Baby Friendly Hospital Initiative: powerful women punishing powerless women for not emulating them


There are a lot of things wrong with the Baby Friendly Hospital Initiative (BFHI), a series of measures designed to promote breastfeeding. Chief among them:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Whatever happened to maternal choice?[/pullquote]

1. It is shaming, implying that women who choose formula don’t care about their own babies.

2. It is punitive. Women who prefer formula are subjected to hectoring on the benefits of breastfeeding; providers are prevented from using their clinical judgment to recommend supplementation; poor women are deprived of free formula samples; and all women and babies face deadly harm from the closing of newborn nurseries.

3. Worst of all, it doesn’t work; there is no evidence that it improves breastfeeding rates.

However, the ultimate irony is that the BFHI recapitulates the ugliest aspects of patriarchal medical care; it’s about the powerful suppressing the powerless for their own benefit. The breastfeeding industry is overwhelmingly female, white, and relatively well off. Women who choose formula feeding are much more likely to be non-white and poor. Rich white women are trying to force poor black and brown (and white) women to emulate them and punishing them if they won’t.

What’s the difference between doctors banning fathers from the delivery room and lactivists banning babies sleeping in well baby nurseries? There was never any evidence that keeping fathers out of the delivery room had any benefit for babies and there’s no evidence that forcing 24 hour infant rooming in by closing well baby nurseries has any benefit for babies. Fathers were banned from delivery rooms because doctors liked it that way; well baby nurseries are closing because the breastfeeding industry likes it that way.

What’s the difference between doctors mandating enemas in labor and lactation consultants mandating that formula be locked up? Neither benefits babies.

And who benefits from banning gifts of free formula samples? It certainly isn’t mothers since they are losing something valuable to them, and there’s no evidence babies benefit either.

The Baby Friendly Hospital Initiative represents a profound power imbalance. Lactation consultants believe their motives are pure; they know better than mothers themselves what’s good for babies.

I’ve written before about gender scholars Annandale and Clark. In their widely quoted paper What is gender? Feminist theory and the sociology of human reproduction, they note:

If we conceive of power as a fundamentally male preserve we are led to gloss over ways in which women may exert power over others, including other women…

They are writing about midwives, but the same questions can be asked of lactation professionals. They can’t point to even a single term baby whose life has been saved by exclusive breastfeeding yet they use their power to enforce it within hospital settings. They can’t point to a single healthcare dollar saved by exclusive breastfeeding of term infants, yet they insist on the expenditure of millions of healthcare dollars to promote breastfeeding.

Natural childbirth advocates railed against obstetric paternalism in banning fathers from delivery rooms though doctors believed it to be better that way. They advocated maternal choice and they were right to do so. We are currently approaching an apogee of lactation maternalism when well baby nurseries are being closed in an effort to force mandatory rooming in of infants because lactation consultants believe it to be better that way. Instead we should be advocating and supporting CHOICE.

The Baby Friendly Hospital Initiative deliberately deprives women of choice, substituting the judgment of lactation consultants for the judgment of mothers. It was wrong when doctors used their power to deprive women of choice and it is just as wrong when the breastfeeding industry uses its power to do the same thing.