At the beginning of March, two researchers from the University of Pennsylvania published a paper arguing that there were sometimes “unintended consequences” to using the word natural in arguments for breast-feeding. The outrage they received online was so passionate that it underscored their thesis: Natural is a word that provokes strong reactions in people, especially mothers.
The paper was authored by two women, doctors Jessica Martucci and Anne Barnhill, from Penn’s Department of Medical Ethics & Health Policy in the Perelman School of Medicine. It looked at the use of the word natural in breast-feeding-advocacy literature by health-care departments and officials. Natural, they argued, is a “loaded” word that health-care providers should think carefully before using.
“It means so many things to so many different people, it seems like bad messaging,” explains Dr. Martucci, “when you should be just communicating the health benefits, rather than lugging this loaded term around.” Her paper with Dr. Barnhill was published on March 4 and picked up by several publications.
“Are there unintended consequences to calling breast-feeding ‘natural’?” asked CNN. “We Need to Stop Calling Breast-Feeding Natural,” said Slate. “Pediatrics Journal says to stop calling breastfeeding natural,” said the Examiner. We went with “We Need to Stop Acting Like Nature and Medicine Are Enemies.”
“I have written about breast-feeding enough to expect a heated response anytime you enter this debate,” Dr. Martucci says. But the paper was not framed as a debate at all. “We were not making any judgments on breast-feeding,” she says, “nor are we even making judgments on the anti-vaccine movement.” But since the medical community is pro-vaccination, “we were asking them to think more critically about the language that they use, in pointing out that some of this language is also applied to breast-feeding.”
Pretty quickly, though, it became obvious that mothers, and lots of them, were very angry. “We didn’t expect mothers to get so upset about this,” Martucci says, “mostly because we didn’t see ourselves as talking to them” — the article was directed at the medical Establishment. “It was not an attack on the actions of actual or individual mothers.”
Comments on the news posts, emails, Facebook comments, and tweets came pouring in. “This reads like an Onion article. I can’t believe this is not satire,” opined one woman on Facebook, while another said, “Extremely upsetting. And simply ridiculous. I mean let’s call a fucking spade a spade. It IS by all definitions of the word the natural way to feed your baby. How is calling it what it is potentially unethical?”
“You and Anne Barnhill both need to be Killed the Natural way the sooner you two are Killed the better off women will be,” wrote a Twitter account with an egg for an avatar. Some of the emails were long and detailed, and some came from mothers who were indeed skeptical of vaccination, Martucci says. But many of the comments on Facebook and on the news stories were from mothers who seemed to have a very emotional attachment to the concept of mother as breast-feeder.
“For the most part, the email response has been very cruel and personal,” says Martucci, who believes many people have misread her paper. But the negative response has not been limited to a bunch of angry mothers on Facebook. The American Academy of Pediatrics’ Committee on Breastfeeding issued this statement:
The AAP Section on Breastfeeding Leadership read with interest the Perspectives in Pediatrics article, “Unintended Consequences of Invoking the ‘Natural’ in Breastfeeding Promotion” by Martucci and Barnhill. While we agree that the words we choose to encourage healthy behaviors certainly matter, equating breastfeeding as “natural” with the supposed “natural” of the anti-vaccine movement is neither logical, nor appropriate. Furthermore, this direct link is not substantiated in the literature.
And several pediatricians objected as well.
What is clear from the vocal and energetic response to the paper is this: Breast-feeding continues to be an issue that makes many women feel under siege. Martucci and Barnhill are clearly not opposed to breast-feeding. (Indeed, the subject seems to hold special interest for Dr. Martucci, who wrote a book about how it was mothers, not the medical Establishment, who “brought back the breast.”) But many women reading the paper construed — rightly or not — that it challenged, in some way, their deeply held opinions on motherhood.
“Public health promotes breastfeeding, but we do next to nothing in this country to actually support mothers, that’s an ethics issue,” Martucci tweeted several days ago. That seems to get to the heart of why women find themselves so angry at the Establishment. With a lack of paid leave, limited community support, and expensive health-care options, mothers feel like they’re facing battles at every turn.