>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
>Texas A&M University BIG TWELVE FOOTBALL CHAMPIONS!!!
>http://www.prairienet.org/laleche/dettwyler.html
>mailto:[log in to unmask]
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Katherine A. Dettwyler, Ph.D.                         email:
[log in to unmask]
Anthropology Department                               phone: (409) 845-5256
Texas A&M University                                    fax: (409) 845-4070
College Station, TX  77843-4352
http://www.prairienet.org/laleche/dettwyler.html