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Choosing to Latch On

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The backlash against New York City 's Latch On initiative has been swift and strong, coming from all stripes of female commentators, from FoxNews to the Daily News to Feministe. Mayor Bloomberg is depriving mothers of "choice;" dictating what they should do with their breasts and of course, making them feel guilty for choosing formula.

This policy is not doing any of those things.

Mothers still have the choice to do what they want with their breasts and the liquid that fills them when they have a baby in a hospital where formula is not readily forthcoming. In today's world, breastfeeding needs all the support it can get. Breastfeeding requires an incredible commitment from a mother; there is no slacking and no time off. Biologically, it slams into the (rightly) accepted notion that women should be able to work away from their babies. Only a third of mothers breastfeed exclusively for three months, let alone the year medically recommended.

The New York Times ran an op-ed arguing that mothers should not fixate on breastfeeding, and then a column in its Well blog arguing essentially the same thing. Both questioned the science behind breastfeeding, admitting that breast milk is probably better than formula, but concluding the marginal benefit may not outweigh the stress on mothers it can cause to make it work. Have we come full circle from the pro-formula '40s, '50s, '60s and the pro-breastmilk '80s, '90s and aughts?

Bloomberg says no. New York City's policy encourages breastfeeding, but also informed choice. Hospitals can choose to join the initiative, which involves presenting mothers with medically accepted information about breastfeeding -- not without controversy of course, and not unlike other information the American Academy of Pediatrics espouses. Mothers are then allowed to affirmatively request formula, free from the profit motive of formula companies.

Isn't that exactly what a libertarian would argue optimal choice is? Being informed and empowered to ask for what you want is the backbone of libertarianism, and this policy seems to help women do just that. Dangling free formula in a hospital puts a thumb on the scale.

Mitt Romney did the anti-Bloomberg in 2006 when he was Governor of Massachusetts - he reversed the state health department's decision to ban free formula, replacing three Public Health Council members who didn't like the reversal. Conveniently, a few days later, pharma heavyweight Bristol-Myers Sqibb, a subsidiary of which makes Enfamil, announced that it was building a factory in the Bay State. Makes it a little hard to argue it was the sanctity of a mother's "choice" that drove his actions.

Free formula sends mixed messages. During my twins' interminable two-month neonatal intensive care unit stay seven years ago, I accumulated many bags of free formula. I started mixing it into pumped breast milk soon after the twins came home and switched to full formula two months after that. Taking that formula and the coupons from the pro-breast milk NICU, I felt like I was reading a woman's magazine with a skinny model in a bikini on the cover and a feature story inside about positive body image.

But what about the guilt? Aren't we moralizing breastfeeding and demonizing formula feeding, when we say tell mothers that the herculean task of exclusively breastfeeding your baby is associated with positive health outcomes and we make it a little harder to get formula?

The guilt I felt with my twins was brought on mostly by myself, not the well-meaning lactation consultants in the NICU. Six years after my twins, I exclusively breastfed my singleton for over a year. I eventually threw out the expired formula samples I took from the hospital. And I felt the criticism the other way -- after a few months, it was not so acceptable to nurse (if you think formula is demonized, try nursing a 1-year-old in public). Pumping is always hard and awkward. I felt guilty about the attention I had to constantly give my youngest at the expense of my older kids, and worried that I was hurting my career by planning my days around nursing and pumping.

So there can be guilt and shame all around, but more information and more informed choices means more confident choices and less guilt.

One way to do approach this would be to look at breastfeeding in a matrix. First, in an ideal world, a woman could decide how much she really wants to breastfeed. She could consider the scientific and medical information -- from the Latch On campaign, her doctor, the Internet and other resources. She could consider her visceral feeling to breastfeeding (disgusting? beautiful?). Then, she could look at her real world situation and the obstacles her life poses to breastfeeding. Are they really obstacles or just phantom roadblocks? How hard would be they be to overcome?

At that point, a woman could consider how much she is willing to try to overcome those hindrances in light of the feelings she assessed in the first step. This would be a dynamic calculation, adapted to changing situations and how the woman feels when she tries to nurse. (Spoiler alert for those who haven't done it -- it often doesn't work right away!) This kind of mother-specific thought process could result in a myriad of outcomes -- formula from the beginning, nursing for a few weeks then formula, some combination of that, nursing exclusively for a few months or longer.

It would make the fact that a hospital may not give formula without an affirmative request much less consequential. And for those who think they really want to breastfeed, but need support for that difficult undertaking, Latch On NYC could make all the difference.