Q&A with Joan Wolf, author of “Is Breast Best?”

For those of you who visit the FFF Facebook page, you may have seen a few of us discussing a new book called Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood (New York University Press, 2010), by Joan Wolf. This book is getting a lot of buzz, and it will come as no surprise to any Fearless Formula Feeder that she’s been the target of much vitriol for daring to question the validity of breastfeeding science.

The unfortunate truth is that most people slamming her on Twitter, blogs or anonymously in comment sections haven’t read her book. Not only does this make their critiques unfounded, but it’s also sad for another reason that I think exemplifies the problem of the infant feeding debate: if they actually took the time to read Wolf’s well-reasoned arguments, they might see where she is coming from. She is not just indiscriminately dismissing every study on breastfeeding outcomes; she is making an overall statement on how we approach scientific research when it comes to parenting, and how mothers are being held responsible for every possible ill their children might endure. The book encompasses several years’ worth of research, and Wolf’s prose is compelling and persuasive. She makes a fascinating comparison between the breastfeeding rhetoric and the language of the “obesity epidemic”; her points extend far beyond breastfeeding, into the way we view women, motherhood, and risk. Hers is a new and important voice, and one that I hope to god won’t be silenced by the cacophony of hate that tries to censor any dissenting voices in this debate. You don’t have to agree with her, but she at least deserves to be taken on her work and not on your own assumptions.

Head on over to Amazon and order the damn book, would you? It’s uniquely readable for an academic book, and I promise you that no matter where you stand on these issues, your arguments will come out smarter and more nuanced after hearing what Wolf has to say. (Oh – and after you read it, leave a review on Amazon. It might help counteract all the idiots who will leave snarky comments and bad reviews without even reading the introduction).

To wet your whistles, here is a short Q&A I did with Joan. Consider it a trailer for the main attraction… I know most of us have limited time to read, but I swear, this one is worth sacrificing your free time during your kid’s nap….

FFF: What got you interested in this subject matter, and provoked you to take on this book project?
Joan: When I first started reading around this topic, I was struck by two things: one, that while feminists had produced tomes about pregnancy, childbirth, and childcare, they had written comparatively little about breastfeeding; and two, that there has been very little disagreement between institutional medicine and women’s health activists that breast is best.  I was curious about how such a consensus had developed, especially given the kind of commitment breastfeeding requires and the reality that it’s not something mothers can share 50-50 with fathers.  I never doubted that breastfeeding had myriad health benefits, so I was actually very surprised at what I found in the medical literature.
FFF: Was it a difficult “sell” in terms of finding a publisher? Did you find people were hesitant to take on such a controversial topic, especially as your thesis was against the grain of popular thought?
Joan: Editors almost always have manuscripts vetted by other scholars, so they are certainly careful before they agree to publish something.  But, generally speaking, I don’t think they shy away from controversial topics if the manuscript is well done.  New York University Press has been a particularly good press for my book because it has a long history of publishing engaged scholarship, the kind of research that contributes to not just academic but public debates as well.  I really wanted Is Breast Best? to be available to both scholars and thoughtful people outside academe, and I have been extremely happy with NYU.
FFF: Do you think there is a divide between what the science really says about breastfeeding and what physicians believe/are imparting to their patients? Can you explain why this might be the case?
Joan: Compelling science tells us that breastfeeding provides babies some protection against gastrointestinal infections.  Doctors and public health practitioners tell us that breastfeeding makes babies happier and smarter and prevents ear and respiratory infections, diabetes, obesity, childhood cancer, asthma, allergies, leukemia, heart disease and scores of other illnesses and diseases.  So I wouldn’t say there’s a divide between what the science says and what pregnant women and new mothers are hearing; I’d say there’s a chasm.  What I ask in the book is, why?  And I think there are many reasons. 
First, we tend to confuse correlation and causality.  So, for example, if breastfed babies are less likely to be obese, this doesn’t mean that not breastfeeding causes obesity.  Mothers who breastfeed might well behave in all sorts of ways that promote health, and these behaviors could be responsible for the better health outcomes that we now attribute to breastfeeding.  The American Academy of Pediatrics actually made this case in 1982, when it warned pediatricians against overstating the benefits of breastfeeding.  Now, the AAP argues that breast is unequivocally best even though science is no closer to distinguishing the effects of breastfeeding from behavior surrounding breastfeeding.  Many advocates point to the sheer volume of studies showing a correlation between breastfeeding and better health.  But when you think about it, if a study leaves a crucial question unanswered, evidence from 50 or 500 similar studies doesn’t make that question go away.  Repetition does seem to have the effect of concealing the problem, which in this case is the absence of any demonstrable causal link, outside of the gastrointestinal tract, between breastfeeding and better health.  It also makes research scientists, doctors, and various media less likely to pay attention to research finding little or no benefit from breastfeeding, and there are plenty of studies with this conclusion. 
The push to breastfeed is also part of a larger cultural preoccupation with risk, and especially health risks.  We expend tremendous energy trying to stave off illness and disease.  And we do this by gathering information and seeking out the opinions of experts so that we can make good, healthy choices.  I’m not suggesting that we shouldn’t encourage people to behave in healthy ways, but we have a terribly inflated sense of how much we, as individuals, can accomplish.  We think we have far more control over our bodies than we actually do, and we underestimate the impact of genetics and social environment on health.  Breastfeeding advocacy is very much part of this mindset that individuals have the power to be healthy if they just work hard enough and make responsible choices.
Finally, breastfeeding is part of what I call total motherhood, the belief that mothers are both capable of and responsible for preventing any imaginable risk to their babies and children.  It’s a moral code in which mothers are expected to protect their offspring from any risk, no matter how small, at any cost.  No dimension of a child’s life is beyond mother’s ability and responsibility to optimize, and no price is too high for the mother to pay in the process.  Of course parenting is, by definition, about prioritizing the needs and desires of our children, and mothers do this all the time.  But we are making mothers crazy today by telling them that they have the power, if they are willing to put forth the effort and make sacrifices, to prevent all sorts of bad things from happening to their kids. 
FFF: Do you think that breastfeeding advocacy, as it stands right now, is effective? Do you have any thoughts on how we could raise breastfeeding rates and support women without misleading them or subjecting them to this cult of “total motherhood” that you so eloquently explain in your book?
Joan: In the absence of compelling evidence that breastfeeding has substantial health benefits, it’s not clear to me that raising breastfeeding rates is all that important.  I’m actually more concerned that women who don’t want to breastfeed are being led to believe that they are somehow doing irreparable damage to their babies if they use formula.  I agree with many advocates that there are inadequate social supports in place for women who choose to breastfeed.  But the stakes of this choice have been dramatically misrepresented by scientists, doctors, and the government, and our first priority ought to be getting women accurate information.
I am also deeply concerned about what can happen when women leave their careers or shift to part-time jobs so they can breastfeed and otherwise provide exclusive care for their babies and young children.  Joan Williams and other scholars have provided overwhelming evidence that these women put themselves (and their children) at real economic risk, especially in the case of divorce, which is how roughly one in two marriages ends today.  I am not suggesting that women shouldn’t breastfeed or take time to be with their babies and toddlers.  But breastfeeding – and total motherhood more broadly conceived – has real costs that are lost in all the rhetoric claiming it is “free.”  The reality is that women need to be prepared to take care of themselves (and their children), and what we should be fighting for are policies and workplaces that don’t marginalize caregivers. 
FFF: I had never thought about the fact that maternal IQ and education was always controlled for in IQ studies, but not paternal… so my question is, do you think this is a problem of a fundamental flaw in the way we think about parenting? Or is there a scientific reason for not acknowledging the dad’s role?
Joan: This general tendency to avoid examining paternal influences doesn’t make any scientific sense.  We have little reason to believe that a father’s genetic contribution in terms of intelligence, obesity, or myriad other health outcomes is any less significant than a mother’s.  The fact that mother’s family history is usually used to determine baby’s genetic inheritance is a wonderful example of how scientists often operate with unconscious (and unproven) assumptions about maternal responsibility.  Facts might be true, but they are inherently partial.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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