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Advertising, Autonomy and Breastfeeding: Some Reflections.

In ethical discussions, we are often quick to lambast advertisements for the way in which they can subvert the consumer’s autonomy. It is certainly true, as other posts on this blog record, that  some advertisements aim to intentionally deceive consumers, and to manipulate their preferences in a manner which can serve to undermine their autonomy.

These autonomy-undermining aspects of certain advertisements make us realise that one of the central aims of almost all advertisements is to persuade the consumer (by fair means or foul) to form a desire for the product or service that is being advertised. As I mentioned above, advertisers will sometimes achieve this by employing certain means which subvert the consumer’s autonomy. But not always. Sometimes adverts coax us to form certain desires in a manner which is compatible with our having autonomy with respect to them. For instance, if all the advert does is provide the (competent) consumer with true information about a product or service which gives the consumer reasons to believe that the product is a good (or a reliable means to a good) worth desiring, then it is not clear how this subverts the consumer’s autonomy in coming to form a desire for that product.

The fact that certain advertisements can subvert the consumer’s autonomy should not make us lose sight of the more fundamental purpose of advertisements which is evident in these latter sorts of adverts; namely, that of informing people about what a product is, and the fact that it exists at all. This latter thought is memorably summed up by Steuart Henderson Britt: who claimed that ‘doing business without advertising is like winking at a girl in the dark. You know what you are doing, but nobody else does’.

If we focus on the informative nature of advertisements which are not deceptive or manipulative, then it seems that advertisements can also serve to increase the consumer’s autonomy. It seems plausible to claim that, prima facie at least, the more available options that an agent has to choose from when making a decision, the more autonomy she will have with respect to that decision. With this in mind, in so far as some adverts can be said to merely make the consumer aware of further options that are at their disposal, it seems that they can serve to increase the consumer’s autonomy. This is something which is commonly forgotten about advertising in practical ethics, given our tendency to suspect advertisers of manipulative practices.

These reflections are pertinent to the recent ‘Latch On’ initiative launched by Mayor Bloomberg in New York, which aims to encourage mothers to breast-feed. This initiative involves three major components: First, the overall promotion and encouragement of breastfeeding. Second, prohibiting the display and distribution of promotional materials for formula milk, and third, discontinuing the distribution of promotional or free formula milk.

The final measure has received considerable criticism elsewhere ( However, let us consider the second measure. Presumably, as Anastacia Kurylo points out in the cited article, the implementation of the second measure seems to be based upon the supposition that “subliminal messaging on promotional materials may make women more likely to resort to formula more quickly”. Accordingly, the defence of the measure seems to be that prohibiting the promotion of formula milk will help safe-guard the autonomy of New York mothers with respect to decisions concerning how to nurture their infant. Now this might be a convincing defence if all the promotions for formula milk involved manipulative measures which would coax mothers to abandon breast-feeding in favour of formula in an autonomy-undermining manner. However, this is very hard to believe. More importantly, even if the advertisements did incorporate such measure, they need not; the producers of formula milk could use their advertising space to appeal to various properties of their product which make it a desirable good for certain mothers. In the cited article on the initiative, Kurylo points several examples of mother’s who would have good reason to use formula milk (although she uses them as examples to attack the third measure).

Furthermore, in prohibiting the promotion of formula, the Latch On initiative implicitly conveys the impression that there is something wrong about using formula, suggesting that it is not a viable alternative to breastfeeding. Now, although breastfeeding has been shown to have various health benefits (see, there is nothing to suggest that there is anything grossly wrong with using formula milk.

By prohibiting non-manipulative informative advertisements about formula milk, the second measure of the Latch On initiative, far from safe-guarding the autonomy of New York mothers actually undermines it; by cutting off an important information source about a viable alternative to breast-feeding, as well as implicitly suggesting the false view that there is something wrong about using formula, the initiative may serve to reduce the number of options which mothers may consider in their decision about how to nurture their child. Indeed, we may go so far as to claim that the initiative thus represents an attempt to coerce mothers into breast-feeding. Although we may laud the attempt to encourage women to breastfeed in so far as it has been shown to have various health benefits, it is less clear that we should be coercing women into doing so. Would it not be better to rely on the first measure, which involves providing mothers with information regarding the benefits of breastfeeding, and which allows women to make an informed, and autonomous choice on the matter?

In a broader context, we might conclude by observing the following; although banning manipulative advertising can help to safeguard our autonomy, banning advertising wholesale can have the effect of undermining consumer’s autonomy. This is true in so far as advertising can serve to increase our autonomy by making us aware of options that are in our choice set, and the facts that count as the actual reasons in each options favour.

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7 Comment on this post

  1. I think there are a couple of flawed points in this piece. First, the author suggests that the primary aim of most advertising is “that of informing people about what a product is, and the fact that it exists at all.” But this seems wrong. While information about a product and its existence may be a component of the advertising message, the primary aim is to sell the product.

    Related, but more to the point of your critique of Latch On, is the question of where and when advertising is appropriate. The initiative is addressing advertising in healthcare facilities – it does not seek to ban all formula advertising (and formula advertising is ubiquitous outside of the hospital – ask any pregnant woman how much of this “information” she has seen during her pregnancy). Shouldn’t the information we receive in healthcare facilities come from…healthcare providers? To provide information produced by the infant formula industry seems inappropriate, at best, and unethical, at worst. Healthcare providers should be equipped to provide evidenced-based care to patients, and in this case this includes both explaining the benefits of breastfeeding for moms and babies, and explaining how to properly use infant formula if desired or required. The NYC initiative does not prevent the latter.

    Furthermore, the initiative does not implicitly suggest that there is something wrong with infant formula – it seeks to provide accurate information about the risks and benefits of each option. The infant formula industry is well-known for failing to provide such accurate information.

    I’ve addressed questions about autonomy and infant formula marketing in healthcare facilities here and autonomy, more broadly, here.

  2. There is a big question that needs to be answered and that is what is the baseline here? By this I mean should we describe breast feeding as having benefits as the author does (thus implicitly imputing formula feeding as the norm and breast feeding as above and beyond this norm) or should we describe not breast feeding as being harmful (thus imputing breast feeding as the norm and formula falling below this norm).

    I think this an interesting and open question which has obvious implications for policy.

  3. You make a good point, But is the consumers autonomy really being undermined? This hinges largely on the argument that formula milk is a viable alternative to breast feeling, which I would suggest it isn’t.
    Who then really benefits from formula milk? Corporations are not altruistic.

  4. Thanks for the comments. Allow me to make a few short responses.

    David; you’re right that is an interesting question. It depends on whether we view the baseline as pertaining to a sufficient level of nourishment for the child to be healthy, or to what is ‘natural’. In the former case, it seems that formula may be regarded as the norm, and breast-feeding as going beyond that norm, since I take it that we do not want to say that infants sustained on formula cannot be healthy. However, as the NHS info page suggests, the benefits of breast milk seem to lie in the fact that, unlike formula, it contains certain enzymes and antibodies which will protect the baby in later life. If we view these ‘natural’ enzymes and antibodies as partly constituting what it is to be healthy, then breastfeeding should be considered the norm.

    Holly; as my reply to David mentions, breastfeeding does have some clear health advantages over formula. However, I’m not sure that this makes formula a non-viable alternative; as the Kurylo article which I refer to cites, there are plenty of cases in which mothers would want to use formula for non-health based reasons.

    Liz; thank you for referring to your articles in your reply; I read them with great interest. However, if I may, I shall reply to you solely on the basis of the content of your reply on here, so that others can follow the discussion. First, I agree with you that the primary aim of most advertisements is to sell the product. But, the point I am trying to make is that a fundamental part of selling a product is informing consumers that it exists. The fact that the advertiser is trying to sell us something by giving us true information about the product does not seem to undermine our autonomy. What would undermine our autonomy is if the advertisement misinformed us, or otherwise attempted to manipulate our preferences. But this latter property of advertisements does not seem to be necessary to them, in the same way that having an aim of informing a consumer about the product is. In this sense, I suggest that the informative aim of advertisements is more fundamental to them than their aim of coaxing the consumer into forming a desire (although, as I said above, I agree that most adverts also have this latter aim).

    This leads to my reply to your second point, in which you claim that “to provide information produced by the infant formula industry seems inappropriate, at best, and unethical, at worst”. I would agree with you if the information that the industry provided was necessarily deceptive and manipulative. And in its current state, industry advertisement might provide information in such a way. However, my point was that it need not; it seems perfectly possible to advertise formula using non-deceptive information. As long as the information is true, and based on good evidence, its provision does not seem to me morally objectionable just because it is in an advertisement.

    The above piece was written primarily as a general reflection on the nature of the relationship between autonomy and advertising which was prompted by my reading about the Latch On initiative. So let me thank you all once again for your comments; I am learning a great deal!

  5. Thanks for the response. I agree that advertising does not necessarily undermine autonomy, and that it’s possible to imagine a way in which formula advertisements could provide information in a non-deceptive manner. However, I think there will always be a deceptive element to advertising infant formula in healthcare facilities. The marketing materials’, particularly the samples, presence in the hospital suggests that the hospital – and healthcare providers, by association – are endorsing the product’s use. In some cases, yes, it would make sense for a provider to suggest that a woman ought to use formula, but there’s no reason why s/he would suggest a particular brand, since all are regulated by the FDA and are equally viable choices. But in the vast majority of cases wherein women are able to breastfeed, it would run contrary to public health for a provider to endorse the use of infant formula over breastfeeding. This doesn’t mean a woman couldn’t choose to formula feed, despite being physically able to breastfeed, but we’d expect her doctor or midwife to recommend breastfeeding, since it is the healthier option. (As with many health recommendations, patients can and do follow them to different degrees, taking into account their life circumstances and desires.)

    Anyway, the main point is that the context within which advertising is taking place matters when we assess the degree to which it undermines autonomy. Here, the context lends the product being advertised undue legitimacy, which means that there is something inherently deceptive about advertising for commercial products in that context, particularly when they do not reflect accepted public health recommendations. I suppose if the product really was superior and recommended by healthcare providers, the advertisement in a hospital wouldn’t be autonomy-hindering (though, for other reasons, I would still find it objectionable to commercialize this space).

    No shortage of interesting autonomy-related questions arising from this issue!

  6. There is a straw man in your piece. That formula advertising is not coercive is hypothetical. Is it misleading and.coercive, particularly in the US which does not apply any regulation to its promotion and sale. it is this way because, for the most part, its business depends on breastfeeding failure.

    Rather than basing arguments about the Latch On initiative on individual freedom and autonomy, it is more sensible to look at it in terms of public health. There will always be women who require formula, for many reasons, and that is fine. But babies who are breast fed are healthier. It is sensible for hospitals to nudge women in this direction. Latch On only brings NYC hospitals in line with those in the UK.

    One other thing to bear in mind isthat formula is a highly regulated product. There is very little difference between brands other than price. Women are induced into spending more than they need to by advertising and the distribution of free samples, as well as the preferred suppliers of formula given for free to welfare recipients (we don’t do this in the UK any more, we now issue vouchers which are either for formula, or healthy food for a nursing mother).

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