“Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.”
I’ve been teaching breastfeeding for about nine years. For most of that time, I’ve started my class off by asking participants, “What are some of the benefits of breastfeeding you’ve heard about? Just call them out.”
I then write down what they come up with. The list usually looks something like this:
- Nutrition tailored to baby
- Provides antibodies
- Helps mom lose weight
To that list, I often add
- Protects against certain reproductive cancers in girls
- Reduces mom’s risk of breast cancer
- Fewer respiratory infections for babies
- Lowers the risk of SIDS
- Colonizes baby’s gut with healthy bacteria
Then I hand out my outline, which lists about ten more benefits. “Wouldn’t you be amazed if someone sold a product that could do all these things?” I ask. “Unfortunately, formula doesn’t come close.” Then I let the class know why I’m emphasizing benefits at the beginning of a class where everybody is already presumably dedicated to breastfeeding: So they can remind themselves of all the benefits if the going gets tough in the first few weeks or months.
Are benefits best?The idea of reframing how we talk about breastfeeding vs. formula feeding is not new. But more and more, we as lactation educators and support people are encouraged to talk about the “risks of formula feeding” rather than the “benefits of breastfeeding.”
It’s a subtle difference. But introducing the idea that an alternative feeding method carries risk helps to establish breastfeeding as the norm, which is an important shift.
I’m all for that. I believe we need more cultural acceptance and support for breastfeeding. I have two thoughts, however, about the risk vs. benefit language:
1) We humans are not very good at assessing risk in our daily lives. We worry about threats of terrorism while giving hardly a second thought to getting into our cars. Which is more likely to kill us? We also have a hard time separating personal risk from societal risk. I would love to see a study looking at how the language around breastfeeding vs. formula feeding in education helps or hinders moms’ decisions to breastfeed. Does it matter whether you say “breastfeeding reduces the risk of a baby dying of SIDS by 73 percent” or “formula feeding increases the risk of a baby dying of SIDS by 42 percent.” (Someone please check my math on this.)
2) As a breastfeeding support person, I am an important–and very personal–link in the chain for many individual moms. I am very sensitive to the enormous differences among us in background, desires, and proclivities.
I think the concept of “harm reduction” has a place in the world of breastfeeding support. It’s a familiar concept in the world of public health. For example: as much as we might wish to put an end to all intravenous drug use, if we’re unable to stop someone from shooting up, it’s better that he or she has access to a clean needle from a needle exchange program. If we’re unable to stop teens from having sex, better that they should do so using condoms.
Similarly, helping a mom to breastfeed a little–for a month rather than a day, or 75% rather than 25%–is better than her not breastfeeding at all. In my role as a support person, I don’t want to present information that could alienate mothers-to-be and set up expectations that end up completely undermining their efforts. That’s what I might be doing if I take breastfeeding advocacy to the bedside. And that’s what I worry might happen if I adopt the language of risk.
As an educator, I will begin to shift toward describing the risks of formula. In my work with individual moms, I will continue to do what I have always done: meet the mom where she is, work to support her goals, and educate her in a way that will help her actually hear and absorb the facts.
In researching this blog post, I discovered several interesting articles and web sites. Among them:
- From the Fall 2009 Reviews in Obstetrics and Gynecology comes a study titled, unequivocally, “The Risks of Not Breastfeeding for Mothers and Infants.” That says it in a pretty straightforward way.
- On the other hand, the American Academy of Pediatrics Policy on Breastfeeding and Use of Human Milk takes completely the opposite tack, mentioning only benefits of breastfeeding, with only one reference to the “risks of formula feeding” — that being to encourage pediatricians to “Communicate the benefits of breastfeeding and the risks of formula feeding to all of your patients.”
- A fantastic article, first published in The Ecologist Magazine in 2006, detailing the personal, social, cultural, political, and commercial challenges around breastfeeding. My favorite part is a couple of sentences appearing toward the end: “Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.”
- And finally, a blog post on exactly this “risk vs. benefit” language from a mother–and parenting expert–who regrets having been convinced to wean her two children at 16 weeks and 8 weeks, respectively.
What do you think? As a mom, do the words “risk” and “benefit” make a difference? What about as an educator, support person, or activist?