The conventional wisdom about breastfeeding is DEAD wrong!

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The reaction to the Trump administration’s decision to oppose the World Health Organization’s formula advertising restrictions has highlighted how conventional wisdom shapes thinking on a topic. The conventional wisdom about breastfeeding is that it is lifesaving, but the conventional wisdom is dead wrong.

Here is one of the best descriptions of conventional wisdom I’ve seen.

In most cases, CW is a lumbering beast: slow to move, but difficult to alter course once its big bullish head is set on moving in a certain direction… It’s loud, pervasive, and impossible to ignore – and avoid. Oftentimes, entire careers are staked on maintaining its veracity. When that veracity is challenged, either by critics or by experiment, the challenger is often silenced… [A] conforming chorus of assent can be mobilized to drown out even the most rigorously defended thesis, just as long as Conventional Wisdom is at stake.

For decades the conventional wisdom on stomach ulcers was wrong.

If breastfeeding saves lives why can’t the WHO find any term babies whose lives have been saved?

When I started medical school, the conventional wisdom was that stomach ulcers were caused by excess acid. The conventional wisdom was loud, pervasive and impossible to ignore. Whole careers in gastroenterology had been staked on maintaining its veracity. When that veracity was challenged, the challengers were silenced.

At about the time I graduated from medical school researchers Robin Warren and Barry Marshall discovered H. pylori, the bacteria that actually causes ulcers.

The backlash was brutal. Dr. Larry Altman, medical correspondent for The New York Times, who reported these results, later wrote, “I have never seen the medical community more defensive or critical of a story.” I spoke with Dr. Altman about these events, and to this day, he recalls that “this was the review that got me the most heat for misleading the public” …

Warren and Marshall eventually broke through the conventional wisdom, and ultimately won the Nobel Prize in Medicine. But someone else had actually made the exact same discovery more than 40 years before they did.

As a young researcher at the Harvard-affiliated Beth Israel Hospital in Boston in 1940, Dr. [A. Stone] Freedberg became curious about stomach ulcers while studying the effects of fever on the heart and circulatory system when infections caused it to collapse. Scientific reports taught him that many such patients developed tiny bleeding ulcers in the stomach and small bowel…

He published his findings but was ignored. His superiors were convinced that he had made a mistake and counseled him to give up his claim and move on.

The conventional wisdom that ulcers were caused by acid was so strong that it suppressed the true cause for decades and people with ulcers, denied effective treatment, died as a result.

Today the conventional wisdom is that breastfeeding saves lives, that breastmilk is the “perfect” food and that women must be pressured into breastfeeding for the good of their infants. Whole careers (including careers at the World Health Organization) have been staked on maintaining the veracity of these claims. When that veracity is challenged, arbiters of the conventional wisdom attempt to silence the challengers.

The conventional wisdom on breastfeeding is DEAD wrong.

The evidence has been around for centuries. There once was a time when all babies were breastfed and 20-30% or more died in infancy. Indigenous cultures on nearly every continent practice pre-lacteal supplementation, giving babies teas, water or honey, in recognition that breastfeeding is often not enough to fully nourish a baby. Formula was invented in 1860’s specifically because some mothers could not produce enough breastmilk or because they died in childbirth. Indeed, as far as I can determine, there was NEVER a time or place where exclusive, extended breastfeeding was practiced in the way the World Health Organization now recommends.

The WHO insists that breastfeeding is lifesaving, quoting a variety of mathematical models that predict that when more women breastfeed fewer babies die. Yet the WHO can’t manage to find any term babies whose lives have been saved or any countries where increasing the breastfeeding rate has resulted in a decrease in infant mortality.

Nonetheless, everyone “knows” that breastfeeding saves lives.

The countries in the world with the lowest breastfeeding rates have the BEST infant mortality rates and the countries with the highest breastfeeding rates (approaching 100%) have some of the WORST infant mortality rates.

Nonetheless, everyone “knows” that breastfeeding saves lives.

In June 2017, NPR published Secrets Of Breast-Feeding From Global Moms In The Know:

It’s almost like in the U.S. we’ve lost the breast-feeding instinct. That Western society has somehow messed it up. [Evolutionary biologist Brooke] Scelza wanted to figure out why: What are we doing wrong?

So a few years ago, she traveled to a place with some of the best breast-feeders in the world.

In the desert of northern Namibia, there’s an ethnic group that lives largely isolated from modern cities. They’re called Himba, and they live in mud huts and survive off the land…

Moms still give birth in the home. And all moms breast-feed.

“I have yet to encounter a woman who could not breastfeed at all,” Scelza says. “There are women who have supply issues, who wind up supplementing with goat’s milk, which is not uncommon. But there’s basically no use of formula or bottles or anything like that.”

NPR neglected to mention that the infant mortality rate among the Himba is astronomical. According to USAID, the infant mortality rate in Namibia is 32.8/1000 (compared to 5.82/1000 in the US).

Nonetheless, everyone “knows” that breastfeeding saves lives.

During World Breastfeeding Week, Melinda Gates posted this on Twitter:

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Between 2009 and 2014 breastfeeding rates tripled to 57% in Vietnam, soared to more than 80% in Bangladesh and increased to more than 80% in Ethiopia. But what happened to infant mortality rates in response? As far as I can determine, the change in breastfeeding rates had no impact on the trajectory of infant mortality rates.

Everyone “knows” that breastfeeding saves lives despite the fact that no one can find any term babies whose lives have been saved.

Meanwhile, as a result of aggressive breastfeeding promotion, we are literally breastfeeding babies to death.

The Baby Friendly Hospital Initiative was implemented around the globe without any evidence that it increases breastfeeding rates. The Ten Steps of the initiative directly violate both scientific evidence and medical ethics. There is no evidence that locking up formula improves breastfeeding rates; there is no evidence that banning supplementation improves breastfeeding rates (and there is evidence that supplementation increases breastfeeding rates); there’s no evidence to justify banning pacifiers and considerable evidence that pacifiers reduce the risk of sudden infant death syndrome (SIDS); and it is deeply unethical to restrict what providers can say when counseling patients about infant feeding.

Worst of all, there’s a growing body of evidence that aggressive breastfeeding promotion is leading to brain injuries and deaths of infants from hypoglycemia, jaundice, dehydration, starvation and infants falling from or being smothered in their mothers’ hospital beds because well baby nurseries have been closed.

But everyone “knows” that breastfeeding saves lives. That’s what the conventional wisdom about breastfeeding tells us but the conventional wisdom is wrong.

Don’t believe me? Ask those, including those at the WHO whose entire careers have been staked on the claim that breastfeeding save lives, to show you the term babies whose lives have been saved. Don’t allow yourself to be fobbed off by mathematical models; insist on real population data.

But don’t hold your breath while waiting for that data; because while everyone “knows” that breastfeeding saves lives, no one knows any term babies whose lives have been saved.

  • Jessica Cupit

    Shouldn’t there be some kind of international move to provide safe (perhaps ready-made?) formula to families in developing countries who struggle with exclusive breastfeeding so that infants don’t have to rely on things like goats milk for supplementation? In all the anti-evil-formula-promotion talk I have seen no staunch breastfeeding advocates (who claim to have infant health concerns at the core of their arguments) recognise that there is a real need for safe formula in developing countries due to insufficient breastmilk (malnutrition of the mother, natural breastfeeding failure rates, maternal death rates etc) – what happens to these newborns? Shouldn’t the focus be on creating guidelines for how and where formula can be promoted, and on gaining access to safe, cheap formula for women who need it and can’t access it, rather than demonising formula altogether and valorising breastfeeding?
    Just my thoughts.

    • Young CC Prof

      I know of one charity that does this, it’s called 2ndmilk. Their main program is providing formula and other culturally appropriate healthy food to people raising babies who don’t have mothers.

    • carovee

      Yes. The problems that are touted are a) formula is expensive so b) people dilute it possibly with c)poor quality water. Well if poverty and water quality are the problems than address that. Pushing breastfeeding isn’t going to help anyone.

      • “solve world poverty then” is a pretty cynical answer

  • Julanar

    This article goes on and on about how wonderful the health benefits are for women:

    “Above and beyond any benefits to the baby, breastfeeding has concrete
    health benefits for mothers. Breastfeeding helps the body to heal from
    childbirth, by releasing oxytocin that helps to stop uterine bleeding
    and shrink the uterus back to its normal size and shape. It lowers the
    risk of ovarian and breast cancer. Some studies suggest that it can help
    to prevent osteoporosis, heart disease, diabetes, and complications in
    future pregnancies. To quote a 2010 Scientific American article, ‘even if technicians could develop a better food for infants, researchers are now realizing that skipping the lactation phase would be problematic for mothers’ health.’ Nursing is not just a parenting decision; it’s after-care. Bodies that have given birth are designed to recover by lactating, and when that process is interrupted, their health suffers.”

    Needless to say, no sources are cited, and I’m always skeptical about supposedly scientific information that uses the word “designed.” I’d be interested in knowing your unbiased opinion.

    • swbarnes2

      As always, it’s really really hard to separate the benefits of breastfeeding from the fact that women who breastfeed in the US tend to be richer, better educated and whiter. That’s likely what’s driving the associations between breastfeeding and all those good health outcomes.

      Ovarian cancer risk is dropped by not ovulating. Breastfeeding is one way to not ovulate, the pill is another, and for lots of women simpler. A woman who has a complication in pregnancy is more likely to 1) have a complication in her next pregnancy and 2) not be able to breastfeed, so that probably explains that association.

      If lactation was so great, I think we’d see that the more children a woman breastfed, the more protected she was from all those negative health consequences, with nulliparous women being the hardest hit. But I don’t think the data shows that at all.

      One could do a small study using women who had term stillbirths as a control…it would be underpowered, but if you can’t see results in a small study, that strongly suggests that the real difference has to be pretty marginal.

      • lawyer jane

        Boy, that seems like a huge jump to go from “breastfeeding has some health benefits for women” to “not lactating is failure to give after-care and causes women’s health to suffer!”

        While I think the science is solid that lactation provides SOME health benefits to mothers, I object to that being used to form the basis of a generalized public health recommendation. Because breastfeeding public health propaganda is NOT directed towards women’s health; it’s directed towards breastfeeding in and of itself. If it were really about women’s health, then we’d see the CDC recommending that nulliparious women at risk of breast cancer induce lactation or get pregnant. That just doesn’t happen.

        Instead, the health benefits to women are inflated and used as a cudgel to breastfeed.

    • Vast

      “No correlation was found between the involution of the uterus and parity, breast-feeding and the infant’s birth weight.” https://www.ncbi.nlm.nih.gov/pubmed/11844171

      “No correlation was found between the involution of the uterus and parity, breast-feeding and the infant’s birth weight.” https://www.ncbi.nlm.nih.gov/pubmed/14758377 (Same wording for that part of the results, different study.)

      “Breastfeeding and parity did not affect uterine involution (r < 0.2)." https://www.ncbi.nlm.nih.gov/pubmed/25363015

      Randomized animal studies back up these results; breastfeeding appears to not affect uterine involution (at least in terms of size, returning to normal, which is what these studies cover). I was really surprised when I found how uniform these results are… this "breastfeeding helps the uterus shrink" thing is so ubiquitous (with never a citation) that I'd assumed it had to at least have something to back it up… doesn't appear to. Maybe there was like one study many years ago with an outlier result?

      • lawyer jane

        wow, thank you VAST! crazy. another myth demolished.

    • demodocus

      And then there are a few of us for whom the oxytocin thing doesn’t really happen. or my sister who had breast cancer and ovarian cancer both before her child was born. There’s a reason why scientists pretty much never say anything is 100% certain, especially in something so messy as biology.

  • Mel

    Bangladesh has had a marked change in slope of neonatal death rates between 2009-2014 – which was also the time frame that the percentage of home births dropped precipitously due to cross-marketing by various NGOs.

    https://www.npr.org/sections/goatsandsoda/2018/02/25/587692950/how-one-country-drastically-cut-its-newborn-death-rate

    I’m sure a bit of statistics might be able to suss out the number of lives saved by breastfeeding compared to medically attended births – but I know which of the two I think did the lion’s share of the work.

    • swbarnes2

      If you ignore 2009, which is a bit of an outlier, the slope of the line is very straight going all the way back to 2000. Deaths followed the same trend before and after all that breastfeeding support.

      • lawyer jane

        Isn’t there ANY research attempting to measure whether increased breastfeeding rates reduces infant mortality? I know that there are many countries that have increased breastfeeding rates and reduced infant mortality, but this happened along side other practices as you note — birth attendants, vaccination, etc.

        • Sarah

          We don’t need it, do we? It’s just common sense…

      • Young CC Prof

        2009 is an outlier in a lot of countries. Worldwide economic catastrophe will do that.

  • swbarnes2

    This site has charts of infant morality starting from 2000

    https://www.indexmundi.com/g/g.aspx?c=vm&v=29

    Vietnam has a perfectly steady drop in infant morality starting from 2005. All this extra breastfeeding didn’t change the slope of the line at all. And eyeballing a bunch of countries, most of them show a decline in the same period, even the ones without wonderful increases in breastfeeding.

    And one has to wonder…was “breastfeeding” really only 20%? Or were they measuring exclusive breastfeeding? It’s a little hard to believe that so many poor families would rather spend cash in hand that could be used to buy anything to buy food for baby instead of doing some breastfeeding.

  • Young CC Prof

    One think that’s important to realize is that traditional breastfeeding culture in the West died out in the mid 20th century. For more than a generation, very few babies were breastfed. Then, beginning in the 1970s, it was essentially recreated, partially by reading, partially by empirical experimentation, partly by guess and imagination.

    Some of those guesses, or conclusions based on very limited data, were later adopted into the literature as established fact. By 1990, breastfeeding was a high priority for global health officials, but many of them were still using this “science” built on sand.

    And when they realized that mothers from many intact traditional breastfeeding cultures all over the world didn’t do things the way the literature said they should, the response was not to question the literature, but to tell the locals that they must be doing it wrong, especially when it came to neonatal supplementation.

    So, we have the general public here in the USA rabidly defending public health policies imposed on poor countries, utterly unable to believe how weak the science behind them really is.

    • An excellent point, Young CC Prof. In fact, if fomula feeding had such a negative impact on health later in life, the majority of those born from the Thirties to the 70s would be in very bad health today

  • Cartman36

    Dr. Amy, I think the US mortality rate is a typo. Should it be 5.82/100 or 5.82/1000.