The inevitable follow-up to the last breastfeeding post.

I think after this one, we'll be ready to move on to cow (or soy) milk and solids!

My last post on the breastfeeding issue pointed you to an academic examination of some of the claims being advanced in support of the superiority of breastfeeding. Joseph from Corpus Callosum left a detailed comment expressing some dissatisfaction with that examination. You really should read the whole comment, but his main points are roughly:

  1. You can find evidence that supporters of breastfeeding are biased, but that doesn't mean you aren't also biased.
  2. In a body of scientific literature, we ought to weigh not only how recent a study is, but also its quality. (So, for example, it may be fine to rely on an older study over a more recent one if the older one is better -- where "better", of course, would be judged by scientific criteria rather than on agreement with the result you were hoping the research would support.)
  3. It's not enough to simply point out flaws with the scientific case that is being made to support breastfeeding if there exist reasonably rigorous studies that shed light on the issue (especially if they end up supporting the conclusion for which the shoddy case is being offered as support).

It's hard to argue with Joseph's points. The Goldin et al. didn't give a comprehensive analysis of all the available literature. Then again, it seems like it was intended as a rapid response to a news item that was creating a buzz. As I noted in my last post, the scientific research is certainly suggestive that breastfeeding is a Very Good Thing as far as infant health is concerned. The contentious issue seems to be how big the risk of not exclusively breastfeeding. And here, I'm not sure I'm in complete agreement with Joseph's take on things. He writes:

[W]hen you consider that every single person on the planet has either been breastfed, or not, whatever risk you find, no matter how small, has to be multiplied by six billion. Take a small number and multiply by six billion, and the product just might turn out to be significant.

First, a little nitpick that may turn out to be significant in how this how discussion is unfolding: Rather than saying every single person on the planet has either been breastfed or not, we ought to recognize that there are loads of people out there who have been breastfed but were not exclusively breastfed. So we're not talking about a binary choice (only breastmilk or only formula) but a range of combinations. We could complicate it further by worrying about possible degradation of pumped breast milk in the fridge or freezer, and how that should factor in, but the burning issue is: Am I doing my baby harm if I feed him or her any formula? Perhaps this is not what DHHS and AAP want mothers to be freaking out about, but the formula-smoking comparisons may be eliciting that kind of freak-out in some quarters.

Well, is the risk significant? Joseph suggests that, in a human population of six billion, it's at least possible that some kid will die as a result of having a bottle of formula substituted for a breastmilk feeding. Maybe it will be more than one kid. Ought we, then, to say that it's not worth taking that risk and that any mother who is physically able must feed her infant exclusively breastmilk?

This would only make sense if there were no risk to the kid from the mother being locked into breastfeeding only. If mom is required to be at home breastfeeding, mom might not be able to work, and mom being able to work might be what gets the infant decent health care (including well-baby appointments, childhood vaccinations, and the like). If mom can't work, mom might not be able to afford adequate nutrition for herself ... which has repercussions for the quality of the breastmilk the kid is getting. And these are just consequences that are relatively easy to pick out. I'd venture that we ought to be considering the risks to the infants range of life choices in a society that may be willing to tell mothers that they have to bear whatever costs there may be to their own well-being in order to exclusively breastfeed their infants.

I'm not saying parenting ought to be a carefree endeavor. Parents move heaven and earth to protect their kids from all kinds of risks, real or imagined. Parenting is not about convenience. But please, please, please let's not pretend that breastfeeding is totally easy, or that the totally exausted mom who gives her kid one bottle of formula because she is fresh outta breastmilk and there's none handy in the fridge because she could not stay awake long enough last night to pump a strategic breastmilk reserve is a selfish person taking unwarranted risks with her child's life!

(By the way, I don't think Joseph is saying that.)

Hey, as far as I know we're all mammals here, so it's hard not to have a bias coming into this discussion. But I think it's worth asking whether there is any other choice we humans make where so much pressure is put on people to manage what might be reasonably small risks so very tightly.



More like this

This whole discussion has been very good.

And here is your transition to cow (or soy - or goat) and solids. The linked blog post is by my daughter-in-law, a new mother, and the author of the pregnancy poem PZ posted on Mothers' Day. She manages to work her way from breastfeeding all the way through adult human consumption of dairy products. I love her closing quote.

This is a serious issue here in sub-Saharan Africa, where there is an AIDS epidemic. Because of the risk of transmitting HIV through breastfeeding, doctors and activist groups are trying to educate women about using formula - but, paradoxically, because of the recent backlash against formula companies trying to persuade women in poor countries that formula is better than breastmilk, it is difficult for them to raise awareness about this. I have been told that it is illegal to advertise formula in South Africa. (This is second-hand information from a long time ago; I apologise if it's inaccurate.)

Anyway, this is an example of how people have latched onto one aspect of this complex issue and tried to make it into a simple, absolute, binary issue, when it isn't. Given some sets of variables, breastfeeding may be better than formula, but in at least case it is *exactly the wrong thing to do* and can have deadly consequences.

And then there is the question of how long to breastfeed, further reducing the binary nature of the debate. Do babies really need a full year of breastmilk exclusively? Are we sure that a shorter period won't do that trick? Show me some data (corrected for maternal age, health, education, all the usual jazz).

By Frumious B. (not verified) on 21 Jun 2006 #permalink

Oh, my goodness, so simple here! As in all socioideological and political arguments which this one is, the only ones really affected by this issue are those that control the means of production, not those who control claim to be agonizing over. Polly A.

By Polly Anna (not verified) on 21 Jun 2006 #permalink

Thank you so much for this series of posts. After my first son was born, the sleep deprivation caused by solely breastfeeding him was a contributing factor in me being hospitalized for post-partum depression.

"If mom can't work, mom might not be able to afford adequate nutrition for herself ... which has repercussions for the quality of the breastmilk the kid is getting."

Wouldn't this introduce an entirely new variable into studying this issue?

At any rate, according to the specialist we worked with when I was dealing with my infant's failure to thrive (due a combination of factors, primarily his being sent home untreated after post-natal loss of more weight than is considered healthy, and due to a huge philosophical disagreement with my pediatrician regarding my own unwillingness to introduce any formula, as well as the effects of c-section delivery, maternal medications, etc.), the mother's diet does not significantly effect the quality of her breastmilk. Thus, women in third-world countries with poor nutrition are still able to breatfeed their infants.

At any rate, breastfeeding is SUCH a complex task. Without proper support from family members, it would be nearly impossible to breastfeed exclusively. It requires a huge commitment of time and energy. In my opinion, the benefits, not only physical but emotional, are far greater than any drawbacks, and I had to almost literally move heaven and earth to get my breastfeeding relationship established effectively with my son, but I can't fault anyone who tries and finds it to be too much to continue breastfeeding exclusively.

I don't really get the choice to not even attempt it, though, considering the wealth of information today regarding the (as-yet-unproven) benefits for baby AND mother.

By The Other Libe… (not verified) on 28 Jun 2006 #permalink