Risk Communication in Lactation Consulting

Breastfeeding has well-established benefits for lifelong health, and public health initiatives have long concerned themselves with increasing breastfeeding rates. There is a debate within the lactation community about whether breastfeeding promotion should emphasize the benefits of breastfeeding or the risks of formula feeding. Benefit-based messaging is the established norm in both public health campaigns and interpersonal counseling by health professionals. Proponents of risk-based messaging point to breastfeeding as the biological norm and argue that formula feeding should always be situated against the norm of breastfeeding. In order to understand the philosophical underpinnings of risk-messaging, the efficacy of each method, and which method lactation consultants prefer, I conducted an extensive multidisciplinary literature review, interviews with lactation education program students and instructors, and a survey of 169 US-based International Board Certified Lactation Consultants (IBCLCs). Research in communication and psychology theory show little or no demonstrable benefit to the use of risk-based communication and, in situations where self-efficacy is low, it may actually increase risky health behaviors and decrease breastfeeding. Survey and interview results show that IBCLCs either favor benefit-based message framing or modify their message framing depending on who they are speaking with. The conclusion of this paper is that emphasis should be placed on decreasing barriers to breastfeeding and promoting overall justice and equity for families as opposed to messaging to persuade people to breastfeed, and in particular, emphasis on risk should be avoided with vulnerable populations