Is the American Academy of Pediatrics morally culpable for the harm they cause by promoting breastfeeding?

unethical to ethical on white paper

It is the LEADING risk factor for newborn hospital readmission. It is responsible for the hospitalization of TENS OF THOUSANDS of newborn babies each year, not to mention an untold number of brain injuries and deaths from dehydration, hyperbilirubinemia and hypoglycemia.

And yet, the American Academy of Pediatrics continues to promote it.

The current situation is an abomination. The harms — the tens of thousands of neonatal hospitalizations, the brain injuries, the deaths — are almost entirely caused by the mindless insistence on exclusivity.

Yesterday the AAP posted this on its Twitter feed:

Breastfeeding matters! It’s important for the health of children – and mothers.

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It’s not true. In the US, breastfeeding DOESN’T matter. With the exception of premature babies, there is no evidence that breastfeeding reduces mortality rates, severe morbidity rates, disease incidence rates or healthcare spending. This despite the fact that breastfeeding rates have nearly quadrupled in the past 40 years. If we haven’t seen the purported benefits yet, they don’t exist regardless of how many mathematical models predicted them.

The accompanying video is filled with bald faced lies.

Breastfeeding is the best start for your baby? Then why is it the leading risk factor for newborn hospital readmission?

Breastmilk contains all the nutrients your baby needs? Then why do breastfed babies need vitamin and iron supplements?

Breastfeeding promotes a “special bond” to your baby? In addition to the fact the claim is a lie that has been thoroughly debunked, it is an unspeakably cruel insult to adoptive parents, fathers and non-birthing partners in lesbian marriages.

Breastfeeding is great when it works. I know; I breastfed four babies. But it is hardly necessary for infant health and wellbeing. Two generations of Americans — the so-called “Greatest Generation” and their children — were raised nearly entirely on formula and mortality rates and morbidity rates continued to drop at a brisk pace. There is no evidence that those generations suffered from bonding difficulties with their parents. They grew up to be taller, healthier, and with higher IQs that the generations before.

The AAP can’t point to any benefits of breastfeeding that have come to pass, while I and others can point to literally tens of thousands of babies harmed each year by breastfeeding promotion. That raises the question: is the AAP morally culpable for the harm they cause by promoting breastfeeding?

In my view, the AAP does bear moral responsibility for the tens of thousands of hospitalizations each year, the permanent brain injuries and deaths, not to mention the soul searing guilt carried by many of the nearly 15% of women who can’t exclusively breastfeed, particularly in the early days after birth.

The AAP bears moral responsibility for these egregious harms because, as exemplified by their Tweet, they continue to promote falsehoods.

I’m not suggesting that the AAP wanted babies to be harmed by aggressive breastfeeding promotion; they never expected it. But they bear morally responsibility for the harms because they have ignored them. The AAP seems to have decided that those hospitalized and injured babies (and their mothers) are acceptable collateral damage.

Why? Because they’ve been co-opted by the breastfeeding industry encompassing, the tens of thousands of lactation consultants, lactation leaders and companies that profit by promoting breastfeeding.

The AAP bears moral responsibility for the harms because they’ve allowed and supported the industry — in the form of BabyFriendly USA — to operate freely in hospitals, replacing scientific evidence with lactivist ideology.

The AAP bears moral responsibility for the harms because they’ve allowed BFUSA to force doctors and nurses to abide by an ideology that many consider untrue at best and harmful at worst.

The AAP bears moral responsibility for the harms because they’ve allowed themselves to be blinded by white hat bias. They are still so angry at the formula industry for its behavior in Africa in the 1970’s that they demonize formula itself.

But most of all the AAP bears moral responsibility for the harms because they have made no effort to stop them. It wouldn’t be difficult. All they would have to do is point out that while breastmilk is good, there is precious little evidence that the purported benefits require exclusive breastfeeding.

The current situation is an abomination. The harms — the tens of thousands of hospitalizations, the brain injuries, the deaths — are almost entirely caused by the mindless insistence on exclusivity.

It’s the equivalent of telling parents that the benefit of a healthy diet for a child is entirely negated by an occasional piece of candy. It’s the equivalent of claiming that the occasional piece of candy would destroy their children’s gut microbiome and result in epigenetic changes. It’s the equivalent of insisting that parents who let their children eat candy occasionally don’t bond to them or love them as much as those who ban candy entirely. It would be ugly, unscientific and cruel to children and parents.

But that’s what the AAP is doing when it promotes breastfeeding exclusivity at the expense of the physical health of babies and the mental health of mothers. And so they bear moral responsibility for the tremendous harm caused by their complicity in a breastfeeding promotion campaign that has produced very few measurable benefits and a large amount of harm.

  • DaisyGrrl

    It makes me sad that so many women twist themselves in knots trying to exclusively breastfeed. I’ve floated the idea with several friends that maybe breastfeeding is being oversold and holy crap, the pushback! They’d acknowledge that formula is fine, but they needed support to reach their breastfeeding goals. Breastfeeding is pushed so hard as the norm, people have forgotten that formula was a transformative development that saved millions of lives.

    I’ve shared this anecdote here before but it’s so illustrative. My father was the 11th child born in his family, and they were unable to care for him when he was born so his aunt and uncle adopted him. He had a relatively good upbringing – only child in a working-class family that was able to provide for all his needs, however he would have been exclusively formula fed. There’s picture of him at a family reunion with his birth siblings when he was in his thirties. He’s noticeably taller than the next tallest brother and head and shoulders above most of the siblings. It’s a rather striking visual.

    I’m doubtful that his siblings received much, if any, formula as infants and would likely have been breastfed with early introduction of food (they were quite poor and spaced fairly close together). It’s almost as if socio-economic factors and access to adequate nutrition were more important to overall early childhood development than breast milk! Who knew?

    Bringing this back to today’s environment – I worry about public health initiatives that push breastfeeding so hard. It’s easy to find breastfeeding support groups and drop-in centers where I live, but I don’t think that a formula feeding mom would feel welcomed there. And these supports are so vital to new parents! Having a place to learn about parenting and available resources, along with making social connections with other new parents, can be life changing.

    Early barriers to accessing these services, even in the form of tacit disapproval through breast is best messaging, can alienate a new parent and exacerbate inequalities and isolation. Will a parent who feels shamed at the outset come back for early childhood drop-in days? Will they trust these public health professionals when they’re given other health information? Since breastfeeding initiation is often linked to education, income, and race/ethnicity, women who are already at a disadvantage are finding further barriers placed before them in accessing services and it’s their children who will pay the price.

    • Cristina B

      I would argue that breastfeeding is pushed so hard that the nurses don’t even know how to formula feed a baby. The postpartum nurse who gave me the guidelines basically just tossed the papers at me and told me to read them. It didn’t even go over the fact that a baby’s needs change significantly over the first few days. I figured that one out at 3 am when my baby guzzled 2 bottles and demanded more. Then I had a home nurse visit and she didn’t even know how much a baby would drink the first week; luckily she called me back later and gave me rough estimates. As much as people love to just say “read the can” when it comes to formula feeding, that info is rather limited…and insists that breast is best for the baby….

      • DaisyGrrl

        That’s awful. Where I live women are counselled about the benefits of breastfeeding and the risks of formula feeding under the guise of making an “informed” choice. Of course, there are clearly no risks to breastfeeding or benefits to formula! Combo feeding is downright discouraged (presumably because that would harm exclusive breastfeeding or something).

        I’m glad you had a home nurse who was willing to look up information and get back to you! Silly that the level of knowledge is so limited these days.

        • Cristina B

          I’m Canadian too, but in BC. They would have covered the risks of formula feeding during the hospital tour, but I skipped that, lol.

    • mabelcruet

      By law, in the UK, formula tins have to be labelled with a statement clearly emphasising the superiority of breast milk. The wording of the law is:
      Article 9.2 relates specifically to infant formula:

      “Manufacturers and distributors of infant formula should ensure that each container has a clear, conspicuous, and easily readable and understandable message printed on it, or on a label which cannot readily become separated from it, in an appropriate language, which includes all the following points:
      1. the words “Important Notice” or their equivalent;
      2. a statement of the superiority of breastfeeding;
      3. a statement that the product should be used only on the advice of a health worker as to the need for its use and the proper method of use;
      4. instructions for appropriate preparation, and a warning against the health hazards of inappropriate preparation”

      Imagine being a mum and reading that-being told that the formula you’ve bought to feed your baby is garbage, and that its only to be used when a doctor gives permission. I find it absolutely sickening, and I don’t even have kids. Not only is it patronising and mum-shaming, its scientifically inaccurate, because breast milk isn’t superior-as Dr T has discussed endlessly and repetitiously, in a developed country there is no significance difference between breast milk and science milk. It’s misleading and false advertising and yet legally its obviously permissible to lie to mothers about it.

      • DaisyGrrl

        I thought we had a similar law in Canada, but can’t find evidence of the doctor’s permission part at least. However, this is what passes for facilitating an “informed decision” in Ontario public health units: https://www.toronto.ca/community-people/children-parenting/pregnancy-and-parenting/breastfeeding/make-an-informed-decision/

        Very much all risk and no reward for formula feeding. And they advise against powdered formula for infants under 2 months whilst advising that formula is costly…

      • alongpursuit

        You’re completely right that it’s mum-shaming. It hurt every time I read it. I couldn’t provide enough breastmilk for my baby despite herculean efforts. I was reminded every time I made her food to keep her belly full that I wasn’t providing the “best” for her, but what other option did I have? Buying breastmilk off of the internet? It just seems like they want to grind mums down and beat us when we’re down there. I guess mums like me are just collateral damage.

      • KeeperOfTheBooks

        I like the phrase “science milk.” 🙂

      • rational thinker

        I don’t know if it is a law in the USA or not but best is best is on most formula cans here. When I had my son I made the choice to formula feed him and I remember saying in my mommy group that breast is best. Our whole group said it and none of us were breastfeeding. Even though I knew better It was like I was socially conditioned to say it or maybe cause every time I made a bottle I had to look at those words.

        The thing that gets me most upset is at food stores. Most stores I have been to have baby formula in the isle and you just take it off the shelf and put it in your cart. Then there are a few stores that have a locking glass display cabinet where they keep the formula. One store by me has the locked formula cabinet and the locked cigarette cabinet side by side by the cash registers. That is just degrading and with it being next to the cigarettes it kind of sends the message that what you are feeding your baby is unhealthy. Then of course everyone in line at the registers will see you bought formula and you will maybe get some dirty looks and if there is a sanctimommy that cant mind her own buisness she may have a nasty comment for you as well.

        • AnnaPDE

          Is the locking up for the “controlled substance” reasons though, or is it because of the risk of theft and tampering? Here in australia, some supermarkets have started putting a plastic locking device on the lid of the formula can that has to be removed at the checkout – there was a surprising amount of theft, and a few scary reports of people opening formula cans in the shop, doing whatever with the contents, and then putting the lid back on.

          • EmbraceYourInnerCrone

            It is to make it seem like a controlled substance and to make moms feel guilty for using it:
            Here is one mom’s experience when she asked for formula:

            http://blogs.wsj.com/juggle/2012/08/02/latch-on-nyc-%E2%80%94-unfair-to-new-moms/?mod=e2tw

            https://www.mamamia.com.au/baby-formula-and-breastfeeding/

            “And yet three days after giving birth, I just stood there and allowed myself to be berated by a midwife at the ward’s front desk – in front of several people – for ‘not trying hard enough’ to breastfeed. She publicly reprimanded me for not expressing milk every two hours throughout the night. I had tried but frankly I was EXHAUSTED. “

          • Heidi

            It probably varies. I’ve seen stores lock up the namebrand formula but the generic wasn’t. We have had problems with people stealing formula, selling it to local baby stores and then reselling it for cheaper than it can otherwise be purchased, especially with the special hypoallergenic kinds. A lot of stores here also lock up Axe deodorant but not the other brands. They also lock up condoms in some stores. I don’t at all think the intention is to shame anyone but they happen to get stolen, either because people can’t afford them or would rather risk stealing them than be seen purchasing them.

  • alongpursuit

    Breastfeeding promotion about bonding and protection harms women.

    When I was trying soooo hard to BF and producing next to nothing all I could think of was how I was failing to bond and failing to protect my baby. Before I had her I had big hopes of being a good mom who was attuned and connected and on whom she could rely for protection. This was so important to me because I am a child abuse survivor and my mother did not protect me. I know that those who experienced child abuse are at a higher risk of becoming abusers themselves so I am hypervigilant to any signs that I am committing harm.

    I trust these organizations to know more than me about how to care for my baby because I don’t trust myself, given my background. I read the BFHI 10 steps poster in my postpartum ward over and over and took it very seriously. I am terrified of hurting my baby because I know what it’s like to be abused, neglected and without protection. Even though I am highly educated and was able to create a safe life for myself, these messages about protecting your baby through breastfeeding and bonding hit me on a deep, emotional level and when I failed I was beyond inconsolable because I felt like I failed at being a mother.

    What an awful and completely unnecessary introduction to motherhood! I’m working through it with a therapist and every day I’m blaming myself less. Calling this postpartum depression is questionable. I was harmed by this type of breastfeeding promotion. What I needed was evidence-based objective information about the benefits of breastfeeding like what is in this article: https://www.mdedge.com/clinicianreviews/article/166932/pediatrics/breast-best-mantra-oversimplification .

    • Megan

      Wow… I could not agree more with you, and am so sorry you had that experience. The “bonding” thing is SO ridiculous when you look at it objectively (which is hard to do of course as a postpartum/anxious mom like I was)…my mom, grandma, and I were all raised on formula and have amazing relationships with each other.
      Have you read the book “Mother-Infant Bonding: A Scientific Fiction”? It seems as though with regards to the fear-based bonding rhetoric, we appropriated evidence from the animal world (goats and the like), and decided it must apply to all humans everywhere in the 21st century. Causes SO much grief for new moms, whose time would be much better spent enjoying their little ones.

      • alongpursuit

        I will definitely check out that book! Thank you for the suggestion. Yes, it’s hard to question “expert” claims when you’re postpartum, sleep-deprived and unaware that they (mainly the BFHI and the nurses implementing it) are pushing an agenda. The messages are hopelessly skewed at this point and have become misinformation and often straight-out deception.

        I remember reading in the BFHI materials that breastfeeding is “anti-cancer” and thinking to myself that I needed to breastfeed in order to protect my baby from cancer (I gave it the same importance as protecting her from second-hand cigarette smoke – a similar public health message). Later when I found out that the anti-cancer claims come from an in-vitro study (HAMLET) and that the only statistically-significant association between BF and “anti-cancer” (acute lymphoblastic leukemia) found that approximately 12,500 infants would need to be breastfed to prevent one case. I think it’s a stretch to claim breast milk is “anti-cancer” and I wonder if my toddler’s blueberry intake perhaps does more for her?

        When I compare the BF public health messages with other ones about the benefits of quitting smoking or using condoms, I find that the BF messages are completely out of line. I’m left feeling lied to and betrayed by the medical establishment because I was sucked into it and destroyed myself in the process of trying to BF because I thought it was so important. If someone had told me that BF would maybe prevent a gastro or ear infection at best, I wouldn’t have put myself through what I did.

        • Megan

          Agreed – and the breastfeeding messages now come not only from the “authorities”, but now are infiltrated through mommy blogs/groups. Moms are covertly policing others, telling them what’s “best” for every baby. They love to be able to say “breast is best” or “fed is expected” and feel superior to others. It’s so human, it’s so hard not to let our egos get the best of us in life. Motherhood is such an all encompassing identity for some, I totally understand why women cling to these mottos. It makes some feel special/unique and, in a country that often devalues women’s work, it can feel good to feel like you’re making a difference. It’s all so complicated, my greatest hope for all of us is that women will set aside the egos and come together to support each other. The world needs a lot more acceptance and appreciation for diversity – not division into camps!

    • Emilie Bishop

      I’m so sorry about your introduction to motherhood and am glad you’re finding healing with your therapist. My own breastfeeding guilt came from infertility and a prior pregnancy loss–it took so long to have this baby that I need to do everything right now that he’s here. The promotion of breastfeeding as a magic bullet to fix any and all parenting issues is indeed so damaging for so many reasons and it needs to stop.