Reply to Maureen Minchin’s non-responsive piece

Reply isolated on cyan blue keyboard button abstract illustration

Maureen Minchin has refused to abide by impartial debate rules so she has forfeited. She’s still forging ahead any way, posting what amounts to an opening statement.

At no point does she provide any evidence that breastfeeding has been shown to actually have the benefits claimed; she simply repeats the claims. On her Facebook page she reports that writing the piece was “a lot of work and great fun, too.”

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Maureen Minchin’s piece — verbose and self-promoting — is non-responsive. She has yet to show that breastfeeding has the benefits claimed; she simply repeats the claims. [/pullquote]

Here’s my response:

Are the benefits of breastfeeding real and clinically relevant or merely theoretical and not reproducible in large populations?

Public health initiatives, by definition, are meant to improve public health.

They are usually based on solid scientific evidence, their implementation saves thousands if not millions of lives, and they pay for themselves many times over in lives saved, earnings preserved and medical expenditures averted.

Consider the classic public health campaigns to promote vaccination and to reduce tobacco smoking.

This graph shows the dramatic drop in incidence of vaccine preventable disease after the introduction of the vaccine for the specific disease:

C370D66E-28BD-4F1D-933B-A2933BD5770F

Notice that the y-axis is logarithmic, which means that the actual changes were far more dramatic than a glance at the graph would indicate. For example, there were approximately a one hundred thousand cases of smallpox per year prior to the introduction of the vaccine. In 2012 there were no cases at all. For each and every vaccine, the number of cases decreased by several orders of magnitude after the introduction of the vaccine.

The public health campaign to reduce tobacco smoking has had similarly spectacular results.

379811B8-793F-4A1E-9F71-E5CF44DFFA0B

This graph originally published in the National Cancer Institute Bulletin shows that in the wake of the Surgeon General’s report of 1964 warning about the link between smoking and lung cancer, per capita cigarette consumption dropped dramatically. After a lag period, lung cancer deaths began to drop dramatically, too.

We have spent millions of dollars promoting vaccination and reducing smoking and it has paid off in both lives and money saved.

How about breastfeeding?

An entire industry, the lactation industry, has arisen to promote and profit from efforts to increase breastfeeding rates. They’ve claimed a myriad of benefits for breastfeeding and predicted that an increase in breastfeeding rates would produce a decrease in infant mortality as well as reductions in a variety of diseases and conditions.

Breastfeeding initiation rates have risen in response. They have nearly quadrupled since 1970 rising from 22% to over 83% today. But the breastfeeding rate appears to have had no impact on the infant mortality rate. The graph below illustrates the steep drop in infant mortality over the course of the 20th Century. I’ve added markers for the breastfeeding rate at various points. As you can see, the precipitous drop in breastfeeding rates did not have an impact on infant mortality and the rising rate of breastfeeding initiation does not seem to have an impact, either.

EDD0D051-7FAC-4B8D-8799-EBA3A3BA0ABD

Breastfeeding was supposed to prevent obesity, but obesity rates continue to rise. It was supposed to prevents asthma but rates have continued to rise. In fact, nearly all the predictions that flow from claims about the benefits of breastfeeding have failed to come to pass.

That raises the question: Are the benefits of breastfeeding real? It also raises a follow up question. If the benefits of breastfeeding are shown to be real, are they clinically relevant?

What do the questions mean?

Before we can answer those questions, we need to understand what they mean. I’m going to use a simple, silly example to explain.

Imagine a study that looked at the average body temperature of children in different grades. The investigator went to a local elementary school and took the temperatures of all 189 first graders in multiple different classes and all 193 second graders in multiple different classes.

He found that the average temperature of first graders was 98.7 and the average temperature of second graders was 98.9; he concluded that getting promoted from first to second grade raises body temperature.

What do we mean if we ask if that is a real result? We aren’t questioning whether the investigator took temperatures properly or whether he accurately wrote them down and accurately averaged them. When we ask if a result is real, we’re asking (among other things) whether it is reproducible. Would the results be the same if the investigator repeated the investigation a month later? Would the results be the same if the investigator repeated the investigation in a different school? Would the results be the same if the investigator repeated the results using 1000 first graders and 1000 second graders?

We can’t consider the results real unless the same results occur repeatedly.

In reaching his conclusion that promotion to second grade raises body temperature, the investigator assumed that first graders and second graders were otherwise the same in all respects except for body temperature. But what if he had measured the temperature of the first graders before recess and the second graders after recess? The extra physical activity of the second graders have been responsible for their higher average body temperature.

Recess in this example is what is known as a confounding variable. It isn’t the promotion that caused the second graders’ average temperature to be higher, it’s the physical activity that occurred before their temperatures were measured.

We can’t consider results real unless they have been corrected for confounding variables.

What do we mean when we ask if a result is clinically relevant?

In the example of the first and second graders, the second graders had an average temperature of 0.2 degrees higher than the first graders. Even if it were a real result (reproducible and corrected for confounding variables), it isn’t a clinically relevant result. Both groups of children had average body temperatures well within the normal range. It makes no difference that the average temperature is higher in second graders; both groups are healthy.

What do the questions mean in the context of breastfeeding?

When I ask whether the benefits of breastfeeding are real and clinically relevant, I’m asking whether they have been reproduced, whether they have been corrected for all confounding variables and whether they make a meaningful difference to the health of babies and mothers.

What won’t answer the questions?

There’s a long list of things that might at first sound impressive, but don’t really answer the questions.

The statements of authority figures or organizations don’t answer the questions.
Scientific citations of studies that found effects in small groups don’t answer the questions.
The naturalistic fallacy (“if it’s natural it must be good”) does not answer the questions.
Personal beliefs and personal anecdotes don’t answer the questions.
Mathematical models based on extrapolation of small studies don’t answers the questions.

What would answer the questions?

As with any public health measure, the proof of the pudding is in the eating. In other words, the benefits must be measurable.

Would we believe that a vaccine was worthwhile if we gave it to millions of children but we could not find a measurable impact on the incidence of the disease it was supposed to prevent? No.

Would we believe that stopping smoking reduces the risk of lung cancer if millions of people stopped smoking and the rate of lung cancer remained the same? No.

Should we believe that breastfeeding has a myriad health benefits for term babies including saving lives if no one can show that any lives have been saved? No. Should we believe that breastfeeding has a myriad of health benefits if incidence of the diseases that breastfeeding was supposed to prevent remained unchanged or even rose? No.

Maureen Minchin’s piece — verbose and self-promoting — is non-responsive. She has yet to show that breastfeeding has the benefits claimed; she simply repeats the claims.

Why? Because she couldn’t find any data that shows that the benefits claimed for breastfeeding term infants are real or clinically relevant.

  • Faizal Tanu

    The Womanly Art Of Breastfeeding >>> https://bit.ly/2FCp1Nm
    One of great book should be read.

    I am a pediatrician and cannot recommend this book enough. It got my
    baby and I through the roughest part of establishing breast feeding. My
    baby is now 5 months old and still has never had formula (some of that
    is her though and not liking it, can’t say I never ever tried). It took
    a good month to get over sore breasts and nipples, and a few weeks into
    it I almost gave up. I had so much advice to put her on a schedule,
    only let her feed every 2 and a half to three hours, etc, and she wanted
    to feed every hour for the first couple months of life. I thought I
    was going crazy. But this book advises differently, to not even watch
    the clock and just let your baby decide when to feed. That helped a
    lot, took a lot of pressure off me. And that advice makes a lot of
    sense, because more frequent feeds mean more let downs and higher levels of hormones. Not only that, this book answers so many questions about pumping and storing milk and things that I would have never thought to ask. I was always pro-breast feeding, but now I am passionate about it.

    Breast feeding my infant has become one of the best experiences of my whole life. Now I can help other moms who are struggling with
    establishing breast feeding and answer all their questions. I have
    recommended this book to many new moms as well. Thank you so much for
    this book!

    https://uploads.disquscdn.com/images/a1fc6a9312fd34e5f054b8008ffd8cfb1cb56988ad23d79a806035bed97fc738.jpg

  • Richard

    You seem to have some real problems with your logic (and I must admit I have not read the first piece to which this supposedly responds, I am writing solely on the merits of your argument). Your first two examples are cases where there is little else that affects the outcome. For example, vaccines work because outside of exposure and immunity, not much else matters. Smoking is also the largest contributor to lung cancer so reducing smoking SHOULD have an effect. Breastfeeding, however, is but one part of infant mortality; if other factors that increase the risk of mortality go up along with breastfeeding, we cannot dismiss breastfeeding. Depending on the society and other elements, it will have more or less of an effect. It had a huge effect in places where water is unsafe for obvious reasons and still has an effect in Western culture though to a lesser degree (e.g., look at cancer data). This is why people look at specific outcomes, and yes, for certain babies on our culture (e.g., premise), breastfeeding does save lives (perhaps just not lives you care about?).

    To just consider the type of evidence you provided just demonstrates a lack of understanding of how nuanced public health policy works. It’s an argument that on the surface sounds reasonable, but wouldn’t hold up in any scholarly debate. Disappointing.

    • AnnaPDE

      This is exactly the point though — there are massive claims about how more more more breastfeeding would lead to SO much better outcomes for babies, and then in the actual data one can’t pin down any such effects. This is a clear indication that whatever positive effect breastfeeding has, it’s small and unreliable enough to be lost in the noise of whatever else is going on.

      If anything, the simplistic connection between breastfeeding and infant mortality is just the reverse, namely that countries with the highest breastfeeding rates have big infant mortality, whereas some of the countries with the lowest breastfeeding rates do best (hello UK!). Which of course doesn’t mean that breastfeeding kills babies, it means that good access to adequate nutrition, clean water, advanced medical treatment and general safety is what makes the difference, and once those are a given, breastfeeding is but a minor detail.

      • mabelcruet

        You could apply similar logic to all the statements that lactivists make. Look at the fallacy that breast fed babies have a higher IQ. A simplistic extrapolation of that would be that countries with the highest breast feeding rates produce the cleverest people, but I don’t see citizens of Rwanda and Burundi sweeping the board at the Nobel prizes. That’s because its actually nothing to do with breast feeding-it’s because the socio-economic environment and the political/financial climate in those countries isn’t primarily geared towards educational attainment, and whilst their populations have the same intellectual capabilities and potential as everyone else, they don’t tend to have the same socio-economic advantages. Remove all of those factors, and the role of breast feeding in IQ and educational attainment becomes irrelevant.

    • mabelcruet

      You’ve simply agreed with her conclusions. In countries where there is no reliably clean water supply, breast feeding is safer. You cannot extrapolate ‘breast feeding is safer’ to countries where there is a reliably clean water supply. Outcomes are different in different environments, which shows the effects of breast feeding are not significant once other factors are taken out of the picture. You have to look at the specific outcomes in a specific environment rather than a blanket and world wide ‘breast is best’ mind set, which is all Dr Tuteur has always said.

    • CanDoc

      You make a fair point, there is more rigorous science out there to be cited: See: PROBIT studies I, II, III and now IV. V pending. Similar babies (17,000 mother baby dyads) randomized to BFI or routine, with differences in breastfeeding rates and follow up data to question whether the different breastfeeding rates meaningfully translate into clinical outcomes. Spoiler alert: Not really.

  • Cartman36

    He is a jerk. I called him out on his comment and he argued for a bit and then some how got everything deleted and then posted his comment new. I think he called customer service or something to get it deleted. He is an idiot

  • mabelcruet

    Slightly OT-I had 4th year medical students in with me today, we were doing an autopsy on a very tiny neonate (who hadn’t regained her birthweight at 7 weeks of age after being born at 34 weeks, so she was basically a term baby now) and got talking about exclusive breast feeding being the biggest risk factor for re-admission to hospital with hypernatraemia, and that bilirubin induced brain damage is on the rise in the exclusively BF group.

    It turns out that their training about breast feeding is with a lactation consultant, not a medic or a midwife. They’ve been taught the backwash theory as fact, and the gem about the neonatal stomach being the size of a marble, that women with mastectomies were still able to breast feed, and about microbiomes and epigenetics. Even as students, they thought the backwash theory was utterly implausible, but they might end up getting an exam question on it, so what do they do? Regurgitate the crap that they’ve been taught, even though its utterly wrong? At least I could show them the size of the baby’s stomach, even when empty, was far larger than a marble. But it sounds like the indoctrination is starting early-if this is common throughout medical schools, we are going to have a cohort of doctors who believe all of the lactivist agenda.

    I might have ranted a little about it-hopefully I might have influenced them to look for the facts on their own and not believe everything they are taught without subjecting it to proper scientific analysis.

    • Amy Tuteur, MD

      So frustrating!

    • StephanieJR

      That is extremely concerning.

    • rational thinker

      That is horrifying. Lactation consultants are not doctors nor did they go to a medical school of any kind. Hopefully these students realized that after an few hours of instruction with you. Thank you for teaching these future doctors actual facts.

      • mabelcruet

        They were supposed to be doing a pathology elective, but we ended up talking more about obstetrics. By 4th year, they have done the majority of their obstetric and paediatric/neonatology attachments so they were quite on top of it. I was actually very impressed with them-I know there are lots of old fogies like me wittering on about ‘in my day’ and complaining everyone is spoonfed, everything is dumbed down, the young uns these days have it easy and they’re all snowflakes that can’t accept criticism or correction….(and so on!) But they were bright, questioning, interested, and certainly were aware that what they’d been taught didn’t make much sense, and were able to address it using basic physiology, anatomy and biochemistry principles.

        I think that with university tuition fees so high these days, students are more demanding-when I was a student, university was free (we got grants as well for accommodation and expenses), and if a lecturer didn’t turn up that meant a free period. But nowadays they are demanding value for money and readily complain if the teaching isn’t up to scratch, so hopefully they might feed back that this wasn’t entirely appropriate.

    • EmbraceYourInnerCrone

      Why is someone without a degree in medicine (nursing/M.D.) teaching ANYTHING to medical students?! argh!

      • mabelcruet

        When I was a student (30+ years ago), all teaching, tutoring, lectures, workgroups and everything we did was medical led. We did a 2 week nursing attachment where we acted as nurses to give us an idea of their role in patient care, and had a few sessions with physiotherapists, speech therapists, radiographers and other allied professions, again to get an overview of aspects of their work but there was no formal teaching as such. However, in the UK the medical model of health care delivery has changed considerably. We have physicians associates, nurse consultants, nurse practitioners, non-medical diagnostics etc all of whom work autonomously or semi autonomously (some can assess, diagnose and prescribe, some can assess but require medical oversight-nurse practitioners act about the level of a middle grade doctor in one specialist area like diabetes or asthma or stroke ). So nowadays a lot of medical teaching is provided by non-medical personnel. I definitely have concerns about it. It is perhaps a cheaper model of healthcare if you have a routine warfarin clinic or a routine asthma clinic and the person is monitoring a known condition, but I worry about unknown unknowns and blinkers-they maybe don’t have the flexibility of thought that a broader based medical education would give and potentially may miss something in a patient if it doesn’t fit with their known asthma or whatever. I’ve seen it happen in pathology, where a diagnosis has been missed because the biomedical scientist wasn’t expecting it. Easy enough to sort out in the lab, but maybe harder on the real world.

        • EmbraceYourInnerCrone

          I worry about the fact that people tend to get tunnel vision and see one aspect of the patient , for example when Serena Williams mentioned to her nurse after her delivery that she wasn’t feeling well and that she had a history of blood clots, she was basically poo-pooed and if she had not pushed, she might have died from the blot clots she did indeed develop after delivery. The pregnancy was the only thing people paid attention too. Not the pre-existing health issues.

          • Daleth

            people tend to get tunnel vision and see one aspect of the patient

            YES. I almost died three different ways having my twins, and because the first way was pre-eclampsia and the second way (hemorrhage) was related (high blood pressure = worse hemorrhage), that’s how the doctors mentally classified me: “pre-e lady.”

            So a couple of days after their birth, when I developed an intestinal blockage that also could have independently killed me, all the doctors were like, “Oh, it’s normal for your belly to swell up like that when you’ve had pre-e.” I must have pointed it out to half a dozen different doctors.

            Finally a resident (!!!) that I mentioned it to said, you know what, I’m going to run you down to x-ray before they close. (And she did run me, in a wheelchair, with just 20 minutes to spare.)

            She hadn’t gone on autopilot about me. She didn’t have tunnel vision. Thank god.

    • Anne

      Anyone with a minute of exposure to immunology would question how a mother would make antibodies to the backwash (love the term) from her infant. Let alone the fact that a baby’s gut closes to crossing of antibodies in less than 7 days after birth.

      • mabelcruet

        Yes, we discussed the suggested mechanism-the nipple sucks up the saliva, bioengineers antibodies and instantly feeds them back to the baby. And also discussed how the milk is allegedly supposed to change according to the needs of the baby, even if you’ve got twins (rather alarmingly they were told there is evidence that if one twin was sick, the milk they get is different because the mum knows exactly what each infant needed). She told them about colour changes-apparently milk that is full of antibodies is a different colour and that’s how you know what’s in it? Is it like urine turning red if you eat beetroot?

        • kilda

          Lord, that’s stupid. Breastmilk isn’t even smart enough to know that babies need iron, but it’s supposed to know how to custom design antibodies for each of two twins?

          • mabelcruet

            But mama’s magical diamond plated boobies are miraculous and can do anything…

        • PeggySue

          Omigod, this is so breathtakingly idiotic. So they probably would’t even wash off the breast after feeding the ill twin and before feeding the well one. Mom will handle it all.

    • Sarah

      Interesting that they realised the backwash theory was a bag of shite. That at least is encouraging.

    • Daleth

      Thank god you’re there to teach them sense.

      That poor baby and her poor family.

      Whenever someone trots out the “baby’s stomach is the size of a marble” BS, I just say, “Your stomach is the size of your fist. Does that mean your meals should only be as big as your fist?” …They get a great look on their face, realizing that can’t be right… And then I say, “It STRETCHES when you eat. How big it is when you haven’t eaten is irrelevant.”

      Once that lightbulb goes on over their heads, it doesn’t seem to turn off.

      • swbarnes2

        I believe a uterus is also the size of a fist?

        • mabelcruet

          A post-menopausal uterus is about the size and shape of a conference pear (those long thin pears). Unless you’ve got fibroids, in which case your uterus could be as big as a football.

      • mabelcruet

        Unfortunately, it wasn’t that type of autopsy.

        The baby stomach size issue has always irritated me. All they needed to do was ask a pathologist, I can give you stomach size very easily. It’s also possible to demonstrate volume, it still stretches after death so clipping off duodenum and filling it with fluid would give you a reasonably accurate estimate of capacity.

  • Cassandra

    The question is not whether breastfeeding has benefits, but whether formula is proven to have no risks. As a doctor, you know that it’s the intervention that has to prove itself, not the natural state. Talking about the benefits of breastfeeding makes as much sense as talking about the benefits of not smoking or the benefits of drinking water.

    It’s interesting that you should mention confounding variables. You point out that an increase in rates of initiating (not continuing, but initiating) breastfeeding has not resulted in better health outcomes. But you ignore all the other variables that affect health: pollution, food, genetics, sanitation… That’s a mistake a beginning logic student would not make. You yourself are fond of pointing out that correlation does not equal causation. Who knows how much worse the health outcomes would have been if breastfeeding initiation rates had stayed low?

    Your logic is faulty, but your choice of data is too. You base your conclusion on rates of initiation of breastfeeding. That means a child given only one breastfeed is considered breastfed for the purpose of your statistics. To get a true measure of the effect of breastfeeding, your reference group needs to consist of people who were exclusively breastfed for six months and then breastfed until at least their first birthdays, as recommended by the AAP and WHO.

    • MaineJen

      Your logic is faulty, too. For children whose mothers can’t breastfeed or don’t want to breastfeed, the benefits of formula feeding (eg NOT starving to death) far outweigh the potential harms of formula feeding (which are……what, exactly?).

      Also…what is this weird obsession with “exclusive” breastfeeding? I truly don’t understand. My children were both breastfed for six months or more. Does that mean that NOT ONE DROP of formula touched their lips in all that time? No, of course not. Because I live in the real world, and I’m a real woman with a life and a career I love and didn’t want to quit. Yes, I pumped at work, but my kids also got formula when they were hungry and I wasn’t there. I think you’d be hard pressed to find ANY child for whom that is not the case. And looking in on their second and fourth grade classrooms now, I defy you to pick out the children who were “exclusively” breastfed versus those whose parents live on a little place I like to call Earth.

      • The Bofa on the Sofa

        I have said it, too. Who cares about this “exclusive” breastfeeding nonsense?

        My kids were breastfed for 9 and 10 mos, respectively. However, they both also had formula around 3 months or so, and were started on solids before 5 months.

        In the “EBF for 6 months” world, my kids have failed. However, I contend that we should be celebrating that they went on to breastfeed, at least at some level, for the time they did. I’d call that all a breastfeeding success!

      • Cartman36

        “the potential harms of formula feeding (which are……what, exactly?)” Jen, I bet you a virtual beer that Cassandra responds by regurgitating something she read on baby center or MM’s website about the gut microbiome or epigenetics.

        Its always funny when you find someone that copy and pastes something that they don’t understand. There is a guy that reviews any book questioning the benefits of breastfeeding on Amazon with almost the exact same comment. I looked into what he was saying once and realized he was literally copying and pasting from the website of a dead dentist who (from nothing more than observations in his practice) believed formula feeding caused jaw problems. The reviewer thinks he sounds so smart when he should be embarrassed.

        • PeggySue

          Every time I see the word “microbiome” or “gut” or “epigenetics” a little switch causes my brain to turn off.

      • Merrie

        My older two children got exclusively breastmilk and did not get any formula, because I produced amply and pumped at work. They are both very smart. But they have two smart parents so, you know, it’s probably more due to that. Youngest is the only one who got any formula, ultimately being EFF by about 11 months old as I just couldn’t keep up with his prodigious appetite and decided I didn’t want to keep trying. He is still pretty young, but somehow I’m not too worried about him falling behind his siblings because of the horror of having gotten formula.

      • Sarah

        Come on, better dead than formula fed! Think of the virgin gut.

    • rational thinker

      “The question is not whether breastfeeding has benefits, but whether
      formula is proven to have no risks. As a doctor, you know that it’s the
      intervention that has to prove itself, not the natural state.”

      Now in reality breastfeeding naturally has risks and this is why we invented formula in the first place, because if breastfeeding is so beneficial and the perfect food why was formula invented then? I will tell you why, it was because babies were dying due to lack of milk or unsafe alternatives.

      Another fact is that countries with the highest breastfeeding rates have the highest infant death rates.
      If you want to look at other studies look at the sibling study where one was breastfed and one was formula fed. It basically showed the benefits of breastfeeding have been greatly exaggerated but you probably wont read it anyway because you already just assumed breastfeeding has benefits because it is natural and that is not how scientific research works so I am guessing that is why you could not understand the data Dr. Amy has posted.

    • Cartman36

      Cassandra – water that comes directly from a “natural” source is often brimming with bacteria, parasites, and amoebas. Other than raw water and anti-flouride idiots, no one goes around talking about the risks of drinking tap water because we clearly see that the intervention (cleaning our drinking water supply) provides massive benefits with little risk. .

      Also, you said that Dr. Amy “ignore(s) all the other variables that affect health: pollution, food, genetics, sanitation..” Try reading more of Dr. Amy’s articles or her book. Her entire premise is that the better outcomes in breastfeed babies is because they are more likely to have access to better foods, parents with a high level of education and disposable income, better health insurance, etc. She discusses confounding variables all the time.

    • EmbraceYourInnerCrone

      Question – Can we check the iron and Vitamin D levels in the Exclusively Breast Fed babies and the formula fed babies after 6 months?
      And do the breastfed babies get any supplements/vitamins/baby food?

      • PeggySue

        I still remember the mom of twins whose blog I followed, and how devastated she was that her proudly breastfed, dearly loved children were diagnosed after some months with significant iron deficiency anemia and needed supplements (which didn’t taste good! The horror!) Apparently no one had told her… also apparently the fact that she herself had intermittent low iron levels did not make her or her doctor ponder.

        • EmbraceYourInnerCrone

          Yup, I have a higschool/some tech school education. Hearing college educated mothers quote the “breastmilk is the perfect , complete food for the first 6 months” at me makes me so depressed. It really seems to be true that if you repeat something enough people believe it because “Everyone Knows”

          Except what Everyone Knows is based on …nothing.

    • Daleth

      The question is not whether breastfeeding has benefits, but whether formula is proven to have no risks

      Why is that the question? Please explain. (Spoiler: You’re not going to be able to.)

      That’s not the question because NOTHING on the face of this earth has NO risks. When it comes to feeding infants, every possible food or liquid has some risks and some benefits. Some have hardly any benefits and a bunch of risks (e.g., juice or soda pop); some have benefits but major risks (e.g., cow’s milk).

      The two good options, breastfeeding and formula, each have their own set of risks and benefits, and they’re not universal. For instance, when it comes to breastfeeding, a woman taking XYZ medication is going to have risks that a woman who doesn’t take any medication won’t have. A woman who is prone to depression will have risks that other women don’t. A woman whose breasts produce less than the average amount of milk will have risks that average and greater producers don’t have. Etc.

      There are also a few universals, or near-universals. For instance, formula contains the amount of vitamin D and iron that babies need, while breastmilk doesn’t contain iron and may or may not have enough vitamin D (that depends on mom’s vitamin D levels).

      So how could there possibly be a universal rule that X method is better than Y method? The risks and benefits are different depending on the mom, and the baby, and their family circumstances. Each mom needs to weigh the risks and benefits and choose what’s right for her. It’s obnoxious for outsiders to pressure her into choosing one method over the other.

    • swbarnes2

      pollution, food, genetics, sanitation…

      Breastfeeding rates tripled in the last 40 years…genetics and sanitation haven’t changed significantly.

      Who knows how much worse the health outcomes would have been if breastfeeding initiation rates had stayed low?

      What a disgustingly dishonest argument. Anyway, England and Ireland have lower breastfeeding rates, and they don’t get worse health outcomes.

      Vietnam had breastfeeding rates triple from 2010 to 2014.

      https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002159

      But when we look at infant and child mortality rate, the slope of the line isn’t changed at all.

      https://data.unicef.org/country/vnm/
      https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=VN

      If breastfeeding is so amazing, why aren’t those lines plunging drastically between 2010 and 2014? Why do they have the exact same trend as they did before 2010 and that amazing increase in breastfeeding rates?

    • VanessaB

      Breastfeeding has risks so take your appeal to nature fallacy and shove it.

    • FormerPhysicist

      Ridiculous. Of course the ‘natural state’ has risks too. The hospital made me sign forms that I understood the risks of my emergency c-section. Because it has to prove itself … such absolute ridiculousness. I was going to be dead within 48 hours, and my baby with me without that c/s. Breastfeeding doesn’t usually kill as quickly, and doesn’t directly kill the mother. Yippee.

      When will people learn that evolution, natural selection, and survival of the fittest means LOTS of DEATH. That’s what non-selection and non-survival means. But, I’m okay only being fit for a technological world.

      • Sarah

        Tits are magic!

    • PeggySue

      Cassandra, where are you getting this “you know that it’s the intervention that has to prove itself, not the natural state?” It sounds as if you expect “the natural state” to be problem free. We know what “the natural state” (birth and feeding with no interventions whatsoever) results in–lots of morbidity and mortality. Holding every intervention to the standard of “proven to have no risks” is pure insanity and way above the standard you happily accept for “the natural state”–that is, if you are being realistic!

    • Sarah

      The thing is, you can pontificate all you like about how actually formula needs to prove it is risk free (nothing is risk free) because nachrel blah blah. But back in the real world, or the part of it that’s well off enough to afford women choices anyway, you know full well that is not the case. That horse has well and truly legged it.

      Women make decisions based on the relative advantages and disadvantages of breast, formula and mixed feeding in their particular circumstances all the time. They don’t come at it from the perspective that breastfeeding somehow has less to prove than the other viable option open to them, much less hold it to some nonsensically unprovable standard.

      Also, you just sound like a fuckwit making a comparison to smoking and sensible non-ideologues switch off at that point.

  • mabelcruet

    There’s absolutely no point in trying to respond to her using logic, or expect her to acknowledge scientific accuracy and statistics. Lactivism is a cult predicated on manipulating women and using shame, guilt and fear. It’s an emotional subject, not a scientific one, for that type of person-she may have covered her lactivism with a veneer of superficially plausible scientific explanation (she knows all the big sciency words and how to use them-boy, does she know how to use them, spewing her endless verbal diarrhoea!) but underneath she will never, ever be turned by a scientific analysis or approach because underneath she’s full of the same twinkly mama magic, breast milk is liquid gold pouring from diamond plated boobies bullshit that the hard core lactivists share. She declares faux sympathy for those who can’t breastfeed, but a woman who openly tells mothers that they have ruined their child health for life by formula feeding is a bully through and through.

    I’m currently not blocked on her FB page-she’s now crowing about you not responding and declaring you’ve forfeited. I honestly wouldn’t bother devoting any more column inches to her, she’s made it very obvious to outsiders the type of person she is.