BREAST-VS.-BOTTLE TIFF GOES ANOTHER ROUND
Greatest pressure comes from health professionals, author says
The backlash was swift — and merciless. She was called selfish. Told she was a bad mother. That this decision would set her up for a lifetime of bad decisions.
“I was gutted,” says Lisa van de Geyn. “I felt sorry, and guilty, and sad.”
The Toronto mother had revealed on her blog that, after two weeks of breastfeeding agony, she had switched to formula-feeding her daughter.
Infant-feeding practices have long polarized parents, health-care professionals and policy-makers alike, but now there is a growing backlash from women who say there is too much pressure on them to breastfeed — and that they feel unjustly demonized when they don’t.
Most recently, photos of celebrities like Olivia Wilde and Gwen Stefani breastfeeding in public that have helped raise awareness of women’s right to breastfeed “anytime, anywhere,” have also inadvertently pitted breast-feeders against bottle-feeders. As women increasingly post breastfeeding “brelfies,” they’ve been widely accused of shaming women who bottle-feed.
In her new book, Lactivism, University of Toronto professor Courtney Jung argues there’s a lot more to the latest infant-feeding angst than moms judging moms. The most devastating judgment comes from advocacy groups and health-care professionals.
Doctors, nurses, hospital posters and pamphlets all promote breastfeeding with the urgency normally reserved for public health issues like smoking.
“Women are given the impression that feeding babies formula is playing fast and loose with their health,” Jung says. “The question of choice, which is central to so many women’s issues, most notably abortion, is almost totally absent from discussions about infant-feeding practices.”
Jung ’s frustration with what she describes as the “moral crusade” among lactivists who espouse compulsory breastfeeding led her to explore the science behind “breast is best.” What she found was contradiction and controversy.
“Breastfeeding is simply not the panacea new parents hope to find to protect their precious and vulnerable baby,” she says. “The problem with most breastfeeding research is it doesn’t come anywhere near the gold standard of randomized controlled trials.”
In March, a Brazilian study in The Lancet found positive links between breastfeeding, IQ and adult income. That same week, the Atlantic magazine criticized the study for its high participant dropout rate, its reliance on mothers’ recall and its lack of accounting for confounding factors, such as socio-economic status.
There’s good evidence that breastfeeding offers babies protection from respiratory, gastrointestinal and ear infections, but it appears many other benefits are up for debate. Last year, researchers at Ohio State University studied siblings who were fed differently as babies and found that whether they were given breast milk or formula made little difference to their longterm health outcomes.
Lead author Cynthia Colen says she assumed that the science outlined in policy papers promoting breastfeeding from respected bodies like the World Health Organization would be a little sounder.
“But there was a disjunction between what the bulk of the research showed and what the policy statements were saying,” she says. “What the science actually tells us is it’s a much more complicated and nuanced picture.”
That’s not what people wanted to hear. Colon faced a lot of backlash after her study was published.
“Make sure to say that I do very much support breastfeeding,” she told me. “I’m just questioning the context in which it occurs, and also how beneficial its long-term impacts are.”
The fact that suspect scientific findings underlie much of the policy used to promote breastfeeding is what bothers Jung the most. “It’s compelling women to make choices that aren’t always what’s best for them or their families,” she says. And the impact on mothers can be devastating.
Last year, a study in the Journal of Maternal and Child Health that followed 14,000 women in England found those who planned to breastfeed but didn’t end up doing so were two-and-a-half times more likely to develop postpartum depression than those who had no intention of breastfeeding in the first place.
“Women are often deeply and profoundly destroyed by the realization that they’re not succeeding at this fundamental criteria of being an even halfway decent parent,” Jung says.
According to Jung, the Baby Friendly Hospital Initiative (BFHI) is one policy that puts too much pressure on new mothers. The WHO and UNICEF launched the initiative in 1991 to implement practices supporting breastfeeding. Thirteen hospitals, seven birthing centres and 111 community health services have earned the designation in Canada.
“The most draconian criteria of the BFHI is the one where a baby can’t be given anything other than human milk except where medically indicated,” Jung says. “I don’t know how hospitals determine what counts as ‘medically indicated,’ but it could be open to interpretation and a baby failing to latch, that for sure doesn’t count.”
Another aspect of the program is that hospitals no longer receive discounts on formula. Dr. Catherine Pound, a clinical investigator at the Children’s Hospital of Eastern Ontario in Ottawa, says any representation of a formula company in a hospital goes against the initiative.
“It’s essentially saying it’s OK to formula feed — and the message I want to get across is not that it’s not OK to formula feed — but the truth is if you’re a baby-friendly hospital, the message you want to send is that breastfeeding is the best thing you can do for your child. By supplying formula at market price, the incentive to push breast milk is a lot higher.”
Pound also insists the science supports the BFHI.
“There’s a lot of evidence that breastfeeding improves infant health,” she says. “Some studies show it decreases the rate of infection-related hospitalization by up to 30 per cent for every additional month of breastfeeding. When you’re in a publicly funded hospital system, that’s huge.”
But Jung worries these policies are too focused on changing mothers’ minds.
“It’s about pressuring them to do one thing as opposed to making structural changes that allow them to truly make whichever choice is best for them,” she says.
Pound acknowledges that breastfeeding advocacy isn’t perfect. The most common reasons women stop breastfeeding before the recommended six months are not enough breast milk and difficulty with technique.
“It’s one thing to say breastfeeding is best and to convince mothers to breastfeed, but health-care professionals aren’t being taught how to support women who have problems,” she says.
Yet not all these problems are easily fixed, or even fixable. Dr. Michael Kramer, professor of pediatrics and epidemiology and biostatistics at McGill University in Montreal, says too often there’s an implication that if breastfeeding isn’t working, it’s because the mother is doing something wrong.
“There are some women who have more difficulty and we don’t really understand why,” he says. “It’s not a slam-dunk for all women and there are some who just don’t want to, either because it’s uncomfortable or they have to go back to work right away — there are all kinds of reasons.”
Kramer, who was the lead researcher on the Promotion of Breastfeeding and Intervention Trail, one of the largest studies on the effects of breastfeeding to date, says too much time is spent arguing over the science.
“While there’s no evidence of any health benefits of formula, there are certainly proven benefits to breastfeeding, and probably things for which breastfeeding has a protective effect that haven’t been discovered yet.”
The bigger problem, he says, is that policy-makers and healthcare practitioners often rely on the outdated research, suggesting that breastfeeding reduces the risk of food allergies, asthma, obesity and other chronic diseases, like Type 2 diabetes. “Given the mixed — and mostly negative — evidence, it does more harm than good.” What is more important, he argues, is how parents support other aspects of children’s lives, like diet, exercise and screen time, “especially in light of the problems we have in Western society of excessive nutrition and insufficient physical activity.”
Either way, a mother’s motherliness can’t be judged solely on how she feeds her infant. “Stimulating babies, reading to them, talking to them, making sure they’re in the right car seats — some of those things are at least as important, if not more important, than breastfeeding.”
That’s not a message moms hear enough, especially from doctors, says Suzanne Barston, author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t and the blog Fearless Formula Feeder.
“I’m not saying that nasty Facebook comments don’t hurt people,” she says, “but it’s very different from going to your doctor’s office and being told you’ve messed up the one thing you’re responsible for, or giving your baby a bottle on the subway under a poster telling you breastfed babies are smarter, healthier babies.”
The latest “mommy war” on breastfeeding is being provoked by people in positions of power, Barston says.
“What we should be talking about is the messaging we give both breastfeeding and formula-feeding mothers, and how that’s affecting them.”
Although her own infant-feeding days are safely over — her kids are five and seven — she’s still active on her blog because she feels “a protectiveness toward moms who are still going through it.”
Both breastfeeding and bottlefeeding mothers struggle, she says, but there isn’t a community to support parents in the second category.
“They don’t have a voice representing them from public health or government, there’s really nothing out there for them. Every day I get emails from distraught mothers who feel suicidal over their perceived failure to make this work — and I think that’s more of a public health threat than the fact their babies aren’t getting breast milk.”
It’s one thing to say breastfeeding is best and to convince mothers to breastfeed, but health-care professionals aren’t being taught how to support women who have problems.