I am running a marathon!

I am doing the Run England Virtual Marathon 2021.  This requires me to run 26.2 miles on a course of my choosing any time before the end of 2021.

I will be running my marathon around Hook on Saturday the 13th of November!

I would be really grateful if you would sponsor me.

I am raising money for FiveXMore - a charity that does wonderful work tackling racial disparities in maternal mortality.

You might not know, but here in the UK, if you are Black you are 4 times more likely to die in pregnancy than if you are white.  (The FiveXMore campaign gets it name from the fact that historically this figure was 5 times more.)  My work in the Philosophy of Pregnancy, Birth and Early Motherhood tries to make things better for mothers and those who are pregnant.  But in this instance, I think the most effective thing I can do is to try to raise money - and awareness of - this charity.

FiveXMore support, empower and advocate for Black women and birthing people; lobby to the government and those in power and train health professionals. You can find more about their work here.

Here is how to sponsor me:

1.  Follow this link to donate to FiveXMore. 
2. Comment below to tell me how much you have donated.  I will then add your donation to my total raised.

(Image shows a baby lying on a bed. She has her hands in her mouth and I think she looks a little puzzled.)

 Last week, the Guardian published an open letter to new mothers from a Health Visitor.  In a key paragraph, the Health Visitor says:

"You talk to me about breastfeeding. I want to tell you that, for some women, it just doesn’t happen. I also want to tell you that something so important now won’t feel so important in a few years’ time. Fed is best, regardless of how."

My Twitter Feed soon started buzzing in response.  

Roughly half agreed with what the Health Visitor said. They were only frustrated that the Health Visitor doesn't say the things she wants to say.

The other half were deeply angered and saddened.

I can understand both reactions.  There are big problems with this letter, but it is also partially right.

What Was Right?
 
It's right that for some women breastfeeding doesn't happen and that it is okay if you do not breastfeed.  (More than that it is okay if you do not breastfeed whether this is because you can't or because infant formula works best for your family.) 

​Mothers have a right not to breastfeed. A mother should not need 'permission to stop' from her Health Visitor.  Unfortunately, many women do end up feeling as if they are required to breastfeed - or try until a medical professional tells them to stop.  I've written about why this might be here.  

I think we can say that it is okay not to breastfeed - and your child is likely to be absolutely fine if you don't breastfeed - while accepting all the reasons breastfeeding advocates want to increase breastfeeding rates.  We need to distinguish between (1) total effects overall a population of trends in behaviour and the risks for an individual; (2) relative risks and absolute risks.  Increases in breastfeeding rates make an important difference at the population level, but this doesn't mean it's risky not to breastfeed for most individual babies. In addition, reports about breastfeeding often discuss relative risk, but if the baseline risks are small, this can mean that 'doubling your chances' doesn't lead to a big absolute risk.   And of course, 'Is it okay not to breastfeed?' is a very different question than 'Is breastfeeding worth doing?', so there might be lots of reasons that make breastfeeding worth doing while it is still true that it is absolutely fine not to breastfeed. 

I also recognise that breastfeeding can be lifesaving in some conditions, for example if there is no access to clean water or so little money that parents end up watering down formula.  But if that is the case then it is not the lack of breastfeeding that we should focus on.  It is the scandalous situation that the parents don't have access to clean water or enough money to feed their family.

What Was Wrong?

The letter gave a lot of people the impression that the Health Visitor thinks breastfeeding is not important.  It's wrong to think that breastfeeding is not important.  Breastfeeding is important to a lot of women. If it is important to them, it should be important to us.

Mothers have a right to breastfeed.  (Well technically, the mother-baby dyad has a right to breastfeed.  You wrong both mother and baby if you violate this right.)  This includes a right to support that is needed to overcome difficulties.

It's also wrong that what feels important now won't feel important in a few years' time.  When feeding experiences go badly, this can deeply affect mothers' experiences of those first weeks and months with their babies.  Women can carry this with them for years.  It can continue when their children are thinking about feeding their own babies, and affect their children's experiences.  (Heather Trickey uses an extremely vivid example to describe this phenomenon here.)  Here it isn't so much how the baby ends up being fed that makes the difference but whether the mother ended up feeling supported, listened to, and at peace with her feeding journey.

One thing that can cause lasting pain is feeling guilty or that others are judging you.  (This is the problem the anonymous HV is trying to solve.) However, it can be equally bad to feel as if you were brushed off, told that it didn't matter and that you should 'just give a bottle', when what you wanted was support to continue - or at least all the information to make the decision for yourself.

I think that many people are angered by the HV's letter because it reminds them to those experiences of being brushed off.  If breastfeeding is important to you, it is heartbreaking to think that you could have done it, if only you'd had the right advice and support at the right time.

I have something like this regret myself.  After my first baby was born, I had to have an epidural and surgical repairs.  (That's right folks. I got the pain relief after labour was all finished.)  We were separated during this time.  After the surgery, it was very late and I was put in a ward with my baby in a cot by my side.  I could not walk.  I could not reach her.  I wanted to try to breastfeed, but everyone was busy and I didn't want to be a bother.  By the time I got to try and breastfeed, she was so weak that she could not latch.  It took a horrible time of pumping and trying to feed round the clock, a lovely lactation consultation, months of nipple shields, and lakes of tears from both me and the baby before feeding finally clicked.  It clouded a lot of the beginning of motherhood for me.  

I am convinced that if I had had the confidence to ask for my baby to be brought to me after birth, I would have avoided all that heartbreak.  And I will probably always be upset about that.  Because it could have been better if I'd had better information. 

It's Not Easy To Get it Right
Some mothers need their health visitors to simply tell them it is ok not to breastfeed.  Some need to be supported to continue.  Some won't end up breastfeeding but need to feel like they have been given all the help and information they need.  It's hard for a Health Visitor to tell the difference - especially when they are, like all health professionals, overworked and underpaid.  But it is important and it starts with listening to each mother.

Nonconsequentialist? Feeling sceptical but relaxed about the doctrine of doing and allowing or the doctrine of double effect? 
You shouldn't be!
Read my paper, "Double Effect, Doing and Allowing and the Relaxed Consequentialist" (which was just published in Philosophical Explorations) explaining why.
Then PANIC!!!!
Then read my book (Doing and allowing harm, OUP), realise that the Doctrine of Doing and Allowing at least has all been sorted out.
And relax.

Abstract of Paper
Many philosophers display relaxed scepticism about the Doctrine of Doing and Allowing (DDA) and the Doctrine of Double Effect (DDE), suspecting, without great alarm, that one or both of these Doctrines is indefensible. This relaxed scepticism is misplaced. Anyone who aims to endorse a theory of right action with Nonconsequentialist implications (henceforth any Nonconsequentialist) should accept both the DDA (or a replacement) and the DDE (or a replacement). First, even to state a Nonconsequentialist theory requires drawing a distinction between respecting and promoting values. This cannot be done without accepting some deontological distinction. Second, if someone is going to accept any deontological distinction she should accept either the DDE or the DDA or some replacement. Finally, anyone who accepts either the DDE or the DDA should accept both doctrines or a replacement of each. Unless both Doctrines can be defended or given a defensible replacement, any Nonconsequentialist is in trouble.

Keywords: double effect, doing and allowing, nonconsequentialism, respecting versus promoting

(Image: selection of cakes to symbolise an excellent party.)


A friend just shared this very cool, very funny video on Facebook.


https://www.facebook.com/BuzzFeedCocoaButter/videos/1984559128494583/


It's all about Quinta, who has been invited to Justin's party.  She does not want to go.  So she says she does not want to go.  

Her friends struggle to understand this.  They offer her a range of excuses.  Is her father visiting?  Does she have roller derby?  No, she just does not want to go.

They cannot cope.  "What is your reason for not going to Justin's party?"

This video is funny.  But it is also philosophically interesting for quite a few reasons.  

First, it links in to the work I've done on infant feeding and the reason/ duty distinction.  Quinta is being treated as if she has a defeasible duty to go to the party.  She can't just decide not to go because she does not want to go.  She needs to give some excuse or justification.  (That's what it means to have a defeasible duty to do something - you have to do it unless you have a good excuse.)

Often we treat decisions about how to feed babies this way.  You can't just use formula just because you want to, you have to have some good excuse.  You can't breastfeed a baby for longer than six months just because you and your baby want to keep feeding, you have to show that it is nutritionally beneficial.  We treat women* as if they have a defeasible duty to breastfeed initially and then as if they have a defeasible duty to stop breastfeeding.  I've argued that this insistence on thinking about how babies are fed leads to all kinds of shame, guilt and judgment and stops us from supporting each other.  We need to stop assuming that women* need to justify their decisions about how they feed their babies.

Of course, how we feed our babies matters a lot more than whether we got to a friend's party, but it is also much more person.  Women shouldn't need to justify a decision not to feed or to keep feeding to others.  Of course, there are a lot of people who do have "excuses".  8/10 women in the UK stop breastfeeding before they wanted to.  We need to improve breastfeeding support - and attitudes towards breastfeeding - so more women are able to feed the way they want to. But the background assumption that you need an excuse to stop can get in the way of getting women who don't want to stop help.  Because women feel like they have to justify their decisions, attempts to find out if they need more support end up feeling like judgment. To read more about this, see my page on infant feeding and philosophy.

Second, it is an amazing illustration of the argument made in this paper by David Velleman, arguing that we should not recognise a right to die, because sometimes having a choice can put you in a worse position.  Sometimes if you have a choice to do something, you end up having to justify choosing not to do it.  You don't get to just do it for no reason anymore.  Velleman worries that if we recognise a right to die, people will end up needing to justify their decision to carry on living.  They will need to justify their continued existence.  This can be deeply harmful.  Velleman actually uses the example of an invitation to a dinner party to illustrate his point.  I still think that we should recognise the right to die, but Velleman's argument certainly adds a really interesting dimension to the debate.  It shows we need to make sure that choosing to die doesn't become a default so that people have to justify their choice not to die.    





*I say 'women' and talk about 'breastfeeding' because this is very much a gendered issue.  However, obviously not everyone involved in deciding how babies are fed identifies as a woman.  

[Picture:  just a stock photo of a very sweet looking baby].

I'm supposed to be writing a paper, but I just got an email with a link from the NCT and I liked it so much, I felt compelled to post about it on Twitter, but then I had too much to say for 140 characters, so I decided to write a blog post.

Why did I feel so strongly about this email?  How we feed our babies is such a tricky issue.  There is a lot of guilt, shame and judgement floating about. Since I have started working on the philosophy of infant feeding, I've talked to a lot of women about their feeding journeys.  I've heard women talk about feeling like a failure for using formula and of the devastating effects this can have on their wellbeing.  I've heard woman feel unable to leave the house because they are too worried to breastfeed in public.  I've heard women on both sides feeling unsupported and miserable.  How we address this issue is so important for the well-being of women and babies.  It made me very happy that the NCT got so much right. I think it is really important to highlight good practice.

The email was the monthly NCT Matters.  I get this email because like so many other parents, I joined the NCT in order to attend their antenatal courses before the birth of my first child.  In the Editor's Welcome, it said:  "Earlier this month, it was World Breastfeeding Week (1-7 August). We know everyone's experience of feeding their baby is different but support and reassurance is always important. We share useful tips and information about feeding for all new parents." [Click here to see the page.]

Right from the start, they acknowledge that all parents need support.

As you will see if you click on it, the link leads to a page called "Feeding: your questions answered."  It contains a lot of helpful information about holding your baby when breastfeeding, expressing, but also a section called "Can You Tell Me About Formula?".

The section begins by noting the variety of different ways of feeding a baby, exclusive formula, exclusive breastfeeding or combination feeding (both breastfeeding and using formula).  This is important because combination feeders can feel invisible - as if they don't fit in either 'group'.

They then reiterate their support and lack of judgment about how you feed your baby:  "This is a personal decision and will depend on individual circumstances."  This is really important.  Women often feel as if they have to justify their decisions about how to feed their babies. You might feel as if other people are entitled to blame you for not breastfeeding unless you have a 'good enough' excuse. You might feel like you have to explain why you are 'still' breastfeeding.  But you don't have to justify how you feed your baby to anyone. (For more on why there is so much mistaken judgment surrounding infant feeding see here.)

Next they include the option of support through their breastfeeding helpline for those thinking of introducing formula because breastfeeding isn't going well.  This is crucial because the UK has a massive 'disappointment rate - 8 out of 10 mothers who stop breastfeeding in the early weeks do so before they planned.  (For good discussion of this, see here.)  We seem to be in a very difficult position where two bad things happen. On the one hand, some mothers feel as if they have no option to use formula when this simply isn't true.  In fact, some mothers complain that they are pushed to use formula as soon as they report any difficulty.  On the other, many mothers feel as if they are pushed to keep breastfeeding and long for 'permission to stop'.  It is crucial to support women so they do not needlessly stop breastfeeding before they want to while ensuring no mother feels that she isn't 'allowed' to stop.

The next paragraph offers support to those who are 'thinking of introducing formula for other reasons'.  There is a lot I like about this.  First, it is wonderful to see acknowledgment that mothers can have other reasons that affect their decisions about how they feed their baby.   This fights back against a tendency to assume that it is only okay to use formula if you are physically unable to breastfeed.  I also like that there is an offer for practical support about how to use formula or to talk through the best option for your 'individual circumstances'.  The implication seems to me to be that help is available if you want to discuss your decision to introduce formula, but, equally, you can just talk about how to do it without needing to justify your decision.

There are also links to further pages on introducing formula milk and on combination feeding.  The page on introducing formula milk has helpful information about what's in formula milk, whether there are different types and whether the brand makes a difference.  This is so important because many parents report feeling uninformed and in the dark about formula.  

Now after so much fulsome praise, you might be wondering if this page is sponsored by the NCT.  It's not.  I'm also not on the NCT payroll.  As I said above, my first experience of the NCT was as a pregnant woman attending an NCT antenatal class.  I've also talked to several people within the organisation about infant feeding shame and guilt and am working with Heather Trickey from the NCT on a project to produce some resources to help people feel good about their infant feeding journeys.  So I feel like I have some sense of how hard they are working on getting their infant feeding messages right, but that I'm not linked with them in a way that makes me biased. (Or makes this blog post speak for them.)

Note some comments have been deleted at the request of the commentator.  This may have lead to some replies also being deleted.

To coincide with World Breastfeeding Week 2016, we will be holding virtual versions of our Breastfeeding Dilemma Workshop at 10am and 4pm GMT on Tuesday 2nd August 2016.  

The Breastfeeding Dilemma:  how do we encourage breastfeeding and support women in doing so, without subjecting those who choose not to breastfeed, or are unable to do so, to shame and guilt with potentially devastating consequences? 

We explore philosophical mistakes in the way we talk and think about infant feeding choices and the impact pressure to breastfeed can have on maternal health and the experience of new motherhood. 

​To join in,

(1) Listen to the Introduction to the Virtual Workshop (recording available here, transcript available here.)

(2)Have a look at the abstracts, recordings, and links to papers which can be found here. (You can look at as much or as little as you wish but I'd suggest beginning by listening to the Overview of Talks.)   

(3) ​Look at the discussion questions, available here.

​(4) Take part in the discussion in the comments section below and follow along as others comment.  I'll be here to respond from 10-11am and 4-5pm (and hope lots of other people will be too), but if you can't make it then, you are still very welcome to post and I will get back to you.

(5) Fill in our feedback form to let us know what you thought about the workshop. ​

Note:  If you are joining us for the scheduled discussion times,  you may want to do Steps 1-3 ahead of time.

Today is an exciting day in the breastfeeding world.  The All Party Parliamentary Group (APPG) on Infant Feeding and Inequality has held an action packed meeting.  I’ve been following the twitter stream avidly (twitter.com/APPGIFI)
 
Although many, many fascinating issues have been raised, I’d like to pick up on a couple which resonate particularly with my own research in the Philosophy of Pregnancy and Early Motherhood.
 
Early in the day, Sally Dowling tweeted a slide from Sally Etheridge’s talk asking if feeding babies is personal or societal.   The slide points to reasons to see it as a societal issue (majority want to breastfeed; Breastfeeding as a public Health priority) but also reasons to see it as person, including worries about making women feel guilty. 

Emma Pickett (@makesmilk) tweeted that on Thursday UNICEF’s BabyFriendly campaign will launch a Call to Action arguing that government action is needed and that feeding choice is not about pressure on women

​I think my work on breastfeeding and the reason/ duty distinction is relevant here.  We can have a reason to do something without a duty to do it.   Reasons make a course of behaviour a good one; while duties leave us liable to guilt and blame if we fail to comply without a good justification.  Women do not have a duty to breastfeed: this means that guilt, blame and requiring women to justify not breastfeeding are utterly inappropriate.  Nonetheless, the huge benefits of breastfeeding mean women have reasons to breastfeed.  And society has a duty to support them in doing so, whether that is through information, practical support or simply defending the rights of women to breastfeed in public.  So infant feeding can be a societal matter without licensing pressure on individual mothers. 
 
Infant feeding is an emotive subject.  Many people do make the mistake of assuming that because breastfeeding is so beneficial, women should breastfeed and are bad mothers if they don’t do so without a good enough excuse..  (Just take a look on social media if you want some examples!)  At other times, someone who just wants to inform and support may be perceived as pressuring or condemning.  That’s because this mistake between reasons and duties, the mistaken assumption that if something would benefit her child, a mother has a duty to do it and can be blamed if she doesn’t, is so common in thinking about maternal behaviour.  So we need to be aware of this when promoting and supporting breastfeeding.  We need to know that women are surrounded by guilt.  But we need to find a way to convey that when we talk about the benefits of breastfeeding, we aren’t implying there is a duty to breastfeed. 

It is National Breastfeeding Celebration Week, and boy could we do with some celebrating of all types of infant feeding!  You only have to boot up your computer or flip open your smartphone to see the guilt, shame and judgment surrounding decisions about to feed a baby.  Mothers (and in this case the blame falls squarely on mothers because men have a get-out-of-guilt free card: they don't have the right kind of breasts*) who feed their babies formula are hounded on social media, told that they are 'poisoning' their babies, that they are lazy or selfish, they are handed cards in cafes or feel like they have to lie to health visitors and midwifes to avoid seeming like bad mothers.  Mothers who breastfeed are fine - so long as they stay at home,  under cover and silent.  If they breastfeed in public or dare to post a 'brelfie', they are exhibitionists/ show offs/ rubbing their achievements in the face of those who can't or decided not to breastfeed.  A large number of sociological studies confirm this: whatever infant feeding decision mother make, they are likely to be prey to feel negative moral emotions.  Guilt is overwhelmingly associated with formula feeding while the lucky breastfeeding mothers get a side order of shame with their lactation cookies. It's a mess!  

But what if philosophy could help?  Perhaps surprisingly, I am convinced that sorting out some philosophical mistakes in our thinking about maternal behaviour can help with all this negative emotion.  Drawing a distinction between 'moral reasons' and 'defeasible duties' can allow us to support and celebrate breastfeeding without condemning those who do not breastfeed to guilt and judgment.

One of the problems here is the assumption that saying that breastfeeding is good and worth doing implies that those who don't breastfeed are less good or failures. Suppose we celebrate breastfeeding.  Suppose we say that breastfeeding is beneficial for babies, or that it is a wonderful bonding experience.  Suppose we congratulate those who struggle to breastfeed and get through the cracked nipples and bad latches and reach the stage where they can breastfeed with one hand, read to a toddler with the other and groom a pet with a comb held in their teeth - all at the same time.  Why does it seem that when we do this, we're saying not breastfeeding is bad? 

I think part of it is that we are confusing two ethical ideas: reasons and defeasible duties.  Defeasible duties are things that you MUST do unless there is some overriding reason not to.  They are associated with requirements to justify and with negative emotions like guilt and blame.  If I fail to live up to a defeasible duty, then I can be called upon to explain why:  if I can't produce a darned good justification or excuse, then I'm in line for guilt and blame.  I think we often treat mothers as if they have a duty to breastfeed: we get to ask them to defend their decision not to breastfeed and if they can't produce a good enough defence ("my nipples fell off!"), then we lay on the blame and guilt.  But, in general, opportunities to benefit give rise to reasons not duties.  It's great to run a marathon for Cancer Research, but no one gets to demand that I justify my failure to do so or to make me feel guilty if I don't.  Even if we think that mothers have a special duty to benefit their children, this can't mean they have a defeasible duty to do every thing that might benefit their children.  That would be intolerably demanding!  So recognising the benefits should mean that we see reasons rather than defeasible duties to breastfeed.

What does that mean?  Well, let's go back to that marathon runner.  We don't think that she's silly or crazy for spending hours training for the marathon.  She can post a photo celebrating her run online without anyone saying that she's non-runner bashing.  We might put community resources into helping her run.  All this is because she has a good reason to run.  And women have good reasons to breastfeed - and to celebrate their breastfeeding journeys.  But we don't have duties to breastfeed, and this means that we don't get to judge other people for not breastfeeding or demand that they justify their decisions not to breastfeed.  And whether you breastfeed or not should not be seen as determining whether you are a good parent - just like whether you run a marathon for Cancer Research shouldn't determine whether you are a good person.  Mothers (and fathers) do so many different things to benefit their children.  Breastfeeding is great - but parenting is so much more than how you feed your children. 

Given this, you might wonder whether we should be celebrating breastfeeding mothers.  Shouldn't we be celebrating all the mothers: the formula feeding mothers? the stay at home mothers? the working mothers? the Waterbabies mothers and the Sing&Sign mothers?  Yes we should celebrate all those groups.  But breastfeeding can be really hard, and there is still a lot of work to be done both in policy to ensure that all breastfeeding mothers get the support they need and when it comes to public attitudes to breastfeeding.  So it worth dedicating a moment (or a week) to celebrate individual journeys and to lobby for change.  But we still face the challenge of fixing those mistakes in the way we think about motherhood, so that we don't assume that if breastfeeding benefits babies then mothers have a duty to breastfeed.  It's that move that makes breastfeeders be seen as show-offs and formula feeders as failures.  And that isn't helpful for anyone!


*It is actually an oversimplification to say that men don't have the right kind of breasts, because of course transmen may be able to chestfeed and there have have been cases of male lactation.  

I'm celebrating!  

I have been awarded a 5 month non-residential research fellowship at the Experience Project to work on my project "Mother Knows Best: Pregnancy, Applied Ethics and Epistemically Transformative Experiences."

I'll be exploring whether there is some morally relevant knowledge that is accessible only, or primarily, to people who have been pregnant - and the ramifications for the debate about abortion and in applied ethics more widely.  

The project springs from my dissatisfaction with the philosophical literature on abortion after pregnancy. Although, I've been interested in the ethics of abortion for many years, after being pregnant most of philosophical literature suddenly appeared cold, bloodless; it did not reflect what pregnancy is like.  At the same time, I noticed how difficult it was to explain what it is like to be pregnant to someone who had not had that experience.  

This is worrying: could there be knowledge which is crucial for ethical debate on issues such as abortion which is only accessible to people who have been pregnant?  How should philosophers respond to this? 

There are wider implications for it seems that there may be similar missing information in debates on famine relief, just war theory, etc. Each of these involves experiences we may struggle to grasp without undergoing.  At worst, our very ability to do applied ethics is threatened.  My conclusion, however, is envisaged to be optimistic. 

​I envisage proposing a system of ‘due care’ in considering relevant experiences that makes meaningful work in applied ethics possible.


I'm so excited, both about my own project, and to be part of this fantastic wider project!

In this interesting piece from Slate, the author argues that promoting breastfeeding as 'natural' may be fuelling anti-vaccine fears.  Linking the 'natural' and the 'good' gives the impression that what is unnatural - like using science to protect our children against life-threatening diseases -  is bad.

​This seems right to me.  Philosophers have long objected to assumption that what is natural is what is good.  See for example, this video explaining Moore's 'naturalistic fallacy' and this more focused version.)  Many bad things are apparently 'natural': disease, death, violence and anger.  Many good things are 'unnatural': medicine, the internet, universities,etc.  Moreover, when we consider that humans are part of nature and naturally technological, the very definition of natural seems questionable.

However, I can understand the motivation for stressing the naturalness of breastfeeding.  First, breasts have lots of amazing features (for example, the way in which they adjust the content of the milk to fit the baby's needs) and it seems likely that this is connected to the way in which breastfeeding has evolved through the marvellous process of natural selection.  

Second, there is a significant need to normalise breastfeeding, so that breastfeeding mothers can get on with their days and go out and about without being forced to cower in toilets or lurk under a sheet every time their infant needs a drink .  When women who breastfeed in public are told that they are 'disgusting' or 'attention seeking' then we might well want to respond by pointing out that they are doing the most natural thing in the world.

Again, the difficulty is how to encourage and support breastfeeding without either stigmatising those who make other feeding decisions or having other unintended consequences.