Jo Anne raises many good points. I am glad that she shared her thoughts. We are in complete agreement that thinking carefully about the many nuances of breastfeeding rhetoric is important.

I also agree that "The proof of true respect and freedom of expression is how those who don't share the majority view are treated." A review of articles on breastfeeding in peer reviewed journals, of breastfeeding materials published for mothers, and of advertisements for formula feeding reveals that the "minority view" is actually risk-based language. The highly prevalent wordings are "The benefits of breastfeeding...", "Breast is best," "Breastfeeding is optimal," etc. which frame formula feeding as the norm against which the health and developmental outcomes of breastfeeding are measured.

I see several issues here and I agree with Jo Anne on many points related to those issues. But I only have time to address one issue in this post: the differences between how we communicate effectively with *individuals* and how an effective Campaign is developed for a *population.* When we are working with individuals, we have the opportunity and a responsibility to consider the similarities and differences between those individuals, whether those similarities and differences are based on culture, socioeconomic status, personal circumstance, or point in history, etc. We have the opportunity and responsibility to try to act in a culturally competent manner: one size does not fit all and there is no one right way to breastfeed. A woman who is already committed to breastfeeding and who has the resources to cope with or avoid social barriers will likely continue in her commitment to breastfeeding whether she hears "Breast is best," "The benefits of breastfeeding..." and "Breastfeeding is optimal..." or she hears "The risks of formula...," "The risks of artificial substitutes for human milk...." and "Breastfeeding is the foundation of normal health and development." However, the Campaign is seeking to engender change in a population whose members would *not* otherwise breastfeed and who would *not* otherwise support mothers to breastfeed. We cannot assume that the language status quo is going to engender change. As a matter of fact, we cannot assume anything--we ought to find out from the women and their potential allies what works for them. So, when we are trying to communicate effectively at the population level, we do the kind of thing that was done with the Campaign: create focus groups (36 of them were conducted during the strategic planning phase of the Campaign) reflecting the diversity of the population and explore with their members patterns of view, recurring themes, patterns of change...their stories, experiences, realities... When themes and patterns emerge as part of that qualitative research, we work to incorporate them into the Campaign--this is cultural competence at the population level.

The research discovered that risk-based language engendered change; that an almost universal understanding that "Breastfeeding is best" exists among breastfeeders, formula feeders...everybody...and does not engender change; that breastfeeding as the "optimal" choice was seen as out of reach by the "ordinary" woman. It seems unethical to me to choose to not incorporate risk-based language into the Campaign, to fail to reframe breastfeeding as within the reach of the "ordinary" woman (or to help women overcome barriers via the community demonstration projects designed to provide support--but these projects are not in jeopardy as far as I know), and to continue to use language that does not engender change. These things seem unethical to me based on the research conducted during the strategic planning phase of the Campaign, as well as for the following reasons:

1. Risk-based language reflects breastfeeding as the biological norm for our species.
2. Continuing to use language that does not engender change matches the approach used by an industry in repeated violation of the Code and whose motives, therefore, we have good reason to suspect are profit-based.
3. Continuing to use language that does not engender change results in continued poor health outcomes for mothers and their children, including increased rates of illness, disease, hospitalization, and death.

I could not agree more that breastfeeding is not "one thing," that there are many worldviews of it, and that there are many experiences of it. Anyone wanting more information can visit my website to read my article "The cultural art of breastfeeding" (on the publications page) or to find out more about my presentation "From Barriers to Bridges: Culture and Breastfeeding." I know many women, including myself, who have found breastfeeding deeply powerful and profoundly transformative. I respect any woman's right to hold that view and have that experience. At the same time, I know that other views and experiences exist which I also respect. I understand that the rhetoric and images that are effective with a particular individual may or may not be effective at the population level and vice versa. My previous post was regarding the Campaign which is directed at a population and regarding the language shown to engender change through research about that population. It was not regarding individual counseling.

I am actually in the midst of writing an article on related issues. So, there's more to come...

An intercultural researcher as well as a psychotherapist,

Cynthia

Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Website: http://home.comcast.net/~ammawell
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