Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood

5. Scaring Mothers: The Government Campaign for Breastfeeding

107 5 Scaring Mothers The Government Campaign for Breastfeeding I N 1 9 8 4 , T H E U.S. Department of Health and Human Services (HHS) convened the Surgeon General’s Workshop on Breastfeeding and Human Lactation. Although just two years earlier, the American Academy of Pediatrics (AAP) had warned against “ignoring the complexity” of infant feeding and had argued that “inherent” differences between mothers who bottle-fed and breastfed made the effects of either method “extremely difficult” to ascertain ,1 the workshop was devoted in large part to promoting breastfeeding . The two-day meeting included only two presentations on breastfeeding science, “Human Lactation as a Physiologic Process” and “The Unique Values of Human Milk.” The latter, in repeatedly minimizing the shortcomings in breastfeeding research, revealed considerable distance between the clarity of advocates and the uncertainty of science about breastfeeding’s benefits: Although the potential roles of specific antibodies, nonspecific immunologic factors, and other functional components may be extrapolated from laboratory studies, a definitive demonstration of their significance in freeliving populations has been much more problematic. . . . Although most studies that compare morbidity among children fed human milk or syntheticformulahavenotcontrolledadequatelyforalloftheconfoundingfac tors ,moststudiesfromdevelopedanddevelopingcountrieshavereported significantlyfewerillnessesinbreastfedinfants. . . .Whereasavailabledata arenotconclusive,theygenerallysupportthetheorythathumanmilkprovidescomponentsthatcomplementadevelopingimmunesysteminthein fant .Althoughitisnotknownwhetherthesecomplementarycomponents participate in the improved development of active immunoprotective abilities,theymayserveassubstitutesuntiltheinfantmaturessufficientlyto mountanactiveimmuneresponse.Whetherornottheprotectiveeffectsof humanmilkcomponentsaremaderealorpotentialbyenvironmentalconditions ,suchbenefitsareavailableonlyiftheinfantisbreastfed. 108 Government Breastfeeding Campaign The last sentence asserts “the protective effects of human milk” that the rest of the paragraph acknowledges are provisional.2 Of the workshop’s six working groups, five focused on how to increase the number of women breastfeeding. The last group made six recommendations regarding research , only two of which called for further investigation into the effects of different modes of feeding. The rest concerned research on promoting breastfeeding. In the ensuing decades, HHS intensified its efforts to encourage breastfeeding . In 1985, it issued a follow-up report on the recommendations of the Surgeon General’s Workshop, and in 1995, it supported the formation of the U.S. Breastfeeding Committee (USBC), an umbrella organization made up of governmental, educational, and nonprofit groups committed to advocating breastfeeding. HHS also sponsored the National Breastfeeding Policy Conference in 1998. In 2000, the HHS Office on Women’s Health (OWH) issued the Blueprint for Action on Breastfeeding, in which Surgeon General David Satcher maintained that “breastfeeding is one of the most important contributors to infant health.” The Blueprint deemed breastfeeding “a public health challenge” that required support from the health care system, the workplace, child care facilities, family, and community .3 It reiterated the breastfeeding goals of Healthy People 2010, which outlined HHS’s overall health objectives for the American population for the next decade: at least 75 percent of women should initiate breastfeeding ; at least 50 percent should breastfeed exclusively through six months; and at least 25 percent should continue breastfeeding, supplemented with other foods, for the first year.4 The Blueprint placed particular emphasis on the importance of persuading African American mothers to breastfeed.5 At the same time, webpages for HHS and the Centers for Disease Control and Prevention (CDC) offered extensive information on a variety of topics : the health benefits of breastfeeding; the challenges of breastfeeding, including physical problems and work constraints; breastfeeding rights and legislation; data and statistics; promotion and support; and human milk banks, where women could donate or purchase breast milk. The National Women’s Health Information Center, part of OWH, also instituted (and continues to operate) a breastfeeding help line with “La Leche League International trained Breastfeeding Peer Counselors” who speak both English and Spanish.6 In 2002, OWH announced that it would partner with the Advertising Council to promote breastfeeding in the United States. The result was the National Breastfeeding Awareness Campaign (NBAC), which ran from Government Breastfeeding Campaign 109 June 2004 to April 2006 and was composed of television, radio, and print advertisements; pamphlets, posters, and billboards; and websites maintained by both OWH and the Ad Council. From the controversy surrounding its launch to the evaluation of its success, the NBAC revealed the workings of a risk culture marked by total motherhood. The campaign exploited the popular obsession with health and diet. It presented breastfeeding research as far more certain than it is and the risks of not breastfeeding as much more severe than they would be even if the science were compelling. It capitalized on the public’s general confusion about risk, including ignorance of the ideological underpinnings of risk assessment and the inevitability of...