Monday, August 12, 2013

Whose right is it anyway?

Who has a right to breastfeed? Mothers only? Babies only? Children of any age? Mothers and children together?

Though most international human rights instruments don’t mention breastfeeding explicitly, they do offer an inkling of enlightenment, starting with:

  • The Universal Declaration of Human Rights (1948) which states that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food”; 
  • The International Covenant on Economic, Social and Cultural Rights (1976), which explicitly describes “the right to health” (“the enjoyment of the highest attainable standard of physical and mental health”), recognizes “the right of everyone to … adequate food”, and notes that steps may be needed to ensure “the fundamental right to freedom from hunger and malnutrition” (as General Comment 12 on the right to adequate food (1999) observes: “The human right to adequate food is of crucial importance for the enjoyment of all rights.”); 
  • The World Health Organization’s Declaration of Alma-Ata (1978), which calls health a human right and defines it as “complete physical, mental and social well-being, and not merely the absence of disease or infirmity”.

Article 24 of the Convention on the Rights of the Child (1989) adds slightly to the picture and, in an encouraging development, explicitly mentions breastfeeding (albeit tepidly) for the first time in a global human rights instrument: “States Parties … shall take appropriate measures … to ensure that all segments of society, in particular parents and children … are supported in the use of basic knowledge of child health and nutrition [and] the advantages of breastfeeding …”. Nevertheless, viewed from a purely chronological perspective – whether in terms of when the Universal Declaration of Human Rights was adopted or at what point breastfeeding begins – it’s curious that not only did we have to wait 41 years for this first explicit mention; we also need to wade through the Convention’s 600-word preamble and first 23 articles (out of 54) before we finally get to it.

The World Declaration on Nutrition (1992) straightforwardly recognizes that “access to nutritionally adequate and safe food is a right of each individual”; and as a basis for the Declaration’s accompanying Plan of Action for Nutrition and guidance for formulating national plans, governments pledged to “make all efforts to eliminate … social and other impediments to optimal breastfeeding”.

Okay, so most of these texts don’t refer explicitly to breastfeeding, least of all to anyone’s “right be to be breastfed”. So what? How else are we going to approach the highest attainable standard of health and truly have access to nutritionally adequate food if we aren’t breastfed? And how else are our children going to manage if they, too, aren’t breastfed?

A baby's 'natural right' or a mother's 'informed choice'?

Some days I get the impression that there’s a permanent stand-off between those who define breastfeeding as a child’s “natural right” and those who adamantly speak only of a mother’s “informed choice”. You really have to love this latter expression, which borders on tautology – as if genuine choice were conceivable in the absence of a minimum of information from a disinterested source (recall Aesop's timeless caveat to fellow Greeks some 2600 years ago: Distrust interested advice!). I’m reminded of the impression that infant formula manufacturers give when they use these magic words: They do the informing while, on this basis, mothers are expected to do the choosing (see "Formula Feeding as a Choice"). In fact, if mothers were genuinely informed they would choose breastfeeding every time, as indeed would babies if they could because that’s what they are naturally prepared to receive when they enter this world.

Meanwhile, even sympathetic human rights proponents are quick to caution breastfeeding advocates that a child’s right to be breastfed is not explicitly recognized under international human rights law. After all, a right for one automatically implies a duty for the other doesn’t it? (The fashionable human rights jargon “claim-holder” and “duty-bearer” might be useful elsewhere, but frankly I find these terms distinctly unhelpful in the present context. They seem to insinuate a mother/child adversarial relationship, as if between claimant and defendant in a judicial proceeding.)

Michael Latham describes as “strange, even aberrant” that the right to breastfeed is even discussed; he calls it a challenge to nature, to natural law and natural practice, and to our ecology and environment, and concludes that huge numbers of human infants not being breastfed and mothers being influenced not to breastfeed their babies is a distortion of nature (I agree fully on both counts). He also refers to mothers, who are not breastfeeding because of obstacles, as having suffered the loss of a right; he argues that, since “almost all mothers living under optimally baby-friendly conditions would make the choice to breastfeed”, what is needed is action to remove obstacles to breastfeeding. I consider this observation to be consistent with my own view that returning breastfeeding to the realm of the ho-hum ordinary requires a society-wide shift in understanding and motivation.

But Latham never really grasps the “mothers have a duty to breastfeed” nettle – and I certainly don’t blame him for this – any more than the WABA Global Forum did in 1996 when it included the following text in its recommendations:

“Combined with the fact that breastfeeding is in the best interest of children and mothers, WABA interprets these general provisions of the Convention on the Rights of the Child as implying that children have a right to mother’s milk as the only fully adequate food, and that mothers and children have a right to enjoy conditions that facilitate breastfeeding. States Parties have an obligation to respect, protect, and facilitate or fulfill the right to enjoy such conditions by the removal of obstacles to breastfeeding and to appropriate complementary feeding by the creation of supportive social and economic environments for parents and children. This shall in no way be understood or perceived as the mother having a duty to breastfeed (emphasis added) since it is the circumstances which lead to the choice not to breastfeed that must be altered.”

Forcing mothers to fulfil their 'duty' simply would not work in practice, due to the reasons set out here.

The dyad's right to breastfeeding

George Kent also depicts the main task as removing the obstacles women face to feeding their infants in accordance with their well-informed choices rather than prescribing what they should do. In addition, he proposes that mother and child together be understood as having a type of group rights - the mother and baby as a dyad.

Since both mothers and children breastfeed, by defining the breastfeeding twosome in terms of a right/duty relationship, we do indeed appear to be painting ourselves into a corner of classic dilemma proportions. Few politicians – and let’s not forget that it’s politicians who decide if and when the human rights bar is going to be raised – are prepared to tell mothers they have a duty to breastfeed their children.

Whose right is it then and how do we satisfy it for the one without infringing on the right of the other? Is it possible to tiptoe between the horns of a dilemma in a way that fully respects the individuality, integrity and rights of both parties?

Well, in my view we can begin by deliberately walking away from this pseudo dilemma. We don’t need to butt our heads against a false conundrum; as some are presently defining it, this indeed becomes a zero-sum game, which automatically produces only one winner – and inevitably one loser – every single time.

We then need to decide what this particular win-win alliance is really all about – children and mothers whose health and welfare are simultaneously and mutually fostered, reinforced and protected, immediately and across the entire life course, thereby rewarding not only mothers and children but the entire society.

A joint right anyone?

When breastfeeding has been understood this way (and I have yet to fix a precise deadline for when this new regime will be fully in place!) we will be well on our way to appreciating that routine artificial feeding – as distinct from an exceptional emergency nutrition intervention – is the height of society-wide irresponsibility.

James Akre prepared this post for The Alpha Parent. It is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).

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