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Thursday, August 16, 2012

Changing Parenting Norms

NYC recently announced an initiative to encourage breastfeeding, to begin this September in most city hospitals.  The initiative is aimed at new parents and entails eliminating advertising and the “goody bags” from formula makers in hospitals, informing mothers about the health benefits of breastfeeding (per existing state law), and only providing formula to those mothers who request it.

 Predictably, heated debates about the initiative are rampant: Does it force mothers to breastfeed?  Is it still too formula-friendly?  What do hospitals do in Australia?  Don’t worry; despite having had my own encounters with the pro and con breastfeeding forces during the births of my kids at an NYC hospital, I’m not going to weigh in on the breastfeeding battle.  What is interesting to me about the NYC initiative is the potential malleability of parenting norms. 

 Many of us know firsthand—and recent discussions on this blog, such as Jody’s last week about bringing children to work, have illustrated—that how people raise their children is usually a deeply personal issue, which is what often makes the debates so heated.  Accordingly, lawmakers and public health experts have struggled with how best to impact parenting behavior.  One notable success story is Sweden’s approach to corporal punishment.  Corporal punishment was banned there in 1979.  Few people were prosecuted; the point of the law was to signal appropriate behavior, rather than actually punish wrongdoers. The Swedish government wanted to change behavior, and it succeeded.  Over the next twenty years, the number of children who had been smacked by their parents dropped from 50 to 10% and public support for parental corporal punishment also declined sharply.  

 Many U.S. initiatives have not had the same success, probably in large part because it is much larger and more diverse than Sweden and than most countries.  And yet this NYC breastfeeding initiative already has shown some interesting results.  One hospital implemented the initiative early and recently announced that its breastfeeding rate had increased from 39 to 68 per cent as a result.  Of course, this is only one hospital in one city, although having delivered three kids at that hospital, I can tell you anecdotally that it has quite a diverse clientele.  This number also only reflects who breastfeeds their newborns in their few days at the hospital, and the understandable fatigue of many new mothers may have made the original number lower than the number who routinely breastfed once they left the hospital.  Nonetheless, it does show that small changes—no more formula swag and a little bit of information—can have significant effects on people’s behavior.


Posted by Cynthia Godsoe on August 16, 2012 at 03:40 PM | Permalink


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Any sense of how the manufacturers of baby formula are responding to this? I can't imagine they'll embrace this change eagerly . . . .

Posted by: SparkleMotion | Aug 16, 2012 5:26:12 PM

The malleability of parenting norms, and the intensity of people's feelings about what constitutes good parenting, result in problems in the enforcement of criminal child neglect and endangerment cases. What was once considered appropriate parenting, even one generation ago--such as letting your child walk to school, or ride bikes in the neighborhood, or play unsupervised in your front yard or a neighborhood park, or deliver newspapers--are now being charged as criminal acts. And with jurors willing to judge parents based on media-inspired hysteria over the virtually non-existent risk of stranger abduction, parents attempting to raise "free range" kids are at serious risk. In this case, it is media-inspired fears for child safety that is shaping these highly malleable parenting norms. Because the statutes are vague, the standard for criminal punishment is entirely subject to the whims of prosecutors (in the charging decision) and jurors (on guilt), and the media, which has seemed to convince police, prosecutors, and jurors that unsupervised children are at risk of abduction. See http://works.bepress.com/cgi/viewcontent.cgi?article=1010&context=david_pimentel
The sad thing is that the efforts to protect children from such illusory risks is doing them even greater harm (loss of independence, responsibility, physical activity) as they are kept indoors. Indeed, child obesity is now a serious health risk for children; probably a direct result of their losing the ability to pursue outdoor physical activity, walk to school, ride bikes, etc.

I recognize that this comment is slightly off topic, in that it doesn't speak to breastfeeding norms. But the "malleability of parenting norms" is the source of these difficulties. And fear of criminal liability may well force parents to adhere to unjustified overprotection norms, at significant cost to their children's health, safety, and development.

Posted by: David Pimentel | Aug 16, 2012 10:04:31 PM

I'd like to point, that unlike corporal punishment, which research has shown to be ineffective in changing the behavior of children - so says my wife the child psychiatrist - some women are physically incapable of breastfeeding, either because of their own physiognomy or the child's inability. The crux of the problem with this new initiative in NYC is that unlike corporal punishment, formula does provide benefits to the child.

And my recollection from when my own kids were first born is that sometimes when the mother is physically wiped out, the child is - suprise - hungry and formula being available for someone else to feed the child is very useful. The breastfeeding, shall we called them for the sake of politeness, lobby often times does not give mothers the necessary recognition to formula's use.

This policy is bordering on the government ordering the public to eat broccoli.

Posted by: Adam | Aug 17, 2012 1:28:28 AM

I agree with all of these thoughtful comments. No doubt the formula makers--a powerful industry, I'm sure--are up in arms about this. And there are definitely significant differences between corporal punishment and breastfeeding, and the breastfeeding "lobby" can be overzealous and even offensive at times. If the Bloomberg administration's materials are to be believed, however, this initiative will not empower nurses or others to try to talk women out of formula; rather, it will just eliminate the advertising etc. which may lead new parents to be mis-informed about the pros and cons.

And I absolutely agree with you, David, that child abuse and neglect prosecutions--whether civil or criminal--have gone overboard and are often being used to enforce culturally and socioeconomically specific norms. I talk about this in my recent article, Parsing Parenthood (at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=195022). This has a tremendously negative impact on children and families, as you point out. Steven Pinker talks about some of this in his wonderful new(ish) book, The Better Angels of our Nature, pointing out that some Sesame Street episodes from the 70's (what I grew up on!) have now been deemed too scary or too something bad for children.

Posted by: Cynthia Godsoe | Aug 17, 2012 9:26:40 AM

Cynthia: I would push back on your use of the word "misinformed;" that assumes that what the doctors/nurses and breastfeeding advocates (FWIW, no need for you to use danger quotes around the word lobby) is more accurate or more correct about the pros and cons. Maybe it is, maybe it isn't. But the initiative does empower doctors and nurses--and the lactation consultants who work with the hospitals--to guide patients in one preferred direction.

Posted by: Howard Wasserman | Aug 17, 2012 11:08:07 AM

Howard, if what you mean is that a pro-breastfeeding push underlies NYC's initiative, then I definitely agree with you. However, having experienced the opposite in my recent (within the last 8 years) deliveries at an NYC hospital, it may be helping to balance out the issue. In any event, you're absolutely correct that medical information and advice is often (usually?) driven by normative goals and not necessarily by scientific "truths."

Posted by: Cynthia Godsoe | Aug 17, 2012 11:27:20 AM

Many thanks for another interesting post. And thanks too for the response to my quick question above. Perhaps I shouldn't assume that the formula manufacturers will find some what to deliver their "goody bags" to mothers, but I do.

But I guess I'm most amazed that you got a nurse in a NYC maternity ward to pay any attention to you at all. Having gone through one of those wards quite recently myself, I find that almost stunning. It's not clear that the nurses at rhymes-with-N-Y-Boo even knew we were there, let alone that we were trying to feed a baby.

Posted by: SparkleMotion | Aug 17, 2012 11:54:04 AM

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