In a message dated 2/6/2015 2:03:14 P.M. Eastern Standard Time,
[log in to unmask] writes:
The anthropologist in me was fascinated>>>>
if you have not had an opportunity to do so, you may be interested to read
some of the thought-provoking work by anthropologist Kathy Dettwyler, PhD
Her CV: http://kathydettwyler.weebly.com/
Years ago Kathy Dettwyler spoke at a local LCA meeting on "Promoting
Breastfeeding, Promoting Guilt", described on her web page at the time;
<<Promoting Breastfeeding, Promoting Guilt- (1.25-1.5 hours) - A frank
discussion of the problem of health care professionals saying they don't
want to
give mothers complete and accurate information about the risks of
artificial
infant formula because they are worried about making mothers feel guilty
about not
breastfeeding. Includes examples of how guilt is often used to promote
healthy behaviors in health advertising, and seeks to understand who is
really being
"protected" from feeling guilty in the breastfeeding context. Ends with a
discussion of the distinction between guilt and regret, and steps for
moving
beyond guilt.>>
She spoke on this topic at a number of conferences, for example: Dettwyler,
K.A., and I.C. Liles 1997 Promoting Breastfeeding, Promoting Guilt?
Conference Papers, Breastfeeding: The Natural Advantage. Nursing Mothers'
Association of Australia. Sydney: Australia. Pp. 47-55.
Here is a sampling of some of her comments in the Lactnet Archives:
<<<<Dec 1998:
>KD: "Dear Dr. Robert Johnson,
>I am an anthropologist who does research on breastfeeding and weaning
practices, both cross-culturally and in evolutionary perspective. I speak
often at lactation-related conferences and at universities. I have an
entire presentation I do on the issue of guilt and breastfeeding, titled
"Promoting Breastfeeding, Promoting Guilt?". I have a written version that
I would be happy to send you, if you send me your street address.
>
>I understand your concerns about "bashing" parents over the head and
turning them off to the information you are trying to convey, whether about
car seats, immunizations, or breastfeeding. The problem I see with the
current state of affairs with ob/gyns and pediatricians is that they
actually *withhold* information from parents about the risks of
formula-feeding for fear of making parents feel guilty when they choose not
to breastfeed.
>
>I think parents should have accurate and complete information about the
consequences of their infant feeding choices, and then it should be up to
them to choose how to feed their babies. They should know that formula
increases their child's lifelong risk of many diseases, including Sudden
Infant Death Syndrome, and breast cancer. They should know that
formula-use increases the mother's risk of breast cancer. They should know
that their child may have a lower IQ if breastfed than if bottle-fed. If
they feel guilty for choosing to formula-feed, after having been given this
information, that would seem to be an appropriate emotion.
>
>Many public health campaigns actively and deliberately use guilt to compel
people to behave in ways that are good for them. Physicians often use
guilt to encourage women not to smoke or drink or use illegal drugs during
pregnancy, and to have their children immunized. My personal favorite is
"Larry's Lament," a public service announcement for the radio from the
National Transportation Safety Board in which Larry (one of the crash-test
dummies) doesn't put his child in a car seat one time, they have an
accident, the child dies, and Larry goes to hell. Another is the "Friends
Don't Let Friends Drive Drunk" campaign. There are also guilt ads for
mammograms, prostate cancer screening, and learning CPR (Red Cross' "What
kind of a wife just stands there while her husband has a heart attack?").
>
>I think physicians need to use whatever approach they feel will work best
with the particular patient they are dealing with -- some patients respond
better to direct orders, others to education, others to incentives. But it
is never acceptable to tell parents that there are no risks from formula
use, that the benefits of breastfeeding "aren't that significant" or cease
after a certain length of time, and that formula is "just as good as"
breast milk. Physicians should always tell parents the truth about the
consequences of their choices. In addition, physicians should support
parents in their decision to breastfeed, and be knowledgeable about how to
handle problems, or be able to refer patients with breastfeeding problems
to board-certified lactation consultants.
>
>I hope you will send me your street address so I can send you a copy of my
talk on guilt.
>
>Katherine A. Dettwyler, Ph.D.
>Associate Professor of Anthropology and Nutrition"
March 1999: KD responding to the question "isn't it the mom's choice?"
KD: "It *should be* a matter of choice -- fully informed choice, with
complete
and accurate information about the risks of formula feeding to both mother
and baby. It is simply not true that "a baby can be well nourished on
formula, too" if you accept the health and cognitive development of a
breastfed child as your benchmark. Concerns about making the mother feel
guilty, or "imposing guilt on them" should [ethically] have no place in the
decision-making process of a health care professional. It is the health
care professional's ethical obligation to give complete and accurate
information about the consequences of the choices a mother is faced with --
both in terms of her health and in terms of the child short- and long-term
health and the child's cognitive development."
March 1999 KD: "Did anyone else notice in their US newspaper yesterday or
today the report
of a study by a group of medical researchers (one was from Emory), showing
that prenatal smoking by the mother was highly correlated with later violent
criminal behavior in the sons?....Anyone think that those researchers
hesitated for a *minute* to publish and
publicize their findings for worry that they might make women feel guilty
for smoking while they were pregnant? It is *only* breastfeeding that gets
the "we must walk on eggshells in order
to not make mothers feel guilty" treatment by health care professionals."
June 2006 KD responding to the statement "When people feel attacked they
often turn us off"
KD: "I understand the point, but whether they turn us off or not should
*not* be
a factor in this matter. When or why do people (parents) "feel" attacked?
When knowledgeable lactation practitioners convey research based evidence
to
parents in a professional manner, and a parent realizes an incongruence
between what they hear from lactation experts and the decisions they made
that
lead to poor feeding choices, poor choices that can have serious and
long-term
negative consequences for their children, can the conveyer of evidence
based
information be held accountable for causing the parents to "feel" attacked?
Example (x10^6): We are way beyond being concerned at all about the
possibility of parents feeling attacked when we tell them the baby must be
in a
properly installed and maintained car seat, ....to drive home the message
we do
not hesitate to give parents research based guidelines, statistics, ....we
show
them car seat videos that graphically illustrate what can happen, even in
a
slow speed crash, to a baby not properly restrained.
Then, when not securing their baby in a car seat and haphazardly putting
that baby at risk for injury or death, some parents feel guilty or, upon
hearing
car seat safety information, they may feel attacked.
Undeterred we continue to disseminate the dangers of unrestrained children
riding in cars." Katherine A. Dettwyler, Ph.D.>>>>
Debbie Tobin RN, BSN
Fairfax County, Virginia suburbs outside the Washington DC beltway
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