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Guest blog debate: has breastfeeding been oversold?

BreastfeedingProf Joan B Wolf is professor of gender studies at Texas A&M University, and author of 'Breast Is Best?' which argues that mothers are being pressured to breastfeed for reasons that aren't, in fact, based on good evidence.

Here she explains more about why she thinks that the science behind the "breast is best" health claims might be fundamentally flawed - and below that Anna Burbidge, Chair of the La Leche League responds to some of her arguments.

What do you think? Are women being asked to breastfeed their babies because of "an ideology of total motherhood that stipulates that a mother can and should eliminate any risk to her children, regardless of how small or likely the risk or what the cost is to her own wellbeing in the process", as Prof. Wolf maintains? Or is the reality that breastfeeding isn't, in fact, an 'orthodoxy' - but rather something about which society at large still feels awkward and uncomfortable?

Let us know what you think on the Talk thread - and if you blog on this issue, don't forget to post your URLs!


Joan B Wolf: Is breast really best?

Joan B WolfEveryone knows breastfeeding makes babies happier, smarter, and healthier, right? Popular perception has it that breastfed babies have higher IQs and more social mobility and are less likely to develop everything from ear infections and allergies to diabetes and leukaemia. They even wet the bed less in adolescence.

Okay, parents often end up turning to infant formula during the first six months. But this usually follows efforts to breastfeed and is explained by a particular set of circumstances that made breastfeeding impossible. Even the companies producing formula milk, which have a vested interest in reducing breast feeding rates, concede that breastfeeding is better for babies and claim that their particular brand most closely approximates breast milk.

But this popular perception is built on a shaky foundation. Anyone reading the research comparing breastfed and bottle fed babies in the developed world will discover a simple fact: almost all of it finds the health benefits of breastfeeding to be non-existent, marginal, or impossible to disentangle from other aspects of a baby's life.

And the better the study is the more it is likely to highlight other health-promoting behaviours that breastfeeding mothers and their partners are likely to engage in – with the breast feeding mattering less and less.

But breastfeeding has become such a moral crusade that formula is now likened to nicotine and mothers who formula feed are essentially blamed for raising children more likely to be sick and a burden on public resources. How did we arrive at such a miserable state of miscomprehension and self-righteousness?

The answer rests on three fundamentally false beliefs: that every time scientific research finds a relationship between two phenomena, one necessarily causes the other; that people who behave responsibly and are willing to make difficult choices can prevent virtually all risk, including health risks; and that breastfeeding is free.

The truth is far more complicated. The overwhelming number of statistical relationships in epidemiological research are not causal. Personal responsibility is unobjectionable, in theory, but much more difficult to define and exercise given the structural constraints that limit people's choices, our limited knowledge of what actually constitutes healthy behaviour, and the inevitable negotiation of trade-offs that is modern life.

Breastfeeding, moreover, can be expensive. Extensive evidence demonstrates that many women feel guilted into breastfeeding and that the process often entails profound physical, emotional, and economic costs for mothers and families. But we tend not to recognize these costs because we think it's just a mother's job to eliminate all risks, including those that are small, unlikely, and costly to prevent.

In Is Breast Best?, I invite readers to imagine if men had functioning mammary glands. Would breastfeeding seem as urgent? Or would we say that its benefits were marginal, at best, and that they certainly did not warrant the kinds of sacrifices breastfeeding demands? Would we say that breastfeeding is convenient and free, or would we be acutely in touch with its disruptions and costs?

When I've suggested that both breastfeeding and bottle feeding involve risks and benefits and that these must be weighed in individual context, I've been compared to Holocaust deniers and advocates of cold fusion. I've been called a lesbian and a feminist, as if these terms signal some pathology that automatically disqualifies anything I argue. I've been told, effectively, "you can't say that."

The trouble is, we'd like to believe that science gives clearer instructions than it can and that mothers have a lot more control than they actually do. But there is no universal, low-risk way to feed babies or parent (or to live, for that matter). For the vast majority of babies in the developed world, either breast or bottle is fine.

Joan Wolf is author of 'Is Breast Best?' and Visiting Fellow at the University of Kent's Centre for Parenting Culture Studies. She presented an Open Lecture at the University this week (13 February) which can be viewed below.



Anna Burbridge

Anna Burbridge responds

Professor Wolf says that mothers who choose to breastfeed usually do so because they have been persuaded that it has health benefits, and they are the kind of mothers who are willing and able to go the extra mile to provide the healthiest environment for their child. While not disputing that breastfeeding does have benefits, she claims that studies which show health benefits are misleading because the groups are self-selecting and that breastfed babies are healthier because their mothers are committed to healthy behaviour.

The implication seems to be that scientists and researchers who have published many well documented papers on the benefits of breastfeeding have overlooked the need to take into account external factors. But in 2011, researchers at the Institute for Social and Economic Research (ISER) conducted several studies to unravel the many positive outcomes of breastfeeding independently of external influences such as the mother’s education, home environment, IQ, social class and attitudes. Breastfeeding was found to have positive effects on the health, behaviour and intelligence of a baby, independent from other influencing factors. (Oct 2011 Early Intervention and Social Mobility: Are pro-breastfeeding policies worth it?)

The starting point for any discussion about infant feeding should not be "Is Breast Best?" but rather that breastmilk is the natural, normal food for a human baby and it provides all the nutrients a baby needs for at least the first six months of life. Infant formula was never intended to be used on such a widespread basis as it is today, being originally developed in the late 1800s to provide necessary nutrition for foundlings and orphans when no other food was available.

Breastmilk is a living substance which interacts with an individual baby in a unique way, and the man-made ingredients added to formula cannot recreate the benefits breastfeeding offers. Breastmilk contains large amounts of essential long chain polyunsaturated fatty acids, growth factors and hormones, which have an important role in the development and function of the brain and central nervous system. Manufacturers are constantly trying to improve their formulas. In the last decade they have started to supplement formula milks with essential fatty acids but the effectiveness of artificially added ingredients such as these is unclear.

Wolf has previously stated that breastmilk is loaded with pollutants and the long-term effect on mother and baby is not known. This statement overlooks the fact that any other food given to a baby will also be at risk of pollutants from the environment, and contamination or omissions during the manufacturing process, without having the benefits breastmilk offers such as building a strong immune system or containing a high level of antioxidants which help to counteract the effects of contaminants.

Professor Wolf seems to see little enjoyment to women from breastfeeding. She's previously spoken of  "the cost to a woman’s well-being", "the labour of breastfeeding", "women being held accountable for outcomes beyond their ability to control" and "women trying to demonstrate there is nothing they wouldn’t do for their child". Using such negative terms to describe breastfeeding reinforces Wolf’s view that women have to sacrifice their own feelings for the sake of their baby. They are terms which seem at odds with the reality of breastfeeding for many new mothers, who feel instinctively that breastfeeding is important for them and their baby.

While women can experience difficulties in the early days, breastfeeding is a partnership between mother and baby, and many mothers who continue breastfeeding often comment on how much they enjoy it and how pleased they are that they persevered through initial difficulties. Having access to good information and support when difficulties arise can make all the difference. Mothering a baby is not just another job. Talking about breastfeeding as "labour" or a chore with an extraordinary cost which is probably not worth the effort of continuing to do it, seems to reinforce the point that in our modern world the importance of the mothering relationship has been devalued or forgotten.

In order to make an informed choice about how to feed her baby, a woman needs accurate information. Although those who talk about the importance of breastfeeding are often labelled as the "breastfeeding police", their aim is not to pressurise women but to give accurate information based on evidence. Some women will choose not to breastfeed. Many more stop breastfeeding believing they do not have enough milk. In the majority of these cases, if they had received the information and support they needed, breastfeeding would have been successfully established. Negative comments about breastfeeding and its importance undermine a woman’s confidence in her ability to nurse her baby and can mean that normal difficulties are seen as an inability to breastfeed.

Mothering a child is a unique experience. As babies and mothers learn and grow together breastfeeding usually becomes a very enjoyable and important part of their early relationship. The time a mother spends breastfeeding cannot and should not have a price put on it. Its value is priceless.

Tell us what you think on the Talk thread - and don't forget to leave your URLs if you blog...

Last updated: 16-Apr-2013 at 12:01 PM