Beyond Health, Beyond Choice: Breastfeeding Constraints and Realities

Chapter 19 Breastfeeding in the “Baby Block”: Using Reality Television to Effectively Promote Breastfeeding

The program Bringing Home Baby opens with a typical schedule for the first days after a baby is born. Title slides read: “First 36 hours”; then, “Day 1: Newborn baby,” “Crying,” and “Diapers.” A second set of slides state: “Day 2: Feeding,” “Sleeping.” Images of real people performing these tasks accompany the slides. For the feeding slide, a father bottle-feeds his newborn. Similarly, the alternate opening of this program features baby items, including bottles, marching into a house. Because breastfeeding is not pictured, this opening presents bottle-feeding as the typical or default means of feeding a baby. This message is not unique to Bringing Home Baby. In 2005, the American Academy of Pediatrics criticized mainstream media for frequently presenting bottle-feeding as the normal means of feeding a baby, stating that these messages have likely hindered breastfeeding rates.1 Considering the health and social benefits lost when infants are not breastfed, the normalization of the bottle, perpetuated by media, is particularly alarming. And yet, little attention has been given to contemporary media representations of breastfeeding. This chapter examines these portrayals, using reality programming to explore what messages are conveyed on television and how this genre could be used as a tool to promote breastfeeding. Media play a significant role in most people’s health decisions, expanding knowledge, changing behavior, and shaping perceptions. Other than personal physicians, media outlets, especially websites, serve as most people’s primary source for health information.2 As news audiences continue to shrink, entertainment television has increasingly been recognized as an effective tool for disseminating information. For example, a 2008 Kaiser Family Foundation Breastfeeding in the “Baby Block” Using Reality Television to Effectively Promote Breastfeeding Chapter 19 226 Katherine A. Foss campaign on HIV and pregnancy found that many viewers could provide the statistic of healthy infants born to HIV-positive mothers after an episode of Grey’s Anatomy covered the issue.3 Entertainment programming has also been used to teach people about emergency contraception, designated driving, reproductive health, and other issues.4 Given this recognized influence, it makes sense that people learn about infant feeding, including breastfeeding information, from magazines, websites, and television—an assumption that is supported by research. In a survey by Samir Arora and colleagues, many bottle-feeding mothers stated that they would have been more likely to breastfeed if television, magazines, or books had provided them with more information on breastfeeding.5 Media messages have also been shown to enact changes in health behavior. For example, in the 1980s media messages about the dangers of giving aspirin to children helped to dramatically reduce the incidence of Reye’s syndrome.6 And, following publicity of former First Lady Nancy Reagan’s mastectomy, the frequency of breast-cancer patients choosing mastectomies over breast-conserving surgery (BCS) increased.7 Campaigns promoting behavior change are most effective if consumers believe that the benefits far outweigh the risk of not changing the behavior and if the behavior is somewhat easy to change.8 With breastfeeding, it is not enough for women to know of the health benefits; they need to believe that not breastfeeding is risky enough to their infants to make it worthwhile. The recognized importance of focusing on risk prompted the Ad Council, as part of the National Breastfeeding Awareness Campaign, to create a series of public service announcements (PSAs) that featured pregnant women riding mechanical bulls or partaking in other dangerous activities, with a voiceover stating the risks of not breastfeeding. Unfortunately, fears about these messages being too effective prompted commercial formula manufacturers to protest.9 And yet this campaign was a positive start toward framing breastfeeding as a healthy behavior with recognized risks if not practiced, similar to public health messaging concerning the risks of not immunizing children. A key social institution, mass media help shape a person’s meaningful reality, reinforcing or challenging dominant ideologies, including those held about breastfeeding.10 The extent to which breastfeeding is perceived as the normal means of feeding an infant can impact breastfeeding success. For example, the attitudes of partners, family, physicians, and others have been shown to significantly influence breastfeeding initiation and duration.11 Therefore, it is not just pregnant women or nursing mothers who are impacted by media messages about breastfeeding. These messages impact overall public Breastfeeding in the “Baby Block” 227 perception of breastfeeding. According to cultivation theory, developed by communication...