The Baby Friendly Hospital Initiative is a moral failure

epic fail wooden letterpress

I’ve argued repeatedly in the past that aggressive breastfeeding promotion in general and the Baby Friendly Hospital Initiative in particular are scientific failures. They ignore the scientific evidence in favor of the personal beliefs of lactation professionals — exaggerating the benefits of breastfeeding, hiding the risks (dehydration, jaundice, brain injures and deaths) and demonizing pacifiers and judicious formula supplementation as harmful when in fact they are lifesaving.

But aggressive breastfeeding promotion, particularly the Baby Friendly Hospital Initiative is also a moral failure. A new paper in Current Sociology, Social roles and alienation: Breastfeeding promotion and early motherhood, explains:

…The article argues that the effort to rigidly impose a moral code as the role [of mothering] is taken on has potentially alienating effects, as it limits the scope for the agent to appropriate and identify with it. An approach to health promotion which instead trusts women to exercise situated moral judgement about infant care, rather than subjecting them to an externally imposed moral code, would reduce the emotional strain and potential for alienation in early motherhood.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Baby Friendly Hospital Initiative treats women not as ethically valuable in themselves but instead as the means for achieving breastfeeding targets.[/pullquote]

Our views about motherhood have recently undergone substantial change:

Motherhood has undergone significant transformation in recent decades, as the expectation of individual autonomy has reshaped gender and family life. Women now expect to become mothers not because of biological destiny, coercion, or social duty, but instead as an aspect of a self-directed life. Motherhood is expected to be taken on only when it is understood as integral to the agent’s realization of her intentions and values.

At the same time, the practices of mothering, particularly in the early stages, have become the focus of intense public interest. Cultural ambiguity about the value of full-time mothering has shifted public debates away from the question of whether mothers should engage in paid employment at all, to a focus on the quality of maternal caregiving.

As a result:

Time-intensive mothering practices, especially breastfeeding, have become an important focus of status claims for both stay-at-home and employed mothers.

Ironically, at the same moment that women have been freed from the expectation to have children for no better reason than because it is their biological destiny and therefore must be best, women who choose to have children are still prisoners of the expectation they will breastfeed because it is their biological destiny and therefore must be best.

It’s hardly surprising then that so many good mothers feel so bad about breastfeeding:

Breastfeeding tends to be experienced as emotionally intense, in positive and negative ways. Sustained breastfeeding is generally understood to depend on self-control, in the form of maternal self-sacrifice and concentrated effort, if it is to be ‘successful’. Most women are fully aware of the message that ‘breast is best’, but tend to act in ways which take account of various other considerations.

Then they are shamed for daring to take other considerations into account.

The expectation that good mothers will breastfeed is a feature of the Baby Friendly Initiative. This is a programme for promoting breastfeeding as ‘the golden standard of care’ in maternity centres and amongst health professionals caring for mothers and infants following birth…

Women have not been imagined as decision-makers in this initiative, but instead as passive recipients of information, training and support.

That is a serious moral defect:

Health promotion strategies like this tend to assume that target populations are likely to comply with moral pressure. Such behaviourist expectations take little account of human agency, autonomy, or the indeterminacy of the social world… Such utilitarianism treats agents not as ethically valuable in themselves but instead as the means for achieving public health targets.

In other words, women are treated as objects to be acted upon, not as individuals capable of making their own decisions.

What’s the harm?

When pressure is brought to bear on women to breastfeed in the first hours, days and weeks after giving birth, the role becomes rigidly defined. This undermines agency, the ability to ‘take and make’ motherhood, developing some command over the role through interpretation and improvisation.

That accounts for the plethora of recent articles in which women detail how they and their babies suffered under pressure to breastfeed. It also accounts for the popularity of the Fed Is Best movement; not only is being fully fed with formula better for babies than starving on breastmilk, using formula to ease the stress of new motherhood is better for mothers than struggling to breastfeed.

Even breastfeeding professionals have been forced to address women’s suffering, but sadly they interpret it through the lens of breastfeeding promotion. They’ve defined breastfeeding “trauma” as the disappointment of being unable to breastfeed when the reality is that breastfeeding trauma is a result of treating women as merely the means to reach breastfeeding targets, instead of compassionately as individuals with their own needs, desires and moral agency.

Her baby, her body, her breasts, her choice!