Unravelling the purity myths of breast milk and lactation non-profits

Unravelling the purity myth: breast milk

Is a woman’s milk pure? I think I believed all those years ago that the milk my breasts and body made for my babies was pure. Still today, lactation non-profits promote mother’s milk as the most biologically pure, the safest option, as perfect, natural, or normal. (ABA)

But in the 35 years since I breastfed my babies, science has taught us that Homo sapiens milk contains germs. A lot of them. Two hundred species of bacteria, many with the potential to create disease - not to mention fungi, viruses, archaea, and protozoa. It’s not possible to think of a milk which contains a flourishing abundance of fungi as pure in any traditional sense.

The milk microbiome is complex, just as the power of culture to shape the biological is complex, just as we need to think differently about what it is to breastfeed in these times, when almost all women report that they encountered breastfeeding problems.

Homo sapiens milk doesn’t look pure, either. It’s not the pure white of the Christian traditions from which the first Western lactation non-profit arose in the 1980s – it’s not the white purity of the sacred lily or the altar cloth or the priest’s alb. It’s not the spotless white of sheets laundered in detergents whose ads guaranteed purity on TV screens, either. Human milk varies in colour from the dense amber of my first colostrum to the fine greyish milk which sprayed from my nipples when my babies were a few months old to the creamy off-white dribbles and pearls visible after they had been suckling for a time.

Some doctors have used breast milk’s lack of strong pure white (which you see when you pour a glass of cow’s milk) to convince women that their breast milk might be too weak, especially at the beginning of the feed, without enough calories for baby, and that this is why baby isn’t gaining weight well. Once, at a Brisbane baby expo, I stood up to question my colleague Dr Brian Symons, who made that claim to an audience of mothers. To be fair, he’d told us when he started that he had an arrangement with security and would not be taking questions. But I felt I couldn’t sit there as a medical doctor in front of so many vulnerable women and not take a stand for the science, so I put my hand up and asked a question which also contained a statement pointing out he was wrong. I was walked out of the venue by a security guard, who politely but firmly took my arm.

Breast milk doesn’t look strong white and pure, like cow’s milk, but it’s an extraordinary living human tissue, a superpower evolved over millions of years to extend a woman’s body and physiological systems into her baby’s, sculpting and protecting her little one’s body and physiological systems, nevertheless.

Unravelling the purity myth: complex systems

Pure is a mirage for us humans, a strange and brilliant species in whom the biological is profoundly entangled with culture. Unlike any other animal, Homo sapiens has developed the capacity to communicate using symbols, so that our tools, which we have used for 300,000 years with singular technical genius, transmitting exponentially growing and intergenerationally transmitted intellectual knowledge down the millenia, exploding now to include global internet connectivity and the threat and opportunity of AI. Pure is a mirage, when human culture enfolds the planet in an envelope of human connectivity and we have forgotten that we are part of the Earth.

I published a systematic review on fungi in human milk once, determined to overturn the outrageous myth which had been around from when I first qualified as an International Board Certified Lactation Consultant (IBCLC) in 1994 that thrush infection is the main cause of persistent nipple and breast pain. IBCLCs referred to lactation medicine doctors who dutifully prescribed weeks and even months of treatment for this, backed by the Australian Breastfeeding Association. Doctors discussed mammary candidiasis in detail at conferences, invented authoritative clinical descriptions that had no basis in research (“thrush causes deep stabbing breast pain between feeds, a shiny pink colour to the nipple skin, and flaking white scales”), and prescribed treatments which made the nipple pain worse, or even caused ulceration – like gentian violet applications. I always knew, both from my own clinical experience and also as the years passed from my analysis of the existing research, that these treatments wouldn’t help.

This was at a time when scientists were also unveiling the wild flourishing of fungi in a woman’s milk. After my paper came out, diagnoses of nipple and breast candidiasis became less common. Our US colleagues, always the loudest because the historical dominance of US-based lactation non-profits gives them a massively outsized platform and financial success, picked up my work and stopped talking about nipple and breast thrush. That single paper was many weeks out of my life, easier and less time consuming than many I’ve published, but still huge amount of unpaid work. I mention this one example of multiple because of the efforts by my own colleagues in lactation medicine to silence, or to devalue, my work.

The La Leche league, which drove the establishment of IBLCE, was founded by seven hardworking Catholic housewives (according to research by the University of Louisville). Founders later said the name came from Nuestra Señora de la Leche y Buen Parto — “Our Lady of Happy Delivery and Plentiful Milk.” The Australian Breastfeeding Association, founded in the 1960s, notes that its founders were inspired by the La Leche League, too, and drew on La Leche League materials.

Both IBLCE and the Academy of Breastfeeding Medicine were founded in the United States in the 1980s and 1990s in response to a dramatic post-war decline in breastfeeding in industrialised societies. The La Leche league drove the establishment of IBLCE, the International Lactation Consultants Association. The ABM endorses (or declines to endorse) conferences solely according to IBLCE's evaluation of WHO Code compliance.

Beliefs about the purity and rightness of breastfeeding arose out of 20th century conservative Christian values which sentimentalised the role of the mother, and blurred with beliefs about the purity of breast milk.

The advancement of breastfeeding in the West from the 1970s and 1980s has been vital work by tens of thousands of (mostly) health professionals, often donating their time to make a contribution, and calls for respect and celebration. But those of us who are passionate about helping breastfeeding and lactating women, their babies, and their families also need to contest outdated ideologies of rightness and purity, as we navigate the complex currents of 21st century polycrisis and its impact upon health systems and how women breastfeed.

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