{"id":3385,"date":"2018-08-22T23:41:38","date_gmt":"2018-08-22T22:41:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3385"},"modified":"2018-09-10T21:48:07","modified_gmt":"2018-09-10T20:48:07","slug":"harms-of-formula-vs-benefits-of-breastfeeding-why-we-dont-know-how-to-talk-about-the-effects-of-different-ways-of-feeding-babies","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2018\/08\/22\/harms-of-formula-vs-benefits-of-breastfeeding-why-we-dont-know-how-to-talk-about-the-effects-of-different-ways-of-feeding-babies\/","title":{"rendered":"\u201cHarms of Formula\u201d Vs \u201cBenefits of Breastfeeding\u201d : Why we don\u2019t \u201cknow\u201d how to talk about the effects of different ways of feeding babies"},"content":{"rendered":"

By\u00a0Fiona Woollard<\/a><\/p>\n

I\u2019m sitting in a room filled with people who care deeply about mothers and babies.\u00a0 Many of them have dedicated their lives to improving support for new mothers to have the chance to feed their babies in the way they want.\u00a0 Someone is talking about cuts to breastfeeding support or about information provided to parents about health benefits of breastfeeding.\u00a0 Then the speaker adds, almost as an aside, \u201cOf course, we know that it is really \u2018the harms of formula\u2019 not \u2018the benefits of breastfeeding\u2019.\u201d\u00a0 There is a general nodding of heads.\u00a0 It seems to be accepted by almost everyone in the room that this is something that we know<\/em>.\u00a0 It is \u2018known\u2019 that any differences in outcomes between babies fed with infant formula and breastfed babies should be described as \u2018harms of formula\u2019.<\/p>\n

I\u2019ve watched this scene many times.<\/p>\n

As a philosopher, I feel a sort of territorial annoyance.\u00a0 This is a deeply complex philosophical question.\u00a0 It is not something that we should confidently claim to know as if there were a simple answer.<\/p>\n

As a mother who has both breastfed and used formula, I feel worried about the effects the use of harm and risk based language may have on vulnerable new mothers.<\/p>\n

Whether we frame infant feeding decisions in terms of harming or benefit, protection or risk matters because these distinctions are generally morally significant.\u00a0 There are much stronger constraints against harming or risking harm than against merely failing to benefit.\u00a0 To describe a mother as \u2018harming\u2019 or \u2018risking harm\u2019 to her baby is to present her as infringing the very strong duty not to harm or risk harm.\u00a0 It is to suggest that she should feel guilty.<\/p>\n

Guilt for using infant formula is widespread and can be devastating.\u00a0 Describing infant formula as harmful is not only likely to contribute to mothers\u2019 guilt for using infant formula; it has an even more insidious effect by suggesting that guilt is appropriate. If guilt about using formula is seen as appropriate, then its effects on maternal wellbeing may be wrongly dismissed as morally unimportant.<\/p>\n

For all these reasons, we should be very careful about using morally loaded terms like, \u2018harm\u2019 and \u2018risk\u2019 to describe the use of formula.<\/p>\n

The general acceptance of harm-based language traces back to Diane Weissinger\u2019s hugely influential article \u201cWatch Your Language\u201d<\/a>.\u00a0 Weissinger argues that health comparisons always use a biological norm as the baseline for comparison.\u00a0 Breastfeeding is the biological norm. Talking about the benefits of breastfeeding treats formula as the baseline.\u00a0 Weissinger argues we should treat breastfeeding as the baseline and talk about the harms of formula.<\/p>\n

Weissinger\u2019s interpretation of public health practice and of anthropology has been challenged<\/a>.\u00a0 However, as I argue in my paper, even if she is right about general practice, this does not settle how we should talk about formula.\u00a0 Because breastfeeding deeply implicates the mother\u2019s body and agency, positioning breastfeeding as the moral baseline is problematic even if it is the biological norm.\u00a0 To do so takes the mother\u2019s body and agency for granted. It does not fit with our use of the concepts of harm and benefit in other situations.\u00a0 In general, we think of harming someone as making them worse off than a neutral state of non-interference.\u00a0 Even if it is the biological norm, breastfeeding cannot be characterised as a neutral state of non-interference.<\/p>\n

Applying the harm\/ benefit distinction to infant feeding decisions is extremely difficult.\u00a0 Like many moral concepts, the harm\/ benefit distinction is designed for interactions between independent adults who can, by and large, leave each other alone in a neutral state of non- interference. We don\u2019t have this kind of baseline state of non-interference when it comes to mothers and infants.<\/p>\n

So we don\u2019t know<\/em> that it is correct to refer to \u201cthe harms of formula\u201d rather than \u201cthe benefits of breastfeeding\u201d.\u00a0 Both ways of talking are philosophically worrying because they appeal to a harm benefit\/ distinction that doesn\u2019t apply well in this context.<\/p>\n

Pragmatic considerations don\u2019t provide an easy answer either.\u00a0 Just as those who use infant formula (and those who care about them) have reason to object to framing infant formula as harmful, breastfeeding mothers and supporters have reason to object to framing breastfeeding as \u2018beneficial\u2019.<\/p>\n

Helen Calvert has written movingly<\/a> on support for breastfeeding on the children\u2019s wards in hospitals.\u00a0 She connects the \u2018Breast is best\u2019 rhetoric to an attitude that breastfeeding is an optional extra which mothers cannot expect busy health professionals to do much to support.<\/p>\n

Framing breastfeeding as beneficial may discourage mothers who are failed by insufficient support to become angry and to demand better support.\u00a0 If we see ourselves as having lost out on the \u2018best\u2019 then we might not see this as a big problem.<\/p>\n

And, of course, this isn\u2019t a simple case of the interests of one group of mothers (formula feeders) versus the interests of a completely separate group (breastfeeders): one and the same mother may both use formula and breastfeed, either at the same time or at different times.<\/p>\n

 <\/p>\n

Paper title: Should we talk about the \u2018benefits\u2019 of breastfeeding? The significance of the default in representations of infant feeding<\/strong><\/a><\/p>\n

Author(s): Fiona Woollard<\/p>\n

Affiliations: University of Southampton<\/p>\n

Competing interests: None.<\/p>\n

Social media accounts of author(s):<\/p>\n

@f_woollard<\/a><\/u><\/p>\n","protected":false},"excerpt":{"rendered":"

By\u00a0Fiona Woollard I\u2019m sitting in a room filled with people who care deeply about mothers and babies.\u00a0 Many of them have dedicated their lives to improving support for new mothers to have the chance to feed their babies in the way they want.\u00a0 Someone is talking about cuts to breastfeeding support or about information provided […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2022],"tags":[],"class_list":["post-3385","post","type-post","status-publish","format-standard","hentry","category-reproduction"],"yoast_head":"\n\u201cHarms of Formula\u201d Vs \u201cBenefits of Breastfeeding\u201d : Why we don\u2019t \u201cknow\u201d how to talk about the effects of different ways of feeding babies - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2018\/08\/22\/harms-of-formula-vs-benefits-of-breastfeeding-why-we-dont-know-how-to-talk-about-the-effects-of-different-ways-of-feeding-babies\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cHarms of Formula\u201d Vs \u201cBenefits of Breastfeeding\u201d : Why we don\u2019t \u201cknow\u201d how to talk about the effects of different ways of feeding babies - 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