One of the things I like best in writing about contemporary mothering issues is the cross-fertilization betweeen academic theory found in journals and lived reality represented by media articles and blog posts by and about mothers. The average natural childbirth advocate or lactivist has little idea how her preferred rhetoric, which she believes was promulgated by childbirth and breastfeeding professionals, has actually been shaped by professors. Similarly, women struggling under the crushing imperatives mandated by those professionals have little idea how — fortunately — their anguish is fueling the writing of other academics.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”[W]e should not treat breastfeeding as a baseline in a sense that implies that women who formula feed are harming their babies.”[/pullquote]
Breastfeeding is a case in point. Most contemporary language on breastfeeding can be traced back to an academic paper written in 1996, Watch your language by Diane Wiessinger.
When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a “special bonus”; but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial baby milk just “to get him used to a bottle” if she knows that the contents of that bottle cause harm.
But now a philosophy professor cautions that the use of risk based language around formula is not morally justified. In a new paper in the Journal of Medical Ethics, Fiona Woollard asks, Should we talk about the ‘benefits’ of breastfeeding? The significance of the default in representations of infant feeding.
In an accompanying blog post, Prof. Woollard explains why she wrote the paper.
She was attending a meeting of breastfeeding professionals:
… Then the speaker adds, almost as an aside, “Of course, we know that it is really ‘the harms of formula’ not ‘the benefits of breastfeeding’.” There is a general nodding of heads. It seems to be accepted by almost everyone in the room that this is something that we know. It is ‘known’ that any differences in outcomes between babies fed with infant formula and breastfed babies should be described as ‘harms of formula’.
Woollard begs to differ.
As a philosopher, I feel a sort of territorial annoyance. This is a deeply complex philosophical question. It is not something that we should confidently claim to know as if there were a simple answer.
In her paper she explains why talking about the “harms” of formula is NOT morally justified.
She, too, traces the use of risk language to Weissinger’s piece. And she opposes the use of such language on both philosophical and practical grounds:
Given the detrimental effects that shame surrounding formula use can have on the well-being of new mothers and their neonates, we have strong reasons to avoid the unjustified use of morally loaded terms to describe infant-feeding decisions. There is significant sociological evidence connecting decisions to use formula and feelings of shame, guilt and failure… The use of morally loaded terms … also gives the impression that such guilt and shame is appropriate. If guilt and shame is seen as appropriate, then its effects on maternal well-being may be wrongly dismissed as morally unimportant.
Where did Weissinger go wrong in her invocation to use shaming language around formula feeding?
Wiessinger appeals to an allegedly standard use of language surrounding health to argue that we should treat breastfeeding as the default and formula feeding as deficient and dangerous. She states: “Health comparisons use a biological, not a cultural, norm, whether the deviation is harmful or helpful…
Even if breastfeeding is the biological norm, it is far from obvious that it should be the moral baseline from which the morally loaded calculations of harm and benefit are calculated…
Why not?
Because breastfeeding deeply implicates the mother’s body and agency, positioning breastfeeding as the moral baseline is problematic even if it is the biological norm. To do so takes the mother’s body and agency for granted. It does not fit with our use of the concepts of harm and benefit in other situations…
Woollard reviews a variety of moral accounts of harm and shows why they lead to the conclusion that formula feeding does not cause “harm.”
For example:
If I were to push “Joe” into traffic on a busy highway and he gets hit by a car, I have harmed Joe. But if Joe runs into traffic and I don’t stop him, I haven’t harmed him. Moreover, if a car is heading is our direction and I don’t step in front of Joe to protect him at the expense of myself, I certainly haven’t harmed Joe.
Similarly, if I were to deliberately expose “Sammy” to a diarrheal illness and he gets sick, I have harmed him. But if Sammy gets a diarrheal illness that might possibly been prevented by breastfeeding, I haven’t harmed him. Moreover, if Sammy gets a diarrheal illness because I don’t use my body to offer him the potential protection of breastfeeding, I haven’t harmed him, either.
Therefore, from a moral perspective, not breastfeeding cannot and should not be described as a harm.
Interestingly, Woollard does not question the scientific evidence on the benefits of breastfeeding. Either she is unaware or in the interests of brevity has decided not to mention the fact that the scientific evidence on the benefits of breastfeeding is weak, conflicting and riddled with confounding variables. She does not mention that the promised benefits of increasing the breastfeeding rate have failed to appear and that breastfeeding has risks (of dehydration, jaundice, starvation and death) as well as benefits. She proceeds under the assumption that breastfeeding is indeed beneficial, but even then a mother who doesn’t breastfeed is NOT harming her child.
Woollard concludes:
When it comes to descriptions of maternal behaviour, we should reject the assumption that there has to be a single appropriate default for infant feeding. Breastfeeding is normal and should not be stigmatised or seen as a lifestyle choice that can only be accommodated under ideal circumstances. The phrase ‘breast is best’ should be avoided. But we should not treat breastfeeding as a baseline in a sense that implies that women who formula feed are harming their babies. Extreme care should be taken before using morally powerful terms such as ‘risk’, ‘harm’ and ‘danger’. Where possible, neutral terms such as ‘difference’ should be used, accompanied by clear information about the outcomes presented non-comparatively.
I strongly agree and I sincerely hope that breastfeeding professionals will take note!
