Insufficient breastmilk is a relatively common condition affecting up to 15% of first time mothers attempting to initiate and maintain breastfeeding.

Lactation professionals are notoriously poorly informed about this risk of exclusive breastfeeding, many insisting that it is only the “rare” mother who has insufficient supply. Furthermore, breastfeeding professionals insist or imply that the benefits of breastfeeding outweigh the risks of infant weight loss and its complications. They are dead wrong.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It is more important to preserve a baby’s brain function than a breastfeeding relationship.[/pullquote]

A new paper, Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration, published in the journal Breastfeeding Medicine reveals the potentially devastating consequences of newborn dehydration.

The authors explain the nature and magnitude of the problem. Physiologic weight loss often occurs in the first few days but should be resolved by the end of the first week.

• If weight loss continues beyond the first week or if weight loss is rapid (more than 2% of neonates weight in each day), insufficient breastmilk should be suspected.
• Neonatal dehydration is almost entirely a phenomena of insufficient lactation and does not occur in the bottle fed child.
• The incidence of NHD has been reported to be 1-3%.
• Initially there are few symptoms, so it is often overlooked.
• The hypernatremia [elevated salt level] and weight loss due to inadequate milk intake in breastfed infants may ultimately cause severe complications such as stroke and intracranial hemorrhage.
• The incidence of NHD has increased in recent years.

The authors looked at 65 infants who had been admitted for neonatal hypernatremic dehydration and compared them to a control group of 65 breastfed infants. What did they find?

The most prevalent sign in infants of case group in our study was weight loss…

We found a significant positive relationship between the severity of weight loss and severity of hypernatremia. In studies by Moritz there was also a positive association be- tween severity of weight loss and severity of hypernatremia. So it seems that early detection of weight loss in neonates can prevent severe weight loss and severe hypernatremia. Uras et al. found that a weight loss of greater than 7% of birth weight was also associated with an increased risk of hypernatremia…

The importance of frequent neonatal weighing during their first week of life to prevent excessive weight loss and its complications is clearly evident.

Neonatal hypernatremic dehydration can be deadly:

In our study 7 out of 65 patients died as a result of complications of hypernatremia. There was a significant correlation between severity of hypernatremia and mortality (p = 0.001). All who died had serum sodium concentration >160 mmol/L.

But even when there were no obvious short term consequences to neonatal dehydration, the longterm consequences could be severe.

All infants in the control group were developmentally normal at ages 6 and 12 months, but in the case group 25% and 21% had developmental delay at 6 and 12 months, respectively. At 18 months the incidence of developmental delay was 3% for the control group and 19% for case group, and at 24 months 12% of case infants had developmental delay versus none for the case group. At the age of 6 months, the severity of developmental delay was directly related to the severity of hypernatremia ( p = 0.001)…

Long-term neurologic delay means that the child at the age of 2 years had developmental retardation of at least two from four Denver (gross motor, fine motor, speech, and Social). For example, baby at 2 years has a delay in speech, impaired walking, and seizures.

Looking back at initial brain CT scans, the authors found:

CT scan was performed in 39 of the cases. The results showed 5 cases with bleeding (12.8%), 29 healthy (74%), and 5 cases with cerebral edema. CT scans were performed in the second to fourth day of treatment.

They comment:

The higher prevalence of intracranial complications in our study may be due to the more severe hypernatremia and also late presentation of our patients. It has been reported previ- ously that a serum sodium concentration concentration ≥158mmol/L is associated with a high mortality rate. Acute brain injury is reported in 8% of patients with hypernatremia. Increased serum osmolality due to hypernatremia can cause brain in- jury with widespread hemorrhage, thrombosis, and subdural effusion, which lead to death or permanent neurologic sequelae…

The take home messages from this study:

• neonatal hypernatremic dehydration is common
• weight loss is a critical prognostic sign
• frequent weights are crucial to diagnosing the problem early before severe complications can occur
• Neonatal weight loss after the first few days is NOT normal and is a cause for significant concern and aggressive monitoring

Early supplementation is the key to reducing the risk of neonatal hypernatremic dehydration. Lactation professionals insist that supplementation can ruin the breastfeeding relationship; that’s not true but even if it were, dehydration can ruin the baby’s brain.

When it comes to the relative importance of the two, there is no contest.

That woman is not too bright, sorry to say. She has no credentials, her sources are limited and biased, and she is obviously just trying to reason away her own guilt for not breastfeeding …

No, that lactivist is not talking about me. She’s talking about Charlotte Faircloth, another professional who pointed out that the benefits of breastfeeding are far smaller than what advocates claim. Faircloth discusses this response in her paper ‘What Science Says is Best’: Parenting Practices, Scientific Authority and Maternal Identity.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists don’t read scientific papers, don’t know what they show and don’t care anyway.[/pullquote]

Faircloth explains the meaning of “the science” to lactivists and the paradoxical invocation of scientific evidence by women who are just as likely to ignore science when they feel like it.

Simply put, lactivists don’t read scientific papers, don’t know what they show and don’t care anyway. “The science” is simply a convenient cudgel which lactivists use to metaphorically hammer away at women who do not follow their example:

The scientific benefits of breastfeeding and attachment parenting serve as a (seemingly) morally neutral cannon about which mothers can defend their mothering choices and ‘spread the word’ about appropriate parenting. I noticed that for some particular women, sharing ‘information’ with other mothers … was a source of great enjoyment – as Felicity in the quote above puts it, she is ‘super empowered’ with the knowledge that she has. Amelia, cited above, also said that she felt ‘like a genius on a planet of idiots.’ Any criticisms she has of other women are de-personalised, because science ‘has no emotional content…’

“A mother describes how she responds to those who criticise her decision to breastfeed her son until his seventh birthday, by saying: ‘I mean, do you want to see studies? Because I can show you studies!’ There are laughs and cheers from the rest of the group.”

But lactivists, who have basically no idea what the actual scientific evidence shows, use “the science” in another way:

Arguably, ‘science’ here is not about understanding, but belief. The use of ‘evidence’ has reached the level of the quasi-religious; not in the sense that the beliefs are other-worldly (quite the opposite) but that they are held to be beyond the possibility of doubt and revered as truth.

In other words, belief is described as “science” in order to trade on the reputation of science. As Faircloth notes:

In many ways, however, it is ironic that my informants refer to science, since many attachment parenting advocates are openly sceptical about scientific knowledge… What is interesting then, is the selective use (and mis-use) of scientific evidence to support certain (moral) discourses about parenting. (my emphasis)

Appeals to “the science” are a rhetorical strategy, and a rather cynical one at that. The very same people who ignore the scientific evidence on the dangers of homebirth, who openly spurn the World Health Organization recommendations on vaccination, and who dismiss the scientific evidence on circumcision by insisting it is only relevant in the developing world choose to misinterpret and misuse the scientific evidence on the limited benefits of breastfeeding.

This cynical misuse of science finds ultimate expression in public health campaigns to promote breastfeeding. That’s why these campaigns continue even though they have been failure on their own terms. The activists who create them, run them and promote them are far more interested in promoting their personal beliefs than in increasing breastfeeding rates.

In Faircloth’s words “sharing ‘information’ with other mothers … was a source of great enjoyment.” That’s because lactivists are not “sharing,” they are browbeating other women as a method of enhancing their own self esteem. As Faircloth notes:

When ‘science’ says something is healthiest for infants, it has the effect, for [lactivists], of shutting down debate; that is, it dictates what parents should do.

Critically, for lactivists, it allows them to “moralize” the choice of infant feeding. In the minds of lactivists, “the science” turns breastfeeding from a choice to an obligation, the classic is-ought confusion.

… [U]nder the assumption that science contains ‘no emotional content’, a wealth of agencies with an interest in parenting – from policy makers and ‘experts’ to groups of parents themselves – now have a language by which to make what might better be termed moral judgements about appropriate childcare practices. [But] ‘Science’ is not a straightforward rationale in the regulation of behaviour, rather, it is one that requires rigorous sociological questioning and debate in delimiting the parameters of this ‘is’ and the ‘ought’.

Hence the example with which the piece began, the vituperation directed at Faircloth for pointing out that the scientific evidence on breastfeeding is rather weak, and, at best, shows only a small, limited benefit. Lactivists responded with anger because their own self conception and their ability to feel superior to other women rests on presenting “the science” as firm, strong, unequivocal and dispositive. In the case of breastfeeding, it is none of the above.

The only thing that has changed since this piece first appeared in March 2011 is that more purported benefits of breastfeeding have been debunked while other soon to be debunked benefits have been proposed.

Imagine a natural disaster: flood, fire, hurricane, blizzard. Or, if you prefer, imagine a manmade disaster: a terrorist attack, a power grid failure, a nuclear explosion deliberate or accidental. Imagine the death, injury, destruction, fear and misery.

What would be your first priority if you were caring for those people? It wouldn’t be promoting breastfeeding, unless you were mad as a March hare — or a UK lactivist.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Disaster planning for lactivists: prevent formula donations.[/pullquote]

Breastfeeding Trends UK just released a position paper entitled Protecting Babies in Emergencies. The ugly truth, however, is it is NOT about protecting babies; it’s about protecting breastfeeding.

UK lactivists are forever bemoaning the “dismal” state of breastfeeding in the UK, as if that has anything to do with infant health. As they never tire of telling us, less than 0.5% of UK babies are breastfed to a year of age. Nonetheless, the UK infant mortality rate is 3.6/1000, the lowest ever for the UK and among the lowest in the world.

Since — as they never stop lamenting — the UK breastfeeding rate is very low, you might think that a document that focused on protecting babies in the event of a disaster would focus on making sure that there is an adequate supply of formula and clean water with which to prepare it. You would be wrong. In a 1250 word document, only two sentences are devoted the vast majority of babies who might be affected:

Babies who are fully or partially formula fed are at risk if their caregivers lose access to clean water, are unable to sterilise feeding equipment or suffer disruption or contamination of their formula milk supplies. A suitable environment for preparation and storage of feeds, sterilising equipment, boiling water and safe storage such as a refrigerator, are all needed to prevent bacterial contamination.

The bulk of the position paper — I’m not making this up — is devoted to preventing worldwide donations of formula!

In the absence of guidance, agencies responsible for co-ordinating emergency response and volunteers working on the front line are often not aware that donations of formula milk can put babies at risk. Risks from donated formula milk include inadvertently distributing products that are unsuitable for babies under six months or for babies with special nutritional needs, as well as distributing milk that is contaminated or out-of-date.

Because in the wake of a nuclear holocaust when babies are dying in droves the last thing we should countenance is using formula after the sell by date.

What do these lactivists fools imagine will happen if there are no formula donations? Potentially tens of thousands of babies might die but apparently they’re expendable because they’re formula fed.

Lactivists, as always, are only concerned with promoting breastfeeding, not saving lives. They’re honest about their real anxiety:

There is also a risk that donations will be inappropriately provided to parents of breastfed babies, which can undermine the protective effect of breastfeeding and cause parents to become dependent on a continued supply of formula milk.

Sure, when formula fed babies are dying from lack of formula, and their mothers are rioting for lack of formula, aid workers will be spending their time searching for the tiny minority of breastfeeding women so they can tempt them away from breastfeeding with free formula. UK lactivists have officially lost their minds.

And what do these geniuses propose to do for breastfed babies whose mothers die during the natural disaster. Evidently it never occurs to them that a lactating mother can be injured or killed, cutting off her infant’s supply of food. Maybe they think “magical” benefits extend to preventing deaths of breastfeeding mothers. Or maybe they think once a breastfed baby is no longer breastfeeding, they’re expendable, too.

Their “guidance” in the event of a disaster is not focused on saving babies; it’s focused on saving breastfeeding … and employing lactation consultants:

…If breastfeeding helpers are not pre-authorised as part of planned disaster response the immediate help that families need can be delayed.

It gets worse:

• …Local emergency planning should have identified appropriate infant feeding support from local health and voluntary services. There are telephone helplines which support caregivers with all aspects of infant feeding:NCT helpline (0300 330 0700)
  The Breastfeeding Helpline (0300 100 0212).
• DO encourage donations of money to recognised agencies so that parents, caregivers and agencies can buy any formula or supplies needed, rather than donations of formula products…
• DO ensure that formula milk is purchased and distributed only for babies who need formula milk, following basic screening of families …
• DO NOT distribute formula milk in an untargeted way.

Do these women even hear themselves?

Basic human ethics demands that we try to save the majority of babies LIVES. In a country where very few women breastfeed that means maintaining a large and ongoing supply of formula and clean water to prepare it. Whatever way that can be accomplished most effectively in the wake of a disaster — and formula donations may be an effective way of accomplishing it — should be undertaken.

Anyone who stands in the way of making sure that as many babies as possible are fed, regardless of how they are fed, is deluded at best and monstrously self absorbed at worst.

Because the incontrovertible truth, especially during a disaster, is Fed Is Best!

Antivax conspiracy thinking has become a serious public health problem. Vaccine preventable diseases, along with the illness, injury and death that they cause, are making a comeback.

Antivaxxers like to portray themselves as possessors of secret knowledge about vaccines. In truth, they don’t have secret knowledge; they have deficient knowledge. In addition, conspiracy theories are less popular among those with higher levels of education. Yet efforts to fight antivax sentiment with accurate information have been notoriously ineffective. That’s because antivax, like most conspiracy theories, isn’t about the subject of the conspiracy; it’s about the psychology of conspiracy believers.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The typical antivaxxer is someone with limited higher education, low sense of control and low social standing.[/pullquote]

Antivaccine conspiracies meet certain specific needs of believers. Inaccurate information can be swept away by accurate information, but unmet psychological needs are, not surprisingly, impervious to accurate information. Hence those charged with keeping the public healthy have an urgent obligation to understand the psychological needs that drive antivax conspiracies.

A new paper in the journal Applied Cognitive Psychology by Jan-Willem van Prooijen attempts to describe those needs. The title is Why Education Predicts Decreased Belief in Conspiracy Theories. It is about conspiracy theories in general, not antivax conspiracies in particular, but antivax conspiracies are in many ways paradigmatic.

Van Prooijen writes:

One demographic predictor of belief in conspiracy theories is education level. Various studies revealed that high education levels predict a decreased likelihood that people believe in conspiracy theories. What is unclear, however, is why this relationship emerges. Education is associated with a range of cognitive, emotional, and social outcomes, and hence, there may be multiple underlying processes that explain this relationship. Establishing these underlying processes provides novel insights that may form the basis for future interventions designed to systematically decrease conspiracy beliefs among the population.

He identifies three underlying processes that lead to belief in conspiracy theories: “belief in simple solutions for complex problems, feelings of powerlessness, and subjective social class.”

1. Cognitive complexity:

Education is associated with cognitive complexity, defined here as people’s ability to detect nuances and subtle differences across judgment domains, along with a tendency to consciously reflect on these nuances. People with high cognitive complexity are better equipped to attain high education levels; moreover, education nurtures and develops such complexity.

As H. L. Mencken explained:

For every complex problem there is an answer that is clear, simple, and wrong.

Van Prooijen notes:

The seemingly articulate nature of some conspiracy theories notwithstanding, these findings are consistent with the assertion that conspiracy beliefs are grounded in a general tendency to embrace relatively simplistic ideas… [C]onspiracy beliefs are strongly associated with a belief in simple solutions for complex societal problems.

Though antivaxxers are not children, their thinking is very childlike: A happened, then B happened; therefore A must have caused B.

2. Control:

People are particularly receptive to conspiracy theories when they lack control, and hence feel powerless. Lacking a sense of control leads to mental sense-making in the form of illusory pattern perception, that is, connecting dots that is not necessarily connected in reality. These sense-making activities are central in belief in conspiracy theories, which are designed to increase understanding of a distressing situation… [P]eople are most likely to believe in conspiracy theories in response to distressing societal events that they cannot control …

In other words, belief in conspiracy theories gives a sense of control to people who otherwise view themselves as powerless. That sense of powerlessness is exacerbated by lack of education:

Throughout an educational trajectory, people learn how to independently solve problems, and they acquire the social skills that are necessary to influence their social environment. It has been noted that, as a consequence, education makes people feel more strongly in control of their life and their social world, thus decreasing feelings of powerlessness …

3. Social standing:

Education influences people’s social standing relative to others, both in objective as well as subjective terms. Education is intimately related with people’s objective social standing in terms of socio-economic status (SES): People with high education are more likely to occupy the relatively privileged positions in society in terms of desirable jobs and high income…

…[F]eelings of societal marginalization are relevant for people’s susceptibility to conspiracy theories. Research indicates that communitarian but marginalized groups within society tend to make sense of the realistic problems that their group faces through assumptions of conspiracy formation (Crocker et al., 1999). In a similar vein, subjective low social class may lead people to blame the psychological or realistic problems that they face (e.g., alienation from the societal elite, unemployment, and relative deprivation) to the existence of malevolent conspiracies.

With these factors we can define the typical antivax conspiracist as someone with limited higher education, low sense of control and low social standing. Those factors cannot be addressed by merely offering accurate information. How can we address them?

Van Prooijen has recommendations for improving children’s critical thinking skills:

… [B]y teaching children analytic thinking skills along with the insight that societal problems often have no simple solutions, by stimulating a sense of control, and by promoting a sense that one is a valued member of society, education is likely to install the mental tools that are needed to approach far-fetched conspiracy theories with a healthy dose of skepticism.

But what about adults? That’s much more difficult because antivax functions for antivaxxers to enhance their sense of control and social standing. That’s why they are constantly parachuting into science websites and Facebook pages and — without any sense of irony — announce that they are going to educate the other readers who are generally far more educated than they.

Since the primary function of antivax for antivaxxers is to bolster their ego, it seems to me that the most effective strategy would be directed against their egos.

It’s been done before, most notably in the cases tobacco smoking and of drinking and driving. Smoking was once seen as sophisticated; now it is viewed as dirty and unhealthy. Smoking used to enhance the egos of those who smoked; it no longer does. Drinking and driving used to be viewed as inevitable and worth boasting about. Spurred in large part by campaigns mounted by Mothers Against Drunk Driving (MADD) and similar organizations, drunk driving went from being viewed as benign to utterly socially unacceptable. Driving while drunk used to have a positive or no impact on ego. Now it is a source of guilt and social opprobrium.

We should embark on a similar “makeover” for anti vaccine advocacy. When refusing to vaccinate is widely viewed as selfish, irresponsible, and the hallmark of being UNeducated, anti-vax advocacy will lose its appeal.

It’s truly one of the great existential questions of the 21st Century. Which is greater: antivaxxers stupidity or their heartlessness?

Antivaxxers latest attempt at “reasoning” involves viciously attacking a mother whose baby died of suffocation, claiming that it must have been a vaccine injury instead.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaxxers demonstrate their derangement.[/pullquote]

As this article on Romper explains:

On the morning of July 3, Jordan DeRosier posted on Facebook that her infant son, Sloan Valor DeRosier, had unexpectedly died. She wrote a touching message …

One day later, DeRosier shared her son’s cause of death on Facebook. Not because she wanted to, but because she wanted her followers and those who commented on her post to know the correct circumstances that led to Sloan’s death. And vaccines were not to blame.

DeRosier bravely explained:

He was last laid down to bed with this blanket made by his great-great grandmother, and one other blanket, a grey one he had been attached to since birth. They took the grey one he had been found with his head in. He had pulled it through the crib rails somehow and gotten himself stuck in it. You never think it will happen to you. You never think it will be your baby. Please do not put your babies to bed with a blanket. Please. He was 7 months old, I thought because he was crawling, standing on his own, and climbing, that he would be fine with a blanket. This is the face of immense, unfathomable grief, the face of longing, of heartbreak, of self inflicted GUILT. I will NEVER stop feeling responsible. I will relive this for the rest of my life knowing EXACTLY what I could have done differently. Please learn from my world shattering mistake.

That’s why we counsel parents about safe sleep practices, including:

• Always put babies on their back to sleep for naps and at night…
• Keep babies near, but in their own crib …
• Don’t let baby sleep or nap in the same bed with anyone else … Another person, no matter how small, could roll over and smother the baby.
• Use firm mattress and a tight-fitting sheet in your baby’s crib…
• Don’t put toys, blankets, pillows, or bumper pads in the crib. These things could make it hard for your baby to breathe.

It couldn’t be clearer; blankets pose a suffocation hazard to babies. The mother put the baby to sleep with a blanket; the baby was found suffocated with his head trapped in the blanket. It’s tragically straightforward.

But not according to antivaxxers:

The grieving mother wrote:

To those who keep commenting and messaging trying to blame vaccines for our sons [sic] death- stop… I will not allow anyone to try and place blame where it does not belong.”

How did antivaxxers “reason” their way to blaming vaccines? In theIf fervid, conspiracy obsessed minds, the “logic” is obvious. A vaccinated baby died; the death must therefore have been caused by vaccines. Never mind that there was no temporal association with vaccination; never mind that the baby was trapped in the blanket; never mind that the baby died of suffocation, not fever or encephalopathy.

It’s yet another example of the breathtaking stupidity of antivaxxers, but it is also an example of their mind boggling heartlessness. How vicious do you have to be to write to a grieving mother in the wake of her baby’s death in order to promote your favorite conspiracy theory? Who does that? Only people who are desperate for validation of their stupidity.

No doubt the antivaxxers thought they were sharing their knowledge. In reality they were merely demonstrating their derangement.

Natural parenting advocates in general, and anti-vaxxers in particular, are certain about one thing: if it’s natural it must be nearly perfect.

Breastmilk is “best” because it is naturally made by the human breast.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There is one human organ that does not receive the same respect as all the others: the human brain.[/perfectpullquote]

Childbirth pain is good for women because it occurs naturally in labor.

Childbirth itself is inherently safe because women were naturally “designed” to give birth.

Natural immunity is all we need to protect ourselves from disease (despite the fact that reliance on natural immunity leads to countless preventable deaths) simply because it is natural.

If natural is better — and it is always “better” — then the product of the human breast, the workings of the human uterus, and the disease fighting attributes of the human immune system must be superior.

Curiously, there is one human organ that does not receive the same respect as all the others; instead of being lauded, its products are derogated. It’s the human brain.

Despite the fact that the human brain is entirely natural, it’s workings are routinely disparaged as unnatural. This disparagement is particularly ironic when you consider that the human brain is the ultimate human organ.

The brain, more than any other organ, has allowed human beings to survive and thrive in a world where its closest hominid relatives became extinct long ago. Tool making hominids vanquished and/or outlasted all other hominid species. The human brain has allowed us to do something that no other large animal species has ever done: survive and thrive in nearly every earth environment.

Curiously, we do appear to appreciate the workings of the brains of other animals. We marvel that chimps construct tools to dig bugs out of rotting logs; we thrill to video of dolphins that have learned to work together, rounding up fish and herding them toward shore to eventually beach them, making it impossible for the fish to escape and easier for the dolphins to eat them; and we ponder the complex underwater communication of whales. All these are products of the animals’ brains and we don’t accuse those animals of behaving unnaturally when they use their brains to solve problems instead of relying on instinct and other organs.

So why have we created a false dichotomy when it comes to the human body and brain? Why do we venerate breastmilk as the natural product of the human breast, but denigrate infant formula despite the fact that it is the natural product of the human brain? Why do we extoll women who passively accept the pain of labor because it is a natural result of the working of the human uterus, but deride women who use epidurals — a natural product of the human brain — as selfish wimps? Above all, why do the antivaxxers among us extoll the limited virtues of natural immunity, the natural product of the human immune system, and deny the unlimited virtues of vaccines, the product of the natural human brain?

The truth is that vaccines, the fruit of years of scientific inquiry conducted entirely by human brains, are perhaps the paradigmatic example of natural humans doing what they do best — recognizing a problem and then using tools to solve it.

Help me understand, antivaxxers: why you practically worship every organ in the human body for what it was “designed” to do, routinely insisting that the products of each organ system are virtually perfect, yet disparage the natural products of the human brain doing what it was designed to do? When you consider that the human brain is our most distinguishing natural feature, how could one of its most spectacular products, vaccines, be anything other than natural and therefore great?

Most of the evidence for the purported benefits of breastfeeding for term infants is weak, conflicting and riddled with confounders … not to mention distorted by white hat bias. Time and again, rigorous studies have failed to confirm the breathless pronouncements of lactivists. Now a new study shows that far from preventing childhood obesity, breastfeeding seems to increase it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Yet another claim of lactivists is demonstrated to be false.[/pullquote]

The title of the study published JAMA Pediatrics is a mouthful: Effects of Promoting Long-term, Exclusive Breastfeeding on Adolescent Adiposity, Blood Pressure, and Growth Trajectories A Secondary Analysis of a Randomized Clinical Trial.

This analysis found:

A randomized intervention that increased the duration and exclusivity of breastfeeding was not associated with lowered adolescent obesity risk or BP. On the contrary, the prevalence of overweight/obesity was higher in the intervention arm…

It is a secondary analysis of data derived from the PROBIT studies, long considered some of the gold standard studies in breastfeeding research.

The Promotion of Breastfeeding Intervention Trial (PROBIT) was designed to overcome limitations inherent in observational studies of the long-term effects of breastfeeding on child outcomes including adiposity and blood pressure. We cluster-randomized 17 046 children from 31 clinics, born between 1996 and 1997, to either a control arm or breastfeeding promotion intervention (based on the World Health Organization and United Nations Children’s Fund Baby-Friendly Hospital Initiative).

The initial data from the studies found that the only solid evidence of benefit from breastfeeding was limited to a slightly reduced incidence colds, and a slightly reduced incidence of episodes of diarrheal illness across the entire population of term infants in the first year. But lead researcher Dr. Michael Kramer believed that the data suggested that breastfeeding might have a beneficial effect on IQ and obesity.

Subsequent data from his studies and others has caused him to change his mind about breastfeeding and obesity. The data is consistent with Kramer’s previous observations:

We previously reported no evidence of a protective effect of the breastfeeding intervention on adiposity or BP at 6.5 and 11.5 years.

So one of the original proponents of the claim that breastfeeding prevents obesity found out years ago that it does not and is now emphatic in denying a connection:

An intervention that achieved substantially greater duration and exclusivity of breastfeeding in Belarus did not prevent over-weight or obesity or lower BP levels at age 16 years, despite differences in growth rates between the trial arms at various ages. On the contrary, overweight and obesity were more prevalent in the breastfeeding promotion intervention arm. While there are many reasons for promoting breastfeeding duration and exclusivity, our trial does not indicate that breastfeeding prevents obesity or lowers BP in childhood or adolescence.

Dr. Kramer does nevertheless engage in a bit of white hat bias. Had his data shown a decrease in risk of obesity in the group that was breastfed longer he almost certainly would have claimed that breastfeeding prevents obesity. But in keeping with the white hat bias of all breastfeeding researchers (that breastfeeding must be better than not breastfeeding) he does not follow where the data leads him: the possibility that breastfeeding causes obesity. I point this out not because I believe that the evidence shows that breastfeeding causes obesity (although it might), but because it highlights the profound bias in favor of breastfeeding within the scientific community.

Kramer himself has long been far more sober about the purported benefits of breastfeeding than many other lactivists.

In a 2016 interview on Canadian radio, Kramer was 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 explained that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He was 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.

In the interview Kramer was refreshingly honest in acknowledging that public health officials underestimate the difficulties of breastfeeding. When asked whether the public health community can present the actual scientific evidence instead of the selected evidence that it prefers to present, he ruefully explained that “no one likes shades of gray,” preferring black and white pronouncements instead.

Breastmilk is food not magic.

Sadly breastmilk has been turned from food into manipulation. Lactivists and their organizations, especially the Baby Friendly Hospital Initiative, have made the harassment, inconveniencing and embarrassment of women a cornerstone of their efforts to promote breastfeeding. As Kramer himself acknowledges, most of their claims are empirically false and their efforts are beginning to backfire.

Michael Kramer, the person whose research led to the claim that breastfeeding reduces the risk of obesity, has officially withdrawn that claim. Does anyone want to bet against me when I predict that lactivist organizations will ignore the latest evidence and refuse to remove the claim from their websites and educational materials?

Lactivist organizations are certain that breast is best even when the evidence not only doesn’t support their claims but actually contradicts them. Regrettably, they are so sure of their own righteousness that they have become entirely unmoored from scientific evidence. Mothers and babies are placed at serious risk, under significant pressure, and with deadly consequences as a result.

There once was a time when all babies were breastfed … and they died in droves

You might think that people would reflect on this before promoting breastfeeding as a lifesaving panacea. Sadly, you would be wrong.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s an appalling presumption that only Western, well off, mostly white women know how to do breastfeeding right.[/pullquote]

The latest example, Breastfeeding Could Save 800,000 Children a Year, appears under Nicholas Kristof’s byline but was written by Aneri Pattani, “a freshly minted graduate of Northeastern University, is the winner of Nicholas Kristof’s annual win-a-trip contest.” She visited Nigeria.

She certainly means well:

While traveling around Liberia, I discovered a super-medicine. In a world full of intractable health problems, it’s a low-cost, practical and easily administered substance that saves children’s lives like almost nothing else.

… I’m talking about breastfeeding.

Breastfeeding is a foundation for good nutrition. It reduces child mortality by providing protection against illnesses like diarrhea and pneumonia, which kill 1.4 million children each year. In fact, by implementing proper breastfeeding practices alone, we could save the lives of 800,000 children a year in the developing world, according to estimates from the medical journal The Lancet.

Yet nearly all those children die in countries that have HIGH breastfeeding rates. Virtually none of them occur in places with clean water and easy access to infant formula.

Consider the United Kingdom where lactivists endlessly bemoan the low breastfeeding rate:

Only one in every 200 children here – just 0.5 per cent – is breastfed until the age of 12 months, placing us bottom of a global league table published in The Lancet medical …

The latest infant mortality rate in the UK — 3.6/1000 — is the lowest ever recorded.

Compare that to Liberia where over 98% of babies are breastfed for some portion of time. The infant mortality rate — 54/1000 — is 1400% higher than in the UK.

Why such a massive difference? As is distressingly typical in the neo-liberal accounting of health, Pattani blames mothers:

Myths and traditional customs often contradict best practices for breastfeeding… [M]any are also given water or solid food when they are young.

Yei Vahn, a 39-year-old mother of 12, told me she’d been giving her youngest son, Arthur, water since he was 4-months-old. “I noticed he would cry a lot when it was very hot outside, so I gave him water from the well,” she said. It’s a habit she developed while raising her 11 older children, and one that she passed on to her daughters as well.

The problem is, it is a dangerous practice. Giving a baby water, especially when it’s not boiled, can introduce harmful pathogens into the child’s system, leading to illness or death. That’s the most obvious problem, but not the only one.

It seems never to have occurred to Pattani that the traditional customs she decries might reflect very real problems with the adequacy of breastfeeding. Pattani is in good company. Though exclusive breastfeeding beginning within an hour of birth is aggressively promoted in industrialized countries, there’s no evidence that indigenous or ancient peoples followed what are now deemed to be “best practices.”

Pre-lacteal feeding (giving substances in addition to or instead of colostrum) is practiced worldwide. Indeed:

Colostrum avoidance has been reported across the globe, in varied places such as India, Nepal, Bangladesh, Indonesia, West Java, the Philippines, Vietnam, Thailand, Bolivia, Guatemala, Guinea-Bissau, Nigeria and Tanzania. Using the term ‘delayed breast-feeding’, Morse et al. found that fifty of 120 cultures described in the Human Research Area Files ‘withheld’ colostrum.

Obviously we cannot know the original reasoning behind the practice, but odds are high that it reflects the fact that 5-15% of women (or more) have insufficient or delayed production of breastmilk. Without supplements, those babies would have died of dehydration. With pre-lacteal feeds, babies lived who would otherwise have died. Over time, that observation was transmuted into a belief that colostrum was harmful and supplements were lifesaving.

The same reasoning may apply to supplementing breastfeeding with water or other substances. The mother quoted above (who has 12 children) explained that she supplemented with water because her baby cried for it when it was particularly hot. In other words, he appeared to her to be dehydrated and she couldn’t produce enough milk to prevent dehydration.

But Pattani, like most of those who promote breastfeeding as lifesaving, ignores reality in favor of blame:

The challenge for breastfeeding in very poor countries is not so much the use of infant formula, which is more of a problem in nations just a bit better off. In the poorest countries, very few have the money to buy formula.

Rather the problem is that breastfeeding isn’t done quite right. Moms delay breastfeeding after birth. They offer the baby sugar water or tea, cassava or fruit, well before six months — or they stick to exclusive breast milk too long.

A mother who has breastfed 12 children, comes from a culture where 98% of babies are breastfed, and has never been influenced by formula manufacturing isn’t doing breastfeeding quite right? Apparently only Western, well off, (mostly white) women know how to do breastfeeding “right.” The presumption is appalling.

No one seems to see what is right in front of their faces: it isn’t mothers who are deficient, it is breastfeeding. It is simply assumed that Liberian mothers who supplement are ignorant when the reality is more likely to be that breastfeeding is not the perfect process that lactivists pretend. Breastfeeding, like conception and pregnancy, is very imperfect. Infertility is far from rare and 20% of established pregnancies end in miscarriage. The rate of inadequate breastmilk supply may not be as high, but it’s high enough to cause significant rates of infant death. Supplementation is not an ignorant custom practiced by backward women, but a reasonable response to a very common problem.

Babies die because the water and other substances used for supplementation are contaminated (as they inevitably are in nature). Supplementation is a bad solution to a serious problem — insufficient breastmilk. Pattani, in company with most lactivists, simply assumes that all Liberian women could breastfeed exclusively, but choose not to do so. She further assumes that if women didn’t supplement (with contaminated water), their babies would be healthier. It is equally possible that their babies would be dead due to dehydration or starvation.

That’s why the Lancet’s claim that 800,000 lives could be saved each year if all women breastfed exclusively is both heartless and witless, not to mention unproven. The Lancet arrived at that figure by extrapolating from small studies. There is simply NO EVIDENCE that breastfeeding rates have any impact on infant mortality rates. And why would they? Breastfeeding didn’t prevent an astronomical infant death rate prior to the advent of sanitation, vaccinations and antibiotics. There’s no reason to think it would prevent astronomical death rates now.

The Lancet’s claim that breastfeeding could save 800,000 lives per year is wrong on so many levels. It is not supported by population data; it is not supported by historical evidence; and it is not supported by the fact that most babies die from causes that cannot be prevented or cured by breastmilk. But what bothers me most about the Lancet claim is its implicit medical colonialism: look at the poor women of color breastfeeding “wrong.” Watch their Western, wealthy (and mostly white) sisters “teach” them how to do breastfeeding right.

It is a terrible tragedy that Liberian babies are dying in such high numbers. But the truth is that they are dying for lack of access to formula made with clean water, lack of access to vaccines, lack of access to antibiotics, not from lack of access to breastfeeding. If we want to save those young lives we should send water purification facilities and clean water, vaccines and antibiotics, not lactivists pontificating about perfection of a process, breastfeeding, that is imperfect to a deadly extent.

Kimberly Sears Allers is shocked, shocked, that fear is being used in discussions of infant feeding.

Her piece on Lactation Matters, the blog of the International Lactation Consultant Association, is part of the new #FactsNotFear lactivist campaign created to combat the message of the Fed Is Best Foundation that breastfeeding has risks as well as benefits.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Lactivists are bewailing the very tactic that they pioneered, exploited and spent millions of dollars promoting.[/pullquote]

Sears writes:

But there is one place where fear should not exist. There is one area, where, as women and
mothers, that we should insist that fear not enter—that is in the precious act of feeding our babies…

That’s why a recent spate of fear-based marketing, particularly from the Fed Is Best Foundation, stoking fears that exclusive breastfeeding kills babies is both erroneous and irresponsible. But it is also the type of insidious marketing that preys on a mother’s existing insecurities that should make all women concerned…

Excuse me while I catch my breath from laughing so hard. Using fear to pressure women into breastfeeding is a deliberate tactic beloved of lactivists. Indeed, lactivists are now bewailing the very tactic that they pioneered, exploited and spent millions of dollars promoting.

Lactivists have been completely upfront about their use of fear to pressure women into breastfeeding. It was first articulated by lactation consultant Diane Weissinger in a seminal paper, Watch Your Language!, in 1996. It’s a blueprint on using fear to pressure women to breastfeed.

Weissinger saw a problem.  For many women, the benefits of breastfeeding simply aren’t great enough to overcome the difficulties and inconvenience:

When we … say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, “So what?” Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy and thus safety and adequacy-of artificial feeding …

She proposed that lactivists pressure women to breastfeed by promoting fear of the risks:

The mother having difficulty with breastfeeding may not seek help just to achieve a “special bonus”; but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial baby milk just “to get him used to a bottle” if she knows that the contents of that bottle cause harm.

For example:

…[B]reastfed babies are not “healthier” artificially-fed babies are ill more often and more seriously. Breastfed babies do not “smell better”; artificial feeding results in an abnormal and unpleasant odor that reflects problems in the infant’s gut.

Lactivists fully embraced fear based tactics for 20 years, until it turned out that breastfeeding has risks that women should fear — risks of dehydration, jaundice, starvation and death. In fact, we can point to literally hundreds of term babies injured annually by aggressive breastfeeding promotion, while we can’t find even a single term infant whose health has been substantially improved or whose life was saved by breastfeeding.

That’s why the hypocrisy of Sears Allers is so mind boggling.

Let’s face it, women are sold fear and anxiety as a marketing tool every day. In fact, the strategy, officially known in business circles as FUD—fear, uncertainty and doubt—was designed by an IBM executive decades ago to persuade buyers to feel “safe” with IBM products rather than risk a crash, virus or server disruption.

Let’s face it, women are sold fear and anxiety as a marketing tool by lactation consultants and lactivist organizations every single day. Lactivist tactics are a paean to FUD — fear, uncertainty and doubt. Women are told to fear the “risks” of formula feeding, to replace their conviction that their babies are starving on breastmilk with uncertainty about their own worth as women, and to doubt their ability to be good mothers if they don’t breastfeed.

Even while decrying fear based tactics, Seals Allers can’t stop resorting to fear based tactics:

The truth is, our bodies were uniquely made to feed the infants we create. Decades of scientific research proves that formula is nutritionally inferior to breastmilk.

The truth is that that our bodies were uniquely made to get pregnant, but that doesn’t prevent a nearly 20% infertility rate among couples; we’re uniquely made to carry babies to term, but that doesn’t prevent a natural miscarriage rate of 20%; and while we are uniquely made to breastfeed, that doesn’t prevent a high rate of infant dehydration, jaundice, starvation and death.

Seals Allers doesn’t hesitate to resort to claims contradicted by scientific evidence:

It’s no secret that, especially in the Western world, women already fear they will have insufficient milk. For some, this fear can become a self-fulfilling prophecy because fear and anxiety can literally limit lactation by stifling the letdown reflex that stimulates the milk glands.

There is no scientific evidence that fear of insufficient milk causes insufficient milk. Indeed, research shows that when women believe they have insufficient milk it’s because they do. In fact, new research shows that there may be a biomarker for low supply.

High levels of sodium in breast milk are closely associated with lactation failure. One study showed that those who failed lactation had higher initial breast milk sodium concentrations, and the longer they stayed elevated, the lower the success rate.

Another paper, The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern, published in April 2017 noted:

…[T]he observed prevalence of elevated Na:K was 2-fold greater in the mothers with milk supply concerns (42% vs 21%)… This result challenges the belief that milk supply concern in the context of exclusive breastfeeding is primarily maternal misperception. (my emphasis)

Sears Allers concludes her piece with a flourish of hypocrisy:

Ultimately, women deserve facts not fear. Women have a right to guilt-free, confidence-building information and support.

Women have the right to the truth and the truth is that breastfeeding has very real, deadly risks.

#FactsNotFear indeed!

Is there anything more emblematic of white privilege than medical colonialism?

Colonialism is the practice one country occupying another country or region and exploiting it for the benefit of the occupier. Medical colonialism is the practice of exploiting black bodies, knowledge and practices and co-opting them for the benefit of the well off white people.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”Invoking simple, contented black women who function based on instinct not intellect is racism, pure and simple.[/pullquote]

Classic examples of medical colonialism come, not surprisingly, from medicine. The Tuskegee experiments, when black men with syphilis were deliberately left untreated, are the most egregious example, but medicine has plenty more including the story of Henrietta Lacks and the use of her HeLa cells for research, and the work of gynecologist J. Marion Simms, who practiced on female slaves to perfect his techniques for repairing obstetric fistulas.

Lactivists have enthusiastically embraced medical colonialism and today’s piece on NPR is a paradigmatic example. Entitled Secrets Of Breast-Feeding From Global Moms In The Know, it romanticized the lives of “primitives” in order to justify the practices of the privileged.

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.”

And Himba women make breast-feeding look easy, Scelza says. They even do it while they’re walking around.

See the simple, contented black women who function based on instinct not intellect!

What’s their secret to instinctual breastfeeding? It’s the same as their secret to in homebirth. They and their babies die in droves.

According to USAID, the infant mortality rate in Namibia is 32.8/1000 and maternal mortality is 265/100,000. In the US, The infant mortality rate is 5.82/1000 and the maternal mortality rate is 26.4/100,000.

Their secret is that instinctual birth and instinctual breastfeeding leads to an infant mortality rate 450% higher than in the US (where we have easy access to formula) and 900% higher than in the US (where we have easy access to obstetric interventions).

It is reprehensible that the NPR article doesn’t even mention infant mortality, let alone address it, but it is typical of medical colonialism to ignore the appalling rates of suffering of black babies and mothers. Instead, we are treated to cluelessly racist “happy, simple black people” version of life in nature.

One idea is that the mom and her newborn have long, uninterrupted contact right after birth. Since women are at home, there are no doctors and nurses whisking the infant away for weighing, fingerprinting or tests. This contact allows the newborn’s suckling instincts to kick in, researchers have hypothesized…

Or maybe it’s because when limited to exclusive breastfeeding, babies just die.

The second hypothesis is that Himba women learn how to breast-feed throughout their childhood. Because women see their moms, siblings and friends breast-feed while growing up.

“Breast-feeding in public isn’t stigmatized at all,” Scelza says.

So by the time they have their own babies, Himba women know what to do and it appears instinctual. Here in the U.S. we hardly ever see mothers breast-feeding. So women never really learn.

Or maybe it’s because when limited to exclusive breastfeeding, babies just die.

Well, turns out both hypotheses aren’t quite right.

“I’m telling you that’s exactly what I thought was going on until I started to talk to Himba women,” Scelza says.

A few years ago, Scelza interviewed 30 Himba women in depth about their experiences breast-feeding, especially in the first few days after birth. And guess what? Himba women are a lot like American women…

Two-thirds of the women said they had some problems at the beginning, such as pain, fear, troubles getting the baby to latch and concerns about the milk supply — just like American moms…

“Most women talked about having little knowledge about early infant care, such as how to hold babies or how to be sure they’re sleeping safely,” Scelza says.

So how do the Himba get over these problems? They have a secret weapon many American women don’t, Scelza says: Grandmothers.”

And yet when limited to exclusive breastfeeding, babies die in droves.

Prof. Scelza and NPR are practicing casual medical colonialism, exploiting black bodies, knowledge and practices and co-opting them for the benefit of well off white people. Scelza and NPR actually think the major issue here is how to increase breastfeeding rates in American women (a preoccupation of Western, well off, white women) and ignore the REAL issue here, how to decrease the infant death rate among the Harimba people. But what’s few dead black babies when you are trying to convince white women to breastfeed? Not even important enough to mention, apparently.

“I think that there’s enormous pressure to succeed with breast-feeding in the U.S. and that you feel like if you can’t do it that this is a huge failing as a mother,” Scelza says. But Himba women didn’t seem to think the problems related to breast-feeding were a big deal.

It’s hard to imagine how Scelza and NPR could be more racist if they tried.