Is breast really best? Risk and total motherhood in the National Breastfeeding Awareness Campaign

From June 2004 to April 2006, cosponsored by the U.S. Department of Health and Human Services and the Ad Council, the National Breastfeeding Awareness Campaign (NBAC) warned women that not breast-feeding put babies at risk for a variety of health problems. "You'd never take risks before your baby is born. Why start after?" asked televised public service announcements over images of pregnant women logrolling and riding a mechanical bull. The NBAC, and particularly its message of fear, neglected fundamental ethical principles regarding evidence quality, message framing, and cultural sensitivity in public health campaigns. The campaign was based on research that is inconsistent, lacks strong associations, and does not account for plausible confounding variables, such as the role of parental behavior, in various health outcomes. It capitalized on public misunderstanding of risk and risk assessment by portraying infant nutrition as a matter of safety versus danger and then creating spurious analogies. It also exploited deep-seated normative assumptions about the responsibility that mothers have to protect babies and children from harm and was insufficiently attentive to the psychological, socioeconomic, and political concerns of its intended audience. Critical analysis of the NBAC suggests that future health campaigns would benefit from more diverse review panels and from a greater focus on providing accurate risk information about probabilities and trade-offs in order to enable informed decision making.