Not a single country in the world meets WHO standards for breastfeeding? So what?

23461995 - so what

Lactivists are bemoaning the latest breastfeeding report from the World Health Organization.

As USA Today reports:

No country in the world supports breastfeeding moms like they should, according to a new report released Tuesday by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)…

By comparing breastfeeding rates around the world, the groups found rates nowhere near 100% in its Global Breastfeeding Scorecard, released at the start of World Breastfeeding Week.

So what?

No matter how long and hard professional lactivists bleat about the purported life saving benefits of breastfeeding, very few parents actually believe them, nor should they. The truth, which lactation professionals refuse to acknowledge, is that breastfeeding rates have virtually nothing to do with infant health.

There is literally zero real world evidence that promoting breastfeeding improves infant health.

Don’t believe me? Consider which countries did best and worst on the WHO breastfeeding report card.

Only 23 countries report exclusive breastfeeding rates at 6-months above 60%: Bolivia, Burundi, Cabo Verde, Cambodia, Democratic People’s Republic of Korea, Eritrea, Kenya, Kiribati, Lesotho, Malawi, Micronesia, Federated States of Nauru, Nepal, Peru, Rwanda, São Tome and Principe, Solomon Islands, Sri Lanka, Swaziland, Timor-Leste, Uganda, Vanuatu and Zambia.

By and large, these countries have terrible rates of infant mortality (expressed per 1000 live births):

Bolivia 31
Burundi 54
Cabo Verde 21
Cambodia 25
Democratic People’s Republic of Korea 20
Eritrea 34
Kenya 36
Kiribati 44
Lesotho 69
Malawi 43
Micronesia 29
Federated States of Nauru 29
Nepal 29
Peru 13
Rwanda 31
São Tome and Principe 35
Solomon Islands 24
Sri Lanka 8
Swaziland 45
Timor-Leste 45
Uganda 38
Vanuatu 23
Zambia 43

In contrast:

Laurence Grummer-Strawn, technical officer with the World Health Organization, said the U.S. received “several red lights” or “failing grades” in the report. Rates in the United States were considerably lower than the average. Fewer than 25% of American moms report exclusively breastfeeding for the first six months. The United States has no paid maternity leave, and data showed only 18% of hospitals support recommended breastfeeding practices. Grummer-Strawn also pointed out there’s no regulation on how baby formula is advertised in the U.S., a reason moms could think formula is a substitute for breastmilk.

But the infant mortality rate in the US is 6/1000, a fraction of the rate in any of the countries given the best grades by the WHO.

The United Kingdom, by all accounts, does even worse with a breastfeeding rate at 12 months of 0.5%, reportedly the lowest in the world … and yet the infant mortality rate in the UK is even lower than the US, 4/1000, one of the best rates in the world!

These figures make is nearly impossible to take UNICEF and the World Health Organization seriously when it asks for ever more money to promote breastfeeding:

The groups are asking for lower and middle-income countries to invest $4.70 per newborn ($5.7 billion) in initiatives, such as access to breastfeeding counseling and improving breastfeeding practices in hospitals, to increase the global rate of 6-month exclusive breastfeeding to 50% by 2025. The Global Breastfeeding Collective suggests such an investment could save the lives more than 520,000 children under age five who die of preventable illnesses, annually, and could generate up to $300 billion in economic gains.

All the existing real world evidence suggest that that can’t possibly be true and isn’t even close to reality. So where do such claims come from? They come from mathematical models that assume that when breastfeeding rates are correlated with low infant mortality, they cause low infant mortality. But as anyone with even a passing acquaintance with statistics can tell you, correlation does not equal causation. The figures quoted above demonstrate that definitively.

Nonetheless, the UNICEF and WHO claims, which have no basis in fact, have been widely disseminated and accepted as conventional wisdom.

A piece published yesterday on the Fast Company website is typical:

We really need to act now to fully realize the benefits of breast feeding,” says France Begin, a senior advisor with UNICEF’s infant and young child nutrition division. “Prioritizing breast feeding will save lives, save money, and will lead to better health and economic outcomes for generations to come.

Yet there is literally ZERO real world evidence that prioritizing breastfeeding will do any of those things. In the real world, there is NO correlation between breastfeeding rates and infant mortality rates. Countries with the highest breastfeeding rates have HIGH infant mortality and countries with the lowest breastfeeding rates have LOW infant mortality.

There is NO real world, population based data to indicate increasing breastfeeding promotion or improving breastfeeding rates would have ANY impact on any infant health of term babies.

Indeed, I posted a challenge on Facebook and Twitter yesterday:

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Take the Dr. Amy World Breastfeeding Week Challenge: Please find any example of industrialized countries where promoting breastfeeding reduced infant mortality.

Thousands of people have viewed the challenge but not a single person has offered a single example. That’s not surprising. There are no examples.

Not a single country in the world meets WHO standards for breastfeeding? So what?

  • carovee

    What saves more lives and produces bigger economic gains – breastfeeding or birth control? $5.7 billion towards increased access to and education about birth control would do so much compared to wasting it on breastfeeding rates. Why is the WHO and UNICEF wasting one penny on this crap?

    • Sheven

      Because loons on both the left and the right are all about fetishizing breastfeeding. Meanwhile any suggestion that a woman might want to have sex without having a baby makes right-wing nuts froth at the mouth and now makes left-wing idiots resist because the Pill isn’t natural.

      • Casual Verbosity

        Who would have thought that boobie-juice could unite such unlikely groups? Then again, I’m often inclined to think that in some respects the political spectrum isn’t a line so much as a sphere. As such it’s possible to go so far to one side that you end up on the other.

        • Sheven

          They’re united by a commitment to the idea that there is something far more important than a woman choosing to do something they consider less than optimal with her body.

    • Valerie

      But don’t you know that breastfeeding IS birth control, promoting optimal child spacing? /sarcasm

      If it really were about infant and child health, they would also be better off spending money on, say, hand hygiene interventions, which have a much larger effect on infections than breastfeeding.

      • Empress of the Iguana People

        And if you say you were ebf and got your period back at 8 weeks, you weren’t bf’ing frequently enough. Oh, so I get penalized because neither my baby nor I woke up between 1130 pm and 330 am? *snort*

        • Valerie

          EBF is optimal, so everything about it is optimal, so if your experience was suboptimal, you were doing it wrong. Is that the logic?

          I know more than one woman who had an unplanned pregnancy while depending on the lactational amenorrhea method- turns out a woman can ovulate and conceive before she gets her first period after childbirth. Imagine that.

          • I’ve had lots of patients who got pregnant thinking breastfeeding was contraceptive, or that amenorrhea always means there is no ovulation.

          • Dr Kitty

            I always put it this way:
            LAM is 98% effective
            IF your baby is under 6 months old.
            IF you breast feed at least 6 times in every 24 hour period, no exceptions.
            IF you don’t have a period.

            BUT
            You won’t know it has failed until it fails.

            So, if you really don’t want another pregnancy, maybe don’t rely solely on LAM and back it up with condoms, sexual activity less likely to result in conception, an alternative contraceptive method, or abstain from sexual intercourse completely.

            At which point most of my patients ask about obtaining coils, implants or progesterone only pills…

          • Heidi_storage

            Hey, within those limitations, LAM’s a pretty good method, but I have seen some cruel and ignorant comments to women for whom LAM “failed” (ie, they got their periods back early).

          • Dr Kitty

            Like I said- 98% effective…

            BUT if you sleep through the night, missing two feeds, and had intercourse in the preceding few days…oops.

            And it’s the sort of oops people don’t consider getting emergency postcoital contraception for, unlike, for example, a split condom or a missed pill.

            That’s where most of the failures are- ovulation triggered by a dropped feed or two, no period yet and conception before you even realised it could happen.

            As long as people know that if ANY of the three criteria aren’t met (and the easiest one to slip up on is missing a feed) then the reliability of the method is completely shot.

            If that’s your chosen method- knock yourself out, different strokes for different folks- but for the majority of women I see it’s just not a reassuring method to use without something else as well.

          • Valerie

            And a woman might not know she’s pregnant because the typical sign, a missing period, doesn’t apply because she wasn’t expecting one in the first place. But, hey, I guess no method is fool-proof, perfectly effective, side-effect-free, etc. Fun fact: I know somebody who was conceived while his mother had a copper IUD.

          • Sarah

            Not that uncommon, I believe.

          • Dr Kitty

            Failure rates with Copper IUCDs are 1/200.
            Which is about the same as Depo Provera, tubal ligation, Essure and Mirena.
            Nexplanon is probably closer to 1/300.
            The pill is 1/100 with perfect use.
            LAM is 1/50
            Condoms are about 1/40

            Vasectomy is 1/2000

          • Sarah

            Yep, I used to work in a family planning clinic so heard all these before! Although the implant had a different name then.

          • jumpygiraffe

            I combo fed and didn’t get my period back for 11 months. One month after a friend who was super bfing.

          • Heidi_storage

            Yeah, it really varies from woman to woman, and sometimes even from kid to kid with the same woman. Dr. Kitty’s right that you want to be using backup if you don’t want to get pregnant, especially if you don’t know what your body’s going to do.

          • Empress of the Iguana People

            and if you’re me, don’t rely on it at all!

          • Young CC Prof

            At a population level, where other contraceptives are unavailable, LAM improves child spacing. On an individual level, I’d like something more effective.

          • Azuran

            People seem to forget that periods occur AFTER ovulation. So even putting aside all cases of barely detectable periods, when you get your period, that means you had at least 1 ovulation and could have became pregnant.

          • Heidi_storage

            Well, not always; my first period postpartum is anovulatory, and my first few cycles have really short luteal phases such that it would be most unlikely that a fertilized egg could implant. But we still take precautions, because we would quite like for me not to get pregnant right now.

  • Heidi_storage

    OT: This article seems kind of irresponsible to me. The author doesn’t prove his case, and stopping antibiotics when you “feel” better seems kind of dangerous, given the subjectivity of feelings:

    http://www.slate.com/articles/health_and_science/medical_examiner/2017/08/stop_taking_antibiotics_once_you_feel_better.html?wpisrc=burger_bar

    Opinions?

    • Chant de la Mer

      Doesn’t look like the author really knows what he’s talking about just from his comments about courses lasting 7 or 14 days since antibiotics are prescribed in widely varying dosages and lengths that do include 3, 4,5 and 10 day courses. Plus he doesn’t mention anything about how bacteria can be reduced below the symptomatic line but still be present in infectious amounts, kind of the reason we are supposed to take antibiotics for a specific amount of time.

      • Kerlyssa

        yeah, the week thing was bizarre. of course our time units affect how dosing is done(see: hormonal bc, etc), but not to the weird extreme he jumped to- if anything, antibiotics are largely exempt from this because you are prescribed a limited course of medication, not an ongoing amount.

      • Casual Verbosity

        At the very least I imagine this approach would result in many extra visits to the doctor, as you’d have to get another prescription when (if) the infection flares up again. In this way you could potentially end up taking more antibiotics cumulatively than if you had just taken the whole dose to begin with.

      • Sue

        This is from the actual BMJ paper:
        “From fear of undertreatment to harm from overtreatment

        Traditionally, antibiotics are prescribed for recommended durations or courses. Fundamental to the concept of an antibiotic course is the notion that shorter treatment will be inferior. There is, however, little evidence that currently recommended durations are minimums, below which patients will be at increased risk of treatment failure.

        Historically, antibiotic courses were set by precedent, driven by fear of undertreatment, with less concern about overuse. For many indications, recommended durations have decreased as evidence of similar clinical outcomes with shorter courses has been generated (table 1⇓). However, the picture is patchy and complicated by comparisons of new and established agents that may have different pharmacological properties (eg, long acting macrolides versus short acting penicillins).”

        • Chant de la Mer

          The length of time to take them could possibly be adjusted but what I meant was that if we stopped medication once we became asymptomatic, it still might not be enough to have actually fully treated the infection. It might very well be better to shorten treatment time, but it’s complicated as the actual source papers states.

    • Kerlyssa

      people like author are why we can’t have nice things

    • Empress of the Iguana People

      Isn’t this part of how we create superbugs?

      • Valerie

        Later in the article it says that it’s a myth that antibiotic resistance comes from stopping a drug after symptoms are gone, extrapolated from some 1945 paper. Perhaps somebody here wants to dig in the literature to see if it’s an evidence-based recommendation or if it’s just “common sense.”

    • Cody
    • Sue

      It’s worth reading the original article in the BMJ of 26th July:
      Complete the antibiotic course to avoid resistance”; non-evidence-based dogma which has run its course?

      I just took a quick look, and it makes a lot of sense.

      First, it seems that the mechanisms for resistance might be different to what we once thought – they are described in the text.

      Then they describe how they are transmitted:

      “When a patient takes antibiotics for any reason, antibiotic sensitive species and strains present among commensal flora on their skin or gut or in the environment are replaced by resistant species and strains ready to cause infection in the future. This collateral selection (box 1) is the predominant driver of the important forms of antibiotic resistance affecting patients today. The longer the antibiotic exposure these opportunist bacteria are subjected to, the greater the pressure to select for antibiotic resistance.

      Importantly for these opportunistic pathogens, resistant strains are transmitted between asymptomatic carriers rather than people with disease. Furthermore, many resistance conferring genes can pass easily between bacterial strains or species. Thus antibiotic selection may drive outbreaks of resistant infections independently of transmission of a specific strain or species.”

      I was at an evidence review course in April where this was discussed.

      It seems that the old dogma might be wrong. We need infectious diseases specialists to advise about practice change.

      • Heidi_storage

        Thanks. I’m perfectly willing to say that practice may need to change, but this seems to be a more-research-is-needed type of thing than “Oh, just stop when you feel better!” thing. I mean, the author does say to consult your doctor, but a) how does your doctor know whether it’s safe to stop or not without updated guidelines; b) it’s hard to get hold of your doctor for advice sometimes, so I think in practice this will work out to still-sick people stopping their antibiotics too early.

  • Heidi_storage

    My little man helped his daddy pull the trash can to the side of the road while wearing no clothes. (My 2-year-old, not his daddy.) Mind you, our neighborhood has lots of small children who run around in the nude, so I doubt anyone was fainting at the indecency.

    Of course, my favorite incident is when my then-2-year-old daughter whipped off her bathing suit in front of visitors, squatted on the driveway, and peed all over it with a big ol’ grin on her face.

    • Heidi

      My 19 month old just discovered the ability to pee. He took his diaper off the other day and decided to pee in different places on the floor, thankfully he chose no carpeted areas. Then he stood at our storm door, which is completely glass, naked to people watch.

    • BeatriceC

      Random, off topic joke; my favorite almost clean joke. Your clarification on who was naked reminded me of it.

      One morning a couple was in their kitchen eating breakfast. The husband was reading the morning news and saw the weather report. He said to his wife, “wow, honey, it’s going to be really hot today, what do you think the neighbors would think if I mowed the lawn naked?” His wife looked at him, gave him a serious look and said, “you know, I think they’d think I married you for your money.”

  • anh

    I was hoping someone could help me understand part of the pro-breast narrative. People constantly trot out the lancet article about how EBF could save 800,000 lives a year. I understand this a projection. My question is, is the model based on the theory that since breast feeding might reduce the occurrence of certain infections then if more people breastfed 800,000 less babies would contract deadly infections? I know what I’ve written doesn’t make much sense. can someone explain it to this French literature major? 🙂

    • jumpygiraffe

      Also, I am pretty sure the study was done before the introduction of the rota vaccine. So surely that would make a difference as well.

      • Heidi_storage

        My pediatrician’s nurse remarked she’s seen less diarrhea since they added that vaccine–and this is in a wealthy county in the US.

        • jumpygiraffe

          The UK saw a drop of hospital admissions by over 80% in the first two years.

          • The Bofa on the Sofa

            Clearly a case of improved sanitation…

        • Merrie

          I was hospitalized with severe diarrhea as a toddler. I don’t remember it, but I’m sure it was terrifying for my parents. I’m glad rotovirus vaccine is available now. I’m still ticked off that the doctor we saw when our firstborn was a baby didn’t stock it and instead of just saying so, jerked us around with all sorts of “oh, we’ll order it, oh, we weren’t able to get it, we’ll try again, etc. etc.” and she aged out of it. If they’d just TOLD us they didn’t stock it and didn’t plan to do so, we could have taken her to the health department. Grrr. Fortunately, we’ve never had any problems. We now see a pediatrician. Our older son was able to get the vaccine and the baby will too when he’s old enough.

          • CSN0116

            Somebody needs to procure a fucking norovirus vaccine. That bug screws me almost every year. Five simultaneously puking kids will make one homicidal, suicidal, etc. Ugh. I would inject the shit out of that into everyone in my household.

          • Mishimoo

            A universal flu vaccine would be amazing too. My household is finishing the second round for this winter and it’s been hellish.

      • Sue

        Emergency Departments see many less miserable, dehydrated kids since the rotavirus vaccine was introduced. Yay for vaccination!

        (But now we see the elderly with norovirus instead 🙁 )

        • Empress of the Iguana People

          i think my husband and i may’ve caught it when our 1st was 13/14 months old (so too long after his vaccinations for us to’ve gotten it that way) Boybard was perfectly healthy. Dem caught it first and then I probably caught it from cleaning up after him. Boybard was so sweet, crawling over to me and bringing me his toys so I’d feel better.

    • Sue

      The theory they use is that, if exclusive BF for six months reduces the rate of certain types of infections by (x) amount, and a certain percentage of children with those infections die, then BFing everyone exclusively for 6mths could potentially prevent those deaths.

      The catch: we don’t know how many of the deaths from those infectious diseases occur in BF vs FF babies. To take the point to the extreme, it’s possible that, although slightly more babies who are formula fed might get certain infections, all the deaths could be in BF infants.

    • Heidi

      I could be totally wrong, but I think they use babies that die in places where water is contaminated and conditions are less than ideal and apply it to the whole world. But the thing is where breastfeeding rates are high babies still die in higher rates. My guess mothers in developing countries aren’t not breastfeeding for convenience but necessity. It reminds me a bit of my teacher in 2nd grade telling me children in Africa would love to have my lunch that I wouldn’t eat. Regardless if I ate my lunch or not, it was not going to prevent a starvation in Africa.

      • Empress of the Iguana People

        Mom tried that one just once on us.

        • Heidi

          I told my second grade teacher to send it to the starving children then. She never brought it up again. Thing is, if I’d had a choice to have nothing at lunch, I would have gladly taken that option over most of the cafeteria offerings. My parents did not allow me to pack my lunch.

          • Heidi_storage

            I vividly remember a day involving some truly terrible tater-tots, a substitute teacher, and everyone standing around in a circle as I became violently sick over at least 1/4 of the class. TATER-TOTS, folks.

          • Heidi

            Our school lunches always managed to gross me out to the point of gagging. The hamburgers always had bone or gristle, the chicken noodle soup would have inedible chunks of chicken that involved cartilage, the fish sticks were smelly, soggy, and involved more scales than actual meat, and even the chicken patties and nuggets, I would be the one to manage to have a chunk of bone in mine. I can’t stand to be get bone or eggshell in my food. The unexpected change in texture ruins the meal for me. Our college salad bar had a chunk of ice in the boiled egg and once I bit into it, it made me think of eggshell and I had to throw it out.

          • Heidi_storage

            Ughh, I remember some tendons messing up a taco for me…

    • Young CC Prof

      That number includes not only infections, but also deaths from other causes on the assumption that breastfeeding reduces things like SIDS and allergies. It also includes some deaths from breast cancer. Problem is, the evidence that breastfeeding produces those benefits is pretty shaky in some cases.

      The other problem is that the Lancet article posited “near-universal” exclusive breastfeeding for 6 months, and, as this very post points out, no country or region on Earth has ever achieved anything like that, because it’s impossible.

  • Sarah

    I’d have so much more respect for the WHO if they were a bit more honest. If they were to say, this is a problem for the developing world and we have reason to believe there are women in x country/countries who are having to leave their babies to work, so the babies are being given unsafe substitutes, and we think this is having y impact on infant mortality. Or similar. Instead of bullshitting.

    • Heidi_storage

      The WHO seems to have this weird thing about not acknowledging the differences between developing and developed countries. The optimal cesarean rate is THE SAME for everyone, regardless of country! EBF should be continued for AT LEAST 6 MONTHS, regardless of country!

      • EmbraceYourInnerCrone

        Not to mention the people who came up with the “optimal” C-section rate just made the number up out of thin air. Squish statistics or suggestions from inadequate or poorly controlled studies are bad enough. Making up your own numbers from NOTHING is really bad science. The WHO later retracted the “suggested” rate but of course the retraction doesn’t get the press that the suggested rate got…AT this point why would I believe anything the WHO recommends? :

        From the WHO 2009 booklet- Monitoring Emergency Obstetric Care:

        “Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …”

      • Sarah

        I vaguely get that they don’t want to make formula feeding seem too western and potentially aspirational, albeit I’m unwilling to give them the benefit of the doubt and assume that’s all it is. But there are ways to do that without pretending the same blanket standards must apply to the rest of the world.

    • EmbraceYourInnerCrone

      They are also making up their numbers based on things like –

      “Breastfeeding will prevent SOOO many deaths or illnesses from childhood leukemia, asthma, allergies, SIDS, breast cancer and the truth is those supposed “protective” affects of exclusive breastfeeding are pretty poorly researched. There have been studies that showed the exclusively breast fed babies actually were MORE likely to have allergies and asthma…and the study about childhood leukemia was a phone survey of just 169 mothers

      https://www.ncbi.nlm.nih.gov/pubmed/18449131

      “Additional factors found to be associated with an elevated risk of lymphoid malignancy were low age and low education of mother.”

      Maybe the fact that wealthier, college educated mothers (who just happen to be able to exclusively breastfeed for longer) ALSO can afford less contaminated homes, less exposure to other kids germs, less lead in paint and drinking water, less air pollution.

      • jumpygiraffe

        Also, don’t have jobs that expose them to chemicals.

      • swbarnes2

        Matching for age and sex is not good enough. If the control group is whiter and better educated than the disease group, duh, they will breastfeed more. The study even saw the association with education, but did they check to see that their controls were matched for education?

        • AnnaPDE

          I don’t know if the study saw that association, but the UNICEF ad actually claimed that “breastfeeding makes your kid more educated” and “makes them more prosperous” claim. If that’s not a classic case of turning correlation and causation on its head, I don’t know what is.

      • Sarah

        Indeed they are. Bullshitting.

    • AnnaPDE

      You mean, actual nuanced advice that takes into account different circumstances and trusts people to understand the underlying idea? No way. The “people are too dumb to understand anything but the bluntest of one-size-fits-all absolutes” type of medical paternalism has found a happy home in the WHO.

  • Sue

    “Stretch targets”

  • Kerlyssa

    holy shit, this is an option? just like, turn a hose on ’em? 😮 mind=blown

    • CSN0116

      Yes. I have literally hosed away her accident piddles off the driveway, as well as hosed down her outside baby potty when she makes it. LOL

  • CSN0116

    OT: I’m potty training my fifth and last. Almost diaper free forever! Holy shit, such tedious and demanding work though.

    I am tired.

    That’s all.

  • Chi

    Yup and already lactivists here in NZ are jumping on this bandwagon, crying that we need more maternity leave to give babies the ‘best start’.

    https://www.stuff.co.nz/national/health/95128608/unicef-calls-for-new-zealand-to-extend-paid-parental-leave?cid=facebook.post.95128608

    Ugh.

  • namaste863

    Honestly, these people might as well just cut the bullshit and start greeting everyone with “Blessed be the fruit.”

    • KQ Not Signed In

      PRAISE BE, BITCH.

      Favorite line from the whole season. But yeah, a bit on the nose, that.

  • Young CC Prof

    No one meets the standard? Maybe that’s because the standard is nonsense based on denying basic biology.

    Most women can breastfeed, but huge numbers canNOT meet 100% of a baby’s nutritional requirements from the day of birth until 6 months. Some need a few days for milk to come in, and some babies outgrow the milk supply or run out of stored iron, and they benefit from solids at 4 or 5 months.

    I had no milk or colostrum for the first 48 hours of my daughter’s life, and then spent the third day so sick I could not even hold her, much less try to nurse. What the heck should we have done?

    • Casual Verbosity

      It’s interesting that they place the standard at 100% when one of the lines they use is “Every drop counts”. If it’s so special that every drop counts, then why can’t the mystical properties of breast milk overcome a little bit of formula or some solid foods?

      • Roadstergal

        I’ve asked that, too, and the answer I got here is that this has changed into ‘every drop counts’ of formula – that is, even a drop will ruin your baby.

        It’s such toxic bullshit.

        • Heidi_storage

          It’s poor strategy, too. A hypothetical mother giving her starving newborn formula can hear, roughly, one of two things: “Supplementing with formula is fine!” or “OMG formula; that’s it for your baby.” Now, which is likelier to encourage the woman to keep on trying to breastfeed? I mean, if she’s already contaminated the baby with formula, might as well keep on doing it, since she’s hopelessly screwed up anyway.

          • Roadstergal

            It’s a poor strategy if the goal is to get more women to breastfeed – just as withholding birth control is a poor strategy if the goal is to reduce the rate of abortions. But I think the goal of the former, when it comes to lactivists, is just as disingenuous as the goal of the latter, when it comes to the US fundies. It’s all about controlling women’s bodies and creating divisions that they can be on the ‘I’m better than them’ side of.

            And just like how you’ll get women on the latter side who can hold the cognitive dissonance of ‘my abortion was different,’ you can get women on the former side convinced that ‘my supplementation was different.’

            It’s not about outcomes… :p 🙁

          • Casual Verbosity

            It’s easy to win a debate when you keep moving the goal posts.

            You’re absolutely right. If it really were about getting more women to breastfeed for longer, the rhetoric would sound a lot different. Instead its about moralising.

          • Young CC Prof

            If it were about getting more women to breastfeed longer, we’d take most of the money spent on breastfeeding “promotion” and researching the benefits and instead spend it on researching low supply and other medical and physical barriers to breastfeeding.

          • Casual Verbosity

            But-but any problems can be overcome with enough support!!!!!!!!!!!!! /s

          • BeatriceC

            And don’t forget about subsequent babies. If I had not succeeded in breastfeeding my first, I would never have tried with the other two. And I only succeeded with my first because my mother insisted on the judicious use of supplemental formula/expressed breastmilk while the baby and I figured out how to actually breastfeed. If I’d been subjected to the line of thought that just one drop of formula ruined everything, I would never have kept going learning how to breastfeed and I wouldn’t have even tried with the other two. Well, perhaps I would have pumped while they were in the NICU, but I wouldn’t have kept going once they were a bit stronger.

  • Because process is easy to measure and making assumptions is also easy, meanwhile, fixing the real problems (extreme poverty, lack of environmental and safety standards, poor nutrition, lack of clean water, etc.) are hard.

  • Mel

    Dark irony:
    I wouldn’t have made it to EBF at 6 months with my son in any of the winner countries because Spawn would have died within hours after birth from extreme prematurity.

    I didn’t EBF Spawn to 6 months in the US for a host of reasons – but my son is 5 months adjusted age, chubby, cute, loving and growing well thanks to a massive medical interventions.

    The WHO had better look at their list of medical priorities if they are actually interested in doing long-term changes in developing nations.

    • Montserrat Blanco

      I love to hear that Spawn is doing great. At almost three years my son is doing great too. medical intervention and (in my case) formula feeding save lives. Poverty, lack of medical attention and lack of formula kill babies. I think the WHO should change the priorities and assign the budget accordingly to real needs.

  • MaineJen

    Good god. If 0% of the countries you’re studying are meeting your standard…then maybe, just maybe, your standard is impossibly high.

    Do they look at the infant mortality statistics in question? Or do they just not care?

  • Emilie Bishop

    There is no exclusively (or nearly) male bodily function that is talked about in this way, as if the weight of the whole world rests on the secretion of some fluid. No one screams shame and bullying at them. No one pushes them to the point of mental breakdown or puts them at risk of harming their children in the name of fluid secretion. Yet this is exactly how we treat women when they’re at their most vulnerable. So freaking sick of it.

    • LaMont

      YO. MEN. If you don’t properly make semen WE WILL ALL DIE OUT. NO PRESSURE.

      • The Bofa on the Sofa

        Isn’t that a thing suddenly? Sperm counts are dropping?

        I thought I heard something about it the other day.

        • Emilie Bishop

          Yes, I did too. But I would bet individual men with low sperm counts will be treated, not shamed, for the most part. Women who can’t breastfeed, on the other hand…

          • LaMont

            Well of course men need more sympathy, it’s all the damn feminism causing low sperm counts in the first place! Evil women on the pill are feminizing teh menz

          • The Bofa on the Sofa

            I’m sure you’re right

          • The Bofa on the Sofa

            Then again, the alternative solution to low sperm count would be to have sex more. What guy would have a problem with that?

          • Montserrat Blanco

            Lots of them!. Men that do not fancy women, catholic priests and monks, and frankly, every game of thrones fan that prefers watching some dragons instead of making out, just to give some examples…

            I know you were joking but I just could not resist answering.

        • Sarah

          Best get pumping then.

        • Kelly

          Only in certain areas. From the latest article I read, overall, the sperm count is fine but certain countries and areas have men with lower than normal sperm counts.

        • Sue

          Isn’t it all those ebil hormone-disrupting chemical-thingies in plastics and chicken, or microwaving plastic chickens…or something?

  • The Bofa on the Sofa

    I’m confused. The US infant mortality rate is really .6%? 1/150 infants die before age 1? Is that correct?

    • Emilie Bishop

      I would believe that. It’s not just from medical issues, but from car crashes, violence, drowning, suffocation, etc., plus medical issues. Babies can’t defend themselves or make decisions about their own care. If we tried to lower the preventable deaths instead of harping on breastfeeding, I wonder if we could compete with the UK.

      • kfunk937

        According to the CDC, the primary driver is preterm birth (36 percent of deaths in the first year). Of additional factors listed, most are preterm risk factors or preterm delivery is itself a risk factor, such as complications of pregnancy, low birth weight, and SUID/SIDS. I believe that their website also used to explicitly address maternal health status and access to healthcare, but that seems to be missing or less emphasised at present.

        In any case, comparing IMR between countries is…complicated. For example, if US rates were adjusted for definition of still-birth, US rates would approach those of European countries. If controlled for preterm birthrate (or say employing strategies to reduce prematurity), US IMR would be closer to Sweden’s, and if both were done would be like Sweden’s, among the lowest in Europe. https://uploads.disquscdn.com/images/999534a86cdd61e5699897f8f0b64eefb1ff3c0a9a38fde9570c839b7fa95860.jpg

        • The Bofa on the Sofa

          And the difference in pre-term birth is predominantly the difference in black population, yes? That is such an issue that would be great to solve.

          • kfunk937

            The disparities are horrific, I agree.

          • Kelly

            Is it just the African-American population that has a higher rate of pre-term birth or Africans/ those of African decent in general?

          • Young CC Prof

            That is the really important question.

            What’s clear is that the elevated risk of prematurity persists after controlling for the obvious socioeconomic variables, access to care, age, marital status, etc.

            We do NOT see an elevated risk of preterm birth among new African immigrants, only among American-born Black women, which suggests an environmental component. However, American Blacks are predominantly descended from (kidnapped) West Africans, while new immigrants are more likely to come from East Africa, which is a very different population genetically.

            West Africans do appear to have a higher risk of preterm birth than other populations, but that probably isn’t the whole story, either.

          • fiftyfifty1

            “new immigrants are more likely to come from East Africa, which is a very different population genetically.”

            Yes. I live in a city with a very large East African immigrant community. I don’t believe a formal study has ever been published, but this group is said to be prone to going overdue, not prematurity. Once again I don’t have hard numbers, but I feel like I induced a LOT of Somali immigrant women for post-dates during my time in residency. So perhaps something genetic. This group also has very low rates of STIs and other vaginal infections like bacterial vaginosis. Infections being another big risk factor for pre-term labor of course.

          • Kelly

            Thanks for information. I wasn’t sure where to look for that kind of information and I am glad to be in a community where people can answer these kinds of questions.

          • Gatita

            Founder effect probably plays a role as well.

      • FallsAngel

        I honestly don’t think we should be “competing” with anyone, but trying to lower our own rates.

        • Sarah

          Absolutely. That goes for all of us. Even the country at the very top of the table should still be trying to lower their rates.

      • EmbraceYourInnerCrone

        Different countries also count differently. For instance in some countries they don’t count babies under a certain number of weeks gestation nor under a certain birth weight in their statistics.

        http://www.nationalreview.com/article/276952/infant-mortality-deceptive-statistic-scott-w-atlas

        “A 2006 report from WHO stated that “among developed countries, mortality rates may reflect differences in the definitions used for reporting births, such as cut-offs for registering live births and birth weight.” The Bulletin of WHO noted that “it has also been common practice in several countries (e.g. Belgium, France, Spain) to register as live births only those infants who survived for a specified period beyond birth”; those who did not survive were “completely ignored for registration purposes.” “

        • Montserrat Blanco

          In Spain you can not register a baby before 24 hours alive. If the baby dies before those 24 hours (gestational age does not matter), you are considered to have had a miscarriage (even with a term baby). we changed the way we counted neonatal deaths some years ago for statistics purposes and now it does include late fetal deaths (babies born death after 24 weeks and babies dead on those first 24 hours) , but for legal purposes it is still like that. Infant mortality in Spain for 2016 is 2.64/1000. The public healthcare system, where every pregnant woman gets free healthcare since the beginning of the pregnancy and the fact that we are a developed country, with easy and cheap access to food, social housing programs, free vaccines, clean water, etc, etc probably explains that low number. Our neonatal death rate (fetal deaths up to 28 days of life) is 1.8 per 1000 live births. The biggest mortality cause in babies are prematurity and neonatal birth defects, as happens in other developed countries.

    • Kerlyssa

      the US has one of the more inclusive infant mortality metrics, as well

    • Young CC Prof

      That is correct. I’ve been elbows-deep in those numbers!

      About half of those deaths occur among the 2% of babies born before 32 weeks (at least 2 months early). Week-by-week, the USA does an extraordinarily good job of keeping preemies alive, but we have too many of them.

      • Dr Kitty

        Compared to other industrialised nations the USA has huge health and economic inequalities, a bigger issue with drugs (prescription and illicit) and has much higher incidence of severe child abuse and neglect than, for example, Scandinavian countries. It’s not a reporting or statistical issue- kids in the USA are genuinely more likely to be killed by a care giver than in most developed nation.

        Some of those infant mortality statistics will be children directly killed by their parents, or who die from neglect of medical conditions that would have been caught and treated earlier in most industrialised countries.

        http://www.bbc.co.uk/news/world-us-canada-15288865

  • CSN0116

    And if nobody can meet your “standards,” your standards might, in fact, blow. And have no relevance in the real world.

  • CSN0116

    WHY ARE THEY STILL PROMOTING EBF FOR 6 MONTHS?

    We know that fucks kids in more than one way, namely allergies. How is it ethical to promote? And what babies can live on pure liquid for 6 months and be happy and satisfied? I’ve had 5 and none of them could. What’s with the arbitrary 6 month line in the sand?! Every kid is just _magically_ ready the moment it hits 6 months, not a moment sooner or later?

  • CSN0116

    WHY ARE THEY STILL PROMOTING EBF FOR 6 MONTHS?

    We know that fucks kids in more than one way, namely allergies. How is it ethical to promote? And what babies can live on pure liquid for 6 months and be happy and satisfied? I’ve had 5 and none of them could. What’s with the arbitrary 6 month line in the sand?! Every kid is just _magically_ ready the moment it hits 6 months, not a moment sooner or later?

    • AnnaPDE

      Mine would have loved to continue a liquid diet for aaaages. If ice cream counts as a liquid, that is. But seriously, he did spectacular choking scenes on the smallest and softest lumps, or really just slightly denser bits of puree, until about 7 or 8 months old. Rice was his sworn enemy until 11 months, with a single unexpected grain triggering projectile vomiting.
      That said, he wouldn’t count as EBF anyway as we combo fed. 😉

      • CSN0116

        Haha that sounds dramatic! Mine were all spoon feeding nicely well before 6 months and really needed it. Loved it. Once they got up over 30-32 oz of formula per day and stopped seeming satisfied, enough was enough. Babies vary, go figure – WHO.

      • EmbraceYourInnerCrone

        I think some kids just have an very overactive gag reflex. I was that way until I was 3 or 4 years old and still am a little bit. Weirdly I also was the one with the broken thermometer… nothing like having your baby spike a 103 fever out of the blue for no apparent reason! My mom called me the high maintenance child!

    • The Bofa on the Sofa

      WHY ARE THEY STILL PROMOTING EBF FOR 6 MONTHS?

      No doubt. Even assuming the goal of breastfeeding, shouldn’t the metric be any breastfeeding at 6 months?

      Of course areas with low resources are going to have high rates of EBF for longer times, because they don’t have any other options. They don’t do it because it’s good, they do it because they don’t have a choice.

      I won’t say that the US would measure up if you used still breastfeeding at 6 mos, but it is a lot more honest than EBF, which is baseless.

    • Mel

      My little guy is not that into solid foods yet. I take that back; he loves to push the food onto his lips then blow a raspberry and feel how the texture changes.

      Simple pleasures.

      I’m mainly grateful he’s never shown any signs of oral aversion which was the NICU small baby boogeyman de jure.

      He does swallow occasionally. I figure it’ll click one of these days 🙂

    • Empress of the Iguana People

      Mine were certainly ready right at 4 months past their respective due dates. Your results may vary.

    • Sarah

      Mine. I’ve yet to have a child who gave a fuck about solids even at 6 months, let alone before.

      • Dr Kitty

        My daughter was not enthused with solids at 5.5 months.
        My son slept through the night and was an altogether happier bunny after some baby rice at 4.5 months.

        She’s still the little scrawny bird who picks at things,he’s the chunky monkey drinking 500mls of milk, two cups of juice and eating three full meals a day at not quite two.

        Kids are different.

        • Sarah

          They are. Mine were sleeping through, but eating? No thanks. Not on their list.

    • Della

      Yeah I’m so confused by this high standard. EBF at 6 months would be very detrimental to my little guys health. He needed more iron than what breast milk could provide and also more calories because -gasp – my milk isn’t perfect and wasn’t giving him enough nutrition, even though I had great supply when pumping! Started cereals as soon as he would take it at 4.5 months.y

    • Caylynn Donne

      Well, I’m a dietitian, and an evidence-based one. I don’t suggest that there is an arbitrary 6 month line, but that most babies will be ready for solids somewhere around 6 months, give or take a few weeks to either side. I tell parents about the signs of readiness that a baby is ready to start solids: they can sit up in a high chair, hold their head up straight, show interest in the foods the family is eating, open their mouths wide when you present them with a spoon, can close their lips over the spoon, and can turn their heads away if they don’t want food (among others). For some babies, they will show those signs closer to 5 months, for some, closer to 7, but 6 is the average. Introducing solids too early or too late both have risks that we generally try to avoid.

      • fiftyfifty1

        But what’s the evidence that these supposed readiness signs are so important? The signs can differ from kid to kid. My second couldn’t sit up in a high chair, but did fine with the food sitting in my lap. My first was never a kid who showed interest in what the family was eating, if we had waited for that we would have waited way too long. Other kids show interest as soon as 4 months. And in my generation, babies got started on solids as soon as 1 month (my mother-in-law has the baby books with pediatrician instructions to prove it.) A number of my immigrant patients still start their babies at 1-2 months. Some of my colleagues spend a lot of time “educating” them out of this practice, but I prioritize other things.

        • Mishimoo

          To be honest, if I could have done that, it would have made life with my youngest MUCH easier since he was always hungry and wouldn’t take a bottle. He started on solids at 4 months and I finally got to sleep through the night instead of feeding him every two hours.

        • Young CC Prof

          Very early introduction of solids goes way back, historically, and probably one reason for that is that the labor of a woman of childbearing age was too valuable to lose for long. If you introduce porridge, then some feedings can be done by an elderly grandmother or nine-year-old sibling while the mother is back out in the fields as soon as she’s done with the “lying-in.”

          • The Bofa on the Sofa

            I’ve told the story before, when our first was having his first side, I was talking to my (then) 94 yo aunt, who talked about how they fed mashed potatoes at 1 week.

      • Sue

        There seems to be evidence that our avoidance of early solids, and particularly nuts and seeds (due to concern about inhalation) has led the increase in nut allergies in kids. Sometimes the treatment is worse than the disease.

    • Cat

      I was bemused by the advice I was given by the nurses at my local children’s centre, which was basically “no solids until she’s exactly 6 months on the dot, not a day less, and then start her with carrot sticks and toast”.

  • namaste863

    I’m curious about something; how did the WHO gather the data? Was it based on government report? If so, half of the countries (North Korea, for example) are probably full of shit anyway.

    • mimbletonia

      I dunno, if your options are EBF or dubious Chinese formula…

    • Sue

      Maybe like “optimal” cesarean rates…someone made up a number.

  • Alax

    But aren’t there a # of complicating factors in the countries you listed that increase infant mortality, like famine, lack of access to vaccines and clean water, violence etc, that would need to be controlled for in a statistical analysis attempting to prove or disprove correlation between infant survival and breastfeeding? Wouldn’t the lack of these complicating factors in industrialized countries need to be controlled for as well? The basis of your argument does not take these factors into account, you’re comparing apples to oranges.

    • yentavegan

      I was thinking the same thing. The countries with high infant mortality struggle with disease, war and the devaluation of women.

      • Amy Tuteur, MD

        Of course. Other factor drive infant health, NOT breastfeeding so it is inexcusably misleading to claim that promoting breastfeeding would improve infant mortality or save money.

      • luna

        Yet the countries that don’t and have much lower breastfeeding rates also have much lower infant mortality rates. So that flat out shows breastfeeding means jack when it comes to infant mortality.

    • Amy Tuteur, MD

      How do the UNICEF and WHO claims take these factors into account? They don’t and that’s why their claims that breastfeeding decreases mortality and saves money are nonsense.

    • AnnaPDE

      That’s exactly the point.
      Infant mortality isn’t governed by breastfeeding rates but by all those other factors you correctly identify. Indeed access to proper healthcare and generally infrastructure is what matters. Not quite coincidentally, the same factors enable mums to feed their child something else than breastmilk in non-exceptional situations.
      And once those circumstances are sorted out, as in industrialised countries, you can see that infant mortality is extremely low anyway and mostly due to causes other than what can be influenced by breastfeeding – congenital stuff, birth complications, accidents etc. In contrast, the extreme promotion of exclusive breastfeeding also harms babies who end up being starved instead of getting supplementation (see Landon Johnson’s story).
      Basically the WHO argument is akin to claiming that wearing a ski jacket is correlated to knee injuries, so everyone should be wearing tweed coats instead, including for sports.

    • CSN0116

      Except the argument isn’t that high rates of breastfeeding cause high rates of infant mortality. It’s that they don’t cause it to be lower. They do nothing. Nothing at all. Which calls attention to spuriousness.

      The only factor that needs controlled for is countries’ financial performance. Then the scatter plots sort themselves out quite nicely.

    • indigosky

      This data proves that exactly: areas with good healthcare, no war, and the majority of the population fed and have low infant mortality but low rates of breastfeeding means that breastfeeding does absolutely nothing for infant health.

      The WHO claims that breastfeeding reduces infant mortality when it is shown that it does not. It is access to food, water, healthcare and safe places to live that decrease infant mortality.

    • fiftyfifty1

      Many of my patients are immigrants who come from countries that lack clean water and reliable supplies of formula (reliable supplies of most things actually.) When these patients have babies, almost all of them attempt to breastfeed. They often combo feed, but most feeds are breast because they know that if they have to travel back home in an emergency, that having to buy formula when there isn’t any and find clean water to mix it when there isn’t any can be deadly. This is an fact and nobody disputes it, including Dr. Tuteur.

      But the WHO takes this obvious fact and perverts it. First off, they pretend it applies to developed countries with clean water and reliable commercial formula, when it doesn’t at all. Even worse, they twist it and apply it to impoverished developing countries. As if breastmilk were so inherently healthful that it magically turns dirty, dangerous, deadly living conditions healthy and happy. As if the problem of infant mortality was a problem of dumb women “not doing it right” rather than about things like sexism and dictators and famine and WAR.