Breast Pumps, Patriarchy, and Profits: The Rise of Pumping and 'Human Milk Feeding'

This debate article, published in the International Breastfeeding Journal (IBJ) in March 2026, is part of a series of critical works examining recent developments in infant feeding practices and language in high-income anglophone countries.

The central thesis is as follows:

The growing normalisation of breast pumps and the progressive replacement of the word 'breastfeeding' with expressions such as 'human milk feeding' or 'lactating parent' do not represent progress towards equality, but rather reflect a patriarchal and commercial logic that is contrary to the interests of women and children.

Note: This is a debate article, meaning it presents a structured argument defended by its authors. This type of publication expresses a position supported by existing data, rather than an original research protocol. Its value for IBCLCs lies in naming structural dynamics that are rarely visible in the clinical literature.

Direct Breastfeeding versus Expressed Milk: Differences That Matter

The authors remind us that breastfeeding is a dynamic physiological relationship between mother and child, one that cannot be replicated by a breast pump. Several biological mechanisms specific to direct breastfeeding are documented in the literature:

The composition of breast milk varies according to gestational age, time of day, and even over the course of a single feed (hormones, nutrients, satiety factors). These variations are lost during expression and storage.
During suckling, the infant's saliva communicates immune signals to the mammary gland, stimulating the secretion of leucocytes and secretory IgA adapted to current infection. This mechanism is absent with bottle feeding.

Lactasource note: The retrograde exchange of infant saliva bacteria to the mother is not proven and has been challenged, particularly on the basis of the physiology of pressure within the lactiferous ducts. If an infant is in frequent contact with an exclusively pumping mother, she will in any case produce adapted immunoglobulins in her milk.

Melatonin secreted in breast milk follows a circadian rhythm and contributes to the establishment of the infant's biological rhythms, as infants do not produce their own melatonin in the first months. This signal is altered by freezing.
Direct breastfeeding is associated with a lower risk of otitis media, dental malocclusion, and sudden infant death syndrome (SIDS), notably through postural mechanisms and airway protection specific to breastfeeding.
The duration of lactation is significantly shorter in women who exclusively pump, with an adjusted hazard ratio for cessation of lactation ranging from 1.77 to 3.3 depending on the study, compared to direct breastfeeding.
Exclusive pumping is associated with greater supplementation with infant formula, altered intestinal microbiota, and reduced maternal responsiveness to infant cues.

The Rise of Exclusive Pumping and Breast Pumps: Practice and Contexts

The authors note that the prevalence of exclusive pumping varies by context: 14% in the United States, 22% in certain regions of China, and 26% in Singapore. In Malaysia, a 2017 study reported that 49% of women of Chinese origin were feeding their one-month-old infants exclusively with expressed milk, compared to 29% who were directly breastfeeding. These figures highlight a structural ,not marginal, trend.

The main reason cited by women for practising exclusive pumping is difficulty latching the baby at the breast (cited by more than 70% in some studies), not a preferential choice: only 8% of women in one American cohort reported pumping out of personal preference. The authors see this as a sign of a structural lack of breastfeeding support, rather than an expression of individual freedom.

Women who exclusively pump describe the practice as exhausting and isolating. A qualitative review of specialist blogs shows that many link exclusive pumping to breastfeeding as a mechanism of repair in the face of guilt over not having been able to breastfeed directly: highlighting the emotional burden of these situations and the need for appropriate support.

Commercial Forces, Public Policy, and Structural Interests

The global breast pump market grew from approximately $620 million in 2011 to over $2 billion in 2024. Wearable pumps (hands-free pumps worn inside the bra) represent a fast-growing segment, estimated at close to $900 million by 2030.

Yet breast pumps are not covered by the International Code of Marketing of Breast-milk Substitutes, leaving their marketing entirely unregulated.

Manufacturers (and in France, breast pump rental companies) directly train healthcare professionals, creating a manifest conflict of interest.

The authors analyse how the professional context structures the use of breast pumps: without adequate maternity leave or parent-infant proximity at work, the pump becomes the only viable option. In the United States (the only high-income country without paid statutory maternity leave) the PUMP Act of 2022 guarantees breaks for pumping, but does not promote mother-infant proximity. According to the authors, this framework deflects political pressure away from employers and the state and onto women, while simultaneously serving the interests of the breast pump industry and employers.

The Language Question: 'Breastfeeding' vs. 'Human Milk Feeding'

The replacement of 'breastfeeding' with 'human milk feeding' or 'lactating parent' is presented in some anglophone countries as an inclusive advance for transgender people. The authors acknowledge the legitimacy of adapted language for these specific communications, but raise concerns about the side effects of its generalisation.

On the one hand, this linguistic shift creates an implicit equivalence between breastfeeding and bottle-feeding with expressed milk, erasing the documented physiological differences. It thereby provides an opening for the breast pump and infant formula industries, which use it to minimise the specificity of direct breastfeeding.

On the other hand, it weakens advocacy for women's and infants' rights to breastfeeding. The authors notably cite the American Academy of Pediatrics (AAP), which has incorporated the expression 'human milk feeding' into two major clinical recommendations (SIDS prevention, feeding in emergency situations) without the available evidence base addressing anything other than direct breastfeeding.

In our daily practice in France, we use the term "breastfeeding" (allaitement maternel) to refer to all forms of breastfeeding, and distinguish between nursing at the breast and pumping. Pumping is a form of breastfeeding (it is not a 'lesser' form of breastfeeding). In

However, bottle-feeding with infant formula is not a form of breastfeeding, even if for convenience one sometimes says 'bottle breastfeeding' (allaiter au biberon). It should also be remembered that many mothers who exclusively breastfeed until 6 months and conscientiously follow WHO recommendations will at some point, in France, need to pump during the day when they return to work. It would be both inaccurate and hurtful to suggest that these mothers did not exclusively breastfeed until 6 months.

The Authors' Proposals: Towards Societal Change

The authors put forward recommendations centred on societal transformation rather than individual injunctions directed at mothers:

Full paid maternity leave of at least 6 months, ideally 12 months, including informal sector workers.
Normalisation of infant presence in the workplace, on-site nurseries, remote working, and part-time arrangements for parents.
Generalisation of Baby-Friendly Hospital Initiative (BFHI/IHAB) practices, with universal access to qualified breastfeeding support in maternity wards and after discharge.
Teaching manual expression of milk to all women, to develop autonomy without dependence on industrial breast pumps.
Including breast pumps within the scope of the WHO Code and prohibiting their direct marketing to the public and healthcare professionals by manufacturers.
Retaining the term 'breastfeeding' in general communications; using inclusive formulations only in the specific relevant contexts.
Unconditional compassion and support for women who exclusively pump, without presenting this practice as equivalent to direct breastfeeding.

Our view on this article

This article raises the tensions between breastfeeding difficulties, work, insufficient support, and commercial pressure that drive women towards pumping. The authors express their desire not to judge feeding choices, but to expose the deficits in breastfeeding support that generate profit for pump companies, which remain subject to no regulation.

From our perspective, and this is what we denounce on this blog, this article rightly points to the industrial interests and patriarchal logic that profit from the normalisation of pumping.

But it is missing another dimension, which we observe daily: the exploitation of young mothers' vulnerability by other women themselves, in the name of a supposed sisterhood.

A few years ago, groups were set up, particularly on Facebook, where exclusively pumping mothers could find support and practical advice. Many lactation consultants who proposed strategies for returning to the breast, or who assessed the exclusive pumping situation as too exhausting, did not always meet these mothers' expectations. Some of these groups gradually became organised and even sometimes led to the creation of associations supporting breastfeeding via pumping. The mothers who formed them became, in a sense, 'ambassadors' of this practice and provide important peer support and experience sharing.

But as is very often the case in perinatal care, the intensity of this experience has led some mothers to want to make it their profession, made easy by the simplicity of setting up as a self-employed entrepreneur, by blurred boundaries between healthcare professional support and coaching, and by an explosion in the pumping market.

This parallel ecosystem of self-proclaimed "experts", without scientific training, without certification, without a code of ethics, who remotely diagnose elastic nipples, prescribe flange sizes, and sell them at a premium in the process, has sometimes become the first port of call for families.

And in the meantime, professionals who ethically refuse to enter into this commerce find themselves denigrated by these 'experts' as incompetent and disconnected from the reality of mothers.

Indeed, some of these experts, aware of their limitations and the restricted scope of their practice, seek to improve their recognition by using strategies that denigrate healthcare professionals, including IBCLCs.

In conclusion, it seems important to us to recall that many factors influence the apparently informed choices of families, and we are committed to making these explicit. We hope that one day all mothers will be able to freely choose how to feed their child, without pressure from patriarchy, marketing, or default lack of support.

References for this article:

Bartick, Melissa & Smith, Julie & Gribble, Karleen. (2026). Pumps, patriarchy, and profits: the rise of breast pumping and "human milk feeding" and why preserving "breastfeeding" is important. International Breastfeeding Journal. 21. 10.1186/s13006-026-00825-w.