I haven’t read the original article, “The Case Against Breastfeeding” in the Atlantic. I am not sure if my stress levels can handle it. I am started with a link to it on Alas, a blog. I am planning on thoroughly enjoying a critique of the Rosin article and her manipulation and misquoting of statistics on the U.S. Food Policy blog. From what I have read (I would have to look this stat up again) there are hundreds of studies a year published that confirm the advantages of breastfeeding. It is easy to hand pick a few with the weakest results and say the evidence is “thin”.
But, that didn’t stop me from posting a reply on the post I did read on Alas, a blog:
One of the main problems I have with a lot of the discussion about breastfeeding is that it is a health care decision. It is not a lifestyle decision or a social decision. Of course, as in any other health decision, there are many cultural and social aspects involved. But, whether one is a stay at home mom or works is not in the Healthy People 2010 goals. Increasing breastfeeding rates is, for a good reason.
There are absolute, irrefutable health benefits to breastfeeding for the mother and infant(s) (congrats on the twins!) that are not on the same level as “talking about the advantages of breastfeeding makes me, a formula feeding mom, feel guilty”. (See Mommy Wars Bingo). Breastfeeding is and should be the way that one is supposed to feed infants, barring any health issues that are contraindications. Just like a vaginal delivery is the healthiest way to deliver a baby, barring any health reasons that are contraindications. Of course there are complications and exceptions, but that is true for every health decision, from aspirin to knee replacement surgery.
It is of course relevant to discuss the greater social aspects of breastfeeding, but it seems like the conversation is always dominated by this topic, and whenever it is brought up as a health discussion, people want to negate that aspect of the discussion by saying the social aspects are more important.
I found an even better reply! This is from the US Food Policy post:
Hanna Rosin did not quote from the wide body of literature on the risks of formula feeding. Breastfeeding is the normal state of feeding an infant. It confers no benefits — it is the norm. The risks and costs of alternatives are what need to be assessed.
First, she uses sleight of speech to disparage a wide body of doctors who contributed to the American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk. She provides no evidence whatsoever to support her statement about these doctors have an agenda. Conflict of interest in the medical arena usually involve payments of large sums of money from those who have commercial interests to those who are making statements. No one pays doctors to make positive statements about breastfeeding.
Second, if you look at the American Academy of Pediatrics statements, she avoids the conditions for which there is solid evidence that there is an increased risk from formula use including bacterial meningitis, bacteremia, diarrhea, late onset sepsis in preterm infants, necrotising enterocolitis, urinary tract infections, and postneonatal mortality. Solid — meaning lots of credible studies. Since I started an MHS at Hopkins in 1983 through completing a doctorate in Nutritional Sciences at Cornell in 1993, I literally read THOUSANDS of credible studies — and there are tens of thousands out there. I have stacks of meta-analyses under my desk and I reach very different conclusions
What she tackles in her article one condition among the many conditions of the “suggestive” research that is very hard to prove. This is the realm of SIDS, asthma, diabetes I and II, overweight and obesity, hypercholesterolemia, Hogkins, lymphoma and leukemia. These conditions are multicausal. It is very easy to design a study poorly and not see results and very hard to design a good study to find the causal links because the many of the effects are modified by other effects.
But even if all of this suggestive research turns out to not be so suggestive, what about the solid research? And she did not even site the risks to women when they don’t breastfeed.
Now, why is it that someone like Hanna Rosin with no science background at all can call into question what is a huge body of research by mentioning one little sideline of the many studies that show an increased risk of disease from use of formula? Does she have better qualifications than MDs that have no conflicts of interest that wrote the policy statement?
As for the economic analysis of a breastfeeding, the World Bank tried such an approach many years ago with their Disability Adjusted Life Years. I worked on the protein energy malnutrition section. This approach was deeply flawed in that there was no way to include the fact that some interventions provide multiple benefits. Those interventions that addressed a single disease showed up better than those that addressed many diseases and had multiple benefits because the economic models were inadequate to deal with multiple benefits.
In terms of the costs of breastfeeding, what we are really talking about is the costs of caregiving. Babies need contact and interaction. Breastfeeding is but one way to provide this while at the same time providing food. What unfortunately has happened during the years when women were discouraged from breastfeeding is that we adopted feeding modes that are unhealthy for infants. I would love to work with exclusively formula feeding mothers to assist them to do what I do with mothers that have had breastfeeding problems — that is “mimic normal infant feeding” and “mimize risk”. The culture has adopted unrealistic expectations for the frequency and length of infant feeding as well as the amount of interaction that is really needed. In the past, women were in communities where sharing of childrearing with close kin members was far more common. Woman also did their productive activities in close proximity to their children so the displacement to feed their infants while working was not as much of a problem. Now women are expected to do it all on their own and conduct their income generating activities in a separate environment from their infants. The segregation of mothers from their infants does come at a cost.
Finally, the real clincher that everyone forgets about is that we had a healthier alternative in the past. Wet nursing was acceptable and available. Your sister could feed your infant to give you a break and no one would bat an eyelash at the practice. Now, in our super sterile environment where we confuse an infant’s normal food with yucky body fluids — such an idea is usually met with shock and horror.
Yet, human donor milk has been shown in many studies to be less risky than formula.
As for her assumption that only formula feeders are given a hard time, I beg to differ. If you took a sample of 1000 women, I am dead certain that 100% of that sample would say that their infant feeding choice has been criticized, regardless of what choice they made. If you took a sample of 1000 women on any parenting issue, you would find the same results. BUT, there is a false equivalency in this statement. If you looked at the degree of negativity in the “criticism” you would find that the most negative, disgusting comments are reserved for women who nurse in public. There is a huge degree of Lactaphobia in the culture due to the sexualization of the breast. You would never get away with saying that African Americans, homosexuals, the elderly, Jews, Muslims or any other group would have to eat in the bathroom. Yet, routinely, women are told that the only place their infants can eat normally is in the bathroom.
Hanna Rosin doesn’t have the credibility to debunk the vast body of literature that I have read with her brief skimming of a few choice articles. She merely follows formulaic rules for justifying a billion dollar industry that took away choice from women for several generations and wants to perpetuate myths the risks of their product.
A better analogy than smoking is diabetes. Would you give insulin to someone without diabetes? No. Would you tell someone with diabetes that they are just as healthy as someone without it? No. Would you hesitate to give insulin to someone with type I diabetes? No. Would you tell them it was poison. No. Would you try to get someone with type II diabetes to eat better and excercise? Yes. If they still needed insulin, would you give it to them? Yes. Would you still work to help them overcome barriers to diet and exercise? Yes. Would you call health care practitioners that spoke frankly about diabetes “fanatics” or “nazis”? No.
Most of the discussion of infant feeding is highly irrational and overly emotional.
In the meantime, I will continue to assist women with pragmatic solutions to mimic normal and minimize risks of feeding their infants tailored to their own specific situations.
Susan E. Burger, MHS, PhD, IBCLC, RLC