Abstract
What do we lose when we lose the word “woman?” What do we lose when we promote “human milk feeding” instead of “breastfeeding?” As a breastfeeding researcher, I have attended more than one breastfeeding conference in the past year in which I almost never heard the words “woman,” “mother,” or “breastfeed.” Instead, presenter after presenter spoke about “parents,” “lactating individuals,” “birthing people,” and “human milk feeding.” This sweeping change in language is increasingly happening in written material as well.
Being inclusive of all people who give birth and nurse their infants is important. All people deserve to feel seen and welcomed. It is important to take steps to demonstrate social acceptance, in part with the language we use. Hence many people avoid using sexed terms such as “women” and “mothers” because of concern that some birthing individuals who do not identify as women may feel unseen or erased by these terms. In addition, “human milk feeding” can be seen as a desexed and inclusive term, as well as a way to embrace the growing number of women who practice exclusive pumping, a trend which is gaining footing in the United States and Asia. 1
While acknowledging the vital importance of inclusivity, it is also worth taking a broad view and asking if there is any cost to the erasure of “women,” “mothers,” and “breastfeeding” from the lexicon. Societies name what they value, so what does it mean for the value of women, mothers, and breastfeeding when they are no longer named? Is there any harm done by shifting our language in this way? And if there is harm, should there be any kind of balance to the language we use, or other ways to mitigate this harm?
Most people would probably agree that use of desexed terms (like “parents”) should be encouraged when the sex of a person or thing is not relevant. However, it is less obvious that using desexed terms when sex is relevant can sometimes be problematic. When discussing reproductive health, using desexed language can sometimes cause inaccurate information to be conveyed and can also cause confusion. My colleagues and I have described many such problems in our widely read article from 2022. 2 In addition, the Academy of Breastfeeding Medicine issued 2021 guidelines about how it will respectfully be inclusive yet accurate in its publications 3 and in its journal.4,5
Aside from such technical problems, with confusion caused by inappropriate use of desexed language, we must consider whether there is a broader social cost to this shift in language. If we do not mention women, are we harming the way society values women? Could this language affect the way women view their pride in their identities as women and mothers? Is there harm to the advocacy of issues that are specific to women, like reproductive rights, paid maternity leave, equal pay, sex-based violence, and workplace discrimination? After all, when “women” are simply “people” like everyone else, discrimination against women becomes invisible.
The disappearance of “breastfeeding” through the use of the desexed terms “human milk feeding” and “lactation” inadvertently erases infants and children. “Lactation” and “human milk feeding,” sap breastfeeding of its social and behavioral meaning and reduce it to a physiologic function of making milk or a transactional function of providing generic “human milk” to generic human infants without inferring any emotional connection. “Lactation” and “human milk feeding” are only about milk and nutrition and have nothing to do with nurturing a child, bonding with a child, or the time spent in constant physical contact with a child. Neither “lactation” nor “human milk feeding” even require physical contact between a mother and her child, let alone an emotional connection, even when such connections exist. These terms are dehumanizing when used this way.
Advocacy for women’s rights cannot occur without using the term “women.” It is important to understand that discrimination against women occurs because of their reproductive differences with men. Women and girls comprise just over half of the world’s population, yet they are nearly universally marginalized. To not be able to name women makes women even less visible and more marginalized than they already are, putting their health and lives at risk. In many high-income countries, women are being increasingly marginalized. Referring to women as “people” or “parents” makes it impossible to advocate for social justice for women, causing them further harm and often harm to their children as well.
The backlash against women’s rights is occurring throughout the world, with right-wing factions increasingly rising to power in Europe, the United States, Argentina, and elsewhere. Women’s bodies are being threatened. In the United States, for example, women face appalling maternity mortality rates, closing of maternity care hospitals, and creation of maternity care “deserts,” 6 as well as the wholesale denial of reproductive rights, particularly the right to surgical and medical abortion.
Advocacy for women is also vital in scientific research. The vast majority of drug research is performed using male subjects (including male animals), 7 even for drugs that are taken by male and female patients for conditions that affect both. This marginalization of women has led to women suffering markedly more adverse drug reactions and toxicities because drugs were never tested on women’s bodies. 8 This kind of consequence may be in part because of the lack of women scientists, so that there are few scientists even asking if females should be studied. 9
Paid maternity leave is a quintessential women’s issue, not to be confused with “parental leave,” which includes partners/fathers. To be clear, women are deprived of adequate paid maternity leave in most countries because it is women who are treated unfairly, not “people” or “parents.” While partner leave is desirable, it must be acknowledged that mothers have biological needs after childbirth that are fundamentally different from the needs of the other parent. 10 There are sexed differences in the care of infants after birth, particularly with regard to breastfeeding, as well as recovery from childbirth. Both parents are not equal in this regard, even though there may be rare instances in which a nonbirthing parent (nearly always a woman) induces lactation. With a large body of research showing the many ways that maternity leave can benefit a country’s economy and boost economic growth,11,12 one must wonder if the inadequate maternity leave in many countries is owing to the subordinate status of women, the marginalization of the needs of women and children, and the disregard for the importance of breastfeeding. To the extent that the sex differences of men and women are erased, the need for paid maternity leave will be further jeopardized.
It is also important to name women when talking about rape as a weapon of war. Combatants use rape of women and girls to terrorize populations and sometimes intentionally to impregnate victims. This type of sexual assault is usually called “gender-based violence,” but this term is inaccurate. “Gender-based violence” would refer to sexual assault of people who look like females, but could include people who have male bodies. War-based sexual assault is sexed-based violence—violence against people with female bodies. In discussing sex-based violence, it is vitally important that the words “women” and “girls” are used because they are targeted specifically because they have female bodies.
Sex-based violence against women and girls should not be confused with violence against transgender individuals. Violence against transgender people is a hate crime that targets people because they are transgender, not because they have women’s bodies, although it may or may not include sexual assault.
In some repressive countries, such as Afghanistan and Iran, women and girls are deprived of the most basic rights, such as freedom of movement, education, freedom in marriage, and much more. A patriarchal society deprives them of such rights, specifically because they have bodies that can potentially bear children. If we cannot name “women,” we cannot talk about this wholesale deprivation of human rights. In such countries, it is not “people” who are targeted—women and girls are targeted because they look like women and girls and are deprived of rights because they have female bodies.
Language is important in lobbying and advocacy. Some legislators and policy-makers may not understand or respond well to desexed language, especially in the growing far right climate. A term such as “breastfeeding woman” is easily understood and may conjure archetypal images in Western culture such as Madonna and child, whereas a term such as “lactating individual” or “birthing person” may be unfamiliar and elicit little sympathy. Many legislators and policy-makers may be unaware that not everyone who lactates or gives birth identifies as a woman. Even those who are aware of gender diverse people in human reproduction may unfortunately look unkindly on gender diverse individuals. Some legislators, particularly those on the far right, may find desexed terms objectionable and purposely avoid considering measures containing terms such as “lactating person.” Success at getting measures passed may depend on using terms such as “breastfeeding,” “mothers,” and “women.”
Sadly, desexed language can result in well-meaning campaigns where misinformation is spread. Some prominent US organizations have advocated for “human milk feeding” in times of disasters, including the American Academy of Pediatrics (AAP). 13 In fact, human milk feeding is quite problematic during a disaster, when there may be no access to electricity, refrigeration, hot water, or sanitation, all of which would be important to support the expression, feeding, and storage of human milk. By contrast, breastfeeding is lifesaving during disasters precisely because it requires none of those things, and offers tailored immune protection, which pumped milk cannot do. 14 Women who feed exclusively by pumping milk may be at a dangerous disadvantage in situations without electricity or sanitation.
The AAP also recommends “human milk feeding” to prevent Sudden Infant Death Syndrome (SIDS). 15 Not only has no research been done to show that “human milk feeding” prevents SIDS, but it may well be that the nighttime behaviors of breastfeeding mothers, such as how they sleep with their infants, are at least as responsible for the lower risk of SIDS as the milk. 16 The physiology of breastfeeding suggests that women who bottle-feed expressed milk likely have a fraction of this risk reduction, but there is simply no data to tell us. The AAP recommendation is inaccurate at best and potentially dangerous at worst because those who bottle-feed formula may engage in hazardous behaviors at night. 17
Finally, it should also be acknowledged that many women and mothers may feel their identities as women and mothers are also erased when they are referred to as “birthing people,” “lactating individuals,” “parents,” or other desexed terms. A grieving mother who lost her newborn may feel additional pain if she is described as “birthing person” or “parent,” as these terms may be seen as insensitive in this context. 18 Language should not be used as a tool to erase any type of person from our lexicon. The desire to be described in a way that is not dehumanizing and reflects one’s full identity as a person is valuable for all people, regardless of sex or gender identity.
Solutions
Women are more than birthing people. Mothers are more than lactating individuals. Breastfeeding is so much more than lactation and human milk feeding. We must strike a balance in which all people can feel seen, and in which the important role of women and mothers is acknowledged. We must allow for the humanity and identity of every person, while promoting the ability to advocate for equality and justice.
The term “birthing people” may be the best term we have that is inclusive of gender diversity, even though it reduces all people to a physiologic function. However, it should not be the only term we use. “Mothers” and “women” are equally important to include, and omitting them would render women and mothers invisible and thus confer a lack of value on them. The use of “parent” when only “mother” and “birthing person” are intended can cause confusion by conveying meanings that are unintended. “Breastfeeding” must be used wherever it is appropriate and not substituted with “lactation” or “human milk feeding” when those terms are not appropriate, as their meanings are completely different.
No word or words can substitute for breastfeeding as a social behavior. While some dyads cannot feed directly at the breast, exclusive pumping should not be embraced as a normal way to feed an infant. The lack of normal physiology is not only exhausting for mothers and infants, 19 but bottle-feeding lacks the aspects of breastfeeding shown to increase maternal sensitivity and mother–child attachment. 20 In addition, pumped milk has a different microbiota profile that offers less immune protection for the infant. 14
“Chestfeeding” and “bodyfeeding” are often used in place of “breastfeeding” as more gender-neutral desexed alternatives, intended to avoid the word “breast.” These terms can be problematic when used in a scientific or academic context because they can have widely varied meanings without medical definitions. They may mean anything from “breastfeeding,” as we typically understand it, to feeding formula through tubing taped to male breasts. It is important to note that in medical parlance, “breast” is not a sexed word, and is used for both the male and female body part, and “chest” does not even include the breasts. Communication would be much clearer if “breast” was also regarded as a desexed word in everyday speech, avoiding the need for unclear alternatives. In an academic, medical, or scientific context, clarity and accuracy demand that “breast” and “breastfeeding” be used instead of “chest,” “chestfeeding,” or “bodyfeeding” in most cases.
We cannot allow ourselves to reach a place where “women,” “mothers,” and “breastfeeding” become obsolete words, particularly in academia and science. Inclusivity is important, and we must find ways to include the diversity of birthing people without unwittingly erasing women, mothers, children, and breastfeeding. These words also matter immensely, now more than ever.