It’s not just a medical topic: disputes over breastfeeding in the field of social science
The WHO, UNICEF, and other prominent health organizations launched global initiatives to protect, promote and support breastfeeding (Schubiger, Schwarz & Tönz,1997). The contemporary emphasis of medical research focuses on exploring the factors influencing breastfeeding (Hector, King & Heywood, 2005) and discusses how to foster these health beliefs and take other intervening measures (Kamran, Shrifirad, Mirkarimi & Farahani, 2012). And it also discusses how to build a system for the overall evaluation of breastfeeding (Pérez-Escamilla, Curry, Minhas, Taylor, & Bradley, 2012), among other subjects.
Beyond the medical and health research fields, the social attributes of the maternal body, the mother-infant relationship, and other essential factors have also made the association between socioeconomic status, medicalization, and breastfeeding gradually accessible to social science research (Wallace & Chason, 2007). Some social science researchers have focused on how to increase the breastfeeding rate by seeking to identify the essential roles of women, family structure, and the social relations involved in breastfeeding-related decision-making and explore how to build a social support system to promote breastfeeding (Prates, Schmalfuss & Lipinski, 2015).
However, critical research opposing breastfeeding originates from the feminist perspective in sociology (McCarter-Spaulding, 2008). Female scholars have realized that many women have seemingly received much social concern and support for their reproductive health and feeding behavior. At the same time, in the tension between the feeding practice and the health suggestions for women as providers, various difficulties have typically been neglected (Gatrell, 2007). Infant health and welfare should dominate in promoting breastfeeding. The theoretical presupposition that lacks the perspectives of women allows no means for females to claim their rights and subjectivity ahead of the public interest in “population health and social development.”
Consequently, there exists a moral hegemony in the discourse, namely that mothers who don’t breastfeed or whose breastfeeding falls short of the public health standard often develop guilt over being seen to violate a universally accepted morality (Williams, Kurz, Summers & Crabb, 2013). In some sense, the dispute over breastfeeding reflects the conflict between the contemporary social structure and the experience of motherhood. For example, some studies have discovered that most women suffered a setback and anxiety due to the lack of knowledge and skills about feeding, while a few women could unhurriedly take effective action to address various issues arising from lactation (Xu & Liu, 2017). From a super-macroscopic perspective, some studies have suggested that females remain confronted by somatic and childrearing anxieties from pregnancy to lactation to childrearing (Francis, 2012). Due to their traditional role, status, and division of labor, females are more connected with their families, overwhelmed mainly by childbearing and childrearing, household duties, and emotional control (Greenstein, 2000).
With the potential conflict between infant health on the one hand, and women’s quality of life on the other, studies on breastfeeding hold different views. In China, the professional discussion on breastfeeding focuses on its health effects on mothers and babies. Moreover, most professionals believe in encouraging breastfeeding and relying on scientific arguments to increase the breastfeeding rate. The studies aim mainly to take practical nursing and intervening measures to guide and encourage nursing women who started breastfeeding to carry on doing it (Yu, Ruan & Wang, 2020). However, they are rarely concerned with the consequence of lactation on nursing women’s social life. Conversely, in the West, although the potential negative impacts of breastfeeding have received attention, few studies are concerned with the influential dimensions of breastfeeding, such as moral experience, social mentality, and social media information (Hausman, 2007; Ryan, Bissell & Alexander, 2010).
Beyond the personal: discussion of breastfeeding on social media platforms
The belief that “breast milk is optimal” has been constructed from modern breast science research and traditional concepts. The time and exclusiveness of breastfeeding created female status and value (Xu & Liu, 2017). Under the weight of popular opinion and scientific guidance, any feeding style other than exclusive breastfeeding over the long term was seen as a significant moral deviation (Lee, 2008). Family members, relatives and friends, social organizations, and even the government developed a holistic discourse upholding breastfeeding out of a desire to promote maternal and infant health, summed up by the principle that “the mother’s milk is optimal.”Researchers know that breastfeeding is no longer a personal decision. This series of acquiescent discourse systems, ethics, and potential risks have perpetuated the disputes over breastfeeding.
Due to the openness of social media, the topic of breastfeeding is widely discussed and debated. On the one hand, the upgrade in health quality requirements has brought the cost, process, and science of childbearing to the attention of modern parents-to-be. They are accustomed to acquiring specialized reproductive health-related knowledge, enjoying accessible and affordable e-health resources, and seeking support in cyberspace both during pregnancy and after childbirth (Moon, Mathews, Oden & Carlin, 2019; Baker & Yang, 2018). The cyber community, constructed with complete access to Chinese social media, has provided space for convenient discussion by pregnant women. Across time and space, mothers of newborns and pregnant women gather to discuss whether and how to implement breastfeeding based on their personal experience (Zhou, 2019).
On the other hand, medical organizations, health communication organizations, and other stakeholders perform diverse functions such as disseminating reproductive health information (Ippoliti & L’Engle, 2017) and providing professional consultancy about breastfeeding (Bridges, Howell & Schmied, 2018). In the routine popularization of science, they construct the cognition and behavior of the masses toward breastfeeding (Ke & Ouyang, 2018) and offer professional, authoritative opinions in the event of critical social emergencies (Ventola, 2014).
The discussion of breastfeeding-related topics among women of childbearing age, new mothers, and health organizations on social media platforms has become a microcosm of the discourse about health topics on the internet. In social media’s environment of co-creation and joint participation (Hether, Murphy & Valente, 2014), an equal relationship has been established between educators and educatees carrying out bilateral, balanced public discussions (Hu, 2012).
As a critical channel for information, social media transfer risk knowledge to the public and construct social cognition, playing a pivotal role in the process where people develop their attitudes towards health. In China, a country where the use of social media is ever-growing, the academic contribution to discussions of health generally and breastfeeding in particular needs to be increased.
Professionals vs. Laypeople in Perceiving Breastfeeding Issues
Extant studies have observed the difference between professionals and laypeople in dealing with risky issues. One viewpoint holds that laypeople are predisposed to rely on hypothetical, subjective, and emotional clues (DuPont, 1980; Covello, Flamm, Rodricks & Tardiff, 2012) due to the lack of relevant scientific knowledge (Stoutenborough, Sturgess & Vedlitz, 2013; Ho, Xiong & Chuah, 2021), while professionals typically tend to treat risks and uncertainties from analytical, objective, and rational perspectives. Therefore, laypeople are accustomed to magnifying risks, while professionals may underestimate risks and underscore the advantages of some controversial technologies (Kasper, 1980). Another viewpoint contends that professionals and laypeople are consistently susceptible to their emotions, world outlook, and values when forming their opinions on controversial issues (Paul, 1999; Bouchez, Ward, Bocquier, Benamouzig, Peretti-Watel, Seror & Verger, 2021). Professionals do not warrant having superior scientific literacy than laypeople regarding specific medical topics (Chen et al., 2019; Alshammari, AlFehaid, AlFraih & Hisham, 2014).
Regarding breastfeeding, an opinion gap still exists between professionals and laypeople remain. Instead of promoting and popularizing aqueous milk, milk powders, and other products, professionals, including scholars and experts in social media, are more inclined to encourage breastfeeding and actively provide scientific support aimed at boosting the rate of breastfeeding. Sharing about alternatives to breastfeeding and mixed feeding mostly comes from mothers. Next, experts are rarely concerned about the negative impacts of feeding on nursing women’s social life after the children have stopped breastfeeding. Conversely, the emotional and physiological negative impact of breastfeeding on nursing women is discussed more by laypeople. Some studies have demonstrated that a previous difficult experience in breastfeeding can significantly impact future thinking and decisions on breastfeeding (Larsen & Kronborg, 2013). After sharing their negative feeding experience on social media, mothers struggling with breastfeeding may influence other mothers’ decisions.
Breastfeeding is a contentious issue in China. Scholars, physicians, and mainstream social media are in a joint campaign to advocate breastfeeding. Contrarily, voices from we-media accounts on social media have depicted the shadier side of breastfeeding. However, the negative impacts of breastfeeding are more often discussed by the public on social media. How laypeople cognize and discuss breastfeeding and its alternatives has been understudied. Differing viewpoints of professionals and laypeople may not only lead to confrontation between social opinions but is also an important avenue for research. In the mediated environment, with the emergence of social media and the increase in internet access, the evaluation of mothers has been judged and intervened. Therefore, this paper adopts extensive data mining and content analysis methods to explore how women, health organizations, professionals, and other people on social media platforms discuss breastfeeding, what they have discussed about the topic, in what conversational style internet users have shared on this topic, and what kind of discourse structure is finally formed in the internet space.
Specifically, this paper attempts to address the following questions:
1. What topics are the focus of the discussion around breastfeeding/alternatives to breastfeeding on China’s social media?
2. What differences are expressed between professionals and laypeople on breastfeeding?
Question 1 leans to the explicit layer and focuses on the primary text features, whereas Question 2 leans to the implicit layer and targets the underlying thematic structures. By integrating both layers, this study delves deeper into the differences between professionals and laypeople regarding their views on breastfeeding and further detail the power structure of the discourse on breastfeeding on China’s social media.