The Politics of Breastfeeding: Assessing Risk, Dividing Labor

Signs Journal of Women in Culture and Society (Impact Factor: 0.46). 01/2000; 25(2). DOI: 10.1086/495446
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    ABSTRACT: This paper explores the framing of public policy related to infant food insecurity in Canada by examining multiple levels and jurisdictions where infant feeding and food security policy merge. It identifies that both policy areas position breastfeeding as the solution to infant food insecurity, primarily isolating policy within health domains. Overall, this paper provides a critique of policy in relation to what we know about the challenges of maintaining breastfeeding as the sole nutrition strategies for infants and the barriers of access to alternative food for infants within the context of low-income circumstances in high-income countries such as Canada. It argues that infant food insecurity is a matter that requires better conceptualization and broader policy responses beyond health policy aimed at shaping infant feeding practice. An informed merging of infant feeding and food security policy could provide the framework for policy development to address the structural relations that make breastfeeding unsustainable, particularly for low-income women, as well food insecurity outcomes that stem from not breastfeeding in low-income circumstances.
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    ABSTRACT: The education provided to women patients has been used historically to deliver messages of social and medical control. I suggest ethical standards of practice to tilt the balance toward use of education to serve women's perceived needs. Specific steps include standards and guidelines that specifically address appropriate gender differences in educational messages, regular elicitation from women of educational needs and satisfaction with educational services, and research that specifically tests the impact of patient education services on women and on men. More broadly, patient education must be legitimated as an essential service for which providers and institutions are accountable, and the predominately nonphysician providers who deliver it must be empowered to challenge current practice. Current work on health care as a gendered system suggests that patient education practice can rid itself of only some of the gender bias that exists.
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    ABSTRACT: From June 2004 to April 2006, cosponsored by the U.S. Department of Health and Human Services and the Ad Council, the National Breastfeeding Awareness Campaign (NBAC) warned women that not breast-feeding put babies at risk for a variety of health problems. "You'd never take risks before your baby is born. Why start after?" asked televised public service announcements over images of pregnant women logrolling and riding a mechanical bull. The NBAC, and particularly its message of fear, neglected fundamental ethical principles regarding evidence quality, message framing, and cultural sensitivity in public health campaigns. The campaign was based on research that is inconsistent, lacks strong associations, and does not account for plausible confounding variables, such as the role of parental behavior, in various health outcomes. It capitalized on public misunderstanding of risk and risk assessment by portraying infant nutrition as a matter of safety versus danger and then creating spurious analogies. It also exploited deep-seated normative assumptions about the responsibility that mothers have to protect babies and children from harm and was insufficiently attentive to the psychological, socioeconomic, and political concerns of its intended audience. Critical analysis of the NBAC suggests that future health campaigns would benefit from more diverse review panels and from a greater focus on providing accurate risk information about probabilities and trade-offs in order to enable informed decision making.
    Journal of Health Politics Policy and Law 09/2007; 32(4):595-636. DOI:10.1215/03616878-2007-018 · 0.96 Impact Factor