Thanks to everyone, Eithne and Heather and others, for putting forward the
case for accepting the mother where she is, and the need for her to feel
psychologically safe.

This is all nice, and reassuring, and accepting and very politically
correct.

It also reflects the western view of maternal autonomy (individual rights,
vs public health).

But in this discourse, I don't hear one word about the health consequences
for the baby nor of our ethical obligation to promote the highest
attainable standard of health for the end-user of the mother's infant
feeding decision.  It's not as if we're ignorant on this point - we know
all too well what the risks of formula-feeding are.  When a mother
absolutely cannot lactate, then those risks are deemed acceptable because
in an emergency the baby must be fed.  But if a mother can breastfeed, but
chooses not to, there seems to be the same compulsion to support her
choice, just because the idea of freedom of choice seems to be somehow
sacrosanct.

In fact, whenever anyone talks about this subject - about whether mothers
should be encouraged or recommended to breastfeed, the conversation
consistently reflects the plight of the mother and of our obligations as
breastfeeding supporters, lactation consultants, nurses, midwives, doctors,
to the mother.

Why is this?

It seems to me that when we frame the debate from the mother's perspective,
the consequences of infant feeding choice are always trivialized.  If there
is a conflict between the interests of the mother and the interests of the
baby it's almost as if we ourselves in the lactation community turn a blind
eye to the profound consequences for the baby of a poor feeding choice - as
if the baby's physical health and well-being doesn't matter as much as the
mother's emotional state of mind.  Yet we have so much evidence-based
research to show that formula-fed babies generally suffer poorer health
outcomes than their breastfed counter-parts, and even that the degree of
exclusivity of breastfeeding also matters a great deal to a baby's health.
How come this research is put aside in order to promote maternal choice not
to breastfeed? Is it even ethical to do this?

You have to live in a society of great privilege for a non-breastfed baby
to even survive.  And it doesn't ever not matter at all.  So why, exactly,
do we so passionately defend the idea that all mothers everywhere should be
supported in their choice, if they wish, to bottle-feed?

Pamela Morrison IBCLC
Rustington, England

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