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: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10799543/

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. https://doi.org/10.3138/ijfab.8.2.139

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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