Ethics of Breastfeeding Interventions

2022 23 Projects FLRF

FLRF and the Institute of Biomedical Ethics and History of Medicine at the University of Zurich (UZH) launched creation of the Ethics of Breastfeeding Interventions Framework in 2021.

It is designed to give health authorities practical guidance for navigating ethical issues around breastfeeding interventions.

In practice, it will flag ethics considerations linked to specific breastfeeding interventions identified in the Best Practice Interventions Framework and Intervention Database. It will help users analyze ethical points relevant to determinants and influencers along the breastfeeding journey, leading to informed decisions and helping prevent unintended unethical practices during scale up. 

Once complete, the Ethics of Breastfeeding Interventions Framework will be available as an open access resource:

  • EFBRI – An Evolving Ethical Framework Informing Breastfeeding Research and Interventions. Here, it will extend Ethics Module 1, a compilation of ethical principles to guide biomedical research in breastfeeding and lactation published by FLRF and UZH in 2021.

FLRF and UZH anticipate the Ethics of Breastfeeding Interventions Framework will facilitate responsible, well-considered actions aimed at improving maternal and infant health. The partners believe the novel approach of pairing ethics considerations with the identification of best practice interventions could inspire similar practices and set new standards for scientific excellence in bioethics. 

The project, led by Professor Nikola Biller-Andorno, carries forward work on implementation research/health policy and systems research ethics already underway at the Institute of Biomedical Ethics and History of Medicine, a WHO Collaborating Centre for Bioethics.

All operationalization resources together, once completed and tested, will provide a comprehensive resource supporting the systematic operationalization of breastfeeding policies to improve mother and child health.

Subramani S, Rasita Vinay, März JW, Hefti M, Nikola Biller‐Andorno. Ethical Issues in Breastfeeding and Lactation Interventions: A Scoping Review. Journal of Human Lactation [Internet]. 2023 Dec 12 [cited 2024 Jan 22]; Available from:

Manríquez Roa T, Biller-Andorno N. Financial incentives for participants in health research: when are they ethical? Swiss Med Wkly. 2022;152(11–12):w30166. DOI: 10.4414/smw.2022.w30166

Barnhill, A., & Morain, S. R. (2015). Latch on or back off?: Public health, choice, and the ethics of breast-feeding promotion campaigns. International Journal of Feminist Approaches to Bioethics, 8(2), 139–171.

Bennett, R. (2007). Routine Antenatal HIV Testing and Informed Consent: An Unworkable Marriage? Source: Journal of Medical Ethics, 33(8), 446–448.

Brown, R. C. H. (2017). Social values and the corruption argument against financial incentives for healthy behaviour. Journal of Medical Ethics, 43(3), 140–144.

Fetherston, C. M., & Leach, J. S. (2012). Analysis of the ethical issues in the breastfeeding and bedsharing debate. Breastfeeding Review, 20(3), 7–17.

Gribble, K. D., & Gallagher, M. (2014). Rights of children in relation to breastfeeding in child protection cases. British Journal of Social Work, 44(2), 434–450.

Griswold, M. K. (2017). Reframing the Context of the Breastfeeding Narrative: A Critical Opportunity for Health Equity Through Evidence-Based Advocacy. Journal of Human Lactation, 33(2), 415–418.

Gross, M. S., Taylor, H. A., Tomori, C., & Coleman, J. S. (2019). Breastfeeding with HIV: An Evidence-Based Case for New Policy. Journal of Law, Medicine and Ethics, 47(1), 152–160.

Hirani, S. A. A., & Olson, J. (2016). Concept Analysis of Maternal Autonomy in the Context of Breastfeeding. Journal of Nursing Scholarship, 48(3), 276–284.

Hoskins, K., Ulrich, C. M., Shinnick, J., & Buttenheim, A. M. (2019). Acceptability of financial incentives for health-related behavior change: An updated systematic review. Preventive Medicine, 126, 1–18.

Hurlimann, T., Peña-Rosas, J. P., Saxena, A., Zamora, G., & Godard, B. (2017). Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. PLoS ONE, 12(10), 1–25.

Kukla, R. (2006). Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia, 21(1), 157–180.

Kukla, R. (2008). Measuring Mothering. International Journal of Feminist Approaches to Bioethics, 1(1), 67–90.

Martucci, J., & Barnhill, A. (2018). Examining the use of “natural” in breastfeeding promotion: Ethical and practical concerns. Journal of Medical Ethics, 44, 615–620.

Nihlén Fahlquist, J., & Roeser, S. (2011). Ethical problems with information on infant feeding in developed countries. Public Health Ethics, 4(2), 192–202.

Østergaard, L. R., & Bula, A. (2010). "They call our children „Nevirapine Babies?”: A Qualitative Study about Exclusive Breastfeeding among HIV Positive Mothers in Malawi. African Journal of Reproductive Health, 14(3), 213–222.

Rosenthal, M. S. (2006). Socioethical issues in hospital birth: Troubling tales from a Canadian sample. Sociological Perspectives, 49(3), 369–390.

Shaw, R. (2004). Performing Breastfeeding: Embodiment, Ethics and the Maternal Subject. Feminist Review, 78, 99–116.

South, J., Purcell, M. E., Branney, P., Gamsu, M., & White, J. (2014). Rewarding altruism: Addressing the issue of payments for volunteers in public health initiatives. Social Science and Medicine, 104, 80–87.

Taylor, E. N., & Wallace, L. E. (2012). For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt. Hypatia, 27(1), 76–98.

Våga, B. B., Moland, K. M., Evjen-Olsen, B., & Blystad, A. (2014). Reflections on informed choice in resource-poor settings: The case of infant feeding counselling in PMTCT programmes in Tanzania. Social Science and Medicine, 105, 22–29.

Wolf, J. B. (2007). Is breast really best? Risk and total motherhood in the National Breastfeeding Awareness Campaign. Journal of Health Politics, Policy and Law, 32(4), 595–636.

Yeatman, S. E. (2007). Ethical and Public Health Considerations in HIV Counseling and Testing: Policy Implications. Studies in Family Planning, 38(4), 271–278.

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