Often when a baby is born, society tends to gloss over the struggles that come with raising a child and focus on the joy that is a new life. Parents must decide how to feed their child, whether it be through breastfeeding, infant formula, or a combination of both. Health providers advocate for breastfeeding; however, many parents opt-out from this advice. Through various methods of breastfeeding promotion, healthcare providers are hoping to increase the number of people who choose to breastfeed – but what is the best way to achieve this goal? New York City launched a health initiative called “Latch on NYC,” aimed at promoting breastfeeding and lessening infant formula usage [1]. Although the goal of this initiative was to benefit the health of infants, it has many ethical issues. In this article, I will explore the ethics behind breastfeeding promotion including promoting shame and limiting autonomy, focusing on “Latch on NYC”.
Before discussing breastfeeding promotion, it is important to understand why breastfeeding is a highly suggested method of infant feeding. According to the CDC, it is recommended that infants are exclusively breastfed for six months [2]. This allows the infant to gain the maximum amount of nutrients for a healthier life. When a parent breastfeeds, antibodies are also passed to the baby, strengthening their immune system to combat harmful bacteria. Moreover, breastfeeding provides generous health benefits that include a lower risk for infections, allergies, diseases, and infant mortality. Mothers who breastfeed are also benefited, as they are at a lower risk for certain cancers, cardiovascular disease, postpartum depression, and type 2 diabetes [3].
With benefits like these, it may sound like breastfeeding is the obvious option to choose when feeding an infant – but breastfeeding is not as easy as it sounds. Breastfeeding is a longtime commitment that requires the breastfeeding parent to consistently be able to breastfeed when needed or pump breast milk. Many parents find this difficult to maintain while also focusing on their professional life, as some professions do not encourage breastfeeding while on the job. Apart from lifestyle changes, breastfeeding can also be a physical toll. Swollen breasts and bruised nipples can make breastfeeding very difficult, influencing many parents to switch to formula [4]. The lack of consistency with breastfeeding is apparent in the CDC’s 2022 Breastfeeding Report Card, which reported that over the span of six months, breastfeeding rates have dropped from 83.2% to 55.8% [2]. This stark drop in breastfeeding motivates healthcare professionals to find ways to promote it until the optimal six months, but not all of their promotional efforts account for ethical complications.
In 2012, the New York City Health Department launched an initiative called “Latch on NYC” to promote breastfeeding amongst new parents. NYC’s health commissioner at the time, Thomas Farley, aimed to “limit the promotion of infant formula in their facilities” because it would encourage new parents to prioritize breastfeeding [1]. When a hospital signs onto the “Latch On NYC” initiative, it is agreeing to the following: only supplementing infant formula for medical reasons, restricting staff access to formula, tracking the distribution of formula and reporting it to the health department, discontinuing free infant formula, and prohibiting materials that promote formula feeding [5]. At first glance, “Latch on NYC” appeared as an extreme way to ensure an increase in breastfeeding; however, the New York government failed to make it clear that formula was still accessible. When assessing the ethicality of “Latch on NYC”, I would argue that it is ethical to promote a practice that benefits the most vulnerable population, infants. However, “Latch on NYC” implements unethical tactics to encourage parents to breastfeed and violates the autonomy of a breastfeeding parent, making it an overall unethical approach to breastfeeding promotion.
“Latch on NYC” unethically promotes breastfeeding by fostering an environment of shame and guilt. Choosing to breastfeed is a private choice within a family, and “Latch on NYC” does not acknowledge the different factors that lead families to choosing infant formula. Promoting breastfeeding and criticizing infant formula can be damaging to families because it suggests that one method of feeding an infant is correct, while the other is not. Both methods of feeding an infant are safe and widely practiced; however, by suggesting that one method is better than the other, “Latch on NYC” implies that a parent who chooses infant formula over breastfeeding is not a “good” parent. Many parents are unable to physiologically breastfeed, while others face social and economic barriers that make breastfeeding difficult. Exposure to health promotion that engrains the “breast is best” message into one’s mind can lead to parents feeling like they are to blame if breastfeeding is a challenge in their lives.
There are many factors that present challenges with maintaining consistent breastfeeding, such as socioeconomic status and family dynamics. It is difficult for a breastfeeding parent to feed for the recommended duration because many families rely on both parents’ income, and breastfeeding is a long-term commitment that does not allow for any breaks . The United States’ limited maternity leave allowances results in many parents having to return to work earlier than desired so they can support their families. In a 2012 study, it was found that there are “sharper income drops in mothers who breast-fed for six months or longer, as compared to mothers who breast-fed for less than six months or formula fed” [5]. It is ironic how health departments praise the benefits of breastfeeding and encourage the practice heavily, but neglect to campaign for proper parental leave. In addition, many families have dynamics that largely impact the course of breastfeeding. Since one parent breastfeeds, there is an asymmetry with the amount of time each parent spends with the infant. A 2011 study on heterosexual relationships found that “fathers of breast-fed infants were less involved in a range of infant care practices as compared to fathers of formula-fed infants” [5]. Many parents value having independent relationships with their child, which motivates them to not exclusively breastfeed. Breastfeeding is also an exhausting task, and the breastfeeding parent may want a break, which is something the non-breastfeeding parent can provide with formula. “Latch on NYC” neglects to recognize these circumstances that many people face. By enforcing strict measures to promote breastfeeding, “Latch on NYC” puts parents in a position to feel guilty about returning to work or shameful for feeling tired or being unable to breastfeed. In an article written by Anne Barnhill and Stephanie Morain, they state that “it is inappropriate for breast-feeding promotion intentionally to make women feel guilty or ashamed for not breast-feeding, given that not breast-feeding is the right choice for some families” [4]. The “Latch on NYC” initiative is unethical because it enforces ideologies that corner parents into breastfeeding and limits their autonomy in choice.
“Latch on NYC” presents more unethical problems as a result of limiting parental autonomy. In healthcare, it is crucial to have full autonomy when making decisions regarding one’s body. While “Latch on NYC” does not completely violate one’s autonomy, it does limit it to a large extent. “Latch on NYC” is not as transparent as possible with communicating their policies and the choices breastfeeding parents have. In an effort to increase breastfeeding rates, “Latch on NYC’s” method of removing infant formula from hospitals gives off the impression that infant formula is prohibited from new parents. However, the initiative does not make it clear that new parents are able to request formula from hospital staff if needed. Although there is the possibility that a new parent could have read about “Latch on NYC’s” policies, it is unlikely that the average citizen is highly educated on the specifics of it. If hospitals are not offering infant formula to new parents, then how are these parents supposed to know they can ask for some? The lack of transparency within this health initiative decreases one’s autonomy because they are not aware of the choices they have. This can make parents feel forced to make a certain decision, despite being unhappy with it. “Latch on NYC” and the New York government worked together to address some of the myths associated with the initiative and its threat to autonomy but this does not excuse the dishonesty within the program itself [6]. It is unethical to have hospital staff withhold potentially beneficial information from a patient with the hopes the patient asks themselves.
Despite the unethical practices of the “Latch on NYC” initiative, breastfeeding promotion is necessary. Increasing breastfeeding promotion efforts is a great idea; however, not at the price of autonomy and inconveniencing parents who rely on infant formula to a certain extent. Society also needs to provide better support resources like guaranteed paid maternity/paternity leave. In addition, it is important to acknowledge that although breastfeeding has valuable health benefits, it may not be the best option for every family. The power of being able to choose which method of infant feeding is best is something breastfeeding promotion needs to prioritize.
Work Cited
1. New York City Health Department launches "Latch on NYC" initiative to Support Breastfeeding Mothers. NYC Health + Hospitals. (2012, May 9). Retrieved February 28, 2023, from https://www.nychealthandhospitals.org/pressrelease/new-york-city-health-department-launches-latch-on-n yc-initiative-to-support-breastfeeding-mothers/
2. Centers for Disease Control and Prevention. (2022, August 31). Breastfeeding report card. Centers for Disease Control and Prevention. Retrieved February 28, 2023, from
https://www.cdc.gov/breastfeeding/data/reportcard.htm
3. Benefits of breastfeeding for you & baby. Cleveland Clinic. (n.d.). Retrieved February 28, 2023, from https://my.clevelandclinic.org/health/articles/15274-benefits-of-breastfeeding
4. Barnhill, A., & Morain, S.R. (2015). Latch On or Back Off?: Public Health, Choice, and the Ethics of Breast-Feeding Promotion Campaigns. IJFAB: International Journal of Feminist Approaches to Bioethics 8(2), 139-171. https://www.muse.jhu.edu/article/592298.
5. Rippeyoung, P., & Noonan, M. (2012). Is Breastfeeding Truly Cost Free? Income Consequences of Breastfeeding for Women. American Sociological Review, 77(2), 244-267.
6. Latch on NYC initiative myths & facts - government of New York City. (n.d.). Retrieved February 28, 2023, from https://www.nyc.gov/html/om/pdf/2012/latch_myth_fact.pdf