Bringing up three girls, there is a phrase we use around the house and that we talk about a lot:
“Empowered women empower women”
This is a hugely important value to me and I try my hardest to apply it in every part of my life because I need to live it before I can pass it on. The infant feeding arena is no different and this value matters if we want to build and be a part of an empowered, empowering and inclusive movement. I want to talk today about a seemingly small puddle that has this week made a very big splash: the term ‘artificial feeding‘. It is a term that I think we should drop from our vocabularies like a sack of hot potatoes (or worse). This idiom hit the news last week in the form of a letter and subsequent BBC article, but I’ve seen it increasingly populating lots of other forms of communication. Here it’s buried within a similar NHS document, if you type #artificialfeeding into twitter there’s no shortage of examples of social media usage, it’s been spotted in academic texts, and I know from speaking to my peers that they have heard the term during interactions with health care professionals and semi-professionals.
“When R was a baby they put FF on his notes rather than BF [for breastfeeding] when we switched to exclusive formula feeding. By the time I had L four years later, they used the term artificial feeding, and the abbreviation AF. The Health Visitor I had at the time was pregnant and planning to exclusively formula feed from birth, and she told me that she’d been mandated to use the term by a directive which came from higher up in the Trust. It’s bloody offensive. And it’s designed to be. I don’t care how they dress it up. Calling anything artificial is calling it less than.”
“It just reads you can use your own “artificial milk” as long as you bring your own & don’t mind us all shaking our heads at you in total judgement!”
“I first saw the term in a BFHI accredited hospital when I was pregnant and I was appalled. Despite being committed to breastfeeding at the time, I thought it was derogatory to anyone who had decided to formula feed for whatever reason. I actually told a Health Visitor I found it an insulting term and her response was “it’s just accurate, not something to be offended by”.”
This ‘don’t get all offended ladies’ response is common from Healthcare Providers;
“All notes and correspondence will specify if mum is breastfeeding, artificial feeding or combination feeding. There’s no malice in it ladies.”
So let’s just inhabit, for a moment, the dystopian landscape where you can say whatever you like as long as it’s ‘accurate’ (and I’ll pretend that a little part of me didn’t die in response to the ‘calm down ladies’ attitude); are the terms ‘Artificially Fed’ or ‘Artificial Feeding’ accurate?
To a layperson, well, no. Almost everything that we consume on a daily basis is ‘artificial’ in some way. From the mug of tea that I have almost surgically attached to my hand, to the banana that has flown several thousand miles to gently blacken in my fruit bowl before being mashed into banana bread. Labelling something as ‘artificial’ isn’t beneficial. In terms of infant feeding there are many ways in which we could identify things as being somehow artificial. Breastfeeding can be a complicated and very involved process to manage, baby might need to be held in certain positions, or various techniques attempted before the relationship really gets going, it doesn’t always come naturally so is that artificial feeding? Some families may use a breast pump to express milk and then store it using plastic containers in fridges; is this artificial feeding? Many parents feed their babies using a combination of breast milk straight from the source and infant formula milk, and maybe even expressed breast milk too! What form of ‘artificial feeding’ is that and is their baby ‘artificially fed’ or just semi-artificial? Babies who need a little help in the early days might receive expressed breast milk that has been fortified in order to provide appropriate calorific and nutritional content. Historically and still today babies around the world receive early supplemental feeds other than human breast milk; there is nothing ‘artificial’ about parents wanting to feed their babies who are unable to feed themselves. The phrase ‘artificial feeding’ is clearly far too vague and general to have any clear meaning in the real world.
What about in a hospital setting where notes are used to indicate important information about patients? I asked several health care providers and here’s what they said:
“For paediatric patients who need specialised feedings we never call it artificial, instead it is described as the type of feeding and what type of nutrients are required for thriving” (Paediatric Nurse)
“I’ve never seen that term” (General Nurse)
“I mean, in the paediatric or adult arena we never say a patient is being artificially fed. No, notes need to be very specific” (Emergency Medicine Specialist)
“I have never heard, or used the term ‘artificial feeding’ in 22 years of practice. If a baby is feeding orally we would describe the milk as a breastmilk or formula feed.” (Paediatric Gastroenterology Nurse Specialist)
I wasn’t at all surprised by this because when we look a little more closely, even within the only field in which this term is routinely used – Midwifery – even people who find the term sufficiently unproblematic to use appear to use it interchangeably with ‘formula feeding’ and ‘bottle feeding’.
For example, the following quotes are all taken from the same page of the same document:
“We asked Midwives and Midwife Support Workers – Was there usually enough time and resources to support new mothers with artificial feeding?“
“We asked mothers who had chosen to bottle feed – Were you given enough information about bottle feeding?”
“…or show women how to prepare artificial feeds for their babies.”
“…there is usually time to support women with the sterilisation of equipment and preparation of formula feeds.”
Here is another example, this time from the same page of an academic text (Brown 2016: p42):
“…makes it difficult to see the negative effects of artificial feeding”
“differences in artificially fed infants…”
“She points to emerging and deeply worrying biological differences between breastfed and formula fed children.”
These aren’t the only examples that I found, the terms are used interchangeably all over the place, so I don’t think we can argue that ‘artificial’ variants are accurate being as they’re either synonymous or potentially require further clarification.
Accuracy is just one element though, let’s leave this dystopian landscape of offence because we know that ‘it’s just accurate’ isn’t reason enough to deem terminology acceptable. If the words that you use cause offence to the people who experience them, then you have to reconsider. This is especially important in a field where being women-centred is crucial and where empowerment is a buzzword we should all be behind. You cannot claim on the one hand to be ‘women centred’ while on the other hand steamrollering over women who have been hurt. When you are told by families that the language you are using is offensive and disempowering you listen and consider their perspective.
Wide eyed innocence about the use of the terms natural vs unnatural and synonyms within science and medicine is misplaced at this point and has been explored at length as it relates to the field of childbirth and infant feeding. It’s not new or surprising that drawing dichotomies between natural vs. unnatural is unhelpful and unnecessary and, in fact, is arguably another example of the ‘risk-based language’ we discussed last week. Diane Weissenger’s famous ‘Watch your language’ essay even goes as far as to state:
“The truth is breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior.”
The good news is that language is not set in stone and within healthcare I can think of numerous examples of where terminology changes over time because people have found terms offensive. Nothing about the term ‘artificial feeding’ is special and it’s not set in stone. We can change it. Even better than that, evidence suggests that if we move away from risk-based language we would get better results.
To clarify a little, nobody believes that anyone who has ever used that term used it because they were deliberately trying to hurt; its creeping dominance appears to be more a case of misplaced and under-considered buzzword usage than anything else. If women are coming forward to say that it’s offensive and disempowering, then what impression does that give of our ability to provide effective, supportive and women-centred care? Empowered women empower women, they don’t tear them down.
The term ‘artificial feeding’ is deliberately provocative, ableist, offensive and trans-exclusionary. Not all families have breasts, not all of those who do have breasts are able to breastfeed. Furthermore, if it belongs to the category of ‘risk language’ then it is most likely counterproductive where the goal is to support women and increase breastfeeding rates. Simply put, if your message hurts the very people that it’s supposed to help, it’s a dud.
*this is obviously tongue in cheek because the image shows a beautiful and loving infant feeding experience!