….But hey, let’s sloppily analyze the benefits again to make our cause even more newsworthy.
I was traveling home to LA from Chicago this morning, and was therefore happily oblivious to the slew of articles that popped up today referencing a study entitled “The Burden of Suboptimal Breastfeeding in the United States“. Just as my flight was about to depart, I checked my Blackberry one last time and saw an email from a friend, linking me to CNN.com. And by the time I got home, there were numerous emails from many of you alerting me to the same study.
So, I got home, unpacked a bit, got FC down (a minor miracle considering he was totally hyped up from a long day of planes, buses and cars, which are his three most favorite things in the world), and got online to blog a little damage control. I’m happy that The Skeptical OB beat me to it – at least there was one common sense reaction to a study that was at best a misguided and sloppy attempt to improve support for breastfeeding.
In the study summary, authors Melissa Bartick and Arnold Reinhold explain their methodology:
…We computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars.
This basically means that they made some estimates about how many medical bills (and more importantly – especially to the scare-mongering media – young lives) could be saved if, by breastfeeding, we helped children avoid these diseases. But let’s think about this for a minute: this only holds relevance if you agree that there is actually a risk of these diseases due to formula feeding. For instance, if you believe that it is truly the act of breastfeeding that lowers a child’s risk of obesity, then yes, calculating the health/financial cost of that future formula-caused obesity would be a valuable economic/public policy tool. If you believe that. And we all know where I stand on that one.
As for the scarier soundbite – that 911 lives could be saved by breastfeeding – I will start off by quoting the words of a much smarter woman than I, The Skeptical OB:
Using highly fanciful methods, Bartick and Reinhold “estimate” that the US could save 900 infant lives and $13 billion if 90% of US women breastfed. These numbers are grossly misleading since not even a single US infant death (let alone 900 per year) has ever been attributed to not breastfeeding and since the purported savings are primarily the “lost wages” of the 900 dead infants.
Interesting, but I also want to point out something else. According to CNN.com:
Bartick and her co-author Arnold Reinhold found that most of the excess costs are due to premature deaths. Nearly all, 95 percent of these deaths, are attributed to three causes: sudden infant death syndrome (SIDS); necrotizing enterocolitis, seen primarily in preterm babies and in which the lining of the intestinal wall dies; and lower respiratory infections such as pneumonia…Breastfeeding has been shown to reduce the risk of all of these and seven other illnesses studied by the study authors.
If 95% of the deaths in question are because of these 3 diseases, I think we should look at each one a little closer. Necrotizing enterocolitis is, as the article states, a condition mostly relegated to preemies. Does this make it any less important or scary? Of course not. But it does change the playing field a bit. Breastfeeding may indeed be more important for premature babies, as multiple studies have shown; however, in most cases, these infants need to be fed through some sort of artificial feeding system (as very premature infants are often unable to nurse), which means they will be drinking expressed breastmilk (which is a whole different animal to a scientist or study author than breastmilk straight-from-the-tap); often women who give birth prematurely are not producing enough milk, and may have to rely on a milk bank… again, all important and worthwhile issues, but an entirely new can of worms, and quite wiggly, convoluted worms at that. I’m not sure how much relevance a reduced risk of necrotizing enterocolitis has to the majority of otherwise healthy, full-term babies in this country.
Next up – the biggie: SIDS. Yes, there have been several studies which associate breastfeeding with a reduced risk of SIDS. especially in the first few months of life. Whether or not this is due to lifestyle factors surrounding formula feeding/breastfeeding is not entirely clear, from what I understand… for example, breastfed babies are often waking more frequently to eat (at least that’s what the reports say. My kid never went more than 3 hours without a bottle at night until about 5 months of age); also, sleeping in the same room with an infant has been shown to reduce SIDS, and perhaps breastfeeding moms are more apt to do this since they can more easily just wake up and feed (as opposed to running downstairs to make a bottle and stubbing your toe in the process on the seventeen pairs of shoes your husband insists on leaving by the landing). But regardless, I can’t really argue the numbers on this one. I did find an interesting website called Orthodox SIDS Prevention, out of New Zealand, which brought to light some noteworthy theories. (Which incidentally seem to follow a similar line of thinking to my post a few days ago….)
Breastfeeding does not reduce the risk of SIDS, as the following statistics demonstrate:
The breastfeeding rate in New Zealand has risen during recent decades and is very high by international standards (over 90% of newborns and 55% of babies aged six months). Yet up to 1995 the New Zealand SIDS rate was the highest in the world.
In the United States, only 60% of newborns and 21% of babies aged six months are breastfed. Yet in 1996 the US SIDS rate (0.75 deaths per 1000 live births) was less than half the New Zealand rate (1.8/1000).
The United Kingdom has a low breastfeeding rate (66% of newborns, falling to 21% of babies aged six months), yet the United Kingdom SIDS rate is low (in 1999 only 0.57/1000).
While breastfeeding is good practice for nutrition and various health reasons, it is not relevant to SIDS prevention.
Lastly, we have respiratory infections like pneumonia. I still stand by my theory that the lowered risk of most contagious diseases in exclusively breastfed children is due to the fact that exclusively breastfed kids are, by default, not in daycare. Here’s a study that might back this completely naive theory up, if you’re interested.
It’s sort of silly that I even feel the need to go into these crazy defensive analyses, because when it comes down to it, we are making a big deal out of 911 “projected” deaths. I know that sounds heartless. We should want to prevent ALL infant deaths, obviously. But considering this is all conjecture – we do not know that breastfeeding will definitely protect those 911 kids from dying – I think it needs to be said that there are more direct risk-benefit relationships that we can focus on. Like how about this one?
A new study appearing in the February 2009 issue of the American Journal of Public Health reports that securing small children and infants in the proper child car safety seats could save their lives. According to the study’s authors, use of child safety restraints dramatically lowers the chances that a child, three years of age or younger, will die in a serious traffic accident.
The study found that the odds of a baby dying in an auto crash dropped by 75% with use of a child safety seat, while the mortality rate for older children dropped by 60%. These findings are important considering that motor vehicle crashes are the number one cause of accidental deaths among kids older than 1.
If we’re talking about the leading causes of death in infants, we should probably discuss “accidental injury” (including traffic accidents), which ranks #6, far above necrotizing enterocolitis. Why aren’t we asking the government for money to give to those parents whose financial hardships prevent them from buying the safest and best carseats? Maybe I’m just tunnel-visioned, but I really don’t see a fraction of the amount of focus, anger or passion directed at protecting kids from injury/death related to improper car seat use in traffic accidents, which is an undeniable risk to our children. Here is something that all parents CAN do for their kids, without feeling like it is taking a toll on their personal health, mental well-being, sense of self, job security, career track, or long-term financial stability.
I just don’t get it. I really, really don’t.