In which I rabbit on about informed choice...

Informed choice requires two things – information and choice!

Seems a bit self-evident really. So why, when it comes to infant feeding, is giving people information – and pointing out inaccurate information (a quick thank you and link to the wonderful Dispelling Breastfeeding Myths here – whose mission is to do just that!) – so often seen as an attempt to curtail women's choices? And why do people seem to think that because some people don't have a choice, the information should be suppressed or downplayed? Or perhaps that it must be incorrect or exaggerated?

If a woman chooses to formula feed, that is her right. She should not be bullied into breastfeeding.

If a woman chooses to breastfeed, that is her right too. She should not be bullied into formula feeding (regardless of whether or not she is experiencing difficulties establishing breastfeeding).

Nevertheless, it is only fair that both of these women are made aware of the genuine risks vs benefits of her choice – and how it may affect her health or that of her baby. They should also be made aware of the other alternatives to breastfeeding or formula – donated milk or her own pumped milk. There are also options that are so far from ideal that they aren't even considered options, such as skimmed milk, coconut milk, fruit juices... Technically, these are all choices that could be made – it's OBVIOUS that any health care professional would criticise a mother's choice to feed any of these to her newborn infant. But, hey, would they rather the baby starved? 

 

It is impossible to make an informed choice if you do not know all the options, or you do not have sufficient information about the options, or you cannot realistically make a different choice.

If you have a choice between spending £1 or £2 on the same item, spending £1 is a good idea, the WISE choice. If someone then tells you that you could've spent 50p instead if you'd been in a different shop, that doesn't negate the fact that you WEREN'T in a different shop (and had no way of knowing about the price in that shop, and possibly couldn't have made it to that shop even if you HAD known). Nevertheless, responding to this information with 'I couldn't buy it for 50p, so I suppose you'd rather I'd spent £2?' or 'I know 50p is cheaper, but £1 isn't any more expensive', or telling others considering making a similar purchase 'I spent £1 and I didn't go bankrupt, so it doesn't matter if you pay £1 instead of 50p' is just nonsensical.

Or a more detailed metaphor:  

The local café has 3 sandwiches on the menu: ham, cheese and rabbit.

Andy and Belinda have never eaten rabbit in their lives. Andy elects to try it, while Belinda plays it safe with cheese. These are choices, but not truly informed choices.

Chris is not told that there is rabbit on the menu. He chooses cheese over ham – it's a choice, but it was made without all the information. Not informed.

Dave is a vegetarian. While he is technically choosing the cheese sandwich (after all, it is his choice to be a vegetarian, and if he doesn't want cheese he could go elsewhere for his lunch), it is hardly a fair choice. It's informed, but his choices were hugely limited.

Ellie is told they have run out of rabbit. She wanted to try the rabbit, but settles for cheese. It's her choice, but between cheese and ham – her choice was informed, but still limited.

Now – suppose that the café is visited by a food critic, who says that, while the cheese and ham sandwiches are passable, the rabbit sandwich is the greatest thing ever. Does this criticise the CHOICES that Chris, Dave and Ellie have made? Surely it can't, since none of them really had the option of a rabbit sandwich! The only people who had that option – Andy and Belinda – had no idea at the time that it was recommended, so it doesn't even criticise Belinda's choice (or for that matter congratulate Andy's), all it criticises is...the food! So, how can the solution possibly be to not give this information to others?

It is indeed rude, insensitive and pointless for Andy to tell all his friends how great the rabbit sandwich was if they won't be visiting the café again. It would be fairly unpleasant of Andy to specifically tell Dave about how great the rabbit is. (Rather like deliberately savouring a cake in front of someone on a diet!*) But Dave being a vegetarian is not a good enough reason for Andy to avoid mentioning that the rabbit is excellent to people who ARE planning to visit the café, even if it happens to be in Dave's hearing.

The fact that a vegetarian can only have the cheese is irrelevant to how good the rabbit is. It doesn't help vegetarians if omnivores decide to eat cheese instead of rabbit. In fact, if you want to help vegetarians get the best possible sandwich, surely advocating for higher quality cheese, or even better - rabbit-flavoured tofu – would be a far more useful solution than bitching about the rabbit-eaters trying to persuade other omnivores to eat the rabbit! In short - giving people reasons to try the rabbit does not remove cheese from the menu.

(* Have I just put a simile inside the metaphor? Blimey...I should wrap this one up)