Thanks to everybody who's commented on my last post – I really appreciate the trouble, and, for once in my life, I'm actually going to try to write a reply to comments. If you haven't read it yet, do please do so and give me your thoughts.
Meanwhile, something that one of the commenters said made me think of an issue on which I'd like the opinions of others. There has been debate and contention, in the past, over whether public health announcements on breastfeeding should frame the differences between breastfeeding and formula feeding in terms of 'benefits of breastfeeding' or 'harms of formula'. (So, for example, do you tell people that breastfeeding helps to protect babies against ear infections, or that formula feeding increases the chances of babies getting ear infections? Which way round do you put it?)
I would really like to know what kind of reaction people have to each of those two ways of phrasing things, and whether one would make you more likely than the other to try to breastfeed and/or try to seek help from others to overcome breastfeeding problems and/or persevere in the face of difficulties. I'm not looking for intellectual arguments as to why you feel one way of phrasing things is better than another, but visceral reactions on your part as to how it makes you feel, and honest impressions of how it might inspire you to act as a result. For reasons I hope will be obvious, I'd really like to get as many opinions as possible from people who are in what you might call the 'wavering would-be breastfeeders' camp – people who like the general idea of trying to breastfeed but have doubts or concerns or have tried it and had problems with it.
Thanks in advance.
Good Enough Mum 
As a health writer I tend to use the carrot not the stick approach – so, helps to protect etc. In my experience, if you scare readers they go into denial…
I’m also a health writer, and I agree 100% with Lee. Anyone whose done research on the psychology of advertising could also tell you that there’s a “rebound” effect when you use too much fear or guilt in your approach.
But you wanted visceral reactions, not professional opinions, right? 🙂 Sorry!
My visceral reaction – holy crap, PLEASE do not encourage anyone else to use the “risks of formula feeding” approach! This is the absolute worst thing breastfeeding advocacy can do. And while it certainly isn’t a scientific or fact-based belief, the old “I was formula fed and I turned out fine” is always going to haunt you. Because in the opinion of most formula fed people, it’s true. And until you can track all of them, prove that they got cancer, are stupider, or have more allergies, you aren’t going to get anywhere (plus I highly doubt you COULD prove that, but hey, that’s why I believe what I believe and others think I’m a dangerous nutcase).
I know the argument is that positive approaches towards breastfeeding promotion haven’t worked in the past, but this is NOT the answer. I think people are missing the point. People aren’t formula feeding b/c they don’t think breastfeeding is better. They are doing it b/c they are either unable to breastfeed or uninterested. The first group is just going to feel worse about themselves, and not be able to do anything about it; the second group could care less anyway. That’s a huge generalization, but when we talk about public policy or campaigns, generalization is somewhat necessary.
Oh and I love that you asked this, by the way – I think you rock. I tweeted it on Twitter but didn’t know your handle or I would’ve added it…
I’m curious if people feel differently about the “risks of not breastfeeding” – to me that feels less loaded than the “risks of formula feeding” because you aren’t making it sound like formula itself is risky, which is an emotional subject because people do feed it to their children (c.f. the term “rat poison”). it also could include risks of doing things other than formula feeding which are also not strictly breastfeeding, such as pumping and feeding, or using donor milk – although maybe that makes it more inclusive in terms of who it offends 😛
@sufficiency I don’t think it really matters between the “risks of not breastfeeding” and the “risks of formula feeding”– it sends the same message.
I shared my opinion about this one when Dr. Sarah asked me on my own blog, so I won’t go into it again here. Suffice to say that I am not a big fan of either approach.
Also, I think that part of this issue is really about finding why women don’t breastfeed (or don’t breastfeed to the 6 month or more recommendation). I tend to feel that what is assumed in the breastfeeding advocacy community is not what women are actually experiencing on the ground. It would be great to hear about some studies on that.
‘harms of formula’
Honestly, I think the whole debate is overreaching. There are some specific properties of breastmilk which carry added benefits. And, theoretically, it’s the ‘natural’ choice and should be the default in our language. Unfortunately, breastfeeding, like childbirth, is determined by myriad complex and counfounding factors which, under ordinary, ‘natural’ circumstances, would result in the death of (and selection against) certain individuals and their offspring. Since that doesn’t make us feel warm and fuzzy, we have invented an alternative food which we are constantly improving.
The ‘harms of formula’ are that your baby gets to survive thanks to a suboptimal food so that he can go on to live the same suboptimal life the rest of us live, despite what we ate as infants, before dying at, hopefully, a ripe age. Likewise, the ‘benefits of breastfeeding’ are that your baby gets to survive thanks to a (maybe) evolutionarily sufficient food so that he can go on to live a suboptimal life.
Nature doesn’t work in “optimal.”
This is a really good and helpful post. I am very proud of you.
Granny C
Tried to comment on the precious blogpost, but it kept on telling me “Sorry, we cannot accept your data”. What’s going on?
Anyway, I hope this one goes through – as far as I’m concerned, it’s a matter of semantics. The real issue for me (and I think that’s what Hannah Rosin was trying to get at as well) is the absolute difference between the two methods. Psychologically and feeding into the “But don’t you want the BEST for your child?!” meme, probably the benefits of breastmilk sounds more encouraging.
Funny that BTW – I was thinking and planning a blogpost along very much the same lines for later today!
Viscerally: “helps to protect” – but this is very influenced by the fact that I was going to bf anyway! Trying to think about something I was on the fence about… yes, I think the positive message is still more likely to influence me than the logically equivalent negative message, fwiw; but really, I’m then going to look at the evidence to the point that the initial phrasing won’t make much difference, and I’m not sure what will be true of people who won’t do that.
On a personal level, I am biased towards “risks of ff”, because in my own experience I encounter it very, very, very rarely. Y’see, I’d always intended to breastfeed, but during pregnancy I got *very* open to the possibility that maybe I wouldn’t be able to, as “it’s so difficult” .
Then, I went to an antenatal class where the midwife (in a gentle, yet matter-of-fact manner; most definitely a non-hectoring manner) explained that the benefits of breastfeeding could also be framed as risks of formula-feeding.
I remembered her during the six-week growth spurt, and I was incredibly grateful for what she’d said. I felt that she’d made it easier for me to think properly about what I wanted to do, given [point of view] and [opposing point of view]. An “informed decision” if you will, although I hate that phrase.
Without her, had I given up, I would, inevitably, have gone on to realise, or read, that the benefits of bf could be re-framed as risks of ff. And then I wouldn’t have been able to unmake my decision.
I’ve been thinking about it more deeply, and I suppose it had less to do with “risk of ff” having any merit as a statement, and more to to do with me finding it refreshing.
As if she was treating me as someone who could cope with explanations without her sugar-coating it, y’know? I felt respected, which may have been down to her personal manner. If I’d *constantly* heard “risk of ff” everywhere I turned, I’d probably have felt really stressed about attempting breastfeeding. Which would not have helped, funnily enough!
I think breastfeeding ought to be portrayed as the default, but that’s far from saying that a campaign ought to be focused on the risks of not breastfeeding.
Hardly anyone sits around specifically comparing the risks of in vitro to those of conceiving a baby the ordinary way, you’ll notice, even though there are dissimilar risk profiles. The reason is that in vitro is not anyone’s first choice, so there isn’t usually any reason to compare the two in that light (if you talk about the risks, it’s usually as compared with doing nothing and probably not conceiving at all). So the question is, how do you make formula be seen as a perfectly reasonable SECOND choice (in a first-world situation with clean water, etc., etc.), but just not a very reasonable FIRST choice?
One thing that I think would help is doing away with the presentation you see in a lot of pregnancy advice books, where both feeding methods are presented with pros and cons, as if it was quite likely that you’d sit down and make a decision without even having had the baby yet. Well, no one does that with different methods of conceiving a baby! I think it would be more realistic to present the possibilities in the form of a flow chart.
I’ve been known to say, humorously of course, and realizing I was oversimplifying madly, that I never thought there WAS a choice. If you have a baby, the obvious thing to feed it is breastmilk, and if you can’t feed it breastmilk, the obvious thing to feed it is formula. What choice?
I am more affected by “protects against” because it makes me feel as though I’d be neglectful if I didn’t protect my child. Stating that formula causes ear infections puts the blame on the formula, not on me (even if I formula fed – I did not design the formula and thus am not being personally attacked or even addressed).