Infant mortality, what’s breastfeeding got to do with it? Absolutely nothing!

Baby Tombstone at Rose Hill Cemetery in Macon, Georgia.

Sometimes a picture is worth a thousand words, or in this case, two pictures.

To hear lactivists tell it, breastfeeding is lifesaving for infants and therefore, formula is deadly. Indeed, there are a variety of scientific publications that purport to show how many lives and how much money could be saved if more women breastfed exclusively.

Breastfeeding saves lives in theory, but not in reality.

Tellingly these papers rely on mathematical modeling NOT actual population data. Why? Because breastfeeding saves lives in theory, but NOT in reality.

Don’t believe me? Below are two pictures of reality and they demonstrate quite impressively that breastfeeding rates have absolutely nothing to do with infant mortality.

This a map of the world colored to reflect exclusive breastfeeding rates at 6 months of age. The data come from the World Health Organization.

IMG_2887

Yellow reflects low breastfeeding rates; progressively redder colors reflect higher exclusive breastfeeding rates at 6 months. You can see the the US, Canada and Eastern Europe have among the WORST exclusive breastfeeding rates in the world.

Now let’s take a look at infant mortality rates. These data come from the the United Nations World Population Prospects report and the CIA World Factbook.

IMG_2884

The color legend shows that the greener the country, the LOWER the infant mortality rates.

The key point is glaringly obvious. The countries with the lowest infant mortality rates have very low rates of exclusive breastfeeding at 6 months. Of course there are countries that have high exclusive breastfeeding rates, such as in South America, that also have low mortality rates, but most of the countries with high exclusive breastfeeding rates have hideous rates of infant mortality.

In other words, breastfeeding has NOTHING to do with infant mortality. Indeed, a visitor from another planet looking at these images might conclude that formula is lifesaving, NOT breastfeeding.

That’s not surprising. Breastmilk is food, not magic. It doesn’t protect children from vaccine preventable diseases, for example, since the antibodies that attack most pathogens are IgG antibodies and these are too large to pass through breastmilk. And although breastfeeding does offer protection from colds and diarrheal illnesses, they aren’t the only important causes of infant death.

Why is there such a tremendous disconnect between theory and reality? Because most research purporting to show benefits of breastfeeding is weak, conflicting, and, critically, riddled with confounding variables. In high income countries especially, breastfeeding is associated with maternal education and socio-economic status. Most of the purported benefits of breastfeeding are actually benefits of wealth and easy access to healthcare.

Breastfeeding is definitely a good thing and we should be providing vigorous lactation support for women who choose to breastfeed, BUT we should not lie about the real benefits and true limitations of breastfeeding. Breastfeeding is NOT lifesaving, not merely in high income countries like the US, but in most countries around the world. The only exception is in the case of premature babies at risk of necrotizing enterocolitis. Breastmilk can lower (but not eliminate) the risk of NEC.

The idea that breastfeeding saves lives in industrialized countries is essentially a lactivist lie, based on theoretical models while utterly ignoring real world population data. It is designed to create demand for lactation goods and services. That does not mean that lactivists don’t believe it; they believe it fervently, but as these images demonstrate, it is obviously not true.

If your goal is a healthy baby, formula is just as good, if not better than breastfeeding, in ensuring infant health.

  • Empress of the Iguana People

    Totally off topic: Does anyone know if margerine is vegan? I’m thinking of making shortbread cookies for a vegan friend.

    • The Bofa on the Sofa

      The foundation of margarine is hydrogenated vegetable oil, so should be vegan friendly. However, I don’t know about the flavorings or colorings added.

      • Tricia Blanchard

        A surprising number have dairy based flavorings, as I found when trying to bake for a friend with milk allergies.

    • yentavegan

      If the kosher symbol contains a “D” it means the item also has dairy ingredients. If you can find the word Parve on the margarine than it is usually also vegan ( this only applies to foods that never contain eggs or honey) If the product has no kosher or vegan symbol I would look for a product that does. Most margarines are also dairy.

      • The Bofa on the Sofa

        What part of margarine is dairy? Unless it is a yogurt based spread, which is what you find a lot for things like “I Can’t Believe It’s Not Butter” these days

        • yentavegan

          some of the chemical derivatives…I only know this because if the kosher OU is followed by a D it means according to kosher standards the food is dairy.

      • Empress of the Iguana People

        Thank you, Yenta. ๐Ÿ™‚

        • Heidi

          I know Earth Balance is vegan. It is surprisingly difficult to find dairy free margarine.

      • Mildredmmccaskill


        my roomate’s ex wife gets $81 every hour on the laptop… she has been unemployed for 11 months but the previous month her profit was $15430 just working at home three hours per day… โžคsee
        โžœโžœโžœhttp://www.GoogleFinancialCashJobs39ProjectShop/Home/Wage….
        โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…โ˜…::::sr39..

  • doula123

    I’m so glad I found this site! While I don’t agree with the tone of some of the commenters and even of some of Dr Amys posts, the content is amazing. To explain; I’m a mother of three and birthworker from England and have recently become disillusioned with the whole NCB movement, mainly because its proponents seem to bully women more than the doctors! Also because of the blatant nonsense that is peddled. I’ve realised also that being a doula and not being crunchy is virtually unheard of. It was my belief – and reason for training – that being a doula was about providing emotional support to women during birth. That’s it. I mean, I consider that to be hugely important, but that’s the scope of the role. Not to try and talk women into home births, breastfeeding or to give any kind of opinion on pain relief. I personally have had a normal delivery with epidural, an induction without pain relief except for gas and air, and a horrible three day induction that ended thankfully in a normal delivery (I was terrified of forceps). As much as I would have loved a hippy hypno water birth in a birthing centre (I wouldn’t personally choose home birth) it was never to be. And that’s okay. My births were still intense, transformative experiences that ended with three happy and healthy children. I did encounter some horrible medical staff. I also encountered some lovely medical staff, particularly the consultant at my last birth who when I broke down in tears at the way I was being treated on induction ward (refused pain relief, spoke to like a child) told off said midwives, went out of her way to find me a midwife experienced in trauma focused care (I’m a sexual abuse survivor) and gave me an epidural that after three days of agony was desperately needed. I’ve since found out that the difference between my first induction (three hour labour, fast painful but great) and the second was they have now changed how its administered so as to make the process more ‘natural’. The interpretation of natural seems to be longer and more painful. No-one explained the procedure to me either. I became a doula to help provide women with support and choice, and now I’m getting moaned at by other doulas for not promoting breastfeeding and homebirth! Like, wtf?

    • Empress of the Iguana People

      Yep, being crunchy is fine so long as one isn’t shaming others for not being crunchy. My mom was a hippie, but even she was relieved when my sister got the c-section her baby needed. (24 hours of labor, then c-section, only to find ovarian cancer had metastasized onto her uterus and her son’s umbilical cord. Dunno what -could- have happened there, but fortunately we didn’t find out.)
      Mom never shamed anyone for getting pain relief either; she knew she had unusually high pain tolerance.

      • doula123

        She sounds great! So glad your sister and baby were ok x

        • Empress of the Iguana People

          10 years after her Stage IV Ovarian diagnosis and my sister is still alive. It came out of remission a few years ago, but its moving slowly. Nephew’s doing well

          • mabelcruet

            Placental metastases from maternal cancers are thankfully very rare-most cases have been malignant melanoma or breast cancers, as they are generally more common in women of child bearing age. If the metastatic deposit is in the placental parenchyma itself (in the disc), there have been case reports of spread to the fetus (in melanoma). The placental architecture is such that the maternal blood and the fetal blood are separated by the vasculosyncytial membrane-the basement membrane and cytoplasm of the fetal endothelial cells in the capillaries and the syncytiotrophoblast of the villus so there is a physical barrier that maternal malignant metastasizing cells would have to breech. The cases where tumour spread to the poor baby were in the baby’s liver.

            Spread to the cord is very peculiar-I can’t think how it would have got there. The malignant cells must have come from the maternal circulation, but the cord is in the amniotic cavity, so did the tumour cells migrate across the chorionic plate? Or did they come across via the free membranes infiltrating from the maternal decidua? Or was there tumour at the chorionic plate that then crawled up the cord? With all due respect to your sister, and I’m sure it must have been a horrible time for everyone, and I’m really happy she’s doing so well, but please tell me someone looked at her placenta because that is absolutely fascinating!

            But cords are very tough-there is a good few millimetres usually between the outside of the cord and the fetal vessels within, and it would take a while for any tumour cells to cross through the Wharton’s jelly, and its also relatively hypoxic (as it has no circulation of its own and take oxygen from the fetal vessels) so it would be quite an inhospitable environment for tumour cells I think-I have no data to back this up though.

            I’ve only ever seen two cases of placental metastasis-the placentas in mums with known malignant disease should be routinely sent for histopathology, so I’ve had lots sent to me with the clinical history of maternal cancer, but I usually find nothing.

          • Empress of the Iguana People

            Sib is a strange case in general. (She’s the one who survived her stillborn co-trips, got skin cancer in her teens, breast cancer in her early 20s, and ovarian in her late 20s. Most recently she was in a chemo trial and she alone is still alive.) I don’t know much in the way of details. I do know the original doc thought it was uterine cancer, then the cancer was tested and proven to be ovarian. My nephew has been tested a few times to see if he had developed cancer, too, i think.
            It’s pretty incredible, literally difficult to believe, but I saw the huge lump of skin cancer and phoned the big hospital when she was having surgery for the ovarian.

          • Heidi_storage

            Holy cow. It’s horrific that she’s had to deal with cancer as a teen and in her 20s and 30s; on the other hand, she sure seems to be good at surviving cancer. Wow.

          • Empress of the Iguana People

            The first was the mild cut out and done kind, the second cut out and zap with radiation a few times and done. The third is the bugger.

          • mabelcruet

            There is probably something very odd going on at a genetic level. Sounds like she’s got two main mutations going on-one giving her a propensity for cancer, and the other giving her resistance to it somehow. Has she been reviewed by a cancer geneticist? Whatever is going on at a cellular level sounds like it could be fascinating, but I’m sure she’s had quite enough poking and prodding to last a lifetime.

            The two cases I had of placental metastasis, one mum died a couple of weeks after delivery sadly. The baby had follow-up for 2 years with 3 monthly MRI scans, and then onto yearly review until age 5. The paediatric oncologists felt that if nothing had appeared at 5 years then he should be OK.

            The other one mum apparently had lumpy breasts all through the pregnancy but wasn’t referred to a breast surgeon or reviewed (I think it was thought to be ‘meh, lumpy breasts, hormones, glandular tissue developing…’.

            At delivery the placenta had multiple firm white areas but the baby was normally grown-usually for normally grown babies we wouldn’t examine the placenta routinely unless there was another indication, but the obstetrician was a bit curious as to why the baby was normal size when the placenta was full of infarcts. So it was sent to me for routine opinion, scared me silly when I saw cancer all through the damn thing. Its been many years since I did adult pathology, and babies don’t really get carcinomas, so it was a rapid ‘Help! Can I have a grown-up pathology opinion on this placenta?’ to my colleague down the corridor. Special stains etc confirmed breast as site of origin, so they went back to mum and checked her out for lumps, and nestled within the benign lumpy bits was cancer. Saved by the placenta! And saved by the midwife who delivered the baby-mum was low risk midwife led care, perfectly straightforward delivery, but the midwife didn’t think the placenta was normal-the midwives here do a routine placental exam after delivery (like I’m sure they do most places), and she asked the obstetrician about it, and he agreed it wasn’t normal. Had no one picked up on the placenta, she may have gone many more months undiagnosed.

          • mabelcruet

            One more thing about placentas, and then I’ll stop talking about them (I could probably talk placenta all day!)

            There are some congenital tumours that present in utero, mostly teratomas, but very rarely malignant neuroblastoma can develop well before term. Monochorionic twins may develop twin to twin transfusion because of vascular anastomoses across the placenta-blood travels between the two fetal circulations. Imagine if you have monochorionic twins and one twin develops a neuroblastoma. Theoretically, metastasis from twin 1’s tumour could traverse the anastomosis and spread to twin 2. I’m sure this situation is vanishingly rare, but I’m convinced a read a case report about it (but can’t locate it online).

            Placentas-amazing things, but when they go wrong, they go very wrong.

          • Empress of the Iguana People

            oh my

          • Amazed

            I think Jen can learn a lot from you but she, as a LC and midwife, it seems (I thought she was just a LC but it looks even worse). But she isn’t willing to venture anywhere in the territory where natural can mean natural starvation, natural tumor, natural death. She isn’t willing to admit that newborns are eating, even!

          • Empress of the Iguana People

            oh my.
            Yeah, she’s got freakish luck. We can’t help wondering if Dad’s testicular cancer when she was conceived might have been part of the reason. (our parents very occasionally joked that Sib got the very last viable sperm)
            The first two were much milder than the last. Still very odd to get any of those at that age.

    • Heidi_storage

      Welcome! I’m glad you found the site. Many commenters on here found it in similar situations; they had been poorly treated or even outright lied to, and they were hurt and angry. Indeed, the comments can be abrasive (including mine), but it is very difficult to remain courteous and snark-free when people keep promoting the same vicious misconceptions and mistreatment of women and babies that this site attempts to address. (I myself was astonished to find that giving bottles doesn’t ruin breastfeeding, and also that breastfeeding has been massively oversold as a Good Thing.)

      Congratulations on your three lovely babies. Thanks for promoting real knowledge, choice, and safety in birth, rather than defaulting to NCB nonsense!

      • doula123

        Thank you! And I agree; while its always nice to keep dialogue ‘snark-free’ its bloody hard when faced with such vitriol from the ‘other side’. The tragic thing is its confused women and their babies caught in the middle…I must confess to being seriously angry with parts of the NCB movement. Their rhetoric – tell women what to do with their bodies and babies – is no different to that of the paternalistic, misogynist doctors they claim to despise. As for breastfeeding..sometimes it just doesn’t work. Thank God for formula. All three of mine were mixed fed and did great.

    • Young CC Prof

      Thank you for being a doula who supports women in their own healthcare goals, rather than yours. If somebody WANTS to go without pain medicine and wants coaching and support for that, awesome. But if what the patient really needs is someone to advocate for the rapid arrival of pain relief, that’s important, too.

      • doula123

        I agree!

    • yentavegan

      Welcome doula 123! This is a great ( albeit blunt!) community of intelligent people. I have learned so much by taking the time to separate the way a truth/fact is shared from the validity of the stated fact. I have not lost my “crunch-cred” just the woo.

      • doula123

        Thank you!

  • Sarah

    I hadn’t realised Angola’s infant mortality rates were so awful. Why is that? I appreciate they’re a majority poor society even in the context of the Luanda boom, but no more so than lots of other African nations. And virtually all the conflict has been over for a while now. I didn’t expect them to be top of the list or anything, but worse than South Sudan and Somalia? They can’t even be particularly old stats either, because South Sudan only became independent in 2011 and the Angolan situation wasn’t manifestly worse then.

    • Kerlyssa

      might have to do w how the stats are collected, or differing disease burdens, since they are a good distance from each other. Sudan has the highest maternal mortality rate, and is not far behind in infant, so it’s not like either is doing well.

      • Sarah

        South Sudan not Republic of Sudan. Of course neither is doing well, but Angola’s are worse, which really surprised me given how very badly South Sudan is doing at the moment (I have Angolan family and a dear friend from South Sudan so take an interest in each). I suspect you may have nailed it with different stat collection.

        • Kerlyssa

          i was going off of (the republic of) south sudan- i double checked, and they do appear to have the highest maternal mortality rates(by a very large margin) as of 2014 at least. (north) sudan’s are a third of theirs.

          • Sarah

            South Sudan having the worst maternal mortality rates is unfortunately to be expected, but I still can’t for the life of me see how Angola’s infant mortality could be better than theirs if they were being reported and collated in the same way. South Sudan is utterly desperate.

          • Kerlyssa

            infant mortality is a bit more open to interpretation than maternal is. could easily be a cultural or policy difference in what is considered a dead infant vs a stillborn, nonviable, child death, etc.

          • Sarah

            Aye maybe. Seems most likely.

  • AnnaPDE

    As someone who earns their living doing mathematical modelling, I’d just like to use this moment to say: And this is why you need to look closely at your input data and analyse what it means, otherwise there’s a good chance that the model outputs will be useless and misleading. Garbage in, garbage out. Incompetent work like that paper you refer to brings the whole modelling approach into disrepute.

    Also a tiny nitpick: the legend on the first chart doesn’t quite match what the colours are supposed to mean; the original picture’s caption had them the right way around.

  • Mel

    I like feeding my baby formula.

    I don’t have to do a ton of math to figure out what amount of fortifier to add to breastmilk like I did while combo-feeding him to make 20 cal breast milk into 24 calorie “rocket fuel” preemie formula.

    Having my husband and parents give Spawn bottles has been a godsend so that I have time to sleep, exercise and manage his assorted medical check-ups and therapist visits.

    He’s started reaching for bottles when he sees them which means he’s almost old enough for a dairy farm rite of passage: showing him a calf-bottle of milk replacer and watching his eyes pop in amazement.

    The last time the he needed a blood draw, the phlebotomist pointed out that he’s developed chubby little baby thighs with a little crease and everything.

    He’s happy. He’s growing. Formula is working great!

    • Empress of the Iguana People

      Love that image (well both the calf bottle and the chubby baby thighs). I did this with my son and focaccia. A local bakery makes single serving ones and larger 4 serving ones. He’d already been mad for the stuff but only saw the smalls for a couple months. Then one day either they were out or I planned to have some with dinner, so I got a big one. His eyes nearly bugged out of his head when I pulled that one out of the bag

    • mabelcruet

      Has he got those little chubby rings around his wrists yet? That always reminds me of the old Michelin man figure, it’s so cute.

  • Empress of the Iguana People

    Babies are happier with a full stomach. Preferably human milk or regular regulated formula of some sort. WHY is this so hard for some people to understand? Sigh.

    • Roadstergal

      Babies have one job, one job only – to grow. And that takes food. Calories, fat, sugar, carbs, protein. Energy and raw materials. Their job is not to lose weight or Validate Mom’s Breasts, it’s to start the process of turning a 6-10lb burrito into a 100+lb walking and talking human.

      Teenagers are infamously starving and un-picky about food when they hit their growth spurt. Just because babies can’t speak yet and can’t drink directly from the carton in the fridge doesn’t mean they don’t feel just the same way.

      • Empress of the Iguana People

        My GirlBard grew 3 inches (7.6 cm) between her 9 month and 12 month appointments. Even teens don’t do that!

        • luna

          My tween grew three inches in three months, now she is two months from turning 12 and my height exactly. Excuse me while I cry. Her birthmom is six feet, birthdad height unknown but birthmom said the guy she thinks it is was about 6’3 so my kiddo is going to be a giant next to adoptive parents who are 5’5 and 5’6.

      • Young CC Prof

        My son conveyed his utter ravenous hunger pretty well. He was born a little early and very small, and at first he was sleepy, but when he passed his due date, it was like some kind of switch was thrown. All the food, all the time!

        There’s a three-week period from which I don’t remember anything except desperately measuring bottles, but during those three weeks, he grew from 6 pounds to 9 pounds and went from scary-skinny to normal baby with little fat rolls.

      • BeatriceC

        MK was the kid of mine with the most spectacular growth rate and even more jaw dropping food consumption (before he got sick). That kid grew about 9 inches in six months, and then another three inches over the following six months. And as an athlete, the amount of food he could consume to not only keep up with his activity level, but his growth as well was extraordinary. My grocery bill was my single largest monthly expense; and that included the mortgage! My current grocery bill is right about half of what it was before MK moved in the boys’ father. And you’re absolutely right. All three of the boys have been known to stand in front of the open fridge and eat their way through various containers while ostensibly “looking for something to eat”.