#ISY Week Guest Post: A nurse’s perspective on infant nutrition and self-advocacy

The following guest post was written by Maria Elena Piña-Fonti, President of the National Association of Hispanic Nurses—NY Chapter, in honor of #ISupportYou Week. I was thrilled she wanted to contribute something, as nurses play an integral part in ensuring that new parents and their infants get the healthiest start possible, while respecting the need for autonomy and an individual approach to care. I hope more health care providers will join Maria in celebrating ISY Week, by helping new parents understand their rights, offering education in a culturally sensitive manner, and showing the world the true meaning of “informed choice”. 

Infant Nutrition and Self-Advocacy

by Maria Elena Piña-Fonti, MA, RN

As a nurse, I come in contact with parents from all walks of life.  First-time parents, experienced parents, confident parents, and sometime confused parents.  What I tell parents—both the mothers and the fathers—is that it is important to have as much information as possible about all types of infant nutrition in order to make an educated, confident decision about what is best for your family.

Exclusive breastfeeding, formula feeding, and combination feeding are all safe ways to feed an infant.  Parents are given a lot of information, advice, and opinions, on caring for their children—especially when it comes to infant nutrition.  But how mothers and fathers feed their baby is a personal decision, one that can be influenced by many factors such as medical issues and returning to work.

As parents, once you make an informed decision about how to nourish your baby, you—and your choices—should be respected and supported.

You are your own—and your baby’s—best advocates to ensure that you have access to all the information and support you need to be successful parents and to raise healthy and happy children.  You should feel comfortable with your choices and confident and empowered that you know best what is right for your own family.

The following are some helpful tips to help advocate for you and your baby:

1.  Speak up. You and your healthcare providers are a team working together for the health and well-being of your baby. You should always feel like a valued and respected member of this team. Don’t be afraid to ask questions about your choices and preferences.

 2.  Be open and honest. Share with your healthcare provider any concerns regarding health conditions or employment that may impact breastfeeding, formula feeding, or a combination of the two. They can only help you if they know the complete picture.

3.  Make your needs and wishes known and respected by your network, family, and friends.  Once you’ve made up your mind, make it clear that you have considered all of the information and are comfortable with your decision.  Ask for their support of your decision.

4.  It’s okay to change your mind.  If your feeding plan is not going as you wished, it’s alright to change your plan. Don’t be upset.  You have not failed. Remember the importance of closeness and touch to a baby.

5.  Get answers and information.  Your healthcare provider should fully support you and can refer you to resources you may need in making the best decisions for you, your baby, and your family.

Nobody knows the needs of you, your baby, or your family better than you do!

What parents need most is support, not shame or judgment.  #ISupportYou parents who breastfeed, #ISupportYou parents who formula feed, #ISupportYou parents who combination feed. No matter how you feed your babies, #ISupportYou.

Maria Elena Piña-Fonti is President of the National Association of Hispanic Nurses—NY Chapter, an association dedicated to community advocacy and well being, which believes parental engagement, education, and choice is essential to parental empowerment.

All new parents deserve a place at the consumer protection table, not just breastfeeding ones: A response to the “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities”

Public Citizen is known for its advocacy for ordinary citizens who have been harmed by large entities–and rightly so.  Much good has been done by this organization in the name of everyday citizens who otherwise have little power to lobby our government for stronger laws and regulations to protect our society.  However, Public Citizen’s recent event, “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities,” does not accomplish the goal of protecting consumers.  A consumer protection advocacy organization has an obligation to women to support their right to bodily autonomy, as well as support their and their children’s health care needs—issues that are sometimes incompatible with breastfeeding and do not currently receive sufficient support in our breastfeeding-centric post-partum health care model.

The Day of Action fails to address many of the true issues that affect women’s and children’s ability to breastfeed.  A complete lack of formula advertising is not going to enable women with insufficient glandular tissue (IGT) to make sufficient milk, or change the fact that many women have to take necessary medications that are incompatible with breastfeeding.  It is not going to prevent complicated births or medical conditions in babies that sometimes make it exceedingly difficult – or impossible –for moms to breastfeed.  It does not reduce adoptive or foster families’ need for formula.  And a lack of advertising is not going to change the fact that some women do not want to breastfeed, and have a right to their bodily autonomy.  While we agree that it would be best for parents to receive information about formula from a non-profit source, currently, there is no such source that provides accurate, unbiased formula information, even to families for whom breastfeeding is not an option at all.

The Day of Action implies that information about formula is plentiful and accurate.  Nothing could be further from the truth.  Information about formula is typically riddled with fear mongering about not breastfeeding and uses value-laden language that assumes women who use formula lack perseverance or are selfish, lazy, uneducated, immoral, or ambivalent about their children’s health, despite ample evidence to the contrary. Formula supplies in hospitals are hidden in drawers or even locked up.  Lactation consultants are held to the WHO Code and urged not to discuss formula unless under special circumstances (lest it send a message that formula is “just as good as breastfeeding,” even though it is a medically appropriate option, and sometimes the only option).  Doctors are not taught about formula preparation and are frequently scared off of even talking about formula for fear of being labeled anti-breastfeeding.  Where are formula-feeding families supposed to get the accurate, unbiased, judgment-free information they need?

Perhaps Public Citizen is unaware of the extent to which breastfeeding marketing relies on shaky claims.  Maternity wards are typically papered over with literature that claims breastfeeding improving babies’ IQ and helps new moms lose weight—claims that some assert are based on poorly-done research that frequently confuses correlation with causation, and that have not been borne out in more powerful, well-designed studies.  Recent research on breastfed and formula fed siblings (three well-regarded published studies[1]) showed little to no long-term effect of breastfeeding for a number of oft-mentioned issues.  These studies are powerful because, unlike many other studies on breastfeeding, variables such as parental IQ, educational status, and socio-economic status are much better controlled.  Several large metastudies (including those conducted by WHO[2] itself and the United States’ Agency for Healthcare Research and Quality[3]) have found that the evidence in favor of breastfeeding is marred by confounding factors.

A consumer protection advocacy organization has the responsibility to ensure that advertising claims are based on sound science, but the “absolutes” plastered on maternity ward walls, city buses, and doctor’s offices (“Breastfeeding prevents asthma[4]”, “breastfeeding makes babies smarter[5]”, “Breastfed babies grow up stronger, healthier and smarter[6]”) and liberally sprinkled in literature distributed to new parents do not fulfill this criteria. Public service messages cannot be immune to the regulations that restrict other advertising.

Further, perhaps Public Citizen is unaware of how much of the advertising for breastfeeding actually benefits corporate entities.  New moms in hospitals are given sample tubes of Lansinoh nipple cream, Medela breast pads, and coupons or ads for local boutiques that sell breastfeeding products such as Boppy nursing pillows and covers.  It is common for new mothers to receive sample magazines, which exist both to promote themselves as well as the advertisers within. It seems counter to Public Citizen’s goals to protest one form of advertising and not others.

Women deserve to know the full range of medically viable options for feeding their children, in an unbiased, accurate, and judgment-free manner, and we feel a consumer protection organization should be at the forefront of that fight.  Formula feeding parents need help, advice, and support just as much as breastfeeding parents. Unless Public Citizen is willing to help establish a non-profit center to train “infant feeding consultants”, not just “lactation consultants,” whose job is to support all medically viable methods of feeding a baby, this Day of Action seems just another way to deny formula-feeding families what little information they can still get about their health care options for their children.  It seems to contradict the stated goals of Public Citizen to protect consumers.

We encourage Public Citizen to speak with actual formula feeding parents, many of who feel marginalized in our healthcare system for the choice or necessity of formula.  Breastfeeding—and products and service providers who support it—is so heavily promoted in hospitals that formula feeding families are left without the kind of education or support that breastfeeding families receive. As there are no non-profit sources of education for formula, other than a few websites run by mothers who have taken up the charge, companies are the only remaining source. This is not ideal, but it is currently all we have. We encourage Public Citizen and all who support this Day of Action to read the stories of actual formula-feeding parents, the vast majority of whom report seeing no advertising prior to using formula, at FearlessFormulaFeeder.com, and consider how they may equitably represent the needs of pregnant, birthing, and post-partum mothers and their babies at the consumer protection advocacy table.

Signed,

Concerned Members of the FearlessFormulaFeeder.com Community

 

 


[1] Evenhouse, Eirick and Reilly, Siobhan. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res. Dec 2005; 40(6 Pt 1): 1781–1802; Geoff Der, G David Batty and Ian J Deary. Effect of breast feeding on intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis. BMJ 2006;333;945-; originally published online 4 Oct 2006; Colen, Cynthia G. and Ramey, David M. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, Volume 109, May 2014, Pages 55–65.

 

[2] Horta, BL and Victora, CG Long-term effects of breastfeeding: A systematic review. World Health Organization, 2013.

[3] NIH Agency for Healthcare Research and Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/Technology Assessments, No. 153, April 2007.

 

 

Guest Post from Jessica of The Leaky Boob: Tough Love

I’m cross-posting this excellent piece from Jessica Martin-Weber, creator of The Leaky Boob, because… well, I think that will be obvious once you read it. THIS is what #ISupportYou is about. THIS is what the FFF community stands for. Working together to ensure that all mothers are supported. Not pushing breastfeeding on those who don’t want to; not cutting down breastfeeding to make ourselves “feel better’ about formula feeding; not advocating for one method over another…. It’s about helping mothers feel confident and educated and celebrated for doing the best they can for their families and themselves. Jessica is a wonderful example of what true breastfeeding support can and should be. and the fact that she is taking a stand against someone who is harming both her community and ours (and of course, they often intersect, since so many of us are not firmly entrenched in specific “camps” like some would have us believe) is seriously awesome. 

So enjoy.  And share. 

- The FFF

***
by Jessica Martin-Weber

Sometimes tough love is necessary, sometimes people getting in your face, calling you names, and yelling at you totally works as motivation. Usually motivation to punch them in the throat but hey it’s motivation. Entire “reality” TV shows have been built on this premise: you can scream troubled teens onto the right path, personal trainers can belittle overweight individuals into exercise and healthy eating, and business moguels can rant apprentices into savvy executives. In spite of all the studies that show that shaming doesn’t actually provide any kind of lasting intrinsic motivation, countless parents, self-help gurus, educators, and others in positions of influence and authority resort to shaming in a desperate attempt to inspire positive change. Sometimes tough love really isn’t tough love, it’s a power trip down false-sense-of-superiority lane.

Even those purporting to support families. Birth, breastfeeding, and, ironically, gentle parenting advocates, far too often resort to shaming other parents. Because that makes sense, something negative is going to have a lasting, positive impact. Undermining parents’ confidence surely is going to result in change for the better, right?

Wrong.

It may get your website page views, it may increase your “talking about” numbers on Facebook, it may even get people pinning your content on Pinterest. But helping people? Not likely. Inspiring them to do something different? Maybe but that may just be to ignore any information or support because it all starts to feel like an attack. I’m not talking about guilt here (though wishing guilt on people is just nasty) but rather intentionally belittling, mocking, and dismissing others in order to induce shame and build a false sense of superiority. Guilt is one’s own feeling and sense of grief over perceived wrongdoing (sometimes legit, other times not) so believing that what they did was wrong, shame is one’s own feeling and sense of grief over their personal ability of perceived wrongdoing (sometimes legit, other times not) so believing that who they are is wrong. Shaming is intentionally trying to make someone not only feel guilt but to internalize it as believing that somehow they are bad/lazy/stupid/unloving/pathetic/unloveable/worthless as a result. Ultimately, shaming comes from a desire to see someone feel bad about themselves.

It’s disgusting. And it doesn’t work to motivate people to change their actions. It isn’t education, it isn’t support, it is really nothing more than abuse.

I’ve shared before that I’m not really passionate about breastfeeding. I mean, I am, but I’m not actually passionate about breastfeeding. What I am passionate about is people and personally, I don’t see how you can actually be passionate about breastfeeding but not be passionate about people. To do so would mean that you care less about people than you do about being heard as right. Do you know what happens with that kind of passion? It hurts people and detracts from the message you are trying to promote. That kind of passion becomes easy to dismiss at best, damaging at worst.

The Leaky Boob isn’t about that kind of passion. The information, images, stories, and interactions we share are meant to inspire and encourage people. While we can’t control nor are we responsible for the emotions of others, we don’t intentionally try to manipulate others’ feelings. Underlying everything at TLB is respect and the belief that with genuine support and information, women are perfectly capable as mothers to make the best decisions for their families based on the information and resources available to them in their individual circumstances. We don’t assume to know what that looks like for anyone.

So it was with horror that we discovered an image of one of our own volunteer admins originally shared on The Leaky Boob Facebook page and then on theleakyboob.com had been turned into a vehicle intended to shame, belittle, and attack certain mothers. An image that was shared to inspire and encourage, to give someone the platform to share their own personal story and breastfeeding journey, had been used as a vile expression of superiority intended to hurt others. Words were applied to this image communicating the very opposite of what TLB and Serena, the woman pictured, stand for as a community. Without permission, Serena’s image was used to spread a message she in no way condones aligning her with those that would bully others.

This message is not approved TAP serena

I’m not going to lie, I am incensed. For my friend, for my community, and for those hurt by this image, I am outraged. Disgusted.

The person that perverted this image stole Serena’s photo and manipulated it in order to send a shaming message to formula feeders. In a statement to me Serena expressed that she felt violated and used. Not only that, but as a woman that has both breastfed and formula fed, Serena’s own image was used to attack a group of women to which she belongs as well.

When I opened FB this morning to a message from a concerned friend with a link to this meme I was shocked. Shocked that MY photo, a photo of a tender moment, could be used in such a hateful, disparaging way. To see that it was posted 28 weeks ago only makes it worse. All this time MY photo has been circulating with such a hurtful message, a message that I would NEVER propagate. Belittling or negating someone else’s breastfeeding issues or choices is not beneficial for anyone. As mothers we all do what we believe is best for our children. Even though our opinions may differ due to choice or circumstance. I am not a breastfeeding martyr, I have used formula in conjunction with breastfeeding when needed. What was important was that I was able to mother my son in the way I wanted to, due to the SUPPORT I received. Support is something that was lacking in the making of this meme. I do not condone the use of my photo in this way. ~Serena Tremblay

 

As far as we can tell, the image was originally posted to The Alpha Parent’s Pinterest board “Dear Formula Feeder,” don’t go check it out, it is a virtual collection of putrid hate filled shaming refuse. Nobody needs to see that. There has been no response to our two email attempts requesting the image be removed and destroyed (and never shared again) and so Serena has followed Pinterest guidelines to have the graphic removed. We have tried to utilize respectful means and the proper channels to have this image removed and do believe that Pinterest will not allow the copyright violation to remain. Still, simply having that image erased from Pinterest won’t be enough. It has been seen and discussed in some circles, it’s message cutting and hurting and not helping anyone. The Leaky Boob stands behind Serena that this graphic is not a message we condone. The Leaky Boob, including Serena and all the volunteer admins hold to a very different set of values:

TLB creed

It is rare that I single anybody out for how they run their own website and social media presence. I respect that there are different styles and a variety of people are attracted to those style distinctives. I don’t have to get it or agree. But this has gone too far. Stealing an image and putting words to it that are directly opposed to the intent of the owner of the photo. Standing against the oppression of others is part of my passion for people, so I have raised my voice to express concern and even outrage when I have seen supposed breastfeeding advocates resort to shaming in general and specifically with this same offender. It is not the first time I have vocally opposed messages coming from The Alpha Parent and I agree with Amy West’s assessment of TAP’s “brand” of support. This time though a line has been crossed and while I have long not tolerated any abusive messages in the name of “supporting breastfeeding” within The Leaky Boob community, now I am taking stand against any and all expressions of shaming in the name of breastfeeding advocacy outside of my own little space.

Why am I sharing this with you? What can you do about it? If you’re reading this and have made it this far you probably care at least a little about how babies are fed, the information moms receive, have an interest in parenting support, or at the very least watch online interactions with a passing interest. To those ends then, consider how you are promoting shaming messages targeting others. Here are some simple steps you can take to not contribute to the type of interactions that do nothing to make our world a better place.

  1. Don’t share or spread memes that mock, belittle, or promote the shaming of anyone. This isn’t just a breastfeeding/formula feeding issue. This is a human issue.
  2. Before you use an image, be sure you have permission and don’t create memes and graphics that mock, belittle, or promote the shaming of anyone.
  3. Question every image you see and the message attached with it, particularly online. Everything may not be what it seems.
  4. If you “like” or follow any personality that regularly engages in such messaging, unlike and unfollow them. Take away their audience and don’t align yourself with the hate they are communicating.
  5. NEVER share materials, even if they seem supportive, from a source that you can not verify as free of mocking, belittling, or the promotion of shaming. Many of the breastfeeding support and education sources I follow share materials from The Alpha Parent because some of her content, particularly her older stuff, is pretty decent. Every time I see one of these resources share content from her I cringe, it’s like leading lambs to the slaughter. I loved her “anatomy of the toddler brain” post from a while back but there is no way I’ll share that with my audience, it would be irresponsible of me to do so. Share responsibly.
  6. Ignore them. It is tempting to take a stand and engage in heated arguments with those that thrive on putting down others, particularly online, but truth be told, ignoring them is far more effective in shutting them up. Don’t engage.
  7. Consistently share and interact with messages that promote true support and eventually the attraction of the fight will fade. Offer supportive support and if you find you are tempted to go on the attack, ask yourself why and what insecurities could be motivating you to do so.

I won’t be linking to The Alpha Parent here but I do encourage you to look through your social media channels and remove The Alpha Parent from your playlist if she is there. My intent is not to shame The Alpha Parent or cause her any harm and I hope that she finds her own happiness that doesn’t depend on a false sense of superiority. I hope we all can.

 

 

Disaster in the Philippines: Why overzealous breastfeeding promotion has no place in relief plans

Dear FFF,

We are based in Manila which, thankfully, was spared from the brunt of typhoon Haiyan. As you may be aware, our fellow Filipinos from the other islands of Leyte and Palawan suffered from this catastrophe. Aid has been slow in coming, and the situation is now miserable and desperate. Donations from all over the world are coming in, but the logistics of getting them to the people who need them are difficult because many of the islands are isolated and cannot be easily reached. Many have not eaten since Saturday. They also do not have clean drinking water and are living in the streets amidst rubble and dead bodies.

Which brings me to my question/issue – What is the best way to feed a baby in a crisis situation like this?

 Our Department of Health has BANNED donations of formula milk – powdered or pre-mix – because of the perils of formula and because it undermines breastfeeding.  According to the Department of Health, the best solution is to breastfeed, or if the mother is no longer breastfeeding, to give support towards re-lactation. If these are not feasible, then the next alternative is wet nursing. I do understand that this is the exact reason why formula has been deemed “dangerous – because preparation of formula in unsafe, unclean conditions (including using unclean water and bottles) can lead to diarrhea and infant mortality.  However, I also believe that the options given by the Department of Health practically require a mother to choose between death of a child by starvation and death by diarrhea.  They say re-lactation as if it was like turning on a switch. Most women who have weaned young babies likely had problems lactating in the first place. How likely is it that she would be able to re-lactate in the midst of the stress, chaos, and misery of a calamity? The Department of Health says that the solution is to provide breastfeeding support, counselling, and breastfeeding-friendly setups where breastfeeding can be encouraged.  In a situation where the most basic of necessities such as water, shelter, and medical care have not even reached the victims, it does not appear that anyone is currently equipped to provide these conditions that would foster breastfeeding in a crisis situation. Wet-nursing or donated milk is the next alternative presented. On wet-nursing, I do wonder if that is really a safe option, since it is possible to also contract disease from tainted breast milk. Again, in a calamity situation, who has the time and resources to check for infectious diseases when looking for a wet nurse?  On donated milk, I concede that this is probably the most viable option, but given the sheer number of people affected, I do not think that it is a sustainable source of nutrition for all the babies affected (given that several hundred thousand homes were affected). Babies need constant nutrition, and while donated milk may augment at the start, is it really sustainable to provide for the nutritional needs of all the victims in the coming days before they are moved to a safe and clean environment? 

And so, I think, banning pre-mix formula donations is a case of letting the principle of promoting breastfeeding defeat the principle of saving as many lives as possible.  Even the American Academy of Pediatrics concedes that pre-mixed formula is the last alternative when the other options are not feasible.  Our government, however, has taken the firm stance against formula and will refuse donations of pre-mixed formula.  Incidentally, pre-mixed is not readily available in the Philippines, but I’m sure it can be procured from other countries or even by local formula manufacturers if only it were allowed.

- S. T.

 

After receiving this email, I logged on to my computer to find several sources reiterating what the author had said. According to Gulf News,

Government and private hospitals in Manila called on nursing mothers nationwide to donate milk for babies in typhoon devastated central Philippines… Explaining the aim of the campaign, (Dr. Jessica Anne Dumalag of Manila’s Philippine General Hospital’s Human Milk Bank) said, “Milk from lactating mothers is preferred over formula milk, which is basically processed cow’s milk.”

The department of health which has been promoting breast feeding has a policy to prohibit the donation of formula milk for babies in temporary shelters, during a calamity….“Children are more exposed to allergy when they consume formula milk. We are also not sure if the water used to prepare formula milk is clean (that is why it is not recommended),” said Dumalag….Government and private hospitals including private organisations were organised to accept donations of human milk. Milk donations will be pasteurised, frozen, and kept in insulated containers before they are sent to evacuation centres in central Philippines, Dumalag said.

 

Concerns over water and sterile preparation of bottle feeds during disaster situations are valid and necessary. Several years ago, we had a lengthy debate here on FFF about this very topic; I’m well aware that if relactation or wet nursing is a possibility, it is without a doubt the safest option in natural disaster settings. Bacteria-filled water, poor sanitation, and lack of resources make formula feeding a deadly proposition; when formula feeding is seen to be “encouraged” in an at-risk population, lactation may be interrupted which can have long-term consequences (i.e., the family would then need formula on an ongoing basis, which could prove difficult if money or resources were an issue). I’m not disputing this, nor am I ignoring the fact that formula marketing in the Philippines is a hot button issue at the moment, and that breastfeeding promotion is in overdrive for reasons that I can’t fully comprehend, as a privileged Western woman.

But that’s not what this is about.

A policy that forbids powdered formula donations and encourages breastmilk donations is simply replacing one easily contaminated substance with another. Donated breastmilk – and this includes breastmilk procured by breastfeeding-related Facebook pages, speaking of privileged Western women – requires careful packaging, transport and refrigeration, not to mention screening for HIV and hepatitis B (the Philippines still has a low rate of HIV infection, but it’s rapidly increasing – TIME reports that every 3 hours a new case is now being diagnosed). There are still the same risks involved with sterilizing bottles, regardless of what’s filling them; nowhere in these news reports are people discussing the importance of cup feeding, for example – something that can significantly cut the chance of bacterial contamination.

There is, however, a substance that can be easily transported without refrigeration; that has a relatively stable and long shelf life; and which can be fed to babies in a perfectly sterile manner, at least in the short-term. That substance is ready-to-feed, pre-mixed formula, served in “nursette” bottles with pre-sterilized nipples (like these).

Granted, the cost of these supplies is rather high. But while I haven’t done the math, I’d venture to guess that the cost of procuring and safely distributing donor breastmilk would be just as prohibitive. And if people are ready and willing to donate RTF and pre-sterilized nipples, what would be the harm in allowing them to do so?

The answer is none. There would be no harm, except, perhaps, to the “cause” of breastfeeding promotion. That cause may be noble and important, but right now, it’s irrelevant. To put breastfeeding promotion ahead of feeding infants safely and in a timely manner is petty, short-sighted, and cruel. Think about it: would we discourage donations of processed, high-fat canned foods to disaster victims because of concerns over obesity, GMOs, or the environment? Or would we ensure that their immediate needs were met, and worry about preaching better health habits after the roads had been rebuilt and displaced families were settled into safe, warm homes?

The fact that Dr. Dumalog, quoted above, uses “allergies to formula” as a reason for forbidding RTF formula donations speaks to the irrationality of this policy. If a child is allergic to formula, there is also a chance s/he will react to something in a stranger’s milk. A breastfed baby may indeed react poorly to formula at first, but this is a case where the mom should receive plenty of assistance and encouragement to continue breastfeeding – not told to feed her baby via bottle with donated milk. With breastfeeding rates in the Philippines being what they are, it stands to reason that most of the babies without lactating mothers present are already formula fed – therefore they will probably do just fine with donated formula, even if it’s not the same brand. We’re talking about a little gas here, not a full-scale anaphylactic reaction.

Gulf News reports that “groups that promote breast-feeding in six hospitals and in several private clinics are part of the campaign.” A disaster situation is no place for “promotion” of anything but disaster relief. And the scariest thing about this is that the Filipino government isn’t alone in letting a hatred of formula get in the way of ration. The American Academy of Pediatrics also advocates for “screened human donor milk” before RTF (although they do, at least, acknowledge that this is an option). I have yet to see one study or agenda-free policy paper that actually looks at the viability of using donor milk as opposed to RTF formula with pre-sterilized nipples during disasters. If there is a logical reason behind these recommendations, I’d love to see it. All I can find are convoluted references to “breastfeeding being interrupted” (not an issue if we’re talking about babies who are already formula fed) and concerns about sterility and availability (absolutely valid, but just as valid in regards to donated milk, if not more so).

Governments must stop putting ideology above practicality. We are in desperate need of a neutral, informed, and rational voice to come up with better policies for infant feeding – policies that do not throw the cart before the horse, and end up running over its citizens in the process.

The biggest problem with the breastfeeding discourse has nothing to do with breastfeeding

Sometimes, a cigar is just a cigar. And sometimes, it’s not.

As any journalist, blogger, or parenting-forum moderator can attest, merely mentioning the words “breastfeeding” or “formula feeding” will create controversy – or at least a comment thread that derails within the first three posts. It’s virtually impossible for someone not to feel offended. It happens on both sides of the debate; some breastfeeding advocates see red anytime a person writes favorably about formula, while some formula feeding mothers are guilty of taking it all too personally, and assuming that every positive aspect of breastfeeding is dig at their lack of lactation.

This bugs me, being someone who writes about this topic regularly, because it dilutes the conversation. We lose track of what we’re talking about, and lose the chance to understand, to evolve, to connect.

Of course, this problem is endemic to any hot-button parenting issue. Circumcision, sleep training, working vs. staying at home, vaccinations… But when it comes to breastfeeding, what I’m talking about goes far beyond the mommy war bullshit. We’ve apparently lost the ability to discuss anything to do with breastfeeding and formula without heaping layers of preconceived notions, philosophical ideals, and emotional reactions onto whatever’s being discussed. Even if the conversation takes place in a respected medical journal, the halls of a hospital, or a human rights nonprofit.

With that said, I want to make something clear: this post is not about breastfeeding. It is not about the benefits of breastfeeding. It is not about a woman’s right to breastfeed or formula feed. It is not about you, or me, or your sister-in-law. It’s about language, interpretation, and bias. If it helps, substitute the word “breastfeeding” for something less emotionally loaded. “Drinking coffee”. “Wearing palazzo pants.” Whatever.

In the past month, two stories popped up, buried so deep in the news that only someone who obsessively googles terms like “infant feeding” and “lactation” would have seen them. They were about studies showing negative associations with breastfeeding (see? Didn’t your heart start beating a bit faster? …Negative associations with palazzo pants. That’s better, right?) The first one found that longer durations of breastfeeding (past 12 months) were associated with higher rates of a specific form of breast cancer in Mexican and Mexican-American women. The evidence was based on subject recall of breastfeeding history, in a specific population. All I will say about the study itself is that it is one, isolated result; more research must be done before anyone can make proclamations about whether women of Mexican descent might want to wean after a year.

Which is basically what I say about every infant feeding study. These results do not prove a causal relationship. It would be patently false and extremely irresponsible to have headlines screeching “breastfeeding causes breast cancer!”

Luckily, there were no such headlines. The story didn’t receive much coverage in major news outlets, but here were the headlines I did find:

Breastfeeding May Increase Cancer Risk for Mexican-American Moms (http://www.nbcsandiego.com/news/health/Breastfeeding–Cancer-Rules-May-Not-Apply-to-Some-226050001.html)

Lactation may be linked to aggressive cancer in Mexican women

http://health.ucsd.edu/news/releases/Pages/2013-10-01-lactation-linked-to-cancer-in-Mexican-women.aspx

Women of Mexican descent more likely to be diagnosed with aggressive form of breast cancer http://www.news-medical.net/news/20131002/Women-of-Mexican-descent-more-likely-to-be-diagnosed-with-aggressive-form-of-breast-cancer.aspx

Mexican Women’s Breast Cancer Risk Tied to Breast-Feeding? http://healthcare.utah.edu/womenshealth/healthlibrary/doc.php?type=6&id=680757

Notice all the qualifiers. May be linked. More likely. And my favorite example, the question mark at the end of the last headline.

Now, let’s compare these measured, accurate headlines with those that stemmed from similar studies (self-reported data, specific populations, single studies rather than meta-analyses) that showed a positive effect of breastfeeding:

Breastfeeding reduces cancer risk http://www.dailymail.co.uk/news/article-88785/Breast-feeding-reduces-cancer-risk.html

Breastfeeding Cuts Breast Cancer Risk http://www.webmd.com/breast-cancer/news/20070417/breastfeeding-cuts-breast-cancer-risk

Study: Breastfeeding Decreases Cancer Risk http://www.npr.org/templates/story/story.php?storyId=9656285

Breastfeeding Protects Against Breast Cancer http://www.reuters.com/article/2009/08/10/us-breastfeeding-cancer-idUSTRE5795CZ20090810

Not one qualifier to be found.

But FFF, you’re arguing semantics, you say. Perhaps. But how can we argue that subliminal messages that come through the advertising of formula or bottles can so greatly affect a woman’s breastfeeding intention, and then argue that the language used in widely-read headlines doesn’t make an impact?

Not convinced? Let’s go beyond the headlines. The one quote from the lead researcher of the breastfeeding/cancer in Mexican women study used in the media was this:

“Our results are both puzzling and disconcerting because we do not want to give the wrong message about breastfeeding…If you treat breast cancer as one disease, breastfeeding is beneficial to both mother and baby. That should not be dismissed.”

Puzzling? Disconcerting? Science needs to be free of bias. It’s perfectly acceptable to be “surprised” by findings, but “disconcerted”? And as for the point about ”breast cancer as one disease“, this is not the sentiment expressed in the quotes from articles reporting a positive effect, many of which proudly extrapolate their specific findings and make sweeping statements about breastfeeding promotion:

Clearly, the researchers conclude, breastfeeding is associated with “multiple health benefits” for both mother and child…”That’s why we need supportive hospital policies, paid maternity leave, and workplace accommodations so that women can meet their breastfeeding goals…” (source: Reuters)

The same double standard popped up a few weeks later, when a study hit the news which found that babies breastfed longer than one year, as well as babies introduced to gluten after 6 months, had an increased risk for celiac disease. Again, hardly any media coverage; the one major outlet (Yahoo News) that covered it used the headline “Parent’s Feeding Choices May Raise Baby’s Risk for Celiac Disease“. Absolutely accurate headline, but no mention of breastfeeding. Granted, there were two findings that came from this study; both of which did involve a feeding “choice”. What I find interesting, though, is that whenever formula is associated with something negative – even if that particular finding is buried in a mess of other data – the headlines make sure to mention it. (Remember the arsenic-in-baby-formula scare of 2012?)

This study had many flaws. (Science of Mom has a great explanation of what these were over on her blog, if you’re interested.) But it didn’t have more flaws than 99% of the formula-is-risky studies which we are subjected to on a weekly basis, none of which are handled with the same degree of intelligence and moderation.

In Bottled Up, I discuss the problem of publication bias, and the professional death knell it is to report or support anything that detracts from the supreme perfection of breastfeeding. This is a bigger problem than one might believe – because if the end goal is to find ways to reduce disease and increase health in populations, we should be striving for information, not propaganda. And this is why I fight so hard to reframe how we discuss and promote breastfeeding – because if we are basing all of our support for the practice on science, then we run the risk of bastardizing – or at least “tweaking” – that science to justify our promotion.

Sometimes, a cigar is just a cigar. But when it comes to infant feeding science, the results are never just the results.

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