Breastfeeding pressure doesn’t care about privilege

I am privileged.

I’m not rich, but I have never gone hungry; never been without a roof over my head; never wanted for anything (well, nothing more pressing than a better body and maybe a date with Ewan MacGregor circa Trainspotting). I don’t know how it feels to be judged by the color of my skin. I’ve been discriminated against, as a Jew and a woman; called names like kyke and jewbeggar and bitch, but I’ve never been racially profiled or held back by a language barrier, or assumed to be suspicious or uneducated because of the way I look.  I have a great husband and amazing friends and ridiculously supportive parents and in laws.

I realize that in the United States, this means I am incredibly lucky. I also realize that this means I have no business assuming things about anyone else’s lived experience. It doesn’t matter how many academic texts I read or people I speak with in a clinical setting – I can’t know how it feels to be dependent on welfare, or in an abusive relationship, or at a dead-end job with a sexually harassing boss.

I often hear that the pressure to breastfeed is a problem plaguing a specific socioeconomic and geographical subset of women; that my assumption that women are being harmed by overzealous breastfeeding promotion is dripping with “privilege-laden assumptions”. The people making these claims insist that poor, minority women think formula is superior (because they’ve all been victims of unscrupulous marketing and social pressure), and do not know the benefits of breastfeeding, and that if anything they feel ostracized if they breastfeed. Formula feeding, they say, is the unfortunate norm – my concerns have no place in these communities.

I don’t deny that I am coming from a certain perspective, and I always acknowledge that things are different depending on where you live, and what your social circles are doing. I also don’t deny that these social and marketing influences are real. But I think it’s just as privileged to assume that all women in lower socioeconomic areas need to be “educated”, and to ignore the fact that the lower a woman’s status in society, the easier it is for her bodily autonomy or emotional well-being to be violated. Ensuring that the rights of these women are protected is more important than raising breastfeeding rates – and the same policies which are worrisome for a privileged white woman are even more deleterious for someone whose voice is already struggling to be heard.

Yesterday morning, I met with two women who work at an organization serving a lower income neighborhood of Manhattan, helping teenage mothers from a variety of cultural backgrounds. These women told me that in some of the ethnic groups they serve, breastfeeding is very much the norm; in others, it is not as culturally accepted. Their organization is extremely pro-breastfeeding – there is no formula available at their office to give to girls in need, and they encourage breastfeeding throughout the prenatal period and beyond. But when I brought up the idea that the girls these women work with are not being affected by the “breastfeeding makes good mothers” philosophy, I was met with disbelief. “The ivory tower ideal is even more of an ideal for someone who is already struggling to fit the definition of a good mother,” one of them explained. They expressed a need for better messaging – encouraging at-risk women to focus on mothering rather than just feeding. Things like promoting skin-to-skin, reading to your baby, eye contact… not putting the emphasis on breastfeeding as the be-all end-all of parenting.

I also learned that the breastfeeding education these girls are given mostly consists of comparisons between formula and breastmilk, and information on how breastfeeding leads to better bonding and healthier kids. There is little instruction on the actual mechanics of breastfeeding, or how to manage the lifestyle barriers that could make exclusive nursing difficult. So while these young women may go into labor wanting very badly to give their babies the best (and they are well aware its the best, as their prenatal education features lectures on the differences between formula fed and breastfed babies), once they leave the maternity ward and have to return to work or school within a few weeks, without successfully establishing breastfeeding, or knowing how to pump, or how to advocate for their right to express in the workplace (if their workplace even falls under the parameters of the latest breastfeeding laws, many end up on formula- without any advice on how to do so safely.

After that meeting, I had lunch with an FFF who lives in Brooklyn. Her story was all too familiar – wanting to breastfeed, finding herself faced with low supply, getting conflicting advice from healthcare providers, balancing her own health and sanity with her (incredibly nuanced) understanding of breastfeeding’s benefits. The same sort of story we often see on this blog, from an educated mom with a supportive partner who had the ability to hire lactation consultants, and knew how to read scientific literature well enough to suss out her own risk/benefit analysis.

Obviously, this woman came from a very different situation than the women represented in the day’s earlier conversation.  But there was a remarkable similarity in what was expressed by everyone I spoke to. There was consensus on what we need: a more balanced, less hysterical, more individualized approach to infant feeding. All agreed that an honest discussion of the challenges of breastfeeding would be helpful, and that education on formula feeding safely and knowledgeably would go a long way in protecting the physical health of babies and the emotional health of mothers, regardless of their socioeconomic or ethnic background.

The stories these women are telling are not about white or black, native or immigrant, poor or rich. This isn’t about politics. It’s about what will be the best choice for an individual woman in her individual circumstances. These are stories with one moral: that we can – we must – support a woman’s right to breastfeed as well as her right to choose not to breastfeed.  This isn’t about doing away with Baby Friendly, because we need to ensure that women are getting a good start to breastfeeding and every opportunity to make it work (and that means switching the focus from vilifying formula to actually helping women initiate and sustain breastfeeding in practical ways). But we need to speak up and insist that there is a way to do this without loading more pressure onto new mothers.

I have a feeling breastfeeding guilt is seen as a problem of the privileged, because we are the ones with the time, resources, and autonomy to speak up about it. That doesn’t mean women of other backgrounds aren’t feeling the same pressure, perhaps manifesting in even more damaging ways. Still, it’s not my place to pretend to understand them, or to put words in their mouths. There’s no way I could, because these women aren’t an aggregate. They are individuals. To speak for the “disenfranchised” or “minority communities” as a sole entity is asinine. My experience is extremely different from other moms in middle-class Los Angeles – that doesn’t make it any less real, or valid.

One-size-fits-all infant feeding policies do not work, because women are not one-size-fits-all. In fact, in both fashion and life, one size usually just fits a lucky few. To label breastfeeding guilt as solely an experience of one type of woman, and paternalistic “education” as necessary for another, is just plain wrong.  It would be nice, instead of arguing about who has the most altruistic motives to help certain groups of moms feel empowered, we just focused on empowering all women to make choices that feel right for them, and to decide how their bodies are utilized.  Because while I would never attempt to speak for anyone, I don’t think it’s a privileged assumption that most of us would appreciate the ability to speak for ourselves.

 

 

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.

WTF, AAP? The problem with the American Academy of Pediatrics’ newest statement on breastfeeding

“Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.”

Thus begins the newest statement from the American Academy of Pediatrics regarding infant feeding. And consequently, thus begins the newest battle for FFFs anyone who cares about the freedom of women to choose how they feed their babies, and how they use their bodies.

The ghosts of statements past

It may seem like an overreaction, but the choice of words in this “official statement” from the preeminent child health organization of the United States, is deeply disturbing to me. To explain why, I think it may be helpful to look at the AAP’s past statements regarding breastfeeding, over the last 15 years.

Back in 1997,the AAP concluded its position paper on breastfeeding by stating that “Although economic, cultural, and political pressures often confound decisions about infant feeding, the AAP firmly adheres to the position that breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant. Enthusiastic support and involvement of pediatricians in the promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth, and development.” This reads like a strong suggestion to breastfeed; a plea for pediatricians to support breastfeeding but at the same time acknowledging that sometimes there are complications which make the “preferred” choice a difficult one to carry out.

By 2005, an updated statement was released. This statement was relatively similar to the 1997 one, but contained some updated information (including an advisory statement about Vitamin D supplements in breastfed infants). The concluding statement was the same as that in the 1997 document.

Now, in 2012, we are presented with a document that’s opening paragraph puts the kibosh on personal autonomy for mothers. There is no longer any acknowledgment – however cursory – of external factors which might complicate the decision to breastfeed; the section on contraindications is worded in a way which suggests that even meth-addicted women are better off breastfeeding; and pediatricians are encouraged that their “role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.” The concluding paragraph is in stark contrast to that of prior statements:

Research and practice in the 5 years since publication of the last AAP policy statement have reinforced the conclusion that breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development. Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as
a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.

I am woman, hear me roar (unless it keeps me from breastfeeding, in which case I should shut up)


In this statement, pediatricians are called upon to visit an AAP website which will “provides a wealth of breastfeeding-related material and resources to assist and support pediatricians in their critical role as advocates of infant well-being.”

Labeling the intended audience of this paper as “advocates of infant well-being” is exactly right: pediatricians are advocates of infant well-being, not maternal well-being. Within a section on “maternal benefits” to breastfeeding, the authors claim that “a large prospective study on child abuse and neglect perpetuated by mothers found, after correcting for potential confounders, that the rate of abuse/neglect was significantly increased for mothers who did not breastfeed as opposed to those who did.” This study was the one we discussed here; if you go back and read that post, you’ll realize that this study did NOT control for the most important (and in my opinion, most obvious) confounder, which was that women who are most likely to be neglectful or abusive will not choose to breastfeed in the first place. This study was one of the weakest, most ridiculous pieces of drivel that I’ve read in the entire body of breastfeeding science, and that’s saying a lot. The fact that the AAP would stoop so low to add this to their official breastfeeding statement speaks volumes, in my opinion. (Although considering they later allude to the infamous Bartick study as an “evidence-based stud(y)” which has “confirmed and quantitated the risks of not breastfeeding”, I guess I shouldn’t be too surprised.) Insult is added to injury by their brief discussion of postpartum depression (“Prospective cohort studies have noted an increase in postpartum depression in mothers who do not breastfeed or who wean early…”).

It is one thing for pediatricians to write a strongly worded statement about the benefits of human milk to babies. If we’re going to talk about maternal benefits, I’d like to hear about that from a cancer specialist, a psychiatrist or clinical psychologist who specializes in maternal mental health, and maybe an OBGYN. Not my child’s pediatrician, who hasn’t focused on adult vaginas or brains since they graduated from medical school. “But FFF”, you’re probably saying, “it’s for the children! The children!!” Yes, it may well be. But if we’re going to discuss subjugating the needs of the mother for the needs of the child, then we are getting ourselves into a very controversial area, and one which I don’t think the AAP has the right – or the depth of knowledge – to tackle. And regardless of where you may personally stand on that issue, I fear that if we go down this path, it’s a short trek over to another road where they start sterilizing women over 40 because they have a higher risk of birth defects, or making certain reproductive technologies illegal because they aren’t the “normative standard” of how we are supposed to reproduce. Melodramatic? I sure hope so, but I don’t think it’s that far a stretch.

Redundant Redundancy

Here’s what I find interesting: the authors state that they are releasing this updated statement because “(r)ecently published research and systematic reviews have reinforced the conclusion that breastfeeding and human milk are the reference normative standards for infant feeding and nutrition. The current statement updates the evidence for this conclusion…” And yet, the main source of data is the AHRQ Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, which is also the basis for the recent Surgeon General statement on breastfeeding. This document is actually a really good read, as nearly every benefit they cite is capped with a strong warning not to get over-excited over the findings as they are bogged down by study limitations, confounding factors, etc. If you haven’t read it, I strongly suggest that you do – it will make you feel a hell of a lot better about the foreboding statements made by our government and the AAP.

If you look at the references at the bottom of the newest AAP breastfeeding statement, you’ll see that quite a few of the cited studies are indeed from after 2005, when the last AAP statement was released. In that sense, a new statement is justified. But what do these studies really tell us that the older ones haven’t? None of the “rules” have changed; it’s more of the same type of evidence, which suggests a slight benefit after adjusting for confounders (which are usually not appropriately comprehensive). As usual, I feel I must state for the record that I am in NO WAY suggesting that these findings are fundamentally incorrect – I’m only trying to remind everyone that the methods used to obtain this data are inherently flawed. Breastfeeding may indeed be so far superior to formula that it makes breastfeeding look like Lindsay Lohan circa-Parent Trap, and formula feeding resemble post-jail Lohan. But so far, the body of evidence looks more like a comparison between chubby Renee Zellwegger and skinny Renee Zellweger. The body might be a bit different, but the face is cute regardless. (And hell, she won an Oscar for the film she did when she was chubby.)

Now, there have been some studies published since 2005 that would have been interesting to include – like this one, which argues that breastfeeding problems are strongly linked to PPD, which may explain away the data that they are using to promote breastfeeding as a maternal mental health advantage. Or how about this one, which counters the claim that breastfed children are smarter than their peers. Or this one, this one, or  this one, which found that breastfeeding has no correlation with future obesity risk? But no. The AAP cherry-picks the studies which support its ideologies, and ignores the ones which might offer some truly new insight. Now, whether or not we like to admit it, here on the interwebz and in scholarly debates, we all cherry-pick to some degree. (In fact, one could argue that I just did it now, by purposely finding 5 studies which supported my argument.) This is because we take sides; we fall victim to confirmation bias; or sometimes, we just don’t do our homework. But a major medical organization should be bipartisan. A major medical organization should be honest about the evidence, especially when there are conflicting studies. A major medical organization should not be cherry-picking.

The really nasty elephant in the room (or better yet, elephantitis, maybe of the testicles. It’s that disturbing.)

And lastly…Let’s pretend, for the sake of argument, that formula is so risky that it is a true health threat to our nation, and meriting this dramatic sort of action on the part of the government and the AAP. Then why the heck doesn’t anyone try to improve formula? We live in a time where we can clone sheep and create human life in a test tube – we really can’t come up with an adequate substitute for human milk? Why shouldn’t women have the ability to overcome their biology if they so desire? Whatever science has to say about modern infant formula as a product, the fact remains that sociology may see it in a different light. Formula feeding does allow a woman to choose to return to work immediately and allow a partner or caregiver – god forbid, even a male one – to care for her infant. Whether we agree or disagree with her choice, it is, and should remain, her right. If we are going to argue that not breastfeeding is as risky as other health concerns like smoking or drinking and driving, then why aren’t we rioting in the streets demanding better?

I don’t believe that the situation with formula is that dire; not be a long shot. I happen to think that formula does a pretty bang-up job of nourishing kids, and that loving, nurturing formula feeding parents do amazingly well at providing the “nonnutritive” advantages despite their lack of lactation. But I’m starting to realize that there is a hideous punchline to this debate: if people think that formula is so awful, why is the only solution to breastfeed exclusively? I believe that for most, breastfeeding would end up being the preferred way to go if all things were equal. Social inequities aside, however – there are women out there who may just not want to breastfeed. Just like there are women out there who don’t want to have a hospital birth. Or women who want to be single mothers by choice. Or pick any other choice which falls outside the “norm” or may not be accepted as kosher by mainstream society.

So, AAP, here’s what I have to say about your “amended statement”: please realize that by “advocating for children” in this manner, you are putting mothers – and fathers, for that matter – in a really stressful situation. You are doing so based on research which is no in many ways no better than it was 5, 10, or even 20 years ago. And you are certainly not helping children by aiding a system which is trying to take away a choice from their parents, a choice which has the ability to solve medical, marital, employment, and financial problems, thus making them better parents in the long term.

FAIL. Try again, please.

 

You’ve (Not) Come a Long Way, Baby: Why feminism and lactivism make such a dysfunctional couple

You know those couples who seem completely wrong for each other? Like, so wrong that you find yourself sitting in a hotel bar the night before their wedding with the rest of the bridal party wondering if you should speak now or forever hold your peace, or just put on the green poufy dress and hold your tongue with a strategically-placed cocktail weenie?

Lactivism and feminism are kind of like that. Seductively intertwined, but fundamentally discordant.

Last year, when I was in the writing process for my forthcoming book, I struggled to find any feminist discourse about breastfeeding. Don’t get me wrong – there was plenty of cherry chapsticked lip-service out there; there’s a Breastfeeding and Feminism Symposium held at the University of North Carolina every year, and plenty of outspoken third-wave, young feminists for whom lactivism is a frequent blog topic. But the conversation was ridiculously one-sided, focusing on the male-dominated medical community which had provoked our bottle-feeding culture in the first place.

(Speaking of that assertion…Knocking women out for childbirth and convincing them that they were too “nervous” for breastfeeding was pretty shitty. But I also think there were plenty of women who were hankering for a safe alternative to breastfeeding, considering the historical prevalence of wet nursing. Even in the 70′s and 80′s, right before breastfeeding’s resurgence, I don’t think we can blame poor breastfeeding rates on a misogynist medical field. In a time when we had to fight tooth and nail for respect and opportunity in the workplace, formula allowed women to get back to work faster. I doubt that many of our moms/older sisters had the luxury to fight for pumping rights, when issues of equal pay and sexual harassment still hadn’t been resolved in any legal way, let alone in the real-world way…)

I have always felt that there were uncomfortable parallels to the abortion debate here, but I hesitate to bring it up for fear of things devolving into a pro-life/pro-choice free-for-all. But if we can put the politics of that debate aside for a moment, I do think it’s important to consider how the concept of choice has been co-opted by certain facets of the lactivist movement. If you try and argue that a woman should have a choice about whether or not she feeds her baby from her breasts, you will likely find yourself shot down quicker than you can say Betty Friedan. The typical lactivist argument is something to the effect that we cannot choose freely, because we are brainwashed by the bottle-loving society we live in, as well as the Big Bad Formula Companies; therefore, “choice” is an irrelevant concept in this context. (For a more nuanced and articulate discussion on this topic, check out this essay by breastfeeding advocate, scholar and author, Bernice Hausman.)

But really, I think there’s something else at the heart of this argument. Like this:

Are there women who should feel guilty for not breastfeeding? In my opinion, yes. If there is no medical barrier (disease, medication, or other conditions) barring her from breastfeeding; if she is otherwise capable of breastfeeding; and she knows that breastfeeding is what she ought to do… yet she still, knowingly, chooses to feed artificial milk… yes, she should feel guilty. Because in that case, there was a choice, a knowledgable choice not to do what she knows is best for her child. I think guilt is entirely appropriate in that case, especially (but not only) if harm results. I am also of the opinion that a woman who does not educate herself should feel guilty later on; if you’re bringing a baby into the world, you owe it to that child to make choices for it that will lead to a healthy life. A choice to formula-feed, all other things being equal, is not entirely the woman’s choice to make: she has, presumably, chosen to have that baby, and in doing so, she makes the choice to give the baby its birthright, the best she can provide.

- Jan Andrea, SleepingBaby.net

I actually applaud this article (although much of it seems like a regurgitated version of Jack Newman’s infamous guilt argument) because, while inexplicably offensive, at least it is honest. The writer does not mince words, nor couch her true feelings in pseudo-feminist diatribes about how poor, uninformed formula feeders have no choice. This, I can respond to; this, I can counter. It’s a lot harder to argue with a feminist throwing haphazard verbal darts about classism, racism or sexism. That kind of rhetoric scares other feminists out of intelligent discourse. And we need feminists to be addressing this issue, because it is getting entirely too Handmaid’s Tale-ish up in here.

In the past week, the conversation I’ve been waiting for finally began, thanks to the brilliant Jessica Valenti , (and a bunch of other semi-anonymous folks who’ve joined the threads of subsequent posts inspired by Valenti’s Tumblr piece). Women who have no stake in the breast/bottle argument are taking notice; young women who have yet to enter the Dark Wood of Modern Motherhood (where at every wrong turn you’re met by an angry gnome who hits you in the kneecaps with Dr. Sears’s Baby Book) may now be able to navigate that forest with some perspective and foresight.

Breastfeeding needs feminism, to ensure that women can combine motherhood with paid employment, and to protect us from the idiots who think nursing a baby in public is obscene, and yes, to shield women from misleading ads or societal pressures which might discourage them from attempting to nurse.

But formula feeding also needs feminism, to ensure that child-rearing and child-bearing are not synonymous; that women are not reduced to biological functions, and can maintain bodily autonomy; and to act as a watchdog group that protects against those who blame all of society’s ills on a mother’s non-compliance with breastfeeding recommendations.

I don’t disagree that women are often sabotaged in maternity wards, or that the current medical system works in ways that are detrimental to breastfeeding success. We need strong and vocal women to put a stop to this. But I also know that vast numbers of women (as evidenced by this blog and the numerous “bottle feeding support” pages cropping up on Facebook) are being coerced, scared, and guilted into breastfeeding, by medical and governmental authorities. Women are being given so many “reasons” to breastfeed – most of them ominous warnings about what could happen if they don’t – as if no one could possibly want to breastfeed, which is demoralizing and insulting, as well as kind of ironic in the colloquial, Alannis Morrisette-sense. Women are being told that they have been brainwashed and taken advantage of, insinuating that the only way to gain back their self-respect is to breastfeed. By presenting it this way, we can avoid the very real (and for some, very uncomfortable) truth that some women really don’t want to breastfeed (hey, y’all, I said SOME. I’m not contradicting what I said a sentence or two ago… some of us really want to nurse, others would rather not. Simple as that.) It’s been that way throughout history. And it’s okay. Just as it’s okay not to want kids, or to want to combine work and motherhood, or to not want to combine work and motherhood, or to home school your kids or co-sleep with them or feed them a vegan diet.

Feminism, to me, is about respecting every woman’s right to define what being a woman means to her. To HER. Not to you. You don’t have to agree with her, or like what she’s about, or want to have a slumber party and talk about how cute Ricky Schroeder is with her. Just don’t tell her what she should think, feel or do with her body, and you’re cool by me.

Formula feeding and obesity: A big fat lie

There are a myriad of benefits attributed to breastfeeding; some which are backed by stronger science than others. Since all of these studies are observational and can’t control for every conceivable confounder, we need to look at “reviews” or meta-studies to see if the same finding is being confirmed in a variety of good-quality studies. For certain benefits – like a decrease in ear infections and gastrointestinal infections – we’ve seen enough evidence to justify touting these advantages. So I honestly have no problem with people claiming that breastfeeding protects against these two childhood health threats.
But one of the least definitive claims in breastfeeding science is that breastfeeding protects against childhood obesity – or, more to the point, that formula feeding increases the chance of obesity. Yet this seems to be the cause du jour of Michelle Obama’s plan to fight childhood obesity. Politics Daily reports:
    
 Looking ahead to what she will do in the second year of “Let’s Move,” Mrs. Obama said: “We also want to focus on the important touch points in a child’s life. And what we’re learning now is that early intervention is key. Breastfeeding. Kids who are breastfed longer have a lower tendency to be obese.
Breastfeeding rates are low among African-American mothers compared to other racial and ethnic groups, according to the Centers for Disease Control and Prevention, and Mrs. Obama took note of this when she addressed the Congressional Black Caucus Conference on Sept. 10.
“And because it’s important to prevent obesity early, we’re also working to promote breastfeeding, especially in the black community — where 40 percent of our babies never get breastfed at all, even in the first weeks of life, and we know that babies that are breastfed are less likely to be obese as children,” she said.
Really, Michelle? We know that? (And guys, before anyone starts freaking out on me, I’m an independent. I hate politics. This is not about politics to me, it’s about bad science.)
 I’m not sure exactly what research Obama is referring to, but at least her administration’s Surgeon General is leaning on a 1997 AHRQ report for their recent “Call for Action on Breastfeeding”. Let’s see what that report actually says about the link between breastfeeding and obesity:
Obesity. Three meta-analyses of good and moderate methodological quality reported an association of breastfeeding and a reduction in the risk of obesity in adolescence and adult life compared with those who were not breastfed. One study reported the reduction in the risk of overweight/obesity in breastfeeders compared with non-breastfeeders was 24 percent (95% CI 14% to 33%); another study reported 7 percent (95% CI 1% to 12%). Both of these estimates took into account the role of potential confounders. Furthermore, they also showed that the magnitude of association decreased when more confounders were entered into the analyses. The third study used meta-regression and found a 4 percent reduction in the risk of being overweight in adult life for each additional month of breastfeeding in infancy. Overall, there is an association between a history of breastfeeding and a reduction in the risk of being overweight or obese in adolescence and adult life.One should be cautious in interpreting all these associations because of the possibility of residual confounding.
Source: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153, AHRQ Publication No. 07-E007. Agency for Healthcare Research and Quality. April 2007.
In plain speak, this report states that while a few studies have shown an advantage (and a small one, at that – a 4 percent reduction in risk is pretty puny, and probably not worth basing a whole campaign over) to breastfeeding when it comes to combating obesity, these studies have also been rife with confounding factors, and that the benefit is not entirely clear.
And guys, that is being GENEROUS. Let’s look at what some other studies have to say on this topic:
    “As in the 1958 birth cohort,3 results from their offspring provide no support for a protective effect of breast feeding on obesity. In studies reporting a protective effect, it is weak and not always supported by a dose-response relation, which might be expected, at least up to a threshold duration. Any effect of breast feeding may be limited to a critical period or depend on other cofactors. Secular trends do not suggest a protective effect: in both Britain and the United States the incidence of breast feeding has increased since 1990, but so has obesity. Promoting breast feeding is important, but evidence for an important beneficial effect on obesity is still equivocal.”
 Breastfeeding and obesity in childhood – a cross-sectional study. BMJ 2003; 327 : 904 doi: 10.1136/bmj.327.7420.904 (Published 16 October 2003)
“Most studies examining the effects of breastfeeding on later obesity have found an insignificant effect. Breastfeeding was positively associated with later body fatness in two studies. A protective effect of breastfeeding on childhood obesity was seen in four studies. An effect of breastfeeding on later obesity, if any, is probably weaker than genetic and other environmental factors. Also, an observed association between breastfeeding and later obesity does not prove causality. Controlling for confounders in an attempt to minimize the effects of differences between breastfeeding and formula-feeding mothers was done to a varying extent across studies. In several of the later studies, adjustment for confounders obliterated the effect of breastfeeding. Whether all the pertinent confounding factors have been measured and whether the differences between mothers who chose to breastfeed and mothers who chose to formula-feed have been controlled for adequately are always questionable… Although a highly provocative concept, the protective effect of breastfeeding on later obesity remains controversial.”
    – The role of breastfeeding in obesity.  Pediatr Clin North Am. 2001 Feb;48(1):189-98.
“According to David Barker, M.D., Ph.D., professor of clinical epidemiology at the University of Southampton, UK and professor of Cardiovascular in the Department of Medicine at the Oregon Health and Science University and one of the authors of the report, “A longer period of breastfeeding was associated with lower BMI (a measure for weight) at one year of age. This relationship disappeared by the age of 7 years.” Similarly, there was no significant difference in BMI at the age of 60 years associated with duration of breastfeeding….Another session presenter, Michael Kramer, M.D., pediatrician and perinatal epidemiologist at McGill University, reported findings from his breastfeeding promotion intervention trial that support Dr. Barker’s results..breastfeeding… did not reduce the development of obesity at 6.5 years of age.”
    – MommyMythBuster
There are other studies which do find some positive correlations between breastfeeding and lower BMI, but even the most convincing of these state that the benefit is consistent, but small. (See “Breastfeeding and Childhood Obesity – A Systematic Review“) I can’t wrap my mind around how large a gap  there is between what science actually says about this and the dramatic claims the government is now legitimizing. 
Michelle’s not totally to blame; it’s easy to get confused about this, when the media is so god-awful about reporting scientific findings. For example, there was a study that just came out which the news outlets were announcing showed that formula fed babies who started solids earlier had a greater chance of being fat:
Regardless of when they started eating solid foods, breastfed babies in the study had a one in 14 chance of being obese as preschoolers.

But the findings, published in the journal Pediatrics, were different among babies who were formula-fed from the beginning, or who stopped breastfeeding before they were 4 months old.Those babies had a one in four chance of being obese at age 3 if they started eating solid foods before they were 4 months old. If parents waited until between 4 and 5 months, the kids’ chances of being obese were one in 20.

The chance of being obese increased again if babies didn’t start eating solid foods until they were at least 6 months old, but there were too few of those babies for the authors to make a firm conclusion about the risk of waiting longer to feed a baby solid foods.”


Okay, I don’t know about you, but here’s what I glean from this Reuters article. Babies who are breastfed have a 1 in 14 chance of being obese no matter when they start solids. Formula fed babies who start solids between 4-6 months, as recommended by the AAP, and as is common practice in this country these days, have a 1 in 20 chance.

What’s lower, 1 in 14 or 1 in 20? I suck at math, but, umm….?

  
And yet, the remainder of this article goes into the same old shpiel about how most babies aren’t breastfed long enough, yadda yadda yadda.
I am all for promoting breastfeeding. I am glad that breastfeeding expenses can be used as a tax write off (although I’m aggravated that my expensive hypoallergenic formula doesn’t fall under the same category). But I am not a fan of misleading claims, especially when it comes to an issue this sensitive for so many women.
I’d also submit one last tibit, courtesy of MommaData’s awesome Polly Palumbo:
   
“Although never significant, there is even some suggestion of slightly higher rates of overweight among those who were breastfed for only a few months compared with those who were never breastfed, particularly among non-Hispanic blacks.”(http://pediatrics.aappublications.org/cgi/content/full/113/2/e81)
 ”Some suggestion” is vague, but then again, so are most of the findings supporting this assertion that formula feeding increases the chance of obesity. What this suggests to me is that the science is far from clear on this issue, and saying we “know” that babies who are breastfed are less likely to be obese is one big fat lie.
I appreciate what Michelle is trying to do in supporting breastfeeding, but supporting it for the purpose of reducing obesity is misguided at best, and coercive at worst.
Related Posts Plugin for WordPress, Blogger...