Good Enough Mum

Anti-prostitution laws: the trouble with the Swedish Model

It's Friday the Thirteenth, so I'm blogging for decriminalisation of prostitution.  For the backstory to that apparent non sequitur plus my general views on the matter, read this post.

This time around, I thought I'd write about a commonly-discussed prostitution law that's usually known as the Swedish Model (as that was the country that thought it up) and sometimes as the Nordic Model (as other Nordic countries have since adopted it) and is often put forward as The Answer To The Problem Of Prostitution.  I picked this one because it's a prime example of a law that's supposed to be for the benefit of prostitutes, but in practice causes them major problems that could be avoided by decriminalisation.

The Swedish Model, simply put, is to make it technically legal to work as a prostitute, but illegal to visit a prostitute.  Well, not literally 'visit', of course - if your best friend happens to be a prostitute, you're still quite free to pop round to her house for coffee any time she happens to invite you.  'Visit' in the sense of 'be a client of a prostitute'.

Let's look at what this means.  Supposing I were to experience some cash flow problems and to decide, after some consideration of the options, that my best bet for making the necessary money was to charge for sexual services (1).  Accordingly I find an interested man, we agree on a price, we do the deed, and he pays me (and I presumably then go and pay my latest mortgage payment or gas bill or whatever I needed the money for).  If this were to take place in a country that's adopted the Swedish Model of prostitution law, then that man would now be a criminal.  For engaging in a mutually consensual and mutually acceptable act,he could find himself subject to a fine, a criminal record, and possibly a prison sentence.

It would make not a blind bit of difference how carefully I'd considered my decision beforehand, how certain I felt of it, how polite and pleasant he was while hiring my services, or how happy I was with the whole transaction after it had taken place.  It wouldn't matter that, according to the law in my country, I have been considered fully capable of making my own sexual decisions for the past twenty-five years.  It wouldn't matter that, had we chosen to do the identical things for free, the law of the land wouldn't have had the slightest interest in us.  In short, under the Swedish Model the question of whether I had consented to what had just gone on would not matter, because I would not be considered capable of giving consent to it. 

So what, exactly, is the idea behind criminalising consensual and harmless activity?

The Swedish Model seems to be based on the beliefs that

a) having sex for money is the one job so unpleasant it's impossible that nobody in their right mind would ever willingly choose it.  Therefore, all women in the job must either have been forced into it by violent pimps or traffickers, or they must not be in their right mind and therefore their opinions on the matter can be disregarded.

b) prostitution is inherently a Bad Thing anyway, and thus ought to be stopped, but doing this via a model that frames women as helpless victims with no say in the matter is more politically correct than doing it via a model that frames them as evil fallen women.

Now, the fundamental problem with this is of course that the first of those beliefs isn't true and the second is an extremely questionable opinion. And, while people are entitled to their questionable opinions, if they want to enshrine them into law to be imposed upon others then they ought to be held to a rather higher standard of evidence. 

Even in the one area where the reasoning behind the law does hold up as ethically solid - the desire to help those women who actually have been forced into prostitution - it's very debatable whether it's doing a blind bit of good.  Dodillet and Ostergren's paper The Swedish Sex Purchase Act: Claimed Success And Documented Effects, and Jordan's newly-published essay The Swedish Law to Criminalize Clients: A failed experiment in social engineering, both examine the effects of the law in practice, and both point out that there is simply no conclusive evidence as to whether the law has helped reduce forced trafficking in the sex trade in the countries where it's been implemented.  (One particular concern that neither paper mentioned on this subject, by the way, is that some women in this situation have actually managed to escape their plight thanks to the help of a client who found out what was going on.  A law that puts clients at risk of being arrested themselves if they approach the police with concerns therefore has the potential to backfire tragically as far as protection for trafficking victims is concerned.)

In addition, the above two papers raise a number of concerns about the impact that this law is having on prostitutes themselves.  I'd strongly recommend that anyone interested read one or both of the full papers (available online at the links I gave above) as there's no chance of me doing the full arguments justice.  However, probably the most worrying are the reported accounts of the effects that it's had on streetwalkers. 

Streetwalkers - prostitutes who pick up their clientele on the streets, rather than in brothels or via escort agencies or personally advertising - account for a minority of all prostitutes, but are the group that best fit the stereotype of prostitutes as vulnerable women living a desperate existence.  The huge spectrum of working conditions that a prostitute might experience, starting at the top end with high-class escort workers who spend much of their time in expensive hotels and command huge hourly fees, hits bottom here.  Much of the streetwalker trade takes place in their clients' cars, which is an extremely dangerous place to be if your client turns nasty.  Their rates are a lot lower.  They're much more likely to be arrested than off-street prostitutes.  Rates of drug addiction are much higher.  They're a lot more likely to be in desperate straits emotionally and/or financially.  So, if the Swedish Model actually was - as its supporters often claim - helpful to all those poor vulnerable prostitutes who need rescuing from the misery of their lives, this is exactly the subsection of the world's oldest profession that you'd expect to see benefiting from it.

According to reports, it is in fact causing them significant and severe problems.

The problem is, of course, that if someone is working in such an unsavoury job it's generally because she's very, very short of other options in her life.  Using the force of the law to drive away a large proportion of their customers doesn't change whatever life circumstances have led them to this point.  All it does is to limit their already limited options even further.  They still need to earn the money, but they have fewer clients to pick and choose from.  That means they may be more likely to feel their only option is to accept unpleasant clients or to agree to acts at which they normally would have drawn the line (potentially including sex without condoms).  On top of that, because of the need to avoid the police, they have to ply their trade on the less well populated, more dimly lit streets.  They have to rush through the initial negotiations for fear of being caught, and that means less chance to assess their potential clients and pick up any worrying or off-putting vibes from them.  All of which can put them in a lot more danger.

So, overall, the Swedish Model looks like pretty bad news for prostitutes.  It's bad news in practice because of the extra difficulties it causes for them and the significant extra danger it inflicts on the most vulnerable women in this job.  And it's bad news in principle, because it's fundamentally based on the idea that prostitutes are not considered capable of making their own decisions about something as important as what work they choose.  That last, of course, could be bad news for other women as well.  Speaking for myself, I really don't want a law on the books that boils down to 'If a woman makes sexual choices outside of what society sanctions as appropriate, she can thereby be considered incompetent to make her own decisions.'  That could be a very scary road to go down.

 

(1) I do wish to point out that this is a hypothetical example.  In the first place, I wouldn't break my marriage vows for love nor money; in the second place, I already have a way of making money from activities that involve seeing people in states of undress and doing a lot of the sort of things that make many people wince "Ick! I could never do that".  Of course, working as a doctor doesn't command nearly as high an hourly rate as Maggie used to earn in her career, but it's still the job I love and I'm sticking with it.  And I defend the right of a prostitute who wants to keep her job to do the same.

Their bodies, their choice

Last year, clicking through links from different blogs, I came across one called The Honest Courtesan, written under the nom de plume of Maggie McNeill.  I've been reading it ever since; it makes a pleasantly interesting change from all the heated debate over parenting-related issues that is my more usual fare.  Maggie is a former escort worker who blogs in favour of decriminalisation of prostitution.

I've never had a problem with the concept that prostitution should be legal; I've always found it far harder to see why it shouldn't be.  I have never seen a voluntary exchange of sex for money as being something that should be the law's business (except insofar as any profession should be assured of good working conditions), and I'd like the portion of my taxes that's spent on law and order to be spent on clearing up things that actually do harm other people rather than wasted on arrests of/sanctions against people who weren't doing anyone any harm in the first place.  So the idea of decriminalising prostitution (1) wasn't a new or startling one to me.

However, reading Maggie's blog, and some of the sites she links to, has been an education on the complexities of the subject.  And an eclectic one.  Maggie writes a lengthy post every day, nearly all of them on the topic of prostitution, and she approaches it from every angle imaginable.  Current events, legalities, ethics, philosophy, personal experience (never written to be racy or titillating, but do be warned that she does get pretty frank and open about some of the details), history, and even the odd bit of prostitution-related fiction (and, no, it's never pornographic fiction).  As you can imagine, I've learned a lot about the subject, and a lot about anti-prostitution arguments and some of their flaws.

So, a couple of years back, Maggie made a suggestion.  For reasons explained here, she suggested making Friday the Thirteenth a day for speaking out in favour of decriminalisation of prostitution. I wasn't reading her blog then, and so I didn't see this until her follow-up post on May 13^th of last year; as it happens, this is the first Friday the Thirteenth since then, and thus the first opportunity I've had to use this day to speak out on the subject.

While most happy to oblige, I wasn't sure where to start on dealing with the complexities of this subject and the many myths around it. As it happens, however, the perfect cue came up a couple of weeks ago; the subject of prostitution somehow came up in the middle of a blog debate about something utterly different, and one commenter summed the different positions up rather nicely:

What a certain sector of feminist thought argues is that sex work can be *chosen* and is a legitimate and potentially empowering choice for women. Those that disagree will often retort that no one would choose prostitution if other options were reasonably available and though they may not be “forced” at gun point they are “forced” by lack of access to education, poor support for addictive illnesses, shredded social safety nets, etc.

And so, for this Friday the Thirteenth, I want to reply to the position described in her second sentence.

First of all, there is an important factual error to note here: the claim that no-one would choose prostitution if other reasonable options were available. In fact, many women do precisely this. Last year, in Wales, researchers surveyed women in the non-streetwalker forms of prostitution (brothel work and escort work) to find out about their reasons for entering the world's oldest profession, and were surprised to find that - far from being forced into it by desperate circumstances - the majority of the women they spoke to had willingly left good careers in other areas to go into sex work.  Similar findings were emerging from research done in the USA.

While many people will have a hard time believing those findings, the fact is that a career in the higher-end forms of prostitution has many benefits – it's very well paid, women can set their own hours, working conditions are often excellent (they may see their clients at luxury hotels, and at least one post on Maggie's blog is a review of the quality restaurants to which her clients took her before, or sometimes even instead of, getting down to the part of the evening more usually associated with the job), and there is no doubt that they're going to have a lot of satisfied clients. So, in fact, it isn't so surprising to find that there are women such as Maggie who genuinely enjoy their work in prostitution and who choose to stay in the job in spite of having other perfectly good options available to them. In fact, the biggest problems that many women face with the job are simply those thrown in their way by the restrictive laws around the profession that have been put into place in misguided attempts to help these women.

However, it is also, of course, quite true that many other prostitutes are only in the profession due to being forced into it by straitened circumstances – they don't like the idea of having sex with multiple strangers, but they need the money and either they have no other way of getting it or the other jobs available to them are worse. (2) And this fact is often used as an argument for trying to stamp out prostitution – that anti-prostitution laws are needed to help and protect those women forced into the profession.  What this argument ignores, however, is that if someone has picked Option X as being the best available to them out of a limited selection of disliked options, all that removing Option X does is to leave them with the options that they've already concluded are even worse.

If a woman has decided that prostitution is the least unattractive option available to her at this time in her life, making it illegal is not going to change whatever life circumstances have led her to that decision.  It may leave her with one of the choices that she has already decided to be more unsavoury to her (destitution, or working at a worse job); or it may leave her working as a prostitute anyway, with her lot made worse by the added burden of anti-prostitution laws.  Either way, it is not going to help her.  She does not need anti-prostitution laws set up in a misguided attempt to 'protect' her - she needs help and support coupled with an acknowledgement of the fact that, if she is an adult of sound mind, she is the person best placed to make decisions about her own life and that she should have the right to do so.

So, for the above reasons and many others: yes, I do agree that sex work can be freely chosen.  I do agree that it is a legitimate choice.  I do agree that it can be potentially empowering for women.  And, while I recognise that there are large numbers involved in the industry who do not find it empowering and would not want to be in that job if they had a better option, I also recognise that making it illegal is not the answer to that problem.  Today is my first Friday the Thirteenth of blogging for the rights of sex workers: I hope it won't be the last.

 

Footnotes

(1) There is, apparently, a technical issue of wording to be considered here: apparently legalisation is not the same as decriminalisation.  Legalisation requires prostitution to be subject to whatever laws and licencing procedures the government may deem relevant, and governments, apparently, have an appalling track record on that score; their attempts to set up legal frameworks to control and regulate prostitutes have invariably led to laws that have done far more harm than good.  Decriminalisation apparently means that you stop making it illegal without the requirement to throw in a bunch of totally unnecessary and problematic new laws.  I am not a lawyer and don't play one on TV, so I do hope I got that distinction right.  In any case, this is why decriminalisation is the term that Maggie uses and the one that I have used here, other than in the footnoted sentence describing my views prior to encountering her blog.

(2) I'm not, in this post, discussing the far more uncommon but far more tragic cases in which women are forced into prostitution in the more literal sense of being under threat of violence to themselves or their families if they don't comply, such as trafficked women.  I think that people from all sides of the prostitution debate can agree that trafficking is a hideous crime that needs to remain illegal, regardless of what happens with prostitution laws.  However, although making prostitution illegal is often advocated as a way of fighting sex trafficking, there is little evidence that it is of any help; meanwhile, anti-prostitution laws harm the women who are involved in the profession by choice.

More thoughts on discipline: enforcing limits

After I wrote my thumbnail sketch of positive discipline (which I'm going to abbreviate to PD, for ease - that's how it's generally referred to on the list I'm on), my sister followed up with a comment on the next post that raised a couple of excellent points - namely, that there is a place in discipline both for teaching specific behaviours (such as saying please and thank you) and for setting firm limits.  I completely agree with both of those, so I'm glad she raised the points.  (Do please keep any other queries coming, folks - I was trying to write a summary of how the PD approach differs from other approaches, not a complete explanation of everything in the theory, so there are inevitably some big gaps and some yes-but-what-abouts.)

PD is often mistaken for a philosophy of letting kids do just what they want, but, in fact, normally PD advocates absolutely do agree with setting firm limits where appropriate.  (They may well set fewer limits simply because of a don't-sweat-the-small-stuff approach - sometimes we get worked up about a particular behaviour because society expects us to/we feel we should rather than because it's actually causing any harm, and PD encourages parents to think more flexibly about these sorts of issues - but the basic principle of settling limits where it is appropriate remains the same.)  There's even a name for this - GOYB parenting, which stands for 'Get Off Your Butt' (and go and actually move the child away from whatever they're not supposed to be doing).  The difference between PD and other forms of parenting lies in how you approach the situation after that.

So, for example, let's say one of your children launches into a fists-flying attack on another.  I think everyone other than utterly neglectful or ineffectual parents can agree on what the immediate response needs to be to that: grab that child, pull him or her off the other one, and physically restrain him/her if necessary to stop the hitting.  The question is - what do you do after that?  (If you're the kind of exhausted drained wiped-out just-getting-through-the-day-please-god parent I was in my children's early years, the answer is admittedly "Tell them to stop doing that and then let it drop", but I'm talking parenting philosophies here.)

Traditional advice would be to smack the offender, to give them the message that they need to avoid that behaviour in future.  More modern parenting experts point out the illogicality of hitting a child to teach them not to hit, and advise time-out instead - if this is a recurring problem, one of today's experts might also advise a reward scheme with some sort of goody given out for periods of time spent 'playing nicely' together (this is, indeed, the first example given in the chapter on rewards in the Webster-Stratton book.)  But the PD approach would be to take this as an opportunity to guide the child through developing the skills needed to handle this situation better.

For example, you could start by acknowledging the child's feelings at the same time as clarifying the limit - "Oh, my goodness, you're so angry with Jimmy, aren't you?  We don't hit people, even when we're angry - we need to find another way to sort this out."  You could help the child to calm down, if needed.  And then you could find out what set this off, and talk through better ways of handling the situation when it next comes up.

(Another prominent feature of PD, though not unique to it, is to look at what else may have been going on to predispose to that particular behaviour.  Is the real underlying problem here that your child is hungry/tired/bored/stressed out over life changes?  If so, that gives you things to work on to either improve the situation now or reduce the chances of the same thing happening in the future.)

You may well be wondering whether PD-practicing parents have to do this every single time we run into a discipline problem with our children, and of course we don't - life's too short, and you don't always have time to sit down and have this sort of conversation.  That's OK.  If the problem comes up again you can deal with it then, and if it doesn't then you don't have a problem anyway.  But, in general, you look to use these times as a chance to teach your child something about how to handle life, rather than as a challenge to your authority or as a surface behaviour to be squelched.

And, yes, I also agree that sometimes the skill you need to teach the child in a particular situation is a simple behaviour ("Say please") rather than a detailed consideration of complex moral issues/social mores.

Discipline and rewards: Addendum

I meant to clarify in the last post that I'm not flat-out against ever using rewards (although I know of some purists in the positive discipline camp who feel that way).  The big advantage rewards have, of course, is that they are useful in the short term when it comes to changing a particular behaviour; and, while in general parenting should be about taking the long view, the reality of life is that sometimes it's important to sort out a short-term problem.  Toilet training is the obvious example - it doesn't require our children to make complex moral choices and I think we'd all prefer it if they didn't develop a passionate interest in the subject, so, if sticker charts or the like give a child the motivation to get interested in developing this new habit, I say go for it.  So, rewards have their place as far as I'm concerned.  I just try to keep that place to a very minor one.

Thoughts on discipline: the problems with reward programmes

For a while now I've been thinking I really ought to write a post about my thoughts on discipline, but shying away from it because it's the kind of thing that can so easily turn into the kind of preachy this-is-how-you-should-do-it post that I hate.  However... the latest session of the Webster-Stratton course was on the topic of rewards, which is one on which I differ quite a bit from what they teach.  The one before that was on praise, on which I don't differ so much from what they say but do have some yes-buts coming largely from the whole rewards controversy.  I've been trying to write posts about those sessions that explain how and why I disagree with them, but, in the end, decided to start off by writing a separate post on the topic of how I see discipline and how I came to think about it in that way, in order to give the background on where I'm coming from on this.

Several years ago, I came across an author by the name of Alfie Kohn.  I came across bits and pieces of his on-line stuff here and there, and eventually ended up getting hold of a copy of his book Unconditional Parenting, analysing the way that society sees discipline and looking at problems with it.  It was fascinating - eye-opening, thought-provoking, paradigm-shifting.  This is not an attempt to give a detailed review or an endorsement of every single point he makes, but a quick summary of the points that most struck me about it.

Discipline systems, Kohn points out, are traditionally constructed around getting children to act in the way we think they should act by means of punishments for acting differently and/or rewards for acting in ways considered acceptable.  Newer systems pride themselves on being less harsh with the punishments (none of that nasty old spanking - time out, that's the way to go!) or more weighted towards the rewards (praise and stickers for good behaviour - so much better than just punishing bad behaviour!), but these changes are just tweaking of the basic concept of using incentives to get children to act in a particular way.  And, if you look at short-term behaviour as your outcome, these are indeed effective ways of doing things - punishments do work well in persuading people to avoid a particular behaviour (or at least to avoid getting caught doing it), and rewards work even better in terms of getting the behaviour we want.

But how does this fit in with what we want for our children long-term?  Surely what we actually want is to raise our children to have moral values and an internal moral compass and to think for themselves about the information and the problems that life presents to them?  How does that fit with the mechanistic, short-term, what's-in-it-for-me focus of punishment and reward systems?  Is this teaching our children the skills they should have to best get through life?

Kohn (in that book and another of his that I've read, Punished By Rewards) cites a stack of studies that raise concerns over the longer-term effects not just of punishment-based systems, but over reward-based systems.  There is, apparently, considerable evidence that rewarding people for doing something is likely to decrease their overall intrinsic interest in doing that thing - rewards, it seems, just give people the message that the task in question is something that's unrewarding enough in itself to need an external incentive for anyone to want to do it.  So that has worrying implications for all those 'stickers for books read' type of programmes that schools love - while they certainly get children to read more books, they do so by giving children the message that books aren't really that enjoyable for their own sake.  There is also evidence that rewarding people for performance can actually harm performance - it can make people less creative, less willing to take risks, as they learn to focus on what will be most likely to earn them the reward rather than on the satisfaction of completing the task as well as possible for its own sake.  And, most worryingly, there are apparently a number of studies showing that rewarding moral behaviour may make people less likely to make moral choices in the future.  Rewards give the message that doing nice things is something you do for a reward, not for the satisfaction of knowing you've made someone else happy.

How good the research on that last is, I don't know; most of it I haven't read myself, and quantity of studies isn't necessarily an indicator of quality.  Long-term moral development is far harder to measure than short-term interest in a task, so there are no doubt plenty of weaknesses that studies in that area might have.  However, Kohn's description of the research, plus the basic question "Do I really want to teach my children that the main reason to act a particular way is because there's something in it for them?" was still enough to be a turning point for me in the whole way I thought about discipline.

Kohn is great on the explanations of why our usual approach is wrong, but less good on the practical nitty-gritty of how, in that case, we should go about managing day-to-day parenting issues.  Some of that gap was filled, for me, by Faber and Mazlish's unutterably superb if-you're-going-to-buy-just-one-parenting-book-make-it-this-one How To Talk So Kids Can Listen And Listen So Kids Can Talk and their other books.  I also came across posts on the Internet from parents trying a new style of discipline that's referred to as either 'positive discipline' or 'gentle discipline', although I don't think either of those names really sums up how that approach is different from the reward/punishment based approach - still, if you're looking for more on that style of discipline, those are the names you'll find it under. 

Finally, searching Yahoo Groups to find a group of parents I could join after the newsgroups I'd been part of for the early years of my parenting crumbled under the weight of the spambots, I stumbled on the Positive Parenting Discipline group, and have been there ever since, soaking up their tips and advice.  Not only is this a big help in practical terms, but it's helped me formulate the philosophy behind this new type of discipline in terms of what it's about, not just what it isn't about.  I should say that this isn't any sort of Official Statement On Behalf Of The Positive Discipline Movement, or anything - I don't claim to speak for everyone who tries to follow this style of discipline, but this is how I see it and how I would put it.

Positive discipline, gentle discipline, non-punitive discipline, or whatever you want to call this concept, is - for me - about teaching children the skills they will eventually need to manage their own discipline and their own lives as moral, independent-minded, compassionate adults.  There are a lot of ways in which we can do this (which, of course, is precisely why it took a long time and a lot of reading for me to be able to articulate this philosophy - this way of doing things just doesn't lend itself to easy parenting-programme-style soundbites like 'Praise everything they do right, ignore them when they don't, one minute of time-out for every year of the child's life as a back-up') and it's beyond the scope of this post to go into them, but that principle is what underlies them.

The other key principle that runs through this form of discipline is something that isn't unique to it - it often gets overlooked in discussions of conventional discipline, but plenty of the parenting experts who work from a reward-and-punishment paradigm still recognise the importance of this one (hence, for example, the Webster-Stratton course starting with three whole sessions on play and communicating with your child).  This principle is connection - maintaining and strengthening the powerful connection to your child that means that, ultimately, parenting isn't just the battle of wills that it could often be mistaken for on reading some of the parenting books on the market, but is also a loving relationship between two people who are (however easy it may be to lose sight of this in the middle of heated battles about bedtime) actually very well motivated to help and support and co-operate with each other.

For an example of how all this works in practice, see this post that I wrote a few months back, on sorting out a sibling clash.  Now, imagine that I'd instead reacted to that same incident by telling the two of them they could have a sticker/treat/sweet if they stopped fighting.  In the case of my two I don't think that would even have worked - neither would have had enough self-control, in the heat of the moment, to calm down for the promise of a goody.  But, even if it did, what would it have done about helping them with the skills of negotiation and compromise that were actually what they needed there?  When I helped them with those skills, we got somewhere.

So, that's a quick outline of how I approach discipline and why.  Feel free to come back twenty years later and see how well it worked out for us all.

Accentuate the negative, eliminate the positive? The problems with Wiessinger's 'Watch Your Language'

Fifteen years ago, Diane Wiessinger, a breastfeeding counsellor and activist, wrote an article about breastfeeding promotion for the Journal of Human Lactation, entitled 'Watch Your Language'.  In it, she claimed to have the answer to the thorny question of why lactation consultants and the health care profession have such poor results when it comes to persuading women in the US to breastfeed.  I find this article, and the huge following it has received, to be of great concern; not only do I see no evidence for her theory, but I see a number of reasons to believe it is likely to do the cause of breastfeeding promotion far more harm than good.

Wiessinger's key premise is that, when we talk about the benefits of breastfeeding, we have it backwards.  Instead, we should talk as though breastfeeding is the norm, and frame all our discussions of the differences between the two in terms of drawbacks and harms of formula-feeding.  And we shouldn't mince words while doing so.  In Wiessinger's opinion, we should be trying to catch our flies with vinegar rather than honey, and particularly bitter vinegar at that.  For example, Wiessinger advocates telling women that 'artificial feeding results in an abnormal and unpleasant odor that reflects problems in an infant's gut', and describes formula-feeding as 'deficient, incomplete, and inferior'.  'Those are difficult words,' Wiessinger writes, 'but they have an appropriate place in our vocabulary.' 

Of course they do; however, that place is not in the speech of those wishing to describe the behaviour of those whose hearts and minds they wish to win over.

I've had a hard time writing this post, simply because I genuinely haven't known where to start - there are just so many things wrong with the article.  But I've also known that this post needs to be written.  Wiessinger's claims are hugely influential in the world of breastfeeding activism.  Google that title and Wiessinger's name, and you'll find her original article posted in its entirety in multiple places on the Net.  Lactivist website after lactivist website tells us that we should refer to breastfeeding as the norm and talk about the harms of formula-feeding instead of the benefits of breastfeeding.  I've even seen one blog describe the approach of talking about the benefits of breastfeeding as 'anti-breastfeeding'.  I think that a post pointing out the fundamental problems with this approach is long overdue and very necessary.  So, here are the many reasons why I disagree with what Wiessinger has to say.

It's counter to the evidence.  One of the principles on which behavioural psychology is extremely clear is that, if you want to change people's behaviour, the carrot is mightier than the stick.  Research in this field established decades ago that potential benefits are much better motivators for change than potential avoidance of harm.  This really is the kind of thing that gets taught in introductory psychology classes.  Which, of course, is why you don't see advertising campaigns framed around the idea that the reason you should buy product X will enable you to avoid the harms caused by going for an alternative - they're framed around the many benefits product X can offer you over the alternatives.  

Oddly enough, Wiessinger herself touches on this when she writes that the phrasing of lactation consultants pushing breastfeeding 'could just as easily have come from a commercial baby milk pamphlet'... and then comes to the rather bizarre conclusion that '[w]hen our phrasing and that of the baby milk industry are interchangeable, one of us is going about it wrong'.  Logically, if two groups of people are going about something the same way, they're either both right or both wrong.  If companies with millions to spend on employing the best advertisers are taking the approach of advertising their product's benefits, shouldn't we be considering the likelihood that they're doing this because they know it to be the most effective way of convincing people?

Yet Wiessinger shows an astonishing disregard for what the evidence in psychological research has to say.  And, given that she gives nothing to back up her opinions on this point, isn't the most likely conclusion that the psychologists all have it right and Wiessinger has it wrong?

Most people aren't that masochistic.  People generally just aren't that keen to listen to criticism.  Think for a minute about how Wiessinger's words might sound to a woman who's happily formula-fed her first child and is now expecting another.  Talk to her about the benefits of breastfeeding, and maybe she'll be open to listening and perhaps having a shot at another way of doing things.  Tell her how deficient, incomplete, and inferior her way of feeding her first child was - letting her know, while you're at it, that you think her precious adorable first baby actually stank - and something tells me that she's not going to be all that thrilled about listening to anything else you have to say.   Harshness only alienates those whom we're hoping to reach.

Of course, I'm guessing (and hoping) that most advocates of Wiessinger's approach would have enough tact to temper their words in that kind of face-to-face situation.  But the words and actions of one part of a movement reflect on the whole, especially when the words come from those speaking on behalf of the breastfeeding movement.  If the voice of breastfeeding advocacy is telling women how awful formula-feeding is, a lot of women are going to expect - and fear - the same thing from individual breastfeeding counsellors.  And that's going to put off that woman who's formula-fed a previous child or children, or the woman who's currently struggling to breastfeed but has found herself giving a few bottles of formula to get through the difficulties and is scared of what reaction she might get if she tries asking a breastfeeding counsellor for help (and, anecdotally, I've read stories from women who were put off asking for help with breastfeeding for precisely this reason), or even the woman with no previous experience who might have been willing to give breastfeeding a go but is too scared of how she might get harangued if it doesn't work out.  Adopting Wiessinger's attitude to formula will make us look horribly unapproachable to a large segment of the women we most want to have approach us.

It fails to connect with people.  When Wiessinger talks about breastfeeding being the biological norm, she ignores the fact that, for many women, it isn't the social norm.  Talking to these women as if breastfeeding was the norm isn't starting where they are.   When you start by ignoring someone's own reality and life experiences in favour of focusing on where you want them to be, or think they really ought to be, you're setting your advocacy attempt up for failure.  If you're not starting where they are, you're making it far harder to form the connection you need to form with them in order for advocacy to be effective.

The stress it causes may be counterproductive.  This is actually a point that hadn't occurred to me, but that another blogger pointed out when we were discussing this online once.  She felt that Wiessinger's approach would have been more stressful to her when trying to get lactation established, and that that stress itself might have done more harm than good by interfering with her milk production.  It's a fair point - we do know that stress can affect milk production.  While there's no way to eliminate all stress from breastfeeding initiation in all cases, we can at least do our best to avoid making matters worse by not making women who need to give some formula while getting breastfeeding going feel attacked for doing so.

It encourages an all-or-nothing attitude.  And this can also be counterproductive, by putting off women who might be willing to consider short-term feeding or mixed feeding or even breastfeeding with the occasional bottle given now and again, but who just can't see themselves wanting to aim for the current gold standard of 'breastfeed for at least a year with nothing but breastfeeding for at least six months'.  How often do you hear 'Because I wanted someone else to be able to give a bottle sometimes when I went out' given by a mother as a reason for her choice not to breastfeed?  How many more of these women might actually end up giving breastfeeding a try if they knew that it is perfectly possible to breastfeed and yet have somebody else give your baby a bottle when you go out?  Or that, if full breastfeeding is not an option, mixed feeding carries most of the same benefits as breastfeeding and is still worth considering?  It's easy enough to introduce those ideas in a context of discussing the benefits of breastfeeding.  But how do we reconcile descriptions of formula as harmful and risky with the explanation that, in fact, it doesn't appear to be a problem (despite some lactivist claims) to give a bottle of it to a fully breastfed baby now and again?  We probably don't, is the answer - and that means yet another group of women we've barred ourselves from reaching.

So, with all these problems, why has Wiessinger's approach been so popular?

When I told my husband about the article, he nodded gravely and commented 'Some people just aren't happy unless they're being unkind to other people.'  Sadly, I think there's some truth to that - there's a nasty little satisfaction that comes from believing you've got a really good excuse to say unpleasant things to people, and I think that, on that subconscious level we don't like to admit to, that may be part of the attraction for at least some of the people who espouse this philosophy.  However, I really don't think that's the whole story, and my guess would be that most of the people who believe this actually have much kinder motivations. 

I think that a bigger reason is that, when you're faced with a thorny and seemingly insoluble problem and someone who gives every indication of knowing what they're talking about comes along and tells you, in authoritative tones, that XYZ is the answer, it's pretty natural to believe them - especially when some of what they say is demonstrably true.  And, of course, Wiessinger makes a few good points in amongst the frighteningly bad ones.  Promoting breastfeeding by talking in the kind of fluffy superlatives better suited to cloud-cuckoo land isn't that great a way of reaching women, either, and it's easy for Wiessinger to convince people that the issue with that approach is the positive framing.  It's true that making breastfeeding sound like something special makes it feel out of many women's reach. (Although, oddly, by the end of the article Wiessinger seems to be taking the same approach herself.  Apparently, we should be advising women that they shouldn't merely breastfeed, but 'mother at the breast' and form a 'breastfeeding relationship'.  But, hey, no pressure to make it Really Special.)

But the use of positive language isn't the problem with the 'best possible start in life, special bond of breastfeeding, blah blah' approach.  The problem is partly that that way of describing is too overblown to be taken seriously (most people, quite rightly, are just not going to be convinced by the implication that the most important choice you can possibly make to get your children well launched into a fruitful life is that of how to feed them at the beginning of it), and partly that it doesn't connect with people any more than Wiessinger does.  The hypothetical lactation consultant Wiessinger quotes isn't finding out where each individual woman is and dealing with her particular concerns and beliefs.  She isn't giving women information about the differences between breast and bottle in any sort of practical, easily comprehensible way that can be used as a foundation for sound decision-making.  She isn't having a genuine discussion.  She isn't starting from where women are.  She isn't connecting.  And the answer to those flaws is not to adopt an approach that keeps those flaws and combines them with several more.  The answer is to put right those flaws.

I've already written about what I'd like to see in breastfeeding promotion.  Wiessinger's article is a prime example of what I don't want to see in breastfeeding promotion.  Let's please, please, please, forever put to bed the attitude that unpleasantness and scare tactics are the most effective ways of persuading anybody to do anything.  Let's go, instead, for an approach that's actually likely to work.

Breastfeeding for longer than a year - myths, facts, and what the research really shows

Welcome to the April Carnival of Breastfeeding!  For this month, the organisers have picked a delightfully controversial topic - extended breastfeeding.  It's one on which I have plenty to say.

Extended breastfeeding is the term given, in our society, to breastfeeding a child beyond the first year.  An increasing number of women are choosing to do this, and, sadly, are more often than not incurring heated disapproval for doing so. Breastfeeding toddlers or older children is believed to make them overly dependent, mothers who do so are accused of thinking only of their own needs and not of their children (that ultimate indictment for mothers), and the practice is looked on as inappropriate and downright perverse.

Fortunately, it's now being increasingly recognised that this position is not supported by either logic or evidence.  Not only is there not a shred of evidence that breastfeeding beyond a year is harmful, there is positive evidence to reassure us on this score - the world is full of societies in which it is considered normal and expected behaviour to continue breastfeeding for considerably longer than a year, and the children raised thusly seem to be doing perfectly well on the practice.  It is, of course, hugely beneficial for children in developing countries where food can be scarce and malnutrition rife, and it has some potential benefits even in our affluent society - it can be a valuable source of nutrition for otherwise faddy toddlers, and it slightly reduces a mother's risk of breast cancer or rheumatoid arthritis.

I'm delighted to see it becoming more widely recognised that there is absolutely no reason why a mother should feel obliged to wean simply because an arbitrary date on the calendar is approaching.  However, there's a twist to this; the pressure is starting to go the other way.  A small but vocal minority are pushing for breastfeeding past a year to be seen not merely as an option for women who want to do so, but as a goal for everyone to aim for.  Breastfeeding a toddler (or older child) is enthusiastically touted as having a host of physical and psychological benefits.  Lactivists are advising mothers that they should do their best to continue nursing until two years at the very least, and preferably longer (nursing until the child decides spontaneously to stop is held up as the ideal).  And the problem is that there really isn't any decent evidence to support this attempted move towards yet another blanket parenting 'should'. 

I'm not objecting, here, to an individual woman deciding that there may be particular circumstances in her child's case - deprived circumstances, an unusual health problem, or even just food faddiness - that might lead to her wanting to continue to breastfeed in hopes that it will be of some benefit.  Also, of course, I'm talking specifically about the situation in the developed world here, not about breastfeeding in developing countries where it is indeed likely to remain beneficial for long past infancy.  My objection is to the claims that extended breastfeeding has been shown to be of general benefit even in situations where other sources of nutrition are plentiful.  It hasn't.  And while this kind of pro-extended-breastfeeding advocacy has been a huge comfort to plenty of women who, having struggled with the pressure from others to wean before they wish to, now feel vindicated, it's also putting some women in the position of feeling obliged to nurse for longer than they really want to, in the belief that they'll be somehow depriving or disadvantaging their children if they don't.  That is not a trend I want to see.

That position, of course, is controversial enough in lactivist circles that it'll need some defending; to break up what's now set to be a very long post, I'm going to go for the 'Debate With Imaginary Opponent' format.

What do you mean, there's no evidence that nursing past a year is beneficial?  Are you trying to claim that a fluid so packed with nutrition, antibodies, and general goodness somehow magically loses all its benefits just because a child has passed the age of one?

Of course not.  What happens is that the child gradually grows, develops and reaches the point where breast milk just doesn't have anything much further to add.  (Just to clarify, in case anyone was forgetting how I began this post, I'm fine with children continuing to nurse after that point if they and their mothers so wish.   All I'm objecting to is the claim that they should continue to nurse, which I don't agree with any more than the claim that they should stop.)

But there's plenty of evidence that breasfeeding is beneficial to toddlers.  For starters, one study by Gulick (1) showed that breastfed toddlers between 16 and 30 months old get sick less often than non-breastfed toddlers and get better more quickly when they do...

No, it didn't.

Huh?

It didn't.  Although lactivist websites all over the Internet claim that that study shows a decreased rate of infections in breastfed toddlers between 16 and 30 months old, it actually shows nothing of the sort.  I know this because I've got hold of a copy of the study and read it for myself.  The toddlers being studied weren't breastfed toddlers - they were toddlers who'd been breastfed in the past but had stopped breastfeeding before entering the study.  What the study was actually looking at was whether longer duration of breastfeeding during infancy had any benefit in terms of reducing infection rates in toddlerhood after breastfeeding cessation.  (It didn't, in case you're interested; at least, not in that study.)  Somehow, someone has managed to utterly and crashingly misreport what the study was into and what it showed, and lactivists across the Internet have simply repeated this misinformation without question.  It's one of the biggest breastfeeding myths I've seen out there.

Well, come on - what about the other studies on the topic?  Look - Kellymom has a whole list of studies showing the immunological benefits to breastfed toddlers!

One of those is a study set in a developing country, showing benefit to children who are severely malnourished children.  As I said, breastfeeding can indeed be beneficial past infancy in such a setting, but it just isn't valid to assume that those results will be applicable to children living in our relatively privileged Western settings.  One wasn't even studying toddlers - it was a study of breastfeeding benefits in babies up to the age of 20 weeks, which is not toddlerhood by any remote stretch of the imagination.  The rest, as far as I can see, all just look at concentrations of antibodies in breastmilk of mothers of nursing toddlers, not at whether those antibodies are actually adding anything to the toddler's own antibodies when it comes to fighting off infections. 

Oh, come on.  Surely all those antibodies have to be doing something.

Not necessarily.  Bear in mind that a child's own immune system also develops rapidly during the early years, and at some point it's going to reach the stage where breast milk just doesn't have a lot else to contribute.

That surely can't be as early as a year, though.  I can't believe that breastmilk doesn't still have some benefit to children older than that.

You're welcome to believe what you like.  It's the claim that it's been proved to be beneficial that I'm objecting to.

So have you any evidence that it isn't?

In the one study I have been able to find on infection rates in breastfed vs. non-breastfed toddlers - a study in New Zealand that followed over a thousand children up to the age of two, looking at respiratory and gastrointestinal infections - breastfeeding didn't show any benefit in toddlers, or for that matter, in older babies (2).  Of course, there are flaws in every study, and I can think of several possible reasons why this one might have underestimated results enough to miss a small but genuine benefit, but it does seem to me that, if that's the case, we can't be talking about that great a benefit.  And, frankly, when the one study we have on the subject shows a complete lack of any benefit, I don't really think that the people claiming evidence of benefit are on solid ground.

But, what about the other benefits for breastfed toddlers?  Just look at the way that it helps an upset or tantrumming toddler to calm down.

I agree that that can be a wonderful convenience of breastfeeding.  However - and feel free to take this or leave it as you like, because we are temporarily stepping out of the realm of objective scientific evidence and into that of my own opinion - I do have my doubts as to whether it's a good idea to do so.  After all, what message does it send children when we regularly and repeatedly teach them to turn to a sweet-tasting food source at times when they need comfort?  I wouldn't use any other form of food or drink to distract my child from a tantrum, because that's not the message I want to be giving to my children about how food should be used; it's not encouraging healthy eating habits.  Why should I make an exception for breastfeeding?  I tried to avoid doing so, for both my children.  Just because something is the most convenient way to calm an upset child doesn't mean it's necessarily the best way in the long term.

But it has psychological benefits over and beyond just calming tantrums.  Breastfeeding for longer actually helps children become more independent!

No evidence for that claim.

Look, Jack Newman says so!  And Elizabeth Baldwin!

And they're entitled to their opinion on the matter.  However, I don't see any reason why I should automatically believe it, any more than I should automatically believe the equally unreferenced opinions of the doctors who claim that longer breastfeeding makes children more dependent.  Either way, they're opinions, which are not the same thing as evidence.

 But there is evidence!  Check out this quote on Kellymom's site - 'One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children' (3).  Or are you trying to claim that that study's being misrepresented as well?

Oh, not with the kind of spectacular degree of inaccuracy as the study by Gulick we discussed above.  However, that quote makes the results sound far more impressive than they were.  We're not told that the differences found were very small, that they showed up in only one of the several measures of psychosocial adjustment that were tested, that adjusting for other factors eliminated practically all the difference found in the teachers' ratings, or that the researchers themselves were pretty unimpressed by their results.  To quote from their conclusion: 'In general the evidence above gives only very weak support for the view that breastfeeding makes a significant contribution to later social adjustment.  The research findings tend to be both inconsistent over time and between measurement sources and at best suggest a very small association between breastfeeding and subsequent social adjustment.  Further it is more than likely that even the small and inconsistent associations that have been reported could have arisen from factors which have not been controlled in the analysis.'  As evidence goes, I have to say that that doesn't really strike me as compelling enough to justify trying to persuade women to continue breastfeeding if they don't want to.

So what about all the other studies listed on Kellymom?  Showing that breastfed toddlers suffer from fewer allergies and have higher IQs?

I've checked all five of the papers she lists as supposedly backing up her claim about reduced allergies in breastfed toddlers (full text of four of them, the abstract of the other), and none of them are about toddlers.  They're all looking at breastfeeding in infancy.  In fact, one of them (a review rather than a study) actually mentions in passing that the existing research shows 'some suggestions' that longer breastfeeding may be related to an increase in allergy risk.

When it came to the studies on breastfeeding and intelligence, after a while I simply gave up.  The only study I did manage to find that looked at breastfeeding over a year didn't find any substantial difference in intelligence or school performance between children breastfed for that length of time and children who stopped shortly before that - longer duration of breastfeeding was initially associated with a slight increase in intelligence level, but then the effect leveled out.  (That one's not available on line, but you might be interested in checking out this one by Mortensen et al that Kellymom also links to, which also studied the association between intelligence and breastfeeding duration and reached a similar conclusion - initially the increased duration of breastfeeding was associated with slight improvement on the intelligence scales, but the effect then levelled off, with children breastfed for longer than nine months having scores no better than those breastfed for 7 - 9 months.) 

I checked several other studies on her list which, again, all turned out to be follow-ups on breastfed babies, not children breastfed past a year.  So, as I say, I gave up.  Checking all the studies she lists would have taken forever and I'm afraid there are limits to the amount of time and effort even I can put in to checking references from someone who's clearly such an unreliable source of information.  (And, before anyone gets offended at me dissing Kellymom, I do actually think she's a great source of information when it comes to dealing with breastfeeding problems; I've just found her to be appallingly bad at giving accurate information on any research dealing with any question in the general category of 'Is it possible that breastfeeding in circumstance X is anything less than incredibly beneficial?')

So, for all you know, there might be studies on her list that do show benefits of toddler breastfeeding and you just haven't seen them?

Well, if you find any, by all means let me know.  I mean that - I'd be interested to read them and happy to spread the word about them.  But, until I actually see a decent-quality study providing good evidence that breastfeeding past a year is actively beneficial for children, I'm not going to tell women it is.  And, given how many studies are being erroneously cited as showing benefits of toddler breastfeeding when they show nothing of the sort - frankly, I think my scepticism about the existence of any studies that do show benefits is completely excusable.

Well, I don't care!  I love breastfeeding my older child and I want to carry on whether or not you've found any studies proving that it's beneficial!  We're both enjoying it, and that's benefit enough!

EXACTLY!  And that's the ONLY reason you need.  You don't need to prove that it's in some way superior to what all the other mothers are doing.  You don't need to score Good Motherhood points on some imaginary scale to justify your choice to others.  You just need the confidence to believe that it's OK and that it's what works for you.  Enjoy nursing your toddler or older child, accept that mothers who have made a different choice from you are doing just as well by their child and shouldn't be conned into nursing for longer than they want to, and support every mother in the choice she makes on the matter, in the knowledge that, as far as we can see from the available evidence, nursing or not nursing a child of that age are equally good options to go for and thus we can happily leave this one in the realm of personal preference where it belongs.

 

References

1. Gulick E. The Effects of Breastfeeding on Toddler Health.  Pediatric Nursing 1986; 12(1): 51 - 4. 

2. Fergusson D.M., Horwood L.J., Shannon F.T., and Taylor B.  Breast-feeding, gastrointestinal and lower respiratory illness in the first two years.  Australian Paediatric Journal 1981; 17: 191 - 5.

3. Fergusson D.M., Horwood L.J., and Shannon F.T.  Breastfeeding and subsequent social adjustment in six- to eight-year-old children.  Journal of Child Psychology and Psychiatry 1987; 28(3): 378 - 86.

 

Do come and check out the other links in the Carnival!

Mamapoeki from Authentic Parenting: Extended Breastfeeding?

Mama Alvina of Ahava & Amara Life Foundation: Breastfeeding Journey Continues

Elita @ Blacktating: The Last Time That Never Was

Diana Cassar-Uhl, IBCLC: Old enough to ask for it

Karianna @ Caffeinated Catholic Mama: A Song for Mama’s Milk

Judy @ Mommy News Blog: My Favorite Moments

Tamara Reese @ Kveller: Extended Breastfeeding

Jenny @ Chronicles of a Nursing Mom: The Highs and Lows of Nursing a Toddler

Christina @ MFOM: Natural-Term Breastfeeding

Rebekah @ Momma’s Angel: My Sleep Breakthrough

Suzi @ Attachedattheboob: Why I love nursing a toddler

Claire @ The Adventures of Lactating Girl: My Hopes for Tandem Nursing

Elisa @ blissfulE: counter cultural: extended breastfeeding

Momma Jorje: Extended Breastfeeding, So Far!

Stephanie Precourt from Adventures in Babywearing: “Continued Breastfeeding”: straight from the mouths of babes

The Accidental Natural Mama: Nurse on, Mama

Sarah @ Reproductive Rites: Gratitude for extended breastfeeding

Nikki @ On Becoming Mommy: The Little Things

Dr. Sarah @ Good Enough Mum: Breastfeeding for longer than a year: myths, facts and what the research really shows

Amy @ WIC City: (Extended) Breastfeeding as Mothering

The Artsy Mama: Why Nurse a Toddler?

Christina @ The Milk Mama: The best thing about breastfeeding

TopHot @ the bee in your bonnet: From the Mouths of Babes

Beth @ Bethstedman.com: Extended Breastfeeding: To Wean Or Not To Wean

Callista @ Callista’s Ramblings:  Pressure To Stop Breastfeeding

Amanda @ Postilius: Nursing My Toddler Keeps My Baby Close

Sheryl @ Little Snowflakes: Tandem Nursing- The Good, The Bad and The Ugly

Zoie @ Touchstone Z: Breastfeeding Flavors

Lauren @ Hobo Mama: Same old, same old: Extended breastfeeding

Tanya @ Motherwear Breastfeeding Blog: Six misconceptions about extended breastfeeding

Jona (Breastfeedingtwins.org): Breastfeeding older twins

Motherlove Herbal Company: Five reasons to love nursing a toddler

Things I Believe About Parenting, And Things I Do Not

The Writing Workshop theme for this week is 'Belief', with various open-ended questions thereof, including an invitation to talk about our beliefs on a non-religious subject if we so wish; such as, for example, parenting. I'm going for that one.  This is not so much an essay as a kind of laundry list of my opinions.  If you find any of them interesting and/or ridiculous enough to request further clarification, please do so; I shall, in theory at least though admittedly possibly not in actuality, be happy to write a further post on why I hold that particular belief/lack thereof.

Things I believe

I believe that the most important part of parenting is building a strong relationship of mutual respect and enjoyment with your children.  That's the best possible foundation both for teaching them the things you'll need to teach them, and for the rest of their lives.

I believe that discipline should, as much as possible (and it is not always possible), center around teaching conflict resolutions skills and the benefit of co-operation, within the kind of relationship described above, rather than centering around figuring out how to get your child to do what you tell them.  (This approach to discipline is generally referred to as either 'gentle discipline' or 'positive discipline', although I don't feel either sums it up very well for me - I generally think of it as 'collaborative discipline'.)

I believe that my job as a parent includes being sensitive to my children's feelings, and letting them know that experiencing those feelings is all right, including the negative ones.  It does not include a requirement to shield my children from anything that might cause them to experience such feelings.

I believe that most babies will thrive perfectly well on any non-abusive and non-neglectful method of baby-raising, as long as it's practiced with affection and enjoyment.  Some babies do do better on one method rather than another, but there is no consistency in which method such babies do better with.  So, regardless of whether the particular method that happens to float your boat is Gina Ford, William Sears, Tracy Hogg, Jean Liedloff, or Wing It As We Go, as long as it suits you, your baby and the rest of the family feel free to get on with it and to ignore anyone who tells you you'd be better off with a different method.  Just don't assume that your success with it gives you the right to assume that your child will turn out superior in some ways to children raised via a different method or to tell other random parents that they should use the same method if they're clearly equally happy with what they're doing.

I believe that breastfeeding has several health and convenience advantages, so is worth trying fairly hard to do if possible.  However, in a list of priorities including breastfeeding, your physical and mental health, and your enjoyment of your baby's babyhood, breastfeeding is at the bottom, so don't sacrifice any of the others for it. 

I believe that there are some risks with taking young babies (in the early months of life) into your bed.  If all safety precautions are carefully followed then they're exceedingly low and it's highly debatable whether it's worth worrying about them if the alternative is living through a nightmare of sleep deprivation (especially given that this carries its own risks for the baby), but they do appear to exist.  (And they're MUCH higher if safety precautions are not followed - so, if you're unable to do so for whatever reason, then it really is much better to try to find another way to manage the situation.)

 

Things I Do Not Believe

I don't believe that one bottle of formula, or even the occasional bottle of formula repeated over time, is likely to have anything particularly important in the way of adverse consequences for the vast majority of babies.   (Exceptions, in case you're interested, are babies with a strong family history of Type I diabetes or of severe - as in, life-threatening - food allergies.)

I don't believe that it matters more than minimally whether you introduce solids at four months or six (though six is definitely easier in practical terms).

I don't believe it makes any great difference whether you nurse your child for a year or five years.  I don't believe that nursing past infancy has either adverse or beneficial consequences, and think it should be considered entirely a matter of personal choice.

I don't believe that carrying your baby in a sling during as many as possible of your waking minutes needs to be on any parent's list of goals, or that it makes a difference to most babies over and above the many other ways of satisfying their needs for touch, affection, and general inclusion in your life.

I don't believe that sleep training causes mental or psychological damage or is a form of neglect.

I don't believe that sleep training is the only way of ever getting children to be good sleepers.

I don't believe that wanting sleep at night automatically makes you a selfish or neglectful parent.

I don't believe that there's either long-term problem or benefit with co-sleeping with an older baby or child if your family is happy that way.  I don't believe that it will make children over-dependent or that they'll never want to leave your bed, but nor do I believe that it's some sort of magic route to making your children extra confident and well-adjusted.  (I believe that the studies that have shown this to be the case have been confounded by the other differences likely to exist in parenting styles between families happy to bedshare and families who aren't.)

I don't believe that bedsharing protects babies against SIDS or that this should be put forward as a reason for advocating bedsharing.  (Since, as stated above, I believe bedsharing can increase the risk of SIDS in some cases, I'm very much against this particular claim.)

I don't believe that sensibly-applied time-outs indicate to a child that you are withdrawing your love from him or her.  (And, yes, in case you were wondering, there are actually people who do believe this.)

 

Things On Which The Jury Is Still Out

(PLEASE NOTE: All of these are issues on which I've seen some research/commentary that has made me form an initial opinion on the subject, but on which I am aware that I have not made a comprehensive enough study of the available research to be sure that I'm not missing some crucial evidence that would change my view.  Do be aware of this when deciding whether or not to take this as advice.)

I'm not sure how much evidence there actually is for continuing breastfeeding past six months (in the Western world, that is - there's no doubt it's beneficial if you're in a country where you can't count on proper food or uncontaminated water).  It seems from one study to reduce risks of gastroenteritis for older babies living in crowded/poor conditions, and there may be some fractional benefits for mental development, but there also seem to be several studies showing no benefit.  Of course, it's still likely to be a hell of a lot more convenient than formula, but if you're living in affluent conditions and absolutely hating the experience of breastfeeding your six-plus-month-old baby then I'm not sure that there's actually compelling evidence in favour of you continuing.

I think (based on a couple of studies I have seen indicating this) that breastfeeding during the night may present a risk of tooth decay as a child grows older.  Obviously this should not be applied to babies, who need to feed during the night if they aren't to risk going short of nutrition/fluid, but, if you are nursing an older child, it's worth night-weaning them.  And, yes, I am well aware that lactivists will hotly deny a possible risk to teeth from nursing and cite studies supporting their position.  Their studies relate to age of weaning (which I agree does not, in itself, appear to present a risk) and NOT to whether or not a child is breastfed at night during this age.  It's the night-time breastfeeding that may present a risk.

I doubt that smacking a child (smacking, not using the word as a euphemism for beating with objects and not taking the opportunity to add in a heavy helping of emotional manipulation) is mentally or psychologically harmful.  I don't do it, because I think it's not the most constructive way of going about approaching discipline (see second point under 'Things I Believe' above; but I remain unconvinced by a lot of what I've read about it, which doesn't appear to take all sorts of potential confounders into consideration.

 

So there you have it.  A mish-mash of the philosophical, the practical, and the sticking out of my neck on subjects on which I don't actually have sufficient knowledge to be making definitive pronouncements.  Pretty apt for a guiding creed of parenthood, when you think about it.

The Case Of The Lactivist Propaganda - A Reply To Ann Calandro

I do realise that I seem to be falling into a pattern lately of devoting this blog to replying to comments on the Fearless Formula Feeder's blog, but this one couldn't be allowed to pass, and the reply I wrote (even though it was shorter than the post I'm going to make here) was still too long to post as a comment, so... sorry about the déja-vu-all-over-again factor.  At least this time it's a reply to someone other than Alan.  Variety is the spice of life, and all that.

Anyway, the comment that Anonymous posted was a link to this infamous lactivist article, an essay by Ann Calandro entitled 'Even the Occasional Bottle of Formula Has Its Risks: The Case of the Virgin Gut'.  (Alternatively, for anyone who felt that title didn't do quite an effective enough job of instilling fear into the heart of any woman daring to think of sullying the purity of her breastfed baby's body with a one-off bottle of formula, I've also seen it posted under the title 'Yes! Just 'One' Bottle Of Formula Will Hurt', by someone who apparently doesn't quite grasp the appropriate use of the subjunctive.)  The article is packed with unnerving comments:

Since my baby had received lots in her stomach besides breast milk, her little gut was not virginal. What did this mean? Had the hospital nurses inadvertently done some kind of damage to her? Had I? What was going on inside my little girl?

But what happens when breast milk is not the only food in that little gut? The truth is very interesting and also very scary.

...destroying the characteristic intestinal flora of the breast-fed baby. [This one was a quote from a breastfeeding book.]

...there is very little that can be done to remedy the situation and save the virginal gut.

A huge increase in diarrheal diseases occurs in babies who do not have optimal "intestinal fortitude," which is only possible with guts that have never been exposed to infant formula.

Not to mention, of course, the story of the baby who had a few innocent-seeming bottles of formula and then developed a severe allergic reaction to cow's milk and was rushed into hospital and had stacks of medical tests and nearly DIIIIIIIEEEEED, all because of that scary formula.  If you can make it through that lot without being reduced to a quivering wreck at the prospect of your baby possibly ending up consuming some formula and being irrevocably damaged, you're a much more confident mother than I was in those scary first-time-around days.  It's thanks to that article, and others like it, that breastfeeding my first baby was turned from the pleasant and relaxing experience it should have been to a miserable, anxiety-ridden chore haunted by the fear of dire consequences if I fell down on the job the least little bit.

Which is terribly sad.  Because - surprise, surprise - despite Calandro's claim that there is 'much research to support avoiding supplementation if at all possible', the available evidence doesn't really seem to support her alarmist tone.

There's not much back-up, for example, for the claim that risks of diarrhoea are hugely increased.  A study in New Zealand in the late '70s comparing babies receieving various amounts of formula in their diet with exclusively breastfed babies (Fergusson et al, the Australian Paediatric Journal, 1978, vol 14(4), pages 254 - 8) found that giving some formula supplements to breastfed babies on an irregular basis carried slightly greater than a one in twenty chance of causing diarrhoea. Now, those were the figures unadjusted for possible confounders, so that will in fact be an overestimate – and it's still hardly the 'huge risk' claimed by Calandro. And that, of course, is more than thirty years ago, when sterilisation techniques were poorer than today. What do more recent figures look like? Well, a 1997 study available in Pediatrics looked at the infection rates in babies receieving different proportions of formula in their diets. Babies getting formula supplements up to around 10% of their total diet showed *no* increase in rates of diarrhoea over babies who were exclusively breastfed. Seems like all those babies were somehow managing to do just fine despite the defloration of their precious virgin guts. Maybe getting a bottle of formula now and again, despite what it might do to bacterial counts, is actually not such a big deal in terms of outcomes that actually matter?

As far as the risk of cow's milk allergy goes, a couple of studies have indeed shown a small risk of cow's milk allergy associated with early formula top-ups (in the one for which I have figures, the risk of developing some sort of later reaction to cow's milk as a result of having had some in the hospital was around one in forty), but the research is actually quite conflicting – another study showed negligible effect, and a randomised controlled trial actually showed a marked decrease in risks of milk allergy in babies with a strong family history of allergy who received formula before having any breast milk. So that one is a possible risk, but far from conclusive.  As for other forms of allergic disease, again, two studies into the effects of early cow's milk exposure haven't shown any increase in later risk of allergies.

The increase in risk of developing Type 1 (insulin-dependent) diabetes does seem to be backed up by better evidence, but needs to be kept in perspective – this is effectively only going to be an issue for children who are genetically predisposed to develop Type 1 diabetes in the first place. In other words, only a tiny minority. If your baby has a close family relative with Type 1 diabetes, it's probably worth trying to avoid any formula in the early months. If not, then this one is a negligible enough risk not to be worth bothering about.

It's fair to say that the available evidence, despite what Calandro and her ilk claim, is in fact fairly limited, and can't currently exclude a small chance that there might be risks associated with even the occasional bottle.  If so, they certainly don't appear to be wildly significant in practical terms, and neither the evidence for them nor the likely magnitude of them justify the kind of scaremongering Calandro is indulging in. If the only reason you're giving a bottle is to get your baby used to one, then I think it's probably worth trying to pump a couple of ounces of milk for that, if possible, rather than giving formula, and I would have liked to see FFF mentioning this possibility in her post. But, for those parents who've already given or need to give their breastfed babies some formula now and again, do I think that these uncertain and largely theoretical risks are worth getting worried about? Hell, no.

Breastfeeding, formula-feeding, demonising, and choice

In recent months I've been following the Fearless Formula Feeder blog, a blog that... actually, I was trying to think how to summarise what it's all about in a quick phrase or two, but in fact since the main point of this post is to (hopefully) clarify the blog's philosophy I'll skip the summary.  If you're interested, do check it out, and with an open mind.  Anyway, in the past few weeks a lactivist by the name of Alan has started some debates in the comment threads which have run into a number of posts, and things have been getting pretty heated, though with an overall civility which is impressive to anyone as used to internet debate as I am.  Inevitably a lot of different and overlapping points are getting debated, and, if I get the chance, there are a few I plan to jump in on myself.  But what I want to write about in this post is this particular comment of Alan's.

In response to this comment from Brooke, a reader defending the site, Alan wrote: 

@Brooke: Thank you for your post, because it shows clearly that despite the disavowals of some here, at least one of you (and I'm thinking quite a few more than one) *is* pushing an agenda of promoting formula feeding for people struggling with breastfeeding (the same potential "converts" the formula companies are after). So if there are people on the fence, not sure what to do, and you are whispering sweet nothings in their ears about how formula's been unfairly demonised, it's not so bad, they ought to just try it, it may be the solution to all their problems...well, I want to be there giving another perspective.

Firstly, a few words about the issue of whether formula has been 'unfairly demonised' and is 'not so bad'.  You've indicated elsewhere in your comments that you feel this attitude has been proved wrong by the medical evidence showing breastfeeding to be better than formula feeding.  You know what?  Both those beliefs are correct.  There is indeed solid evidence that breastfeeding reduces the risk of a variety of short- and long-term illnesses and problems - but I've also seen plenty of lactivist scare stories and hype that claim benefits that aren't actually backed up by evidence and/or go way beyond what the impartial evidence supports in the way they present formula.  There is no contradiction in believing that Y is genuinely worse than X but that propaganda has exaggerated the differences between the two.

And now the main point I wanted to address: the accusation that some of the people on the site are 'pushing an agenda of promoting formula feeding'.  This was in direct response to a comment that clearly stated 'No one here is trying to make anyone formula feed, just question the dogma that pervades certain parts of our society.'  Why was Brooke nevertheless accused of pushing an agenda of promoting formula feeding?  Because, it seems, she wants women to feel able to try formula if they feel that something is going wrong with breastfeeding.  This, as far as I can see, is what you classify as 'promoting formula feeding'.

Here (at the risk of sending this off on a massive detour into a completely unrelated and even more heated debate) is what that attitude reminds me of: the arguments about the pro-choice position on abortion rights that always crop up in the abortion debate. 

I am a pro-choicer: this means that I believe that all women should have the right and the opportunity to choose whether or not they want to continue their own pregnancies.  Back when I used to discuss such matters on debate boards, I would regularly see pro-lifers accuse pro-choicers of being 'pro-abortion' or imply/state that we were trying to push women into abortions.  And, over and over again, we would try to explain that, no, that is not what the pro-choice position is meant to be about.  It is meant to be about the belief that women should be allowed to make informed, unpressurised choices about whether or not to continue their own pregnancies.  I believe that abortion should be available for women who choose it, and that women shouldn't have barriers thrown in their way if they seek abortion.  Those potential barriers include exaggerated or incorrect information about potential risks of abortion, and a stigma of shame and guilt attached to it.  I want to get rid of those barriers, and I want a society where a woman who is unhappy with being pregnant can explore her options and can choose abortion if she genuinely feels this to be the right option for her.

And that is not at all the same thing as being 'pro-abortion' or promoting abortion.  What I'm promoting is informed choice.  My beliefs do not mean that I would ever tell a woman that she should consider abortion or try to push her towards that solution.  In fact, I would be flat-out against doing any such thing, because that would be just as anti-choice as trying to push a woman into continuing an unwanted pregnancy against her wishes.  Not only that, but I'm very much in favour of implementing the measures (better access to effective contraception, better social circumstances) that could reduce the overall need for abortion.  I would be delighted to see a drop in the number of women ending up in a position of wanting to have an abortion; I would not be delighted to see a drop in the number of women wanting an abortion and being able to get accurate information and unbiased support in helping them make the best decision for their own circumstances.  In being pro-choice, I am not promoting abortion.  I am promoting abortion rights.  Get the difference?

Hopefully you also get the analogy, but I'll spell it out to make it as clear as possible: Believing that women should get accurate and non-demonised information on formula, believing that women should have the option of being able to ask questions and consider formula as an option, believing that women with qualms about breastfeeding shouldn't be pressured into continuing if they genuinely feel that that is the wrong option for them... those beliefs are not the same as 'an agenda of promoting formula feeding'.  I believe that most or all of the people who follow this blog, including myself and, I am guessing, Brooke as well, do not believe in 'promoting formula feeding' and are in fact all in favour of women breastfeeding, just as I as a pro-choice advocate am all in favour of women continuing their pregnancies.  Now, anyone from the site who feels I'm incorrect in thus speaking for them is more than welcome to speak up now and set me straight.  But, the way I see it, we don't try to put pressure on women to try formula; we try to stop everybody else putting pressure on women to use any particular feeding method (whether that be formula or breast).  We don't try to talk women out of breastfeeding.  We just want to be sure that they feel freely able to stop it themselves if they want to do so.