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.

 

 

 

Is donor milk dangerous? Not as dangerous as hypocrisy.

Those of you who have been reading this blog long enough are probably well aware that I hate hypocrisy. I mean, I hate it. I hate it in politics, I hate it in religion, I hate it in the spats I have with Fearless Husband, and of course, I hate it in the breastfeeding/formula feeding debate.

But most of all, I hate it in myself.

That’s why I’m sitting here agonizing over how to report on a study that hit the news cycle tonight. According to NBC News,

…a new study finds that human milk bought and sold on the Internet may be contaminated — and dangerous…Nearly 75 percent of breast milk bought through the site OnlyTheBreast.com was tainted with high levels of disease-causing bacteria, including germs found in human waste…That’s according to Sarah A. Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, where her team purchased more than 100 samples of human milk last year, compared them to unpasteurized samples donated to a milk bank and then tested them for safety…what the researchers found was worrisome: more colonies of Gram-negative bacteria including coliform, staphylococcus and streptococcus bacteria in the milk purchased online, and, in about 20 percent of samples, cytomegalovirus, or CMV, which can cause serious illness in premature or sick babies. The contamination was associated with poor milk collection, storage or shipping practices, the analysis showed.

Here’s the problem: I look at articles which report on the dangers of formula with an intensely critical eye. It would be horrendously hypocritical for me not to do the same in this case – and I’m especially worried, because the people purchasing donor milk are in the same boat as many FFFs – people who wanted to breastfeed and couldn’t. I don’t want to turn my back on my audience and be a hypocrite in one fell swoop.

And yet.

Obtaining milk online is a new construct. We do not have several generations of humans raised on donor milk to examine and rely on for (admittedly insufficient, but oddly comforting) anecdata. We can’t define “donor milk” as clearly as we define commercial formula, because it isn’t a static product. Formula does not change based on a baby’s needs and age, or based on the diet or environment of the woman producing it; breastmilk does. There is not the issue of online, anonymous dealings when we discuss formula (well, unless you count the 16 cans of Alimentum my husband purchased on Ebay…I know, I know, but it was sealed. And that shit’s expensive if you buy it retail).

Discussing donor milk and the safety thereof is not the same as discussing formula, because there are so many more issues at play. This study is not about whether donor milk can nourish an infant better than formula can. This is about the biology of a live substance, and what happens to that substance once it leaves one person’s body and is transported to another’s. This is about body politics, and e-commerce. It is so much more complex than breast versus bottle.

So I hope I’m not being hypocritical when I look favorably at this study, because I do think it’s one worth taking seriously, as long as we acknowledge the limitations. Let’s review those, first:

1. It was a singular study. ONE study. Which used donor milk from one specific organization.

2. As the study is not yet available online, there’s still a lot we don’t know. NBC reports, “Of the 101 samples analyzed, 72 were contaminated with bacteria and would not have met criteria for feeding without pasteurization set by the Human Milk Banking Association of North America, or HMBANA.” I’m not sure how these criteria are set by HMBANA, and I don’t know exactly what the dangers of these bacteria are.

3. We don’t know that any of the babies who would have received this milk would necessarily have gotten sick. (This is one of the things we discuss with formula feeding studies, remember? For example, many people worry about the GMOs in formula. And yeah, most formulas contain ingredients derived from genetically modified corn, soy, and other foodstuffs.  But we have no evidence that babies fed these formulas suffer any ill effects from these tiny amounts of GMOs.)

Now, let’s talk about why this study is a little different than most of the breastmilk vs. formula studies we encounter.

1. The results were in vitro – aka, found in a lab. These were not observational or self-reported or marred by recollection bias. These were findings that were discovered from looking at samples under a microscope, in a controlled environment.

2. We do know that some of these bacteria are dangerous to babies.  20 % of the collected donor milk samples contained cytomegalovirus, which according to NBC “can cause serious illness in premature or sick babies.” 20% is a substantial amount.  The article didn’t give numbers for the samples which contained other disease-causing bacteria like coliform and staphylococcus, nor do we know if the amount of bacteria was sufficient to cause illness. (Please note: I think we do need to approach this with caution until we see more information, because there’s a chance the amount of bacteria wasn’t clinically significant.)

3. A large part of my ennui with formula studies is that most tell us the same thing: breastfeeding mothers are associated with healthier children. There’s not much variance in the theme of the research, or what can be done about it. This study is nothing like that. It is giving us actual information about the actual risk of bacterial contamination through donor milk. This is exactly why I started taking formula preparation rules so seriously when I saw in vitro studies on bacteria found in infant formula. It’s hard to argue with cold, hard science that has removed the human condition from the equation.

More importantly, this study offers us an opportunity. Not only does it allow us to improve milk sharing – something that can and should be a choice for moms who cannot or choose not to breastfeed – it reminds us that cold, hard science can be translated into better feeding options for families. Donor milk can and should be tested, to see how it needs to be stored and transported and screened. Formula can be compared with donor milk so that parents can understand the risks and benefits to both scenarios. Since one of the advantages of breastmilk is its ever-changing, adaptive personality, we could look at how the donor milk from a mom nursing a toddler might affect a newborn. We could even see if, say, the milk from women with higher IQs equates to higher IQs in babies fed their donor milk (oy, can you imagine the eugenic excitement over a finding like that? ::shudder::). You see where I’m going with this. When we’re discussing the substance rather than the behavior, a whole world of research will open up – research that can ultimately lead to improved formula, improved donor milk, and improved options for both babies and parents.

Lastly, it seems that defensiveness about negative press for one’s feeding choice is not exclusive to formula feeders. NBC quotes one milk sharing network’s founder as accusing the research of being “A blatant attack on women attempting to feed their babies”:

“..(It) is cruel and you should feel ashamed of yourself for spreading misinformation,” Khadijah Cisse, a midwife who founded MilkShare, a portal for connecting women cited in the new research, said in an email to NBC News. “Anyone can type up any bit of lies they want and make claims. Breast milk is supposed to contain bacteria.”

I feel bad for Cisse, as I know what it feels like to read research that denies my own lived experiences, or makes me feel judged for feeding my child in a specific manner. In her defense (and mine), it’s really hard to keep a lid on one’s anger when the media takes a 5k story and runs a marathon with it, without any consideration for context or nuance.

Imagine how much easier it would be to keep that proverbial lid tightly locked, if feeding choices were supported and respected. If the dialogue didn’t always involve universal bests. If we could make choices armed with more cold, hard science so that the choices themselves didn’t have to so damn cold and hard.

There’s a lot we could learn from this study.

Or, you know. It could die in an avalanche of hypocrisy.

 

 

 

 

 

 

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

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

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

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

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

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

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

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

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

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

Lactation may be linked to aggressive cancer in Mexican women

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

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

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

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

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

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

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

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

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

Not one qualifier to be found.

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

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

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

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

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

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

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

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

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

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