Promoting breastfeeding as 'natural' way could result in harmful decision-making, experts warn

Breastfeeding campaigns that extol breastfeeding as the "natural" way to feed infants could result in harmful decision-making by some parents on other important health matters, according to experts from the Perelman School of Medicine at the University of Pennsylvania. Writing in a Perspectives column in the April issue of Pediatrics, Jessica Martucci, PhD, and Anne Barnhill, PhD, Medical Ethics and Health Policy researchers at Penn Medicine, warn that "[t]his messaging plays into a powerful perspective that 'natural' approaches to health are better." Promoting breastfeeding in this way may therefore indirectly undercut important health practices not viewed as natural, the authors say, highlighting childhood vaccination in particular.

Martucci and Barnhill cite the measles outbreak of 2014-2015 as an example. Some parents and others who oppose vaccination voiced their conviction that "natural immunity" is better than manufactured and therefore "unnatural" vaccinations. But the researchers note that all credible medical authorities believe that denying children such vaccinations poses unnecessary health risks.

Martucci and Barnhill write that while public health authorities and medical experts widely agree that breastfeeding is beneficial for both infants and mothers, there has been little discussion about the potentially harmful consequences of promoting breastfeeding as natural.

In addition to vaccination, the authors cite other examples of a "natural is automatically better" fallacy, including the rejection of genetically modified foods, reflexively preferring organic over conventionally grown foods, and rejecting assisted reproductive technologies, as well as longstanding concerns over water fluoridation.

Examples of campaigns citing breastfeeding as natural, and therefore implicitly superior, say the authors, include the US Department of Health and Human Services' "It's only natural" breastfeeding promotion, the American Academy of Pediatrics labeling of breast milk as "the best and most natural food for infants," and a New York City Department of Health and Mental Hygiene poster describing breastfeeding as "Mom-made" as compared with formula feeding, labeled with a red circle that reads "Factory-made."

The authors write that in addition to leading to health-related overgeneralization by some parents, breastfeeding-is-natural efforts "can inadvertently support biologically deterministic arguments about the roles of men and women in the family (for example, that women should be the primary caretakers of children)."

Martucci and Barnhill conclude: "We should think twice before referencing the 'natural' in breastfeeding promotion, even if it motivates women to breastfeed."