Keep government out of breastfeeding

Breastfeeding promotion seems to be the paradigmatic example of the “nanny state.” According to Wikipedia:

The term nanny state was probably coined by the Conservative British MP Iain Macleod who referred to “what I like to call the nanny state” in his column “Quoodle” in the December 3, 1965, edition of The Spectator.

Usage of the term varies by political context, but in general nanny state is used in reference to policies where the state is perceived as being excessive in its desire to protect (as a nanny would protect a child), govern or control particular aspects of society…

In the case of breastfeeding, the State, insisting that it is protecting children, has campaigned vigorously to increase breastfeeding rates as well as duration of exclusive breastfeeding. Putting aside for the moment consideration of whether the State has a compelling interest to promote one form of infant feeding over another, the primary assumption of governmental breastfeeding promotion is that breastfeeding is “better” for babies, mother and families, but as British parenting scholar Ellie Lee notes in Feeding babies and the problems of policy:

… [T]he research suggests a much less cut-and-dried picture. In particular it draws attention to important tensions between policy presumptions and mothers’ actual experience of feeding their babies …

Lee identifies three key issues:

1. Infant feeding needs to be depoliticised

Policy in this area should aim to support individual mothers to feed their babies in the way that makes most sense for them and their families. It should cease to connect mothers’ infant feeding practices with solving wider social and health problems. Doing so, evidence suggests, has failed to do much to increase breastfeeding rates; has generated a distorted picture of the causes of health and social problems; and has encouraged a situation where many mothers experience being placed under pressure to feed their baby according to priorities laid down by others.

The reality is that the scientific evidence simply does not comport with the claims made about the benefits of breastfeeding. While there is some evidence that breastfeeding improves infant health within certain very restricted parameters, there is simply no high quality evidence that breastfeeding improves overall infant health, either during infancy or later in life.

Moreover, much of the evidence that does exist fails to meet the basic criteria (Hill’s criteria) for demonstrating causation. The findings are neither strong, consistent nor specific. The best we can say is that there seem to be small, time limited benefits to breastfeeding. There’s not enough evidence to support the expansive claims of breastfeeding advocates, and therefore not enough evidence to justify a massive public health campaign.

Lee continues:

2. Policy makers should treat infant feeding as an issue in its own terms

Active efforts need to be made to separate infant feeding from morally-charged ideas and rhetoric about motherhood. The moralisation of infant feeding is detrimental for mothers – however they feed their babies – and damaging for wider society. Policy needs to be disentangled from the promotion of a particular orientation towards motherhood and family life.

The moralization of infant feeding choices is based on two assumptions, neither of which is supported by the scientific evidence.

First:

The mental/emotional health of mothers and babies is also deemed to be maximised by breastfeeding; some policy statements suggest a connection between ‘good parenting’ and breastfeeding, often through reference to the relation between breastfeeding and mother-infant attachment, or ‘bonding’;

Second:

It is suggested that policy reflects what mothers themselves want: the goal of increasing breastfeeding rates is represented as empowering for women, as this objective is allegedly in harmony with the aspirations of most women when it comes to how they want to feed their own babies.

These claims are not based on scientific evidence. Rather, they reflect the personal biases of breastfeeding advocates, the people who create and lobby on behalf of governmental breastfeeding campaigns. Breastfeeding advocates extrapolate from their personal experiences of emotional fulfillment and empowerment through breastfeeding. There is no evidence that women in general agree with them.

Finally:

3. Policy makers should aim to promote an ethos and practice whereby choice really means choice

Mothers feed their babies in a range of ways, yet as things stand, lip-service is paid to choice in infant feeding: alternatives to breastfeeding are routinely portrayed as inferior. As a result, tensions exist between mothers and health service staff. Policy makers need to work to change this situation. Mothers should be provided with properly balanced information about all feeding methods as a matter of course. Policy should seek to encourage maternal confidence and a sense of mutual trust between mothers and those who are there to offer advice and support. They should seek to engage fully with the real experience mothers have of feeding babies, and develop the approach of the health service accordingly.

Breastfeeding promotion fails on its on terms; it doesn’t seem to increase rates of breastfeeding. It does not change the way that mothers feed their babies; it merely makes women feel pressure and guilt about their own choices. The decision to breastfeed in merely one choice, not the only choice for infant feeding, and not the most important health choice made by new mothers. The scientific evidence is too flimsy to support a campaign that drives a wedge between new mothers and their care givers and that undermines their self confidence at a time when they are particularly emotionally vulnerable.

The sad reality is that government policy has been hijacked by activists seeking to promote a personal agenda, not a health initiative. They are secular “believers” who have convinced government agencies to promote a personal “gospel” of fulfillment and empowerment through infant feeding, and to berate “non-believers” with accusations of ignorance and selfishness. Babies have not benefited; mothers have not benefited. In fact, it appears that the only people who have benefited are the activists themselves.

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