Want to increase breastfeeding? Then shut up about how it saves money!
UNICEF today announced research showing that increasing breastfeeding rates in the UK could save the NHS tens of millions of pounds. The report notes that investing more money in encouraging more mothers to breastfeed, and for longer, will pay dividends.
Is this likely to get more mothers breastfeeding? Well, I don’t think we’re off to a very good start. Take a look at some of the headlines used to report this story:
More breastfeeding will save NHS millions (Public Service)
A common theme in all these headlines is that they represent the breastfeeding-induced reduction in illness and NHS spend in terms of money and lives saved. This is not the only way to represent the data: rather than viewing breastfeeding as saving money and lives, we could view formula-feeding as costing money and lives. Increasing breastfeeding rates would, then, be a way to recoup some of the losses brought about by the prevalence of formula-feeding.
This alternative way of seeing things is not common, however. I ran a Google news search for reports of today’s UNICEF research, and of the 16 ‘most relevant results’, 9 mentioned in their headlines the reduction in illness and/or NHS spend that increased breastfeeding would bring about, and 8 of these represented this reduction in terms of savings rather than costs. (The result whose headline did not view the reduction in terms of savings also did not view it in terms of costs, but merely in neutral terms.)
Why is this important? Well, because of the way our views about gains and losses shape our behaviour. ‘Breastfeeding saves money and lives’ takes the current situation–in which breastfeeding rates are low–to be normal, and tells us us that breastfeeding would help improve it. ‘Not breastfeeding costs money and lives’, on the other hand, takes as normal some situation in which breastfeeding rates are higher than they are currently, and tells us that the reason the current situation is worse than normal is because we don’t breastfeed enough. In other words, ‘Breastfeeding saves money and lives’ tells us that our balance sheet is zero, whereas ‘Not breastfeeding costs money and lives’ tells us that we are running at a loss. And it is a fact about human psychology that people are much more highly motivated to try to recoup losses than they are to secure gains. This need to ‘break even’ and recover losses helps explain why gambling can be so addictive: those who see themselves as running at a loss continue to risk what little money they have left on gambles that the rest of us wouldn’t entertain. Therefore, we should expect policy-makers, healthcare professionals, and parents to be more strongly motivated to increase breastfeeding rates by the message ‘Not breastfeeding costs money and lives’ than by the (far more widespread) message ‘Breastfeeding saves money and lives’.
The dangers of viewing the benefits of breastfeeding as better-compared-to-the-norm have been recognised by the Breastfeeding Network, who in 2010 urged the government to scrap its ‘Breast is Best’ slogan on the ground that it does not motivate mothers to breastfeed. The chair of the Breastfeeding Network, Lesley Backhouse, complained that the slogan ‘implies something special, whereas breastfeeding is the physiological norm, and suggests that formula is the standard way to feed babies’. The importance of viewing breastfeeding as the norm also seems to be recognised by UNICEF, which refers many times in its report to the risks and costs associated with not breastfeeding. It is also recognised by the American breastfeeding advocate Diane Wiessinger in her famous article ‘Watch your language’, and by manufacturers of infant formula, who promote the ‘breast is best’ message without appearing to view it as a threat to their sales (see, for example, here, here and here). Presenting breastfeeding as better-than-normal conveys the message that breastfeeding is best, but not breastfeeding is okay. And it’s okay to be okay.
Of course, the danger of presenting formula-feeding as worse-than-normal is that it makes non-breastfeeding mothers feel bad. There is an appealing and pervasive view that we should support the feeding choices of all mothers, whether or not they breastfeed. However, this does not entail that non-breastfeeding mothers are best supported by shying away from strongly motivating mothers to breastfeed. Anita Tiessen, Deputy Executive Director of UNICEF reports that ‘90 per cent of women who stop breastfeeding in the first six weeks discontinued before they had wanted to’. Such women know that formula-feeding is an inferior choice. To encourage them to believe otherwise may be well-intentioned, but it is disrespectful and patronising: it fails to recognise what they already know about the relative merits of breastfeeding and formula-feeding, and it fails to acknowledge the disappointment and guilt that they may feel as a result of stopping breastfeeding.
How, then, can we best ensure that non-breastfeeding mothers are not made to feel guilty? Sorry, but we can’t. Even setting aside the perils and pitfalls of trying to breastfeed a child, becoming a mother is a good way of ensuring that you will spend a large portion of every day feeling guilty about something or other. (Diane Wiessinger has a great discussion about guilt in her article.) It is not constructive to deal with feelings of failure by adopting the attitude of Aesop’s fox and concluding that one is no worse off for having failed to achieve what one wanted–particularly when doing so deprives others of support in trying to achieve the same valuable end. A better approach would be strongly to promote the valuable end whilst offering support to those who fail to achieve it. In the case of trying to increase breastfeeding rates, that entails presenting breastfeeding as normal, presenting formula-feeding as sub-normal, and being respectful and sympathetic to mothers who do not breastfeed.