Breastfeeding might not protect kids from obesity. So what?

The past few days have produced a flurry of articles on how breastfeeding may not protect against obesity. You’d think I’d be shouting an obnoxiously loud DUH or TOLD YOU SO. Instead, I want to poke my eyes out and claw at my ears until they bleed. That’s maybe slightly dramatic, but seriously – I’m at my wit’s end, here.

The truth is, there have been quite a few studies and reviews that showed negligible or conflicting results regarding the effect of infant feeding practice on later obesity (ie, this one, this one, or this one). That hasn’t stopped numerous government or health organization from urging us to support breastfeeding because it will solve the obesity epidemic, opting to focus on this convoluted claim rather than the myriad of health benefits that have been repeated consistently over metastudies and reviews (i.e., lower risk of gastrointestinal infection, lower risk of ear infections, hell, even the IQ thing is more soundly supported by the research).

I get why there’s more attention being paid to this finding – it comes from the PROBIT study, which is the closest thing we have to a randomized, controlled experiment in the infant feeding world (other than sibling studies, of which there have been exactly two- at least that I’ve been able to unearth). For those who don’t spend their free time reading the canon of breastfeeding research, let me give you the Cliff’s Notes: PROBIT was a study undertaken in Belarus, which had low breastfeeding rates at the time. They took a cohort of pregnant moms and gave one randomized group more intensive prenatal breastfeeding education and baby-friendly hospital etiquette when they delivered; the other group got the status quo by way of breastfeeding support. The thought was, the group that got better education and support would breastfeed more exclusively and for longer; the other group probably wouldn’t.

Are you confused? You should be. The thing that puzzles me (and hopefully you as well) is that while this plan might have convinced more women to initiate breastfeeding, the same pitfalls that plague all breastfeeding research still remain. Some of the women in the “breastfeeding friendly” group still – presumably – could not breastfeed for physical reasons, others may have chosen not to. All this study can really show us, after all the necessary confounders are accounted for, is whether this type of breastfeeding promotion and support can increase breastfeeding rates. Otherwise, it’s basically more of the same. There are still fundamental differences in the women who were able to breastfeed and those that couldn’t/didn’t.

But, for whatever reason (desperation?) the medical and advocacy communities have grasped onto PROBIT as the Holy Grail of irrefutable breastfeeding science. So, if PROBIT shows that breastfeeding confers no protective effect against obesity, that means something. (Incidentally, as the babies involved in PROBIT get older, I’m sure we will see a lot of headlines on the long-term effects of breastfeeding… so if you’re interested in this stuff, try and familiarize yourself with it now. Here’s some good literature on it, to get you started.)

While I believe, based on my reading of additional research into the obesity link (more on this in Bottled Up, not that I’m plugging my book or anything. I mean why would I have to, book sales being as horrible great as they are?), that there truly is little to no advantage to breastfeeding in regards to later obesity, there’s no excuse for bad science or bad reporting. And this, my friends, is a both. We are taking ONE finding from ONE study – a well-designed one, to be sure, but far from perfect or immune from the problems plaguing most infant feeding research- and proclaiming its results as absolute truth. The sad thing is, some of the biggest breastfeeding advocates are just as guilty of this as the knee-jerking media: Dr. Ruth Lawrence, one of the founders of the Academy of Breastfeeding Medicine, even admitted that she was “disappointed” about the result (although as someone so wisely pointed out on our FFF Facebook page, how freaking ridiculous is it that she is “disappointed” to find out that the vast majority of Western babies – being that they are nearly all at least partially bottle fed – are not doomed to a life of morbid obesity just because their mothers were “suboptimal” breastfeeders?? And what does this suggest about the inherent bias of breastfeeding researchers?).

The near-hysteria surrounding this finding is just further evidence of how warped our thinking is around infant feeding. Why is it such a big deal that breastfeeding doesn’t solve the obesity epidemic? Because we’ve made it a big deal. We’ve built a house of cards on top of this one health claim: it’s the basis of the First Lady’s push to support breastfeeding; Mike Bloomberg has used it to justify locking up formula in NYC hospitals; pretty much every article about breastfeeding in the past year has suggested that formula fed babies better start saving up for Lap Band surgery. The grotesque amount of fat-hating aside (because if you think formula feeders have it bad, you should see how awfully we treat overweight people in our public health discourse), it’s ridiculous that we’ve focused so much attention on this supposed benefit of breastfeeding when common sense says that our nation’s growing waistlines are due to a multitude of factors – genetics, cultural differences, lack of clean air/safe streets/room to move in our cities, processed food, sedentary lifestyles, the time we waste on the (ahem) internet….

My hope is that breastfeeding advocates and health officials might learn from this; that they might take a step back and reassess the way they are promoting something that should be a basic human right as a medical necessity. But at the very least, I hope this will be a cautionary tale for those of us who strive for critical thinking to remain skeptical of absolutism, in both science and in life.

 

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.

 

 

 

Public Citizen Jumps on the Ban–the-Bags Bandwagon: Advocacy group forms petition to rid hospitals of formula samples

One time, this potato bug terrorized our stairs for three days straight. Being the anti-violence-against-all-creatures vegetarian I am, I urged it to move on by gently prodding it with a stick. It wouldn’t budge. I finally gave up and decided it was it or me, so I ended up spraying it with all-purpose cleaner. It survived the assault. (All we had was organic cleaner in the house, so for all I know the stuff I used made the bug grow bigger and stronger.) Finally, I had to be all lame and stereotypically female and call my husband to take care of the situation – and he had to stomp on it seven times before it expired.

He was too ugly to live. Forgive me. 

I feel like a broken record, talking about the movement to outlaw formula goodie bags from hospitals, once again… but just like our friend the potato bug, the damn issue just won’t die.

The newest incarnation of the old debate comes from the advocacy group Public Citizen. They have put forth a petition on their website, and have submitted a letter to hospitals that continue to hand out formula samples. According to the letter,

There is overwhelming consensus among all major health professional organizations regarding the health benefits of breastfeeding for mothers and babies and the importance of exclusive breastfeeding for the first six months of life.[1]  Hospital promotion of infant formula through dissemination of these discharge bags contravenes this consensus, needlessly and inexcusably harming babies and families. Moreover, formula feeding imposes a significant burden on the nation’s economy. Breastfeeding saves families and the economy countless dollars….
 When hospitals distribute formula samples…they imply that these products are medically approved and recommended. Yet, there is ample evidence that formula samples reduce breastfeeding duration and exclusivity. Multiple studies have shown that women who receive commercial hospital discharge packs stop breastfeeding sooner than those who do not.[2] Hospitals expend resources to support mothers to breastfeed, but reduce the impact of these efforts by distributing formula samples.  Research shows that bag distribution sends a message more powerful than any verbal messages.[3] New mothers who at first experience difficulty breastfeeding are apt to choose to use free formula samples given to them in discharge bags instead of seeking out assistance with breastfeeding. Aware of these dangers, in 1981 the WHO established the International Code of Marketing of Breast-milk Substitutes.[4] The Code states that healthcare facilities are not to be used for the marketing of infant formula. Hospitals in the U.S. that continue to distribute formula samples are in violation of the WHO Code.

I’m not going to rehash my feelings about formula samples (if you’re interested in what I think – and trust me, it’s not all that interesting or revolutionary – you can check out this previous post or this one on the same topic) or drone on about WHO Code (like I did here). I simply want to address some of the inaccuracies and (what I feel are) harmful statements in this letter, which is making the rounds in the media and blogosphere.
1. The authors do not give a citation for the statement that “formula feeding imposes a significant burden on the nation’s economy”, but I’ll give them the benefit of the doubt that they meant to cite the Bartick/Reinhold study which claimed that “suboptimal” breastfeeding costs the United States 911 lives and 13 billion dollars per year. Please look to Momma Data’s Polly Palumbo for an astute analysis of this study and form your own opinions about the truth of this statement. I’d also submit that even if you believe Bartick and Reinhold were 100% correct, these results were basically a hypothesis; the study did not give sufficient information to start making such dramatic claims as if it were fact. 

2.  They state that “when hospitals distribute formula samples…they imply that these products are medically approved and recommended.” Well, um…that’s because they are. They are not recommended over breastfeeding (except in some cases) but they are indeed medically approved and recommended as breastmilk substitutes. Like it or not, formula has been deemed a safe alternative to breastmilk by medical authorities. A more accurate statement would have been “when hospitals distribute formula samples, they imply that they are advocating the use of formula over breastmilk.” Now that’s a train upon which I could climb on board. Hell, I’d even be the conductor. I agree that handing parents a bag of formula without asking if they are planning on formula feeding is utter and complete crap. It’s contradictory to the “breast is best/breast is normal” message and very confusing, especially coupled with the typically sub-par, hospital-grade breastfeeding support. (Don’t get excited – I’m not advocating that they do away with these sample bags. I think they should offer two versions – a breastfeeding one and a formula feeding one. Breastfeeding one could be provided by the state, since they are pushing so hard for the citizens to nurse their young. Formula one could be provided by the formula companies, because no one else is going to do it. And while we’re at it, it’s pretty depressing that the literature which comes in these bags is often the only education most parents get on how to safely bottle feed.)

3. Invoking WHO Code is pointless. The United States is notorious for being the only “major” country that doesn’t enforce the WHO Code; in this country, it is not a “law”, but rather a moral code which formula companies are “asked” to respect. It doesn’t matter that distributing these bags is violating the Code; until the government makes it illegal to pass out formula samples, hospitals have a right to do so.

Speaking of making formula bags illegal, the Ban the Bags movement was in the news for a different reason this week, as well.

(Ahem. Before I “go there”, I’m going to ask that we pretty please with a ginormous cherry on top do not let this veer off course into a political argument. This is not about the candidate in question or his political party, but merely some statements made by his camp many years back.)

One of the skeleton’s dragged out of Republican presidential contender Mitt Romney’s closet was his clash with breastfeeding advocates back in 2006. As Governor of my former home state, Massachusetts, he fought against an initiative to legally ban formula sample bags in hospitals.  According to BuzzFeed.com,


Romney’s spokesmen at the time and current campaign advisor Eric Fehrnstrom said the decision was about freedom of choice. “We’re not disputing the health benefits of breast-feeding, but we think that new mothers should make that choice,” Eric Fehrnstrom said. “If they choose to bottle-feed, they should be supported in that decision.”… Romney attacked the decision by the Department of Public Health as an intrusion of big government saying “I’m not enthusiastic about the heavy arm of government coming in and saying, ‘We think we know better than the mothers and we are going to decide that they can’t get free formula when it comes as a welcome home kit from the suppliers of formula with Q-tips, baby lotion and so forth. Let’s let the moms decide.”

Regardless of your political views, I do think it’s interesting that this story came out in the exact same week that Public Citizen released its letter and petition. If I were prone to conspiracy theories, I might say that Big Formula isn’t the only group that can orchestrate clever marketing campaigns. But I’m not prone to conspiracy theories, so I’ll just say this: Romney may or may not have been in cahoots with the formula companies (as was the accusation at the time, obviously), but that doesn’t make what he or his spokesperson said any less true. Let the moms decide.

So: if you really believe that receiving a sample bag hurt your breastfeeding efforts, let your voices be heard. Sign the petition. But please, don’t let this ridiculous battle overshadow the realities of the infant feeding discourse. Fighting for better support, longer paid maternity and paternity leaves, etc., would do far more for actually helping women to meet breastfeeding goals.

Lastly, using coercive tactics to convince the public about the superiority of your product is never okay.
And I’m not just talking to the formula companies.

World Breastfeeding Week post for my imaginary friends

Remember a few weeks ago, in the post I did for the Breastfeeding Carnival, I talked about my “dream world”? I was thinking about that world again today, as I contemplated my deepest/darkest thoughts about World Breastfeeding Week (August 1-7, 2011).

Of course, one can’t discuss dream worlds without acknowledging the masters of this particular domain: young children. My son’s BFF, “J”, is so convinced by his own vivid imagination that he becomes possessive of imaginary objects. He’ll be playing “ice cream shop” and his dad will pretend to steal a cone, and J will fly into a rage…”Give me back my ice cream coooooone….!!”

I love this kid. Probably because I can relate to this pathological suspension of disbelief. Blame it on 25 years in the theater world, but I tend to get so caught up in the way I think things should be that I forget that they aren’t that way. Which is why I get excited for Breastfeeding Week every year, in the hopes that it will focus on the right sort of breastfeeding promotion, rather than being what is little more than a masturbatory exercise, patting the same folks on the back for pushing the same sort of primarily well-intentioned, but typically misguided form of lactivism.

This year, the Surgeon General kicked off WBW with a statement that made me think that my dreams might actually be coming to fruition:

World Breastfeeding Week provides an opportunity to highlight the benefits of breastfeeding and to encourage everyone to support mothers who want to breastfeed. One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed. It protects babies from many infections and illnesses, such as diarrhea and pneumonia. Children who have been breastfed have lower rates of childhood obesity. Mothers who breastfeed have a decreased risk of breast and ovarian cancers.

The decision to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot or chooses not to breastfeed. But given the importance of breastfeeding for the health and well-being of mothers and children, we need to do what we can to help mothers who want to breastfeed to do so successfully.

Earlier this year, I released the Surgeon General’s Call to Action to Support Breastfeeding which outlines steps that can be taken to remove some of the obstacles faced by women who want to breastfeed their babies.
The Affordable Care Act has made significant progress to support breastfeeding,which include historic new insurance guidelines that will ensure millions of women receive preventive health services without a co-pay or deductible. These new guidelines, developed by the independent Institute of Medicine, require insurance companies to cover certain women’s preventive services, including breastfeeding support, supplies, and counseling.

In addition, the ACA amends the Fair Labor Standards Act of 1938 by having employers provide reasonable break time and a place, other than a restroom, that is private and clean for a mother to express milk.

I hope World Breastfeeding Week will spark conversations and efforts that will support women who want to breastfeed.

Source: Statement from Surgeon General Dr. Regina M. Benjamin on World Breastfeeding Week, August 1-7. 2011.


Notice all the caveats? Women who want to breastfeed? Breastfeeding is a personal choice? This is good, FFFs. This is progress. I can’t help but feel that our voices are finally being heard.

Now, this doesn’t negate the fact that this Surgeon General has championed breastfeeding as a panacea, for the cure for whatever ails ya, and still neglected to address the multitude of underlying issues that make exclusive breastfeeding difficult. In this same statement, there are definitives where there should be “suggestives”. Rather than stating that “children who are breastfed have lower rates of obesity”, it would have been more honest to write that “in a few select studies, children who have been breastfed exclusively have lower rates of obesity at x year of age, although this may be more a case of correlation.” Doesn’t quite have the same ring to it, though, does it?

In honor of my dream world version of World Breastfeeding Week, I submit to you what I would like to have seen the Surgeon General write in her statement. I know it’s irrelevant, and preaching to the choir, but my stats have been falling lately…I doubt many people are reading this blog anymore, so I might as well enjoy myself.

In that spirit, here is the FFF Amended Surgeon General Statement for World Breastfeeding Week, August 1-7, 2011.

World Breastfeeding Week provides an opportunity to highlight the advantages of breastfeeding and to encourage everyone to support mothers who want to breastfeed, as well as all mothers who are feeding their babies so that they grow and thrive. One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to feed her baby in a way that works for the entire family. Breastfeeding may have a slight protective effect over bottle-feeding against ear infections and gastrointestinal distress (although instructions on proper formula feeding could lessen these risks to a certain degree, as well). Studies have suggested that mothers who breastfeed have a decreased risk of breast and ovarian cancers, although other studies have shown that waiting too long to have children, taking birth control pills, or taking drugs to dry up milk may also have beneficial or deleterious effects on these cancers as well.

Therefore, please realize that the decision to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot or chooses not to breastfeed, nor should she choose to breastfeed under a cloud of fear or misunderstood risk. But given the importance of breastfeeding for the empowerment of women – many women find breastfeeding to be the most rewarding thing they have ever done – we need to do what we can to help mothers who want to breastfeed to do so successfully.

Earlier this year, I released the Surgeon General’s Call to Action to Support Breastfeeding which outlines steps that can be taken to remove some of the obstacles faced by women who want to breastfeed their babies. However, I want to be clear that this Call to Action misrepresented much of the breastfeeding-related science, and that it exacerbated an already grotesque misunderstanding of risk in our fear-driven culture; for this, I apologize. I do maintain that the obstacles to breastfeeding should be removed, though, because every woman should have the right to feed her baby from her own body; additionally, the same obstacles that prevent women from nursing their babies also prevent women from enjoying and caring for their babies, regardless of how they choose to feed them.

I realize that our society is driven by the almighty dollar, and we have had to present breastfeeding as a means to save us money in healthcare costs, otherwise no one would give it the time of day. But I admit this is a risky way to go, considering mothers may now be blamed for the decline of our nation’s health and well-being, when the real culprits are more likely a toxic environment, nasty food (including horrific school lunches), a public education system that’s in shambles, a lack of exercise and fresh air, and parents so strapped for time and money that they need to rely on sub-par childcare or fast food or the tv/video games as a babysitter.

The Affordable Care Act has made significant progress to support breastfeeding,which include historic new insurance guidelines that will ensure millions of women receive preventive health services without a co-pay or deductible. These new guidelines, developed by the independent Institute of Medicine, require insurance companies to cover certain women’s preventive services, including breastfeeding support, supplies, and counseling. I am also allocating funds to conduct research into common breastfeeding problems, since I believe women when they tell me that they did have proper support and still suffered insufficient milk, children with extreme allergies despite stringent elimination diets, and babies who could not latch.

In addition, the ACA amends the Fair Labor Standards Act of 1938 by having employers provide reasonable break time and a place, other than a restroom, that is private and clean for a mother to express milk. I think this will help, but I am also pushing for paid maternity and paternity leave, because a woman having breastfeeding problems should not be left alone with an infant; many of us do not have family or friends who can help out for the first 4-6 weeks which lactation experts claim is the typical “hump” the breastfeeding dyad must survive in order to enjoy a successful breastfeeding relationship.

I hope World Breastfeeding Week will spark conversations and efforts that will support women who want to breastfeed, in REAL ways that address real women. I hope that it will allow for women who have tried and “failed” to openly express their concerns and offer suggestions for ways we can improve breastfeeding support. I also hope that someday we can rename this “World Feeding Your Baby Safely and Happily Week”, so that all women will be afforded proper support, guidance and encouragement to find a manner of feeding that is correct and appropriate for their individual situations and needs; that we can support mothers for the sole purpose of supporting motherhood and all its challenges, rather than focusing so much on what those mothers are doing with their nipples.

Yeah, I know. It’s a dream world, okay? Don’t make me face reality just yet. As my little buddy J would say, give me back my ice cream cone. I want to enjoy a few more imaginary licks before it’s taken away.

The Bull(shit) That Wouldn’t Die: The 2003 DHHS Breastfeeding Ad Rears its Ugly Head

I had fully intended on coming on here tonight to post for the first time in months; easing back into  things with an innocuous little piece about how my first four months with my daughter had been… It would be a lighthearted foray back into the blogging world, and then I’d go clean my kitchen.

But now my dishes are going to have to stay dirty.

See, back in ’03, the Department of Health and Human Services, Office of Women’s Health, put out this piece of drivel. It basically compares not breastfeeding to riding a mechanical bull while pregnant.

I have an entire chapter about this in my book, but I think you’ll get the point I spent 32 double-spaced pages making by watching the ad. So go do it, and then come back here.

 Back already? Did you throw up in your mouth a little? Sorry about that.

A lot of people got angry about the ad,  not only because it was misleading, but also because it was degrading and insulting and wrong on so many levels that it needs a freaking elevator. The Executive Committee of the AAP spoke out against the campaign, which of course they only did because they were in the pockets of big formula, and not because they had compassion for parents or the ability to understand the faulty science behind the claims stated in the ad. Or so the Breastfeeding Section of that same organization loves to tell us. Anyway, in the end, the ads got pulled; a lot of breastfeeding advocates were pissed; and the whole thing went down in the lactivist history books as a colossal FAIL. I’ve seen the destruction of this ad campagin referenced as one of the prime examples of how the formula companies have duped women. If we’d only been so privileged to see this ad, then maybe we would have breastfed. Or at least we would’ve known that we were horrible, unfit parents if we’d decided not to.

A few people had mentioned that they thought they’d seen the ad recently, to which I’d replied, assuredly,  “No flipping way. That thing has been good and dead for eight years!” But then I got this email today, from my friend  Kristine (she doesn’t have kids yet, but she’s a smart cookie and works as a high-end baby nurse, where she’s seen the breast-vs-bottle craziness firsthand, so I think we can consider her an honorary FFF) who wrote while she was watching Southern California’s K-CAL 9:

Um.. I’m so annoyed – they just showed a tv commercial with a woman who was supposed to be pregnant riding a mechanical bull and then she falls off. Next, there is a caption that says, “You wouldn’t take risks before your baby is born, why start after? Breastfeed exclusively for 6 months.” And then, a voiceover states that recent studies show breastfed babies are less likely to develop ear infections, respiratory infections and diarrhea. Babies were born to be breastfed.”  You probably already know about this from writing your book, but I wish there was a way to sue the pants off of them for putting that on the air. That commercial probably just made some poor woman, that’s sitting there trying to breastfeed, no milk coming out, her nipples bleeding, and her starving child screaming, cry her eyes out. Assholes. 

I immediately emailed her back to confirm she’d seen this on live TV, and hadn’t accidentally stepped into a Delorean. But the Bull(shit) is apparently back.

I think it is particularly insidious that this thing got resurrected with so little fanfare. Considering the brouhaha that went down when DHHS and the Ad Council tried to run the ad last time, it strikes me as odd that they would suddenly start running it again, especially in a manner so under the radar. The first time the ads came out, there was a media blitz; the folks responsible were bragging about their advertising genius to anyone who would listen. (Obviously, whoever taught them Advertising 101 neglected to mention that guilt and fear appeals can have a rebound effect; if you scare or induce guilt to enough of an extent, you piss off your audience.) But this go-around, the ads are popping up innocently during reruns of Scrubs, and no one has bothered to explain what has changed in eight years that makes it okay for these insulting, ridiculous PSAs to be inflicted on the public.

I would like to start a grassroots campaign to run these ads back into the hole from whence they came. I’m not sure how to go about doing this; PSA’s are tricky, both in the way they are made and the way that they get distributed. Who do we protest to? The stations running the ads? The Ad Council? DHHS? (I’m thinking of writing a letter to Obama, since DHHS is a government thing, but considering Michelle’s stance on breastfeeding I assume it would fall on deaf ears. Plus he’s probably a bit distracted at the moment, what with finally killing Bin Laden and all….) If anyone has any thoughts, please share. I know we are just a tiny, mostly disliked corner of the mommy blogosphere, but someone has to speak up for that woman Kristine referenced.

And speaking of which… Guilt-Ridden Woman with the Bleeding Nipples, if you’re reading this, listen up. Not breastfeeding is NOTHING like bull riding while pregnant. The people who created this ad fully intended on scaring you, making you feel like only a craptastic mother would feed her child formula. The ads completely ignore the myriad reasons that women do not breastfeed. They do not address the societal factors that impede breastfeeding, nor the physical problems that can happen, nor the emotional/professional/personal reasons that women have for performing their own risk assessment and deciding whether breastfeeding is right for their families. They ignore the father completely, making it seem like this is only a mother’s decision; only a mother’s fault. They over-simplify the science. The kind of woman who would risk riding a mechanical bull – in a bar, no less – has nothing to do with you or your decision to use your breasts to feed your child. Turn off your television, and take a deep breath. If I could hug you, I would.

For the rest of you… I guess this is the closest we’ve come to a Fearless Formula Feeder Call to Arms. I am going to investigate the best way to counteract these ads, but in the meantime, keep an eye out for them and let me know the station/location/time/show that they appear on.

I’m a lifelong vegetarian, so I never thought I’d say this, but… let’s slaughter the bull.

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