SHE Pod Season 2 Episode 4: Kathryn MacKay on Breastfeeding and Public Health Messaging

3:37AM Apr 26, 2021

Speakers:

Kathryn MacKay

Lisa Dive

Keywords:

campaigns

paper

laughs

health promotion

breastfeeding

people

obesity

women

context

duty

mother

messages

children

roles

childhood poverty

addressing

thinking

podcast

kate

benefit

Hello, and welcome to the SHE research podcast. I'm your guest host today, my name is Lisa Dive. And today I'm joined by Kate Mackay to talk about her new paper, 'Mothers: The Invisible Instruments of Health Promotion', which recently came out in the Hypatia Journal. Welcome, Kate.

Thank you, Lisa. Thanks for being here.

I'm so looking forward to chatting about your paper with you.

Thank you. Me too.

Great. So I will just let's jump straight in. And why don't we start by asking you to give us the high level, the sort of elevator pitch summary of this paper.

Okay, so it's actually, oof, when you're on this side of things, it's actually hard to do. I think the elevator pitch of this paper is that I was living and working in Britain. And I was interested in health promotion campaigns. And I came across these different health promotion campaigns by the NHS and Public Health England that had to do with both sort of obesity, like body weight, and breastfeeding. And I had worked on obesity campaigns before, but now I saw a new overlap with breastfeeding. So the point of this paper was to start exploring that kind of overlap in the health promotion campaigns.

Interesting.

And to think about what they were saying about mothers obligations towards their children. And to... so I wanted to try to conceptualise what mother's duties actually are. And I'm not the first person to do that. So I was sort of continuing work in this area that others had started. Thinking about what it means to have a maternal duty to benefit a child. And whether or not these campaigns were in any way close to what mother's duties actually are. And in the paper, I argue that they're not, they're really off base.

Oh, okay. Right. So talking about your motivations for writing this paper or doing this kind of study, is that Is there anything you'd like to add on that?

Well, I guess my motivations were, and maybe we'll come back to this as one of the challenges. But my motivations, were seeing the campaigns and kind of thinking, 'well, that doesn't seem right'. You know, seeing, seeing the posters in bus stops or at train stations and thinking, 'that doesn't seem like a health message'. And that doesn't seem morally appropriate (laughs).

Right. Yeah, fair enough. It's so interesting to me that you chose that overlap between obesity campaigns and breastfeeding campaigns, because when I read your papers, something that really struck me was that it's kind of the work that you're doing here seems to sit at that intersection between personal responsibility in the context of obesity and general sort of cardiovascular disease, diabetes, all those kinds of public health, chronic disease campaigns, and then also at the, where they intersect with the kind of gender normative assumptions about the roles of women in the home in the family, and particularly in relation to child rearing.

Exactly. That's exactly it. And it's a strange and interesting intersection, because mothers become this locus for public health activity. And, and I don't think that I have done, you know, a complete job in this paper of capturing what that means.

Well, it's a huge topic.

Yeah it's a huge topic. So this is really just a start. But thinking about how, like you said, we've got this, we've got a narrative of individual responsibility for these, you know, so called and I say this was scare quotes around it "lifestyle issues", the modifiable risk factors for disease, and very value-laden views of mother's roles and women's roles within a family. So, deeply gendered assumptions about who feeds kids, how to feed kids. Yeah, and, you know, I think it, it gets really complex in the way that the obesity and breastfeeding health promotion worlds have now kind of collided. Is really, it really needs to be untangled and analysed.

Yes. Absolutely. So could you step us through some of the main points of interest or the argument that you make in this paper?

Sure. So the first part of the paper is actually to lay out the campaigns. And interestingly, I originally had this part of the paper later in the paper, but... and the first few times I presented the paper I didn't include PowerPoint, you know, I was I wasn't doing it with slides. And I realised that people wouldn't... didn't really believe me. If they couldn't see the campaigns I was talking about because they're really radically... I don't know what the word is... afronting.

Yeah, they're... they're quite weird and like, they're just bizarre. They try to put promote health or breastfeeding, or the roles and obligations in this context with that kind of imagery, I found it quite surprising.

Yes, me too. And since this is a podcast for the listeners, some of these campaigns involve just a picture of a purple party dress, or a picture of patent leather, red stiletto heels. Another of a woman dressed in like a going-out outfit, like a party outfit, she's wearing a short purple dress, and she has tights on and high heels. And they say things like, this one says 'she's not a model, she's a star', the one with the dress, and the high heels says 'be a yummier, mummy' (laughs). And these, so my first instance was kind of like, wow, what do I even say about these? And I realised, after getting some comments from people, I had to include the images in the paper first off, and I had to put them up front in the paper to set the scene.

Yes.

So the first move in the paper is really just to say, just to do a kind of a very light descriptive analysis of what's going on here.

Okay.

The kind of messages that might be actually sent by showing red high heels and saying 'be a yummier mummy'.

Yeah.

What, you know, what kind of message is that? So that's the first move in the paper is kind of to say 'well I don't think that these are health messages. I think these are very gendered messages, very sexually objectifying.' And also I argue that these images of mother are very limited. So they don't include women of any sort of diversity whatsoever.

No.

No, it's very strictly white, very thin,

Yes.

Middle class, woman, cisgendered able-bodied. And in fact, one of the images shows a person who probably has never even been pregnant

Yes, it certainly does look like it (laughs).

As a breastfeeding, breastfeeding helps you to lose weight quicker after birth, but it shows a very flat tummy. And it's just breasts to hips. So as well as being all of these other things, it's reifying of a woman's body, it just focuses in on the reproductive areas of a person's body. So that's kind of the first part of the paper to say, like, 'Look, this is what's happening in these things'. The second part is to say, 'Okay, well, if that's not the right way to think about mothers obligations, and I'm going to talk about mothers as a role, rather than as this very limited view of who can be a mother, what do these campaigns say about what what mothers need to do and who they are that does it?' So, I talked a little bit about what it means to claim that something is the cause of something else. So you know, to claim that breastfeeding or not breastfeeding is the cause of obesity, what, what's involved in that kind of causal claim. And then I further the final part of the paper is to examine, well, what kind of duty does a mother actually have in terms of a duty to benefit. And then I follow Fiona Willard and Lindsey Porter in their way of casting maternal duties to benefit as hypothetical imperatives to say, you know, this isn't a maximising term that would make sense.

Yeah.

It's that you have a kind of baseline duty to benefit your children. And there are lots of things that will fit into there. And you have a duty to do some but not all. And it's going to depend on context.

Yeah.

And it's a very, it's something that can be fulfilled in many different ways. There's no specific set of things that you do to benefit your children.

Yeah. And I thought that that way of understanding the maternal duty to benefit a child as a general thing, which is very contextual, that fits really well with the idea that context plays a huge role and environmental factors in the determinants of health. Absolutely, yeah. Yeah. I really liked that way of looking at it. It was great.

Yeah, I think so too. And I really think that it's the only it's the only way to make sense of what a maternal duty to benefit would be.

Yeah.

Yeah. Because even just to take a simple example, that I don't include in the paper, but you know, you can do all kinds of things, if we're taking the Kantian, you know, duty sense. Well, one of the duties is to develop talents, for example, if... does a mother have a duty to develop the talents and her children? Probably somewhat, but you can't send your child to a different activity every day of the week, because you'll actually be undermining their welfare.

Yeah, exactly.

(laughs). So it has to be a hypothetical duty, because you have to only be, you know, choosing certain of the things - it can't be perfect. You can't be... yeah, having to do the complete set at all times. T

hat's right. Yeah. So what about the challenges that you encountered in writing this paper?

I think the first challenge in writing the paper and I kind of hinted at this already was just sort of figuring out what to say about these campaigns, actually. I think I found that difficult because they just seemed so obviously unethical. And then it was kind of a challenge to figure out what would be interesting to say (laughs).

Yeah, how to pin down specifically, what is actually wrong with them.

Yeah, yeah. How to pin down specifically what's wrong in a way that is interesting and new, and not just sort of saying, 'well, this is obviously objectifying'. And I guess the part of the question that I still have, is, why would anyone create these thinking that they're promoting of health? But I think that... I think that part of the answer to that is just that beauty and sexually-objectifying ideals are still very powerful in our society. And that, yeah, I don't know, I guess that, that's still something that, you know, women do still value that.

Yeah. So, although as being a woman, I found them mildly insulting in that way (laughs).

Of course!

Like, why would you assume that that's what I would care most about? I found like, that's, yeah...

Yeah. No, I agree.

I found that that really uncomfortable.

(laughs). I agree. So I think, yeah, that was the first challenge of the paper was just sort of saying, I also found them uncomfortable - pin down why. Why is it, what is it that makes these uncomfortable? What, how do I give a good and you know, ethically, morally rigorous explanation for why these are uncomfortable, but also immoral. And you know, that they shouldn't be using these kinds of images or messages. And I actually really did find that tough, because having to kind of get over outrage to get into the intellectual space to uncover the different layers is sometimes just difficult work.

Yes, I think yeah, I think he did a great job of it, though.

(laughs).

I thought it was so insightful that this idea that women's bodies are instrumentalised for the purposes of other people, and all the other people like the men and the children and that the women bodies are not for themselves at all. They're just a tool of doing other things, which is sort of societal familial goods.

Exactly. And then the public health capitalises on that pre-existing instrumentalisation., really.

Yes.

To continue to use women as their instruments. Their instruments for delivering health promotion. Yeah.

So the campaign sort of uncovered this normative assumption that is deeply embedded in our, in our societies and in our culture. And yeah...

Yeah, I think so.

Pick that up and ran with it.

Yeah, exactly. So and I think if there was another, if there was another challenge with it, I think this, this paper actually did take me kind of a long time to write. And I think it is partly because it was challenging to find something new to say, which I don't know, that might sound, you know, odd or something like that. But the first couple of times I presented it, I didn't really feel like I was saying anything very new because campaigns... health promotion campaigns have been analysed quite consistently over the past little while, and even I mentioned earlier that, you know, I've worked in this area before on obesity campaigns.

Yeah.

And Quill Kukula has a very famous paper on breastfeeding campaigns. It's also an hi patient. I think that that might be from the early aughts, maybe around 2006. I think... I referenced it in this paper. But... so I was joining a literature that's established. And so within that, sometimes, you just sort of have to hunt around a little bit to figure out - what am I going to add? You know, yes, these campaigns are outrageous, but what am I going to add intellectually? To this discussion?

Yeah.

So I think that that took me a little bit of time as well.

Oh okay. So having gone through that process, what is it that you hope that people will take away from this paper?

Well, what I really, I think the thing that I repeat in different areas of my work is the importance of context, like you said, Iat the beginning, when we were talking about the kind of overview... that people aren't making individual decisions in a vacuum. People are making decisions in a very rich and complicated context.

Yes.

And that things like the social determinants of health have a really important impact on contextualising people's choices. So this paper, I see this paper adding to that discussion, and sort of saying, look, mothers play a central role in bringing up children, but they can't do it alone (laughs). They, you know, we need to if we actually want to improve health outcomes at the population level, we need to be addressing the population factors. And one of the things that I say in the paper is that there's a great deal of moral concern about whether or not women are breastfeeding, or whether they're feeding their children healthy home-cooked meals, but there's not as much concern about childhood poverty. Yes. So why? (laughs). And I hope that one of the takeaways from the paper would be, look, these health promotion campaigns, health promotion campaigns are okay as a complement to other kinds of public health messages, like you'd want to have a fully-formed suite of interventions.

Right.

One might be a campaign telling people that you're doing this intervention, but then you need to have other branches of it. So if you want to improve childhood nutrition, having campaigns might be an okay part of that. But you have to have those other layers as well.

Yes.

Addressing the complexity.

Yeah. And the sort of systemic factors that impact on the way that people make decisions. And live their life.

Exactly. Because if you're not addressing those, then you're really not doing anything. You're just... in some ways that can be like the government just ticking the box to say, 'we're engaged in this issue', but not really doing anything to help people.

Yep.

So I think that that would be the sort of takeaway message of this paper is, on the one hand... I guess, two. One, that these sorts of campaigns are unacceptable and really ought not to be pursued in any case.

Yes (laughs).

And then second, if you're going to pursue health promotion campaigns, they shouldn't look like that. And they should be complemented by things that really address the social determinants and things like you know, childhood poverty would be a start.

Yeah.

The overall context of people's nutrition and food options.

Yep.

To make a difference.

Grace.

Yeah.

Cool. That's a very positive, positive message.

Hopefully

Yeah, I hope so. Thank you so much, Kate. It's been such a pleasure to talk about your really interesting paper.

Thank you.

And thank you all for listening to this episode of the SHE Research podcast. You can find the paper that we discussed linked in this episode's notes, along with the transcript of this podcast. The SHE Pod is usually hosted by Kate Mackay, but today it's Lisa Dive. And it's produced by Madeline Goldberger. You can find our other episodes on Spotify, Radio Public, Anchor or wherever else you get your podcasts of quality. Thank you again for listening. Goodbye.