Dr. Bartick, who’s really fueling the mommy wars?

Dr. Melissa Bartick is one of the premier exponents of the health benefits of breastfeeding and chair of the Massachusetts Breastfeeding Coalition, the prime mover behind the Massachusetts ban on formula gift bags. I am thrilled that she has chosen to enter the discussion in the comments section of yesterday’s post.

Here’s an excerpt of her comment:

Dr. Tuteur, I heard you interview on WBUR and your statements were fraught with inaccuracies and frankly your understanding of the medical literature around breastfeeding is not current. You also seemed more concerned with fueling the mommy wars than with the issue at hand

You seem unfamiliar with the AHRQ report of 2007 — detailing all available evidence about maternal and child health around breastfeeding. You are mistaken when you claim that no child in the US has ever been harmed or died from formula. My own study published in Pediatrics in 2010 showed that there are 911 excess child deaths per year in the US due to formula feeding. This study, which also found that suboptimal breastfeeding costs the US economy $13 billion a year to our economy…

I have bolded 3 claims that I’d like to address.

1. The AHRQ report of 2007

The Agency for Healthcare Research and Quality published Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries in April 2007. The 415 page report is often cited by lactivists in support of efforts to increase breastfeeding rates. I’m not sure why Dr. Bartick thinks I am unfamiliar with it since I had it in mind when I pointed out multiple times during the radio program that the benefits of breastfeeding, while real, are small and most of the data is weak, conflicting and plagued by confounders.

The authors of the ARHQ report acknowledge this fact right at the outstart of their report, in the abstract:

A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings…

The authors could not have made it plainer. No one should use their study or the data in their study to claim that breastfeeding causes the improved outcomes they discuss in the report. In other words, the report supports MY contention, not hers.

2. Dr. Bartick’s study

I reviewed Dr. Bartick’s study, The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis, when it was published in 2010. My assessment?

…Using highly fanciful methods, Bartick and Reinhold “estimate” that the US could save 900 infant lives and $13 billion if 90% of US women breastfed. These numbers are grossly misleading since not even a single US infant death (let alone 900 per year) has ever been attributed to not breastfeeding and since the purported savings are primarily the “lost wages” of the 900 dead infants…

Bartick and Reinhold’s argument is only theoretical anyway because, as the ARHQ report on breastfeeding found, “one should not infer causality” between breastfeeding and improved health outcomes. Indeed Bartick and Reinhold’s paper is just another weak paper based on research plagued by confounders.

3. Fueling the mommy wars

I almost laughed out loud when I read this since it is lactivists like Dr. Bartick who are fueling any mommy wars about breastfeeding, not me.

What are mommy wars? They generally refer to conflicts between working mothers and stay at home mothers about which is better for children. In other words, both sides insist that THEIR choices are better for children and therefore imply that those who do what they do are better mothers. They often insinuate that if other mothers made the same choice that THEY made, those women’s children would also benefit.

When it comes to lactivists, they DO insist that their choice to breastfeed is better for babies and they do imply that women who breastfeed are better mothers because they are giving their babies the “best.” Moreover, the banning of formula gift bags is a direct expression of their belief that, not only would other women’s children benefit if their mothers made the same choice to breastfeed that THEY made, but that other mothers must be cajoled and manipulated to make the same choice to breastfeed that THEY made.

If I were trying to fuel the mommy wars, therefore, I would be a formula feeder, and, more importantly, I would insist that formula feeding is “best,” and that formula feeders are better mothers. In addition, I would be working to enact a ban on free gift bags containing breast pads and breast cream in an effort to discourage breastfeeding. Obviously I am doing nothing of the kind.

I DID breastfeed my children. I DO promote breastfeeding. I ACKNOWLEDGE that it has real, though small benefits over formula feeding. So I am hardly promoting MY choices.

I’m certainly not claiming that bottle feeding is “best” or that mothers who bottle feed are better mothers. The essence of my claims is that there is no feeding method that is best for everyone and that NEITHER method of infant feeding makes one a better mother.

So who’s really fueling the mommy wars, Dr. Bartick? You, who are insisting breastfeeding is best, that “good mothers” want what is best for babies and therefore breastfeed, and that women should be cajoled and manipulated into following YOUR choice? Or me for pointing out that both feeding methods are equally valid, equally safe, and that women should be supplied with information and be supported in making whatever choice works best for themselves and their families?

Please don’t try to imply that “if you’re not with me, you’re against me.” Please don’t ignore the voices of women who make different choices or demean those choices. And please don’t pat yourself on the back for the formula gift ban. There’s nothing admirable about women who would never use formula, taking formula away from those who would.

Addendum: If Dr. Bartick wishes to write a reply, I would be happy to publish it, unedited, in its entirety, as a companion piece.

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