For many women experiencing motherhood for the first time, the message they receive is clear: mothers who do not breastfeed ought to have good reasons not to; bottle feeding by choice is a failure of maternal duty. We argue that this pressure to breastfeed arises in part from two misconceptions about maternal duty: confusion about the scope of the duty to benefit and conflation between moral reasons and duties. While mothers have a general duty to benefit, we argue that this (...) does not imply a duty to carry out any particular beneficent act. Therefore, the expectation that mothers should breastfeed unless they have sufficient countervailing reasons not to is morally unwarranted. Recognising the difference between reasons and duties can allow us to discuss the benefits of breastfeeding and the importance of supporting mothers who wish to breastfeed without subjecting mothers who bottle feed to guilt, blame and failure. (shrink)

Breastfeeding policies and the production of motherhood: a historical–cultural approach This paper revisits some of the aspects that allow us to situate historically the process that has been called the ‘politicization of women's breasts’. It is part of a broader research project being undertaken in Rio Grande do Sul, Brazil, which is studying information from the educational material used in the National Campaign for the Incentive of Breastfeeding. The methodological approach used is cultural analysis, and its theoretical basis (...) is informed by feminist studies and cultural studies, from a poststructuralist perspective. Knowledges and practices that produce notions of maternity are problematized to argue that current political and economic arrangements have necessitated a redefinition of motherhood. This re‐signification of motherhood has transferred to women the duty of solving an array of problems that were previously considered government's responsibility, in particular those related to the physical and emotional development of infants. (shrink)

Breastfeeding remains an understudied topic in research and theorizing about reproductive experience and women's bodies. This article reports on women's experiences of breastfeeding in public as revealed through in-depth interviews with 51 women. The current construction of the good maternal body requires women to carefully manage the performance of breastfeeding in specific ways and with particular attention to the dominant notion of a sexualized rather than nurturing breast. Women accommodate to, and resist, the perceived boundaries of the (...) good maternal body through their breastfeeding behaviors. (shrink)

It is commonly assumed that only women, and in particular women who have recently given birth, are able to breastfeed. However, through induced lactation, adoptive mothers, fathers and trans people have begun breastfeeding with greater frequency. Although breastfeeding is often regarded as a paradigmatic example of sexual difference, it actually exposes the instability of binary categories of sex. Luce Irigaray insists that sexual difference demands a new poetics, a language that is dynamic and fluid, capable of expressing difference (...) while always keeping open the possibility of transformation and change. This article extends Irigaray’s work in order to theorise breastfeeding from a perspective that is both feminist and queer. (shrink)

Should financial incentives be offered to mothers for breastfeeding? Given the significant socioeconomic and sociodemographic differences in breastfeeding in the USA, researchers and policymakers are exploring the role of financial incentives for breastfeeding promotion with the objective of increasing uptake and reducing disparities. Despite positive outcomes in other health domains, the acceptability of financial incentives is mixed. Financial incentives in the context of infant feeding are particularly controversial given the complex obligations that characterize decisions to breastfeed. After (...) situating the specific ethical tensions related to personal responsibility, fairness, and intrusiveness, we argue that exploring carefully designed financial incentives can be ethically justified to support breastfeeding uptake particularly given established medical guidelines that support breastfeeding benefits, wide socioeconomic and racial/ethnic disparities and notable influences in the broader choice architecture of infant feeding in the USA. Additional empirical research is warranted to better understand effectiveness, cost and specific ethical concerns related to free and informed choice. (shrink)

Many feminist sociologists would agree that most breastfeeding research to date has been primarily undertaken from the perspective of medical and public health discourses. While there is evidence of a shift in research on breastfeeding to qualitative studies that focus on the lived experiences of breastfeeding women, this article addresses a number of concerns remaining in the literature surrounding breastfeeding. First, it questions the absence of breastfeeding as a legitimate philosophical topic, and, as a corollary, (...) the invisibility of breastfeeding women as moral or ethical subjects. Second, by drawing on Michel Foucault's account of ethics and Judith Butler's notion of performativity, it is suggested that breastfeeding is best conceptualized as a gendered and embodied ethical practice rather than an aspect of one's being. Finally, this materialist approach to theorizing breastfeeding is discussed in relation to the Lucy Lawless poster that was released in Aotearoa New Zealand to launch World Breastfeeding Week in August 2002. (shrink)

This article is designed to explore ideas in the recent sociology of morality about the conjunction of ethics and embodiment in everyday life. While it draws on an interpretation of the ethical encounter as a relation of moral proximity, it extends this conception of ethics beyond the dyad to include a discussion of gift giving and generosity in the present context. This is done in order to analyse a concrete empirical event in terms of the web of moral and social (...) codes that inform it. The event in question is a well-known New Zealand breastfeeding case in which a woman breastfed another woman's baby `without her consent'. As well as drawing attention to the ethical risks in encounters between strangers and others in contemporary social life, this particular breastfeeding case also brings to the fore the invisibility of breastfeeding as an embodied ethical practice. (shrink)

To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical (...) justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities. (shrink)

Variation in the durations of exclusive breastfeeding (exBF) and any breastfeeding (anyBF) is associated with socioecological factors. This plasticity in breastfeeding behavior appears adaptive, but the mechanisms involved are unclear. With this concept in mind, we investigated whether durations of exBF and anyBF in a rural Maya population covary with markers of a form of socioecological change—market integration—and whether individual factors (individual learning, physiological plasticity) and/or learning from others in the community (social learning, norm adherence) mediate these (...) changes. Using data from 419 mother-child pairs from two Guatemalan Maya villages, we fit a bivariate linear mixed model. The model compared exBF and anyBF among children from households of varying degrees of market integration whose mothers follow what we inferred to be local infant-feeding norms. It controlled for other factors expected to affect breastfeeding durations. We found evidence that exBF is associated with whether mothers follow their population’s infant feeding norms, but no evidence that exBF is associated with the household’s level of market integration. Conversely, anyBF is significantly associated with the household’s market integration, but not with the villages’ inferred norms. Because deviations from exBF norms are likely to result in infant mortality and reduced fitness, we hypothesize that the incentive to conform is relatively strong. Relatively greater individual plasticity in anyBF allows mother-child pairs to tailor it to socioecological conditions. Deviations from anyBF norms may be tolerated because they may provide later-life health/fitness payoffs, while posing few risks to infant survival. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable (...) gas as a substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

In this paper, we provide a new framework for understanding infant-feeding-related maternal guilt and shame, placing these in the context of feminist theoretical and psychological accounts of the emotions of self-assessment. Whereas breastfeeding advocacy has been critiqued for its perceived role in inducing maternal guilt, we argue that the emotion women often feel surrounding infant feeding may be better conceptualized as shame in its tendency to involve a negative self-assessment—a failure to achieve an idealized notion of good motherhood. Further, (...) we suggest, both formula-feeding and breastfeeding mothers experience shame: the former report feeling that they fail to live up to ideals of womanhood and motherhood, and the latter transgress cultural expectations regarding feminine modesty. The problem, then, is the degree to which mothers are vulnerable to shame generally, regardless of infant feeding practices. As an emotion that is less adaptive and potentially more damaging than guilt, shame ought to be the focus of resistance for both feminists and breastfeeding advocates, who need to work in conjunction with women to oppose this shame by assisting them in constructing their own ideals of good motherhood that incorporate a sense of self-concern. (shrink)

It may be tempting for breastfeeding advocates to respond to challenges to breastfeeding older children or breastfeeding in public by pointing out the nutritional or developmental benefits of breastfeeding or by noting that breastfeeding is often extremely discreet. Such responses may concede more than they should: by focusing on rebutting the empirical claim, breastfeeding supporters may end up implicitly accepting two presuppositions about breastfeeding: first, the presupposition that breastfeeding requires justification in terms (...) of health or developmental benefits to the child; second, the presupposition that breastfeeding in public is only acceptable if assumed standards of discretion are met. -/- This paper aims to use the methods of analytic philosophy to: (a) show how, if left unchallenged, these implicit assumptions can become part of the pragmatic presuppositions of the conversation, so that the discussion proceeds taking their acceptance for granted; (b) argue that we can expect these presuppositions to have negative effects on all mothers, no matter how they feed their babies, and on the tenor of public discussion of infant feeding; (c) reconstruct the reasoning that might underlie these presuppositions and show that this reasoning is mistaken; (d) show that recognising breastfeeding as a family way of life and a loving interaction between parent and child gives rise to a moral right to breastfeed in public without social sanction, whether one is able to breastfeed discreetly or not. (shrink)

Breastfeeding is one important form of maternal investment that is influenced by support from kin and non-kin. This paper investigates who provides support for breastfeeding mothers and their children, what type of support they provide, and how support impacts breastfeeding duration. The data were derived from a survey of 594 American mothers and were analyzed using quantitative methods, including Cox regression. Analyses indicate that mothers receive significant support, particularly from spouses and maternal grandmothers. More frequent breastfeeding (...) discussions with La Leche League and maternal grandfathers were associated with longer duration, whereas discussions with physicians were associated with shorter breastfeeding duration. Results indicate that consulting others specifically about breastfeeding may influence breastfeeding decisions. The results are consistent with the idea that social support may influence breastfeeding duration and that some types of support are more influential than others. Furthermore, support persons should be educated about breastfeeding to prevent early weaning. (shrink)

Mothers serve as an important layer of the health-care system, with special responsi-bilities to care for the health of families and nations. In our social discourse, we tend to treat maternal “choices” as though they were morally and causally Self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers’ caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. I (...) give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

This article is a discussion of the recently emerging critique of pro‐breastfeeding discourses in academic literature, and what this means for midwives and other professionals who find themselves promoting breastfeeding because of professional expectations or indeed workplace policies. Various strands in the debate are explored, starting with dominant and familiar ‘evidence’ and descriptions of breastfeeding and breastmilk that are carried through to international policies that advocate breast over formula feeding. We then consider evidence predominantly from social science (...) literature that has found some women's experiences of infant feeding to be at variance with the dominant pro‐breastfeeding ideology. We argue that midwives and others delivering maternity care are the means to deliver the policy aspirations contained in the World Health Organization (WHO, 2018) Baby Friendly Hospital Initiative document that makes selective positive claims about breastfeeding without adequately considering its potential drawbacks. We conclude that although the benefits of breastfeeding tend to be exaggerated in promotional material, on balance the weight of evidence still favours breast over formula feeding. We challenge the charge that breastfeeding jeopardises women's financial position by arguing that it is not breastfeeding per se that impacts negatively on women's economic prospects, but rather the way in which society is socially organised. (shrink)

: Mothers serve as an important layer of the health-care system, with special responsibilities to care for the health of families and nations. In our social discourse, we tend to treat maternal "choices" as though they were morally and causally self-contained units of influence with primary control over children's health. In this essay, I use infant feeding as a lens for examining the ethical contours of mothers' caretaking practices and responsibilities, as they are situated within cultural meanings and institutional pressures. (...) I give a close critical reading of the content and strategy of the new breastfeeding advocacy campaign sponsored by the United States Department of Health and Human Services. I argue that the campaign is unlikely to substantially increase breastfeeding rates, unresponsive and even hostile to many women's actual concerns about breastfeeding, and well positioned to produce shame and compromise agency among the women it targets. (shrink)

State-sponsored breastfeeding promotion campaigns have become increasingly common in developed countries. In this article, by using the tools of liberal political theory, as well as public health and health promotion ethics, we argue that such campaigns are not justified. They ignore important costs for women, including undermining autonomy, fail to distribute burdens fairly, cannot be justified neutrally and fail a basic efficacy test. Moreover, our argument demonstrates that breastfeeding campaigns are a rare case that bridges the fields of (...) public health ethics and the ethics of health promotion campaigns. This demonstrates the need to consider the ethics of state promotion of both voluntary and coercive behavioural change that benefits third parties. (shrink)

Breastfeeding advocates have criticised the phrase ‘breast is best’ as mistakenly representing breastfeeding as a departure from the norm rather than the default for infant feeding. Breastfeeding mothers have an interest in representing breastfeeding as the default, for example, to counteract criticism of breastfeeding outside the home. This connects to an increasing trend to frame feeding babies formula as harmful, which can be seen in research papers, public policy and information presented to parents and prospective (...) parents. Whether we frame infant-feeding decisions in terms of harming or benefit, protection or risk matters because these distinctions are generally morally significant and thus holding that those who decide to use formula ‘harm’, ‘risk harm’ to their babies or describing formula feeding as ‘dangerous’ is likely to contribute to guilt associated with formula feeding and thus to undermine the well-being of vulnerable women. It may undermine attempts to improve breastfeeding rates by leading women to reject information about health outcomes surrounding infant-feeding decisions. However, these distinctions do not apply easily to infant-feeding decisions, in part because of difficulties in determining whether we should treat breastfeeding as the normative baseline for infant feeding. I show that neither the descriptive ‘facts of the matter’ nor moral or pragmatic considerations provide an easy answer before discussing how to respond to these considerations. (shrink)

This paper explores the social and emotional consequences of three major assumptions about human action underpinning breastfeeding promotion campaigns in the UK. Drawing on Joas's critique of instrumental accounts of rational action, the paper illustrates the ways in which these campaigns firstly contribute to the moralisation of motherhood; secondly value highly individualised, de-contextualised forms of action; and thirdly promote an objectified view of the human body as a pliable instrument of human intentions. The consequences of these assumptions, as they (...) shape the efforts of mothers to care for their babies and young children in complex, unpredictable and often uncontrollable situations, provides the focus of discussion. The paper concludes that a target-driven health-promotion policy, relying on a mechanistic account of social and emotional life, is contributing to the burden of early motherhood in ways that are not conducive to infant and maternal health and attachment. (shrink)

Some of the ways in which the experience of mothering is shaped by the moral and cultural constructions surrounding breastfeeding discourse are examined using a critical deconstruction of recent Canadian health education material. Connections between the understandings surrounding breastfeeding and cultural constructions of nature and sexuality are raised, as is the overlap between breastfeeding discourse and a number of other social discourses including those surrounding child-centered parenting expertise, the remoralization of pregnancy, and the neoliberal preoccupation with individual (...) responsibility and the cost of social programs. Some of the implications that this understanding poses for mothers are examined. (shrink)

The paper presents the results of two vignette studies that examine how company breastfeeding accommodation influences ratings of organizational attractiveness and work-related intentions. North American business students and employees engaged in long-term employment found organizations that accommodate breastfeeding to be more fair, attractive, and were more likely to apply to them, and accept jobs from them, than organizations that did not accommodate. Effects were stronger for female participants than for male participants. Female participants without children indicated lower support (...) for breastfeeding accommodation than female participants with children and male participants. (shrink)

This paper discusses Merleau-Ponty’s use of idea of ambivalence and its role in psychological conflicts. Merleau-Ponty affirms ambivalent conflicts as lived and social rather than biologically determined, as one might have in some developmental accounts, or hidden, as in some psychoanalytic accounts. With this concept, the paper takes up feminist considerations of the conflicts experienced by mothers in breastfeeding. It argues that the Merleau-Pontian and feminist approach to considering breastfeeding provides a nuanced model for thinking about development that (...) is better suited to cases where both the child and the parent are co-evolving. (shrink)

In 1997, the American Academy of Pediatrics issued a policy statement strongly supporting the physiological benefits conferred by human milk. It recommended that infants be breastfed for 12 months and called for employers to support breastfeeding. The following year, federal legislation was formulated to facilitate breastfeeding among women in paid work. Although both these events represented significant developments in the U.S. context, they nevertheless posed potential gender equity concerns. This article explores the National Organization for Women's response to (...) these developments. In doing so, it also examines the way in which the issue of breastfeeding and women's labor market involvement was addressed in equal-treatment/special-treatment debates in the previous decade. The article concludes by arguing that “equality and difference” discussions need to be extended to provide a new theoretical and practical framework for achieving equity in the workplace that would also accommodate the needs of women who wish to breastfeed or to express/pump breast milk. (shrink)

The combination of money and intimacy, particularly in the context of paid caring, can be difficult, given the tendency to view them as belonging to separate spheres. This research studied paid caring within the context of breastfeeding and labor support, using 72 interviews with lactation consultants, doulas, clients, and health care professionals, as well as 150 hours of ethnographic observation. Building upon the work of Viviana Zelizer, I examined the relational work of lactation consultants, doulas, and their clients, finding (...) that this process is highly influenced by the way gender is mapped onto the separate spheres dichotomy. Lactation consultants, doulas, and their clients drew boundaries around their social relations to construct them as different from family care in order to legitimate the combination of money and intimacy. Lactation consultants and doulas both experienced tension in determining appropriate transactions and media for their care work, which illustrates how the separate spheres ideology can perpetuate the relative low pay of care work. (shrink)

References to the ‘natural’ are common in public health messaging about breastfeeding. For example, the WHO writes that ‘Breast milk is the natural first food for babies’ and the U.S. Department of Health and Human Services has a breastfeeding promotion campaign called ‘It’s only natural’, which champions breastfeeding as the natural way to feed a baby. This paper critically examines the use of ‘natural’ language in breastfeeding promotion by public health and medical bodies. A pragmatic concern (...) with selling breastfeeding as ‘natural’ is that this may reinforce the already widespread perspective that natural options are presumptively healthier, safer and better, a view that works at cross-purposes to public health and medicine in other contexts. An additional concern is that given the history of breastfeeding in the USA, ‘natural’ evokes specific and controversial conceptions of gender and motherhood. (shrink)

References to the ‘natural’ are common in public health messaging about breastfeeding. For example, the WHO writes that ‘Breast milk is the natural first food for babies’ and the U.S. Department of Health and Human Services has a breastfeeding promotion campaign called ‘It’s only natural’, which champions breastfeeding as the natural way to feed a baby. This paper critically examines the use of ‘natural’ language in breastfeeding promotion by public health and medical bodies. A pragmatic concern (...) with selling breastfeeding as ‘natural’ is that this may reinforce the already widespread perspective that natural options are presumptively healthier, safer and better, a view that works at cross-purposes to public health and medicine in other contexts. An additional concern is that given the history of breastfeeding in the USA, ‘natural’ evokes specific and controversial conceptions of gender and motherhood. (shrink)

Breastfeeding has become a subject of moral concern as its benefits have become well known. Encouraging mothers to breastfeed has been the goal of extensive public health promotion efforts. Emmanuel Levinas makes absolute responsibility to the Other central to his ethics, with giving food to the Other the paradigmatic ethical act. However, Levinas also provides an important critique of the autonomous individual who is taken for granted by breastfeeding promotion efforts. I argue that the ethical obligation to feed (...) the hungry child must be recognized as coextensive with meeting the needs of women, especially given the current absence of important social and economic supports for breastfeeding. Under a Levinasian framework, each of us is ethically responsible for feeding children; this responsibility is not limited to mothers. This ethical responsibility needs to be expressed through improving social and economic supports necessary for those individuals who wish to breastfeed, instead of attempting to convince women to breastfeed. This ethical responsibility must also be understood in a broader context of a politics of hunger, which provides access to quality food for all, and goes beyond mere nutrition to include the importance of culture, touch, and intimacy in the enjoyment of food—what Levinas calls “good soup.”. (shrink)

The key objective of this paper is to emphasize the importance of acknowledging breastfeeding as an embodied social practice within interventions related to breastfeeding and lactation and illustrate how this recognition holds implications for public health ethics debates. Recent scholarship has shown that breastfeeding and lactation support interventions undermine women’s autonomy. However, substantial discourse is required to determine how to align with public health goals while also recognizing the embodied experiences of breastfeeding and lactating individuals. Presently, (...) interventions in this realm predominantly revolve around health-related messaging and the promotion of individual behaviors, often neglecting the systemic and structural factors that influence choices and practices. I closely examine breastfeeding interventions in India, in particular Mothers’ Absolute Affection health promotion program, along with breastfeeding narratives. I argue that for such interventions to evolve, they must acknowledge the intrinsic embodied social nature of breastfeeding during their design and implementation. Furthermore, it is important to emphasize that achieving equity and justice objectives necessitates moving beyond the confines of both conventional public health frameworks and frameworks solely centered on private choices. Instead, a more encompassing approach that embraces the concept of embodiment should be adopted. (shrink)

This article situates breastfeeding politics in the context of intimate citizenship, where women's capability to care in a range of social spaces is at stake. Drawing on the work of Lefebvre and Fenster, the article considers the extent to which recent breastfeeding promotion work by the Health Promotion Agency in Northern Ireland has sought to reconceive of social spaces in ways that have the potential to improve intimate citizenship for breastfeeding women.