Does it hurt to call breastfeeding “natural”?

Today, pregnant women and new mothers encounter the mantra 'breast is best' at every turn. Along with extolling the health benefits of breastfeeding, breastfeeding promotion regularly refers to breastfeeding as the 'natural' way to feed infants. Recent work has challenged the extent of breastfeeding's benefits, and ethical criticism of breastfeeding promotion as overbearing, stigmatizing and shaming has also grown. Despite this growing critical perspective, there has been little said thus far about breastfeeding promotion that praises breastfeeding as the 'natural' way to feed infants.

As we discuss in our article in the journal Pediatrics, invoking 'the natural way' in public health campaigns is a double-edged sword, and this language is far from benign. While public health authorities and medical experts generally agree that breastfeeding is important for infant and child health, there has been little discussion of the implications of promoting breastfeeding as 'natural'. Using this language plays into a view that 'natural' approaches to health and parenting are inherently better and healthier, an argument wielded by the anti-vaccination movement to the detriment of public health.

It doesn't take much internet digging to find some of the potentially problematic implications for a public health campaign built around an argument that 'natural' is better. A search for 'natural living' turns up a variety of sites devoted to natural parenting. Parenting blogs and natural news sites often discuss practices and ideas ranging from home-birth and consuming the placenta after birth to homeschooling, breastfeeding, and homeopathy. But these are also spaces where one might expect to run across writers and commenters expressing concerns about the necessity and safety of childhood vaccinations and the promotion of immunity through 'natural' disease and healing processes.

The measles outbreak of 2014-2015 brought this issue of vaccine skepticism back into the spotlight. Some who oppose current vaccination practices believe that vaccines contain harmful levels of toxins and impurities. For some, opposition to vaccines is grounded in a specific, and not necessarily illogical, worldview – a rejection of the manufactured, the synthetic and the 'unnatural'. Studies have shown that anti-vaccination sentiment tends to overlap with reliance on and interest in complementary and alternative medicine, skepticism of institutional authority, and a strong commitment and interest in health knowledge, autonomy and healthy living practices.

Meanwhile, many breastfeeding promotion materials by mainstream medical and public health organizations refer to breastfeeding as the natural way to feed infants (see World Health Organization and U.S. Department of Health and Human Services).

Appealing to 'the natural' in this way raises practical concerns. A recent report by the Nuffield Council on Bioethics examines the complicated role that 'the natural' plays in our modern dealings with science, medicine and technology. The authors suggest that referencing 'the natural' or 'the unnatural' can be highly problematic precisely because these terms have no fixed meaning and because they invite us to infuse them with meanings of our own that may be highly variable and inconsistent. If doing what is 'natural' is best in the case of breastfeeding, how can we expect mothers to ignore that powerful worldview when making choices about other health practices, like vaccination?

Although breastfeeding promotion campaigns surely do not seek to conjure up the rejection of the 'unnatural' that often fuels anti-vaccine sentiment, it is not clear that the meanings and consequences of this kind of rhetoric can be controlled. The 'natural' is a double-edged sword in public health.  Rather than wielding it inconsistently we should abandon reliance on arguments for it.

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Drs. Martucci and Barnhill are both affiliated with Penn's Department of Medical Ethics and Health Policy and the authors of the article "Unintended Consequences of Invoking the 'Natural' in Breastfeeding Promotion" (Pediatrics, March 4 2016). Dr. Martucci is also the author of Back to the Breast: Natural Motherhood and Breastfeeding in America.

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Editor's Note: Cross-posted on the Health Policy$ense blog of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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