Making the Case: Effective Language for Breastfeeding Advocacy

By Melissa Bartick, MD, MS
March, 2007

In Massachusetts, we have learned a lot about using the most effective language to get policy-makers to support breastfeeding, after then-Governor Mitt Romney quashed the nation’s first statewide ban on the hospital marketing of baby formula. Lessons from those battles of words can be applied to other aspects of breastfeeding advocacy and make your message more convincing.

One of the biggest lessons we learned was that we needed to reframe the argument, rather than react to our opponents’ charges. When you reframe the argument, you are in control of the message you give; when you respond directly to their charges, they are in control of your message.

For example, countering "freedom of choice" with assurances about supporting choice only deflates your message by turning it into part of your opponent’s message.

"Choice" is the language of breastfeeding opponents. When they talk "choice," it’s best to respond using entirely different language, like "marketing" or "profits." Avoid the word "choice" altogether.

Politicians and proponents of baby formula often talk about "freedom to choose" how to feed a baby. Freedom of choice is a concept frequently raised by makers of other unhealthy products, like junk food and tobacco.

These corporations say that healthy choices are the individual’s personal responsibility. They minimize the effect their marketing has on consumer behavior.

Companies cannot admit that they want to get people to buy as much of their unhealthy product as possible, so they veil their marketing efforts as ways to "educate" the public about their products.

The strategy is effective, in part because consumers do not want to admit that they are vulnerable to the effects of advertising, even though, clearly, those vast sums spent on marketing are not for nothing. One Romney staffer even told us, "Women are too smart for that." She turned unethical marketing on its head by praising women’s "intelligence."

You may be the most passionate breastfeeding advocate on the planet, but if your audience sees you as such, you risk becoming marginalized and losing credibility. Policy makers need to recognize breastfeeding as a mainstream health and family issue. Use calm and measured language and always sound professional.

In 1996, Diane Wiessinger published her seminal treatise, "Watch Your Language," in the Journal of Human Lactation.¹ She argues that we should not talk about the "benefits of breastfeeding," because that implies that formula is normal and breastfeeding is just something "extra." To paraphrase her key points:

• Instead of talking about the "benefits of breastfeeding," talk about the risks of not breastfeeding. Instead of breastfeeding "preventing" breast cancer or obesity, we should note that breast cancer risk increases with shorter durations of breastfeeding.
• Avoid describing breastfeeding as "ideal," "perfect," "optimal" or "special." Formula companies use these words make breastfeeding sound unattainable. They know most people are content with just "regular."

Breastfeeding is a public health issue, just like smoking, safe sex, and seatbelts. This message removes the baggage of your audience’s personal breastfeeding issues, and is an effective antidote to the language of "choice" so popular with our opponents.

• Cite the risks of not breastfeeding, both to mothers and to children, both for acute and chronic illnesses.
• Include specific statistics rather than just general language about risk. By itself, saying "there are risks to not breastfeeding" may be interpreted as a value judgment. By contrast, saying "babies who are formula-fed have double the risk of diarrhea" sounds informative and scientific.
• Frame breastfeeding as a systems issue, rather than an individual issue. Explain how policies impact breastfeeding success and duration.

People are often concerned with inducing feelings of "guilt" in women who choose not to breastfeed, or who fail at doing so. But, as Linda Smith of the US Breastfeeding Committee asks, "How much of this guilt is really anger or grief?" Indeed, a woman may see her breastfeeding difficulties as a personal failure, rather than the result of the many roadblocks that undermine nursing mothers. But once a woman recognizes how others have failed her and her baby, she doesn’t feel guilty " she feels angry. Help women transform their frustrations into voices for change.

It’s hard to argue with "Stand up for mothers and children." When you phrase breastfeeding support this way, you are also acknowledging that breastfeeding is a normal part of family life. You can remind people that most mothers actually do breastfeed initially, but poor support results in short duration.

When you say, "We need to help women follow medical recommendations," you remind people that breastfeeding is the medical recommendation, after all.

It is particularly challenging to convince anyone why "freebies" might be a bad thing. Here are some of the arguments we used to fight the hospital distribution of formula company discharge bags:

Unethical marketing and the profits of Big Pharma:

Many people do not realize that the name-brands advertised on most formula bags are owned by two pharmaceutical giants: Abbott Labs (Ross/Similac) and Bristol-Myers Squibb (Mead Johnson/Enfamil). We tapped into the growing movement against the unethical marketing techniques employed by the pharmaceutical industry.

• "Why are hospitals marketing baby formula?" The very question makes a powerful statement.
• "Hospitals should market health and nothing else."
• "The only way to sell more formula is to sell less breastfeeding."
• "We would never tolerate the idea of giving out coupons for Big Macs on the cardiac unit."

Do you want to be used?

Health professionals get angry when they hear this quote from a Ross training manual that was cited in a Texas court case:

• "Never underestimate the importance of nurses. If they are sold and serviced properly, they can be strong allies. A nurse who supports Ross is like an extra salesperson." (Abbott Labs v. Segura, 1995) Nobody wants to be "sold and serviced."
• Another approach: "You went to nursing school (or medical school) to take care of patients, not to peddle baby formula."

Practice evidence-based medicine:

Research shows that when breastfeeding moms get commercial bags, they are less likely to breastfeed exclusively.²

Some people think formula company materials provide useful information on breastfeeding. They do not realize that research shows that breastfeeding information provided by formula companies is associated with lower breastfeeding rates than when it comes from a non-commercial source.³

• "Giving out bags goes against evidence-based medicine," -- something near and dear to health professionals.
• "The bags undermine the advice we give our patients. How can we tell them breastfeed exclusively for 6 months, then hand them a formula bag?"
• The CDC notes that the women most susceptible to the effects of the bags are those who are most vulnerable: non-white women, primiparas, and those with illness or complications.⁴ The bags increase health disparities, not close them.

The bags advertise only pricey name-brands:

Our opponents often argued that taking the bags away from indigent mothers will hurt them. In fact, the bags encourage all parents to spend more money, an average of $700 more a year above store brands.

We found that reporters did not seem to care about the price differential, but we found that average women cared deeply about it when we talked to them.

• "The bags aren’t free."
• "This free bag costs you $700."

What’s your opponent’s real agenda?

Why did Romney go to such extreme measures to make sure women got their bags? We will never know for sure, but less than two weeks after he quashed the ban in May 2006, he proudly announced a $660 million deal with Bristol-Myers Squibb, the nation’s largest formula maker, to build a pharmaceutical plant in Massachusetts. The deal conveniently allows Romney to boast that he "brought jobs to Massachusetts" as he runs for president.

Reframe the argument instead of just answering your opponent’s charges. Identify yourself as a voice from the mainstream. Remind people that exclusive breastfeeding for six months is the medical recommendation. Hammer home that breastfeeding is a serious public health challenge, worthy of funding and legislation. Include numbers when you can, and always remember to talk about the risks of not breastfeeding, rather than the "benefits of breastfeeding." Discuss "marketing" and "profits," not "choice."

With carefully chosen words, your voice can lead to change.

Also, please view and download the One-page summary handout we gave legislators.

©  2007 Massachusetts Breastfeeding Coalition

1. Wiessinger D. Watch your language! J Hum Lact 1996;12(1):1-4.
2. Donnelly A, Snowden H, Renfrew M, Woolridge M. Commercial hospital discharge packs for breastfeeding women. Cochrane Data Base Systematic Review 2000;2(CD002075).
3. Howard C, Howard F, Lawrence R, al. e. Office prenatal formula advertising and its effect on breastfeeding patterns. Obstet Gyencol 2000;95(2):296-03.
4. Shealy K, Li R, Benton-Davis S, Grummer-Strawn L. The CDC Guide to Breastfeeding Interventions. Atlanta: US Department of Health and Human Services, Center for Disease Control and Prevention; 2005.