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29 October 2012

Science, Money and Women’s Reproductive Choices

Clare Murphy, Director of External Affairs at BPAS, writes on the Huffington Post UK.

A recent report on breastfeeding suggested the NHS could save millions of pounds by encouraging more women to feed their babies naturally. An eye-watering array of figures arranged over more than 100 pages showed the cost-savings that would be made by reduced incidences of hospital admissions for both mother and baby through an increase in rates of breastfeeding.

Researchers have often found it hard to divorce the health benefits of breastfeeding for mother and baby from broader socio-economic factors that may make these families more likely to thrive in the first place. But even if we take the reported benefits and cost savings at face value, what is really lacking in the research around how women feed their babies is the reality of women’s lives - and why women make the choices they do.

Some women may abandon breastfeeding because they have been given insufficient support - and if so that certainly needs to change. But many other women may choose to stop or reduce breastfeeds because of the physical burden and sleep deprivation, the desire to share care with their partner, or because they need to be able to time feeds to fit in with the needs of their other children. They do not discontinue breastfeeding because they do not want the best for their baby, but because this is their way of being the best mother that they can.

Feelings run high in the debate around breastfeeding, just as they do in other areas of women’s reproductive decision-making. Ultimately, the scientific risks and benefits of one choice over another will only ever be one part of women’s decision-making process as she weighs up what is best for her in the specific circumstances of her life.

By and large for example, women do not make decisions about ending or continuing a pregnancy based on the relative risks of childbirth versus abortion. They make up their minds on the basis of whether they are able to take on the significant responsibilities of bearing a child at that moment in their lives and whether they feel it would be right to do so. More than half of women having abortions are already mothers and they consider the impact of a further pregnancy on their existing family.

Even at the less fraught level of contraception, policy makers are often exasperated by women’s “failure” to choose the most effective methods, such as implants and coils. As well as providing the highest level of protection against unwanted pregnancy, they are also the most cost-effective for the tax payer when compared to daily alternatives. Are women who decide against these making the wrong choice for themselves and the taxpayer? No, while they are a fantastic option for many women, others find the associated side-effects simply incompatible with their lives.

What matters in all these discussions around women’s reproductive choices - from contraception through to feeding a newborn - is that they are just that - choices. Women’s decision-making should be supported - and respected, not considered fair game for public judgement. Science and cost/benefit analyses can tell us much, but they will never be able to explain the needs and realities of a woman’s own individual life and how it will quite rationally shape her decision making - that’s something only she can know.

Science, Money and Women’s Reproductive Choices. By Clare Murphy. Huffington Post UK, 28 October 2012