Lactation non-profits and charities are not necessarily organisationally pure (i.e. operating in the best interests of the public)

Non-profits are not necessarily operationally pure and pull commercial levers to ensure their own survival

Lactation non-profits leverage goodwill from the belief that the non-profit is a pure or superior form of governance structure for supporting breastfeeding women, compared to a business or social enterprise structure.

This belief in the governance purity of the non-profit fails to take into account the growing critiques of charity and non-profit operations, their vulnerability to poor governance, and their difficulty responding in an agile or timely way to emergent challenges. Because non-profits and charities, too, need to survive commercially, they can quite easily take on the worst of predatory business practices. Others may be tightly controlled by families or founders, in order to secure founders’ incomes, though this may not be transparently declared as a conflict of interest. Still others use levers to exclude or silence perceived competitors under the guise of non-profit purity of intent. This naivity concerning the governance structure of lactation non-profits (which I shared prior to founding a charity) does not, in the end, serve the best interests of lactating women and their babies.

I personally have rarely received research funding. The most I had was $10,000 in 2009. The Chris Silagy award from the RACGP in 2009 gave $20,000 – but stipulated none could go to the researcher herself. The NDC Rural grant funded the charity and project staff to execute the project but didn't alter my income. My own role in my 30 or so research publications has been self-funded. That is, most of the work I’ve done over the years has been ‘voluntary’, funded by seeing my patients in the clinic (and latterly, by investing my superannuation).

I feel an ache when BMNANZ’s automatic emails refer how the organisation is run by volunteers, asking the recipient to understand and forgive delays and so on. I feel an ache because I am confident I have invested many multiple times more of my personal finances and indeed my own future into the voluntary work that I have and still perform in this field relative. BMNANZ is right to ask others for special understanding because it's run by volunteers (though the independent for-profit business organising their conference needs to be paid) - yet BMNANZ declines to allow network members and Australian doctors to know about the NDC Lactation Fellowship, or the Guest Speaker series, or the Lactation Medicine Lab - stating that this is because The NDC Institute operates as a social enterprise, not a non-profit.

My willingness to expose myself to financial risk in the absence of spousal protection or generational wealth is a kind of crazy-brave bone-deep commitment to the future of families who seek the help of lactation medicine doctors and other lactation professionals, and something for which I take complete responsibility. This investment of my own financial security has been a clear-eyed choice and I understand that most would see it as foolish. For me, it has been a matter of purpose, of meaning, and I’ve not known what else I can do to earn a living into the future in a way that uses what is now my highly specialised skillset. I dare to trust that it is all going to be ok.

But I'm very sad that my own volunteer work is not considered by my colleagues on the BMNANZ Board as something to respect and honour and support, even to celebrate.

Lactation medicine needs to be embedded in a 21st understanding of complex systems

Each of these beliefs – that the disruptive outsider who disrupts group purity requires stigmatising punishment, that the lactation non-profit mission is pure, that there is a purity of knowledge and authority in lactation education - these beliefs are simplistic distillations of very complex realities. For instance, the disruptor does cause discomfort and inconvenience, even though she needs to be invited into the group, for the sake of the health of the group and ultimately for the sake of the families they serve.

21st century knowledge of complex systems teaches us that If we start to behave according to simplistic or reductionist paradigms, we risk causing unintended and sometimes dangerous outcomes, in a world and in families which operate as complex systems. This is the tragedy of lactation medicine today, even as it begins to gain traction as a standalone special interest or field within medicine.

It’s why I’m calling for change. I lift my often quite afraid but resolute older woman’s voice (since what else is there for me to do really in what’s left of my professional life, having given so much to this field?) to say that the lactation non-profits globally are driving dangerous levels of overmedialisation, paramedicalisation, and overdiagnosis, and this is because of a historical ‘purity’ of thinking, that fails to grasp either intellectually or viscerally the nature of the complex systems of the times we are forced to inhabit. I lift my older woman’s voice to say to the younger ones that isn’t time to mess around: leaders in every field of human endeavour, including in lactation medicine, need to get real about the extraordinarily complicated nature of our times, and quickly. We need to get real about complexity and abandon fantasies of purity.

There’s something cruel about the smallness of purity. There’s something cruel about excluding women who decide, in the face of shocking nipple pain or damage, in the face of the exhaustion of long-term triple feeding (that’s direct breastfeeding, pumping, then bottle feeding routines) and baby weight gain concerns, in the face of a little one who fusses on and on at the breast, that they need to change over to formula. There’s something cruel about excluding them from the title of lactation medicine which at the same time is now, I notice, claiming to offer special expertise in multiple domains of infant care, not just lactation.

There’s something cruel about excluding women (it is mostly women researchers and educators who are affected, though not always) from educating in a field that they are passionate about, have devoted their life to, are courageously attempting to make a contribution in – at the same time as their work is extracted from, without appropriate acknowledgement, often without recognition of where the work even comes from since this has been going on for so many years.

I suppose it might be different if I was dead, but I'm still here and very much alive and planning to be around for a long time yet - and still working hard to make the most meaningful contribution I can towards the wellbeing of families and their babies!

There is a cruelty to the pure, and I'm walking away from it.

Recommended resources

Possums Breastfeeding & Lactation articles which address lactation non-profits, ideology, and harm