This is in response to Joyce's letter regarding a handout that her institution is using for teaching bottle feeding: 

I fully understand your predicament, I was once asked to teach about artificial feeding under the guise of providing choice, respecting diverse views and other ridiculous excuses. I fully refused and was quite vocal about my decision to work in an ethical manner. Here are some suggestions based on my experience. 

Optimally you will present your opinion to the institution in conjunction with evidence based research and respected position statements. Your presentation will be stronger if define your argument clearly. Accordingly, I would not waste time discussing each point on the handout, the points are irrelevant and mask the real issue. 

The real issue here is that aim of health education is to increase acts that lead to health rather than the opposite.This corresponds to ethical obligation to provide their clients with tools for informed decision making. Optimal health focused decisions reflect current and evidence based information on how to obtain the goal of overall well being. 

Increasing information is demonstrating the normalcy of nursing. In addition, research is clarifying that artificial feeding is an activity that increases the risks for impaired physiological and emotional development. Hence, since, the act of NOT breastfeeding is hazardous to maternal, infant and overall family health, health care professionals should be not be promoting this behavior. In other words they should not be providing clients with reasons to engage in artificial feeding. Instead they should be taking steps to enhance families abilities to take on healthy behaviors i.e. to nurse. 

Enrich your co-workers' comprehension of this point by giving them copies of articles on the hazards of not breastfeeding (for example Marsha Walker's articles). 

Help the institution understand the far reaching effects of their actions. Provide them with information about the "equivalency position". This is a marketing tool used by artificial baby milk companies to poise their product as a feasible "feeding choice". Help them understand that by presenting artificial feeding as a choice with benefits they are in essence helping to advertise a product rather than facilitating health. 

Most importantly provide them with information about the WHO code. Accordingly, the WHO code clearly states that information about artificial feeding should only be provided to "mothers or family members who need to use it; and the information given should include a clear explanation of the hazards of improper use." (article 6.5: WHO/UNICEF, The International Code of Marketing of Breastmilk Substitutes, 1981) In other words, information about artificial feeding should not be taught at the prenatal stage and should only be taught to families who are actively engaging in this activity. The purpose of providing this information is to ensure that these families use the products in the safest way possible and not to promote the use of the product. Photocopy this segment of WHO code for your institution.


In short, your argument should be clearly defined and inclusive of evidence based information. 

So Joyce, I fully understand your "shock". I too am shocked that you should even have to discuss this issue. One would think that health educators would be able to differentiate between activities that boost health in comparison to those that interfere with well being. 

Keren Epstein-Gilboa MEd BScN RN FACCE LCCE IBCLC 

PhD (Candidate, Human Development/Family Relations)

  

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