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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