What breastfeeding research REALLY shows

Evidence

Yesterday I wrote about the Trump administration’s typically ham handed effort to oppose a World Health Organization breastfeeding resolution.

Make no mistake; Trump was only thinking about the welfare of formula manufacturers. But WHO breastfeeding recommendations are actually injuring and killing babies and they should have been changed long ago. How do I know? I read the scientific research.

Babies are dying because lactivists are lying.

I hope you will read it, too so I’m citing and explaining the most important papers of the past 4 years. Collectively they show that that insufficient breastmilk is common (up to 15% of first time mothers), formula supplementation makes successful breastfeeding more likely, pacifiers prevent SIDS and extended skin to skin contact leads to babies falling from their mothers’ hospital beds or suffocating while in them. Most importantly, the myriad purported benefits of breastfeeding actually come from the higher socio-economic status of breastfeeding mothers, not breastfeeding itself.

The 2014 study, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons by Colen and Ramey, was a breakthrough study that showed that almost all the claimed benefits of breastfeeding don’t actually exist.

We have always known that breastfeeding varies among ethnic, cultural and economic groups and indeed, previous studies that corrected for these factors show that breastfeeding has only small advantages. This study looks at breastfeeding vs. bottlefeeding WITHIN families by comparing siblings who were fed differently.

The authors found that there were differences between breastfed and bottle fed children in 10 of the 11 measured variables when looking at the overall group. Those differences persisted when comparing families in which all the children were breastfed to families where all the children were bottlefed. But when the authors looked within families, there was NO SIGNIFICANT DIFFERENCE between breastfed and bottle fed children.

Previous research, in particular the PROBIT studies conducted over the past two decades by Michael Kramer in Belarus suggest a variety of benefits that have subsequently found to be illusory. At this point, the only confirmed benefits of breastfeeding for term babies are a slightly decreased risk of colds and episodes of diarrheal illness across the entire population of infants in the first year. The vast majority of infants will experience no measurable benefit from breastfeeding. The one exception to this is premature infants; breastmilk reduces the risk of necrotizing enterocolitis, a serious complication of extreme prematurity.

Don’t believe me? Listen to Michael Kramer himself.

Kramer is emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma. When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.

So most of the claimed benefits for breastfeeding don’t exist. But the real problem with aggressive breastfeeding promotion is that it HARMS babies.

That’s why in 2016 US public health officials changed the United States Preventive Services Task Force (USPSTF) guidelines reduce the relentless pressure on women to breastfeeding.

An accompanying editorial Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms noted that the vaunted Baby Friendly Hospital Iniative wasn’t merely a failure, it also exposed infants to danger.

The BFHI bans pacifiers in contradiction to the scientific evidence.

Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of sudden infant death syndrome,7 the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assessed in the evidence review. A recent Cochrane systematic review reached the same conclusion. Thus, routine counseling to avoid pacifiers may very well be ethically problematic.

The BFHI bans formula supplementation in contradiction to the scientific evidence.

Counseling mothers to avoid giving infants any food or drink other than breast milk during the newborn period is step 6 of the BFHI and one of the primary care interventions most commonly used to support breastfeeding. Three randomized trials have specifically examined the effectiveness of counseling to avoid giving newborns any food or drink other than breast milk; none showed a beneficial effect of such counseling on breastfeeding duration.

Other harms were noted in the 2016 paper Unintended Consequences of Current Breastfeeding Initiatives:

Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature confirmed many of the risks noted above as well of the lack of effectiveness of the BFHI itself.

How many babies are being harmed?

According to the 2018 paper Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al.:

We had data on inpatient feeding for 105,003 (96.6%) vaginally delivered newborns and 34,082 (97.0%) delivered by Cesarean. Among vaginally delivered newborns, readmission after discharge from the birth hospitalization occurred for 4.3% of those exclusively breastfed during their birth hospitalization and 2.1% of those exclusively formula fed during their birth hospitalization (p<0.001)… For Cesarean births, readmission occurred for 2.4% of those exclusively breastfed during the birth hospitalization and 1.5% of those exclusively formula fed during the birth hospitalization (p=0.025)…

To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year — nearly a quarter of a billion dollars. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.

Lactivists have developed a cult-like fixation on exclusive breastfeeding and consider formula supplementation to be anathema, but the scientific evidence shows the opposite.

The Effect of Early Limited Formula on Breastfeeding, Readmission, and Intestinal Microbiota: A Randomized Clinical Trial

Current public health initiatives emphasize the importance of exclusive breastfeeding during the birth hospitalization, but our randomized trial of 164 newborns did not demonstrate improved outcomes for infants receiving exclusive breastfeeding compared with limited formula supplementation using the ELF strategy…

[T]hese results suggest that using ELF in a carefully structured, temporary manner may not interfere with breastfeeding or maternal experience in the first month or have a negative impact on intestinal microbiota. At the same time, our results suggest that further studies are needed to assess whether ELF reduces the risk of neonatal readmission, especially in the first week after birth. Using small volumes of formula on a temporary basis for newborns with pronounced weight loss may have the potential to help clinicians and mothers provide the nutritional volume needed by babies without interfering with duration of breastfeeding or with the health benefits achieved from longer breastfeeding duration.

Why is there such a disconnect between what lactivists claim about breastfeeding and what the scientific evidence actually shows?

Most papers cited in support of the benefits of breastfeeding are mathematical models based on extrapolation of small studies that are often riddled with confounders.

To my knowledge — please correct me if you have other data — there is NO CORRELATION (let alone evidence of causation) between breastfeeding rates and infant mortality rates. The countries with the lowest breastfeeding rates have the lowest rates of infant mortality and the countries with the highest infant mortality have breastfeeding rates approaching 100%. There is NO EVIDENCE that increasing breastfeeding rates within a country has any impact on the mortality rates of term babies.

Why have lactivists grossly exaggerated the benefits of breastfeeding and hidden the significant risks? That’s a philosophical problem; lactivists have claimed that breastfeeding — in contrast to all other natural processes — is perfect. But there is no biological process that is perfect. Just as 12% of women experience infertility, and 20% of pregnancies naturally end in miscarriage, breastfeeding has a failure rate, too, up to 15%.

Imagine what would happen if we told women struggling to get pregnant that infertility is rare and probably their fault. The result would be failure to have desired children and tremendous anguish. Imagine what would happen if we told women that miscarriage was rare and probably their fault. The result would be that millions of women would have their grief compounded by the sense that they were alone and could have prevented the miscarriage if they’d tried harder or had more support.

We don’t need to imagine what would happen if we told women that insufficient breastmilk was rare (though it is common) and that they could have breastfed successfully if only they’d tried harder or received more support. We know what happens: tens of thousands of newborn hospital readmissions; brain injuries and deaths from dehydration and other complications of insufficient breastmilk; injuries and deaths from babies smothering in or falling from their mothers hospital beds; an increase in SIDS from cosleeping and from depriving babies of pacifiers.

The sad truth is this: babies are dying because lactivists are lying.

Don’t take my word for it; read the scientific literature!

  • fiftyfifty1

    Note how Jon Hakim criticizes Dr. Tuteur below by accusing her of having a “technophile and pro-interventionist agenda.”

    There we have it in a nutshell. Jon Hakim objects to Dr. Tuteur because she has the audacity to question The Natural. For years, Nature’s death rate for reproductive women and their babies has been staggering, and Dr. Tuteur is advocating we not just accept this as our fate. Uppity woman!

    • I’m actually quite the fan of medical and scientific progress. Myself, my parents, my siblings and my wife have 7 degrees in the sciences between us and have used them well, in one case even as a medical professional. However, to make claims that technological intervention is inherently superior to natural processes (such as when Dr. Tuteur said that formula is perfect while breastmilk is flawed, or when she claimed that midwives who perform natural births are part of a cult) is taking things too far.

      • space_upstairs

        She was probably inspired to do so by the fact that there’s a large…not sure if “community” is the right word…subculture, perhaps? out there which takes the opposite notion too far: breastfeeding and unmedicated vaginal birth are better *because* they’re not technological and nature has been working longer than technology. Unfortunately, it seems quite common if not ubiquitous that those who speak out against a trend that they see as problematic tend to take on much of the tone of the very people they oppose. It’s just how argument works these days, especially on the Internet. Which is part of why I’m not an activist myself, and only occasionally pitch in on these kinds of discussions when the issue is of interest to me: I try to read the facts and refine my own opinions, but most everyone else who posts just seems to read and escalate the tone. (Maybe the other people like me just never come out of lurking.)

        • That’s probably the most accurate and fair comment made on the issue so far.

          • space_upstairs

            Thanks. And I should probably say that I might be discrediting other posters when I say that “most everyone else” seems to just escalate things…but the escalators do tend to dominate the conversations. I actually agree with a lot of what Amy says, but how she says it might lead to some trouble sometimes, and these particular discussions piqued my interest because I thought you and she both had good points that risked being lost in the tone of the argument.

          • Yeah, once again I agree a lot with all that, and admit my part in it. I’m often too aggressive in debating my stance, and extremely defensive to a fault when I feel I’m being unfairly accused or mocked.

          • Amazed

            The escalators are the only reason there is a conversation at all, though. Nice blogs saying these same things nicely get, at best, polite neglect. Few ever stop to comment.

            You should really comment more if that’s your wish. But don’t try to make it as it would all be good if the escalators weren’t here. Without the escalators, no one would have known that this blog and the issues it brings even exist.

          • space_upstairs

            You do have some good points as well: emotion is faster than thought and is generally needed to guide it according to some very good psychological research. I read it a while back in the popular work of Antonio Damasio. Therefore, intensely emotional appeals are often needed to get a discussion started and draw attention to the matter. Unfortunately, maybe it’s just me and a few other people these days, but it increasingly feels like conversations get stuck there, and maybe this is really just me, but sometimes it feels like the ones with the most passionate rhetoric are trying to guilt and shame others into siding with them. And it’s the (often also passionate) response against that kind of guilt and shame that draws me to places like this blog.

            I tend to imagine discussions would work better if the escalation that tends to happen in them could be balanced more often with de-escalation, trying to take the sting out of what’s being said and draw attention back to the information itself that people need to make their decisions or take their sides. But I guess I could be dead wrong about that for the average person, and I should only try to take the sting out of the messages just for myself and not pretend that any others will draw any benefit from it. Maybe others really only need the right sting from the right person. It just so happened that the discussions on the last few threads, for me, have been matters that I feel I would personally benefit from seeing with a lot less sting in them, because I have to sort out my own mixed feelings on the personal and political sides of the issue.

          • Amazed

            No, it isn’t just you. Some conversations does get stuck there, that’s true. But not all of them. This is one of the few blogs where people can usually find what they seek: nice discussion for you, heated exchange of arguments for me. (Believe it or not, I used to be quite moderate here in the past but a few particularly obnoxious commenters plus seeing unpleasant consequences of idiocy like the one this sight is fighting close to me drained my supply of good manners one and for all and my patience with DANGEROUS deluded posters will never come back, most likely.) These discussions tend to get heated because people have usually received flak from being on either side in RL. But you must have seen that there are patient people, willing to converse in a civilized manner. I am really one of the hardliners here. People are generally nice and I’d hate it if someone really felt pressured into keeping silence. There are enough posters for a thread of the kind you prefer.

          • space_upstairs

            Yeah, I guess I can’t blame people for getting impatient, and worried about other people’s certain hard lines, but I also can’t blame people when they get derailed, confused, or alienated from being able to see the other side of an argument by the existing tone of it. And that’s where I butt in: usually when I get the sense that people on both sides are capable of mutually understanding each other and coming to some degree of agreement (or a civil “agreement to disagree”) and somehow fancy that I might be able to help. I’m more likely to stay silent of I don’t see that potential for mutual understanding. If I do feel like the side that I feel closest to is trying to push/guilt/shame people leaning toward their side to a more extreme position than I’m comfortable taking, I either take a break to process the stuff on my own first or just steer clear of that land mine.

      • fiftyfifty1

        Where has Dr. Tuteur made claims that technological intervention is inherently superior to natural processes? Nowhere. She has merely (and accurately) pointed out that formula is a complete source of nutrition whereas breastmilk comes up short in a few nutrients. If you have a hangup with technology making improvements on nature, that’s your own issue to process.

        Also it’s nice that you have a family member who is a medical professional, that certainly does give a person a bit of insider perspective. But being a medical professional is my full time job. So for me, breastfeeding-associated rickets is not something theoretical, it’s something real that I’ve had to fix first hand. And iron deficiency anemia. And hospital readmission for neonatal hypernatremic dehydration due to primary lactational failure. And as for homebirth midwives being part of a cult, I’ve had to deal with the ugly aftermath of that reality too. If you had ever been in my shoes I think you might have a different perspective about who is and isn’t “taking things too far.”

      • shay simmons

        . However, to make claims that technological intervention is inherently superior to natural processes

        You mean like vaccines being inherently superior to achieving immunity by getting the disease?

    • Amy Tuteur, MD

      What about the MANY studies that have been published since then? Why are you ignoring those in favor of a four year old criticism of one paper? Could it be because it’s easier to do that than to address the fact that that particular study has never been rebutted?

      • I haven’t ignored any “many” studies. Medical journals continue to show that the vast majority of studies show enormous overall benefits to global health, and cherry-picking the minority of studies that support the narrative you wish to push doesn’t help your argument.

        I don’t see why I should believe you over the scientific and global consensus. Especially when you picked such an obviously faulty study to highlight as your case.

        Here’s a synopsis of the research out there:

        https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00210-5/fulltext

        You still keep failing to answer my question of WHO is pushing this giant conspiracy that you claim has overtaken everyone else. Who are the lobbyists who have managed to convince the World Health Organization, the American Academy of Pediatrics, the USDA, and nearly every country in the world except the USA to align with the majority of scientific studies on breastfeeding, while you and a number of largely American formula advocates keep claiming that your minority of studies is in the right?

        And why do these mystery lobbyists for a fringe industry with almost no presence outside of North America manage to convince the whole world that they’re right when their opposition outpaces them in funding 100 to 1?

        • Uh, this link is not a systematic review or meta-analysis; it’s an opinion piece. And look at “But, more importantly, genuine and urgent commitment is needed from governments and health authorities to establish a new normal: where every woman can expect to breastfeed.” Do you see nothing wrong with this statement?

          • Heidi, I’ll assume that was an innocent error on your part – that’s not an opinion piece, it’s the introduction to their work. If you had clicked on the very first link in the very first sentence you would have been able to see the link to the full text of the studies.

            “The results of 28 meta-analyses on the associations between breastfeeding and outcomes in the children and mothers, of which 22 were commissioned for this Series”

            https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext?code=lancet-site

          • Amazed

            “Every woman can expect to breastfeed”? This sentence tells me all I need to know about these 28 meta-analyses: they’ve been gathered with the specific purpose to make the likes of you believe that breastfeeding is possible for every woman.

            Even lactivist-infested healthcare workers give lip service to the fact that not every woman can make milk and not every baby can draw milk effectively, no matter how much they try to make trhe actual numbers of breastfeeding failure look smaller. By default, not every woman can expect to breasteed. The fact that the Lancet brazenly claims she can proves that they cherry-picked what they wanted to show to the world.

          • You’re completely misreading the statement in its context – they are expressing their hope that sufficient support will be provided so that every women can expect to breastfeed, they are not saying that every woman will actually be able to do so in the end.

            The Lancet is one of the most prestigious medical journals in the world and more than once has criticized WHO policy when deserved, if you think they have made such a basic error then it’s worth re-reading it and seeing how you might have misinterpreted them.

          • Amazed

            This very expectation is a lie. What about women who have had breast cancer? Should they expect to be able to breastfeed? In a highly published case, yes, the mother was told by a LC that she could try to lactate through their armpits.

            No amount of support could make milk appear from a breast that is not there. Support with the expectation of breastfeed should not be given to mothers with risk factors that make it unlikely for them to be able to breastfeed. Sure, support them all the way but be realistic about their chances. And I’m actually kind of suspicious about the effect of this so-called support. I think that in many cases, it just boils down to, “her milk came”. That was the case with my mother. When she returned from a prolonged stay in the hospital after nearly dying giving birth – without any interventions during the birth and lots of interventions to save her from bleeding out after, – she already knew that she’s be unable to breastfeed. At this time, there was no formula where I am. My first memory of my brother is how he turned blue with wailing until my father made him some powdered milk. The next morning, he was at a breast that could feed half the neighbourhood. It happened without any support but if my mom had had a LC, she would have taken the credit for her body doing what it was supposed to.

            I know what Lancet is. It isn’t above reproach, though. Not immune to biases, as history has proved.

          • I think the average Lancet reader was quite aware that young women who, say had mastectomies on both breasts or some other extreme condition would not expect to be able to breastfeed. I don’t think the doctors who wrote that report meant to imply otherwise.

          • Amazed

            Yeah, I don’t think so either. But at least one LC thought so even without this “encouragement”. I have great trust in medicine and I know that the majority of them doctors are not like Hide in the Herd but Don’t Tell the Herd that You Are Hiding Sears. This is not what bias is about.

            Still, there are many reasons that make the ability to breastfeed an unlikely option. And we have posters who, in Facebook, with their names, have said that LC, in Baby Friendly Hospitals, actually wrote down that they wouldn’t tell them how unlikely it was to be able to breastfeed with these factors, resulting in starving babies. Generalization is a step too far. Basic grasp of biology should tell everyone that breastfeeding isn’t the only bodily function that works flawlessly. It’s like the (now proverbial) preterm baby I talked about: every child should expect to have great eyesight but there are reasons to expect that this one won’t. Not because she’s preterm but because in her extended family, there is exactly 1 person without glasses.

            Sure, she may turn out to have great eyesight. This far, things look promising. She loves colourful stuff. But her chances are not the same as a kid coming from generations of excellent eyesight.

        • Amy Tuteur, MD

          I just wrote 6 posts in a row explaining all this, Perhaps if you read them you would understand the issues.

          • No, you did not explain that

            I read all your posts Amy. As in the previous time we interacted, I once again saw you use condescension, the claim that you alone know what is right while everyone else is wrong, and the repeated assertion that your opponents are a “cult” to explain away a lot of things that didn’t fit your consistent technophile and pro-interventionist agenda.

            I’m beginning to get a feel for what kind of debater you are. Condescending snark will not win the day though. I keep challenging you to respond to these questions over and over, and you keep refusing to answer them:

            #1. You claim that this insidious “lactation industry” is responsible for the false information around breastfeeding, because it’s a big “multi-billion dollar” industry. You refuse to answer how, when said industry is almost entirely within North America and compromises 1/100th the size of the formula industry, it has managed to overcome the massive lobbying efforts of the large corporations that profit on formula.

            #2. You repeatedly fail to demonstrate that this insidious “lactation industry” has paid lobbyists to influence national policy across the world, and you fail to explain who they’re influencing. Your repeated insistence that this “multi-billion dollar industry” has caused the current situation lacks any believable mechanism for them to have done so.

            #3. In the face of #1 and #2, you have no explanation for how this industry has pulled the wool over the eyes of policy-makers and doctors’ organizations across the world, while only a few brave Americans know the real truth. You keep portraying “the truth” as you see it, as something obvious and clearly demonstrated, while ignoring that the Worth Health Organization and nearly all its member states outside the United States, as well as the American Pediatric Association within the United States, see if differently than you do.

            #4. When you offered a study which supported “your side”, it was a terrible one, with obvious systematic errors that made its conclusions meaningless. When challenged with a clear rebuttal you said, “But what about all the others?”, without explaining why you had used such a faulty study as your highlight piece nor acknowledging that the bulk of “all the others” weighs in the opposite direction of your claims. Instead, you offer at best vague correlations (or non-correlations) that don’t account for conflating variables while at the same time dismissing any correlations that work against you by claiming the unproven existence of conflating variables.

            #5. When confronted with the summary claims on the issue of a respected medical journal, you fail to explain how they come to the opposite conclusion that you do regarding the research.

            #6. You repeatedly claimed that breastfeeding initiatives take money away from the development of safe water infrastructure, ignoring that you well know that international infrastructure funding doesn’t work that way at all and no money for clean water infrastructure has ever been diverted to breastfeeding initiatives.

            #7. You fail to address that there are numerous other issues relating to the use of infant formula by women in poverty that go far beyond clean water, even when I listed out these issues explicitly.

          • Julanar

            Amy is no more condescending than the people she criticizes, and judging by your own condescending tone, you have no right to criticize anyone for theirs.

          • If you ever see me use condescension or snark in place of an argument, I welcome you to call me out on it.

            I am much more interested in the repeated points I keep making that aren’t getting addressed though.

            I haven’t personally seen anyone do the things to Amy that she has been doing to them (call her part of a cult, call her part of a profiteering conspiracy, use snark instead of replying to her specific arguments), and I don’t see why that would be a justification for it even if it were happening.

          • Julanar

            Shaming people for how they spend their money? Accusing them of being shills for the formula industry? Insisting that people in war zones don’t count because there aren’t enough of them? Appealing to authority and the bandwagon? That’s pretty damn condescending. Telling women what to do with their bodies and shaming them if they don’t comply is also pretty damn condescending, yet you don’t seem to have a problem with it.

          • Julanar, if you follow the discussion back further you’ll see that I wasn’t the one who tried to shame people for how they spend their money. Amy did that, trying to claim that advocates for breastfeeding promotion are the reason that clean water isn’t available. That was a false dilemma, and I used bottled water and coffee to illustrate it.

            People in war zones certainly count, and no one has suggested otherwise. However, they do deal with specific issues that are not the same as those faced by the majority of the global population.

            Appeal to authority is a valid argument when the authority in question has legitimacy. We all recognize that when we cite peer-reviewed studies and those who analyze the conclusions of such studies, as only a small percentage of us have the time and knowledge to read and evaluate the thousands of relevant studies available and compare their effects to each other.

            All public health and in fact all medical care involves some degree of informing and recommending what people should do medically. I don’t think that medical advice is by default condescending.

            Shaming people who don’t comply with medical advice is problematic, and unhelpful. You see it a lot, in everything from vaccines to antibiotics to mental health.

          • Julanar

            Amy merely pointed out that we have limited money to spend on public health and did not shame anyone, which is more than I can say for you.

            You agree that shaming people is wrong? Excellent. We agree on something. So stop doing it. And public health organizations should also stop doing it.

          • Why do you think we have limited money to spend on public health? Globally, there is no shortage of dispensable income, as proven by all the ridiculous things we spend billions of dollars on.

            I don’t know what definition of “shaming” you are working with that somehow indites me and not Amy. Merely arguing for one’s position is not “shaming.” However, claiming that everyone who falls on the opposite side is a baby killer who basically an anti-abortion activist ideologically and just wants to control women’s bodies goes way into the “shaming” spectrum.

            I’m not the one who said:

            “WHO recommendations are killing babies”

            “babies are dying because lactivists are lying”

            “Lactivism is about controlling women through policing their bodies”

            “Perhaps if you read them you would understand the issues”

            “That’s the same type of argument the anti-choice crowd makes when opposing abortion”

            “That’s a big lapse for someone making accusations about why women don’t breastfeed.”

            “Has it ever occurred to you that accusing women who disagree with you of being corporate dupes is rather ugly?”

          • Amazed

            1. You mean you don’t know of any babies who died because hospitals blindly adhered to WHO recommendations which, in turn, blindly pretend that ALL women can breastfeed? Because if you have heard of even one, that means that WHO recommendations are killing babies. Should I point you at such cases, or can you find them on your own?

            2. Lactvivists ARE lying. I’ve heard them. You also have and if you haven’t, emerging from the cave you live in is in order. Lactivists claim that ALL women can breastfeed. That signs that reflect those of hunger in a newborn are not signs of hunger at all. They are lying. Babies are dying. See No1.

            3. What do you THINK lactivism is about? You telling me that my breasts were made for nursing babies is you policing my body. And lactivism is all about trying to mom hard enough. Oh, they’re careful not to say it but it’s there for everyone to see. Try more, try more, try more, leave your job (cue the Searses), breastfeed, breastfeed, breastfeed!

            4. Or perhaps you won’t. You read them, didn’t you? And you didn’t understand the issues, did you?

            5. Isn’t it?

            6. It is.

            7. You mean it’s pretty? Wow.

          • First off, are you saying that no matter how you say it, it’s not “shaming” as long as the root of the claim is true? Then where have I been “shaming” anyone?

            1. And if I can find one baby who died due to formula use, I can say, “Formula kills”? That’s not how that works. No one justifies saying, “seatbelts kill” because they found one person who died due to a seatbelt.

            2. I don’t have a ton of personal interaction with “lactivists”, but the consultant my wife and I visited two weeks ago explicitly said that not all women can breastfeed. As some subset of all people spread misinformation, I’m sure you can find an example of a lactation consultant making a false claim, just like I caught Amy making numerous false claims in the last day alone.

            3. In many cases, following the best public health research available. Some of you appear to think very, very low of the doctors and researchers who comprise the American Academy of Pediatrics, WHO, Lancet, etc. if you really believe all they care about is controlling women’s bodies. You’re making it sound like conservative America alone is enlightened on this front of women’s freedom, which I find laughable on its face.

            4. I understood perfectly well. In fact, I specifically listed the 7 issues that Amy had failed to address. She still hasn’t addressed those 7 issues.

            5. No

            6. No such lapse existed.

            7. Never did such a thing.

          • Amazed

            Have I said that you were shaming anyone? I haven’t. I happen to think that you are shaming and I just find it ironic how, given your impassionate stance on shaming, you’re happy to use ot yourself. Whatever. I don’t care. Of course Dr Amy is shaming! What else should she do to gain notice? You didn’t go to any of the nice blogs who are gently explaining their arguments, did you? You came here. We’ve got experience with bloggers saying the same things Dr Amy does in the kind manner all of you newcomers here seem to want – but you still come here. You don’t go over there. I suspect that kind manners make it easier to brush off the message.

            1. Yes, of course. If formula prepared with clean water, according to the manifacturer’s direction, under the eye of professionals who should provide healthcare for the baby but instead kept cheering the mother to the very end to give the formula despite the baby clearly struggling makes a baby dead, of course you should say “Formula kills”. How else are people supposed to improve it? I’m talking about babies whose mother were under the delusion, carefully maintained by their environment which included professionals, that their babies were getting enough nutritional milk but they did not.

            2. Two weeks ago, I was listening to a crook MD with lactation credentials explaining how one bottle would FOREVER doom your baby to be confused and not knowing that your breasts are a source of food. At this moment, my friend was preparing a bottle and her severely preterm, saved by interventions baby – hurrah for them interventions that you seem to decry – was literally shredding my dress and bra apart. I thought she might suffocate while trying to push her head into my neckline in her search of a breast. This is a kid who has never been put at a breast but she knows what breasts are for, baby-wise. And this LC leader was far from the only one I’ve heard nonsense from. If the leadership is like this, I don’t expect much from the regular LC. If many of them are reasonable, that’s good. But it doesn’t change the fact that they are TAUGHT lies. And babies do die.

            3. I’m not talking about healthcare professionals. There are LC who are healthcare professionals but these are not synonyms. BTW, the LC healthcare professionals are the worst since they throw the weight of their academic credentials behind faulty science and theoretical models. Cue: Melissa Bartick. Lactivism consists of LCs and women whose only credentials are that they have breastfed. And they totally look down on women who don’t breastfeed, especially if it is by choice. Funny thing, for all their screeching of true, non-stressful (on the kids) mothering that inevitably starts with breasts, they are not women whose results I’d like to see in my own children. I mean, the only ones who can give me mothering advice on the basis of being mothers are women whose grown children prove that their mothering methods were right. Lactivists (not the same as breastfeeding mothers) usually turn breastfeeding into a part of a complex method of mothering, the results of which I’d never want to reproduce.

            4. That’s your opinion. I don’t think you understood the issues at all.

            5.Again, a matter of opinion.

            6. The ones you defend are doing it on a regular basis.

          • shay simmons

            Why do you think we have limited money to spend on public health?

            It would be more accurate to say there is limited money allocated to public health. The present Administration’s decision to cut the CDC’s budget for responding to global disease outbreaks by 80% comes to mind.

          • Amazed

            You haven’t seen it? It’s all over the place, both here and on her facebook page. You either didn’t bother to read, or are lying through your teeth. But then, what did I expect of a lactivism admirer?

          • No, you did not explain that

            #1. You claim that this insidious “lactation industry” is responsible for the false information around breastfeeding, because it’s a big “multi-billion dollar” industry. You refuse to answer how, when said industry is almost entirely within North America and compromises 1/100th the size of the formula industry, it has managed to overcome the massive lobbying efforts of the large corporations that profit on formula.

            #2. You repeatedly fail to demonstrate that this insidious “lactation industry” has paid lobbyists to influence national policy across the world, and you fail to explain who they’re influencing. Your repeated insistence that this “multi-billion dollar industry” has caused the current situation lacks any believable mechanism for them to have done so.

            #3. In the face of #1 and #2, you have no explanation for how this industry has pulled the wool over the eyes of policy-makers and doctors’ organizations across the world, while only a few brave Americans know the real truth. You keep portraying “the truth” as you see it, as something obvious and clearly demonstrated, while ignoring that the Worth Health Organization and nearly all its member states outside the United States, as well as the American Pediatric Association within the United States, see if differently than you do.

            #4. When you offered a study which supported “your side”, it was a terrible one, with obvious systematic errors that made its conclusions meaningless. When challenged with a clear rebuttal you said, “But what about all the others?”, without explaining why you had used such a faulty study as your highlight piece nor acknowledging that the bulk of “all the others” weighs in the opposite direction of your claims. Instead, you offer at best vague correlations (or non-correlations) that don’t account for conflating variables while at the same time dismissing any correlations that work against you by claiming the unproven existence of conflating variables.

            #5. When confronted with the summary claims on the issue of a respected medical journal, you fail to explain how they come to the opposite conclusion that you do regarding the research.

            #6. You repeatedly claimed that breastfeeding initiatives take money away from the development of safe water infrastructure, ignoring that you well know that international infrastructure funding doesn’t work that way at all and no money for clean water infrastructure has ever been diverted to breastfeeding initiatives.

            #7. You fail to address that there are numerous other issues relating to the use of infant formula by women in poverty that go far beyond clean water, even when I listed out these issues explicitly.

          • Why are my comments detailing the exact things you didn’t explain getting pulled repeatedly? I’ll believe it could be some system glitch I don’t understand, but it is odd.

        • swbarnes2

          The Lancet articles says that 800,000 a year could be saved by breastfeeding?

          About 657,000 children under 5 die a year from bad water. Does it makes any sense to say that breastfeeding will save more children than clean water will? Isn’t that obviously nonsensical?

          https://www.unicef.org/media/media_68359.html

  • MediaSELLS

    There was an extensive study on this funded by the Gates foundation with the assistance of Dr Zhang Shuyi, the researcher of Capital Institute of Pediatrics concluded “Most of formula manufacturers increase sales through promotion and exaggeration of effectiveness which is in violation of International Code of Marketing of Breast-milk Substitutes. In the short term, breastfeeding can help infants reduce risk of diarrhea and respiratory illness. In the long term, breastfeeding can reduce risks of acute otitis media, dental problems, type 2 diabetes and obesity. Infants who are breastfed score an average of 3 points higher IQs than non-breastfed infants.” It’s important to also recognize a key element to this was it’s relationship to diarrhea, as it’s major cause of death for children in the developing world, enteric and diarrheal diseases kill about 500,000 children under 5 each year. Children who survive face repeated infections by gut pathogens in the early years of their life, which can lead to serious, lifelong health problems.
    Evidence suggests an association between repeated gut infections and gut dysfunction, which may lead to poor nutrient absorption, weaker immune response to oral vaccines, stunted growth, and impaired cognitive development. Globally, 159 million children are stunted, which means they face diminished opportunities and productivity over the course of their lifetime.

  • rox123

    OT: I would very much like to get a Mirena but I am not sure how I feel about it. The back story is: I took BC pills a few years ago and a few months along the way I got galacthorrea which I haven’t been able to shake off seven years later, including after pregnancy and (not exclusively) breastfeeding for 16 weeks this year. So – while some drs told me it can’t have anything to do with the BC pills I am still skeptical and weary of putting a hormone releasing device in my body.
    My question is: does science point to causality between Mirena and increase in breast cancer risk?

    • Thiel

      I’m not a scientist or a doctor, nor do I play one on TV. Still, I did some research into this myself before getting a Mirena. From what I found on PubMed (translated for me by my research biologist sister), the evidence is inconclusive. Some studies have found a possible link, while other studies show no statistically significant connection. There is a decent indication that Mirena and other levonogestrel birth control can decrease chances of ovarian, endometrial, and pancreatic cancers. The Mirena does include warnings about breast cancer in the package insert, but the warning requirements for package inserts are extremely loose- if there’s even a hint of a connection to a condition it generally gets included in the warnings.

      If you’re seriously worried, the Paragard IUD has not been connected to breast cancer and serves as highly effective contraception for even longer than the Mirena. Of course, it doesn’t have any of the benefits of a hormonal IUD (I haven’t had a period in a year :P), so that’s something to take into account.

      Also, keep in mind that the hormones in your bc pills might be different than the Mirena. I don’t know if you were taking combination bc (estrogen and progestin) or progestin only pills. If your pills did include estrogen, then the hormonal effects may well be different if you switch to a progestin-only form of birth control such as Mirena.

      Tl;dr: maybe yes, maybe no. The research is conflicting at this point. The effects of your oral bc may be very different from the effects you get with Mirena. And if you’re still leery, there are non-hormonal options such as Paragard. And of course, talk with your doctor about your concerns- they are definitely more qualified than I to advise you.

      (edited to add paragraph breaks, didn’t realize just how much of a wall of text it was initially)

      • rox123

        Thanks for taking the time to answer!
        I am thinking of Mirena exactly because of the reason you mentioned – if I am one of the lucky ones I’ll get rid of the periods, so Paraguard wouldn’t do much for me. The BC pill I took was combination. I read about the research result you mentioned – about it being inconclusive for the time being, I just hoped there’s something more out there that can answer my question. Apparently only time and more research will tell. I think I’ll just refrain from getting one for now.

  • Erin D

    Dr Amy, I can not even say how much I appreciate this article and I think you are amazing!! The one thing additionally I’d like to point out is the propensity for postpartum issues in mothers exacerbated by the lactivist pressure. As if early motherhood isn’t hard enough, especially in first time moms, Add to that the sheer exhaustion from being up literally day and night trying to nurse a baby when not producing enough to satiate them, and no wonder why there are women developing postpartum depression, anxiety, and psychosis. I suffered horribly with PPA with my first, and I have no doubt things would have been far better if I had not had it pounded into me my entire pregnancy that formula was poison. I never even thought it was an option and ended up with a baby that lost 15% of his birthweight and was jaundiced and dehydrated at one week old. Only after I was born he would be hospitalized did I finally start feeding formula. But it was too late for me and I had I had severe anxiety until he was as old as 1 1/2 or two. Truth be told, the first year and a half of my first child’s life was the worst year and a half of my entire life.

  • PeggySue

    Thank you for this. I encountered one screamer who said that until she found a study that PROVED formula feeding was BETTER than breastfeeding she would still push breastfeeding. Also she described herself as “a birth professional for over 30 years.” She’s a doula. A freaking DOULA.

  • The Bofa on the Sofa

    To my knowledge — please correct me if you have other data — there is NO CORRELATION (let alone evidence of causation) between breastfeeding rates and infant mortality rates.

    It’s not obvious that the plot of infant mortality vs breastfeeding rate shows much of anything. It certainly does not show an association between the two, but it also doesn’t contradict one. The problem is that there are many other factors that affect the mortality rate and these mask the effects of breastfeeding.

    Which, of course, is the whole point. Breastfeeding or the lack thereof is a minor issue, and its effect is small compared to everything else. Sure, there is a much bigger association with poverty and sanitation. But instead of dealing with that, it’s a lot easier to blame women for not breastfeeding.

    Yeah, it’s true that women in poor countries pretty much have to breastfeed. They don’t have any other options! But instead of worrying about the 3% who aren’t breastfeeding, imagine how much could be improved with things like vaccines and clean water?

    • Merrie

      “But instead of worrying about the 3% who aren’t breastfeeding, imagine how much could be improved with things like vaccines and clean water?”

      Pushing breastfeeding is probably easier than doing anything about those other factors. Eyeroll.

      • Sue

        Of course there is significant overlap between lactivism and anti-vaxism, but, as Dr Amy regularly points out, the impoverished countries with high BF rates also have high infant mortality. Strangely, breast milk doesn’t magically protect against infectious diseases.

        • Mimc

          I pointed out to an anti-vax lactivist the other day that if breast milk actually provided immunity to these diseases they won’t have been preasent at all before the invention of formula.

          • Daleth

            HIGH FIVE! How did she respond?

          • Mimc

            She didn’t. It was online so she just ignored my comment.

          • Sarah

            I’m shocked.

      • Sarah

        I can assure you that whatever the problem is, the appropriate solution will lie in black and brown women using their bodies in the approved manner.

    • Twicker

      Pretty much all of the scientific data and studies show that breastfeeding reduces infant mortality. https://www.ennonline.net/attachments/415/bob2-effect-of-bf-on-infant-mortality.pdf It even prevents it in developed countries. http://pediatrics.aappublications.org/content/113/5/e435 And if there was improved sanitation (and the causes of death are things that are not prevented by vaccines) you would still have the problem of poor people being able to afford the formula pushed on them by formula makers. This is not a small thing. And the reason that the formula makers have such an effect is that they market to countries that can’t possibly afford their product, and have done such things as promoting shots to dry up breastmilk or feeding babies formula before the mothers breastfeed them.Putting babies on formula, giving sugar water or pacifiers can make it more difficult to establish nursing. Having medical personnel who know something about nursing can help facilitate it. Formula is great for those who can’t breastfeed, or work in countries with clean water and heat in their homes, but aggressive marketing has killed many babies.

      • Daleth

        show that breastfeeding reduces infant mortality… It even prevents it in developed countries

        Do you know what the difference is between association (a.k.a. correlation) and causation? FYI I’m not being snarky or sarcastic at all (I’m just clarifying that since there’s no tone of voice on the web).

        The reason I ask is that the studies you posted do not say what you think they say. The second one, for instance, does not say anything about BF’ing “preventing” or “reducing” infant mortality (i.e. causing a decrease in infant mortality). It just says, and this is a quote, “Breastfeeding is associated with a reduction in risk for postneonatal death.”

        Here are a few other things that are “associated with” or “correlated with” each other:

        The presence of a large number of firefighters at a fire is associated with an increase in the risk of severe property damage and loss of life. That’s true, but it doesn’t mean that more firefighters CAUSE property damage or death.

        Smaller hands are associated with a reduction in risk for early death. Again, true, but not because larger hands cause early death–it’s because women have smaller hands than men, and also tend to live longer.

        In New York City in the 1980s, a study on crime showed a strong correlation between the crime rate and the amount of ice cream sold by street vendors. Again, true–but there’s still no causative relationship here: ice cream sales didn’t cause crime and crime didn’t cause ice cream sales. What caused BOTH was a completely separate thing: summer. In the summer, both crime and ice cream sales go way up.

        Correlation or association does not show causation. With breastfeeding studies, the biggest problem is that these days in the US and Europe, there’s a big socioeconomic difference between moms who decide to breastfeed and those who don’t. Is the mom white, college educated and upper middle class? She’s probably going to breastfeed. Are any of those things (race, class etc.) not true? The more different the mom is from that profile, the less likely she is to breastfeed.

        So when you do a study like that, you’re not comparing equivalent populations. You’re literally comparing executives, lawyers, college professors and their babies to janitors, bus drivers, nurses’ aides, unemployed women and their babies. You’re comparing a healthier, richer population that lives in safer environments to an unhealthier, poorer one that lives in less safe environments.

        The second study you posted recognized that problem: “the effects of breast milk and breastfeeding cannot be
        separated completely from other characteristics of the mother and child.”