Posts
Note: This post was drafted several weeks ago, shortly after
the publication of the article it discusses. My initial intention was to publish it right
away, but to be honest I was uneasy because I felt like I didn’t dislike the
article as much as I “should”. While that ended up being a fantastic inner
monologue leading me to some interesting insights about the nature of science
and of communication, it did not do me any favors in terms of cashing in on the
debate. In short, you might say that I wussed out. But in any case, here’s the basic story as I see it.
Back in February an article in the journal Social Science and
Medicine made some minor waves with its claims that breastfeeding- currently
exalted within Western culture as The Way Things Ought To Be- is completely overrated.
At least, that’s what some in the media would have us believe. The study,
headed by two sociologists at Ohio State University, looked at longitudinal
data from three groups: 8,237 children, 7,319 sibling pairs, and 1,773 sibling
pairs within which one sibling was breastfed and the other bottle-fed. The investigators
analyzed data on a number of markers for physical and mental health, including
body mass index (BMI), obesity, asthma, hyperactivity, parental attachment and
behavior compliance as well as vocabulary, reading recognition, math ability,
intelligence and scholastic competence. Though breastfed children did seem to
have an advantage in terms of most of these metrics, there was no statistically
significant difference between the breast- and bottle-fed siblings in the
discordant pairs- a finding which indicates that the similarities of experience
for these sibling pairs outweighs the effects of their different feeding
styles.
That sounds
like a reasonable enough conclusion, but I have plenty of questions about
their results. They looked at an impressive list of metrics, sure, but they certainly
didn’t look at everything (plus I have my doubts as to whether something “parental attachment” can truly be summed up quantitatively anyway). And there are fundamental issues with the independent variable, like the fact that breastfeeding time is measured in weeks- quite short compared to current guideline- and that exclusive vs. mixed feeding was not accounted for in analysis, that muddy the whole picture and make it harder to base any definitive claims on the data. But all in all, this is not a terrible article. It’s just that it says a
few very specific things about very specific infant feeding dynamics in a relatively privileged western society…and that’s all. Information
on the short-term benefits of breastfeeding (Horta and Victoria 2013)-
including passive immunity- are acknowledged but glossed over as though they
are have no connection to long-term outcomes, and the potentially protective
effect for breastfeeding mothers against breast cancer is missing altogether (MÖller et al 2002). Additionally, while the study
controlled for socioeconomic status, there are just *so many* other confounding
variables that could not be addressed with the existing data set (post weaning
diet, physical activity levels, exposure to allergens, prenatal environment…)
that extracting meaning from this is like looking at a puzzle with half the
pieces missing.
E.A. Quinn, an Anthropologist and breastfeeding researcher
who blogs at Biomarkers and Milk, makes the point that nothing in the article is especially newsworthy for anyone with
a solid background in breastfeeding science. Given that I am NOT a
breastfeeding researcher, though, it was news to me. And it will certainly be news to most readers. Most importantly, it was considered “news” to
the study’s authors, who not likely to be extensively trained in human biology
(though to be fair, Dr. Colen does have substantial background in public
health) and so were perhaps not fully equipped with the understanding of
physiology necessary to adequately and responsibly contextualize their
findings. All in all, this leads to substantial potential for public misinterpretation.
There’s a piece at Evolutionary Parenting that eloquently tackles both the study’s limitations and
the way the information has been misrepresented in the media better than I ever
could. The post points out that, while the authors should bear some
responsibility for this runaway train (they did, after all, begin the title of
their article with the question “Is breast truly best?”, and I can’t imagine
they didn’t know where that might lead) it really is the journalistic community
who ought to be called out for the unnecessarily clickbait-y headlines.
The very first two hits on the word “breastfeeding” this
morning are "There's Way More to Parenting than Breastfeeding", at the Boston Globe
(perfectly fine!), "Breastfeeding Benefits Overstated?" (Less fine,
as far as I’m concerned)
With just a little bit more effort (search terms
“breastfeeding 2014") you can find this gem over at Slate, which is the article
that popped up on my Facebook newsfeed the other day and irked me enough that I
had to write this post.
What it comes down to is this: The decision whether or not
to breastfeed is a really big deal to most new mothers. It is true that our
current cultural climate is such that many women feel guilty and shamed if they
are unable or reluctant to breastfeed.
That is 100% wrong, and I wish it were not the case. I also believe, though, that everyone who
wants to explore breastfeeding should be able to do so in a supportive
environment with accurate *and complete* information readily accessible to them. Inflammatory headlines claiming no real
benefits to breastfeeding are shallow and misleading. OF COURSE no one should have to feel bad
about opting to formula feed, but no one should be made to feel like they're
buying a myth for opting to breastfeed, either, because it's simply not true.
There are aspects of infant attachment and well-being that cannot be easily
quantified, and even if we accept that they won’t change the entire trajectory of a child’s life, they
still matter.
If you read through the blog posts and articles mentioned,
including the press release for the study itself, you’ll notice a common thread
of looking out for mothers and wanting to help create that more supportive
environment regardless of feeding method.
It seems that in the end everyone’s gotten this one vital aspect right,
at least. But this is proof that we can
do better- breast vs. bottle does not need to be a divisive issue with
victories or losses to tally up. I only
wish everyone would acknowledge that up front instead of giving in to the
impulse to antagonize. For an informative and thought-provoking take on
breastfeeding, check out The Situated Mother by the ever-insightful Kaitlin
Drouin. And, as always, let me know what you think about all this.
Sources:
Colen CG, Ramey DM. Is breast truly best? Estimating the
effects of breastfeeding on long-term child health and wellbeing in the United
States using sibling comparisons. Social Science & Medicine. 2014.
doi:10.1016/j.socscimed.2014.01.027.
Drouin, K. H. (2013). The situated mother: Evolutionary
theory and feminism as complementary components to understanding breastfeeding
behavior. Journal of Social, Evolutionary, and Cultural Psychology, 7(4), 326.
Horta BL, Victora CG: Long-term effects of
breastfeeding: a systematic review. Geneva, Switzerland: World Health
Organization; 2013
Möller, T., Olsson, H., Ranstam, J., & Collaborative
Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and
breastfeeding: collaborative reanalysis of individual data from 47
epidemiological studies in 30 countries, including 50 302 women with breast
cancer and 96 973 women without the disease. Lancet, 360(9328), 187-195.
Retrieved from https://lup.lub.lu.se/search/publication/1123899
on March 16 2014
