Resiliency in Breastfeeding and Lactation Research: A Conversation About Scholastic Transparency,Bias,and Systems of Support

What we need during times of change is resiliency. Through breastfeeding, we anticipate and prepare our children on a cellular level for their changing environment. As discussed by Cerceo et al. (2024), breastfeeding fosters resilience in infant feeding because it is close, contained, and local; it doesn’t have to be dependent on the built environment, but can be a system existing directly between two humans. In this moment of accelerated environmental change, human milk and breastfeeding are exquisitely important to our resiliency, and our ability to adapt and to extend ourselves into new experiences.

The key to this mechanism of resiliency is an ability to react quickly to change. Through breastfeeding, we incorporate our environment into the care of our children, to prepare them, in turn, to thrive in concert with that environment. However, it is exactly that sensitivity that makes breastfeeding also vulnerable. Our world and the food we eat contain, within their structure, the story of the industrial byproducts in our environment, and so does our human milk. Human milk is not pure and sterile—it is not untouched; instead, it is full of our touch, our experiences, and our environment. Our resilience is in our vulnerability and, by being vulnerable and open to our systems, we build our resilience. Like the autonomic nervous system, this process works in the background, until something goes wrong—and then we need to understand how the system works to discover the error. Understanding requires knowledge, knowledge requires research, and good research requires honesty and transparency.

Approaching the conversation from a different direction, breastfeeding is resilient through our learned ability to stretch the distance between the parent and child to meet the realities of our lived experience. Simply put, feeding at the breast can no longer be assumed for the duration of the breastfeeding relationship. The totality of breastfeeding has expanded to include feeding human milk to human babies in creative and necessary ways. We express milk by hand and with pumps. We feed at the breast and by bottle, cup, or tube. We share milk across communities of parents so that those who are unable to produce enough milk can be supported by those who are producing more milk than they need. This stretch expands our definition of breastfeeding, adding resilience, while also increasing vulnerability. To support this extension, we need an understanding of the realities of lived human experience, at the macro- and micro-levels. We need to study, to share ideas across belief systems, and to merge systems of information if we are going to advance our lactation/breastfeeding research base. We need papers such as Non-Puerperal Adoptive Breastfeeding as Lactational Rescue in the Rohingya Refugee Camp: Two Case Studies (Sujon et al., 2024), which you will find in this issue. However, sharing our knowledge can be complicated. Being an ethical and transparent researcher is only the first step in the process.

During our tenure on this planet, humanity has created a wealth of cultures and belief systems, and what we believe we know is not necessarily translatable from ourselves to others. We find this in our environmental sciences as we debate global climate change. The cause of rising temperatures is still a point of disagreement in many global conversations, which makes how we extend ourselves in the present to prepare for an uncertain future profoundly difficult. As we move from the microcosm of cellular function to the integration of ideas about that function, we lean on scientific writing with small steps forward, building knowledge piece by piece, as a community.

This brings us to the heart of the debate about our role as a research journal in human lactation. If we are to discuss, to understand, to study, to extend and support breastfeeding in all the ways it shows up in our current diverse cultural contexts, we need to be open to publishing manuscripts that cover both the act of breastfeeding and the totality of providing human milk for human babies. We need to understand breastfeeding as a biological system (Christian et al., 2021; Groer, 2023) and, once milk is outside of the body, we need to understand it beyond its role as a nutritional substrate. We need to learn about how to manage its potential, to understand what it is, what it is doing, and how our processes affect its composition and activity. As a research journal, we will have to talk about bottles and teats, breast pumps and milk storage. We will have to be honest about the differences between embodied feeding at the breast or chest, and milk that is given by bottle. We will have to study suck as it differs between breast, bottle, supplemental feeders, and cups if we are to progress forward in form and function. Do we lose oral muscular development? Do we affect the quality of the immune system? Do we introduce chemical components into the milk because of the vessels we are using? And what of the lactating anatomy? How does our use of a pump extend and support lactation? As described by breastfeeding advocacy groups, breastfeeding is made vulnerable by the marketing of false teats when it is done for the wrong reasons. As a journal, how do we draw the line between corporate profit and the extension of access to human milk for human infants?

It is at this juncture that research and advocacy are obligated to take divergent paths to sustain the whole. Advocacy, in protecting the breastfeeding couplet from harm, necessarily favors shielding breastfeeding from interruption by unnecessary interventions because we do live in a world in which the market economy has—and does—harm breastfeeding, causing the illness and death of infants (Rollins et al., 2023). Research, at the same intersection, must not shield, but instead explore and discuss all options to contribute to the evidence that allows the deepest understanding of breastfeeding. If we are to grow the evidence base and meaningfully push the boundaries of what is known in the science of human lactation, it is vitally important to give researchers flexibility so that they are able to conduct this work while remaining vigilant for ethics violations, bias, and conflicts of interest with the market economy.

This is a difficult edge to walk, and it requires the editors of scientific journals to move forward with attention and purpose. Thankfully, there are systems in place for managing this process and implementing scholastic transparency. Funding statements and Disclosures and Conflicts of Interest statements are set up to protect the scientific community and our readers. We learn from qualitative researchers that we, the researchers, are never absent from the research itself, and so we present our biases to our readers. We discuss the limitations of the work we are doing in the Limitations section of a research paper. We reference our work, demonstrating that we are building on the shoulders of our colleagues through our Background and Discussion, moving slowly enough to create strength in our Outcomes and Conclusions.

In lactation, our history is particularly fraught with the conflation of innovation and corporate profit. This means we must be hypervigilant if we are going to publish ethical research with minimal bias. We must carefully assess all our work for inherent biases, racism, misogyny, and respect for cultural differences.

Caution is necessary. But too much caution will limit what we can accomplish. We cannot draw a line and stand by it. Instead, we must constantly assess how that line supports the resiliency of the whole of human lactation. At JHL, we aim to keep the conversation open and carefully moving forward by holding our authors to a level of openness about their outcomes, disclosures, and limitations. We do this so that you, the reader, can judge for yourself whether a research paper is biased.

We believe that by fostering open conversation over censoring, by defining human lactation with inclusivity, by accepting the presence of bias and communicating its potential source to each other, that we are doing our job as leaders in the field of lactation research; and, in so doing, we are building the evidence base and resiliency in breastfeeding and lactation research.