In May, delegates to the World Health Assembly (WHA) were pressured by their U.S.counterparts to vote against a resolution that called on governments to support breastfeeding. In one case, delegates from Ecuador were threatened with negative trade repercussions and a loss of military support. Ultimately, the United States’ efforts were thwarted, and the resolution on infant and young child feeding passed, with a few revisions.

But the U.S. opposition to the WHA resolution was about more than only breastfeeding. These actions, recently reported by the New York Times, were a stark reminder that breastfeeding is political and an important component of reproductive health.

Breastfeeding is typically nestled comfortably somewhere between maternal and child health. We often tout the short- and long-term infant and child health benefits of breastfeeding and pay minimal attention to the benefits to the lactating individual. For example, a 2016 Lancet series shared that universal breastfeeding would prevent more than 800,000 child deaths and 20,000 maternal deaths a year and save $300 billion annually in reduced health-care costs and improved economic outcomes for those reared on human milk. There are significant health benefits associated with breastfeeding for women and lactating individuals over the course of their lives. Yet, breastfeeding is rarely seen as a women’s health, reproductive health, or reproductive justice issue in the United States.

For decades, breastfeeding has been framed as a human rights issue globally, as part of the right to health. However, this human rights framework does not integrate an intersectional lens, which is critical to both reproductive health and reproductive justice.

In this country, breastfeeding is often framed as an individual choice. This framing is harmful and counterproductive. At best, there is an illusion of choice. Many individuals, specifically people of color and those living in low-resourced communities, often encounter numerous structural, societal, historical, cultural, and sometimes physiological barriers that affect their ability to meet their breastfeeding goals. Further, breastfeeding advocates are often depicted as fierce opponents of the $70 billion dollar formula industry and supplementation. Supporting breastfeeding does not equate to restricting access to formula. One can be supportive of global and domestic breastfeeding and also support individuals and families who supplement with formula.

Instead of impeding global efforts to support and promote breastfeeding, the United States should focus more resources addressing the critical strategies outlined in the 2011 Surgeon General’s Call to Action to Support Breastfeeding.

While many health professionals were taken by surprise by U.S. attempts to block the resolution, the political tactics used during the World Health Assembly (part of the World Health Organization) were not new. These tactics are in line with the current administration’s efforts to restrict global and domestic funding, resources, and support for women’s and reproductive health initiatives. To name a few, the Trump administration reinstated the global gag rule in January 2017, which prevents nongovernmental organizations receiving U.S. federal funding from providing education or discussing the full range of reproductive health options, particularly abortion. It has proposed budget cuts to or attempted to weaken the Affordable Care Act, Medicaid, the Teen Pregnancy Prevention Program (TPPP), and Planned Parenthood. In May, the Trump-Pence administration also considered implementing a domestic gag rule.

Given these efforts, it was no surprise that breastfeeding found itself in the political crosshairs. The systematic erosion of funding and support for reproductive health initiatives is emblematic of this administration’s prioritization of corporate profits over human interests, especially those pertaining to women, children, and pregnant individuals.

Going forward, breastfeeding can no longer be separated from reproductive health and reproductive justice. According to Loretta Ross, one of the founders of reproductive justice, it is an intersectional theory, practice, and strategy that grounds four principles in a human rights framework: 1) Every person has the human right to decide if and when to become pregnant and to determine the conditions under which they will birth; 2) Every person has a human right to decide they will not become pregnant or have a baby and options for preventing or ending pregnancy are accessible and available; 3) Individuals have the human right to parent children they already have with dignity, with the necessary social supports in safe environments and healthy communities without fear of violence from individuals or the government; and 4) Individuals have the human right to disassociate sex from reproduction and that health sexuality and pleasure are essential components to whole and full human life.

Reproductive justice seamlessly integrates and amplifies issues which disproportionately impact people of color and marginalized communities. This framing is critical to breastfeeding as communities of color, specifically Black communities, are disproportionately affected by poor birth outcomes such as prematurity, low birth weight, infant mortality, lower breastfeeding rates and maternal mortality and morbidity. While breastfeeding or the provision of human milk cannot prevent prematurity or low birth weight, it has strong potential to mitigate poor birth outcomes and prevent infant mortality by supporting infant health, neurodevelopment, and immune system development in vulnerable infants; and it reduces the risk of cardiovascular disease, diabetes, and breast and ovarian cancers in the lactating individual.

Breastfeeding is political. Breastfeeding is also a critical element of women’s and reproductive health.

Health professionals and breastfeeding advocates must think beyond the safe space of our breastfeeding bubbles. We need to think big picture, expand our knowledge, and collaborate with our reproductive health and reproductive justice colleagues.

There are a number of things you can do right now to better support breastfeeding and the provision of human milk:

1. Support regional and national organizations currently doing this work such as Reaching Our Sisters Everywhere, the Center for Reproductive Rights, SisterSong, the Carolina Global Breastfeeding Institute, the Black Mamas Matter Alliance, the Women’s Foundation of California, and California Latinas for Reproductive Justice.
2. Reach out to your professional organizations via email, letters, phone calls, and social media platforms and ask how they are addressing breastfeeding and other reproductive health and justice issues.
3. Review the U.S. opposition to WHO resolution action steps created by the United States Lactation Consultant Association.
4. Join the United States Breastfeeding Committee in Atlanta, August 4-5, 2018, at the National Breastfeeding Coalitions Convening. There will be opportunities to learn about how to engage reproductive health colleagues and ways to integrate a reproductive justice approach into your current breastfeeding and human milk work.

This article would not have been possible without contributions from Monica McLemore of the University of California, San Francisco; Aunchalee Palmquist of the University of North Carolina, Chapel Hill; and Tanefer Lumukanda Camara of Alameda Health System.