LONDON – Everyone knows that breast is best. Not a day goes by without more evidence. “Breast-feeding for 20 months decreases risk of ovarian cancer by 50 percent.” “Breast-feeding burns up to 500 extra calories a day.” “Breast-feeding reduces infant mortality by 15 percent.”
These are just three stories on Twitter in two days from from a sample of 1,000 Chinese women by Curtin University in Australia, a New York state health department campaign and the health education and literacy program in Pakistan.
But is breast-feeding far and away the best thing? Or have we done women a disservice by overstating its benefits?
Earlier this week one of the leading figures in a backlash against breast-feeding argued in an open lecture at the University of Kent, Canterbury, on England’s south coast that “the scientific evidence for breast-feeding’s health benefits is weak.”
Joan B. Wolf, a professor of gender studies at Texas A&M University, contends that breast-feeding has been oversold because of three factors. First, we have a cultural obsession with eliminating risk, she says. Second, much of the research into breast-feeding is methodologically flawed. Third, we’re in thrall to “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.”
Without disputing the fact that breast-feeding does have obvious benefits, increasingly academics are starting to speak out against the limitations of the scientific evidence. In her book “Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood,” Wolf argues that the science behind many breast-feeding studies is problematic.
“In the science we trust most, we do randomized controlled trials. But you can’t do that with breast-feeding. The groups are self-selecting. Women who choose to go through the labor of breast-feeding have made a commitment to go the extra mile for the sake of their baby’s health,” says Wolf. “They are likely to be doing all kinds of other things too. Their homes are clean. They wash their hands. They will be reading more, talking more, serving more fruit and vegetables. … When you look at all of those things and hold them up to the very small differences that researchers find, it could very well all be down to these environmental factors.”
Tom Jaksic, an expert on neonatal nutrition at Harvard Medical School in the United States, has expressed concern that most of the studies are “population-based,” meaning that it is impossible to separate the effect of breast-feeding from the combined impact of caring parents and a positive environment. Dr. Nancy Butte, professor of pediatrics at Baylor College of Medicine in Texas, and an authority on childhood obesity, has said that it’s “hard to distinguish between a well-cared-for bottle-fed infant and one who’s breast-fed.”
We are in danger of ignoring the drawbacks of breast-feeding, says Wolf, such as the potential loss to women’s earnings. And we are in danger of “holding mothers accountable for all sorts of things they don’t have control over. You end up having this very strict set of rules about what mothers can and can’t do. Once you begin to say, “Better safe than sorry” — which is what people say about breast-feeding — there is no end to that kind of logic. One of the greatest lies promoted by breast-feeding advocates is that breast-feeding is free. But it’s not free if you count mother’s labor. For many you could say it has an extraordinary cost and is probably not worth the effort of continuing to do it.”
Wolf’s message has not been received warmly by the breast-feeding lobby. “Many people were and remain very angry with me.” She has been called “a gender-confused cow,” likened to a “Holocaust denier” and accused of hating mothers and children. She admits the response to her book has been “mostly negative.” One blogger writes: “It bespeaks great scientific arrogance (of the kind that Wolf supposedly decries!) to maintain that an artificial formula could offer absolutely every crucial natural constituent of mother’s milk.” But others have applauded her for “bringing sunlight to this topic” and opposing the “breast-feeding mafia.”
The arguments in the U.S. are heating up since a “baby-friendly hospital initiative” was launched in New York last year with the backing of Mayor Michael Bloomberg. As part of the Latch On, NYC campaign, formula is to be kept under lock and key on maternity wards. If a parent requests it, a nurse must deliver a lecture on breast-feeding and then document a medical reason for giving out the formula. The Huffington Post reported that mothers would have to “sign the formula out like medication.”
In the U.S. the debate is highly politicized largely because of the absence of maternity leave. Those who caution against placing breast-feeding front and center of health campaigns point out that working mothers (who have no choice but to return to work in the early weeks or months if they want to keep their jobs) are sentenced to spending time at work expressing breast milk to maintain their supply. This is such a part of American working life that in 2010 the authorities took the decision to make breast pumps and supplies tax deductible.
In Britain, meanwhile, the strange thing about breast-feeding is that all the promotions and campaigns exist alongside a climate of supposed guilt and noncompliance. Anyone who has breast-fed a baby past the age of six months, let alone past one year, knows that it’s quite hard to find other mothers who are still breast-feeding partially or solely by that age. If you breast-feed past a certain number of months, you will get funny looks in public and questions about why the baby hasn’t grown out of it. All the official information suggests that a six-month-old should be breast-fed. And yet the statistics tell a different story: at two weeks old more than half of British babies have had formula.
Last year UNICEF’s UK’s report “Preventing Disease and Saving Resources: The Potential Contribution of Increasing Breast-feeding Rates in the U.K.” showed that breast-feeding rates at birth have increased from 62 percent in 1990 to 81 percent in 2011. But by six weeks more than half of parents have introduced formula.
From Unicef UK: “Only 45 percent of women reported that they were breast-feeding exclusively [i.e., no formula] at one week after birth. Fewer than 1 percent were still doing so at six months.” The report concludes: “The great majority of babies in the U.K. are fed with formula in full or in part at some time during the first six months of life. And by five months of age, 75 percent of babies in the U.K. receive no breast milk at all.”
This is contrary to the cultural messages we receive about breast-feeding: that we should be doing it and we should feel bad if we don’t. In fact, only a minority of mothers are doing as they’re told. Despite all the fuss about breast-feeding, there is not much research into this.
One 2007 study in the Journal of the Sociology of Health and Illness showed that 32 percent of formula feeders feel a sense of failure about not breast-feeding. A total of 23 percent “worry what the midwife/health visitor might say.” And even fewer worry about the effects on the baby’s health. Instead, 88 percent are just “relieved their baby is being fed.”
There’s a doublethink going on here, a disconnect between what people are “supposed” to say they’re doing and what they’re actually doing. And yet the message persists that breast is the only way forward.
Christina Hardyment, author of a history of childcare, “Dream Babies,” says: “The history of breast-feeding fashion tends to be a middle-class thing. Most people just do whatever they can do and what they can afford. The more women go out to work, the more acceptable it is to not breast-feed.”
But there is also a sense that there is a historical cycle at work here, she says. “At the beginning of the 20th century they were obsessed with formula and thought breast-feeding was unscientific. There was a big reaction in the 1920s led by Truby King. He said that babies needed their mother’s milk and this sparked a terrific fashion for breast-feeding. It was about feeding by the clock, though, not on demand. People became pro-breast-feeding to the point that mothers began to be desperate. Then in the 1960s the Dr. Spock “just relax” business came in and people started to say, ‘If you can’t breast-feed, then formula is just as good.’ ”
As a historian she argues that the scientific research proves “there is no doubt mother’s milk is made for babies.” However, as a mother of four and grandmother of eight, she says: “I would not exaggerate the hugeness of the research into the benefits of breast-feeding. It’s lovely if you can do it. But formula is the next best thing. I don’t think it makes much difference either way if you provide lots of love and cuddles.” Some things science can’t disprove.
Breast-feeding rates in the United Kingdom fell sharply throughout the first half of the 20th century, after being almost universal up to the late 19th century. A survey in England and Wales in 1975 found that 51 percent of women began breast-feeding. (UNICEF UK, 2012)
The health benefits
Breast-fed babies are less likely to suffer serious diarrhea and vomiting, have fewer chest and ear infections; less chance of being constipated; less likelihood of becoming obese; less chance of developing eczema. (NHS)
“We expect mothers to work to prevent any risk to their children, regardless of how marginal the risk or what the cost or tradeoff is to the mothers themselves. Every mother is out there trying to demonstrate that there is virtually nothing she wouldn’t do for her child.’ (professor Joan B. Wolf)