An academic critique of contemporary breastfeeding promotion


A new paper succinctly lays out the academic critique of contemporary breastfeeding promotion, and basically recapitulates most of the arguments I have been making for years.

The paper is Discourses and critiques of breastfeeding and their implications for midwives and health professionals by midwives Smyth and Hyde.

Current policies must change to reflect the truth — not the wishful thinking — about breastfeeding.

While the slogan ‘breast is best’ has historically been a truism in health promotion discourses internationally, in recent decades, criticisms have emerged that challenge the campaign for breastfeeding. In this article, we consider a number of strands in the debate, starting with discourses of breastmilk and breastfeeding used to promote breastfeeding and then move on to explore charges that the em- pirical support for breastfeeding is not as strong as breastfeeding advocates often suggest.

1. The benefits of breastfeeding have been overstated.

While official organisations collectively promote breastfeeding on the grounds of scientific evidence, the science behind the consensus of breastfeeding has been challenged. Wolf asserted that many research studies linking breastfeeding to improved health are weakly significant and often fail to control confounding variables that could affect the outcomes…

Indeed, the benefits predicted by breastfeeding researchers — that increased breastfeeding rates would lead to decreased infant mortality, severe morbidity and healthcare expenditures — have failed to materialize.

2. Bias in promoting breastfeeding

Parallel to the increase in research on the health outcomes of breastfeeding in biomedical literature, including less than strong evidence of its superiority, social science literature (predominantly) has criticised the pro-breastfeeding discourse as problematic and biased. A growing concern is that educational and promotional breastfeeding literature has become one-sided and more a tool for persuasion than education and replete with hyperbole (Wolf, 2011). Knaak raises the question ‘Are we educating or advertising?’ Foss noted how the media have been criticised for perpetuating the ‘myth’ of breastfeeding as a choice. Indeed, breastmilk has been so highly regarded in media discourse that it has been suggested that the result is an implied assumption that ‘breastfeeding is the only ethically acceptable option in infant feeding’.

3. Ignoring the harmful impact on many women

For the woman who experiences great difficulties in breastfeeding and for whom breastfeeding is a less than joyous experience, feelings of guilt and failure may provoke a crisis in her sense of self. Williamson [et al.] noted that women were often surprised by the difficulties faced when breastfeeding and experience anxiety, upset and damage to their self-worth when breastfeeding fails. Foss … [noted] that [“breast is best”] is ‘dripping with insinuation on a mother’s inferiority and attributions of blame for not breastfeeding’. In Símonardóttir and Gíslason’s study, women experienced difficulties and pain (often severe) when breastfeeding with negative consequences for their emotional well-being. The pressure to breastfeed was linked to postnatal depression by several women in the study and one described her experience of feeling constantly guilty and ‘like a terrible failure’ for ‘not being able to perform this simple task’.

4. Ignoring the impact on women’s economic and professional status

Law argues that breastfeeding serves to consolidate the maternal role in the home, exacerbates the gendered division of labour and negatively impacts on women’s participation in the workforce. This limits women’s choices and impedes their progress in paid employment, sustaining their economic dependency on men. Law (correctly) asserts that promotional material about breastfeeding fails to mention the negative outcomes of breastfeeding, including its impact on women’s economic position in society in the long run. While breastfeeding may be free at the point of delivery … the cost to women’s lifetime earnings because of their lost years in the workforce does not get toted up, and thus, they trail behind men in terms of power and privilege.

So the benefits of breastfeeding have been exaggerated, breastfeeding promotion is biased, and the harmful impact of breastfeeding on women’s mental health and economic status has been entirely ignored.

How are midwives supposed to counsel women when the Baby Friendly Hospital Initiative makes claims aren’t supported by the scientific evidence?

The fact that midwives and other health professionals may work in hospitals that are signatories to the Baby Friendly Hospital Initiative potentially places them in a difficult position, where their own critical assessment of the practice of breastfeeding may be silenced by the need to convey an official pro-breastfeeding position.

Current policies must change to reflect the truth — not the wishful thinking — about breastfeeding. It’s the mother’s baby, the mother’s body, and it ought to be the mother’s choice how to feed her infant, free from manipulation by healthcare professionals.