On the Supposed Responsibility to Breastfeed from Moral Concerns Even the sea monsters draw out the breast, they give suck to their young ones: the daughter of my people is become cruel, like the ostriches in the wilderness. - Lamentations 4:3, KJV “Are you planning to breastfeed?” Every pregnant person gets this question – from doctors, from friends and co-workers. I did. Those asking aren’t generally just making small talk. They often have very strong opinions about and reactions to one’s answer. And these opinions are not limited to individual busybodies. Well-funded government and non-profit campaigns publish blogs and books; scientific and popular journals continuously generate articles on breastfeeding’s effects; moms worldwide chronicle their views on forums like Babycenter.com; self-described “lactivists” stage nurse-ins; while other feminists rail against the shame and guilt they claim are used to pressure moms to nurse babies. The buzz over breastfeeding is pervasive, to say the least, prompting article titles like Emily Oster’s 2015 “Everybody Calm Down About Breastfeeding.”1 But why all the buzz? Clearly, breastfeeding is not “just” a lifestyle choice. Planning to breastfeed or not is not like planning to go to the beach vs. the mountains for your next vacation. People think it matters (a lot!) whether moms breastfeed. I want to suggest, along with some other philosophers who have written about the topic recently2, that people are abuzz about the moral status of breastfeeding – is it morally required? Do moms have a duty to try to breastfeed? Is breastfeeding morally virtuous – that is, is it a morally valuable and admirable practice if not strictly a required one? Can a truly good and loving mom use formula, even if she has the option of breastfeeding? People are also abuzz about the morality of our collective breastfeeding conversation – for example, is it morally okay to use shame to influence moms to make decisions that benefit society? But I’m going to focus for the most part on questions about the moral status of breastfeeding itself. I’m going to suggest that although society believes moms have a responsibility to breastfeed, we’re wrong about that. And some of the strongest objections to this supposed responsibility have historical roots in moral philosophy. 1. The dominant narrative I’m going to refer to the claim that moms have a moral responsibility to try to breastfeed because it’s better for their babies, as the dominant narrative. I call it a narrative because it’s part of the story we tell each other about what being a good mom looks like. I call it dominant because, well, it is tacitly endorsed by all mainstream popular and professional organizations that inform parenting decisions, and it’s been pretty thoroughly internalized by millions of moms. But for those unfamiliar with the breastfeeding buzz, it may be helpful to review some of the messages moms receive and the impact those seem to have. The dominant narrative really is dominant. 1 https://fivethirtyeight.com/features/everybody-calm-down-about-breastfeeding/ 2 See, e.g., Overall and Bernard (2012) “Into the Mouths of Babes: The Moral Responsibility to Breastfeed,” Philosophical Inquiries into Pregnancy, Childbirth, and Mothering, eds. S. Lintott and M. Sander-Staudt, New York: Routledge; Woollard and Porter (2017) “Breastfeeding and defeasible duties to benefit,” Journal of Medical Ethics, 43(8): 515-518; REDACTED 1 Let’s start with reputable medical and scientific organizations. The American American Academy of Pediatrics3 claims that “Breastfeeding and human milk are the normative standards for infant feeding and nutrition.”4 Why? The AAP policy continues: “Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.” After a lengthy review of available data supporting the benefits of breastfeeding for babies, the policy concludes: Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. Here it is claimed not only does breastfeeding benefit baby, but not breastfeeding risks harm to the baby. Again we see affirmed that breastfeeding is not a lifestyle choice but rather a “basic health issue.” It’s a short step from these claims to the claim that breastfeeding is a moral issue. Consider also the World Health Organization’s introduction to “10 facts about breastfeeding”: Breastfeeding is one of the most effective ways to ensure child health and survival. If breastfeeding were scaled up to near universal levels, about 820 000 child lives would be saved every year. Globally, only 40% of infants under six months of age are exclusively breastfed. WHO actively promotes breastfeeding as the best source of nourishment for infants and young children.5 The first “fact” about breastfeeding presented, then, is that “Breastfeeding for the first six months is crucial.” Indeed, the clear suggestion is that breastfeeding is crucial because breastfeeding could literally save your child’s life. No mention is made in this passage about the relevance of access to clean water for mixing formula, or about where or from what the estimated 820,000 child lives would be saved. The 40% global rate of compliance – which we are presumably meant to lament – is about three times higher than the current U.S. rate, which suggests that moms in the U.S. are far from off the hook but rather a major part of the (moral) problem. These messages are not isolated in think tanks or dusty clinical manuals. They make their way quickly to actual moms, in part via advice websites like babycenter.com, parents.com, whattoexpect.com, and americanpregnancy.com, each of which devote whole pages to the benefits of breastfeeding that focus mainly on benefits for the baby – clearly a morally weighty consideration. And these pale in comparison to the claims of more partisan pages that advocate breastfeeding, like kellymom.com, askdrsears.com, or La Leche League’s site. For example, Kellymom publishes an astoundingly long list of the “many benefits of breastfeeding,” including “cancer protection,” “less SIDS” (sudden infant death syndrome), and higher “intelligence.” And La Leche League incorporates the morality of breastfeeding into their “philosophy,” excerpted here: 3 The American Academy of Pediatrics was founded in 1930 and is currently an organization of 66,000 pediatricians. 4 “Breastfeeding and the Use of Human Milk,” Pediatrics (2012), http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552 5 http://www.who.int/features/factfiles/breastfeeding/en/ Updated August 2017 2 “Mothering through breastfeeding is the most natural and effective way of understanding and satisfying the needs of the baby… In the early years the baby has an intense need to be with his mother which is as basic as his need for food. Human milk is the natural food for babies, uniquely meeting their changing needs.” From CDC “Healthy People” targets, to AAP “Health Initiatives,” to the advocacy of organizations like La Leche League and baby friendly hospitals, breastfeeding advocacy groups are vocal and powerful. And although the U.S. Preventive Services Task Force revised its 2016 recommendations to physicians, such that they now only ask physicians to “support,” rather than “promote and support” breastfeeding, many breastfeeding advocates are relatively unconcerned about even the explicit use of shame and guilt in campaigns. Consider an excerpt from “Breastfeeding and Guilt,” published on kellymom.com6: One of the most powerful arguments many health professionals, government agencies and formula company manufacturers make for not promoting and supporting breastfeeding is that we should “not make the mother feel guilty for not breastfeeding”. … It is, in fact, nothing more than a ploy. … If a pregnant woman went to her physician and admitted she smoked a pack of cigarettes, is there not a strong chance that she would leave the office feeling guilty for endangering her developing baby? … Given that this is the sort of information available to new moms, it is perhaps unsurprising that many who do not breastfeed do in fact feel guilty – or rather, perhaps, ashamed7 – having made that choice. One anonymous babycenter.com user writes: I found it excruciatingly painful to breastfeed my baby even though three lactation consultants told me I was doing everything right and my baby was latching on correctly. After a few weeks of crying more than my infant, I finally switched to formula. But now I'm consumed with guilt. Everywhere I look, even on formula packages, breastfeeding is touted as best. How can I make peace with my decision? (2002) Perhaps even more telling is the answer that babycenter.com ranks as second-“best,” which 473 users to date have found “helpful”: With my first, I was determined to the point of lunacy to breastfeed. I knew I couldn't handle the guilt if I didn't nurse… My daughter initially couldn't latch on … and as a result dropped down from 7 lbs to less than 5 1/2 lbs and was jaundiced. I refused to supplement, and somehow made it through her illness and my stress… With my second daughter, I endured cracked, sore bloody nipples, but managed to nurse her for a year… 6 https://kellymom.com/blog-post/breastfeeding-and-guilt/ 7 See Taylor and Wallace (2012) “For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt,” Hypatia, 27(1): 76-98. 3 A chilling report, given that babies actually die when moms struggle to breastfeed and refuse to supplement.8 Yet these are not isolated, anecdotal sentiments. A 2009 review of 23 studies involving over 13,000 participants, attempting to understand parents’ experiences of bottle-feeding summarized: “Mothers who bottle-fed their babies experienced negative emotions such as guilt, anger, worry, uncertainty and a sense of failure.”9 Both the information available to moms and their reported experiences of infant feeding decisions support the dominance of what I’m calling the dominant narrative.