Breastfeeding policy is tainted by bias


Hundreds of women are venting their fury on my Facebook page. Why? It isn’t merely because I have spent World Breastfeeding Week 2018 challenging their cherished belief in the perfection of breastfeeding. It’s because I’m raising doubt about their conviction in their own minds.

Nearly all of the touted benefits of breastfeeding are based on predictions made by extrapolating from small studies. The predictions often take the form of how many lives would be preserved, how many cases of serious illness would be averted and how many healthcare dollars would be saved if only the breastfeeding rate were higher. I’ve had the temerity to point out that breastfeeding rates in the US have risen dramatically since their nadir of 24% in 1973, yet NONE of the predicted benefits have occurred. Many have searched for data to rebut this claim but to their shock and horror have found that the predicted benefits of breastfeeding have indeed failed to appear.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding policy has been determined by biases that have nothing to do with actual science — bias toward the natural, anti-corporatist bias and anti-feminist bias. [/pullquote]

In their fury, they’ve accused me of being biased. I must be anti-breastfeeding, though I breastfed my four children. I must hate breastfeeding although it’s hardly hateful to point out that breastfeeding has failed to live up to the claims made on its behalf. Most egregiously, I must be in the pay of formula companies. No one has any evidence for that libel; I don’t receive any industry money from anyone.

In response they keep citing the same faulty studies whose predictions have failed to occur. Or they advance the logical fallacy of arguing from authority, insisting that if the WHO, UNICEF, the American Academy of Pediatrics, and various other health organizations claim that breastfeeding is superior, then it must be superior.

What they fail to realize is that contemporary breastfeeding policy is tainted by three specific kinds of bias: cognitive bias, anti-corporate bias and anti-feminist bias.

Cognitive bias

The belief in the innate superiority of breastfeeding has its intellectual root in the naturalistic fallacy, the belief that anything natural must be superior. This bias toward the natural is specific to Western cultures of the late 20th and early 21st Centuries. Prior to that, the same cultures exhibited a pronounced technological bias. That’s part of the reason why infant formula became so popular in the first place; in the early 20th Century all technology was viewed as inherently superior simply because it was an innovation. But neither is inherently superior. The relative value of the natural vs. the technological varies with the circumstances.

But cognitive bias toward breastfeeding is so strong that it led to publication bias. The aim of nearly all breastfeeding scientific literature is to validate the belief that breastfeeding must be better, not to test it. Most of the breastfeeding scientific literature is produced by partisans in journals that are edited by partisans. I am aware of researchers who cannot get their scientifically accurate papers published because calling the purported benefits of breastfeeding into question produces cognitive dissonance among those who have staked their scientific careers on the supposed superiority of breastfeeding.

Anti-corporatist bias

Breastfeeding policy is rooted in anti-corporatist bias toward Nestle and other formula companies. Don’t get me wrong, Nestle and other formula companies DID engage in unethical behavior in Africa by luring women away from breastfeeding even though they lacked access to clean water with which to prepare formula. The result was the death of tens of thousands of babies.

But what got lost in the righteous anger toward Nestle’s behavior is that there was NEVER anything wrong with formula itself; the problem was the water used to prepare it. All the African babies who died would have lived if Nestle had provided clean water along with powdered formula. No matter; formula itself was demonized and a series of draconian advertising restrictions instituted specifically to punish formula companies. Bias toward Nestle was transmuted to bias toward its completely safe, perfectly healthy product.

This anti-corporatist bias is a form of white hat bias:

‘White hat bias’ [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors…

But bias in the service of righteous ends is still bias and bias has no place in scientific research or policy.

Anti-feminist bias

La Leche League and its daughter organizations have been the prime movers in ALL breastfeeding policy in the past 35 years. They lobbied the WHO/UNICEF to punish Nestle and other corporations and to demonize formula in the process. But LLL always had another agenda entirely. It was created by religious traditionalists to promote breastfeeding as a means of forcing working mothers back into the home.

In the book La Leche League: At the Crossroads of Medicine, Feminism, and Religion, Jule DeJager Ward explains that LLL was founded as a backlash to the emancipation of women:

[A] central characteristic of La Leche League’s ideology is that it was born of Catholic moral discourse on family life … The League has very strong convictions about the needs of families. These convictions are the normative heart of its narrative… The League’s presentations and literature carry a strong suggestion that breast feeding is obligatory. Their message is simple: Nature intended mothers to nurse their babies; therefore, mothers ought to nurse…

The original goal of LLL was to convince women that their primary purpose in life was to use their reproductive organs rather than their intellect or talents. It has succeeded beyond its wildest dreams. Now there are women who actually claim that the decision to breastfeed is feminist when it is nothing more than biological essentialism. And it has produced a cadre of lactivists — women who define both themselves and other women by how they use their breasts. Because breastfeeding has become part of lactivists’ self-image, any suggestion that it is less than immensely beneficial produces profoundly uncomfortable feelings of cognitive dissonance.

The bottom line is that breastfeeding policy has been determined by biases that have nothing to do with actual science — bias toward the natural, anti-corporatist bias and anti-feminist bias.

Pointing out that breastfeeding has failed to deliver its predicted benefits isn’t hating breastfeeding; it’s simply loving truth more than comforting biases.