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12 November 2013

Breastfeeding bribes

A new scheme that gives new mums money to breastfeed is an assault on choice. By Jennie Bristow, editor, Reproductive Review.

A pilot scheme in South Yorkshire and Derbyshire is bribing new mothers to breastfeed their babies. Those who breastfeed for the first six weeks will get £120; those who continue for the next six months will get an additional £80. ‘It is a way of acknowledging both the value of breastfeeding to babies, mothers and society,’ said Dr Clare Relton, the Sheffield University expert leading the project.

From a pro-choice perspective, there are so many things wrong with this scheme that it would be impossible to list all of them. But at the top of the pile is this: Why is it ‘society’s’ business how a mother feeds her baby?

One of the most regrettable elements of the breastfeeding promotion campaigns that have dominated maternity care for the past couple of decades is the way that infant feeding has been cast as a ‘public health’ issue. The benefits of breastfeeding over formula feeding have been exaggerated to a ridiculous extent; breastfed babies, we are told, are so much healthier, cleverer, slimmer, and more emotionally stable than their bottle-fed peers that this justifies locking formula away in hospital cabinets, and bullying and bribing new mums to breastfeed however much they struggle, or simply do not want to.

As it goes, the benefits of breastfeeding over formula feeding in developed countries today are pretty marginal. As the American academic Joan Wolf explains, in her critical review of the evidence about breastfeeding: ‘When studies find an association between breastfeeding and reduced risks [to infant health]… it is not at all clear that one causes the other, and the conclusion that breastfeeding confers health benefits is far less certain than its proponents contend. Indeed, a great deal of evidence suggests that the difference between breastfeeding and bottle-feeding has little impact on the overwhelming majority of infants in the developed world.’

When breastfeeding goes well, it can be good for babies. But when it doesn’t, both babies and mothers can suffer. From mastitis to dehydration to exhaustion, the negative effects of unsuccessful breastfeeding can easily outweigh the health benefits that might accrue from breastmilk over formula. A genuine ‘public health’ campaign would recognise that really all that matters in the first months of a baby’s life is that both mother and baby are doing all right. That certainly means supporting mothers who want to breastfeed – but it also means recognising that formula feeding is fine too.

Even if the public health case for breastfeeding was much stronger than it actually is, it would still be wrong to bully new mothers to do it. This comes down to the simple matter of women’s autonomy. As a society, we recognise the importance of permitting women to decide whether and when to have a baby – even opponents of contraception and abortion tend to agree that it is better that a child is wanted. Part of this commitment to choice is that we entrust to women and their partners the task of raising that child over the next 18 years – a task that has to be undertaken by adults, who can make decisions for themselves.

By removing from women that first, most basic decision – how to feed her baby – and making out that this decision will determine her child’s life chances, a huge amount of damage is done to that woman’s status as a grown-up. Put simply: if she cannot even decide for herself how to feed her baby, how can she be entrusted with the bigger decisions along the way?

One of the most shocking things about the reaction to the breastfeeding bribes story is that many of those who have raised objections have done so, not out of a desire to support women’s decision-making, but because they think the scheme will not work, or that the pressure to breastfeed should take a less consumerist form. These objections simply reinforce the idea that it is right for ‘society’ to determine how a mother should feed her baby.

Concerns have been raised that the incentive of vouchers will encourage women to lie to their midwives about their feeding practices – as if women didn’t lie already, to avoid the opprobrium they already feel from judgemental health professionals. Anecdotal evidence suggests that midwives and health visitors are often quite sensitive to the damage that the relentless campaign of breastfeeding promotion has done to the relationship of trust between new mothers and health professionals; yet news reports often underplay this, pretending that somehow society is still debating whether women should be put under pressure to breastfeed.

In reality, from the moment a woman becomes pregnant she is instructed that breast is best, and made to feel guilty if she has let a plastic teat come into contact with her baby’s lips. The fact that the vast majority of women in Britain do formula-feed simply means that the vast majority of mums are guilt-tripped. Nobody benefits from this: and even without this latest grubby cash incentive initiative, breastfeeding promotion campaigns have already caused a great deal of harm.

Breastfeeding mothers offered £200 in shop vouchers. BBC News Online, 12 November 2013

Should mums be paid to breastfeed? Jennifer Howze of BritMums debates the issue on Sky News, 12 November 2013.

Can you say breast isn’t (always) best? US academic Joan Wolf talks to Jennie Bristow about why advocates of the ‘Breast in Best’ message find her book so hard to swallow. Reproductive Review, 8 January 2013.