Discussing the risks of formula without alienating people

Last week on the Lactivist Facebook page I reposted an image from World Alliance for Breastfeeding Action WABA

The image got a lot of reaction, some people thought it was too strong, some people thought it said what should be said.

One of the responses was from Emma Ashworth and with her permission I’ve copied and pasted her entire post as I felt it was wasted on Facebook….

Emma said…

Fascinating reaction to this information, and how it’s presented. We understand that offering this information by discussing the “benefits” of bfing, eg reduces the risk of XYZ, can ironically undermine bfing by normaising FF (which is how formula marketing is so powerful). Yet it seems that this kind of more detailed information is even less well accepted this way round. It’s interesting that many people are reading this and just believing it’s untrue. Why? Preferable to hold that belief than recognise the real risks of FF? The psychology is essential to understand if we are to ensure that parents accept this information as fact and the worrying thing is that as anyone who knows more than the basics of breastmilk chemistry and the biology of the breastfeeding dyad will understand, this list barely touches the surface.

Perhaps a good analogy is climate change – note, no longer called global warming because while climate change is happening because of an overall warming of the global temperatures, in individual areas the climate may actually be cooler due to the temperature increase changing huge weather systems. It’s hard to believe in “global warming” when we have weeks of rain or flooding (although visit the Masai Mara frequently and you’ll see catastrophic change happening before your eyes, season by season as the Mara slowly boils to death). A change of name explains the same effect better and therefore it’s more likely to be believed. Without belief we can have no change.

With climate change the percentage of scientists involved in its study who believe that humans are changing the environment to the point of destruction is close to 100%. Yet, human-created climate-change sceptics will sieze press releases from the 1 or 2% of scientists who believe that it’s a natural phenomenon as being proof that the remaining 99% (or so) are wrong. This is a poor evaluation of risk and probability but it fits better with a desire to not change behaviour – and more importantly a desire to not be afraid. No individual other than the leaders of a few countries can realistically make any difference themselves, and given the danger of the problem it’s far nicer to believe it’s not true.

But, breastfeeding IS different. Most of us can breastfeed if we want to, we have more control as individuals, but most of us don’t and here’s a summary of why:

1) Of those who want to, some will without help (not many), some will with help (lucky people to have help) and some will despite poor “help”. Unfortunately many won’t get the help they need due to virtually no NHS support (and in fact as most health visitors and midwives aren’t trained in breastfeeding support it gets worse as mums think they’re getting good support so if it doesn’t work out they think *they* failed which is an absolute fallacy).

2) Of those who get going ok, there is so much undermining of bfing in our culture due to a lack of understanding of normal baby behaviour. For instance, people expecting a baby to feed every 3-4 hours may make comments such as “are you feeding him again?” which makes a parent second guess themselves and can undermine confidence. And of course many people don’t yet feel confident about bfing in public.

3) Most people don’t know the risks of not breastfeeding, or choose to not believe them. I often see the comment, “when they’re in the school playground you can’t see a difference”. True – you can’t because you can’t see a higher risk of cancer, or eczema unless it’s on the face or hands, or a higher risk of diabetes. This does not mean they’re not there.

4) Many people take their own experiences and use those as facts. We all know someone whose grandmother smokes 60 a day and drinks 6 pints of Guiness before bedtime and is alive and well at 103. It doesn’t mean that the stated RISKS of smoking and drinking are incorrect. It means that in a population of people, of those who smoke (say), a significantly higher number will contract specific cancers than those who do not smoke. It doesn’t mean it WILL happen. Similarly, it doesn’t mean that someone who never smokes will never contract, say, lung cancer. They’re just far less likely to.

I use the smoking and drinking example not (as I will accused of) because I feel that formula feeding is akin to sticking a fag in a baby’s mouth, but because it’s a well understood scientific area of risk and as an analogy it therefore has merit.

So, when a baby is exclusively breastfed for 6 months and then is found to have an allergy, it doesn’t mean that the science is wrong. There are multiple reasons why people have allergies and not breastfeeding is just one of them. Similarly there are multiple causes of diabetes, but, a significant number of children who contract diabetes would NOT have done had they been breastfed. Others would have no matter what.

I think that this is information that every parent deserves to know. I think that every mother also should have excellent breastfeeding support so that if she chooses to breastfeed she has the maximum opportunity to do so. This is a massive endeavour as it requires understanding of:

- How labour and birth can affect breastfeeding (eg artificial oxytocin use or the disrespect of the oxytocin system in the labouring woman, pain relief use, instrumental delivery and CS)
- How physical issues may be overcome (eg forceps/ventouse causing baby pain and difficulty latching, inverted nipples, low milk supply or perception of such, a good latch)
- Normal baby behaviour (eg healthy sleep patterns, the dangers of baby training and some routines, frequency of feeding)

But it’s all chicken and egg. Without the desire to breastfeed driven by information such as this, parents won’t necessarily have the desire to search out appropriate help. Those who do seek help may not find it, or find the right help. Often support is sought after birth when learning more before birth may be more helpful and conducive to a positive outcome and breastfeeding experience.

So this poster addresses one small part of the equation. It’s putting across information. Some people think the information is false which is a shame as it scientifically proven and well known fact. Some people think it’s bullying. Others feel it makes them feel guilty. Others still think the information sharers are ignorant of the awful experiences that some parents have (nothing is further from the truth). In answer to the question of “what do I think about it”, it therefore fails as a BFing promotion poster on many levels although it will touch enough people, make enough people think a little more about the importance of breastfeeding to their baby’s health who otherwise may not that it will have value.

But, at what cost? While you can’t please all the people all of the time it is not acceptable to alienate so many people.

We need some really good risk analysis psychologist to work this out. The movement from discussing the benefits of breastfeeding to discussing the risks of formula feeding is a step in the right direction but it is clearly not the solution. What I don’t know is what the solution is. What I do know is, there are enough of us who want to find out.