Guilt and blame

Whenever advocates of breastfeeding start to get a bit overenthusiastic, there is often someone popping up behind them to say “Er, steady on, what about all the women who can’t breastfeed?”

What they mean is – don’t bang on about how great breastfeeding is, or suggest that formula feeding is positively risky – because some women can’t or don’t do it and we should not try to make them feel guilty.

You can just about get away with saying that breastfeeding is “the healthiest choice” or some such. But don’t criticise formula, don’t say formula is sub-optimal or puts the formula-fed baby at risk, don’t go overboard about the massive differences between these two “equally valid choices”.

This is a powerful argument, because breastfeeding advocates are not generally about making women feel guilty, or forcing them into breastfeeding. Apart from anything else, we know that this is counterproductive. What the best advocates of breastfeeding want to do is to empower women to make their own free, informed, successful choices.

I want women to have all the information available, not sugar-coated toned-down platitudes designed to show that formula feeding isn’t so bad and that your choice doesn’t matter that much. I want women to know that there is a massive divide between the perfection of breastfeeding and the dangers and cost of formula feeding. If they are going to undertake the risks of formula feeding, I want them to do it with their eyes open, sure that it is the best thing for them and their baby (which in some cases, of course, it is).

So let’s get this straight.

Formula feeding is not an “equally valid choice”. Formula companies have been very successful at persuading the world that it is, but it is not. Breastfeeding is nature’s way and breastmilk is fantastic. Although we know only a fraction of what there is to know, we have already discovered that it is an amazing living fluid with astonishing properties that just blow your mind. It is constantly adapting itself to your baby’s changing needs: day to day, hour by hour. It contains perfectly designed nutrition – yes, perfect – uniquely crafted for your baby. Formula is just modified cow’s milk with a few bits and pieces added.

Mothers are frequently made to feel guilty when it comes to decisions other aspects of their child’s upbringing. As Jack Newman puts it in Breastfeeding and Guilt

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? If she admitted to drinking a couple of beers every so often, is there not a strong chance that she would leave the office feeling guilty? If a mother admitted to sleeping in the same bed with her baby, would most physicians not make her feel guilty for this even though it is the best thing for her and the baby? If she went to the office with her one week old baby and told the physician that she was feeding her baby homogenized milk, what would be the reaction of her physician? Most would practically collapse and have a fit. And they would have no problem at all making that mother feel guilty for feeding her baby cow’s milk, and then pressuring her to feed the baby formula.

When it comes to smoking, drinking, drugs or feeding with cow’s milk, it seems to be acceptable to pressure mothers into the “right” choice by making them feel guilty. It is only when it comes to breastfeeding that this tactic is deemed unacceptable. Why? Why is it OK for a mother to be demonised for smoking and yet it is inappropriate to do or say anything that might make her feel guilty about using formula? Why the distinction?

Jack Newman again:

The reason of course, is that the formula companies have succeeded so brilliantly with their advertising to convince most of the world that formula feeding is just about as good as breastfeeding, and therefore there is no need to make such a big deal about women not breastfeeding. As a vice president of Nestle here in Toronto was quoted as saying “Obviously, advertising works“.

It is also a balm for the consciences of many health professionals who, themselves, did not breastfeed, or their wives did not breastfeed. “I will not make women feel guilty for not breastfeeding, because I don’t want to feel guilty for my child not being breastfed”.

Let’s look at this a little more closely. Formula is certainly theoretically more appropriate for babies than cow’s milk. But, in fact, there are no clinical studies which show that there is any difference between babies fed cow’s milk and those fed formula. Not one. [my emphasis]

So feeding with formula is not necessarily any healthier than straight cows milk. But one gets you the spawn-of-the-devil treatment and the other does not. Because of the formula companies and their marketing strategies. Because of the health professionals and their own ignorance and, perhaps, their suppressed guilt.

There is more to this.

If a mother does not breastfeed, should she feel guilty?

If she made an informed choice not to breastfeed, that’s one thing. In any case, a woman making an informed choice, based on full knowledge of all the facts, would not normally feel guilty about her decision even if criticised – it is probably the right decision for her and her family and so criticism would be misplaced anyway. If someone does criticise her, she is more likely (rightly) to feel outrage at their presumptuousness than guilt.

But that is not the standard case. These days, it is all but impossible to make a truly free and informed choice. There is too much advertising, too much commercial pressure, too many positive images of formula feeding and not enough positive images of breastfeeding. There is too little knowledge among midwives and other health professionals about breastfeeding and breastfeeding support, too little experience in society (especially the mothers of new mothers, who should be supporters but are often victims themselves of the raging bottle culture of their own experience). There are too many myths, too many persistent misconceptions. There is too much of an idea that breastfeeding is difficult or unpleasant, that it will be weird and sexual, that it is for hippies or the middle class liberal do-gooders. That it is “not for me”.

Given the odds that are stacked against breastfeeding, it is a brave and unusual woman who could choose breastfeeding without proper information, encouragement and support. Where is that information, encouragement and support?

So few health professionals know much about breastfeeding at all that they cannot provide it. Breastfeeding support is not a standard part of every health visitor’s training. Those who have undergone training will often have done a couple of hours in a seminar, and may not even have seen a real breastfeeding situation as part of that training.

So much of the encouragement and support we should be able to expect from our families, especially the older women in our families, is just not there. I met a woman recently who wanted to breastfeed, but her extended family kept telling her bottles were better. I hope she will persist, and I admire her for standing up to this pressure – but she shouldn’t have to! Her relatives mean well, I am sure, as did mine when they kept offering me “support” by telling me that I wouldn’t be a failure if I gave up breastfeeding. Our loved ones mean well, but they lack the knowledge and experience and positive attitude that is needed to truly support us, because the whole of our society and culture lacks that knowledge, experience and attitude.

By saying “hush about breastfeeding, you will make formula feeding mothers feel guilty” what are we saying? We are saying that if breastfeeding is so great, formula feeding mothers should feel guilty.

Well here’s a thing. Breastfeeding is so great. But no mother should feel guilty if in such unpromising circumstances she fails to breastfeed. She should not feel guilty. She should feel angry. She should rage at the disservice done to her and her child.

For the blame does not lie with mothers.

It lies with the ignorance of health professionals and the system that perpetuates this ignorance. It lies with the marketing efforts of formula companies which have so undermined breastfeeding. It lies with the politicians who fail to redress these wrongs by simple expedients like implementation of the WHO code on the marketing of breastmilk substitutes.

Don’t feel guilty. Blame the real culprits.