My honest reaction to The Honest Company’s new formula

So there’s a new formula on the market.

Honest-Company-Formula-DHA

This should be good news, right? Especially as this particular formula brand (The Honest Company) is trying to corner the organic, natural-minded formula feeder market, which is steadily growing. I’ve heard from many FFFs who import a British organic formula because it’s the only one that suits their needs; this is certainly not cost-effective or efficient, and it’s spectacular that these parents now have a Stateside option.

Unfortunately, most of the formula feeding community (including me) learned of this new product via an article on PopSugar which only served to infuriate a good deal of its target audience.

“When you’re trying to feed your baby, you’re riddled with emotion, shame, judgement . . . all these extra layers,” Christopher Gavigan, the company’s cofounder and the creator of the formula, told us. “We acknowledge that breast milk is the most nutritious form of food on Earth, but if you look at the research, the majority of moms will end up doing some combination of feeding, whether it’s a choice or because they have to. It’s a growing reality around the world. And in that reality, parents have to be able to choose something.”

Um, I’m no marketing genius, but since when has “well, we know you feel really shitty about using this – and you SHOULD – but since you have to do it, you may as well choose us” been an effective marketing strategy?

One could argue that for moms who just need to supplement a little, or who are still feeling awful about their “failure” to breastfeed, this self-flagellating attitude might be welcomed. But that doesn’t mean it’s helpful. I wonder about the impact of this language on moms who already worry enough about nutrition to shell out $30/can for formula.

This product launch is also causing drama because Gavigan implies that other widely-used commercial formulas are sub-par:

What he came up with was a formula carefully modeled after breast milk, nutritionally complete, easy to digest, and meticulously blended using ingredients sourced from trusted organic farms. It’s free of gluten, GMOs, flavorings, steroids, growth hormones, and pesticides. And it’s the only formula on the market that has chosen to leave out hexane-extracted DHA (while the fatty acid is known to help with baby’s brain development, the synthetic forms don’t meet safety standards).

While there are many who don’t feel comfortable with hexane-extracted DHA (and I’m thrilled they have a new option, because all parents deserve to feel comfortable with what they are feeding their babies), it’s patently false that the forms used in other formulas don’t meet safety standards. They may not meet Gavigan’s safety standards, or the Cornucopia Institute’s standards, or European standards, or YOUR safety standards, but they do meet the safety standards formula companies must adhere to. Speaking of which, I highly doubt this formula’s ingredients closely resemble breastmilk any more so than Good Start’s. Every formula company wants to get as close to breastmilk as possible. That’s sort of the end-goal. If Honest Company has cracked the code, I think we’d be seeing articles in the Wall Street Journal, not PopSugar.  (Also, for the record, Baby’s Only also has a hexane-free option, although they market it as a “toddler formula” because they believe babies should be primarily breastfed for the first year. But it really is an infant formula. Which is weird. But whatever.)

That said, it is plausible that they have sourced all their ingredients from trusted organic farms. That’s probably where the hefty price tag comes from.

Yet, while Gavigan’s quotes in the Pop Sugar article left a lot to be desired, whoever designed the company’s website is a genius. In the introduction to their feeding section, they state:

No breast versus bottle, no right or wrong: We believe how parents choose to feed their babies is a personal process based on the needs of their families. We know it can be quite an emotional decision. That’s why we’re here not to judge, but rather to support parents with a range of researched information and safe, premium products that empower every family to make the best choices given their unique circumstances.
We’re aware that breast is best, but we also understand that families may choose or require other options. No parent should have to feel guilty for choosing to feed her or his baby one way or another. Parents have been nourishing their children in all kinds of ways since the beginning of time as we know it. With Honest Feeding, The Honest Company hopes to represent the next step in the evolution of nourishment as we help you lay the foundation for a safe, healthy and happy future.

 

Freaking amazing, isn’t it? And even better, they have a section called “Transparency” where they take you through the ingredients in their formula, where they are sourced, etc. The old guard formula companies could learn a lot from this approach. It’s beautiful.

Problem is, I don’t know if what’s on the site is merely lip service, and the “persona” of Honest as a formula company will be closer to the PopSugar representation. I really, really hope that Gavigan was just misquoted.

Regardless, when I posted about this new formula on the FFF Facebook page, all hell broke loose. Some echoed Gavigan’s feelings about currently available commercial formulas, saying that what was available was “garbage”. Others understandably balked at this suggestion. Feelings were hurt, insults were hurled, and I ended up turning off the computer and watching Law & Order SVU because it was less frightening.

(**This is what we’ve come to. We’re so reactive, because we’ve been forced to live in fear, under this heavy, smelly cloud of judgment. It puts us in bad moods, makes us jumpy and defensive, and who can blame us? You spend too much time under a smelly cloud, and you start to kind of stink, too. I know I do.** )

So where do I stand on this new product? First, it doesn’t matter what I think. It’s not my baby. It’s yours. And what mattered to me when I was choosing formula doesn’t have anything to do with what matters to you. My kids couldn’t tolerate anything but expensive hypoallergenics, and I was so relieved to have a way to feed them that allowed them not to starve or bleed from their GI tract that I wouldn’t have cared if the ingredients came from the seventh layer of hell. If organic, hexane-free formula is important to parents, then I damn well want to see organic, hexane-free formulas on the market. We should have more options, overall. That doesn’t mean formulas differ in how they will nourish your baby – they all meet the same nutritional standards and your baby will grow well on all of them, unless s/he has a special need/allergy/intolerance that necessitates a specialty formula. But there’s enough “noise” out there when it comes to our food (not that I condone or agree with this noise, but that’s not really here nor there) to make any new parent anxious, and when you’re already feeling anxious about not breastfeeding, the last thing you need is more anxiety.

One more thing I want to address, in this convoluted post: On Twitter, a lot of pediatricians I respect and who have fair, balanced perspective on formula use, surprised me with their reaction to this new formula. I share their skepticism on the marketing claims, but I worry about this attitude of “no formula will ever match breastmilk, so why even try?” That’s fatalist and scientifically pessimistic. There is always room for improvement. This may mean more options, better safety protocols, more transparency from the formula companies  And yeah, someday, it might mean making a formula that is even closer to breastmilk, at least in terms of certain specific aspects of human milk that we could potentially recreate in a lab. It’s not outside the realm of possibility.

Sometimes, I think that our desire to promote breastfeeding denies us the opportunity to do better for our population as a whole. As Gavigan rightly points out, many parents use formula. That will not change, at least not in our lifetimes. Throughout history, babies have been fed with drinks and foods other than breastmilk, much earlier than the currently advised 6-month mark. Providing the healthiest alternative possible should be a major goal. Dismissing formulas as “all the same” translates to “all junk” in the hyper-alert minds of loving parents. That’s not the message we should be sending, and more importantly, it’s not true.

Here is what it comes down to: No formula is “better” than another, nor is any parent “better” than another. We make choices; sometimes those choices are made for us, for financial or health reasons. The beauty of having options is that we feel we can exert some control over our babies’ health. The downside of having options is that we feel pressured to make choices that can exert control over our babies’ health.  And it gets even more complicated, because no one can agree on what is “healthy” half the time. Depending on whether you read Food Babe or Grounded Parents, your definition will vary.

But here’s what it also comes down to: We can’t confuse innovation, marketing and development within an industry with the politics of infant feeding at large. It’s the difference between arguing whether parabens should be in skin care products, and proclaiming that no one should be using anything but water and olive oil to clean their faces in the first place. It’s telling a car company that they shouldn’t be talking about their safety ratings, but rather encouraging people to walk.

It’s good to talk about these things. And no one should feel they have to sugarcoat or keep mum about issues that concern them. But if we could all just be realistic, be wary, and be kind, it would make for a much more palatable and productive discussion.

Honestly. It’s that easy.

You don’t need to know why I don’t breastfeed, because it shouldn’t matter.

This past week, Emily Wax-Thibodeux’s excellent essay, “Why I don’t breastfeed, if you must know”, went viral. As it should have. It’s a cutting, heartfelt expose of just how ridiculous the pressure to breastfeed has become, made all the more powerful by the author’s recounting of her double mastectomy.

Unfortunately, even breast cancer didn’t stop the haters from hating.

“95% of the time people don’t breastfeed for reasons other than terminal illness. This is a red herring argument. She shouldn’t feel bad for having a legitimate reason for not breastfeeding and if she does then its really a personal problem,” said one comment on a Today.com thread.

“We all understand should and can are different. A mother who cannot breast feed is different than a mother who can but chooses not to…Breast milk is better for an infant than formula, I don’t think there is a doctor, nurse or midwife who would say that formula is better…Shame people would criticize this mother who CANNOT breastfeed like it was her choice,” wrote another (who happened to be male).

And then there was the woman who insisted that “(t)here is absolutely zero systematic or general judgment against infant formula or bottle feeding. It is the absolute expected norm by the majority of adults and parents in our culture. No one cares if you feed your baby infant formula or use a bottle…Most children start on the breast. Most children are weaned. Most children are given formula and fed with bottles. There is no public backlash against infant formula or bottle feeding. But here’s an article that pretends “infant formula shaming” is some actual thing. No. It isn’t. Not in the real world of critical thought and evidence. The data doesn’t support this notion at all.”

In the FFF community, there was tremendous support for Wax-Gibodeux’s piece, but an underlying concern about the title – because why must we know why she isn’t breastfeeding? Is shaming more acceptable for some mothers than others? What is the litmus test that rewards us with a breastfeeding “pass”? If a double mastectomy doesn’t quite cut it, I don’t know what will.

So maybe we should stop giving reasons altogether.

For those who fear formula as a product, no reason in the world is sufficient for a baby to be given anything other human milk. It doesn’t matter if the baby has to be wet nursed by someone with an unknown medical history – that is still better than formula.

For those who like to shame mothers – because that’s what it really is about, enjoying the act of shaming, of making yourself feel superior, or feel better about your choices by questioning those of others – no reason in the world will make a mother above reproach. She could always have done more – after all, breastfeeding is 90% determination and only 10% milk production, as a recent meme proudly stated. Best case scenario, she might get pity – but pity carries its own heavy scent, similar to the sour stench of shame.

Giving a reason for why you didn’t breastfeed is pointless.

That doesn’t mean telling your story isn’t important, because our narratives matter; they help those floundering in their own messy journeys make sense of what’s happening and find community with those who’ve been there. But there’s a difference between telling your story and owning it, and telling it to defend yourself. One gives you power, the other takes it away. 

We are at a turning point, I hope. Jessica Martin-Weber of The Leaky Boob has taken a stand against romanticizing the reality of breastfeeding, and is helping those in the breastfeeding community feel comfortable with bottle (and formula) use. When one of the leading voices in breastfeeding advocacy speaks out against a culture of fear and rigidity, that means something. Wax-Thibodeux’s piece has brought many powerful voices out of the woodwork, allowing women who’ve swallowed their shame to regurgitate it, and make the uninitiated understand just how sour it tastes.

Now is the time to draw a line in the sand. This conversation has moved beyond breastfeeding and formula feeding and whether one party is more marginalized than the other, or how superior one product is nutritionally to the other. We’ve been there, done that, and nothing has really changed. We’re all still hurting. We’re all still feeling unsupported, unseen, and resentful, like a 3-year-old with a colicky new sibling. Now, we need to stand up, collectively, and say it doesn’t matter why I am feeding the way I am. It is not up to anyone else to deem my reason appropriate or “understandable”. I’m going to stand up for anyone who has felt shamed about how she’s feeding, instead of just people who’ve had identical experiences to me, or those who I feel tried hard enough. 

A breastfeeding advocate shouldn’t be afraid to admit she questions aspects of the WHO Code. A breast cancer survivor shouldn’t have to have awkward conversations about why she’s bottle feeding. A woman who chooses not to breastfeed for her own personal reasons should not have to lay those reasons out in front of a jury of her peers.

This Tower of (breastfeeding) Babble has reached a fever pitch. It’s time for it to come down. Pick up your axe and start chopping. And next time someone asks, simply tell them, “You don’t need to know why I don’t breastfeed. Because it shouldn’t matter.”

 

Two sides to every story – except when you’re talking about breastfeeding

I’m starting to wonder if the health journalism community needs some lessons in scientific reading comprehension, or if we’re all just so convinced of the benefits of breastfeeding that we read every study with rose colored glasses. Either way, the discrepancies in the reporting of a group of new infant feeding studies are so alarming that I don’t even know where to start.

You know what? I do know where to start. How about the studies themselves.

Source: www.encognitive.com

Source: www.encognitive.com

All come from a special supplement published in the journal Pediatrics, using evidence from the 2005–2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old.

A couple articles from this publication are specifically making headlines, the first being Breastfeeding and the Risk of Infection at 6 Years. The results:

The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48–0.98]), throat (aOR: 0.68 [95% CI: 0.47–0.98]), and sinus (aOR: 0.47 [95% CI: 0.30–0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35–0.79]).

Translation: No link between breastfeeding for any duration and the risk of colds/upper respiratory infections, lung infections, or UTIs. Babies breastfed for any amount of time had lower risk of ear, throat and sinus infections, and babies primarily breastfed for the first 6 months had lower odds of sinus infections.

The second one to cause a stir is Infant Feeding Practices and Reported Food Allergies at 6 Years. The researchers found:

In this cohort of 6-year-old US children, socioeconomic (higher maternal education and income) and atopic (family history of food allergy and infant eczema) factors were significant predictors of pFA (probable food allergy). Our analysis did not find a significant association between pFA and feeding practices at established dietary milestones in infancy. However, among children who did not have pFA by age 1 year, exclusive breastfeeding of ≥4 months was marginally associated with lower odds of developing pFA at age 6 years. This potential benefit was not observed among the high-risk atopic children, which suggests the need to separate children according to atopic risk when studying preventive benefits of exclusive breastfeeding on food allergy.

Translation: Kids in higher socioeconomic demographics, kids with higher-educated moms, and those with family history of food allergies were at higher risk for food allergies by the age of 6 than their peers. The only time breastfeeding or not seemed to make a difference was in kids with none of the risk factors I just mentioned, who had been breastfed at least 4 months.

A slew of other studies were also included in this supplement, and were summarized by a team of AAP researchers:

The first set of articles examines child health outcomes at 6 years of age. The study by Li and colleagues demonstrates that longer breastfeeding and later introduction of foods or beverages other than breast milk are associated with lower rates of ear, throat, and sinus infections in the year preceding the survey. However, they find no associations with upper or lower respiratory or urinary tract infections. Luccioli and co-workers find no significant associations between exclusive breastfeeding duration or timing of complementary food introduction and overall food allergy at 6 years old. Pan and colleagues examine childhood obesity at 6 years of age and show that consumption of sugar-sweetened beverages by infants doubles the odds of later obesity. Lind et al describe how breastfeeding is associated with various aspects of psychosocial development. They show a protective relationship between duration of breastfeeding and emotional, conduct, and total psychosocial difficulties, but these relationships become statistically nonsignificant after other confounding factors are controlled for. Though certainly not conclusive, these studies demonstrate that infant feeding is predictive of some later health outcomes (eg, some infectious diseases and childhood obesity) but not others (eg, food allergy and psychosocial development).

The American Academy of Pediatrics reported these findings, publishing an entry on its website called “How infant feeding practices affect children at age 6: A follow up.” Great, neutral, accurate title. Here is what they report:

The longer a mother breastfeeds and waits to introduce foods and drinks other than breastmilk, the lower the odds her child will have ear, throat, and sinus infections at 6 years of age.
Children who breastfeed longer consume water, fruit, and vegetables more often at 6 years of age and consume fruit juice and sugar-sweetened beverages less often.
When children drink sugar-sweetened beverages during the first year of life, this doubles the odds that they will drink sugar-sweetened beverages at 6 years of age.
When children eat fruit and vegetables infrequently during the first year of life, this increases the odds that they will continue to eat fruit and vegetables infrequently at 6 years of age.
Study authors conclude the data emphasize the need to establish healthy eating behaviors early in life, as this could predict healthy eating behaviors later in life. For more information about the IFPS-II and the IFPS-II follow-up study, visit www.cdc.gov/ifps.

Pretty clear, right? 

Apparently not.

From ABC News: Breastfeeding May Influence Kids’ Eating Habits at Age 6

“Childhood nutrition experts not involved with the study said the findings provide additional weight to the importance of shaping a child’s diet early. Dr. David Katz, editor-in-chief of the journal Childhood Obesity and director of the Yale University Prevention Research Center, said the findings serve to underscore the long-established relationship between breastfeeding and health in mothers and children.

 

“The question we need to be asking is not ‘Why should mothers breastfeed?’ but, ‘Why shouldn’t they?’” Katz said. “For all mammals, our first food is breast milk.”

For the love of god. At least now we know about the publication bias of Childhood Obesity. 

No mention of the fact that the researchers themselves stressed that breastfeeding was only protective in certain ways, and not others, and that aside from consuming more veggies/fruits/water, there were no other nutritional advantages associated with breastfeeding in this study. No mention that they found no positive association between breastfeeding and food allergies in the highest-risk populations.Just a skewed interpretation that makes it sound like breastfeeding is the MOST important part of your child’s future health and nutrition, instead of ONE important part.

Strange framing also comes from Today.com:

Breast-feeding in infancy also increased the likelihood that children would be consuming a healthy diet later on. At age 6, children who were breast-fed drank sugary beverages less often and consumed water, fruits and vegetables more often than those who were bottle-fed, CDC researchers found.

 

That all makes sense, Scanlon said. “We know from other studies that children’s eating behaviors and preferences develop very early and are influenced by a variety of factors,” she explained. “They seem to have an innate preference for sweet and salty foods and dislike bitter flavors, which are found in vegetables.”

 

That can be changed when children are exposed to in utero and through breast milk to the flavors found in vegetables, Scanlon said. “Breast-fed infants are more open to different flavors,” she added.

Sure, that makes sense. But considering the same study found that breastfed infants were just as likely to eat junky savory/salty snacks, I am not sure that one could say breastfeeding = “healthy diet”. What the study did find was that they drank a statistically significant less juice, and ate more fruits and veggies at age 6. My daughter can’t stand juice and eats her weight in brussel sprouts, broccoli, and blueberries. But she also pours sugar on oatmeal and sneaks chocolate chips from my fridge and basically lives on soy yogurt. I wouldn’t call that a “healthy diet”.

WebMD’s title suggests a much different story than the one we can glean from the studies – “Breast-Feeding Lowers Kids’ Allergy, Infection Risk” – and frames the findings in a way that is…. well, see for yourself:

They found that children who had been exclusively breast-fed for four months or more had about half the odds of developing a food allergy compared to children who had been breast-fed for a lesser amount of time.

 

As Wu noted, the finding did have one limitation, however. “While breast-feeding did not decrease food allergies in high-risk populations, such as families who already have a history of food allergy, there was a decrease in low-risk populations,” she said.

“One limitation, however”? Um, considering the highest rates of allergy were found in the “high risk populations”, and this particular finding was somewhat brushed aside by the researchers themselves, it’s puzzling that WebMD latched on (sorry) to it.

And then -

Another expert said the studies provide valuable information.

 

Nina Eng, chief clinical dietitian at Plainview Hospital in Plainview, N.Y., said the findings “point out two of the many important benefits of breast-feeding.”

 

“These articles provide evidence that should inspire new moms to breast-feed their children,” she said.

 

Does it? Will it? I don’t know about you, but I don’t think any of these findings are so convincing that they might “inspire” a mom to breastfeed if she’s already decided not to. For those who have chosen to breastfeed, sure, maybe they will be somewhat heartening…. but I find it seriously odd that the media is spinning these studies as evidence of a “breastfeeding boost” (thank you, Today.com) instead of the more realistic framing: we now have a body of evidence that shows that choosing better foods at weaning and being responsive to feeding cues may have lasting effects.

In other words, give your kids produce and don’t force feed them. But that’s not as sexy as talking about breastfeeding, so…. BOOBS. There you go. Problem solved.

 

Why The World is So Screwed Up About Breastfeeding Research, In Several Paragraphs & A Few Headlines

The headlines:

“Study: Breastfeeding can ward off postpartum depression” (Press TV)

“Breastfeeding mothers less likely to get postnatal depression” (The Independent)

“Breastfeeding ‘helps prevent postnatal depression’” (ITV)

“Breastfeeding could help prevent postnatal depression, says Cambridge researchers” (Cambridge News

“Breastfeeding ‘cuts depression risk’, according to study” (BBC

“Failing to breastfeed may double risk of depression in mothers: study” (Telegraph)

“Mothers who breastfeed are 50% less likely to suffer postnatal depression” (The Independent)

“Mothers who choose not to breastfeed are ‘twice as likely to get postnatal depression because they miss out on mood-boosting hormones released by the process’” (Daily Mail, UK)

“Breastfeeding Keep Mothers Happy and Reduces Postnatal Depression” (International Business Times)

“Breastfeeding moms have lower depression risk” (Health Care Professionals Network)

“Breastfeeding protects mothers from postnatal depression, study finds” (The Australian)

 

And the reality:

New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions.

Borra C, Iacovou M, Sevilla A.

Abstract

This study aimed to identify the causal effect of breastfeeding on postpartum depression (PPD), using data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers’ mental health measured at 8 weeks, 8, 21 and 32 months postpartum. The estimated effect of breastfeeding on PPD differed according to whether women had planned to breastfeed their babies, and by whether they had shown signs of depression during pregnancy. For mothers who were not depressed during pregnancy, the lowest risk of PPD was found among women who had planned to breastfeed, and who had actually breastfed their babies, while the highest risk was found among women who had planned to breastfeed and had not gone on to breastfeed. We conclude that the effect of breastfeeding on maternal depression is extremely heterogeneous, being mediated both by breastfeeding intentions during pregnancy and by mothers’ mental health during pregnancy. Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.

In other words, women who wanted to breastfeed and did = low risk of PPD. Women who wanted to breastfeed and couldn’t = high risk of PPD. The researchers stress “providing compassionate support for women who had intended to breastfeed but…found themselves unable to”.

This does not prove that breastfeeding cuts depression risk. It proves that women who had a goal and met it tend to have lower rates of depression. It does not prove that there is a biological reason that breastfeeding may be protective against depression. That may indeed be the case, but then the depression risk would have been similarly high in women who never intended to breastfeed.

Our societal confirmation bias is so damn strong, that we blatantly overlook the finding that suggests something potentially negative about breastfeeding promotion. But here’s something to ponder: while we can’t force insufficient glandular tissue to produce adequate milk, or force women to breastfeed who don’t want to, we CAN ensure that every mother gets support in her feeding journey. We CAN listen to research that suggests the pressure to breastfeed is contributing to feelings of guilt, shame, and judgment – a potent trifecta of emotions for those prone to depression – and do something about it. If we are going to take this one study as “truth”, as so many parenting-related studies are mistakenly interpreted, something good might as well come out of it.

At this point, there is a pretty clear correlation between not breastfeeding and PPD. Instead of using this as ammunition against formula use, we could be asking the tougher questions: Why are women who don’t breastfeed more depressed? If it is something biological, wouldn’t the rates of PPD have been skyrocketing in past generation where breastfeeding was rare? If we stop making breastfeeding seem like the only-best-right choice to raise a happy, healthy child, would it mitigate this risk?

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

Source: http://en.wikipedia.org/wiki/Albert_Szent-Gy%C3%B6rgyi#Medical_research

One of my favorite quotes about research comes from the Nobel-prize winning scientist who discovered the importance of vitamin C, Albert Szent-Gyorgyi: “Research is to see what everybody else has seen, and to think what nobody else has thought.” These days, the reverse seems to be true – research is to confirm what everybody else has seen, and everybody has already thought. This needs to change, and it won’t, as long as our society and media turns even the most interesting findings into self-confirming soundbytes.

 

Win-win or lose-lose: Study suggests breast may not “beat” bottle in multiple long-term outcomes

Every morning, I receive Google alerts for several terms: breastfeeding, formula feeding, infant formula, breastmilk, etc. And every morning, I brace myself, waiting for the inevitable headline that will cause panic among bottle feeding moms, or re-ignite the incessant argument between breastfeeding advocates and formula feeding parents (as if it ever needs reigniting – it’s like one of those trick birthday candles, always sparking back to life even after you’ve wasted all your breath), or force me to take some semblance of a “position” on an issue that is hardly ever black and white.

One might expect that this morning, I would’ve broken out in that annoying Lego Movie song. You know, ’cause everything is awesome!!!!!

Source: connectedprincipals.com

Source: connectedprincipals.com

News broke that a study out of Ohio State, which examined sibling pairs where one child was breastfed and the other formula fed, had found that there was no statistically significant advantage to breastfeeding for 11 outcomes. These outcomes included things like obesity, asthma, and various measures of childhood intelligence and behavior. As the study explains:

“Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy…

 

Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.”

 

Source: Colen and Ramey, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling ComparisonsSocial Science & Medicine, Available online 29 January 2014

I will admit that the comments made in several news outlets by the lead author of this study, Cynthia G. Colen, have made me want to run through the streets, acting as a one-woman ticker-tape parade in her honor. (Case in point: “I’m not saying breast-feeding is not beneficial, especially for boosting nutrition and immunity in newborns. But if we really want to improve maternal and child health in this country, let’s also focus on things that can really do that in the long term – like subsidized day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.”) But I’m not celebrating the results of this study, any more than I’d celebrate one that said formula feeding caused children to sprout green hair from their chiny-chin-chins and opt to live under bridges.

Why? Because this shouldn’t be a freaking contest.

The backlash that comes out of studies like these feels more like if someone came out with research that claimed fried Oreos were just as healthy as raw kale. Instead, we should be approaching it as if someone came up with a way to make a vitamin supplement that would offer similar benefits to kale, for those who hated the taste. One is natural, one is synthetic; one is manufactured, one exists organically. But for those of us who don’t or can’t eat raw kale on a daily basis, a good substitute is a godsend. (And maybe helps us justify those fried Oreos. A girl can dream.) Now, a study showing comparable effects of the supplement to the organic kale would not negate the fact that kale, grown in your own garden, is a nutritious, amazing thing – and tastes quite delicious to those of us who have a palate for it. If we started telling the kale aficionados that the supplement was better in some way, that would be a problem. But if the people who loved kale insisted that the supplement wasn’t a valid option and was somehow morally wrong, that would be a problem, too. Chances are, if we were really talking about kale, nobody would care all that much. The people who liked kale would eat it, and those who didn’t, might opt for the supplement – feeling confident due to the research that suggested the supplement was a viable option.

But we’re not talking about kale. We’re talking about breastmilk. And that, apparently, is where we all fall apart, and are rendered completely incapable of rational, measured discussion.

What the Golen/Ramsey study shows should not be controversial. The results should be reassuring- evidence that formula feeding does not condemn a child to a life of obesity, poor health, and lackluster intelligence; proof that whether a woman chooses, or is capable of, feeding a baby from her breast is not what defines her as a mother.

Imagine, for a minute, if we didn’t compare breast and bottle, but rather celebrated BOTH as valid, safe, healthy options for mothers and babies. Accepting that formula has legitimacy – that there is a reason it was invented (out of a need and a desire for a safe breastmilk substitute), and a reason why a woman may decide that a substitute is preferable – should not threaten those of us who celebrate breastfeeding. Yes, we should continue to rage against predatory formula marketing, especially in the developing world. Yes, we should speak up and speak out when companies (hello, Delta) retreat to 1953 when they express their breastfeeding policies. (For that matter, we shouldn’t need breastfeeding policies – if children are allowed, breastfeeding should be allowed. End of story.) Yes, we should ensure that women are entitled to adequate pumping breaks, and given solid breastfeeding assistance, and are supported by solid research regarding medications and breastmilk and best practices from pediatric professionals. But none of that means formula has to be Public Enemy No. 1. None of that means parents who formula feed should be left floundering due to an embarrassing lack of support and education. And for the love of god, none of that means we should be smugly celebrating when formula fed babies are shown to fare poorly, or gleefully rejoicing when and if the opposite occurs.

This is one study, with its own set of limitations and biases, like any other study in the modern canon of infant feeding research. But it’s a good study, artfully designed, and one that raises some extremely important questions about how the emphasis on feeding babies might be distracting us from the real work of supporting better maternal and childhood outcomes. Because speaking of retreating to 1953, it’s awfully easy to shove the responsibility for future generations onto women’s chests, rather than addressing true social inequities that can impact children’s lives. Maybe if we stopped wasting energy trying to prove how evil formula is, and just accepted it as part of life – not a slap in the face to our mammary glands, or an excuse for idiots to treat nursing mothers as horribly as they do now – we would have more energy to understand and destroy these inequities.

Or, you know, we could do what we always do and spend time looking for vague connections to the formula industry to discredit the study authors. Because that’s a really great way of helping families thrive.

 

 

 

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