Earlier this week, I wrote about the alleged benefits of breastfeeding being vastly overstated.
My goal in writing that post was not to nurse some long-standing grudge against breastfeeding advocates. Nor was it an attempt to justify my own parenting choices: I breastfed both my children for well over a year.
(And yes, as some readers have inquired, I know just how wonderful breastfeeding can be. How breastfeeding your baby can be calming and joyful, even magical. But whether I found breastfeeding magical or a chore–or, in actuality, both–has nothing to do with whether it lowers the risk of asthma, or heart disease, or anything else.)
In response to my post, someone shared this comment on Facebook:
“Anyone who thinks this [my post] a solid piece of work needs to read my latest book, Milk Matters: infant feeding and immune disorder. No one has to prove that breastfeeding (the evolutionary and physiological norm that provides free stem cell transplants) makes a positive difference. Those who assume, claim or promote artificial feeding as safe or adequate need to prove that deviating from such basic physiological norms is safe, that there are no short or long term harms from doing so. …”
I am sharing this comment not because I find it particularly compelling, but because I think it nicely illustrates the problem with arguments made by many breastfeeding advocates: They start with the assumption that breast is best. And then, inevitably, they fail to scrutinize the evidence, no matter how flimsy, that supports that assumption.
And the evidence is flimsy indeed. Most of the alleged benefits of breastfeeding are found only in observational studies, which are widely acknowledged as biased. On average, breastfeeding mothers have a higher levels of education, higher incomes, and live in safer neighborhoods than formula-feeding mothers, granting their children an early leg up in life. Separating the effects of breastfeeding from these other advantages is next to impossible.
How do we know that these observational studies are biased? Primarily because we do not find the same benefits in better-designed studies–sibling comparison studies and the PROBIT randomized controlled trial. The only clear-cut benefit seen in these studies is a lower risk of severe vomiting and diarrhea during infancy. (For a detailed summary, see my earlier post).
To be fair, breastfeeding advocates are right, in a way. Breastmilk does contains numerous hormonal, antimicrobial, immunological, and nutritional factors not found in formula. This is why breastmilk helps protect against vomiting and diarrhea during infancy.
Before the advent of clean water, sanitation, and modern medicine, breastfeeding was frequently life-saving. In countries where access to these resources remains limited, it still is. There’s no bigger possible benefit than survival.
But these beneficial properties do not imply that breastmilk has any long-term benefits for the panoply of modern ailments: allergies, asthma, obesity, type 2 diabetes, and cardiovascular disease. We cannot claim such long-term benefits without sound empirical evidence. And that is entirely lacking.
If the American Academy of Pediatrics, and others were to say, “We recommend breastfeeding because it reduces the risk of severe diarrhea and vomiting during infancy, and because breastmilk contains unique immune, hormonal, and nutritional factors not found in formula, the long-term benefits of which are unknown,” I would have no problem with their claims.
But instead, they have chosen to present poor quality evidence as fact. Playing fast and loose with the evidence in this way undermines their credibility. Worse, it violates the trust that women have placed in them.
I just wanted to show you some love and say that I thought your first post was fabulous — well researched, well explained, well cited, and helpful to science-types like me who want to make decisions taking into account all the evidence (and understanding the design and limitations of each study). As you say, it’s not about criticizing anyone who chooses to breastfeed — far from it, and as you say yourself, you breastfed both your children! As I wait for my first (living) child to arrive in three months, I want to be able to make an informed decision about breastfeeding based on the best available evidence — right now my inclination is to try (hard) to make breastfeeding work for me… but if it doesn’t, whether that’s because I have issues with milk production or the logistics of pumping at work, I don’t want to beat myself up over it unnecessarily.
Thank you so much! And congratulations on your pregnancy. I hope breastfeeding goes well for you!
I thought both this post and the one preceeding it were fantastic. I never felt you implied breastfeeding was a poor or invalid choice. If anything, you affirmed women who breastfeed while also offering empirically based comfort to those who can or do not. I hate that it’s become such a loaded decision for women, especially knowing what you’ve found in your thoughtful and thorough review of the evidence.
Thank you, Amy. That was my hope. When I started working on this article, I was honestly pretty surprised at how little real evidence there was for most of the alleged benefits. I guess I too had bought into the hype.
Thank you!! While I am currently breastfeeding my five month old, she is supplemented from time to time. I just couldn’t believe, manufacturerd “food” for infants could possibly replace breastmilk in my eyes. But, I had to do it…supply issues, going back to work, attempting to leave the house for more than 2-3 hours. I began digging up the research on breastfeeding and was truly baffled by how uncompelling the evidence in support of exclusively breastfeeding seemed to be. It is magical, it does offer the immunological benefits, and it helped me bond incredibly well with my sweet girl. I must agree though, I thought I would feel much more compelled to stick with EBF…. It reassured me, I wasn’t completely missing the boat…. Anyways thanks for the post.
I think it might be interesting to do a survey of older children, to see the how the effects of the mothers choices affect their children in the long run. And I mean long run.
I am 27, I was formula fed as my mother could not produce enough milk for me and here I am, all grown up, at a healthy weight, no allergies, not unintelligent. Never being an ill child either.
I know I am just one person but I would like to see the results of this survey, as it seems that anyone on any side of the argument then seems to forget about when food is introduced past infancy and how that effects all the claims of benifits. But I suppose that is a debate in itself. I know a couple of families that EBF their daughters and now one of them seems to be a sick little bean all the time! And the other one is not..
there are so many variants to trials and surveys for breast milk. And each mother and child is different.
I don’t know if I’m making much sense.
Anyway. When my baby arrives, I will attempt to breastfeed. If it works; fab. If not I have no qualms about formula feeding. Fed is best, no stress is best, and rest is best.
There is no point mothers losing sleep over how their child is eating.
Would you say the same about a toddler who ate only French fries? Fed is not best, fed is the bare minimum. “Fed is best” sounds good as a slogan, but it isn’t true.
The point of Fed is Best is that fed is better than starving, and for this claim, the evidence is irrefutable.
“Fed is better than starving” does not mean “fed is best.” Fed is the bare minimum. Fed is necessary. Fed is indeed better than starving, but fed is not “best.”
Breastfeeding does not have benefits. Formula feeding carries risks. Do we need evidence that breathing fresh, clean-ish air is beneficial? Before we have this conversation, formula needs to prove itself 100% safe. That it produces no adverse physiological effects on an infant body whatsoever. Feed your babies how you want to – but be informed. And remember, formula companies are all about the bottom dollar, not about the truth. And definitely read “Milk Matters: Infant Feeding and Immune Disorder”