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As a Pediatrician who is a strong proponent of both breastfeeding and vaccines I find your commentary fascinating food for thought.
I do find our confidence in "man made" solutions to our problems interesting as they often turn out to be problematic in the end due to our inability to see the whole picture- eg antibiotics and the the microbiome. I also think breastfeeding and vaccines can both be seen as our attempts to manipulate the natural to our ends as opposed to imposing our own solutions but that could be argued many ways.
I do take keen interest in your idea that breastfeeding may be used to enforce stereotypical parental roles. I am not for that. We have been actually attempting to include father/family more as we promote breastfeeding- doing skin to skin with both mom and dad, going to couplet care and relying on dad/support person to care for baby too, educating both parents during their post partum stay. If we encourage dad to take a more active parenting role from the start could we not use breastfeeding promotion to break down stereotypes instead?
Thanks for a thought provoking piece.
The authors’ argument—that it is “ethically problematic” to apply the term “natural” to the act of breastfeeding, and that to do so could inadvertently undermine vaccine promotion efforts and “support biologically deterministic arguments about the roles of men and women in the family”—is strained at best.
By all measures breastfeeding fits the Oxford Dictionary definition of natural: “Existing in or caused by nature; not made or caused by humankind.” Breastfeeding is a hallmark of all mammals; if it is natural for lions, whales and apes to nurse their young, why is it any less so for humans?
The idea that the use of “natural” to promote breastfeeding will lead parents to question the “unnaturalness” of vaccination hinges on a false dichotomy: that parents considering vaccination are faced with a binary choice between the natural (probiotics, herbs, nutritional supplements, etc.) and the unnatural (manufactured vaccines). In reality, parents often choose a mix of these measures, none of which are completely natural in the Oxford Dictionary sense. The drive to protect our children from infectious diseases—whether by amulets, prayer, vaccination, or the harvesting, processing, packaging and sale of herbs, supplements and the like—has always involved a substantial degree of human intervention.
Finally, the idea that the use of the word natural “may inadvertently endorse a controversial set of values about family life and gender roles” is far-fetched. With...
Finally, the idea that the use of the word natural “may inadvertently endorse a controversial set of values about family life and gender roles” is far-fetched. With the exception of much of the 20th century in the industrialized West, breastfeeding has been the standard mode of infant feeding in all eras and under every sociopolitical system imaginable. (My grandmother’s 109 year-old child-rearing manual lauds breast milk as “the natural food of infancy.”) Whose “controversial set of values” should we fear?
The authors of this article, Jessica Martucci and Anne Barnhill, seem to think that when the mothers see the word “natural” associated with breastfeeding, which of course makes perfect sense, they are likely to embrace other alternative parenting practices, such as anti-vaxxing.
Indeed, their assumption leads one to guess at the source of their funding.
According to the CDC's 2014 Breastfeeding Report Card, "Breastfeeding rates continue to rise in the United States. In 2011, 79% of newborn infants started to breastfeed. Yet breastfeeding did not continue for as long as recommended. Of infants born in 2011, 49% were breastfeeding at 6 months and 27% at 12 months."
Therefore, it's difficult for me to believe that with such low numbers for extended breastfeeding, the authors' theory could possibly hold water. The alternative life-style decisions they seem to fear are simply not going to be engendered by short-term breastfeeding.
Today’s economy requires that most mothers work, often making breastfeeding a logistical difficulty, if not a complete nightmare. Imagine trying to pump in the ladies’ room of an office or fast-food restaurant, and storing your breast milk in the employee fridge. For these mothers, breast milk may be more natural, but removing it from the breast certainly isn't. This is one reason why more babies aren’t breastfed at 6 and 12 months.
Besides, wouldn’t the word "natural," ju...
Besides, wouldn’t the word "natural," juxtaposed with breastfeeding, be just as likely to encourage vegetarianism, or moving to a farm, as anti-vaxxing? Or maybe even growing dreadlocks?
As a former La Leche League leader and the mother of four grown children - all breastfed - I think that when women research the benefits of breastfeeding, take time to attend natural childbirth classes, and educate themselves about better nutrition, they come into their own as confident mothers. They are learning to advocate for themselves and their children. Some are the first to breastfeed in many generations. And we should be proud of them.
Suggesting that the media distort the truth about breastfeeding by deleting the word "natural" is a ludicrous attempt at manipulating public opinion. It's duplicitous. If the authors don't personally believe that breastfeeding is the most natural way to feed babies, well, that's too bad. They should do their homework – and maybe direct their efforts elsewhere. Meanwhile, they should leave the media, and moms, out of it.
The AAP Section on Breastfeeding Leadership read with interest the Perspectives in Pediatrics article, “Unintended Consequences of Invoking the ‘Natural’ in Breastfeeding Promotion” by Martucci and Barnhill. While we agree that the words we choose to encourage healthy behaviors certainly matter, equating breastfeeding as “natural” with the supposed “natural” of the anti-vaccine movement is neither logical, nor appropriate. Furthermore, this direct link is not substantiated in the literature.
Breastfeeding is the normative standard for infant feeding, and the standard by which all other feeding methods should be compared. Infant formulas are inferior to this standard, as documented in multiple evidenced-based studies, including the recent Lancet series on breastfeeding, which concludes that the evidence supporting breastfeeding benefits for mothers and babies is now “stronger than ever.” Accordingly, we disagree that higher risks of formula feeding to mothers and babies are being oversold.
The Nuffield Council on Bioethics Analysis Paper states that public agencies, governments and organizations “should avoid using the terms natural, unnatural and nature” unless they make transparent the “values or beliefs that underlie them.” The US DHHS Office on Women’s Health 2013 campaign entitled “It’s only natural, mother’s love, mother’s milk” specifically targets African American families, the demographic least likely to breastfeed, yet facing the greatest burden...
The Nuffield Council on Bioethics Analysis Paper states that public agencies, governments and organizations “should avoid using the terms natural, unnatural and nature” unless they make transparent the “values or beliefs that underlie them.” The US DHHS Office on Women’s Health 2013 campaign entitled “It’s only natural, mother’s love, mother’s milk” specifically targets African American families, the demographic least likely to breastfeed, yet facing the greatest burden of adverse health outcomes. Among mothers giving birth in 2012, 83.0% of white women (non-Hispanic) and 82.4% of Hispanic women initiated breastfeeding, while only 66.4% of non-Hispanic black women initiated breastfeeding, a concerning disparity. For the targeted population of the “It’s only natural” campaign, breastfeeding initiation is not “natural.” The language of the campaign was chosen to convey that breastfeeding is achievable when African American mothers receive culturally sensitive education, help and support, using a multi-pronged approach.
AAP policy states that infant feeding should be considered a public health issue and not a lifestyle choice.2 Breastfeeding is indeed at the core of public health promotion and primary prevention. Additional important preventive measures advocated by the AAP and other health organizations include routine immunizations, which protect against preventable childhood diseases, based on centuries of proven benefits. The ideal way to connect breastfeeding with vaccinations is to highlight breastfeeding as the “first immunization” recognizing the abundant immune protective factors present in breastmilk, and especially in colostrum.
Choosing our words carefully in health promotion is important, but even more important is the effect our words have on the desired health outcomes. Just as the authors are concerned about a theoretical effect of breastfeeding promotion on vaccine rates, we are concerned about the effect of their article, and other similar articles, on breastfeeding promotion and rates. Let us state clearly that breastfeeding is the normative standard for infant feeding, and other feeding methods put mothers and children at risk for both short and long-term adverse health outcomes. It is our responsibility, as pediatricians and children’s advocates, to inform parents of these facts, just as we explain the importance of immunizations.
Thank you to the Leadership Team of the American Academy of Pediatrics Section on Breastfeeding for their contributions and review of this comment.
1. Eidelman AI, Schanler RJ, American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–e841
2. Victora CG, Bahl R, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475-490
3. Nuffield Center on Bioethics. Ideas about naturalness in public and political debates about science, technology and medicine. November 2015. Available at http://nuffieldbioethics.org/wp-content/uploads/NCOB_naturalness-analysi.... Accessed March 8, 2016
4. U.S. Department of Health and Human Services, Office on Women’s Health. It’s only natural, mother’s milk, mother’s love. April 2013. Available at http://womenshealth.gov/itsonlynatural/. Accessed March 8, 2016
5. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2012 National Immunization Survey. July 2015. Available at http://www.cdc.gov/breastfeeding/data/nis_data/index.htm. Accessed March 8, 2016
Thank you for your interest in spreading the word on Pediatrics.
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