Another day, another opinion piece overselling breastfeeding

Ethiopian woman takes water from a well

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.