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State power and breastfeeding promotion: A critique

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Contemporary Political Theory Aims and scope

Abstract

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 (which focuses on coercive measures to protect third parties) and the ethics of health promotion campaigns (which focuses on encouraging voluntary change that benefits the target individuals themselves). This demonstrates the need to consider the ethics of state promotion of both voluntary and coercive behavioural change that benefits third parties.

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References

  • Ahluwalia, I.B., Morrow, B., Hsia, J. and Grummer-Strawn, L.M. (2003) Who is breastfeeding? Recent trends from the pregnancy risk assessment and monitoring system. Journal of Pediatrics 142(5): 486–493.

    Article  Google Scholar 

  • Arneil, B. (2000) The politics of the breast. Canadian Journal of Women & Law, 12, 345.

    Google Scholar 

  • Australian Breastfeeding Association. (2005) Why breastfeeding is important. http://www.breastfeeding.asn.au/bfinfo/general.html.

  • Australian Breastfeeding Association. (2006) Not enough milk? http://www.breastfeeding.asn.au/bfinfo/lowsupply.html.

  • Australian Bureau of Statistics. (2001) Breastfeeding in Australia. cat no 001. Canberra.

  • Australian Government. (2008) Australian Government response to the House of Representatives Standing Committee on Health and Aging Report on the Inquiry into the health benefits of breastfeeding ‘The Best Start’. Canberra.

  • Australian Institute of Health and Welfare. (2012) Experience of perinatal depression: data from the 2010 Australian National Infant Feeding Survey. Information Paper. Cat. no. PHE 161. Canberra: AIHW.

  • Balint, P. (2017) Respecting Toleration: traditional liberalism and contemporary diversity. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Ball, T. and Wright, A. (1999) Health care costs of formula-feeding in the first year of life. Pediatrics 103(Supp 1): 870–876.

    Google Scholar 

  • Beauchamp, T.L. (1988) Manipulative advertising. In T.L. Beauchamp & N.E. Bowie (eds.) Ethical Theory and Business (3rd ed.) Englewood Cliffs: N J Prentice Hall.

    Google Scholar 

  • Benet, S., Pitts, R.E. and LaTour, M. (1993) The appropriateness of fear appeal use for health care marketing to the elderly: Is it ok to scare granny? Journal of Business Ethics 12(1): 45–55.

    Article  Google Scholar 

  • Berk, S.F. (2012) The Gender Factory: The Apportionment of Work in American Households. New York: Springer.

    Google Scholar 

  • Bianchi, S., Sayer, L., Milkie, M. and Robinson, J. (2012) Housework: Who did, does or will do it, and how much does it matter? Social Forces 91(1): 55–63.

    Article  Google Scholar 

  • Bruk-Lee, V., Albert, D. and Stone, K.L. (2016) Lactation and the working woman: understanding the role of organizational factors, lactation support, and legal policy in promoting breastfeeding success. In: Research Perspectives on Work and the Transition to Motherhood. New York: Springer International Publishing, pp. 217–239.

  • Butte, N.F. (2001) The Role of breastfeeding in obesity. Paediatric Clinics of North America 48: 189–198.

    Article  Google Scholar 

  • Callahan, D. (Ed.) (2000) Promoting Healthy Behaviour: How Much Freedom? Whose Responsibility?. Washington: Georgetown University Press.

    Google Scholar 

  • Christman, J. (2015) Autonomy in moral and political philosophy. In: The Stanford Encyclopedia of Philosophy (Spring 2015 Edition), Edward N. Zalta (ed.). http://pofetnlato.stanford.edu/archives/spr2015/entries/autonomy-moral/.

  • Conroy, S. (2003) Research Report: Health Promotion Messages: To Scare or Not To Scare? National University of Ireland: Department of Health Promotion.

  • Coons, C. and Weber, M. (2014) Manipulation: Theory and practice. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Crossley, M. (2009) Breastfeeding as a moral imperative: An autoethnographic study. Feminism & Psychology 19(1): 71–87.

    Article  Google Scholar 

  • Department of Health. (2000) The NHS Plan. London: The Stationery Office.

    Google Scholar 

  • Department of Health. (2004) Choosing Health: Making Healthier Choices Easier. London: The Stationery Office.

    Google Scholar 

  • Duffy, L., Faden, H., Wasielewski, R., Wolf, J. and Krystofik, D. (1997) Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media. Pediatrics 100(4): e7.

    Article  Google Scholar 

  • Duke, C.R., Pickett, G.M., Carlson, L. and Grove, S.J. (1993) A method for evaluating the ethics of fear appeals. Journal of Public Policy and Marketing 12(1): 120–129.

    Google Scholar 

  • Dworkin, G. (1972) Paternalism. The Monist 56(1): 64–84.

    Article  Google Scholar 

  • Dworkin, G. (1988) The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Dworkin, R. (1989) Liberal community. California Law Review 77(3): 479–504.

    Article  Google Scholar 

  • Dyson, L., McCormick, F. and Renfrew, M. (2005) Interventions for promoting the initiation of breastfeeding. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001688.pub2.

    Google Scholar 

  • Dyson, L., Renfrew, M., McFadden, A., McCormick, F., Herbert, G. and Thomas, J. (2006) Promotion of breastfeeding initiation and duration: Evidence into practice briefing. London: National Institute for Health and Clinical Excellence, available at http://www.nice.org.uk/niceMedia/pdf/EAB_Breastfeeding_final_version.pdf.

  • Edelman, C.L. and Mandle, C.L. (2006) Health Promotion Throughout the Lifespan. St Louis, MO: Elsevier Mosby.

    Google Scholar 

  • Forste, R., Weiss, J. and Lippincott, E. (2001) The decision to breastfeed in the United States: Does race matter? Pediatrics 108(2): 291–296.

    Article  Google Scholar 

  • Friedman, M. (1997) Autonomy and social relationships: Rethinking the feminist critique. In D. Meyers (Ed.): Feminists Rethinking the Self. Boulder: Westview Press, pp. 40–61.

    Google Scholar 

  • Gatrell, C. (2007) Secrets and lies: Breastfeeding and professional paid work. Social Science and Medicine 65(2): 393–404.

    Article  Google Scholar 

  • Gillman, M.W. (2002) Breastfeeding and obesity. Journal of Pediatrics 141(6): 749–750.

    Article  Google Scholar 

  • Gonzalez, E. (2008) The Role of Information in Contemporary Migration. Working Paper WP08-005. Barcelona UOC.

  • Gostin, L. (2006) Public health strategies for pandemic influenza: Ethics and the law. JAMA 295: 1700–1704.

    Article  Google Scholar 

  • Guttman, N. and Zimmerman, D. (2000) Low-income mothers’ views on breastfeeding. Social Science and Medicine 50(10): 1457–1473.

    Article  Google Scholar 

  • Hauck, F., Thompson, J., Tanabe, K., Moon, R. and Venneman, M. (2011) Breastfeeding and reduced risk of sudden infant death syndrome: a metaanalysis. Pediatrics 128(1): 103–110.

    Article  Google Scholar 

  • Hausman, B. (2003) Mother’s Milk: Breastfeeding Controversies in American Culture. New York & London: Routledge.

    Google Scholar 

  • Heinig, J. (2007) The Burden of proof: A commentary on ‘Is breast really best? Risk and total motherhood in the National breastfeeding awareness campaign. Journal of Human Lactation 32(4): 374–376.

    Article  Google Scholar 

  • Hopkinson, J. (2007) Response to ‘Is breast really best? Risk and total motherhood in the National breastfeeding awareness campaign. Journal of Health Politics, Policy and Law, 32(4): 637–648.

    Article  Google Scholar 

  • Ip, S., Chung, M., Raman, G., Chew, P., Magula, N. and DeVine, D., et al. (2007) Breastfeeding and maternal and infant health outcomes in developed countries. In: Evidence Report/Technology Assessment, 153. Rockville, MD: Agency for Healthcare Research and Quality.

  • Jaggar, Alison M. (1983) Feminist Politics and Human Nature. Totowa, NJ: Rowman & Allanheld.

    Google Scholar 

  • Johnston-Robledo, I., Wares, S., Fricker, J. and Pasek, L. (2007) Indecent exposure: Self-objectification and young women’s attitudes toward breastfeeding. Sex Roles 56(7–8): 429–437.

    Article  Google Scholar 

  • Kass, N.E. (2001) An ethics framework for public health. American Journal of Public Health 91: 1776–1782.

    Article  Google Scholar 

  • Kelleher, C.M. (2006) The physical challenges of early breastfeeding. Social Science and Medicine 63(10): 2727–2738.

    Article  Google Scholar 

  • Kramer, M.S., Aboud, F., Mironova, E., Vanilovich, I., Platt, R.W., et al. (2008) Breastfeeding and child cognitive development: New evidence from a large randomized trial. Archives of General Psychiatry 65(5): 578–584.

    Article  Google Scholar 

  • Kramer, M.S., Chalmers, B., Hodnett, E.D., Sevkovskaya, Z., Dzikovich, I., et al. (2001) Promotion of breastfeeding intervention trial (PROBIT)’. Journal of the American Medical Association 285(4): 413–420.

    Article  Google Scholar 

  • Kramer, M.S., Matush, L., Vanilovich, I., Platt, R.W., Bogdanovich, N., et al. (2007) Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 Y: Evidence from a large randomized trial. American Journal of Clinical Nutrition 86(6): 1717–1721.

    Article  Google Scholar 

  • Kramer, M.S., Matush, L., Vanilovich, I., Platt, R.W., Bogdanovich, N., et al. (2009) A randomized breastfeeding promotion intervention did not reduce child obesity in Belarus. Journal of Nutrition 139(2): 417–421.

    Article  Google Scholar 

  • Law, J. (2000) The politics of breastfeeding: Assessing risk, dividing labor. Signs 25(2): 417–420.

    Article  Google Scholar 

  • Lawrence, R. and Pane, C. (2007) Human breast milk: Current concepts of immunology and infectious diseases. Current Problems in Pediatric and Adolescent Health Care 37(1): 7–36.

    Article  Google Scholar 

  • Lee, E. (2007) Health, morality, and infant feeding: British mothers’ experiences of formula milk use in the early weeks. Sociology of Health & Illness 29(7): 1075–1090.

    Article  Google Scholar 

  • Lee, E. (2008) Living with risk in the age of ‘intensive motherhood’: Maternal identity and infant feeding. Health, Risk & Society 10(5): 467–477.

    Article  Google Scholar 

  • Lee, E. (2011) Infant feeding and problems of policy. In P. Liamputtong (Ed.): Infant Feeding Practices: A Cross-Cultural Perspective. New York: Springer.

    Google Scholar 

  • Lee, E. and Furedi, F. (2005) Mothers’ experience, and attitudes to, using infant formula in the early months. University of Kent: School of Social Policy, Sociology and Social Research, available at http://www.kent.ac.uk/sspssr/staff/academic/lee/infant-formula-full.pdf.

  • Lowe, P. (2016) Responsible ‘choices’ and good motherhood. In: Reproductive Health and Maternal Sacrifice. Basingstoke: Palgrave Macmillan, pp. 17–45.

  • MacAlister, A., Puska, P., Salonen, J., Tuomilehto, J. and Koskela, K. (1982) Theory and action for health promotion: Illustrations from the North Karelia Project. American Journal of Public Health 72(1): 43–50.

    Article  Google Scholar 

  • Mahoney, R. (1995) Kidding Ourselves: Breadwinning, Babies, and Bargaining Power. New York: Basic Books.

    Google Scholar 

  • Maushart, S. (1997) The Mask of Motherhood. Sydney: Vintage.

    Google Scholar 

  • Meek, J.Y. (2001) Breastfeeding in the workplace. Pediatric Clinics of North America 48(2): 461–474.

    Article  Google Scholar 

  • Naidoo, J. and Wills, J. (2000) Health Promotion: Foundations for Practice. Elsevier: Bailliére Tindall.

    Google Scholar 

  • National Center For Chronic Disease Prevention and Health Promotion. (2014), Breastfeeding Report Card: United States 2014, available at https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf.

  • National Institute for Children’s Health Quality. (2015) Best Fed Beginnings Final Report. Boston: NICHQ.

  • Okin, S.M. (1989) Justice, Gender, and the Family. New York: Basic Books.

    Google Scholar 

  • Ottonelli, V. and Torresi, T. (2013) When is migration voluntary? International Migration Review 47(4): 783–813.

    Article  Google Scholar 

  • Price, J. (1988) Motherhood: What It Does to Your Mind. London: Pandora Press.

    Google Scholar 

  • Rawls, J. (2005) Political Liberalism (Expanded ed.). New York: Columbia University Press.

    Google Scholar 

  • Raz, J. (1986) The Morality of Freedom. Oxford: Oxford University Press.

    Google Scholar 

  • Rosin, H. (2009) The case against breastfeeding. The Atlantic Online. Available at http://www.theatlantic.com/doc/200904/case-against-breastfeeding,

  • Schroeder, D. and Gefenas, E. (2009) Vulnerability: Too vague and too broad? Cambridge Quarterly of Healthcare Ethics I 18(2): 113–121.

    Article  Google Scholar 

  • Selgelid, M. (2009a) Promoting justice, trust, compliance and health: the case for compensation. The American Journal of Bioethics 9(11): 22–24.

    Article  Google Scholar 

  • Selgelid, M. (2009b) A moderate pluralist approach to public health policy and ethics. Public Health Ethics 6(1): 11–20.

    Google Scholar 

  • Sheeshka, J., Potter, B., Norrie, E., Valaitis, R., Adams, G. and Kuczynski, L. (2001) Women’s experiences breastfeeding in public places. Journal of Human Lactation 17(1): 31–38.

    Article  Google Scholar 

  • Smale, M. (2001) The stigmatisation of breastfeeding. Ch. 22 In: T. Mason et al. (eds.) Stigma and Social Exclusion in Healthcare. London: Routledge, pp. 234–245.

  • Spence, H. E. and Moinpour, R. (1972) Fear appeals in marketing – A social perspective. Journal of Marketing 36: 39–43.

    Article  Google Scholar 

  • Stearns, Cindy A. (1999) Breastfeeding and the good maternal body. Gender & Society 13(3): 308–325.

    Article  Google Scholar 

  • Strauss, R. (2003) Breast milk and childhood obesity: The Czechs weigh in. Journal of Pediatric Gastroenterology and Nutrition 37(2): 210–211.

    Article  Google Scholar 

  • Taylor, E.N. and Wallace, L.E. (2017) Risky business: Breastfeeding promotion policy and the problems of risk language. Journal of Women Politics & Policy. doi:10.1080/1554477X.2016.1268877.

    Google Scholar 

  • Thomson, J.J. (1971) A defense of abortion. Philosophy & Public Affairs 1(1): 47–66.

    Google Scholar 

  • UNICEF. (ND) ‘The baby-friendly hospital initiative’: http://www.unicef.org/programme/breastfeeding/baby.htm.

  • Upshur, R. (2002) Principles for the justification of public health intervention. Canadian Journal of Public Health 93: 101–103.

    Google Scholar 

  • Van Houtven, C.H., Coe, N.B. and Skira, M.M. (2013) The effect of informal care on work and wages. Journal of Health Economics 32(1): 240–252.

    Article  Google Scholar 

  • Victora, C.G., Bahl, R., Barros, A.J.D., Franca, G.V.A., Horston, S., Kraseyer, J., et al. (2016) Breastfeeding 1: Breastfeeding in the 21st century: epidemiology, mechanisms, and life-long effects. The Lancet 387: 475–490.

    Article  Google Scholar 

  • Victora, C.G., Habicht, J.P. and Bryce, J. (2004) Evidence-based public health: Moving beyond randomized trials. American Journal of Public Health 94(3): 400–405.

    Article  Google Scholar 

  • Wall, S. (2010) Neutralism for perfectionists: The case of restricted state neutrality. Ethics 120(2): 232–256.

    Article  Google Scholar 

  • Ward, L.M., Merriwether, A. and Caruthers, A. (2006) Breasts are for men: Media, masculinity ideologies, and men’s beliefs about women’s bodies. Sex Roles 55(9–10): 703–714.

    Google Scholar 

  • Weaver, I.C., Cervoni, G.N., Champagne, F.A., D’Alessio, A.C. and Sharma, S., et al. (2004) Epigenetic programming by maternal behavior. Nature Neuroscience 7(8): 847–854.

    Article  Google Scholar 

  • WHO. (2000) The World health Report 2000 – Health Systems: Improving Performance. available at http://www.who.int/whr/2000/en/.

  • Williams, G. (1984) Health promotion — Caring concern or slick salesmanship? Journal of Medical Ethics 10: 191–195.

    Article  Google Scholar 

  • Wilson, P. (2006) Breastfeeding diet. Ninemsn 24 August 2006, available athttp://health.ninemsn.com.au/pregnancy/parenthood/694357/breastfeeding-diet.

  • Witte, K. and Allen, M. (2000) A meta-analysis of fear appeals – Implications for effective public health campaigns. Health Education and Behaviour 27(5): 591–615.

    Article  Google Scholar 

  • Wolf, J. (2007) Is breast really best? Risk and total motherhood in the National breastfeeding awareness campaign. Journal of Health Politics, Policy and Law 32(4): 595–636.

    Article  Google Scholar 

  • Wolf, J. (2011) Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood. New York: New York University Press.

    Google Scholar 

  • Wolfe, C. (1994) Liberalism and paternalism: A critique of Ronald Dworkin. Review of Politics 56(4): 615–639.

    Article  Google Scholar 

  • Zilanawala, A. (2016) Women’s time poverty and family structure differences by parenthood and employment. Journal of Family Issues 37(3): 369–392.

    Article  Google Scholar 

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Authors and Affiliations

  1. UNSW Canberra, Canberra, Australia

    Peter Balint

  2. Gothenburg University, Gothenburg, Sweden and Flinders University, Adelaide, Australia

    Lina Eriksson

  3. University of Adelaide, Adelaide, Australia

    Tiziana Torresi

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  1. Peter Balint
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  2. Lina Eriksson
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Correspondence to Lina Eriksson.

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Balint, P., Eriksson, L. & Torresi, T. State power and breastfeeding promotion: A critique. Contemp Polit Theory 17, 306–330 (2018). https://doi.org/10.1057/s41296-017-0158-3

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