Public health campaigns in healthcare: mothers should breastfeed!

Pär SegerdahlPublic health campaigns do to some extent infringe upon our lives. Maybe we are prepared to allow some of these intrusions. We protest a little, just for show, but still adopt the message and begin to think that we probably ought to eat a little more X and a little less Y.

Some campaigns, however, encroach on sensitive areas of life, in more vulnerable situations, and in places where one would expect more personal respect.

Campaigns to encourage mothers to breastfeed, instead of giving infant formula, provide an example. These campaigns occur not least in healthcare, in contacts with new mothers who for various reasons may have difficulties with breastfeeding, or who don’t want to breastfeed.

Earlier this year, Jessica Nihlén Fahlquist had an article published in Nursing Ethics about such mothers’ experiences. It’s about mothers who don’t breastfeed and about their experiences of contacts with healthcare and being met with campaigning.

The survey responses described in the article suggest that these mothers can feel like bad mothers. They are told that breastfeeding is the best and safest option for the child, that all mothers can breastfeed if they just try, and that “artificial” formula feeding increases the risk of malnutrition and various diseases in the child.

The mothers feel that they don’t get opportunity to talk about their problems or desires to find a way of feeding their child that works for them. Might not bottle feeding be the better option for some mothers and children? The information seems, to a great extent, to be about communicating the norm that a real mother should breastfeed. That’s at least how the mothers in the study appear to experience the situation, and they may feel guilty not only because they don’t breastfeed, but also because they don’t enjoy it.

Nihlén Fahlquist points out that information about feeding infants in essence is a form of risk communication where parents are informed about the risks and benefits of breastfeeding and bottle feeding. She suggests that breastfeeding campaigns tend to be deficient in three ethical respects, which need to be addressed:

Parents are informed about risks and benefits on a collective level, without regard to individual problems, needs and circumstances. The public health perspective overshadows the unique situations of these mothers, even though the question how to feed one’s child is intimate. Risks and benefits should be weighed individually.

Campaigning collides with respect for autonomy, which is important in healthcare. The risk communication is one-way; questions and doubts are not taken seriously. It’s about informing parents about “the best option.” One-way communication should be replaced by dialogue.

The effects of breastfeeding campaigns should be evaluated not only statistically, in terms of how many mothers are breastfeeding. They should also be evaluated ethically, in terms of good care. The mothers who responded to the survey don’t seem to experience good care, sensitive to their individual needs.

For me, the article shows how public health campaigns conducted in healthcare need to be adapted to the type of meetings that we need and expect there. Otherwise, risk communication might be perceived as an unwarranted intrusion. Additional sensitivity is required when campaigns revolve around strong norms that easily give rise to feelings of guilt, such as norms of motherhood.

Pär Segerdahl

Nihlén Fahlquist, J. 2016. Experience of non-breastfeeding mothers: Norms and ethically responsible risk communication. Nursing Ethics 23: 231-241

This post in Swedish

In dialogue with patients

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