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Smoking, Breastfeeding and Public Health

Recently a DJ from an Orlando, Florida, radio station interviewed a midwife about nursing in public. The DJ would prefer that women not nurse in public, and his questions to the midwife were very anti-breastfeeding in nature. At one point he said something to the effect of, “Well, if women are allowed to breastfeed anywhere, then smokers should be allowed to smoke anywhere they want.”

Today's piece is part of a collaborative effort that seeks to demonstrate why smoking in public is not an appropriate analogy for nursing in public (N.I.P.). Please visit the other writers' sites to learn more as links post throughout the week. The schedule of posts is as follows:

  • Monday, July 19: Lauren at Hobo Mama gives suggestions on how to deal as the observer with either smoking in public or N.I.P.

  • Tuesday, July 20: Annie at PhD in Parenting writes about the public health aspects of smoking and breastfeeding.

  • Wednesday, July 21: Dionna at Code Name: Mama compares legislation on both smoking and breastfeeding.

  • Thursday, July 22: Paige at Baby Dust Diaries discusses the impact on bystanders of smoking versus breastfeeding.

  • Friday, July 23: Our posts will be posted as a whole at NursingFreedom.org, where they serve as a complete resource anytime smoking in public is compared to nursing in public.

Individual Rights and Public Health

We all pay for other people's poor health decisions. Whether through private insurance or public health care, when other people make bad decisions about their health or when they do things that have a negative impact on the health of others, it costs us money. I reluctantly accept the idea that people have the right to make poor decisions about their own health and that our health care system (be that private insurance or public health care) should still take care of them. But, I also think that our governments and insurance companies have a role to play in promoting healthier alternatives, ensuring those alternatives are accessible to everyone, taxing bad choices, and protecting people from being directly affected by the poor health decisions of others.

Smoking is bad for you. Smoking around other people is bad for them. There are countless studies and stories that point out the negative health implications of tobacco smoke.  According to the World Health Organization:
Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2020. Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco.

In addition to direct exposure to cigarette smoke, secondhand smoke is a significant problem. The Society of Actuaries in the United States determined in its 2005 research report Economic Effects of Environmental Tobacco Smoke that exposure to secondhand smoke costs the United States about $10 billion annually (out of a total of $150 billion annually for all smoking related health costs). This amount has decreased by $5 billion in recent years due to a reduction in the percentage of smokers among the population and also a reduction in exposure to smoke, showing that efforts to promote public health in this regards are having some level of success.

Breastfeeding, on the other hand, is good for you. It is good for the mother and good for the child. According to the World Health Organization:
The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.

An economic study by Melissa Bartick et al called The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis and published in the Pediatrics journal found that if 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year. If women feel uncomfortable or are made to feel uncomfortable nursing in public, there is a greater chance that they will wean earlier and be unable to meet those targets. It is inconvenient to have to always find a private place or private way to nurse and I can understand how feeling that you need to do so would lead moms to switch to formula. In addition, in order to increase breastfeeding rates, we need more women to be breastfeeding in public and being open about doing so. Only when our society sees nursing as the normal way to feed a baby, will it become the default way of feeding a baby.

So from a public health perspective, in order to improve the health of our population and cut down on medical costs, we need to continue to tell people that smoking is bad for you and ensure that people are not exposed to second hand smoke against their will. We also need to promote breastfeeding and ensure that women are encouraged to breastfeed whenever and wherever.  Also, from a humanitarian point of view, we need to protect people from having their health threatened by others and also protect their right to do what is best for their family's health.

Interestingly, one of the linkages between the tobacco issue and the infant feeding issue is that poverty is a significant factor in both. People who are poor are more likely to smoke and to spend a significant amount of their limited budget on tobacco. People who are poor are also more likely to formula feed, which can also be costly (although it is often subsidized for low income families). From a public health perspective, I think one of the priorities needs to be on ensuring that low income families have the resources that they need and the role models that they need to be able to breastfeed successfully and to give up tobacco successfully. A part of that, to me, means ensuring that women are not ridiculed for breastfeeding in public by some jerk who is blowing smoke in their faces.

Please visit the other bloggers when they post this week.
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Reader Comments (17)

I think that you hit the nail on the head with your point about resources. Given the amount of money that's saved by breastfeeding, and by quitting smoking, it seems like a no-brainer. Let's get on it, policy-makers!

July 19, 2010 | Unregistered CommenterAmber

And this DJ is probably a guy without children. And why do I get the idea that he wouldn't object to a woman out in public in a lowcut top?


Smokers have the right to their choice, but they don't have the right to give ME or my kids cancer from their nasty habit. Breastfeeding is good for babies.

July 19, 2010 | Unregistered CommenterKayris

Wow. The sheer disconnect of that statement, comparing a healthy activity that might offend someone's eyes with something that is unhealthy both for the smoker and those near them.

Sometimes I wonder how often these people have ever seen NIP. Probably more often than they know, but not as often as they would if there weren't so many social obstacles to breastfeeding in the first place.

The $$ numbers could tell the whole story all by themselves (money lost smoking v. money saved by bf'ing). Unfortunately, $$ is what drives our government to continue to allow the consequences of secondhand smoke. I agree that people should have the right to kill themselves by smoking, but that right shouldn't endanger others.

I've also written about the smoking/breastfeeding analogy this week with regards to personal choice and public health (though not in reference to nursing/smoking in public). My post is more about how your health care provider talks to you about smoking or about breastfeeding. While the DJ was likening smoking to breastfeeding (as in, something that other people could be offended by), I am comparing smoking to formula (as in, something that has negative health consequences).

July 20, 2010 | Unregistered CommenterAlicia

Comparing smoking with breastfeeding? Wow. What a ridiculous analogy. Using the same logic, "well, if people are allowed to kiss in public, they should be allowed to beat each other with baseball bats."

July 20, 2010 | Unregistered CommenterKari

That analogy didn't even make sense, you can't compare the 2. One makes you healthy, the other (potentially) kills you and makes your face, hands, body and clothes stink.

Like someone else mentioned, probably a guy with no kids, obviously a smoker and wouldn't bat an eye if he saw a woman walking around in a low-cut top.

I hope his mother smacks him silly. Radio personalities in the US - GEESH!

July 20, 2010 | Unregistered CommenterCindy


I don't like comparing smoking to formula, because smoking is something that has only health risks and no health benefits. I prefer to compare formula to something like having a c-section or undergoing some other surgery. It is something that can help, in certain circumstances, but it isn't something you would choose to do if you didn't need to because it has health risks associated with it to.

July 20, 2010 | Unregistered Commenterphdinparenting

I guess I see how he came up with it-they are both activities you are legally allowed to do but which many people don't want you to do in public-but beyond that his analogy totally fails. I always wonder what smokers think about secondhand smoke (anyone want to enlighten me?) like are they concerned about it? Do they figure it won't hurt if you are just passing through? I just don't understand how you could smoke in public and not be concerned about the potential health effects on those around you.

July 20, 2010 | Unregistered CommenterMaman A Droit

Yes, I see what you are saying and I agree that it isn't the best analogy in that way because there *can* be health benefits to formula depending on your situation (unlike smoking). I think that my point was more about the way that health care professionals talk to their patients about their choices - they should not be specifically supporting the less healthy option as though they have equivalent outcomes, particularly just so that you can feel better about your personal choice. That would also apply to how doctors talk about c-sections as you suggest, but c-sections are not often just a matter of personal choice the way that formula and smoking often are for the patient. Having a c-section requires a doctor's cooperation and consent, while smoking or using formula are choices that a patient may make on her own and potentially against a doctor's recommendation. So, if we are talking about the way that a doctor talks to you about your personal health choices, I think that smoking fits better than c-sections because it is a decision that the patient makes on her own outside of the doctor's office. I could see formula and c-sections being comparable in this way if formula required a prescription, because then both would require a doctor's permission and the level of personal choice would be much different. When you say that it isn't something you would choose to do if you didn't need to because of the health risks associated, I think that is an idealized way of thinking about it, but it's not really what happens.

July 20, 2010 | Unregistered CommenterAlicia

[...] Read more here, both about the radio interview and why that is the stupidest analogy ever. [...]

Yesterday I blogged about how stupid it is when people think moms should take their babies into the bathroom to nurse.
But wow, comparing smoking to breastfeeding in public? That's even worse!

July 20, 2010 | Unregistered CommenterWrangler Mama

[...] July 20: Annie at PhD in Parenting writes about the public health aspects of smoking and [...]

Dionna said what I wanted to say. My breastfeeding (2nd Hand Breastfeeding, lol) does not HURT someone else like smoking does. Unless you include their delicate (ignorant) sensibilities. I don't mind bruising someone's sense of propriety. I do mind damaging someone's ability to breath and/or contributing to their death.

My dad was a smoker and 20 years ago he would have said "second hand smoke is bull" and went about his business. Then he had a granddaughter (he had previously quit smoking himself) and now you better not pull a pack out within 100 yards of her! The only thing I can contribute his change to is EDUCATION he got in cardiac rehab. Before that he thought people who complained about smoking were being cry babies but now he knows it can kill. I think public education would help a great deal.

I love your last sentence: "A part of that, to me, means ensuring that women are not ridiculed for breastfeeding in public by some jerk who is blowing smoke in their faces." Yes!

It's really amazing when you see the numbers laid out like that. I know that most health professionals and policymakers (with the exception of those being intensively lobbied by big tobacco) take the smoking numbers seriously (in terms of financial, public-health impact), and I hope they start taking the breastfeeding ones seriously as well.

July 22, 2010 | Unregistered CommenterLauren @ Hobo Mama

It is very interesting to read :)

October 27, 2017 | Unregistered CommenterBrinda Jack

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