Monday, July 03, 2006

New York Times Editorial Apologist for Breastfeeding

The New York Times editorial on breastfeeding: “About Breast-Feeding...” Week in Review, p.9, 2 July 2006, http://www.nytimes.com/2006/07/02/opinion/02sun2.html, reduces the important public health implications of breastfeeding to something to consider only in a situation with “all things being equal” and then purports to support a middle ground. This editorial comments on a proven public health intervention - breastfeeding - as though it were one of two equal viewpoints, the other being formula feeding, and provides the casual observation that folks are doing okay without it, dismissing its value. To this reader, this does not appear to be a “middle of the road” stance, and, simply put, it is irresponsible. The issue that was originally raised was one of misplaced guilt and responsibility surrounding breastfeeding, but this editorial reduces this editorial reduces the issue of breastfeeding to something to consider only in a situation with “all things being equal”.

This editorial expresses scientific opinion that can impact negatively on the health of its readership and that is, at best, ill-informed and misleading. If a "middle of the road" option were defined in this piece, it certainly is not supported by the final sentence: "Millions of Americans have thrived on [infant formula] and are doing quite nicely as far as we can see." This sort of statement would be similar to saying that "millions of Americans have smoked and are doing quite nicely". As a medical epidemiologist, I concur that both of these statements are true, but each one belies the importance of the preventive health message.

In epidemiology, it is common that not every study, or every individual's anecdotal observation, will reveal the marked impact of an important intervention. Rather, reporters and scientists, alike, should rely on the evidence. When there is "biological plausibility" and the majority of the evidence points in the same direction, even if some studies do not achieve statistical significance, there is indeed cause for concern. Every person who smokes does not get heart disease or lung cancer, and yet we strongly discourage smoking because we have studied the consequences. Every non-breastfed child does not become ill, and every non-breastfeeding mother does not get breast cancer, but we know that the probable risks of these consequences for the mother and the child are increased, and therefore we should strongly support breastfeeding.

Why do we see these differences in health outcomes, despite agreement that formula is generally nutritious? Because breastfeeding is not nutrition alone. Every baby is born deficient in terms of its immunological maturity, and the milk from its mother carries the necessary immune factors needed until the baby's system can mature. And every baby is born with susceptibilities, and breastfeeding can lessen the risks for many, or delay onset until the child is old enough to handle it. In addition, there are many additional factors that help the infant adapt to the world outside, and that change with the child's needs over time, that are only found in mother's milk.

We who were not breastfed may well be among the "millions of Americans doing quite nicely", but what would our situations have been if we had been breastfed? There is a wealth of scientific evidence that we could have been healthier in many ways: perhaps brighter, perhaps thinner, with better vision and straighter teeth and, perhaps, less likely to have a chronic disease such as cancer. We can only decry that our mothers were not supported to feed us in the manner that is proven to reduce the risks of childhood illnesses, and which would have had, according to most studies, long term consequences for both her and for us.

Why didn’t our mothers and grandmothers breastfeed? There were many social pressures on women to work during the war. And in the 1950s, when women were encouraged to stay home, the commercial pressures may have taken over. For example, my infant formula-sponsored baby book, the one that my mother was given when I was born, stated, more or less: Congratulations on your new baby. Your hormones are going wild, and you may feel like doing something bizarre, like putting your baby to your breast. Resist. Your doctor knows better.

The commercial sector no longer makes such statements, but we are the progeny and the students of the generations of well-meaning women who received this sort of counsel from the medical profession and media, alike. Any woman who succeeds with optimal infant feeding in our society is deserving of respect and applause.

To return to the editorial, what is the "middle of the road" on this issue, anyway? Perhaps a middle ground might emerge where there is a situation in which women were enabled to truly make a choice. What would that look like? To make a fully informed choice, a woman and family would have ready access to accurate information, free of commercial bias, and, if she chooses the healthful option, she is enabled to breastfeed by a society that supports women by providing third party payment for breastfeeding support, training all healthcare workers in the basics of breastfeeding health, ensuring maternity leave and/or workplace support for continued breastfeeding, and offering constant encouragement in giving every infant the best start on life.

When our society has achieved this support for women of all circumstances, dedicating at least as much in the way of resources to breastfeeding support as the commercial sector provides for advertising the nutrition-only breastmilk substitute, then, perhaps, we will be able to define a "middle of the road."


3 comments:

Melissa Bartick, MD said...

We need to reframe the message in response to formula industry and others who say "Women need choice" to "Women deserve support," calling attention to the failure of hospitals, employers, insurers,legislators and the public to support new mothers.

Melissa Bartick, MD said...

"Women deserve support" means that providers have training, and insurers pay for what needs to be done to allow women to breastfeed exclusively for 6 months. It also states that it's not breastfeeding itself that's the problem, but everyone else.*

Melissa Bartick, MD said...

"Women deserve support" means that providers have training, and insurers pay for what needs to be done to allow women to breastfeed exclusively for 6 months. It also states that it's not breastfeeding itself that's the problem, but everyone else.