Case study: 'cancelling' an evidence-based primary care innovation which offers alternatives to low value care for management of breastfeeding problems and unsettled infant behaviour
The NDC or Possums programs have been developed as a response to the high levels of overmedicalisation and paramedicalisation in early life care
Over the past two decades, in direct response to the growing problem of low value care of common breastfeeding and infant care problems, I have developed Neuroprotective Developmental Care (NDC or the Possums programs) as a primary health care (or community-based) clinical innovation developed by applying the principles of implementation science. My approach to development has aligned with the principles articulated by Armstrong 2018:
“There is growing recognition within healthcare improvement research of the gains to be had from ensuring that the design and execution of improvement efforts are appropriately theoretically informed, and [articulate] a clear theory of change, an account of how and why the planned activities are credible as a means through which the desired outcomes can be achieved. It’s also important to ensure robust evaluation of efforts to tackle the problem.”
The NDC or Possums programs are a multi-component suite of clinical interventions which address the domains of breastfeeding, feeds, sleep, cry-fuss problems, infant sensory motor needs and development, and perinatal and infant mental health, based on acknowledgement of the interrelated complexity of each of these domains. The NDC interventions are clinical translations of theoretical frameworks established in about 20 systematic or narrative theoretical framing reviews, and have been refined in response to 10 peer-reviewed published evaluations which demonstrated the programs’ efficacy, as well as ongoing feedback from clinical practice. Education pathways for health professionals include NDC Accreditation and a high level Lactation Fellowship.
You can find here the scientific publications contributing to the development of NDC which have raised the alarm about overtreatment and unintended outcomes in management of breastfeeding problems and unsettled infant behaviour.
Breastfeeding and lactation non-profits use commercial levers to ‘cancel’ the Possums or NDC innovations in clinical breastfeeding and lactation support
"All flourishing is mutual." Robin Wall Kimmerer
The International Board of Lactation Consultant Examiners (IBLCE) currently operates a global monopoly on breastfeeding education for International Board Certified Lactation Consultants (IBCLCs), of whom there are about 38,000 worldwide. It is not necessary to be a registered health professional in their own country to qualify as an IBCLC. Two associated non-profits endorse various lactation courses, which are deemed to be compliant with IBLCE requirements.
IBCLE has withdrawn attribution of Continuing Professional Development points from the Possums programs and my related presentations anywhere in the world, in response to my publication of two research articles which challenge bodywork- and frenotomy-dominated approaches to breastfeeding problems, and which offer alternative evidence-based clinical strategies. Withdrawal of CPD attribution ‘cancels’ this innovative suite of evidence-based interventions from visibility amongst IBCLCs and breastfeeding medicine doctors internationally. You can find out more about this here.
Unfortunately, this has become a widespread problem, affecting dozens or more of the world's leading researchers in the field of breastfeeding and lactation, and has the affect of seriously skewing the kind of education received by breastfeeding medicine doctors and other health professionals, including IBCLCs.
Australian breastfeeding non-profits align with IBLCE to 'cancel' the Possums or NDC innovations in clinical breastfeeding and lactation support
In other local examples
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I had just finished setting up a small trade table for Possums at the Breastfeeding Medicine Network of Australia and New Zealand (BMNANZ) Conference April 2024, when I was required to fill out a form which questioned whether IBLCE had previously sanctioned anyone participating in the stall. I had flown down to Melbourne for the event and the need to declare my IBLCE blacklisting hadn't been mentioned previously. I stated on the document that there would be no-one manning the stall and therefore no-one who had been sanctioned by IBLCE would be at the stall. I didn't stay by the trade table throughout the duration of the conference. I communicated with the conference organiser that I was concerned about this form, and asked that she communicate my concern to the BMNANZ Board. I received an email from the BMNANZ Board stating: IBLCE states "CERPS cannot be recognised for programmes sponsored by or connected to organisations that violate the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions, including programmes where a speaker has identified connection to an organisation that falls within such scope." As our trade tables and their representatives are included in the programme, we felt it appropriate to confirm that they were also compliant to ensure we were not at risk of a breech. We appreciate your understanding. BMNANZ Board.
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Although I'm a network member, on 6 April 2025 the Board Directors of BMNANZ declined to allow mention the NDC or Possums programs in their newsletters which aim to inform members of news and initiatives in the field of breastfeeding medicine. This included declining to allow colleagues to be notified of the new Lactation Fellowship and our program of international guest speakers. The Board wrote: "Given the growing number of providers in this space, it would be difficult to include all opportunities equitably, and we want to ensure a fair and consistent approach. To maintain alignment with our mission, we have decided to limit inclusion to not-for-profit network activities. This will include ABM as the peak international body, ABA and BMNANZ as our national networks, and then state-based events as they occur." I note there is no other organisation within Australia offering an education pathway for breastfeeding medicine doctors which covers the NABBLM certification curriculum, or which offers a regular online guest speaker program which aims to educate breastfeeding medicine doctors.
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This decision was upheld by the Board on 12 April 2025 after I made a courteous written appeal. The Board of Directors wrote: "We will not be providing an exemption for The NDC Institute. We will be limiting any associated mentions or promotions to current not-for-profit educational sources. At this stage, we anticpate that this will be imited to the Australian Breastfeeding Association and Academy of Breastfeeding Medicine. .... This is nonetheless our final decision." I note that the BMNANZ newsletter nevertheless continues to raise the profile of various breastfeeding medicine doctors who run educational or clinical small businesses in the field of breastfeeding and lactation support.
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I had made two offers to participate voluntarily in education roles within BMANZ over the previous year and I repeated that offer for a third time on 1 July 2025, mentioning that I hadn't heard back one way or the other. The BMANZ Board replied that BMANZ wasn't "currently in a position to take on additional volunteers" and would be hoping "to create more opportunities for member involvement in the future as our capacity grows." Here's some context.
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BMNANZ continues to bring in lots of Australian doctors to offer their education and presentation opportunities, many of whom have upskilled with the Possums programs.
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I have records of very positive feedback from Australian GPs over the past decade of teaching breastfeeding and lactation medicine courses, which are sent through to the RACGP in the compulsory feedback for Continuing Professional Development points.
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In response to an approach by Dr Monica Pina, in 2024 I applied for, and was awarded, recognition as a Fellow of the Academy of Breastfeeding Medicine for my service in the field of breastfeeding medicine.
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The Australian Breastfeeding Association (ABA) declined to allow NDC or the Possums programs to pay for advertisements to parents in their parent magazine in 2025, stating that to do so would not align with their goals, even though the ABA accepted, at the time and subsequently, paid advertisements from a wide range of businesses which offer low value health care, including from baby expos which extensively promote low value health care interventions.
These are just small examples of the powerful ways in which commercial levers, driven by breastfeeding ideologies rather than commitment to quality and genuinely evidence-based health care, are currently used by the world's dominant single-issue breastfeeding non-profits to ‘cancel’ genuinely evidence-based primary health care initiatives in the fields of breastfeeding and unsettled infant behaviour.
This is a major issue for those who care about the ethics of breastfeeding medicine, and the wellbeing of breastfeeding mothers, their infants, and their families.
Recommended resources
Groundbreaking research is 'cancelled' by single-issue breastfeeding non-profits
Selected references
Armstrong N. Overdiagnosis and overtreatment as a quality problem: insights from healthcare improvement research. BMJ Quality and Safety. 2018;27:571-574.
Azad MB, C NN, Bode L. Breastfeeding and the origins of health: interdisciplinary perspectives and priorities. Maternal and Child Nutrition. 2020;17:e13109.
Chetwynd E. From censorship to conversation: agnotology, market infuence, and the ethics of breastfeeding research. Journal of Human Lactation. 2025;4(3):303-305.
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.
Kimmerer, Robin Wall. The serviceberry: abundance and reciprocity in the natural world. New York: Scribner 2024.
