The Opposites Game

Karin chats with Maha Mohammed Al-Madani at the International Conference.
Karin chats with Maha Mohammed Al-Madani at the International Conference.

What’s the opposite of breastfeeding? It’s easy to think of formula feeding as the antithesis of breastfeeding, right? But Karin Cadwell invited 22nd Annual International Breastfeeding Conference participants to explore this question in depth a few weeks ago in Orlando, Fla.

Here’s the game we played at the conference to brush up on our antonym skills: Working in groups, we thought of any word, then the opposite of that word, then a word that started with the last letter of the former word, then the opposite of that word. Get it?

Here’s an example: Hot, Cold, Down, Up. And another example from my group: Left, Right, Table, Chair. This is where I got hung up. Is “chair” really the opposite of “table”? I questioned nearly every antonym our group came up with. I’m certain my teammates were annoyed with me!

Behavior and conceptual framework

The Opposites Game!
The Opposites Game!

When all groups reconvened, we discussed behavioral opposites. What’s the opposite of eating meat? Not eating meat. What’s the opposite of doing vigorous physical activity? Not doing vigorous physical activity. Those seemed fair to me.

Then Karin broke down the reasons behind why people eat or don’t eat meat; why people do or do not do vigorous physical activity. The number one reason why people don’t eat meat is because of animal cruelty. The number one reason why people do eat meat is because they like it.

“The behavior is separate from the conceptual framework,” Karin pointed out.  In other words, people who eat meat don’t do so because they like to kill animals.

Richetin, Conner and Perugini’s research states that “…cognitions about not performing a behavior are not simple opposites of cognitions about performing the same behavior because they rely on separate goals.”  

Next, Karin invited us to think about the reasons why women choose to breastfeed and why women choose to formula feed.

The top three reasons women choose to breastfeed are: for their baby’s health, because it is natural, and to bond with their baby.

Women choose to formula feed because of their perception of the father’s attitude regarding infant feeding, concerns over the quantity of milk they will produce, and the perception that they will be able to return to work sooner than if they were to breastfeed.

With Richetin’s research in mind, the opposite of breastfeeding is not formula feeding. Rather, the opposite of breastfeeding is not breastfeeding, or not feeding the baby, and that’s not an option, so formula becomes the most accessible alternative.

In The impact of attitudes on infant feeding decisions, Mary E. Losch, et al point out that, in the profiles of women who decided not to breastfeed, one of the most consistent findings was that “women who decide to formula feed are not so much embracing this method of infant feeding as rejecting breastfeeding.”

Sales or customer service?

Karin posed another question to the roomful of breastfeeding advocates. Are we acting as sales reps or customer service reps?

She suggested we leave sales up to the formula companies and focus on individualized maternal care. Forget about being breastfeeding-centered; the support we offer must be woman-centered, she said.   

In fact, Karin mentioned that it takes less time to give quality woman-centered care than a one-size-fits-all approach. When lactation professionals provide woman-centered services, we are dealing specifically with the woman’s own concerns instead of going through a premeditated spiel, checking the boxes off of a list.

Similarly, while prenatal breastfeeding education has been shown to increase mothers’ breastfeeding success, Karin challenged us to provide prenatal support rather than prenatal education.

I thought back to my prenatal breastfeeding education options when I was pregnant with my first baby. My choices were an eight hour Saturday class or a four week series. Karin described the type of information typically divulged in prenatal breastfeeding classes: the advantages of breastfeeding and the “ooey-gooey” stuff like mastitis, plugged ducts and engorgement. Yikes. While trying to be comprehensive, what kind of message are we sending? What about the valuable time we are wasting?

“At 2 a.m., moms aren’t thinking, This is the healthiest for my baby. They are thinking, Who is going to help me?!” Karin explains.

Even if we as a nation fall short of our goals, there’s no doubt most moms want to breastfeed.

“We don’t ask women if they want to deliver their placenta. Why are we asking about breastfeeding?” Linda Smith commented at the conference.

She suggested we approach new mothers with something like: “Your milk is going to come in; how do you want me to help you with that?”

Results of our belief in opposites

There has been damaging backlash as a result of our implicit belief in opposites: The case against breastfeeding, Lactivism, Bottled Up, Guilt-free bottle feeding, Is breast best? Karin named a few.

There’s also No Nursery, No Formula, No Pacifier: Are “baby-friendly” hospitals unfriendly to new mothers?, Is the Baby Friendly Hospital Initiative really the Baby Deadly Hospital Initiative, and Surviving the “baby friendly” hospital: Tips for those planning to formula feed.

1f7c8f61-77ee-4283-adde-12ae73efdd11A conference participant suggested that, with this notion of opposites at play, that all hospitals not designated “Baby-Friendly” must be “Baby-Unfriendly.” She went on to explain that in her community, many believe that Baby-Friendly Hospitals must not be friendly to formula-feeding families. She shared that this is not the case at the hospital where she practices; they support mothers’ choices.

Judging by the previous titles shared, there is a gigantic misunderstanding of what the Baby-Friendly Hospital Initiative stands for.

BFHI USA’s website states: “The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.” (bold text added)

But as Healthy Children’s Cindy Turner-Maffei points out in Is any progress good progress?: “Practice in health care settings does not always mirror written policy. What administrators and staff believe is happening does not always mirror the experiences reported by mothers…”

During our continued opposites discussion, another participant commented, “Breastfeeding is so hard that we need experts to help us do it. No one is certified as formula feeding consultants.”

But a 2009 revision to BFHI requires mothers show that they know how to safely prepare formula for their babies. Formula feeding can be tricky. Breastfeeding can be tricky. Implementing policies that influence the health and well-being of all babies regardless of their feeding method may help close the divide that we often perceive between breastfeeding and formula feeding.

Consider this

Other important questions that resulted from Karin’s presentation were: Do formula companies benefit from our implicit belief in opposites? Do they want consumers and lactation providers alike to believe that formula feeding is the opposite of breastfeeding?

Also, if Karin is suggesting that we leave the sales business behind and focus solely on providing mother-centered, customer service, how can we combat formula companies’ marketing strategies?

How can we navigate the fine line between denouncing formula marketing while still supporting families who formula feed? (To start, check out Best for Babes’ article We Support Formula-Feeding Moms AND We Fight Formula Marketing.)

In this Leadership Pittsburgh presentation about “Milk Money,” Todd Wolynn proclaims, “Economics dismantled us as a species.” He’s referring to formula companies.

The Analytical Armadillo writes in Stick Your “Mummy Wars” Advert Up Your…..:

“The news can report that formula cans are overloaded with aluminium at unsafe levels for babies, or that the excessive iron in follow on milk (only ever invented to get around the marketing restrictions of first milk) is linked to developmental delays.  Yet loyal users still believe the formula companies give an actual damn about anything but billions in profit. This ‘faux empathy’ is sucked up and in turn it builds a trust between supplier and customer, and further increases the divide between parents – who by now all believe the ‘mummy wars” exist.’”

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Formula companies do phenomenal work profiting off of our inherent belief in opposites! Formula companies do phenomenal work pitting us against each other in the sneakiest fashion. We have the power to dismantle them.

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