a monstrous greedy web of extractive commercial enterprises, which damages human health, threatens the environment, and specially targets the impoverished and disempowered who are hidden from view. The WHO has released scientific reports on the devastating effects of predatory commercial milk formula company practices in low and middle income countries. But right now, there’s no science-based or rational reason to think that the global efforts by lactation non-profits to rein in unethical marketing practices of the formula companies have any impact upon breastfeeding rates in high income countries.
Breast-milk-pump related charities and companies offer an important source of philanthropic investment in breastfeeding and lactation research, for which there is less and less funding available. Every lactation medicine doctor around the world with even a passing interest in evidence-based practice draws upon the studies published by a research team which has been philanthropically supported by a breast-milk-pump related charity.
After making some important historical impacts, lactation non-profits' ongoing sanctions in an increasingly complex world demonstrate an abundance of impotence, particularly in low and middle income countries today, since they are attempting to address in isolation one tiny facet of the global crisis of predation and extraction which threatens the very survival of life on Earth. In high income countries, ideologically-based sanctions not only lack evidence of benefit; I join other voices speaking out now about the harms these sanctions are causing world-wide to women who hope to breastfeed their baby.3,4,5,7
Sanctions meted out by lactation non-profits are specifically intended to cause hurt and damage
In practice, the collective punishment meted out by lactation non-profits fundamentally shapes how our lacation doctors and other professionals are educated at home and internationally. Lactation non-profits sanction formula companies, which makes sense to me, as long as this is not diverting scarce resource away from innovation and advancement in the lactation sciences. But lactation non-profits also sanction and campaign against manufacturers of breast milk pumps who sell teats for bottles that contain expressed breast milk. This doesn't make sense given that there is a lot of outrageous marketing of teats out there and only companies who are attempting to do good by investing in lactation research (and in the case that effects me, who no longer even manufacture teats) are singled out. This is quite perplexing to many outsiders looking in, or even laughable.
Punishment is meted out to researchers who are philanthropically funded by manufacturers of those teats through standard university channels, or who publish in philanthropic online collections of papers supported by a charity which also owns a company which manufacturers of these teats for bottles of expressed (even when those teats are no longer being sold). Punishment is also meted out, through a long chain of associations built on expressed breast milk bottle teats, to a clinician-researcher such as myself, who published two articles, one theoretical and the other a small evaluation of the gestalt method of fit and hold, with the professor who is (many would agree) the world’s leading breastfeeding and human milk researcher. Both articles took out many months of my life, funded by the time I spent in the clinic each week, and I imagined every day as I wrote them that they were another meaningful, if small, contribution to the wellbeing of breastfeeding women and their babies.
The punishment is to exclude me from having continuing professional development points attributed to my presentations and courses, through formalised mechanisms which are specifically designed to cause financial and reputational damage in the world of breastfeeding medicine. “We’re looking at tightening up our sanctions,” a high profile lactation medicine doctor said to me sadly just a year or two ago, referring to the Academy of Breastfeeding Medicine's Ethics Committee. “What a shame you published with the University of Western Australia!” The punishment is eratically applied, without transparency, in a way that suits the purposes of local lactation non-profit leaders.
Is it possible that I’m too sensitive, not brushing things like this off with a shrug? But I’m a clinician - all my research and education work arise out of my encounter with a patient in the clinic. I like to believe that if I have a fundamental professional talent, it is a deep sensitivity to my patients, a capacity to read even the most subtle signals of bodies and souls. It's an acute sensitivity to power structures, to my patients' feelings of disempowerment, and to what might best nurture the blossoming of empowerment after the patient leaves our consultation. It’s my passionate commitment to my patients who try so incredibly hard to breastfeed and the way in which the collective tools used within breastfeeding medicine have failed us over my lifetime which has driven my efforts at clinical innovation over the past decades. I'm grateful for the support of colleagues with a special interest in psychological medicine, who call out the dangers of the myth that doctors should adopt a non-feeling or machine-like persona. My sensitivity is absolutely fundamental to my contributions to lactation medicine.
And then there is the terrible fear that I won’t be able to afford to continue my work, that everything will come crashing down because there is no university funding, there is no hospital funding, there is no reasonably attainable clinical primary health care research funding – clinical primary care research is notoriously lacking in financial support. This is why I decided years ago to disseminate my work through the platform of a charity (2013-2023), and after that, with the help of my courageous son, through a certified social enterprise. My work has been funded for decades out of my time spent in the clinic, and most recently by investing my superannuation as we rebuild. There is no money available for a general practitioner attempting to research and innovate in education, but what else do you do if you love the work and believe you're called to it, that this and this alone gives you professional satisfaction come this late stage in your career? I've kept on going, and I dare to believe it's all going to be alright. I'm grateful that I have meaningful, purpose-driven work. I am also very grateful for the nurturance and richness of my life outside my work. But it's been painful to gradually realise that my colleagues on the BMNANZ Board are determined to maintain a complete silence about my lactation medicine courses and guest speakers within the N (the second N, for network) of BMNANZ. It seems to me this use of the word 'network' misleads Australian doctors, who would reasonably believe that a network includes all doctor-led lactation medicine opportunities in our country.
My days and my intrays are filled with lactation medicine, and not only because for about six years I’ve been writing breastfeeding programs, including a research-based Lactation Fellowship for doctors, a major project the scale of which can't be understood, perhaps, unless you've tried to write something similar, at the same time as you published key elements in the research literature! Everything I've done in Possums or Neuroprotective Developmental Care, one way or another, has it’s roots in the world of lactation medicine. So just coming to my desk to work, just turning on my laptop, has caused me escalating heartache since BMNANZ began its series of (plausibly deniable) rejections.
In the hardest times, back in the Possums charity before I had to leave, I used to lie in bed at night and think that at least I had the support of Australian doctors. It comforted me, to know that many of my local medical colleagues thought that what I was trying to do was worthwhile. Similarly, it has been devastating to know that I am not allowed to let other doctors who care about lactation medicine in Australia know about my work - not about the Lactation Fellowship, the Guest Speaker series, the Lactation Medicine Lab for Doctors, let alone the Breastfeeding and Lactation Masterclasses and other courses.
I can, of course, turn up as an attendee to the BMNANZ conferences – and did in 2024, listening to some presentations from which I learnt, managing my sadness during other presentations which continued to promote overmedicalisation and overtreatment and which I knew (from the research and from clinical experience) were typically accompanied by unintended outcomes (that is, accidental harm to mothers and babies). I had already felt pressured by a last minute request by the conference organisers to fill out a declaration about IBLCE and sanctions. I got around it by saying that I would not sit at the Possums trade table. But that didn't feel right.
It's not that everything contestable in conference presentations needs to be picked up and discussed publicly, not at all. But excluding selected clinical-researchers who may be well placed to discuss the research and its translation into clinical practice exposes the BMNANZ Board to reasonable concerns that they perceive rigorous intellectual engagement as threatening - or as potential commercial competition. At the same time, BMNANZ explicitly directs it's Australian and New Zealander members to breastfeeding medicine educators from the United States (in a health system which is recognised in the research literature to be especially prone to overmedicalisation and overtreatment). The Australian Breastfeeding Association, to which BMNANZ is also willing to direct doctors, does not offer an equivalent Lactation Fellowship upskilling. I decide it's best to stop trying to belong, to stay away from the conference. I accept that in a field dominated by outdated and unethical ideologies, I will be excluded, cancelled, silenced, using strategies of obfusctation and plausible deniability. It hurts too much, it feels too small and mean - and too US-facing - to continue trying. "Is this the same in all areas of medicine?" my non-medical friends ask me, astonished.
NDC calls for an ethical and integrative lactation medicine
"All scientific theories are ultimately shown to be incorrect. Thus, the point of the scientific journey is not to generate correct ideas but to develop more useful half-truths whose limitations can be more quickly and certainly known. A progressive scientific field builds on useful ideas, continuously weeding out those that are not." Hayes et al 2013 p.1 (ref 6)
I'm walking away, and I'm walking towards a different, much more ethical future for lactation medicine. No Australian doctor needs to choose between BMNANZ and NDC when they're interested in upskilling in breastfeeding medicine; in my vision there is ample room for the flourishing of diversity. What matters is that we don't exclude each other, and also that we refrain from unethical extraction - which is use of other's professional lives and work without appropriate acknowledgement, without even taking the time to understand.
Why does this matter so much? It matters so much to me because it's mothers and babies who suffer when lactation medicine closes out research-based dissent and debate. It matters to me because of the tiny humans who cry and cry at the very beginning of their life, though much of their distress could have been prevented. It matters to me because of the mothers who come into my consulting room and weep, year after year, decade after decade, though so much of their distress could have been prevented.
This is why it matters to me. This is why I'm unable to attend the BMNANZ conference. And this is why I'm offering NDC as a different kind of lactation medicine future: ethical, inclusive, and welcoming of debate.
By Dr Pamela Douglas, Goomburra 12 April 2026
Related resources
The ethical lactation medicine of the future refuses to accept lactation non-profit ideology
Helping women with their milk and the cruelty of the pure
Groundbreaking research is 'cancelled' by single-issue breastfeeding non-profits
Recommendations to mitigate groupthink in clinical settings (DiPierro et al 2024)
Selected references
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Suetani S, Gill N, Salvador-Carulla L. The mental health crisis needs more than increased investment in the mental health system. Medical Journal of Australia. 2024;220(9):doi: 10.5694/mja5692.52281.
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Grattan RE, London SM, Bueno GE. Perceived pressure to breastfeed negatively impacts postpartum mental health outcomes over time. Frontiers in Public Health. 2024;12:1357965. DOI 1357910.1353389/fpubh.1352024.1357965.
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Azad MB, C NN, Bode L. Breastfeeding and the origins of health: interdisciplinary perspectives and priorities. Maternal and Child Nutrition. 2020;17:e13109.
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Chetwynd E. From censorship to conversation: agnotology, market influence, and the ethics of breastfeeding research. Journal of Human Lactation. 2025;4(3):303-305.
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Chetwynd E. The 4-year question: optics, ethical clarity, and the future of lactation research in times of upheaval. Journal of Human Lactation. 2025;41(4):451-453 doi:410.1177/08903344251387116.
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Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and Commitment Therapy and Contextual Behavioral Science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behavioral Therapy. 2013;44(2):180-198.
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Kendall-Tackett K. Have we returned to the Dark Ages: Excommunication and its chilling effect on science. Clinical Lactation. 2020;November:DOI: 10.1891/CLINLACT-D-1820-00024.