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Penn experts warn that touting 'naturalness' of breastfeeding could backfire

Labelling public health initiatives as 'natural' may be contradictory

University of Pennsylvania School of Medicine

PHILADELPHIA - Breastfeeding campaigns that extol breastfeeding as the "natural" way to feed infants could result in harmful decision-making by some parents on other important health matters, according to experts from the Perelman School of Medicine at the University of Pennsylvania. Writing in a Perspectives column in the April issue of Pediatrics, Jessica Martucci, PhD, and Anne Barnhill, PhD, Medical Ethics and Health Policy researchers at Penn Medicine, warn that "[t]his messaging plays into a powerful perspective that 'natural' approaches to health are better." Promoting breastfeeding in this way may therefore indirectly undercut important health practices not viewed as natural, the authors say, highlighting childhood vaccination in particular.

Martucci and Barnhill cite the measles outbreak of 2014-2015 as an example. Some parents and others who oppose vaccination voiced their conviction that "natural immunity" is better than manufactured and therefore "unnatural" vaccinations. But the researchers note that all credible medical authorities believe that denying children such vaccinations poses unnecessary health risks.

Martucci and Barnhill write that while public health authorities and medical experts widely agree that breastfeeding is beneficial for both infants and mothers, there has been little discussion about the potentially harmful consequences of promoting breastfeeding as natural.

In addition to vaccination, the authors cite other examples of a "natural is automatically better" fallacy, including the rejection of genetically modified foods, reflexively preferring organic over conventionally grown foods, and rejecting assisted reproductive technologies, as well as longstanding concerns over water fluoridation.

Examples of campaigns citing breastfeeding as natural, and therefore implicitly superior, say the authors, include the US Department of Health and Human Services' "It's only natural" breastfeeding promotion, the American Academy of Pediatrics labeling of breast milk as "the best and most natural food for infants," and a New York City Department of Health and Mental Hygiene poster describing breastfeeding as "Mom-made" as compared with formula feeding, labeled with a red circle that reads "Factory-made."

The authors write that in addition to leading to health-related overgeneralization by some parents, breastfeeding-is-natural efforts "can inadvertently support biologically deterministic arguments about the roles of men and women in the family (for example, that women should be the primary caretakers of children)."

Martucci and Barnhill conclude: "We should think twice before referencing the 'natural' in breastfeeding promotion, even if it motivates women to breastfeed."


Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania(founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $409 million awarded in the 2014 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2014, Penn Medicine provided $771 million to benefit our community.

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