Such a campaign would be a joke in England. It's a lottery as to where you are, as to how much help you can get. Where I am, you have to pay to join something like the National Childbirth Trust to get specialised breastfeeding help in private, one-on-one.

The US government is using a shock tactics ad campaign  to increase breastfeeding rates with startling tv ads, recently reported in the New York Times here.

To summarise the campaign, the TV ads show a heavily pregnant woman on one of those mechanical rodeo things bucking around all over the place and she falls off. The strapline says "You wouldn't take risks while pregnant so don't take risks after. Breastfeed exclusively for six months... (voiceover lists all the proven medical benefits)... Babies were born to be breastfed." There is another one with two pregnant women running on a moving log in the water in a competition and they fall over - same straplines.

The article uses this quote:
"Just like it's risky to smoke during pregnancy, it's risky not to breast-feed after," said Suzanne Haynes, senior scientific adviser to the Office on Women's Health in the Department of Health and Human Services.

Shocking? Yep indeed. It is designed to shock mothers from their weary fatigue in the last months of pregnancy and into breastfeeding their newborns. The visuals underline that you are deliberately harming your baby's health if you do not breastfeed. So much so, you might as well blow smoke in its face.

Smoke, highs and shags
Shock tactics are nothing new. The first time I became aware of shock tactics was the AIDS campaign in the 1980s, showing tombstones and warnings to use a condom. While the ads stayed in my mind, I know an awful lot of people who haven't always used barrier contraception.

Shock advertising is commonly used to convey key messages, particularly for health campaigns. A new European Union directive aims to have pictures on cigarette packets that show rotting teeth and gums on 40% of the front and 50% of the back of fag packets.

The idea is to shock people into giving up and prevent teenagers taking up the habit by showing them what they could look like if they smoke - appealing to their youthful vanity. Read more about it here

In the classroom, children as young as nine or ten are shown videos about the death of heroin addict Rachel Whitear in an effort to prevent drug experimentation and addiction. Also, with a 62% rise in STDs between 1995-2004, the UK government launched a shocking TV campaign to change the sexual behaviour of young people two years ago.

But will the shock tactics stem smoking-related diseases, drug addiction and unprotetcted sex among the young?

It's a difficult one. I believe that shock tactics do indeed "shock" but that they are pretty ineffective in isolation. While we may watch a commercial and think, "Shit, that's terrible!" it might not be enough to change our habits for life. It has to be underpinned by a major education programme and support network over a longer period of time. A 60 second commercial is not enough to educate. You can't ask people to stop smoking or taking drugs without providing advice, weaning patches and support groups. When I think about the AIDS campaign in the 1980s, I think of the massive sections of the main channels' TV schedule that were devoted to programmes on factual information about AIDS (how you get infected and who is at risk), advice, helplines and practical lessons of how to put a condom on. I am sure there was almost a Live Aid type kidnap of one channel with an AIDS special that lasted all day. All this as well as the TV commercials. The shock ads were backed up.

Anecdote antidote
The health industry also needs to take into account that they are fighting the anecdotal. For every case study showing that formula risks your baby's health, smoking causes cancer, STDs can cause infertility and drug taking can kill, there will be an anecdote antidote. Such as "we were all formula fed and we are fine" or "my grandpa smoked 60 a day for 40 years and lived until he was 92" and even "my friends all take drugs and they've never OD'd." No matter how strong the factual information, these obstacles loom like burning towers.

I personally feel that campaigns should provide factual information that enables people to make informed choices in their own time, rather than just relying on short-lived shock to force action. People don't like to be railroaded into choice, they like to feel they are in control of their own decisions. If shock tactics worked, the cancer warnings on cigarette packets would have dramatically reduced the number of smokers. Yet many people continue and thousands will die, as their behaviour is unchanged by the warning printed on a cigarette packet.

Where's the back up support?
I worry that the breastfeeding campaign in the US will irritate and alienate more people than it will encourage. It might shock people into trying but is the REAL reason breastfeeding rates fall over the first six months because there is NOT enough support through the health service and in business.

What's more I can't imagine such a campaign being accepted over here. Our breastfeeding education is laughable. Support on post-natal wards and through midwife care is hit and miss. I wouldn't even say it was a postcode lottery, it's more who you have access to rather than where you live. The NHS ante-natal class I attended featured a midwife trying to operate a video player for 20 minutes before giving up. I then decided to give the NCT ante-natal classes a go instead, which you have to pay for but are, in my experience, better than the free NHS ones. It promoted close contact with other mothers and because we worked in group workshops, I got to know a group of women that I kept in close weekly contact for a year after Molly's birth.

Like most pregnant women who read pregnancy magazines and books before giving birth it was clear that formula was a poor subsitute for breastmilk. But no amount of reading or looking at people doing it helped me when it came to being faced with feeding a baby for the first time. It's completely different when it is you and your baby. You need practical help when you are actually holding the baby for the first time and in the days that follow. If you don't get the right information and support at that point, it is very hard to recover and work it out on your own. Especially as you have so much to deal with.

There also needs to be more support in this country for those wishing to return to work. Hardly any companies (and I am not talking big conglomerates but small-medium enterprises) have crèches that would enable you to feed for the first six months if you financially couldn't afford to stay at home. If you are self-employed finance is critical, especially when the £400 a month maternity allowance you get from the government is taxable. And as for private areas for pumping and time to do so, well I would be willing to bet that the percentage of firms that have such provisions is tiny. We are a nation where most lunches are eaten at your desk and overtime is normal. Being allowed the time to attend to personal matters like that? It's hard enough saying you can only be at work at 9am because nursery only opens at 8am and you HAVE to pick up your child at 5.30pm. Most employers resent that they have to make any special provisions for parents, let alone nursing mothers. There's a LONG way to go.

Emotional impact
While I understand that the US campaign is primarily aimed at women who haven't even given a second thought to how to feed their babies, I feel that the emotional impact on those who tried and failed shouldn't be ignored. I've written at length on here, in the comments and other people's blogs about the guilt, desperation and isolation that follows when you can't do what you want to do for your baby. What will such a campaign mean for them? Will they just sink lower into their personal abyss and develop PND from increased cultural pressure or will they have to stick labels on their baby's bottle saying: "Before you say anything I DID try my best"?

The fact that it could further the divide between mothers is of particular concern. It's not even as simple as the anti-brigade against the pro-club. When it comes to breastfeeding, tolerance of other people's trials and tribulations is weakening. For example, some feel fed up with those who didn't breastfeed (for whatever reason) feeling guilty and being portrayed as victims when they believe they should feel guilty.

Guilt's a funny thing. A counsellor once said to me said that you can feel guilty even when innocent. Guilt is a way of processing the emotions resulting from events involving you. By feeling guilty, you are forced to evalate and process your personal responsibility. It is the way the mind heals itself (read this Guardian article about about how the brain processes and heals after something like 7/7). For example, survivors of major castastrophes feel guilty for surviving, sex abuse victims feel guilty for not preventing it and children feel guilty if they parents separate incase it was something they did that caused it.

Guilt doesn't means you ARE guilty every time. Those that tried to breastfeed but couldn't due to pain, lack of advice and support from the health service, family or work, or technical reasons (such as not enough milk or getting an infection that requires antibiotics and being advised to stop) should not blame themselves. Nor should women who have been raped and abused who can't process the concept of having a child suckling or baring their body in public because of emotional triggers.

Divided we fail
I agree that it IS important to get nutrition information out there to new mums, but I fear the shock method might do the opposite of its intentions. It's important also for society to understand that not all bottlefeeders are anti-breastfeeding and that many bottlefeeders have tried to breastfeed and failed for several reasons. I am also trying to show through personal anecdotes why access to free expert support for all mothers is as important as just providing factual information and statistics. I also want to help others understand that those who do not even try might have valid personal reasons, why they can't do it. And, finally, not to write someone off with a bottle without knowing how they got to that situation IF they want to share that information. The best way forward to increase breastfeeding rates is not shock, but the sharing of advice, experience and support between those who succeeded and those that want to try, specialised support from medical professionals and a change in the business community.