May I ask your views on this article by Ellie Lee?

[Springsintheair]

blogs.kent.ac.uk/parentingculturestudies/files/2011/02/CPCS-Briefing-on-feeding-babies-FINAL-revised1.pdf

I am very pro bf and found this article quite annoying (have to review it for college). However there are some interesting and valid points as well. Maybe it's her style of writing which seems all about 'opinion' and doesn't look at bf in a wider context. Anyway I would like to understand this article better and wondered if others here have some helpful thoughts...

I think I read somewhere that her research was funded by a formula manufacturer but couldn't find any evidence of this.

Would love to see what others think. Thanks.

"I never buy this idea that it's formula marketing that leads women who were otherwise wanting to breastfeed to give up breastfeeding. I hear it all the time and it makes me rage."

Of course it makes you rage - because it isn't true, and it isn't what I said. It is far more complex than that. Unethical marketing does not 'lead' anyone to do anything they don't want to. I could write a lot on this, but no time. It is part of the environment in which feeding decisions take place; breastfeeding women are marketed to....no doubt about it.

"I would also dispute the statement that most women would like to breastfeed. Most middle class women do. Most educated women do. But there is a vast demographic of women who have no intention of breastfeeding."

Just read the stats - I haven't made this up :) Over eighty per cent of UK women start off breastfeeding.

"Anyway. So if you say that formula marketing is one of the major factors leading to women giving up breastfeeding"

I didn't say that, and I don't think it.

You said that the unethical promotion of infant formula is one of the (many and complex) reasons why women give up on breastfeeding.

I don't think that is accurate at all.

Just to elaborate a bit there, I don't think women opt for formula over breastfeeding because advertising convinces them that formula is nearly as good as breastmilk. Formula is the only option when one can't breastfeed (and let's not have a debate on what "can't" means). I know some loons who would say formula is the fourth best option behind breastfeeding, wet nursing and donated milk, but let's be realistic.

But also: what sort of advertising are we talking about here, when first milks cannot be advertised?

seaoflove - unethical marketing which goes far beyond advertising direct to mothers, which is illegal in the UK) is one of the reasons why women do not breastfeed for as long as they planned to. This is not the same as saying it 'leads mothers to give up breastfeeding'

You are persisting in trying to see this in simplistic terms.

Personally I think like many things (mental health, diet to name 2...) if the nhs spent as much time on support as they did on promotion it would help an awful lot of women.
Who told me (in a way not terribly helpful to my worry levels ) what I "should" do? Videos and MW/HV I never saw again.
Who actually gave me practical help so I could/can breastfeed?
100% volunteers out of the kindness of their hearts.

...no wonder people who can't are angry.
Imagine that system with anything else
... told something is vitally important then left to search for support from over stretched volunteers.
And this is the nutrition of babies and the wellbeing of mums.
I think they should put their money where their mouth is: fewer posters, more paid nhs feeding experts ready to help every new mum.

seaoflove, you ask what this promotion is, when ads for first infant milks are illegal.

OK - for starters:

• advertising to HCPs is permitted (this is not informative stuff - it's as fluffy and misleading as any other form of advertising) and MASSIVE
• baby clubs
• 'free' tat like logo'd fridge magnets
• 'free' helplines which purport to answer any questions on anything related to feeding and baby care'
• social media campaigns
• ads for follow on which share branding with first milks

And a whole load of other things.

This is one of the reasons why formula milk is so ridiculously expensive.

... by promoting I mean posters and videos, MW acting like it's easy because they've been told to etc. The usual health promotion stuff which is proven not to work that well (as it's far simpler than complex private media).
It doesn't convert people who have zero desire to breastfeed any more than simple factual "breast milk helps digestion, development and immunity" message wold
... and it doesn't support or give practical help with cluster feeding etc which, if properly funded, would make all the difference.

Some of us are lucky and live in cities with lots of volunteers. .. but for women in other areas, it simply isn't practical. If your child has any other health concern you'd expect supporters to be rewarded/paid for their expertise! Yet there government are happy to rely on 100s giving up time for free because they care and the government can save money by SEEMING to care via posters.

I wasn't insisting on seeing things in simplistic terms tiktok, but as a layperson and a mother I just didn't know what you were alluding to. Thanks for clarifying.

However, I still don't really buy it. None of the things you listed sound persuasive enough to me. Women know breastmilk is best. No amount of advertising, no matter how insidious, is going to alter that. And as I said earlier, to argue that advertising is relevant is to blame mothers for breastfeeding failure, instead of blaming an inadequate and unsupportive NHS.

NickyEds post upthread was a good one. It echoes my experience massively. Women fail to breastfeed because breastfeeding support postnatally pales into insignificance compared with breastfeeding promotion antenatally. Because talk is cheap.

Seaoflove, I don't understand why you are persisting in believing I see this in terms of formula marketing 'persuading' individual breastfeeding women to give up breastfeeding. It is not as (sorry) simple as that. Marketing works on a cultural, social level as well as a personal one. Marketing to hcps is especially important for example. This then works on women. If you think none of the industry expenditure (vast) on marketing actually changes behaviour directly or indirectly, and ends up selling more formula as a result then you might wonder why the industry bothers to spend their money on it.

By the way I never talk of breastfeeding failure. That is blaming language. Of course I think women need appropriate help and support to bf, from knowledgable non judgmental people.

I think one of the findings of this article is this (I'm really paraphrasing); Heavy promotion of bf hasn't worked, but, even if it had it might not by worth the expenditure as the health benefits in this country are not very large compared to f and the impact on women who chose to ff is very negative. I think how much you concur/rate/value this article will, as with so many other similar issues, depend on your personal view on this. I'm not convinced the article would change any minds. If we could, say double the rate of women who ebf their babies to 6 months and it cost X amount of money, should we?
I also think that there is a difficulty in plans, expectations and wishes. When I was pregnant I planned and expected to bf. I didn't give ff any thought really. At 11 days old DS had some f top ups and I thought that I would bf for, well perhaps another week. After a month I wished to bf for longer and get to 6 months. At 6 months bf had tailed off and I felt somewhat a failure but i had only ever wanted to bf for 6 months as we wanted to conceive. Now at a year I see friends really struggling, wanting to stop bf and their babies have other plans and I'm glad I stopped. I also really enjoyed mix feeding. What I'm saying is plans do change so saying that introducing f effects a woman's plans to bf might not always be a negative for the woman.

I don't think that many people seriously argue against the health benefits of bf for mother and baby (or am I just being hopelessly naive?). I think one of the problems (??) is that when you're 6 days into bf and it hurts and your baby always seems hungry and you just want to sleep, evidence in an infant feeding survey is easier to overlook than the evidence that ff babies are fine, which is all around you. That's the difficulty in a country where ff is very deeply ingrained.

Good paraphrase, Nicky :)

I think you are arguing for an individual approach to support in infant feeding - and you raise the issue that a public health agenda to get more women to breastfeed for a longer time may inevitably ride rough shod over individual feelings and experiences, and is this a price worth paying (financially and otherwise)?

I'd say that this is a challenge for all of public health which largely tries to influence and sometimes dramatically alter human behaviour via persuasion, encouragement, whatever, when actual legislation is not available as a sanction.

Coming from a media perspective - the current government are famed for the unsubtle/old fashioned (and usually unsuccessful) "advertising" for the public good. funnily enough they're pretty good at advertising for votes and minimising crap they've done.
Their campaigns can't compete with the subtle stuff private companies use. And emotionally can trigger resentment or worry as much as desire (this goes for many campaigns not just breast is best).
They cost a lot!
Hence my stance that those who HELP should be rewarded... actually "breastfeeding can be tough, though it has huge benefits. .. but we CAN provide support" might work better than "Breast is best. .. don't mention problems .. and if you're very lucky your hospital MIGHT have a bf session once a week..."
Especially as current media campaigns are like something from the 80s, and just cannot compete with formula promotion or really "engage" with a modern audience.

On the face of it, it seems well written and reasonably supported by evidence but to make any decent assessment of the arguments you would need to read all her primary sources, judge if she has interested them correctly and familiarise yourself with the literature to see if she has omitted any studies hostile to her conclusions.

The most one can conclude from this paper is that you have been tasked with an impossible and vague assignment. This is not the way to develop critical thinking and research skills.

Booboostoo I don't think that this proports to be a paper, not in the journal-based, peer reviewed sense anyway. It's certainly not formatted as one. It's described as a "briefing" in the link and an "article" by the op. It would carry far more weight if it were a paper, was peer reviewed in a high impact journal, but it's not and doesn't seem to pretend to be.

For me if an academic writes a briefing on a research topic they are supposed to give an overview of the area with a critical analysis of overall conclusions, areas where more research is needed, etc. it's a common enough task whether you are writing a briefing for, for example, the Nuffield Institute, a commissioned overview piece for a refereed journal or a chapter in a Handbook/Companion.

Either way what does it matter what it is? The OP has been asked to review it, in order to present a critical analysis of it she needs to examine all the evidence the numerous arguments are based on, that's a huge task!

What am I missing?

"The OP has been asked to review it, in order to present a critical analysis of it she needs to examine all the evidence the numerous arguments are based on, that's a huge task!" Thank goodness I don't have to do that! The article is just one of a few sources I need to look at to start thinking about bf interventions... However I found it a strange format and I guess that's explained by it being a "briefing". The comments on this post have really helped me to understand the context in whoch the article exists, thank you everyone!!!

What I would like love to also understand is (seeing that most people on this thread seem to agree that there has been too much focus on bf promotion but not quite as much on actual bf / infant feeding expert support) what could be done to address this imbalance? What would work better?

Do you know what it was for op?

Rent out my sister It was her who taught me how to bf in the end!

Just read the stats - I haven't made this up smile Over eighty per cent of UK women start off breastfeeding

But the numbers of women that start bf tell you nothing about whether or not this was what they actually wanted.

Round here, many women bf in hospital because they don't know they have the option to ff from the start. They get all the bf promotion stuff and think they don't have a real choice. As soon as they come out they switch to ff because that is what they wanted to do in the first place.

Also it is quite common to lie to the mw/hv about it. The common consensus is to tell them what they want to hear, otherwise you might never get them off your back. If you live in a shit area, the general rule is the less engagement with professionals you have the better because it always carries a risk of social services.

I dunno, betternextlife, maybe you have some inside knowledge of how many of the 80 plus per cent of women who initiated bf only did it because they didn't know they were able to ff instead, and/or who lied to the infant feeding survey researchers (not midwives or hvs and not actually known to the mothers).

I am sure that there is a spectrum of feeling about bf - not all those eighty odd percent will be crazy keen desperate to breastfeed. But to suggest the stats we have are exaggerating the numbers because whole chunks of women really did not want to breastfeed at all is an excuse someone might give for withdrawing support for bf, in case any support is seen as pressure.

Do let me know if you know if any decent research that quantifies the number of these breastfeeders who really did not want to do it at all.

They do exist, no doubt, but you do need proper studies. You'd also need to find out how many women who ff from the start actually wanted to bf. These women exist, too.

Maybe they will cancel each other out?

I would have thought that the 20% of women who don't bf at all would account for a large chunk of women who, well, don't want to bf at all, no?? I was quite shocked at the stat quoted by tiktik upthread that half of bf babies have f on the post natal ward. In a healthy, term baby whose mum wants to have a go a bf I can not understand this. Why is it?(genuine question). It sort of hints that post natal wards aren't a place where, in general, women are put off formula and don't know they can ff.
I think that there's many reasons why women start bf and switch to ff. Among my friends these include; I only ever wanted to give colostrum, I didn't make enough milk, poor weight gain, pressure from hv/mw, My milk didn't come in, it hurt, I didn't want to be stuck on the sofa for 3 months, I needed to take medication that i couldn't bf with. I don't think these are uncommon. Many of us decided to mix feed mainly so that we could have some time away, poor weight gain, didn't like feeding in public, didn't want a baby that refused bottles. Again, I think these are quite common.
It would be interesting to know how many women end up unhappy with how their babies have been fed. After say 3,6 and 12 months? It's one thing if the women who ff just really prefer to and quite another if they want to continue bf but stop for some other reason. Is it the case that women just prefer to ff?

nicky infant feeding survey in UK says that nine out of ten women who stopped bf by six weeks (at any time up to six weeks) would have liked to continue.

When giving reasons for stopping, 'had bf for as long as planned' only starts to be a common reason when the baby is about six months.