The two headed chimera of infant feeding studies

It’s been a crazy week here, and I was really hoping to pull some pithy, short post out of the exhausted recesses of my brain. So when a study came across the wire touting extended formula feeding as a risk factor for a certain kind of childhood leukemia, I stuck my fingers in my ears. (Well, I posted about it on the Facebook page, but that’s kind of like the passive aggressive form of social media, isn’t it?) And a day or two later, when the Interwebz started buzzing about the British version of the infamous Burden of Suboptimal Breastfeeding “study”, I shoved a pillow over my head and sang the soundtrack of Beauty and the Beast really loudly (that’s what’s popular with the Fearless Children these days. It’s a great soundtrack and all, but seriously, how many times can a person hear Be Our Guest without going nuts? Although I did recently discover this YouTube gem, which has given Little Town – or, as Fearlette calls it, “Belle Sahwng” – a whole new meaning…).

One is named “Twitter”, the other “Parenting Science”

Unfortunately, I’m realizing that there is far too much inaccuracy and fear mongering going around to ignore. I don’t think I have the mental capacity to write a whole long diatribe, but I do want to address a few memes that are spreading like a California wildfire.

Courtesy of the UNICEF “Preventing disease, saving resources” report, I recently saw a discussion of how in the UK, only 1% of women are breastfeeding exclusively at 6 months. The consensus was that since formula feeders are so obviously in the majority, there is no need for them to feel marginalized.

I was shocked at that 1% statistic, and when I first heard it I was seriously blown away. But let’s look a bit closer at what the report actually says:

“….the proportion of women still breastfeeding at six weeks after birth increased by only a few percentage points between 2000 and 2005 – to just under 50% (Bolling et al, 2007). Rates of exclusive breastfeeding are much lower – only 45% of women reported that they were breastfeeding exclusively at one week after birth; fewer than 1% were still doing so at six months (Bolling et al, 2007). The rapid discontinuation of breastfeeding in the early days and weeks after birth, seen consistently since national surveys began in 1975, has only marginally improved to date, demonstrating that women who start to breastfeed often encounter problems, whether socio-cultural or clinical in nature, and stop. Ninety per cent of women who stop breastfeeding in the first six weeks report that they discontinue breastfeeding before they want to (Bolling et al, 2007). As a consequence, women can feel that they have failed their babies (Lee, 2007), and the great majority of babies in the UK 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% of babies in the UK receive no breastmilk at all.” (p. 35)

First things first: notice the amount of 2007s in that paragraph. Yup, the stats they are citing are from a 2007 report, which offered statistics gleaned from a 2005 infant feeding survey. 

Aw, come off it FFF, 2005 wasn’t that long ago.  Things can’t have changed all that much in 7.5 years. 

Well, let me just say this: I want to see statistics from at least 2010. (They have them, but these 2010 survey results do not include information on duration, just initiation.) I have a gut feeling, from my reading of the research and observations I’ve made from the sheer number of emails I get from our UK sisters, that things have changed. In a Twitter conversation tonight, someone with an adolescent son mused that if social media had been around when she was a new mom, her postpartum experience would have been markedly different. The advent of social media has changed the infant feeding world – yes, it may only be on a sociological level, and we may not yet be seeing huge statistical jumps in breastfeeding rates, but both breastfeeding awareness and pressure have increased since new mothers began spending more time on Twitter and Facebook than in mommy-and-me groups, or with their sisters, friends, or mothers.

Additionally, the last sentence of the paragraph – perhaps the most jarring- carries no citation. If we don’t know what they are basing this on, it’s hard to say if it’s hard fact, or merely an assumption by the authors. (Oh- and that reference to women feeling like they have “failed their babies” rather diminishes its citation, Ellie Lee’s landmark 2007 paper about how morality plays into the infant feeding debate. From what I gathered from her work, these women do feel they failed their babies when they switch to formula because they are MADE to feel that way by society- not because they have an innate sense of wrong-doing. I think this allusion ignores a large piece of the puzzle, and allows the authors to pay lip service to formula feeders while simultaneously perpetuating the cycle of shame. Then again, I’m already ornery, so maybe I’m over-analyzing this.)

What strikes me as odd is that I recently saw this press release, also from Unicef, applauding NHS for achieving a landmark: 8 out of 10 British babies are now breastfed, thanks to the Baby Friendly Initiative. Obviously, this is referring to initiation rates, not duration, so it’s apples and oranges. Any yet, the difference in tone confuses me – if the rates are going up, and it’s a cause for celebration, why the pessimism in this new UNICEF report?

I don’t doubt that UK breastfeeding rates are lower than most Western nations. That’s been the case for awhile. But even in Norway, exclusive breastfeeding rates at 6 months are pretty abysmal. That’s because… wait for it… most babies have received some solids by then. Even before the 6-month “ready for solids” party line started being questioned, most moms were letting their babies try a bit of rice cereal or some veggies between 5-6 months. Exclusive breastfeeding means exactly that – exclusive. As in NOTHING BUT BREASTMILK. This 99% of women not exclusively breastfeeding at 6 months back in 2007 was not necessarily a group of supplementers or early weaners – they could just as well have been people who cheated a bit on the 6-month rule for solids. (And more power to them if they did, considering some experts – and many moms- believe that when to start solids should be an individual thing, and based on a baby’s readiness anytime between 4-6 months).

The thing that scares me is that this paragraph – oh bloody hell, this whole report – is based on the assumption that no journalist or policy maker is going to take the time to dig up every cited study, or to pay attention to where the statistics are coming from. I would say the majority of people (shall we say 99%?) are going to assume that this paragraph translates to only 1% of women nowadays, in 2012, are making it to 6 months without using formula and that, my friends, is simply not the case.

Stupid thing to obsess about, right? Well, it might be, except this kind of confusing rhetoric is used throughout the report. They make a big stink about only using “quality” evidence, stating that the costs to British society would be far greater if they were able to use the plethora of less-conclusive scientific literature which links “not breastfeeding” (the word “not” is italicized every time it appears in this context. Kinda weird…) with things like ovarian cancer, SIDS, adult obesity, and Celiac disease. As it stands, they have calculated the health care costs of treating diseases primarily seen in non-breastfed babies: ear infections, gastrointestinal infections, respiratory disease, and necrotising enterocolitis, as well as breast cancer in mothers.

But what exactly does this “robust evidence” consist of? The authors thoroughly vetted the studies they used to determine the rates of specific diseases – so much so, that the outcomes were often based on one or two studies (like in the case of ear infection), as well as a few used for “corroborative evidence”. This report was not trying to determine the quality of breastfeeding research, nor does it purport to offer new evidence for the correlations they site. Rather, they are simply going through, deciding which studies to use based on specific criteria, and using those outcomes to determine economic savings.

(FYI, the authors admit that they leaned heavily on the Burden of Suboptimal Breastfeeding methodology to calculate their own costs. Please refer to our friend Polly over at MommaData for a good breakdown of why this method is inherently flawed.)

The report, which was distributed to and covered by every major media outlet in the UK, is lengthy and exhaustive – great for researchers, not so great for journalists. I doubt many who reported on this study read all 104 pages, including citations; I doubt many understood that the goal of the report was not to determine whether any of these conditions are actually caused by not breastfeeding versus being a matter of correlation too muddled by confounding factors, but rather it went under the assumption that these diseases/conditions were in fact PROVEN to be directly influenced by suboptimal breastfeeding. Get it? Report= economic case for breastfeeding. This is not a study proving anything new.

I admit that this report is far more palatable than its Yankee counterpart. There is legitimate attention paid to why women aren’t breastfeeding, and it even references studies and literature about the guilt and feelings of failure which occur when women cannot breastfeed (if somewhat incorrectly – see above reference to Ellie Lee). I appreciate that. But just as I worried (justifiably, it seems) with the Burden of Suboptimal Breastfeeding, I fear that this will be adopted into the infant feeding canon, and used incorrectly to support a myriad of other studies. This is how it works, unfortunately.

I also want to mention that the lead author of this study is Mary Renfrew, who has been quoted as saying that “women are born to breastfeed”. To me, this rings of bias, which can easily lead to confirmation bias. And when you’re basing a report on the opinions of a few key people as to what is considered “quality” evidence… I wonder if a neutral party would have given this study more gravitas. Good luck finding a neutral party in this field, though…

Moving on. The next hot new thing on my Twitter feed is a study which links childhood leukemia with a longer duration of formula feeding. This study may very well be credible. I have no idea, and neither does anyone else commenting on it – because it isn’t published. It isn’t even peer reviewed. And yet it is flying through the airwaves, causing squeals of “formula feeding causes cancer!!” in a manner that echoes with thinly veiled I-told-you-so’s.

But that’s not even the interesting part. Let’s go under the assumption that this study will come out and be stellar and scientifically sound (because we can’t really do anything in terms of dissecting it until we can see the damn thing, anyway). According to the study, do you know what also carries a comparable risk of childhood cancer development? Later introduction of solids, regardless of infant feeding method. Breastfeeding alone did not have a significant effect, but rather the length of time using formula, and the length of time the child went without solids in their diet.

I haven’t seen one freaking tweet about the solids thing. Not ONE.

I may well be a Defensive Formula Feeder, as one beloved lactivist blogger has knighted me, but here’s what I don’t get: one of these (assumed) correlations supports advocating for an act which often involves major social, emotional, physical, and economical sacrifice on the part of women. (It shouldn’t, but right now, in our society, it often does.) The other correlation just implies that you need to start giving Junior a daily dose of butternut squash around 6 months of age. Why are we so focused on the one that is complicated by socio-biological factors, and not one the one which would be easy for most parents to incorporate into their child-rearing?

I’m not pissed about the studies, people. I’m pissed because THIS is how we’ve arrived at this place. This place where women are being pitted against each other; this place where we are made to feel responsible for the wealth and health of the nation, so that our governments can spend a few bucks pressuring women to breastfeed rather than figuring out real ways to enhance socioeconomic disparities; this place where one can’t question the intentions or quality of a research paper without being accused of being anti-breastfeeding or anti-mother or anti-science.

Speaking of Beauty and the Beast…this game of championing-research-which-can-mislead-and-and-scare-new-parents-before-stopping-to-fully-comprehend-it reminds me of The Mob Song (my son’s favorite). As the townspeople march towards the Beast’s castle with fiery torches, they sing: “We don’t like what we don’t understand- in fact it scares us, and this monster is mysterious at least… here we come, fifty strong, and fifty Frenchmen can’t be wrong…”

Imagine those Frenchmen with Twitter and Facebook accounts, multiply them by about 1000, and you have a great explanation of what’s wrong with social media and parenting science, my own personal two-headed Chimera.

 

 

 

About the Author:

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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10 thoughts on “The two headed chimera of infant feeding studies

  1. I want to just send a link to this piece to every single bloody UK news outlet who reported on that “study”. Because, like you, I found it only too clear that the majority journalists had done little more than skim the abstract and conclusions.

  2. Later introduction of solids…and perhaps failure to introduce fruits and vegetables at ANY point? REAL fruits and veggies? Has anyone considered what those fruit chewy things are doing to our children? What about McDonalds? Etc. Maybe vitamin deficiencies lead to higher rates of cancer. I’m not convinced that artificial food sources with vitamins taken out and added back in (after processing) and multivitamins can entirely make up for a lack of fresh fruits and vegetables in one’s diet. Anyway, point being there are a lot of potential environmental reasons why the rate of cancer has gone up in children – or in any one particular group of children.

  3. I really enjoyed this Suzie. You said quite a few things that ring true for me. I hate how if you go look up formul feeding on twitter there are about 5,000 posts about formula causing leukemia. It’s not even increased risks, it’s just formula feeding = cancer. What mother is going to see that and panic.

    And yet, it’s not a vetted study. Or even inherently something anyone could prove as they are arguing two completely different factors.

    Offering real food, as Wendy so rightly pointed out, is so different from the baby rusks and chewy things and whatever else is aimed at parents. I personally WANT to see more research into kids being fed real food. It was hugely important to us for Sophie as she was so far behind in eating, weight, health etc.

    I cannot understand how they could possibly test this hypothesis and I am ashamed that fellow breastfeeders would hop onto this as some sort of proof when one could equally question them about delayed solid introduction.

    It’s fucked up.

  4. Regarding the cancer study… So were the breastfeeders also less likely to vaccinate? More likely to feed real/healthy food? Less likely tolive in the city? There are (as always) simply far too many factors to weigh.

  5. I find the “exclusive breastfeeding” thing a bit mad, really. I’m surprised that even 1% exclusively BF to six months based on the WHO/UNICEF definition (http://www.unicef.org.uk/Documents/Baby_Friendly/Research/4/infant_feeding_definitions.pdf?epslanguage=en). The fact that my baby had a piddling bottle of sugar water in the hospital and started small amounts of solids from 4.5 months means that she now officially constitutes a sort of Public Health Problem… ha!

    Even water’s not allowed, according to the definition. Which makes you feel like getting a bit silly, and saying “Okay, so… what if they swallow some water in the bath? What if the bathroom’s steamy and they BREATHE IN a bit of water vapor… is there some sort of threshold level here? Come to think of it, what if they put their fingers in their mouth and there’s dog hair or car hair or crumbs or something on them….?”

    I do understand why these guidelines make sense as a goal to achieve if you are living in, say, a village in Bangladesh where even a small sip of water could give an infant a fatal diarrheal disease, but in a developed country?

    • LOL! I agree – and it sounds like the occasional relief bottle is a no-no too. So your child could be 98% breastfed but that doesn’t cut it for the advocates. Having worked in the social development field before I know that people love to stretch stats and make them sound more dramatic to get funding for “urgent” health problems. I suspect that’s what is going on here. And that’s yet another reason why I think public health advocates should get the fuck out of monitoring what should go into our babies, and get into the business of trying to ensure we have humane amounts of maternity leave, and focus on getting funding and training for LCs for those who need them, and generally making it easier for women who so wish to CHOOSE to BF rather than scaring us about how few of us meet their standards for Virgin Mary perfection.

      • Ha ha ha! I’ve always been a bit mystified be the adamance about exclusive breastfeeding. I remember once reading an article (don’t remember where, sorry) that lamented how few babies were EXCLUSIVELY breastfed, calling it “non-compliance”. And of course these ‘bad mommies’ are responsible for a host of illnesses and the cost of treating them and maybe even their children’s’ deaths.

        So, my mom who breastfed me most of the time and had my dad give me a daily relief bottle (of formula) was being “non-compliant,” and I’m lucky to be alive? Right then. /Sarcasm. I’m guessing the same statement would apply when infants were fed a little cereal/ porridge or pureed veggies when they were five months old.

        And what if they ate some pet food, dirt or sand before somebody noticed/ could stop them? That’s right. Some of those babies you thought were perfectly and exclusively BFed (and studied to show what a cure/ prevent-all it is) ate dog food! *Gasp* Maybe you should take a look at the benefits of puppy chow for human babies. ;-)

    • That’s exactly what I was thinking. I breastfed my son for quite a while, but if I had been asked after 6 months whether he was “exclusively breastfed” I would have said “no.”
      The way the data was reported could make a difference as well. Self-reported data leaves a lot to interpretation. Even if you have someone sitting there asking questions, unless the SAME person polls EVERY person, and qualifies everything EXACTLY the same way, you can’t be certain that the data will be accurate.

  6. “I also want to mention that the lead author of this study is Mary Renfrew, who has been quoted as saying that “women are born to breastfeed”.

    Shocking. Another example of a breast-feeding advocate moonlighting as a breast-feeding reseacher and sadly here public health auteur. No conflict of interest? Just imagine the outrage if a researcher came out and said she (or he) firmly believed the benefits have been exaggerated and that said evidence didn’t justify the current recommendations. Then they went on to publish studies showing little to no difference between breast-feeding and formula. Imagine the slaughter, the sudden concern about conflict of interest.

  7. I was so cross about this study and the media coverage – and I’m a journalist myself. I’m not sure whether you remember, Suzanne, but I interviewed you last year when my baby was tiny and I started writing a book about the bullying that goes on here in the UK over breastfeeding… things like this just fan those stupid flames :(

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