Sunday, December 17, 2006

Television campaign strategies ineffective in promoting breastfeeding due to failing to employ social and behavioral science principles - Ellen Kim

Babies are born to be breastfed. Although extensive scientific research and pediatricians nationwide overwhelmingly agree over the benefits of breastfeeding, only 72 % of new mothers in the United States attempt to breastfeed and only 13.9% breastfeed exclusively for 6 months without supplemental foods and liquids (Figure 1, 1). The United States Breastfeeding Committee and the United States Department of Health and Human Services Office on Women’s Health share the responsibility of addressing the disparities in breastfeeding rates. Over the past year, these two vital organizations have developed television public service announcements that address the importance of breastfeeding by suggesting that not breastfeeding your baby is reckless. To illustrate, the “Ladies Night” spot opens with a middle class African-American pregnant woman vigorously riding a mechanical bull followed by text on the screen that reads: “You wouldn’t take risks before your baby’s born.” What ensues is the sound of a fall in the form of a clump and the final set of text that reads: “Why start after.” In another television public service announcement known as the “Log rolling” spot, similar recklessness prevails when two Caucasian middle class pregnant women participate in a log rolling contest. Once again, the shock value of the commercial leaves any audience speechless, for who would ever imagine any mother riding a mechanical bull, or much less participate in a log rolling event? Following both public service announcements is the tag line on the screen: “Babies are born to be breastfed.”
In an industrialized world where roughly 60% of the women form part of the working population (2), the practice of breastfeeding is invariably more complicated than what is portrayed in recent television ads. The campaign strategy of national breastfeeding awareness ads maybe ineffective because it conveys a guilt-ridden rhetorical message, sends misinformation, and fails to promote the importance of breastfeeding.
In the media there are effective and ineffective ways to employ fear. Media persuasion can facilitate in changing attitudes. However, inducing too much fear interferes with the information processing (3). In consequence, the audience ignores the relayed message (4). The inappropriate utilization of fear appeals may impede the importance of breastfeeding message delivered to the audience. In an event in which the fear seems highly unlikely, it deters the audience from processing the public health message and to focus more on the derisive ad and the hazardous scenario that evolves before their eyes. To a certain degree, using an unrealistic example of a pregnant woman riding a mechanical bull or log rolling to describe the dangers of not breastfeeding, produces an almost fatuous feeling to the issue at hand. Breastfeeding your child is a serious issue and one that should be addressed in the same fashion. Furthermore, research suggests that depicting the severity of health consequences fails to impact an individual’s intention to change the recommended behavior (5).

Studies have shown that the more similar the source (communicator) is to the audience (recipients) in terms of age, gender, and ethnic background, the greater the delivery of the message (4). Data from the 2005 National Immunization Survey regarding Breastfeeding Practices further reveals that non-Hispanic black or African American and socio-economically disadvantaged groups have the lowest breastfeeding rates (1). The television campaign appropriately used a non-Hispanic black woman in one of their ads, but in the other ad used two Caucasian women. Next, they used middle class women when data suggests it is the socio-economically disadvantaged groups who have the lowest breastfeeding rates. In order for public health officials to reach this target audience, they need to present actors who portray the target audience. In the development of public health messages, officials need to be aware that emphasizing the similarities between the communicator and audience increases the effectiveness and acceptance of the message (6).

Research also suggests that individuals are likely to resist the information if they are called to learn something that contradicts what they already know. Atherton asserts that cognitive dissonance occurs when “discomfort [is] felt at a discrepancy between what you already know or believe, and new information or interpretation” (7). The television ad uses an inappropriate and inapplicable analogy by equating a fictionally dangerous activity with failing to breastfeed an infant. The false implication relayed is that feeding an infant formula is as dangerous as bull riding or logrolling. Feeding misinformation is counterproductive in relaying the message to the audience; consequently, the audience is unlikely to accept the message and change their behavior. Instead, the campaigns should align with the American Academy of Pediatrics recommendation that the media should portray breastfeeding as positive and normative (8).

Maslow’s Hierarchy of Needs theory states that the basic physiological needs of an individual must be met before he or she self actualizes the need to attain one’s highest potential (4). The needs that need to be met include physiological, belongingness and love, safety, and esteem needs. When these needs are met, then the individual is ready to motivate him/herself to grow and find self-fulfillment (9). However, the underlying message from these television campaigns is that women who do not breastfeed are going against nature and what is deemed as healthy in the community. Guilt-ridden campaigns are counterproductive in making women feel accepted and possess self-esteem; in so doing, these ads may cause women to live unconstructive lives and engage in unhealthy behaviors. Guilt may sometimes serve as a catalyst to become proactive but, on the other hand, it can also lend itself to motivate the wrong action. Any manipulation of inducing feelings of guilt runs counter to the value of noninterference or liberty (10). Additionally, women need to develop high self-esteem so that they make positive health decisions. Research confirms that “individuals with high self-esteem exhibit well-integrated behavior…such individuals are assumed to make optimal use of the information given them concerning health matters, and to perceive the consequences of certain actions for their health” (11).

According to Chin and Benne, there are three basic strategies for effecting change and they include the rational-empirical, normative re-educative and power-coercive strategy (12). The television ad campaign used the normative re-educative approach to employ tools such as the fear tactic and guilt ridden messages. It is essential to provide all women basic information about the importance of breastfeeding, along with the power to make informed choices. In certain situations the normative re-educative approach is appropriate, but not in a situation where women are left with low self-esteem, guilt and fear.

Women who choose not to breastfeed and those, who cannot, for a variety of reasons, are left feeling ridiculed. Although research has suggested breastfeeding is superior to infant formula, there are also studies that reveal contraindications to breastfeeding, which include: medical disorders, viruses, and medications that a pregnant woman may currently be using (13). Women who are unable to breastfeed, due to economic reasons or other deficiencies, should not be left feeling ashamed or inadequate. Those feelings of inadequacy will not translate to accepting the recommendation that breastfeeding is best for their baby. These ads do not address the major barriers among poor women. Not many women are fortunate enough to afford the 12 weeks of unpaid vacation mandated by the Family and Medical Leave Act. It is imperative that the economic, social and cultural needs of a pregnant woman are met as well as ensuring that the proper avenues of support and involvement from society and health care professionals are made available to achieve an increase in breastfeeding rates in the US (8).

The success of any public health campaign depends on examining the broader picture. Television campaigns can effectively promote breastfeeding by incorporating the epidemiology of breastfeeding armored with the understanding of the cultural, medical, economic and emotional needs of mothers, and approaching interventions using social and behavioral sciences. Conversely, utilizing the fear tactic and conveying guilt-ridden messages are ineffective in meeting women’s self esteem; thereby, the ad fails to promote the importance of breastfeeding among the target audience. In general, breastfeeding is necessary for optimal infant and child health, growth and development, but cannot be achieved without the continued societal and government support, education, collaboration and positive enthusiasm from the environment (8).


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American Academy of Pediatrics Policy Statement: Breastfeeding and the use of human milk. Retrieved November 15, 2006 at;115/2/496#T1

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Chin, R. Benne KD. (1976). General strategies for effective change in human systems. In Bennis W et al. (eds): The Planning of Change (3rd edition), pp. 22-45.

Chandran, L., Gelfer, P. (2006). Breastfeeding: The Essential Principles. Pediatrics in Review. Vol. 27(11): 409-417.


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