Ethical Standards in Breastfeeding Research

2022 10 Projects FLRF

Development of Ethical Standards for the Evaluation of Research Projects in the Field of Research on Breastfeeding, Breastmilk and Lactation, from the Institute of Biomedical Ethics and History of Medicine – a WHO Collaborating Centre for Bioethics at the University of Zurich (UZH).

Ensuring ethical integrity in research begins with early identification of fundamental and serious ethical considerations. Thus, the Institute of Biomedical Ethics and History of Medicine at UZH, with support from FLRF, collected a set of published, international standards for the ethical evaluation of biomedical research and interventions within the field of breastfeeding and breastmilk.

Supported by a technical advisory group of clinicians and legal experts and led by Professor Nikola Biller-Andorno, the project compiled a comprehensive, well-founded compendium of ethical considerations to aid scientists, reviewers, healthcare practitioners, decisionmakers, policymakers, planners, implementation specialists, educators, funders and other stakeholders.

The compendium is being published in several modules under the name EFBRI – An Evolving Ethical Framework Informing Breastfeeding Research and Interventions.

  • Module 1, launched in 2021, focuses on research. 
  • Module 2 will focus on interventions (in development by UZH and expected in 2024). 

Future modules will be shaped by user needs and globally evolving ethics. Please help develop EFBRI by sharing your feedback and suggestions: ethics@lactahub.org.

EFBRI is based on relevant national and international standards, including the Swiss Human Research Act, the Declaration of Helsinki and the Bioethics Convention of the Council of Europe.

Read the press release. 

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

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Bennett, R. (2007). Routine Antenatal HIV Testing and Informed Consent: An Unworkable Marriage? Source: Journal of Medical Ethics, 33(8), 446–448. https://doi.org/10.1136/jme.2006.018861

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. https://doi.org/10.1136/medethics-2016-103372

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. https://doi.org/10.1093/bjsw/bcu004

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. https://doi.org/10.1177/0890334417698691

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. https://doi.org/10.1177/1073110519840495

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. https://doi.org/10.1111/jnu.12211

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. https://doi.org/10.1016/j.ypmed.2019.105762

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. https://doi.org/10.1371/journal.pone.0186897

Kukla, R. (2006). Ethics and Ideology in Breastfeeding Advocacy Campaigns. Hypatia, 21(1), 157–180. https://doi.org/10.1111/j.1527-2001.2006.tb00970.x

Kukla, R. (2008). Measuring Mothering. International Journal of Feminist Approaches to Bioethics, 1(1), 67–90. https://doi.org/10.3138/ijfab.1.1.67

Martucci, J., & Barnhill, A. (2018). Examining the use of “natural” in breastfeeding promotion: Ethical and practical concerns. Journal of Medical Ethics, 44, 615–620. https://doi.org/10.1136/medethics-2017-104455

Nihlén Fahlquist, J., & Roeser, S. (2011). Ethical problems with information on infant feeding in developed countries. Public Health Ethics, 4(2), 192–202. https://doi.org/10.1093/phe/phr019

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. https://doi.org/10.1525/sop.2006.49.3.369

Shaw, R. (2004). Performing Breastfeeding: Embodiment, Ethics and the Maternal Subject. Feminist Review, 78, 99–116. https://doi.org/10.1057/palgrave.fr.9400186

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. https://doi.org/10.1016/j.socscimed.2013.11.058

Taylor, E. N., & Wallace, L. E. (2012). For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt. Hypatia, 27(1), 76–98. https://doi.org/10.1111/j.1527-2001.2011.01238.x

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. https://doi.org/10.1016/j.socscimed.2014.01.005

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. https://doi.org/10.1215/03616878-2007-018

Yeatman, S. E. (2007). Ethical and Public Health Considerations in HIV Counseling and Testing: Policy Implications. Studies in Family Planning, 38(4), 271–278. https://doi.org/10.1111/j.1728-4465.2007.00139.x

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