There is no moral duty to breastfeed

Got ethics? Are you ethical question handwritten with white chalk on blackboard with eraser smudges

In a fascinating paper in the Journal of Medical Ethics, philosophers Fiona Woollard and Lindsey Porter conclude that mothers do not have a moral duty to breastfeed.

The paper is Breastfeeding and defeasible duties to benefit. The authors begin by quoting colleagues Lee and Furedi who deftly summarize the current moral milieu.

A process of cultural transmission seems to have turned provision of health information about the benefits of breastfeeding into hostility about formula use. This has a detrimental effect on relationships that are very important for new mothers, namely with health professionals and with other mothers.

The moral duty to feed a baby does NOT imply a moral obligation to breastfeed just as the moral duty to educate a child does not imply a moral obligation to pay for private school.

Or, as Woollard and Lindsey explain:

For many women experiencing motherhood for the first time, the message they receive is clear: mothers who do not breastfeed ought to have a darned good reason not to; bottle feeding by choice is a failure of maternal duty.

That’s certainly what professional lactivists believe, but they’re wrong.

We argue that this pressure arises in part from two misconceptions about maternal duty. First, confusion about the scope of the maternal duty to benefit and second, conflation between moral reasons and duties.

Indeed:

While mothers clearly have a general duty to benefit their offspring, we argue that this does not imply a duty … to carry out each particular beneficent act. Mothers do not have a moral duty to carry out each and every act that would benefit their baby. Mothers do have moral reason to perform each beneficial action. However, not complying with a moral reason, unlike failure to comply with a duty, is not an accountable matter. Therefore, the act of holding mothers to account for individual beneficent act omissions, and the demand that individual omissions be justified, is unwarranted. The expectation that mothers who bottle feed should have a ‘darned good reason’ is morally unwarranted, in addition to being demonstrably harmful.

We generally take this for granted in the day to day business of parenting. Mothers (and fathers) have a duty to protect children. Skiing is a potentially dangerous leisure activity. If mothers had a moral duty to carry out each and every act that might possibly protect their children, they would be morally required to forbid their children from skiing. But though everyone recognizes a mother’s duty to protect her child, very few people think that duty encompasses forbidding any activity that raises the possibility of injury.

Similarly, in many areas of the country private schools offer better education than public schools. If we believed that mothers have a moral duty to provide what is “best” for children, we would be forced to conclude that those mothers have a moral duty to provide the private school education regardless of the cost, but we don’t.

Though mothers have a general moral duty to provide “the best” for their children, they does not imply specific moral duties to provide every possible advantage in education or any other sphere. No one expects mothers to provide a ‘darn good reason’ for sending their children to free public schools.

Many lactivists are also natural childbirth advocates. Curiously they have no difficulty recognizing that the general moral imperative for mothers to protect babies does not imply a specific moral duty to give birth in exactly the way that doctors recommend. They argue — correctly in my view — that mothers have a right to autonomy over their own bodies and that, therefore, the moral duty to protect babies must be balanced against the moral right of women to give birth in the way that they choose.

For example, homebirth in Oregon has a perinatal mortality rate 9X higher than comparable risk hospital birth, yet very few believe that any Oregon mother who chooses homebirth must justify her desire to have a homebirth to other healthcare providers, other mothers or society at large.

The benefits of breastfeeding are far smaller than the benefits of hospital birth, yet lactivists routinely invoke a maternal moral duty to breastfeed. Diane Weissinger, in her seminal paper on the language that should be used to counsel new mothers, recognized this problem:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding …

In other words, Weissinger acknowledges that there is no moral duty to breastfeed … but then goes on to ponder how women can be browbeaten into believing that such a duty exists regardless.

The mother having difficulty with breastfeeding may not seek help just to achieve a “special bonus”; but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial baby milk just “to get him used to a bottle” if she knows that the contents of that bottle cause harm.

The mantra of the lactivist movement, “Breast Is Best,” is understood as invoking a moral duty to breastfeed. That’s why lactivists generally feel superior to mothers who formula feed, and feel justified in shaming those other mothers.

And that’s why they vehemently hate the phrase “Fed Is Best.” “Fed Is Best” embodies the very real maternal moral duty of making sure that babies are adequately fed while implying correctly that there is no moral duty to breastfeed.

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  • Empress of the Iguana People

    Technology is natural for humans; we’ve been making tools to make our lives easier since before we branched off from our mutual ancestor with the chimpanzees. (mmmm, termites on a stick, yummy). I don’t want an “woke ob” like a friend of mine was talking about. Even if the instruments *were* invented by some guy who was into actively torturing his slaves, *my* obstetricians have done their best to be as gentle as possible. What makes the writer of that stupid article think nothing has changed since slavery was legal in the US? We’re talking about medical practice, not homeopathy.

  • Sue

    “While mothers clearly have a general duty to benefit their offspring, we argue that this does not imply a duty … to carry out each particular beneficent act.”

    Exactly this!

    Amongst a billion parenting choices, how many others are judged in this way?

    What if one person breastfeeds for three years but never has a book in the house, another breastfeeds for six weeks, then goes back to work two jobs to pull their family out of poverty, and a third doesn’t breastfeed at all, but supervises post-doc students in her lab while her partner does full-time child-care?

    Who wins the most parenting points?

    • FormerPhysicist

      Too many others are judged this way, and even though I’m long past breastfeeding this piece resonates in my life.

  • Sheven

    This is a great way to illustrate the difference between giving children the “best possible” life, which is a parent’s duty, and making the best possible choice at every single instant, which is an impossible and inhumane standard.

    It’s the one time I’m happy with the “breast is best” assumption (even if the authors don’t really make it) because it affirmatively claims a parents’ right to make suboptimal decisions instead of embracing the martyr-mommy ideal.

    • Sue

      Yes, that’s the point – we don’t need to navigate the complex web of “best” for every one of a million choices – because “good enough” IS good enough.

      We could say
      “breast is best” but well-fed is healthy
      “Mozart is “best” but love of music is better than never hearing any
      “100% home-cooked fresh food is best” but any well-balanced diet is perfectly compatible with good health

      and so on, forever.

      I’m up to the driving lessons stage of parenting. Many people say that getting formal driving instructor lessons first is “best”, but I’m doing it the other way around, starting with the parental lessons. Immoral parenting?

      • Gæst

        My parents refused to teach me to drive before the professional lessons, and when I got to the first lesson the instructor was shocked and annoyed to have to teach me everything (even though it was illegal for my parents to teach me without my learner’s permit).

        • N

          Oh yes, it was a good thing that my dad taught me a bit of driving before professional lessons, without that it would also have been a hard time for my instructor. And: a lot of young people, if they don’t learn it from their parents, they learn it from friends, which is even more dangerous. My dad was not only a bit surprised, when he wanted to teach my younger sister, and saw that she could do it already…

      • Empress of the Iguana People

        Nay, Mendolssohn is best! Both of them! Mozart just gets all the press.

      • SporkParade

        I refused to drive with my parents in the car until I already had my license. “Best” is whatever teaches the child to drive safely without making them want to kill whoever is teaching them.

  • fiftyfifty1

    I know these semi-wonky philosophy/ethics posts never attract many comments, but please keep them coming. They are my favorite and I suspect a lot of us here chew on them for days afterward.

  • Rivkah Rainey

    love this. brilliant. honest. clean and straight.

  • Heidi_storage

    There is one thing I don’t like about this article, and that is that the authors seem to buy into breast being the best choice in all situations. This is demonstrably untrue; for instance, women who give up life-saving chemotherapy to breastfeed are depriving their children of a much bigger benefit than that conferred by breastmilk.

    • sleepy

      It also says, that breast milk is a baby’s “ideal food, perfectly balanced for optimal infant nutrition.” That’s not true though. Breast milk is deficient in iron, vitamin D, and vitamin K.

      • Empress of the Iguana People

        and discounts that small group of babies who cannot drink milk

        • Heidi_storage

          Indeed. Some friends of ours just had a baby, and he apparently cannot tolerate proteins or even peptides; he’s got to have this absurdly expensive amino-acid formula. Breastfeeding would be decidedly bad for him.

    • Allie

      Haven’t read the full paper ‘cuz not a free download, but I wonder if they merely stipulate that breast milk is absolutely, grade A, numero uno for the sake of argument. That assumption is kind of key to the argument that EVEN if everything wonderful lactivists say about breast milk were true, there would still be no moral duty to breastfeed. I’m a bit puzzled by their approach as I would think the mother’s right to maintain her bodily integrity would provide a more solid foundation to refute a moral duty to breastfeed.