Ask the Ethicist: Mother’s milk and other goodness?

Q: I read an article in a major daily newspaper about how breastfeeding is over-promoted and not really that good for a baby. But people tell me that I should be breastfeeding my baby and they always imply I’m wrong for not doing it. Help?

A: I think I know the article you’re talking about and it in The Globe and Mail. I’m not a real doctor, so I can’t tell you anything about the medical benefits beyond what you could research for yourself. On the other hand, when you say that people think you should breastfeed – now you’re talking the language of what you ‘ought’ to do and that is something I know a little more about.

I have been through the public health lectures about breastfeeding when my wife was expecting our first daughter a few years ago. I can say that it was certainly my impression that bottle-feeding was a distant second-choice for the public health nurses, and I was hopeful that my wife could successfully breastfeed, because not breastfeeding  was portrayed as a pitiful failure of the woman – either in body due to medical problems or in character, because she wouldn’t. Some of the things the nurses didn’t emphasize in those sessions was how hard breastfeeding is.

Women who breastfeed have to want to do it, and I mean want in the non-superficial sense of the word – they have to be deeply committed. The test of that resolve comes when baby “cluster-feeds” – wanting to eat many times an hour, for many hours in a row, before settling into a less demanding pattern. That is the test of resolve for breastfeeding mothers, and many mothers I know found their resolve insufficient after a couple of days and switched to bottle-feeding because their schedule wouldn’t allow it, or they weren’t that committed in the first place, and simply professed the desire to breastfeed because they felt that they had to be as “good” a mother as the others.

Having said all this, is it morally better to breastfeed? There are advantages to breastfeeding for the baby’s health. Some of the claims – such as breastfeeding makes your baby more intelligent – have been debunked. Now the argument is being put forward that breastfed children are less prone to obesity – which plays on our current obsession about the health aspects of obesity, which grew out of our long-standing disdain for fat people in general.

While parents can be said to have an obligation to promote and protect the health of our children, is the obligation absolute? Do I sacrifice everything for anything my child needs? Obviously parents cannot do this for a child’s whole life, and while we would expect them to do what they could to ensure their children’s health, the margins of “good” here are slim. For me to smoke around my daughter is doing something pretty consequential to her health, but to bottle feed her is not anywhere near as significant. I probably will make other choices for her that will not benefit her as much as I hope – does that make the choice unethical? Also, how can we be held accountable for choices when we don’t know how much benefit they will accrue over their lives?

I think that there are some cultural factors imposing themselves on our ethical debate: namely gender and economics. Gender is involved because the desire to be the “best” mom is highly promoted in our society, and to sacrifice the role of motherhood for your career seems like many as an invitation to be scorned by others.

The second aspect – economics – comes about with the widespread marketing of infant formulas by major corporations. The behaviour of some of them has been exposed as less-than-ethical, and many of the pro-breastfeeding campaigns are “anti-bottle,” thus helping to create a value judgment that goes along with a mother’s choice to breast or bottle feed.

In short, I think the ethical issue of your choice of bottle vs. breastfeeding doesn’t really amount to anything significant outside of how you are made to feel about the choice. Think about the big picture and consider the larger “good” of your child within your family. It is also quite smart for you to think about how breastfeeding will affect you, because it isn’t easy, and it takes a toll on you as well. It is better for your baby, but not enough for us to start saying people “ought” to do it.