Hellow Sarah,

Sarah Vaughan writes:
: My apologies for not getting back to the debate until now.

Yes. I am sure you have a very busy schedule, and your routine
does not allow or require you to be at a computer terminal as often
as I am.

OK. I have read your response, and while there are a number of
statements I don't agree with, I think they are quite coherently
written and on point to the paragraphs to which they respond.

For that reason, I will continue to continue the practice of
responding in-line to specific points. However, in reading your
reponse, I also noted a couple of general overview remarks I wanted
to make. I will place those remarks here, before the quoted
material. These can be viewed as general remarks that apply in
general to your entire post.

First, there is the issue of "historical perspective." Reading your
responses below, I believe that there is an assumption or belief on
your part that there is no question of historical perspective
involved. You seem to be taking the view we should simply inform
mothers of the value of breastfeeding with no other message attached,
and that will be adequate for any education that needs to be done,
and further it is "more sensitive" to womens sensibilities and fears.

I think there is something much more involved. For the past 60 years
or so, we have been bombarded by a stream of messages from the formula
industry which was intended to convice women to feed formula as an
alternative to breastfeeding. This message has become deeply ingrained
into the public consciousness. It is necessary to say not only that
breastfeeding what should be done, but that a wrong message has been
propogated and we need to retract that message and say that formula
does not have the value that has been claimed for the 60 years.

The inaccuracy and damaging results of previous formula advertising
must be made known the prospective nursing mothers because of the
myriad ways they can continue to receive the inaccurate message until
it is finally and firmly debunked!

: wrote:
: Sarah Vaughan writes:

: [...]
: There need to be two messages. The first message
: is intended for all women and should be transmitted universally.
: "Breastfeeding is the best thing for you and your child, it is superior
: to any other feedign method,

: This whole debate started because Jo and you objected strenuously to a
: message that said this.

: and you should breastfeed unless you are
: physically unable."

: Larry, you seem to think that telling people what they should do is a
: great way to get them to say "In that case, I'll do it." It's actually
: a great way to put people's backs up and alienate them.

IMO, this response on your part ignores my distinction of general versus
targetted messages. You are treating the case of telling women that
formula feeding is inferior feeding breastmilk causes you to translate
my message into a direct "You (personally) should not feed formula."

I have spent a considerable time and effort explaining that this is NOT
the way to propogate the message, but you persist in turning my mass
message into a targetted message.

: [...]
: Now, what do you do about the women who are unable to breastfeed. You
: use targetted messages to these women. Yes, they will hear the message
: above, and they will know that breastfeeding is really best. There is
: nothing the can (or should) be done about that! Even if these women
: cannot breastfeed, they should also be advocates for breastfeeding and
: convincing their friends who have not had babies yet to breastfeed.
:
: When these women run into problems, (and not before) the medical
: professionals who are dealing with them need to focus a targetted
: message to them saying "If breastfeeding were available it would be
: preferable, but in the circumstances, by feeding what the professional
: recommends you are doing absolutely the best for YOUR child." She
: needs to be made aware that she is performing an exception action
: because of exceptional circumstances, and that by doing so, she is
: doing the best for her child.

: So, what about the women who don't contact any medical professionals
: before starting to feed formula because messages of "Formula is inferior
: and your baby needs breastmilk" have left them so sensitive on the
: subject that they're scared of criticism and just want to avoid talking
: to anybody about it? What about the women who are scared away from
: seeking help by this approach?

I have responded to this argument before, but I will do so again here.
First, what I have suggested is that mass media messages propogated to
the general public be the main carrier of the formula is inferior message,
but that medical professionals dealing with mothers with feeding problems
simply take the compassionate approach or helping the mother to solve the
problem in the best way possible. A woman who is faced with the decision
of whether to consult a doctor over a health quetion is not going to base
her decision on messages propogated in the mass media, but on her (and her
friends) experience with doctors in similar situations. If compassion is
shown in these cases, there is no reason for fear. Sarah, I am afraid
that your straw horse will just not hold a rider in this case!

Further, there are an order of magnitude more women who could be educated
than there would possible be in the situation you describe.

: First, regarding
: women who could have breastfed, but received bad advice. I would posit
: that your suggestions perpetuate the dissemination of bad advice, but
: that the steps I outlined above eliminate or mitigate it by making the
: good advice socially pervasive. It becomes common wisdom.

: In fact, the steps you've outlined above have nothing to do with advice.
: They have to do with instruction, which is not the same thing.

Again, instruction, per se, is a targetted message. I have repeatedly
said that the breastfeeding message should NOT be targetted, but should
be generically dissemninated in a general manner. I would call it
education, not instruction!

: What women need is not advice to breastfeed, but advice about _how_ to
: breastfeed. Given that there are people out there who still believe the
: earth is flat,

Isolating the comment below so the response stands out:

: I'm sure that if you looked long enough and hard enough
: you could find someone who genuinely believes that there really isn't
: any quality difference at all between formula and breastmilk, but I'm
: also sure that the numbers of such people are vanishingly small.

This is where we disagree quite strongly. This is the whole point I
made above about 60 years of misinformation. It is still a common
viewpoint that formula is just as good as breastmilk, or at least
close enough so that it hardly makes any difference which you choose!
Further, this is a view which the formula companies want to perpetuate
by withholding and minimizing the differences.

: In
: general, women don't formula feed because they've failed to get the
: message that breast is preferable; they formula feed because they don't
: know how to overcome the practical problems associated with breastfeeding.

I think it is a combination of the two, and that the belief that forula is
just as good, or almost just as good reduces the motivation to seek a
solution to keep breastfeeding when moving to formula is seen as the easy
answer.

: Many times
: these women who have gotten bad advice (for example, with their first
: child,) will have another child. We want the opportunity to reach
: these women with the correct message in time for that subsequent baby.

: And the correct message is that those women can seek out help and advice
: without fear of judgement or criticism for their previous actions.

I don't disagree that advice and support should be given with compassion
and without judgment. You seem to be latching onto that as a reason for
not advertyising the disadvantages or formula. I think the two issues
should be separated.

: Women who didn't breastfeed because of bad advice already know
: breastfeeding is better, or they wouldn't have been trying to breastfeed
: in the first place. The reason these women didn't breastfeed is not
: because they actually believed formula feeding was just as good, but
: because they received bad *practical* advice - they were told that they
: couldn't breastfeed when in fact they could, or they were given
: inappropriate advice about how to breastfeed that sabotaged their chances.

Again, this is a misleading statement which is only half accurate.
Many were also told to supplement because "it didn't matter" at the same
time they were being given the bad advice. I agree that they should be
given better advice, and I agree that they should be treated with
compassion, and not judged. Pediatricians are *still* giving breastfeeding
mothers bad advice to supplement when they don't have any breastfeeding
problems, and are nursign perfectly well. Until we get the general
message out to the entire public as a whole, including the medical
profession, this travesty will continue to happen, and yes, the numbers
are much higher than the number of mothers who don't breastfeed because
of fear of judgement!

: [...]
: Finally, I think your moral conclusions are, at the least, inaccurate.
: I have already pointed to several clear reasons why my suggestions are
: a BETTER strategy, regardless of the guilt issue.

: I don't think this is the case. The only reason I can see that you've
: given is your claim that "Formula is inferior" makes a more persuasive
: argument than "Breastfeeding is superior", and, as I said, this is in
: direct contradiction to what I've learned in psychology.

Then we will have to agree to disagree. Most of the advertising industry
is based on the direct contradiction to what you have learned. My main
reason for claiming that formula is inferion is that is is damaging in
a statistically significant portion of the population.

: However, regarding
: that question, you have to ask WHY are "pro breastfeeding cousellors"
: viewed as judgmental. It is because formula feeding is viewed as
: normal, and they are trying to convice women to do something abnormal.

: No, it's because some breastfeeding counsellors actually are judgemental.

And they should be re-educated or replaced! :-) I also think that there
is a historical reason for this sad situation, also. The lie that was
propogated by the formula industry created a confrontational backlash
in an attempt to fight the lie. This is the germ of the social situation
that created "judgmental couselors." By correcting the lie (throught
affirmative means to re-educate the public), we can reduce the level of
confrontation so that those who understand the value of breastfeeding
don't have to feel that they are on a battlefield whenever they try to
promote it. Then we can eliminate the judgemental approach to couseling.

: It's not about what you try to convince women to do, but about how you
: convince them. Some breastfeeding counsellors can be very critical of
: women's choices. I think that this is a case of a small minority
: getting the rest a bad name, but, unfortunately, the problem does exist
: and will only be exacerbated by messages that are critical of women who
: formula feed.

You misinterpret again. No one ever said to criticize women who formula
feed. The criticism should be reserved for formula and the formula
industry itself. Women who formula feed should be viewed with compassion
becasue of their difficulties. The message MUST be phrased in this way
Criticize the formula; show compassion for mothers.

: If breastfeeding were viewed as the norm, they could simply be viewed
: as helpers, rather than police(women).

: Not getting blind drunk regularly is viewed as the norm, but there are
: still alcoholics who don't seek help because they're scared of getting
: criticised for their behaviour.

This is a non-sequitar, and I don't know what it is doing here. Are
you saying that formula feeding is an addicitve behavior?

: : Larry, that just isn't true. I know this because I've _done_ a
: : psychology course which specifically covered the topic of public health
: : messages and how they should be presented. So if you want to know what
: : the equivalent of Psych 101 actually does teach - well, it taught me
: : that research shows people to be more motivated by aiming for benefits
: : than by trying to avoid harms.
:
: Based on what you argue above, I would suggest than in addition to you
: public health psych courses, that you also take some advertising and
: advertising psych classes. This not just a question of phrasing the
: message regarding aiming for benefits rather than avoiding harms. It is
: a question of deviating from the norm or not. Human beings have a very
: strong herd instinct. They are usually very unwilling to deviate from
: the norm unless there is a strong reason to do otherwise.
:
: If you phrase the message so that formula feeding is viewed as the norm,
: even if you portray breastfeeding as "superior" it is very easy to say
: "Yeah, it may be a little bit better, but since formula feeding is the
: norm, the benefit probably isn't that great, so it is good enough for
: me. On the other hand, if you phrase the message so that breastfeeding
: is the norm, even if you only portry formula feeding as adding only
: small risks, it is much easier to say "Breastfeeding is the norm,
: everybody is (or should be) doing it, so I better do it too. This is
: the point where attitudes get changes.

: Larry, I think the problem is that you're confusing two subtly different
: meanings of the word 'norm'. What you've been talking about here is
: establishing breastfeeding as the norm in the sense of the approved
: standard that we should all be aiming for. However, this is not the
: same as the 'everybody else is doing it' sense of the word.

Absolutely not. I have consistently used norm a "common behavior."

: If anything, I'd say that messages about the inferiority of formula *or*
: about the superiority of breastmilk both make breastfeeding seem *less*
: like the norm, because they leave people with the subtle message that if
: the point needs to be argued in this way, then clearly lots of people
: *aren't* breastfeeding. It's a 'protest too much' kind of effect - it
: draws attention to the problem.

First, there is a problem. To wit: 60 years of false and misleading
adversiting have led the general public to believe that there is no
effective difference between feeding breastmilk and formula. Second,
a significant portion of the population still hold that belief, particularly
among the poor and disadvantaged. Third, even among those that believe
breastmilk might be better, they believe that the advantages are small
enough that it makes no effective difference in the health of children.
Fourth, a significant portion of our children's health is being risked
by these false beliefs.

This is why it is not a question of "protest too much." We have a
situation where a false message has been disseminated and ingrained into
the publich psyche that it is necessary to conduct an very publich
education campaign to reeducate the public and discredit the falsehood.
The problem requires attention for an effective solution.

: A much better way, both psychologically and practically, would be to
: skip the whole "Breastfeeding is best because yadda yadda yadda"
: paragraph entirely (regardless of whether it's phrased as "Breastfeeding
: is best" or "Formula is inferior"), and instead have something like
: "Although nearly all women want to breastfeed, many wrongly believe that
: they will be unable to do so. Here's some useful information that may
: help you breastfeed correctly", followed by some brief information on
: how to cope with common problems, or on common myths and why they're myths.

I totally agree that more practical help should be given to women who want
to breastfeed, but are having difficulty. I totally agree that women
who wrongly believe they cannot should be *gently* helped. And I hope
and pray for the day where this kind of work will solve most breastfeeding
problems. However, in today's social climate in the aftermath of the mid
and late 20th century, this would address only a small portion of the
reasons why women do not breastfeed.

: Now, this does several things. In practical terms, it's a darned sight
: more help than yet another bang on the breastfeeding-is-best drum. In
: psychological terms, it gets the message across that pro-breastfeeders
: are actually there to *help* rather than lecture. And in more subtle
: psychological terms, it starts from the premise that women usually want
: to breastfeed, stated almost in passing as an obvious fact. That's far
: more effective in getting the breastfeeding-as-norm message inculcated
: into people.

I continue to stongly disagree.

: Sarah, I hope I have been clear and logical enough so that you think
: my arguments have merit.

: Not remotely, I'm afraid. I still don't see how "Formula is inferior"
: is meant to inspire women to seek help with breastfeeding problems. If
: you're a woman who's feeling guilty over having struggled with
: breastfeeding and who's worried about being criticised, to whom are you
: going to turn? To the people who are telling you what you should do,
: telling you how inferior your course of action is, telling you that the
: stuff you're not managing to give your baby is the stuff it needs, who
: are generally making you feel so much worse than you already feel? Or
: to the people who tell you that it's just fine to give formula and who
: make you feel OK about what you're doing?

As a summary paragraph, you comments above must represent the points
you want to emphasize at the end of your post.

1. The "formula is inferior" message is intended to correct and retract
misleading claims made in the last 60 years that formula is just a good,
and which claims are still believed by a significant portion of the
population.

1.b There is still a significant faction of the medical profession that
pushes formula and supplementation as the solution to any feeding problems.
This message would give women the background to question such advice.
That problem is a order of magnitude larger than the guilt problem you
seem so concerned about.

2. The criticism should be reserved for the formula itself. The women
should be treated with compassion. The message medical professionals
should be given to women is "I empathize with your difficulties, and I
pledge to work with you to find the best possible solution we can for]
you and your baby." None of the suggestions I have made contradicts or
detracts from that message.

: All the best,

: Sarah

: --
: http://www.goodenoughmummy.typepad.com

: "That which can be destroyed by the truth, should be" - P. C. Hodgell

Amen, sister, Amen!

Larry