Guide to more effective, nuanced discussions about infant feeding

In my previous piece on breastfeeding science denialism, I noted that many professionals, clinicians, and public health advocates have expressed uncertainty as to how approach the issue with the general public. It just so happens that I have a tiiiiny bit of public relations and science policy experience, and have road-tested some language and strategical approaches to these discussions, and found them to be helpful. What follows is a collection of tips.

Note: I apologize for the ads. I know they’re ugly. I’m sorry and I’m working on it!

Who this guide is for

Clinicians, public health advocates, parents, and educators who actively engage others on this topic (or want to do more of it!) and are interested in supporting science-informed, nuanced, and compassionate discourse surrounding infant feeding practices in the West, and promoting public literacy in the biology and social science of human infant feeding. It can be used for personal discourse, both online and off, and teaching. This guide assumes the reader is at least somewhat familiar with the the science in this area, and has encountered breastfeeding science denialism, but lacks experience science communication. This guide was written for people on BOTH “sides” of this issue. (As you dig deeper into the literature, you will note that there are not exactly two nice, neat sides to this issue.)

Forthcoming is a piece specifically for science communicators and public relations professionals, specifically on crafting position papers, press releases, OpEds, and articles.

Why I compiled this guide

In recent years I’ve noticed an upsurge in misinformation related to infant feeding in the media discourse, and it has started to become more organized. Infant feeding is a highly consequential public health and equity issue, so how well the public understands this subject has very real consequences in the realms of ethics, economics, and sustainability.

What this guide contains

  • Suggested language to use and to avoid in public discourse
  • Common logical fallacies employed on both “sides” of this debate–how to avoid them and how to respond to them
  • Discussion strategies that will help you have more productive conversations
  • Ethical guidelines to help you avoid causing harm with your words

What this guide is not

  • How to “win” an argument or convert someone to your side
  • A list of sick burns
  • A tool for shaming, othering, excluding, or condemning people you disagree with
  • An easy way out of this very, very complex issue
  • A review of the scientific literature (that would take forever, but maybe someday I will do that)

The questions I asked when writing this guide were how do we make online discourse about breastfeeding more:

  • Evidence-based
  • Effective
  • Compassionate
  • Nuanced

Research on Breastfeeding Science Denialism

The information I share here is derived from both research on public science communication and the psychology of science denialism, but also the training and experience I’ve gained from working in science policy at the national level. However, it is important to note that there is very little research on science denialism in breastfeeding specifically, since the current iteration of it is so new and uncharted. To my knowledge, I am the first person to refer to it as “science denialism.” Where research on this specific topic is not available, I will be using vaccine hesitancy as a proxy, since it shares much in common with this debate, especially with regard to its strong association with parental identity. It should be noted, however, that the parental identities associated with vaccine denialism appear to be very different than those associated with breastfeeding denialism.

Also please note that my review of this area of literature is ongoing. Several scientists in this area have forthcoming publications on this phenomenon, and I will come back and update this document as necessary.

So, without further ado, here are some guidelines you may find helpful.

Check your bias/emotions.

Ask yourself:

  • On what assumptions am I basing the points I am trying to make? What evidence is there for these assumptions?
  • What personal experiences am I bringing to this conversation? Is this a reaction to what my parents did? Something I learned in school? Something I saw on TV? An anecdotal experience my friend had? Consider that emotions stemming from these experiences may influence your perspective–either productively or destructively.
  • What do I know for sure and what am I not as sure about? How do I know?
  • Why am I engaging with this particular person, on this particular issue? What might happen if I just move on and let them be wrong?
  • What are my goals with this discussion? Is my goal to “win” the conversation, or do I want to actually teach something? All too often, I encounter self-proclaimed “science advocates” employ conversational strategies that are driven by emotion, impulse, and intellectual laziness, all in the name of “informing people.” If you really, truly care about promoting science, then you need to use evidence-based strategies.


Logic

I advise everyone to educate themselves in formal logic and memorize all of the common logical fallacies and know how to identify them and avoid them. Here are some of the common ones I see in this particular context. You may notice others that I have not.

  • The “fed is best” phrase itself constitutes several logical fallacies. 
    • False dichotomy — Implies that there are only two options for feeding babies, which is untrue. Infant feeding comes in various forms along the spectrum between exclusive, on-demand breastfeeding formula feeding with a bottle, including dry suckling a formula fed infant at the breast, which will, in fact, yield some of the same health effects as breastfeeding.
    • False equivalence — Implies that it doesn’t actually matter how an infant is fed, which is biologically untrue. Ethically, however, depends on your moral standards.
    • False premise — Saying any feeding at all is “best” implies that there are actually people who think that “less than fed” is an option, which is obviously untrue and makes no sense.
    • Straw man — Implies that there are actually people advocating for starving babies in the name of breastfeeding, which they are not.
    • Red herring — Distracts from the larger, more difficult to solve issue, which is that we do a poor job as a society of supporting families in their breastfeeding goals, which is the only reason this is even an issue in the first place.
  • Avoid false dichotomy. As one familiarizes themselves with the literature in this area, one inevitably comes to understand that “breastfeeding vs. formula” is not an either-or choice, and most of the time is not actually a “choice” at all. 
  • Avoid appeals to authority. It is important to note that respected authoritative bodies release committee opinions and recommendations based on consensus. Therefore, a statement such as, “[Insert respected scientific organization here] says…” is not an Appeal to Authority; it is a representation of scientific consensus. Appeal to authority is “trust me, I’m a doctor,” whereas scientific consensus is “Scientists agree that…”
  • Avoid Appeal to Nature. Be careful with the word “natural.” In the discourse, this word is often used in reference to breastfeeding and related topics associated with a particular parenting philosophy or identity. However, it is important to note that this is a heavy word for parents. There is a strong association between the word “natural” and morality–implying that “natural” is somehow “better.” Yes, technically, breastfeeding is a mammalian process and is therefore “natural,” but so is death, disease, and all of the chemicals that make up our world–some of which hurt us, some of which help us. Also, for many folks, the word “natural” in reference to breastfeeding implies that it is supposed to be easy, because it’s instinctual. However, because in the West there are strong social forces interfering with the biological processes and practical variables that are crucial to making breastfeeding work, it isn’t always easy.

Science/Research

I won’t cover the scientific evidence on infant feeding itself in here, because that is very involved. But I do have a few recommendations as to how to approach the science.

  • Frame “fed is best” and related messaging as denial of scientific consensus. It is science denialism. Many of the folks who promote “fed is best” and related misinformation about breastfeeding claim a scientific background (and may actually have one, albeit usually in an unrelated field) and use scientific language, and cherry-picked studies to perpetuate the notion that there is some sort of debate happening in science over breastfeeding, when there in fact is not. The WHO, AAP, ACOG, and all of the relevant medical and scientific organizations around the world agree that breastfeeding is unequivocally the optimal form of nutrition for human infants. Therefore, when you argue that it is not, you’re arguing against scientific consensus.
  • “Breast vs. Formula” is a manufactroversy. It’s a totally real social debate, but it originates with the media and culture, not with scientists. Scientists do not debate the difference between formula and breastmilk.
  • Drive home the scientific consensus. Since the popularization of breastfeeding science denialism organizations like AAP, WHO, and ACOG have doubled down on their position on breastfeeding, and many scientists are starting to speak out. A 2015 randomized study on vaccine denialism indicated that consensus messaging is a very effective and simple that even overcomes powerful identities such as political affiliations (van der Linden, 2015). However, research on consensus messaging on the issue climate change has indicated that consensus messaging may worsen polarization in cases where the issue is closely tied to political identity. In the case of breastfeeding, there does seem to be an element of identity at play, here, but to what degree that affects people’s ability to accept scientific consensus, is unclear. What we do know is that a common tactic of breastfeeding science deniers is to align themselves with the science through use of scientific language, authority, or cherry-picked studies, infiltration of science communication and skeptic communities, and labeling breastfeeding families and public health advocates as “crunchy” and “anti-science.” This area needs more research, but it stands to reason that pointing to the scientific consensus on this issue may help decouple breastfeeding science denialism from it’s attempted claim to science.
  • However, avoid actually calling people “science deniers” or “anti-science.” This is confrontational and will serve only to alienate folks and not bring them over to your corner. As Kari Fischer of the New York Academy of sciences notes, pretty much everyone loves science, and accepts most of it. Most vaccine-hesitant folks also actively embrace the science on climate change. When it comes to their pet issue that they deny, they do not view themselves as anti-science; rather they believe that they merely have the “correct” interpretation of the science. Moreover, Fischer notes, most folks reject certain areas of science–even you–particularly on issues you have a strong emotional reaction to.
  • Avoid speaking of the “benefits” of breastfeeding–or the “risks” of formula. “Benefits” is very similar to the word “bonus,” and implies that breastfeeding is something “extra” and nice, but not particularly necessary, like some sort of extra credit parenting project. It’s not “extra,” it’s the biological norm. However, while breastfeeding is the default for our species, and it is more scientifically accurate to speak of the “risks” of formula feeding, the general public does not conceptualize the word “risk” in the same way scientists do–in the statistical sense. The colloquial meaning has a strong negative connotation, as if the formula feeding parent is “putting their child at risk,” or formula feeding is “risk-Y” which is also not quite accurate. And the negative effects of risk-based language is demonstrated in initial research in this area. So, if “risk” language is counterproductive, but “benefits” is inaccurate, what to say instead? First, just use neutral language, such as speaking of the “effects” of breastfeeding,” or speaking in general terms of the “science on infant feeding method.” We can also use the more colloquial term “chances of x” in place of “risk.” But also, research suggests that education is most effective if you couple information with affirmation and doable action items.
  • Avoid using value-laden language like “best” as well. It brings up a lot of negative feelings for people, and general research in science communication suggests that it is counterproductive (Druckman, 2015). Instead, try and stick to purely descriptive language. We can say that “breastfeeding is the biological default” or “Every species has certain biological constraints that were shaped by natural selection. Breastfeeding constitutes the conditions that the infants of our species evolved to expect, and when those conditions are not able to be met, this can sometimes contribute to or increase the chances of diseases arising either in childhood or later in life.” If you feel stuck, “optimal” is preferable to “best” because it is less value-laden and is more about working with one’s circumstances to maximize outcomes rather than assigning morality to a choice. Even better, though, is to be specific. For example, “X is associated with an increased risk of developing [a condition or category of conditions].”

Strategy:

  • Use an approach that is rooted in empathy for the other person/side. You need to meet people where they at and respect their journey. Aside from being ethical, this approach is *more effective*. If you’re familiar with the psychological research on cognitive bias, you know that humans are not robots, and are not prone to being swayed with logic and evidence alone. Research on the so-called “Backfire Effect” suggests that people aren’t so much fact immune as fact-resistant. Facts do help. but leading with a “knowledge gap” approach–that is, dropping information to fill in the gaps in their knowledge that lead to them holding the opinion you are arguing against–can be counterproductive if you haven’t yet established a human connection with the person.

    I recommend Gleb Tsipursky’s method, which employs the acronym “EGRIP”

    • Empathize — Also Emotions, as in set yours aside, and empathize with your interlocutor or audience. You’ll be surprised how far JUST this step alone gets you.
    • Goals — Establish shared goals
    • Rapport — Build rapport with your audience/interlocutor. Crack a joke, make them feel heard, point out a shared experience. This puts them at ease and lets them know you’re on their side.
    • Information — Only once you’ve done all the other things is it okay to start filling the information gaps. Start with more neutral facts, or interesting things they may not have thought of. Focus on facts that address your shared goals.
    • Positive reinforcement — Compliment the other person on areas where they’re correct, as well as any efforts they make to change their view or at least understand your point of view. This is supported by research that suggests that the Backfire Effect is less likely occur when information is coupled with self-affirmation.

      More about this method here.
  • KEEP EMPATHIZING. Remember that breastfeeding science denialism is fundamentally “a backlash” movement. It is a reflection of real, genuine pain and shame resulting from an individualist culture that told parents to breastfeed but did not pave the way for them. Anger is very, very understandable in this situation–even if you disagree about who people should be angry at.
  • Go in with a learner’s mind. Accept that you might be (even if it’s a very small chance) either partially or entirely wrong. You will be surprised at how freeing this is. If you begin with the assumption that the other person is completely, unequivocally, dead wrong, you pass up an opportunity to gain a deeper understanding of the issue.
  • Avoid seeming like an “advocate.” A 2010 study in Women & Health on breastfeeding promotion found that people are less likely to trust information from a “breastfeeding advocacy” organization than a general “infant health” organization. In other words, if people perceive you as having an agenda, they will assume that you are biased and that the information that you provide is biased as well. This is reflective of research in climate change denial which suggests that appearing partisan damages a scientist’s credibility (Jamieson and Hardy 2014).
  • Stay rooted in the scientific wonder of human biology. Research in science communication indicates that appealing to people’s sense of wonder is an effective strategy in communicating science. This is where you pull out your cool facts!
  • Redirect the conversation (pivot) to the larger question. “Breastfeeding vs. formula” would not even be an issue if there wasn’t a media narrative that connects feeding method with identity and pits parents against each other–a narrative which, intentionally or not, large corporations (formula companies as well as the “natural wellness” industry) profit from. These narratives distract from the larger, must more difficult issue, which is that most parents start out wanting to breastfeed, but end up stopping sooner than they wanted. Why? If 83% of parents start out breastfeeding, and 64% of parents are not still breastfeeding at 12 mos, what the hell are we doing to sabotage the efforts of the remaining 19% who ‘gave up’ and the additional 12-14% (83% plus the estimated 3-5% who suffer from primary milk insufficiency, subtracted from 100) who didn’t even feel like it was worth trying? (CDC 2018 Breastfeeding Report Card, Neifert et al., 1990)
  • Frame breastfeeding as an ACCESS ISSUE. — Piggybacking off of the previous point, we speak of breastfeeding as if it were a lifestyle choice and not a public health issue. But breastfeeding is often not actually a choice–even when people think it is. A choice is freely chosen. A parent who couldn’t bear the disapproving look from her boss as she left yet another meeting to pump did not cut breastfeeding short by choice. A parent who didn’t breastfeed because they weren’t aware of all the science was not afforded the informed choice to which she has a right. As with many public health issues, socioeconomic status and personal circumstances play a huge role, here. Even the most economically privileged and highly educated families face social stigma that prevents them from breastfeeding in public, thereby contributing to maternal isolation. Hell, even doctors have insufficient professional support at work, and they’re the ones telling everyone else to breastfeed! And I haven’t even touched on the degree to which the “breast vs. bottle” debate completely ignores the generational trauma of families of color.
  • Use care when addressing anecdotal stories. — People will, invariably, bring up their own personal stories, or stories of a friend or family member who struggled with breastfeeding. Do not diagnose on the internet!!! Even if you suspect that person was misdiagnosed or suffered from a problem easily treated, you can’t know for sure without examining them personally. Also, you weren’t there, and you’re not that family. Anecdotes can be useful, but they can also distract from the larger issues at hand. Instead of getting bogged down in the details of the case, just say “I’m sorry that happened to you/your friend,” find a more general point that the story helps to illustrate (or at least something kind of related) and use it to pivot to a larger point, such as how we need to fix System Component X so Y doesn’t happen to other parents. Express genuine empathy for people’s stories; don’t sweep them under the rug. But don’t let them derail the conversation, either. (It’s a delicate balance, I know.)
  • Meet people where they are culturally. If you are a lactation professional or experienced breastfeeder, you are likely very acclimated to the idea of breastfeeding a toddler, as is recommended, but most folks aren’t. Be mindful of where people are coming from and ease into these subjects, lest you alienate them with worldviews they are not accustomed to. Do not give the impression that you are pushing some sort of “crunchy agenda.”
  • Don’t lead with talk about formula company greed. It is well established in public health that formula company advertising is insidious and poorly regulated in the U.S. However, the general public is not sold on this idea, and may view that language as “conspiracy talk.“ Although it’s just normal and expected capitalistic behavior, not conspiracy, it will be a turn-off to folks not intimately familiar with regulatory guidelines for human milk substitutes. If you do go here, provide evidence from a credible source such as science journals, WHO, or UNICEF.
  • Emphasize that this argument mostly only exists because we don’t support breastfeeding–but define “support.” Be sure to define exactly what you mean by “support“ because most people think that breastfeeding support basically means verbal encouragement (“You go girl! Do the thing!”) and maybe bringing moms a glass of water while they breastfeed. You and I know that actually “support” means a whole lot more –– community level education and acceptance, government policy changes, and in many ways completely restructuring huge chunks of society. Steering the conversation towards community-level changes will make the conversation less confrontational and more positive and productive.
  • Focus on the “fence sitters.” Research in science denialism indicates, unsurprisingly, that extremists are harder to turn. In public discourse, and especially in heated back-and-forth discussions, consider lurkers to be your main audience, and speak with them in mind. They’re quieter and easier to forget, but they’re much more numerous and easier to influence.
  • Embrace uncertainty and admit what you don’t know. It seems like admitting what we don’t know for sure may damage our credibility, but this is not reflected in the research on science communication. People respond well to honesty. When you admit what you don’t know or what the science isn’t clear on, you gain people’s respect. In a white paper on science communication research for the American Association for the Advancement of Science, Matthew Nisbet and Ezra Markowitz write, “Explicitly state the uncertainty in research and present them in probabilistic terms, since this helps build credibility and promotes dramatic tension and interest in an unfolding story or mystery about discovery and understanding complexity.”
  • And please, for the love of god, be polite and professional. I don’t care what the other person is doing. Represent your camp well. Don’t give it a bad name.
  • Be kind. There is a real human person on the other side of this conversation, and you have no idea what sort of emotional baggage they’re bringing to this conversation. You would want the same for yourself.

Discussion ethics

  • Don’t be confrontational. Avoid calling out individuals or organizations unless you feel there is no other choice, and you’re confident it will yield productive results. Particularly be careful with individual parents who have a history of trauma or negative experiences with infant feeding. 
  • Don’t be condescending or shaming. Don’t call people stupid. Don’t fault people for having less education in science than you do; educational attainment is a function of privilege, not character. If shame has not been shown to improve obesity, it’s not going to improve breastfeeding. BTW people know when you’re trying to act smarter than them, and it is not a good look on you.
  • Accept and admit the areas where advocacy and clinical has fallen short. Ultimately the only reason this debate exists is because advocacy has been insufficient. We’ve been talking about “promoting” breastfeeding when really we need to be talking about enabling and protecting it. We’ve been focusing on individual choice without realizing that for many it isn’t really a choice. And yes, many clinical practitioners and educators come off as pushy or judgy to some moms–perhaps not intentionally, but when we are tired and in a hurry, we sometimes have poor bedside manner. We are also often lacking in awareness of the role that our own luck and privilege had in providing access to breastfeeding ourselves, contributing to success in meeting our own goals, and creating an overall positive experience with it.
  • Don’t minimize or ignore the range of maternal experiences. Many mothers share painful personal stories surrounding their perceived “failure” to meet their breastfeeding goals. Anecdotes are not data, but it is important to understand that the biology of infant feeding is absolutely inextricable from the complex social forces surrounding it. Even the arguments that can be regarded as denying of the science in this area (e.g. stories that blame breastfeeding itself, rather than failed social systems) have important points to make, and we need to talk about them.
  • Respect their journey. Meet people where they are at personally, and be mindful of the fact that you don’t necessarily know what personal experiences they are bringing to this conversation. Understand that a lot of this debate is rooted in/fueled by grief over something parents feel was stolen from them, and they have every right to be angry, even if you disagree about who or what they should be angry at. There is no need to allow folks to spread misinformation out of compassion for their suffering, but you don’t need to beat them when they’re already down, either. In other words, don’t be a bully.

Conclusion

I hope you have found this guide helpful. This guide is not at all comprehensive, because time and space are limited. My review of the available literature on breastfeeding science communication, and on health science communication more generally, is ongoing, and I hope to write a piece specifically on what the literature says. This piece, though, is mostly for folks who just want a list of pointers, so they can get their bearings in this disorienting new cultural milieu where breastfeeding and social media converge.

Also, although I have had training in public relations and science communication, I am not a professional in this area, and would constructive feedback from folks who are. And, if you decide to employ these techniques, please report back on your results, so I can further refine this document. I can be reached at raisingwondermail at gmail.

Additional resources

Here is a list of additional resources that I think you will find helpful:

Scientific American: How to Talk to a Science Denier without Arguing — Includes Gleb Tsipursky’s EGRIP method, which emphasizes empathy and building rapport

The Scientist: “What You Believe about ‘Science Denial’ May Be All Wrong” — Lessons from last year’s conference on science denial, co-hosted by the Rutgers Global Health Institute and the New York Academy of Science. This article also emphasizes empathy, active listening, and building trust and rapport.

Medium: Cognitive Bias Cheat Sheet — An in-depth overview of cognitive biases, organized into categories

Big Think: “Believe it or not, science deniers aren’t stupid” — Emphasizes the counterproductiveness of ridicule and condescension in arguing with science deniers, as well as the value of empathy and patience.

Science Communication Media by Aaron Huertas — If you are someone who speaks to the media about your science, this guide will be helpful for you. It contains basic information about how the media works, and tips and tricks to help you communicate your science more effectively and avoid common pitfalls of TV, radio, and print interviews.

If I Understood You, Would I Have This Look on My Face?: My Adventures in the Art and Science of Relating and Communicating, by Alan Alda — A great introduction to the world of science communication, and the value of making a human connection, and telling a story.


Other sources cited:

Druckman, J. N. (2015). Communicating Policy-Relevant Science. PS: Political Science & Politics, 48(S1), 58-69.

Jamieson, K. H., & Hardy, B. W. (2014). Leveraging scientific credibility about Arctic sea ice trends in a polarized political environment. Proceedings of the National Academy of Sciences, 111(Supplement 4), 13598-13605

Len-Ríos, M. E., Bhandari, M., & Medvedeva, Y. S. (2014). Deliberation of the Scientific Evidence for Breastfeeding. Science Communication, 36(6), 778–801. doi:10.1177/1075547014556195

Matthew Nisbet and Ezra Markowitz. Science Communication Research: Bridging Theory And Practice — Commissioned Synthesis and Annotated Bibliography in Support of the Alan Leshner Leadership Institute American Association for the Advancement of Science

van der Linden, S. L., Clarke, C. E., & Maibach, E. W. (2015). Highlighting consensus among medical scientists increases public support for vaccines: evidence from a randomized experiment. BMC public health, 15(1), 1.

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