BFUSA presents breastfeeding as natural yet requiring medical and administrative oversight, mothers as empowered but uniquely vulnerable, and medical staff as responsive to mothers but driven by objective goals and unquestioned medical evidence. BFUSA policies frame mothers as capable of, and entitled to, individual choice but then undermine this “choice” by repeatedly pointing to the ways in which a mother’s infant-feeding practice impacts not just her, but her baby and society as a whole.
I’ve written a great deal about the ways in which the Baby Friendly Hospital Initiative is coercive and violates women’s fundamental right to bodily autonomy. Cornerstones include forced lectures on benefits, prohibitions on formula supplementation and pacifiers, and mandated 24/7 rooming in of babies. It rests on power differentials, duress and false claims about the benefits and risks of breastfeeding.
Lactation professionals treat women who can’t or don’t want to breastfeed, not as individuals with valid concerns, but as deviants who jeopardize lactivist goals.
But I had never fully appreciated the way in which rhetoric has been mobilized with the specific aim of silencing and oppressing women until I read Reframing Efficiency through Usability: The Code and Baby-Friendly USA by Oriana Gilson. It appears in the forthcoming book Women’s Health Advocacy: Rhetorical Ingenuity for the 21st Century.
The chapter is larded with jargon (I’ve tried to excise as much as I can in the following quotes), but it is worth the effort to read it and explore the themes.
In this chapter, I consider rhetorics of efficiency … to analyze how the policies and guidelines of BFUSA [Baby Friendly USA] rhetorically situate certain bodies as bearing responsibility for the public health…
Gilson is challenging the insistence by BFUSA that their claims are morally neutral, arguing that they ignore the reality of breastfeeding by blaming women.
Engaging issues of silencing … [feminist scholars] address how “medical evidence” can silence patients … I argue that … power-diffused rhetoric is needed within breastfeeding policies. Such a move would not only support … opening space for … communities previously unacknowledged – but would also provide space for diverging medical evidence to be incorporated and understood … This approach moves beyond a singular objective truth that negates the possibility for diverse user voices to weigh in and be recognized. With the aim of … making apparent the benefits and constraints of “choice” in breastfeeding policies, I draw on feminist rhetorics and disability studies scholars as they situate the rhetorical construction of binaries as both false and materially oppressive;
Lactation professionals in general and BFUSA in particular use the rhetoric of “medical evidence” to silence and coerce women who can’t or don’t want to breastfeed. “Medical evidence” is used to justify ignoring women’s voices and women’s experiences, creating the false binaries of educated and loving breastfeeding mother vs. uneducated and lazy formula feeding mother. The very name of the Initiative, “Baby Friendly,” is a rhetorical strategy designed as a blatant false binary; if breastfeeding is “baby friendly” then women who don’t breastfeed can’t possibly be good mothers.
What are the rhetorics of efficiency to which Gilson refers?
Concepts of efficiency are rhetorically and culturally situated … and ultimately privilege particular bodies, evidence, and practices over others. I suggest that the rhetorical construction of efficiency (both explicitly and implicitly) in BFUSA policies fail to adequately acknowledge that what is framed as most efficient – for baby, family, and society – relies on a disproportionate investment of time, energy, and self on the part of certain bodies.
In this case, the privileged bodies are those of white, well educated, well off, married women. The cost to women in lost income, lost career opportunities and lost time are viewed as irrelevant.
Hence breastfeeding advocates relentlessly promote economic models of how much money could be saved if more women breastfed. These models, besides being unvalidated and therefore false, never include the costs — economic and personal — to women, because they are predicated on the notion that women’s time is worthless and women’s bodies exist to serve others.
BFUSA policies aim to bring bodies into alignment through traditional, patriarchal rhetorics designed to persuade – to intentionally and consciously convert or change another. In doing so, the policies engage traditional rhetorics of efficiency – promoting a single practice performed by a normative body as objective and good – and explicitly or implicitly ignore or undermine varied embodiments and alternative approaches which are instead framed as jeopardizing the success of policy goals…
BFUSA treats women who can’t or don’t want to breastfeed, not as individuals with valid concerns, but as deviants who jeopardize BFUSA’s goals. Instead of invoking best practices in medical communication — listening, sympathizing and respecting differing viewpoints — BFUSA seeks to “educate” women, pressure them and force them to breastfeed.
These would be unacceptable tactics even if there were substantial benefits to breastfeeding. The truth is that the benefits of breastfeeding term babies in industrialized countries are contested:
This … ignores the considerable body of work that calls into question the extent and scope of beneficial health outcomes directly linked to the practice of breastfeeding versus other indicators (for instance, socioeconomic status or family dietary habits), and reflects what some argue is breastfeeding advocates’ tendency to conflate correlation with causation.
Therefore we have policies that:
•ignore or undermine competing and/or nuanced views in order to further an image of the policies and guidelines as grounded in objective fact;
• stress measurable outcomes (for instance, target numbers or set goals) over responsiveness to individual users;
• rely on reductive rhetorics of “choice” that downplay inequities and situational constraints, and instead point to individual motivation or ignorance as the barriers to successful outcomes; and
• hold mothers responsible for individual, infant, and public health.
Breastfeeding rhetoric is designed to silence and coerce women. Babies and mothers are suffering as a result.
