It’s time for a little more realism and empathy on breastfeeding

Infant feeding is back in the news, as the World Health Organisation (WHO) recently proposed new guidelines calling for a ban on social media “influencers” promoting baby formula through their channels. Understandably, there is concern about unqualified people giving what might amount to nutritional advice in a domain such as infant health where it is important that people have good information at their disposal. For this reason, the marketing and sale of infant formula is highly regulated. If only something could be done to control the eye-watering prices in the current market. Instead, we have policy pushing in the opposite direction – regulations prohibit consumers getting value scheme points for infant formula, putting it in the esteemed company of cigarettes and lottery tickets. Depressingly, formula is increasingly one of the most shoplifted items around.

So, we know what the WHO doesn’t want, but it’s worth looking at what it does want when it comes to infant feeding. For the uninitiated, the WHO’s recommendation – endorsed by the Health Service Executive and the Department of Health – is that infants should be exclusively breastfed on demand for the first six months of life, where “exclusively” and “on demand” mean as often as the child wants, day and night, and no bottles or soothers should ever be used.

This means no feeding schedules and no partner or co-guardian feeding. Leaving aside, for argument’s sake, the issue of whether all new parents can fulfil this (they can’t), the implications are fairly obvious – in the absence of some kind of identical-twin wet nurse, a mother breastfeeding a child cannot be apart from the child for the first six months.

Colleague Ben Davies and I recently published a paper on just how demanding the WHO guidance is and made the case that it is ethically unsupportable as a piece of public-health advice. Even if we just take the wellbeing of children into account, the approach is misguided. For those of us with more than one child, a mandate that you must breastfeed your baby at the very moment they seem to want it means removing yourself from other children without notice during potentially important activities, and at a time when they may be craving maternal attention more than usual.

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[ Why are Ireland’s breastfeeding rates stubbornly low? ]

From the point of view of the infant being fed, even if you accept that breastfeeding is the clear best option for nourishing a baby, it’s sensible to think that infant wellbeing is about more than nutrition alone. For many new mothers, this guidance will demand a very radical shift in behaviour, one which will be exhausting and distressing to many, and it is easy to wonder whether it is not better for an infant to have a less put-upon carer in those first crucial months.

Speaking for myself, I am certain that flouting the WHO advice and the equal division of labour it facilitated between my husband and me meant I was as happy and well rested as I could be in those first months with my children, which allowed me to be more giving of myself as a mother in other ways.

Nobody can be everything to all people with a newborn (nor should they try to be), but stipulating that people be completely, unrelentingly available to one person is extreme. Further, a piece of public-health advice that entails that no father can feed his child for the first six months (even if he’s feeding the child breast milk) should strike as overreaching and symptomatic of something strange in this policy domain.

By recommending as a norm that people go above and beyond the call of duty we run the risk of giving people a distorted sense of how they’re getting on in a vital element of early parenthood

One might respond by saying that nobody actually expects people to do things to the letter, but if so, then why be so specific in framing it that way in the guidance? I met a woman at a wedding this summer who, when I mentioned I had recently published some research on infant feeding, started berating herself for “merely” combination feeding (combining breastfeeding and formula). She was leaving the wedding at the reception to retreat to a nearby hotel room for an evening of nursing her baby while her friends and partner danced the night away and still believed that she was somehow doing her baby a disservice.

By recommending as a norm that people go above and beyond the call of duty we run the risk of giving people a distorted sense of how they’re getting on in a vital element of early parenthood – it’s like telling people they’re not really running unless they run ultra-marathons. Philosophy has a term, supererogatory, for acts regarded as above and beyond the call of duty. Some philosophers resist the concept, believing rather that moral perfection should be strived for by all. Others believe that such standards are counterproductive and likely to produce anxiety about failure and moral anguish. One might think that it’s simply too much to ask of new parents that they adhere to this onerous regime. However, it’s not even obvious to me that a world in which everyone adhered to this advice would be a better one.

If health policymakers feel that the benefits of breastfeeding that withstand trials with decent controls are sufficiently important to justify a blanket recommendation of breastfeeding to all new parents, then that is one thing, but they should give serious consideration to whether the austere version they currently endorse isn’t sending the wrong message entirely. As a country with a history (and, in places, present) of chastising women for breastfeeding, we would do well to allow families the space and dignity of parenting their infants in ways that suit their individual circumstances.

Dr Clare Moriarty is an Irish Research Council postdoctoral fellow at Trinity College Dublin