Is breast best?

Messaging about breastfeeding has become news and not just among La Leche League leaders and IBCLCs. From the so-called Mommy Wars to two recent New York Times pieces, there’s been lots of talk about how we talk to moms about breastfeeding. But is the question the message? Or should we really be asking a different question – who is our audience?

In her Monday NYT blog, Jane Brody asked if “breast is best” messages are causing mothers “guilt and serious hardship” when financial pressures and insufficient leave make exclusive breastfeeding challenging.

Her argument: breast is best messages inflict unnecessary guilt, because breastfeeding can be very challenging, is not as easy as portrayed by advocates, and isn’t as beneficial as we’re told.

Brody’s post comes just after Alissa Quart’s NYT opinion piece, Milk Wars. Her point? “We need more balanced, reassuring voices telling women not to feel guilty if they can’t nurse exclusively for months on end. Given how difficult it is for some women to nurse, we should understand that we might sometimes be asking too much.” (She, too, argues that breastfeeding is not as beneficial as we’ve been led to believe.)

The good news comes from Dr. Alison Stuebe, who at the Breastfeeding Medicine blog highlights what’s wrong with both of these pieces (starting with the credentials of the sources they cite on the risks of formula – Hanna Rosin (Hanna-as-questionable-source background here) and Amy Tuteur (Amy-as-even-more-questionable-source back story here) respectively).

Importantly, she calls attention to the larger policy issues: “The fact that so many mothers and babies run aground reflects our failures as a society – and it underscores the urgent need to address those failures.”

Yes, yes!

She also adds another voice to those calling on reporters to focus on real issues: “And we need journalists writing about breastfeeding to treat it as a real public health issue, not another round in the media-generated “mommy wars.”

We have work to do

The answer? Get to work. Or, as she puts it, “The time has come to stop the madness. We have work to do.” Well put!

So what is our work? Crafting a “breast is best” message that doesn’t make mothers feel guilty?

Maybe the question isn’t one of message, but of audience.

Right now, the media – right along with formula companies – is driving the message. Mother guilt. Mommy wars. If we want to use communications to support breastfeeding, our work is to get clear on three things: our goals, the audiences we need to achieve those goals, and the messages that will persuade those audiences.

Are mothers our target audience? I have been listening to mothers, online and in real life, and I believe that the NYT pieces have one thing right: when mothers are unable to reach their breastfeeding goals, they often do struggle, with sorrow and yes, guilt. But the guilt that mothers are experiencing is not a reason to stop our communications work. It should be our call to action – that guilt is a canary in a coal mine, telling us something isn’t right for breastfeeding mothers. But is the message the cause? Or is it that we have directed the message to the wrong audience?

Breastfeeding initiation rates now mean that three in four mothers start nursing after birth, effectively reaching the Healthy People 2010 guidelines. Mothers appear to *know* that breastfeeding is best, but, as Dr. Stuebe points out, lack the structural supports to succeed. She calls for evidence-based education of mothers and health care providers, improved maternity care practices, paid maternity leave, and improved support for working mothers. So should mothers even be our target audience? How can we reach these larger policy goals?

If mothers know breast is best, what if we stopped pouring resources into broad public education campaigns directed at telling mothers the benefits of breastfeeding, and instead find ways to deliver one-on-one assistance to mothers. Evidence-based, practical help (like the Best for Babes Booby Traps series) – not a “breast is best” session (not even the more accurate and stronger Wiessingerized message, “formula has risks.”)

What if we focused our energies on carrying the message of risks of formula feeding to legislators who can help create new mother-friendly policies, like those outlined in the Surgeon General’s Call To Action To Support Breastfeeding.

Or if more of us scheduled a time to talk to our local Chamber of Commerce on the business case for breastfeeding, easing the return to work for new mothers. (Check out the messaging and materials at The Business Case for Breastfeeding program).

Or creating conferences and resources specially designed to reach not just other IBCLCs and breastfeeding pros and volunteers, but are carefully targeted to reach and educate the front-line health care providers, like OBs and pediatricians.

Let’s figure out not just the message, but the audiences we need to reach our goals. Until then, we’re allowing formula companies and magazine cover sales drive the conversation around breastfeeding.

What do you think about breast is best? Should we be targeting a different audience? And what are the existing efforts that we can all get behind?