Government vs. Private Efforts to Promote Breastfeeding: My Response to a Critic

I recently published an op-ed at The Hill entitled “Breastfeeding Controversy Shows Need for Private Efforts—Not Government Campaigns.”The piece came after U.S. ambassadors faced considerable criticism for attempting to block a World Health Assembly resolution calling for governments to devote more resources to promoting breastfeeding and to place more stringent advertising regulations on breastfeeding substitutes in developing nations.

Instead of criticizing politicians, I tried to address what I consider a more pressing question: Do we really want governments more involved in promoting global health efforts? My answer was no. To justify my stance, I provided peer-reviewed research indicating that government efforts to promote public health and improve living standards in developing countries have repeatedly failed. As an alternative, I provided evidence that private efforts to promote childhood nutrition (specifically breastfeeding) were more up to the task.

Calling for less government to solve pressing global health problems is usually an unpopular proposition, and I’ve received some criticism for it.

One such critic recently took to Twitter to argue that my piece contained three “misleading facts.” In this post, I respond to each of his criticisms. Because I do not use Twitter, I cannot respond to his tweets directly. Instead, I summarize each of his criticisms, link to the corresponding tweet, and respond:

Tweet #1 criticizes @realDonaldTrump (President Trump) and me for suggesting the World Health Assembly resolution calls to regulate access to breast milk substitutes. Instead, he notes the resolution calls to eliminate inappropriate marketing for these substitutes, which he considers a “big difference.”

I can’t speak for the President (@realDonaldTrump). However, my only remarks regarding marketing breastmilk substitutes were, “It [the resolution] also calls for more restrictions on advertisements for breastfeeding substitutes, especially baby formula.” But this is only half the story.

The resolution calls for both increased governmental efforts to promote breastfeeding and more stringent regulations on how milk-substitutes can be advertised in developing countries. Restricting marketing efforts for one product while promoting another substitute product, will affect access. It might be a “big difference” regarding how the resolution is worded or in policy intentions, but not for policy implications.

Tweet #2 questions my comparing governmental efforts to promote breastfeeding in developing nations to governmental efforts to promote public health and other standards of living through foreign aid and other development projects. He tweets the resolution focuses on national governments obligations to “protect, promote and support #breastfeeding” rather than bilateral aid efforts.

Mr. Mathisen is correct, the resolution doesn’t focus on bilateral aid. I did not intend to suggest this. Nonetheless, the immense resources behind repeated failures of governmental efforts to help developing nations achieve higher standards of living, including health-related outcomes, should serve as a cautionary tale for proposing yet another government-led effort. As New York University Professor of Economics William Easterly noted his book The White Man’s Burden, “The West spent $2.3 trillion on foreign aid over the last five decades and still had not managed to get twelve-cent medicines to children to prevent half of all malaria deaths.” Even local government efforts to promote public health frequently fail. Consider, for example, the U.S. government’s effort to combat the obesity epidemic. Despite considerable financial resources and policy efforts dedicated to the cause, obesity rates have increased.

Whether “governments have an obligation to protect, promote, and support breastfeeding” or not, a more useful starting point to address this issue might be to ask whether governments are even up to the task. I assert decades of evidence suggest they are unlikely to succeed.

Tweet #3 criticizes using La Leche League as an example of private efforts to promote breastfeeding, calling it “not pure private sector” and noting some affiliated organizations receive government funding.

I’m not sure what is meant by “pure private sector.” La Leche League does not receive any financial support from governments. It also began with the efforts of seven concerned woman and grew into an international organization dedicated to promoting breastfeeding. The Human Milk Banking Association of North America has a similar background.

My point was that efforts to promote childhood nutrition on a widespread scale do not require government. I do not dispute that other organizations aiming to promote breastfeeding receive government funding. But not all of them do. This is evidence that government funding is not necessary.

Ultimately, I believe many of the criticisms I’ve received stem from disagreements over means and not ends. I find the state of childhood nutrition in developing nations to be a pressing and often heartbreaking issue. I imagine my critics feel the same way. However, I am pessimistic that an additional call to action by governments will be fruitful. Instead, I am more optimistic that private efforts can provide solutions. The criticisms I’ve received for holding this view have not changed my mind.