The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

My first reaction to the now-infamous Time magazine cover was to groan out loud. Like many of you, I was horrified by that cover's mean-spirited tone. If we didn’t get the message from the picture, there was also the antagonistic caption: “Are you mom enough?” It wasn’t until later that I recognized that this cover, and the controversy that followed, actually reflected a positive shift. Many things had changed since I first became aware of this topic more than 20 years ago.

In 1992, I was just finishing my post-doctoral fellowship at the University of New Hampshire and was expecting my second baby.  My first experience had gone not particularly well, so I spent months educating myself about birth, breastfeeding, and postpartum. During this time, I became friends with Dr. Muriel Sugarman. We were both on the board of a local child abuse organization in Massachusetts. Muriel was a child psychiatrist at Harvard’s Massachusetts General Hospital and an amazing ally to the breastfeeding community. She was interested in long-term breastfeeding and had collected some data. (“Long-term” was operationally defined for that study as “six months or longer.”)  We started working on it together, and bit by bit, had some findings to report.

We submitted one of our first articles on weaning ages to [a well-known journal in pediatrics].  Consistent with studies in other parts of the world, when weaning was child led, it tended to occur at ages 2.5 to 3. So far, so good.

But then there were our outliers….the babies who weaned at age 5…and a couple of babies were even older. The reviewers, all women we later learned, went completely nuts. If it had been up to them, we would have been both rejected…and flogged. (Eighteen years later, these are still the worst reviews I’ve ever received.) They hated us, our study, and mostly definitely our “weird” mothers.

I wasn’t sure what to do next, until a colleague handed me an article called, “Darwin takes on mainstream medicine.” It described how extended breastfeeding, babywearing, and cosleeping  conferred a survival advantage for moms and babies, and was presented at the American Association for the Advancement of Science meetings. That was radical stuff in the mid-1990s. I sacked our introduction and rewrote it using this framework.

The next question was where to send the revised manuscript. I called a pediatric researcher I knew in Philadelphia. He said, “Oh, I never send articles to [well-known pediatric journal]. They’re mean!” That had certainly been my experience. He recommended Clinical Pediatrics, where we got a much more positive reception. The article came out. We were happy. End of story….or so we thought.

In 1997, AAP Statement on Breastfeeding was released. Controversy swirled around that statement for months about one bit in particular: that women breastfeed for at least 12 months and “as long thereafter as is mutually desired.” I was going about my business, blithely unaware that Muriel and I were smack in the middle of the controversy. What reference did the AAP cite to support “as long thereafter as is mutually desired”? You’ve got it: Sugarman and Kendall-Tackett (1995)!

That paper taught me a lot. Ten years later, when I applied for APA Fellow, I identified it as one of the most important in my career. I learned firsthand about the intense negative stigma surrounding extended breastfeeding. I was equally amazed to discover a quiet underground of women who were defying cultural norms and nursing their older babies right under the radar of family, friends, and healthcare providers. Avery described this phenomenon as “closet nursing,” and noted that extended breastfeeding had a lot in common with revealing sexual orientation. Brave souls who chose to be up front faced marginalization—or worse.

Through much of the decade that followed publication of our article, Muriel and I, along with Liz Baldwin and Kathy Dettwyler, frequently had to write letters to courts and child protection agencies on behalf of mothers who were being investigated for child abuse. Their crime? Extended breastfeeding.

Which brings us up to the present time. Yes, the Time magazine article said mean things. But look at it this way: extended breastfeeding is being discussed in a mainstream publication. In addition, thanks to social media, the “quiet underground” is quiet no more. I’ve been amazed at outpouring of support from both celebrities—and ordinary moms—speaking opening and positively about extended breastfeeding. It was something I couldn’t even imagine in 1995. I think it’s safe to say that extended breastfeeding is officially out of the closet.

In closing, I’d like to suggest that we all owe a debt of gratitude to Drs. Ruth Lawrence and Larry Gartner, and the other brave members of the 1997 AAP Committee on Breastfeeding. Their statement did much to move extended breastfeeding out of the margins and into the public square (and Muriel and I were happy to have a small part in that). We still have a ways to go. But let’s take a moment and savor this small victory.

And to the members of the 1997 AAP Committee, I say this: We, the quiet underground, salute you!

The two articles published from that data set are:

Kendall-Tackett, K.A., & Sugarman, M. (1995). The social consequences of long-term breastfeeding. Journal of Human Lactation, 11, 179-183.

Sugarman, M., & Kendall-Tackett, K.A. (1995). Weaning ages in a sample of American women who practice extended nursing. Clinical Pediatrics34(12), 642-647.

 About Kathleen Kendall-Tackett

Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is Owner and Editor-in-Chief of Praeclarus Press, a new small press specializing in women’s health. She is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is Editor-in-Chief of the journal, Clinical Lactation, a Fellow of the American Psychological Association, and is president-elect of the APA Division of Trauma Psychology.


The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Mary-Jane Sackett
Thank you Kathy for an informative look at a subject which remains controversial and filled with so much misinformation. My favorite quote sums up how I feel about breastfeeding in general, and especially about "sustained" breastfeeding: "For those who understand, no explanation is necessary. For those who cannot understand, no explanation is possible."

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Rebecca Dekker, PhD, RN, APRN, ACNS-BC
This is wonderful! Thank you so much for your work! I was actually at a neurology appoinment last week and the neurologist told me, "You can stop breastfeeding now, you know." My infant is only 11 months. Are you kidding me! He then went on to say, there are "no benefits to breastfeeding past 3-6 months. My generation wasn't breastfed, and we turned out fine." My jaw just about dropped to the floor! After I gave him a little lecture about the benefits of extended breastfeeding (and I don't even count yet as an extended breastfeeder), I don't think his viewpoint changed at all. But hopefully someday healthcare providers like him will be in the minority.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Kerstin D
I just want to thank you for being a pioneer and making this road easier for all women. Before reading this I sort of took for granted that this path had even been forged. I have been nursing babies and toddlers non stop for 7 years, and I've felt some negativity, but I've always felt like those people to give me a problem were the ignorant minority. I realize now that the work you've done has had an impact on my empowerment even though I didn't see it until now! Thank you so much!

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Ann Sinnott
So pleased to read this! My daughter was born in 1992 and over here in the UK I was part of that 'quiet underground' and went on to be one of the 'outliers' and knew several others. Knowing the issues for mothers and the cultural prejudices surrounding sustained breastfeeding, and also knowing that little had been written about the practice (apart from the notables above), in 1997 I tried vainly to find a publisher ('Yuk!' was the usual reaction). A decade or so later I found a publisher and finally the book that mothers (and others, including medics and academics) needed was published by Free Association books in 2010 'Breastfeeding Older Children', in part based on a global survey with more than 2000 respondents, has been warmly greeted by mothers and others. Post publication, I discovered vibrant communities of sustained breastfeeding mothers on Facebook, and discovered that a good proportion had participated in my survey. I have no doubt that sustained breasteeding has and continues to increase. There's no doubt that social networking sites have played a large part in this growth and mothers tell me that my book (and Facebook Page with same title) has also played its part. But detractors should be clear, mothers continue to breastfeed their children because it's what their children want and mothers (and, in very many cases, fathers) can see how their children benefit. And, also for detractors, having met very many long-term breastfed children, I can say with certainty that, as a generality, these children are not developmentally impeded in any way. Though Western cultures are in many ways inimical to the practice and not every woman wishes to be an outlier (and no blame attaches there), there is no doubt that children have an innate need and urge to continue to breastfeed until that need and urge fades away.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Walker Karraa
Great perspective. Thank you.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Jeanne Ohm
We knew that the time cover was a set up as well! So we contacted Jamie personally and did a special feature article with a legitimate photo shoot. The press it generated surprised us, but we knew the conversation was shifting and extended breastfeeding was gaining respect. Huffington Post, Dr Drew show and many, many bloggers created a conversation that contributed to a raising of the consciousness. Here is our press page link with many interesting comments and articles on this topic: BTW: At Pathways, we love Science and Sensibility and this blog! Your work is outstanding.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Ruth Callahan
Thank you for such a smart helpful re-framing of that crazy media storm of a story.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Jeanette McCulloch, IBCLC
Agreed - we should see the Time magazine article as an opportunity to have more open discussions about breastfeeding, "closet nursing," and biological norms. Thanks for the great piece!

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Nancy
I will look up the article but that last sentence that Mary-Jane wrote says it all. I will have to store that one away whenever I feel doubt about what I am doing. I am a mother of a 22 month old still breastfeeding. I am lucky that I have a doctor who said, "And you're still breastfeeding. Well you can do that for as long as you want."

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27, 2012 07:00 AM by Deena H. Blumenfeld, ERYT, RPYT, LCCE, FACCE
This is a totally new perspective to me. Maybe it's because many of my friends and peers, practice extended breastfeeding. They did so before I got pregnant with my 1st, and continue to do so now. So, for me EBF was not a new concept. It seemed normal, because of my peer group. As a mom, baby #1 weaned at 2.5 yrs, and baby #2 still nurses occasionally at 3.5. I'm a bit ready for her to be finished... As an educator, I see the cultural differences between, "Ugh, nursing past 6 months!" and "whenever the baby is finished". I do think that EBF happens organically. The breastfeeding relationship just works, so mother's keep doing it. I however, saw the TIME cover in a different light: But, then I see these moms duking it out online, regularly.

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 30, 2012 07:00 AM by Ted Greiner
Great article and fascinating to read what you were doing at the same time I was publishing on extended breastfeeding (calling it "sustained" because extended felt like it had a touch of judgmental quality to it, but that never caught on). Like an earlier paper of Dr. Sugarman's that I cited (Reame SB and Sugarman M. Breast feeding beyond six months: mothers’ perceptions of the positive and negative consequences. J Trop Pediatr 1987;33:93-97.), I published in a journal about health in developing countries, the United Nations University's Food and Nutrition Bulletin (Greiner T. Sustained breastfeeding, complementation and care. Food and Nutrition Bulletin, 16(4):313-319, 1995). A slightly revised version is available at I lived at that time in Sweden where sustained breastfeeding had just emerged from the closet after being "exposed" (but via a series of articles that discussed it in a positive way) starting with an article on the front page of the largest Stockholm newspaper, Dagens Nyheter, in 1990 with a photo above the fold of a woman breastfeeding a 1.5 y/o on a bench in the central train station with an old lady beside her looking on a bit askance. The headline said (in Swedish of course), "Swedish women being forced to breastfeed in the closet," and went on to say that many women, pursuing the popular democratic form of child-rearing there, ended up breastfeeding for years because their children did not want to stop yet. Was it right to stigmatize them? The articles showed photos of (not breastfeeding) and had interviews of 5 and 6 year olds who were still breastfeeding and could tell us what it's like! They were such harmonious children that I found myself understanding how parents feel when they learn too late that their children "should" have been breast fed longer. Sadly, mine were each only breastfed for 3.5 years!

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