The BBC is touting a new study claiming that paying women to breastfeed is effective. What it really shows it that bribing women to breastfeed is a spectacular waste of precious healthcare funds.
Offering shopping vouchers to new mothers can encourage them to breastfeed their babies, a study published in JAMA Pediatrics has found.
About 10,000 new mothers in Yorkshire, Derbyshire and Nottinghamshire were offered up to £200 in vouchers as an incentive.
Breastfeeding rates increased in these areas, which typically have low uptake.
The study is Effect of Financial Incentives on Breastfeeding: A Cluster Randomized Clinical Trial by Claire Relton et al.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The authors spent more than $300,000 to get 300 women to partially breastfeed for 6-8 weeks, $1000 for each additional mother![/pullquote]
According to the authors:
In the intervention (5398 mother-infant dyads) and control(4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, −0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, −0.2 to 4.8; P = .07).
In their conclusion they acknowledge the weakness of their data:
Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data.
But the weak data and limited effectiveness are not the biggest problem with the study. The biggest problem is that bribing women to breastfeeding is not remotely cost effective.
According to the authors’ own data, an addition 5.7% of women in the bribery group partially breastfed for 6-8 weeks compared to the control group. That’s approximately 300 women. How much did that increase cost?
This was the payment structure:
The incentive intervention was offered to women condi- tional on their infant receiving any breast milk. The scheme offered shopping vouchers worth £40 (US$50) 5 times based on infant age: 2 days, 10 days, 6 to 8 weeks, 3 months, and 6 months (ie, up to £200/US$250 in total). Vouchers were exchangeable at supermarkets and other retail shops with no restriction on allowable purchases. Receipt of vouchers was conditional on mothers signing a form stating that “my baby is receiving breast milk” and a countersignature from a clini- cian for the statement “I have discussed breastfeeding with mum today.”
Therefore all the woman who partially breastfed for 6-8 weeks received a total of $150. Since 37.9% of 5398 women (2159) partially breastfed for that long, the authors spent nearly $324,000 on those women. In other words, the authors spent more than $300,000 to get 300 women to partially breastfeed for 6-8 weeks, $1000 for each additional mother!
Even with all that money they didn’t increase the breastfeeding initiation rate, the rate of exclusive breastfeeding at 6-8 weeks and they didn’t increase breastfeeding rates at 3 months or 6 months.
Of the nearly $324,000 spent, only $45,000 went to the mothers who had been bribed to breastfeed. Nearly $280,000 was given to mothers who would have breastfed anyway.
The total cost of the program far exceeded the $324,000 because women who partially breastfed for 3 months received and additional $50 and women who partially breastfed for 6 months received an additional $100. All of those women would have breastfed for the same length of time even if they hadn’t received the money. Moreover, the program itself almost certainly cost additional money to administer.
Who could have predicted that such a large amount of money would be wasted? I not only could have predicted it, I did predict it!
In November 2014 I wrote Early results from the “bribe a woman to breastfeed” trial. I discussed the results of an earlier pilot study also written by Relton and colleagues. The pilot study involved only 108 women and a similar voucher scheme. When I did the math I found:
The government spent $1100 per woman to increase the breastfeeding rate and the bulk of that $1100 went to women who were planning to breastfeed anyway…
I predicted that the much larger study would just waste a much larger amount of money and that’s exactly what happened.
Shockingly, you would not know that to read the study because they authors either neglected to calculate or neglected to mention the simple arithmetic that is fundamental to determining whether the study was a success. Getting an additional 300 women to partially breastfeed for 6-8 weeks is likely to have a trivial impact on infant health. So the return on investment of $300,000 to get more women to breastfeed is essentially zero. A zero return on investment is an abject failure.
Just about any healthcare expenditure you can think of would have been a better use of scarce healthcare dollars. But that won’t matter to lactivists. They are so sure that breastfeeding is better for babies that they don’t dare to examine their own findings too closely; they fear that their own studies won’t confirm their prejudices.
Not married, no kids (I’m terrified of the idea of being a parent), but if I do welcome any kids, don’t you DARE bribe me to breastfeed.
Yeah, I live in a place without much of a social safety net.
My husband had to take time off of work due to illness and need for medical treatment, during the last months of my pregnancy and the first months of our baby’s life.
I had to choose between
– staying home, bonding with my baby and breastfeeding
and
– bringing in an income that could provide us with food, basic medical care, and a roof over our heads.
Most working class women, and women who live under or near the poverty line are faced with the same choice. It isn’t really a choice at all.
I should add, my time was far more precious to me in those perinatal months, than the amount of money the state could offer. The local government did offer some small cash incentives for mothers to get certain checkups and screenings, as part of a public health initiative. As badly as I needed money, I turned them down, even though I had the checkups and screenings.
Taking transit downtown to the state offices to fill out the paperwork and collect a modest check would take up hours of time – hours when my husband and baby needed me, hours when I could be working at a higher rate.
Good grief. I want breast feeding researchers to really look into the ‘why’ of why some women don’t breast feed, with an open mind. I would start with the assumption that the majority of women want the best for their baby and their family, and would make considerable effort and sacrifice to achieve this. I would also assume in the UK and the western world that they are well aware/sick of being harassed about the benefits of exclusive breastfeeding.
So with caring, knowledgeable parents there is still something about breastfeeding that doesn’t stack up for UK mums, as is shown in the low breastfeeding rates. Could It be, on balance, formula feeding is preferable for some mums and babies? Even if it costs more, does it make balancing family life easier? Does it allow mothers to have a break, get more sleep, go back to paid work or care for a demanding toddler or elderly relative? And does it really matter given that infant mortality is better than it’s ever been (apart from tragic mistakes in childbirth)?
Research always seems to conclude that (uneducated, careless) mothers would exclusively breastfeed if only they had more support or education. I’ve never seen balanced research that acknowledges that some families may find formula to be the best solution, and questions whether the endless pursuit of exclusive breastfeeding is really of benefit.
(PS I’m pro-breastfeeding if that’s best for your family and did so myself for 8 months. But was totally sick of all the propaganda in the Aussie public health system)
Since Newfoundland was the province with the lowest breastfeeding rates in Canada, some researchers set out to figure out why. Here’s one of the qualitative studies that looked at the reasons: https://link.springer.com/article/10.1186/1471-2458-13-645
Some researchers have also looked at why adolescent mothers have lower breastfeeding rates:
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-149
So some of this work has been done in a Canadian context. I don’t know if there are similar studies out of the UK.
I know some researchers don’t value qualitative studies, but they certainly have their uses.
Geez, that first study is so condescending toward its participants! ” Such comments provide some evidence that these mothers have been told or are educated to believe that breast is best. However, they rationalize their own behavior of choosing to formula-feed by voicing the opinion that formula is just as good as, or perhaps even better than breast milk.”
Formula-feeding mothers are not naughty toddlers trying to explain why it’s okay that they colored on the walls. Ugh.
“They rationalize their own behavior”
Fucking really? I decided as a first time mother that between work, military duty days and moving 8000 miles when my kid was 2 months old, that I did not want to breast feed. So I didn’t. My sister the stay at home mom breastfed all four of her kids. Jeez what a bunch of condescending prats who apparently went into the study with their minds already made up.
Breast actually isn’t best for everyone.
That was not an informed decision on what mode of feeding would best suit you and your family; it was rationalizations for your behavior. (I was pleasantly surprised that the second study on teens was not nearly so condescending.)
Agreed that it is incredibly condescending. However, they are working in Canada, where most mothers will qualify for maternity leave benefits if they were working During the 52 weeks leading up to their maternity leave (and they will be paid 55% of average weekly earnings). Military moms will even have their maternity leave benefits topped up by the Federal government, and many other employers also provide maternity leave “top ups” (i.e. topped up to anywhere from 70% to 100% of their salary/average weekly wage). Women can take up to 35 weeks maternity leave at 55% and an extended 61 weeks at 33% (that’s the amount they get from Employment Insurance benefits – employer top ups are separate). Or they can split the number of weeks with their partner. Some split it evenly, but in most cases, the woman who gave birth will take longer parental leave, and the partner will take a shorter amount of time (if they take any at all).
Parental leave benefits are changing in the new year, and I don’t know all the details. In my experience, both as a health care provider and as a friend to numerous women who have had children, most women take a year of maternity leave, especially if they have an employer who tops up benefits. Plenty of women still choose not to breastfeed, for a whole slew of reasons, but having to go back to work right away is not one of them for many (even most) women.
Right, but I think that the larger point is that women’s perfectly valid choices are being dismissed as stupid. Frankly, a woman doesn’t need to “rationalize” her decision to formula feed (or breastfeed, or pump, or whatever), no matter what led her to make this decision.
Yeah, I just came back here to post this (similar) gem of a quote:
“In some regions of the province, the rates of formula feeding are very high, even though many women appear to know the benefits of breastfeeding. Women in these regions appear resistant to changing their choice of infant feeding method and often rationalize their decisions to formula-feed.”
I’d “appear resistant”, too, if I wanted to use formula so I could… work, not pump, be able to sleep through night feeds or just have my breasts back. These are personal choices.
And the women “appear to know…” it’s so unbelievably condescending.
So, the researchers wanted to ask these women “why” they are using formula. Then they say the women are “rationalizing” when answering the questions.
just based on the tone of the paper, I can’t imagine how rude those researchers must’ve been while interviewing these formula feeding moms….
Do we know what happened to the mothers that ‘failed’? Do the researchers care that they potentially set them up to fail twice with this- firstly at breastfeeding and then secondly at bringing in some potentially much needed additional household income? I really hope they looked after those that didn’t manage to meet their goals, particularly in a demographic who may not have had arbitrary “breastfeeding goals” before the intervention of this study. Fucks sake.
Also, can we please stop assuming that all poor people will do whatever we think they should be doing morally if we just chuck some money at them? Perhaps next time these researchers will take the time to ask these women why they don’t want to breastfeed in the first place and try to address what the actual barriers/concerns they have are. OR just leave them alone to feed their babies formula seeing as it’s a perfectly excellent infant food and do some research into something actually useful. Just a crazy idea right there.
Additionally, they forget that breastfeeding requires 2 people, the mom and the baby, and no amount of money is going to convince the baby to want to breastfeed.
My first child breastfeed easily and grew quickly. My second child did not enjoy breastfeeding, and definitely preferred a bottle, gaining weight much better once we switched to a bottle full time. Nothing I could do could convince the baby to have a different preference.
I read somewhere that regular ejaculation decreases the risk of male prostate cancer. So while we’re at it, why not kick in some extra money to women who up the frequency of sex with their partners? Women’s bodies are a natural resource! Blessed be the fruit! /s
May the Lord open.
I could get behind that…
I could, too, but we’re not the doggy style types….
I’m equal parts impressed and outraged at that one!
NoLongerCrunching:
Are you quoting the Handmaid’s Tale? (“Blessed be the fruit.”)
I recently re-watched the show and re-read the book. Scary stuff.
No, oh…I mean… “Under His Eye.” /s
This research seems to be slightly unethical. In my research methods class in graduate school, we learned that any incentives to take part in research have to be small enough that participation isn’t coercive. Otherwise people who really need the money / incentive will participate just for the sake of the incentive, even if they don’t want to participate in the study. Given the value of the vouchers in this study, it seems that the incentive could be considered to be coercive, and thus the research would be unethical. It has me wondering how this study managed to be approved by an institutional research ethics board.
I work with a lot of low income clients, and for many of them, $50 is a LOT of money. Many of the new parents would participate in a study, even if they didn’t really want to, just for that much money in grocery vouchers.
The UK has a human subjects ethics review requirement, just as the US does. It sets strict limits around compensation. These limits have been debated and vetted at length ahead of time by experts in ethics, so I’m inclined to give that a level of respect. But if you don’t like their limits, you can take it up with them. Keep in mind, however, that if they lower their compensation limit they have to lower it for ALL studies, not just the ones you disapprove of.
If I sound a little sore on the subject, it’s because I am. I’ve seen the “It’s an unethical bribe” argument used to try to silence research before- research I played a part in indirectly (medical director of one of the clinical sites). In this case it was used to silence research on preventing spread of STIs in a high risk population. Because, you know, sex and immorality and blah blah blah. Ultimately it did not shut down the study completely, but it did get shut down at my clinical site, which was a real loss.
I’m not in the U.S. I’ve been involved in studies where we were compensating participants and we had to keep the incentives at a very low dollar amount in order to make it past our IRB. In some cases, this was for sensory testing of different food products, something not terribly controversial. Yet the IRB balked at us giving participants more than a token incentive (~$5 to cover their transport costs; apparently their time wasn’t worth anything).
If experts in the UK have determined that these amounts aren’t coercive, then I obviously can’t argue with them, as I’m an expert in aspects of human nutrition, not in research ethics. I was commenting based on my experience in conducting research with human subjects, in which offering $50 would be seen as coercive, especially when dealing with certain populations.
I see both sides. I’m reassured to know about the level of ethical expert input that’s gone into this, but equally can envisage a situation where a woman might end up breastfeeding longer than she wants to in order because of the financial incentives in the study, and that thought isn’t a pleasant one.
Paying a woman to use her body in a certain way…
On the other hand, who is better able to balance the benefits of each course of action better than the mother? If she decides that the money allows her to do something she wanted to, but otherwise could not afford, why not give her the option? There are harmful behaviors that we should not incentivize..I just don’t see breastfeeding as one of those behaviors.
In theory, yes – but breastfeeding doesn’t work for all women and all babies, and there are times when it is definitely contraindicated (HIV+ moms, moms needing medications that can pass to the fetus, etc). It also exacts a physical and/or emotional toll on some moms that can be onerous. In reality, this is being done in a context that does not give women accurate information on which to judge the ‘benefits of each course of action.’
And it punishes women who are doing the right thing for their child/family – in those cases where formula is the right thing – by not permitting them to ‘do something she wanted to, but otherwise could not afford.’ Especially when you consider that a large barrier to breastfeeding in the US is low-income moms working hourly jobs. You would have to give them a sustainable income rather than a little perk – which by and large would go to the women who are already better-off, because those are the women who have the best chance at successful breastfeeding.
Don’t get me wrong, I’m in favor of higher corporate taxes being fed to universal sustainable incomes, but don’t tie it to an accident of biology. Again, I am fortunate to be very regular, but it would be silly to give me a sustainable income based just on the frequency of my poop. And to incentivize women to poop 3+x/day by paying them.
It seems to me that the use of vouchers in this study is ethically problematic for a variety of reasons. The study is aimed at low income individuals who are more likely to consider $50 a lot of money, thereby increasing the pressure on them. The study is aimed at pushing women to use their bodies in societally improved ways. More importantly, there is no proven benefit to the intervention. There’s no evidence that convincing a few women to partially breastfeed for 6-8 weeks (or at least pretend that they did) improves anyone’s health. The UK has the lowest breastfeeding rates in the industrialized world, but it also has a very low infant mortality rate. Finally, it’s an ethically unjustified use of healthcare resources; there are many more effective and cost effective ways to spend the money.
Yep, your objections are super similar to the objections that got the study pulled from my site. Aimed at low income women who were more likely to view $50 as a lot of money thereby increasing pressure on them…the study is pushing women to be ok with having premarital sex which is the Liberal-approved way…no proven benefit to the intervention…No evidence that this is about anyone’s health, this is about normalizing premarital sex…unethical use of healthcare resources when abstinence is better. Oh blah blah blah, I’ve heard it all.
There is a reason we leave these decisions up to ethics committees rather than armchair ethicists.
Correct me if I’m wrong, but isn’t it entirely ethical to push women to be ok with premarital sex? Not having it if they don’t want to, of course, but not shaming those who do have it? Was the $50 for the purpose of purchasing prophylactics, or just for reporting their sexual behavior and using prophylactics if sexually active? Because the former could be coercive, but the latter is not.
The study’s goal was to see if sex ed could reduce STI rates among already sexually active young women living in zip codes known to have high STI rates. The intervention was one-on-one comprehensive sex ed sessions done over a span of months. Each of the 3 sessions lasted up to 60 minutes and they got a gift card after each session. Total amount $60. I was told it was unethical because the young women “could not say no” due to all the $$$$ (although lots of them did decline.) I was told that my clinic was supporting “a form of sex trafficking.”
As a total non-expert in ethics, it seems to me there’s a difference between incentivising someone to do something with their body and to attend an educational programme. I know the aim of your research was to get them to behave in a different way but it’s one more step removed than this.
So I don’t agree at all with the comments made about your research but I also think this is something a bit different. The equivalent with breastfeeding would be attendance at some kind of class, I think.
Those who know more about ethics than I do are very welcome to either flesh this out further or correct me if it’s completely off the mark.
“it seems to me there’s a difference between incentivizing someone to do something with their body and to attend an educational programme.”
I would agree there is a difference. But does that mean that only education program research is ethical and “do something with your body” research is unethical? Because if that is the case, we will have to outlaw a LOT of studies. For example no more cancer research where you have to give a blood sample or take a med. No more research where they study the effects of diet or exercise interventions. No more studies incentivizing well child checks. Is that what we really want?
Look, I’m not a fan of this breastfeeding study either. But I would be a hypocrite if I got all concerned about poor people being exploited for $50 in this study while being fine with it in studies I like.
Well, breastfeeding to the extent needed to get the vouchers in this research is much more intensive and time consuming than even repeated blood samples. So I don’t think you’d be a hypocrite to object to this and not that. It would be understandable, in my view anyway, to draw your personal line somewhere between something that could be a one off and something that requires hours a day, at least initially.
There’s also the context of women historically not and still sometimes not now having full control over our own bodies. So anything that’s about trying to persuade women to use our bodies in a particular way inevitably comes up against that in a way that something affecting both men and women, like cancer research, does not. Especially where it’s motherhood and fertility related. There’s a particular resonance there, especially in a society where women can’t always access legal abortion. I wonder if there was some of that at play with the objections to your STI work actually.
Yep, people with an agenda are way more likely to try to censor science if it has to do with hot button issues like women and reproduction (sex ed, contraception, lactation etc.) Of course they often won’t admit that they just disagree with the politics, they will dress it up as concern for the research subjects. That’s why I support our current way of doing this–we have a neutral professional ethics committee make the call as was done for this study.
Are there the same issues with bullshitting about other areas of medicine you mention as there are with breastfeeding? I’m not sure if I posted my edit after you posted your most recent response or not.
I think researchers trying to exaggerate the benefits of a certain approach is found in just about every area of research. Drug industry research is the classic example, but I bet it’s in every area. Probably this includes areas that I care about and are in line with my own politics. In my mind, once again, this is why these decisions need to be left to an independent neutral human ethics board. Otherwise it can rapidly degenerate into “research I like is the only ethical research.”
Agreed. In my field (human nutrition) it’s not only hard to accurately measure what people are actually eating (except for those few nutrients for which we have good biomarkers, however biomarker tests are often very expensive), but researcher bias can influence how the research results are interpreted. For example, a nutrition researcher who is a vegan and strongly believes in the health benefits of a vegan diet is more likely to emphasize the positive results of vegan diets when researching different dietary patterns.
Interesting. Here’s an off topic question for you: What % of human nutrition researchers do you estimate have currently, or have had in the past, an eating disorder? The reason I ask is because eating disorders are extremely common among my patients who are nutrition undergrad majors or who work as Registered Dieticians. Is the same true for nutrition researchers?
That’s a really good question and I haven’t seen any research on it (unlike the research on the prevalence of eating disorders and disordered eating among dietetics students and dietitians). In my experience, the prevalence among nutrition researchers who hold the RD credential (like myself), is similar to that found in RDs in general, maybe a little bit lower. Among nutrition researchers who aren’t RDs, I’ve seen a lot more disordered eating / clean eating / potential orthorexia than actual diagnosable eating disorders. I’ll have to check and see if there’s been any good research done on the topic. Something to potentially explore in the future if it hasn’t been done! (I can tell you that weight bias / negative attitudes towards those who are overweight or obese, are unfortunately extremely prevalent among nutrition researchers, with the possible exception of those researching food insecurity or how the social determinants of health affect nutrition and food literacy).
What was your study? If it wouldn’t cause you any problems to be more specific obv.
It was the pilot study that led to the Safer Sex Initiative.
In addition to being a colossal waste of money, the premiss this is based on is breathtakingly stupid and sexist:“ If only someone gave those guillable women money for shopping maybe more children would benefit from breastfeeding.“ As if it was not enough that we have information omitted by some healthcare professionals when it comes to birth and breastfeeding. If this was purely financial wouldnt more people breastfeed to forego spending money on formula? At least they had the decency to offer around 6 times the amount you get for a litre of cow‘s milk.
To be fair, I think the use of vouchers rather than cash is a standard thing in UK research. Not just for women. I’m involved in a piece of research into the flu spray for 2 year olds and the impact on them and their families at the moment, and we’re being paid for that in vouchers. They came to the house to do the vaccination rather than me having to lump a whiney toddler to a GP clinic, so frankly I’d have done it for free, but we are also getting Love2Shop vouchers for participating. I think that’s just what they do instead of cash. I would have preferred the cash though!
I got a £10 Love2Shop voucher for taking part in a study on congenital heart disease when I was pregnant with #2.
It was a questionnaire about exposure to various environmental toxins while trying to conceive and in early pregnancy (cleaning chemicals, hair dye, industrial solvents are the ones I remember). Obviously for some sort of case-control thing.
Vouchers are auditable- you know when they are spent and can confirm that a researcher didn’t give out £5 and keep £5 for themselves, that is why they are popular.
Yes I was surprised by the admin. I had to sign and they gave me a receipt! In contrast I’ve also had love2shop vouchers recently for taking part in some research for a government department (my household seems to be of great interest to the research community all of a sudden) and no signing necessary. They just posted them out. I suppose the rules are more stringent for the NHS.
I did not know that and that somewhat alters my perspective. It still makes me uneasy that the voucher is not only compensation for participation in a clinical study but very much object of the study and directly tied to breastfeeding performance.
Using vouchers is also common in Canada, i.e. a $10 voucher for a grocery chain. Also popular (especially in survey research) is the “answer a survey on -such and such- for a chance to win an -insert expensive device, i.e. iPad, iPod, Android phone, etc.-“
No amount of money was gonna incentivize me to breastfeed kid2. No money was needed for me to breastfeed kid1. I bf’d 1 until I quite literally couldn’t take another minute; kid1 was not quite 11 months old. A few quid or even a few thousand quid isn’t going to help my kids much if my brain has slipped over that sharp edge I’ve spent the last 2 years trying to not go over.
So they asked women if they’d breastfed, and their doctors if they had discussed it with the mothers. Actually I’m surprised this didn’t have a 100% effectiveness rate given all you apparently had to do was lie. How certain are they that the increase wasn’t just women who really needed the money? Did they watch them breastfeed?
Pocket the money saved on vouchers, spend it on formula, enjoy your baby.
That would be the first response that occurred to me, certainly.
Wow. The benefits of breastfeeding would have to be truly miraculous in order to justify spending so much money for so little return.
Not to mention – what would be the ultimate outcome? You’d think it’d be the health of children. But it seems they didn’t look at that at all, and I doubt there would be an iota of difference.
I mean, giving parents money _would_ have some effect on the health of children. But not for an arbitrary biological process. Would they give money only to parents who could poop more than 3x/day?
Right? This is ludicrous. I want money for not having a single cavity ever. I want money for having nice blood pressure, cholesterol, and blood sugar numbers. Not that I really deserve that, because I have other things that have evened those out, but neither do women with functioning breasts get money on top of the bragging rights lactivists already give them. It’s just gross.
Oh yes I’m due for those payments too! Then again, they’d probably be cancelled out by the number of ear and throat infections I had prior to getting my tonsils out – so much for my EBF immune system.
Of course they didn’t look at the overall health of children! And you know very well why.
That’s the thing, though. It suggests that they _do_ know, deep down, that it doesn’t help.
It’s not really relevant to the Great Breastfeeding Push…