Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood

Preface: Why Breastfeeding?

xi Preface Why Breastfeeding? I N C H I C AG O, A counselor at a federal women, infants, and children (WIC) clinic laments the tragedy of teenaged mothers choosing to go to school instead of breastfeeding their babies.1 The director of the neonatal intensive care unit at DC General Hospital tells mothers of infants with runny noses that the babies would not be sick if they breastfed.2 And an anthropology professor argues that infant formula producers, “just like tobacco companies, produce a product that is harmful to people’s short and long-term health.”3 Meanwhile, in Congress, Representative Carol Maloney has introduced legislation to amend the 1964 Civil Rights Act to include various protections for breastfeeding, and Senator Tom Harkin has proposed that warning labels, similar to the Surgeon General’s warning on cigarette packages, be affixed to formula containers.4 How did we arrive at a place in the United States where formula, which nourishes millions of healthy babies every year, can be likened to nicotine? Where breastfeeding her baby can be considered more important to a teenaged mother than getting an education? Where, without evidence, a doctor feels professionally and morally justified telling bottle-feeding mothers that not breastfeeding essentially causes babies’ illnesses or that breastfed babies do not get sick? These are the questions that drive this book. Hyperbole is commonplace in the world of breastfeeding advocacy, and it is staked on an overwhelming consensus that breastfeeding is the optimal form of nutrition for virtually all babies everywhere.5 According to the most recent policy statement of the American Academy of Pediatrics (AAP), the “diverse and compelling advantages for infants, mothers, families , and society from breastfeeding and use of human milk for infant feeding include health, nutritional, immunologic, developmental, psychologic, social, economic, and environmental benefits.”6 Infant-feeding studies frequently begin with a reference to breastfeeding’s well-known advantages, and in 2009, a director at the U.S. Department of Health and Human xii Why Breastfeeding? Services’ Agency for Health Care Research and Quality announced that “the debate over the relative value of breastfeeding compared with artificial means of feeding is over, as the data are unequivocal in favor of breastfeeding .”7 Even formula companies, which have a vested interest in reducing breastfeeding rates, explicitly state that human milk is the nutritional “gold standard” and advertise their products as “closest to breastfeeding.” In the chaos of conflicting opinions about caffeine, epidurals, cosleeping, and practically every facet of pregnancy, childbirth, and child care, the hegemony of the “breast is best” message in public discourse is remarkable. It is all the more so because the science behind the consensus is deeply problematic. While compelling evidence indicates that breastfeeding reduces babies’ risk for various gastrointestinal (GI) infections, medical journals are otherwise replete with contradictory conclusions about breastfeeding’s impact: for every piece of research linking it to better health, another finds it to be irrelevant, weakly significant, or inextricably tied to factors that are difficult to measure with the standard tools of science . While many of these studies describe a correlation between breastfeeding and more desirable outcomes—for example, some studies have found that breastfed babies have fewer respiratory infections—they rarely control adequately for what scientists call “confounding variables,” factors that have not been examined but could be affecting the outcome. Perhaps most troubling, breastfeeding cannot be distinguished from the decision to breastfeed, which could represent a more comprehensive commitment to healthy living that itself is likely to have a positive impact on children’s health. If mothers who breastfeed also wash their hands more frequently, keep their babies from crowded places, and expose them to fewer viruses, is it breastfeeding or careful hygiene that produces fewer infections? Furthermore, despite numerous theories, scientists have been largely unable to demonstrate how breast milk works in a baby’s body to protect or promote health.8 In instances like this, in which the “exposure” (breast milk) and the “confounder” (the choice to breastfeed) are highly correlated and the biological processes by which the exposure has salutary effects have not been identified, determining causality is especially challenging . When studies find an association between breastfeeding and reduced risks, therefore, it is not at all clear that one causes the other, and the conclusion that breastfeeding confers health benefits is far less certain than its proponents contend. Indeed, a great deal of evidence suggests that the difference between breastfeeding and bottle feeding has little impact on the overwhelming majority...