Insisting breastfeeding matters to everyone, Dr. Meghan Azad shows why it doesn’t

One percent on white background. Isolated 3D illustration

The Fed Is Best movement has completely changed the conversation around breastfeeding.

True, they haven’t yet gotten lactation and health organizations to acknowledge outright that the benefits of breastfeeding term babies in industrialized countries are so trivial that they literally cannot be measured. But we (I consider myself part of the movement though I’m not part of the Foundation) have forced a re-framing of the conversation. And as I’ve written many times in the past, when you frame the discussion, you own it.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Breastfeeding matters to approximately 1% of babies in industrialized countries. There is no evidence that it has a substantive impact on 99%.[/pullquote]

A new piece from microbiome researcher Meghan Azad, PhD, offers an excellent example. In explaining why breastfeeding matters to everyone, Dr. Azad unwittingly shows why it doesn’t much matter.

The author begins with the fallback position into which breastfeeding researchers have been forced: the language of breastfeeding “goals.”

Research in the US has found that most women (60%) do not meet their own breastfeeding duration goals…

This reflects the lactivist understanding that intense pressure to breastfeed, such as the Baby Friendly Hospital Initiative, will no longer be tolerated going forward. That doesn’t mean that lactation professionals recognized the error of their anti-feminist ways, merely that they’ve modified their language.

“Look at us,” they invite. “We’re not pressuring women to breastfeed; we’re helping them meet their goals!”

That’s about as persuasive as the fashion industry absolving itself of the pressure on women to be thin by declaring, “We not pressuring women to lose weight; we’re helping them meet their weight goals!”

Dr. Azad then asks:

But is breastmilk truly better than formula milk for supporting infant health outcomes?

She answers yes, but puts so many qualifiers around it that she’s basically acknowledging that no, it doesn’t matter.

… [T]he magnitude of difference depends on a multitude of factors including genetics, the environment, socio-economic factors, medications, length of gestation (prematurity), and method of birth. Simply put, a healthy full-term infant born vaginally with no genetic risk factors may not benefit to the same extent from breastfeeding as a premature infant requiring multiple medications and interventions …

This is just another way of admitting to what I have been writing for more than a decade: in industrialized countries breastmilk can have lifesaving benefits for extremely premature infants (only 1% of infants born each year) but has negligible benefits for term babies.

When it comes to the rest of the world, Dr. Azad persists in promoting the fantasy that breastfeeding could save more than 800,000 lives per year. She fails to note that this is based on a mathematical model that has never been validated and the model itself erroneously assumes causation for every observed correlation. She also neglects to mention that the countries with the highest breastfeeding rates (98%+) have the highest infant mortality rates. If the babies who are already being breastfed are the ones who are dying, how could increasing breastfeeding rates elsewhere save them?

Then Dr. Azad pivots to tenuous “benefits” that have never been confirmed. As I recently explained, the ever more nebulous benefits of breastfeeding (the microbiome! epigenetics!) are a fallback position, an acknowledgment that the substantive benefits of breastfeeding have been largely debunked.

Breastmilk also contains many factors that directly enhance the infant’s immune system, regulate appetite and support their gut bacteria. For example, there are special sugars in breastmilk called human milk oligosaccharides (HMOs). HMOs are the third most abundant solid component in breastmilk, yet they are completely indigestible to the infant. The primary role of HMOs is to act as a prebiotic, or food source, for beneficial bacteria in the infant’s gut, such as Bifidobacterium longum subspecies infantis (B. infantis). This bacterium is specifically adapted to proliferate in the presence of HMOs, allowing it to prevent the growth of other potentially pathogenic bacteria by crowding them out.


B. infantis and other gut bacteria (collectively known as the ‘gut microbiome’) also help train the infant immune system and produce essential vitamins, having a long-term impact on infant health and development. While there is still much to learn about what constitutes a healthy or unhealthy microbiome, we know that breastfeeding is among the most influential factors shaping this important community of ‘good bacteria’.

How does that affect the health of individual infants? To date, there is no evidence that it does.

Dr. Azad continues with ever smaller benefits:

Breastfeeding is also protective against breast cancer, offering a 4.3% reduction in risk for every 12 months that a mother breastfeeds over the course of her lifetime …

But pregnancy raises the risk of breast cancer by 16% over the following years. Yet the researchers who made that discovery claim that risk is so small that it shouldn’t be factored into the decision to have children. If that’s the case, why should a much smaller reduction in the risk of breast cancer from breastfeeding factor into the decision on how to feed infants? It shouldn’t.

But wait! Breastfeeding is important for the environment!

It is important to consider the environmental savings of breastfeeding as opposed to the environmental footprint created by formula feeding. It is estimated that more than 4000 L of water are required to produce 1 kg of powdered formula and that 86 000 tonnes of metal and 364 000 tonnes of paper end up in USA landfills annually as a result of formula packaging…

This is taken directly from the new nonsensical editorial in the BMJ that I wrote about only last week (Climate change: have you tried squirting breastmilk on it?).

The calories in breastmilk come from the increased amount of food that breastfeeding women must eat. In contrast to cows who need only consume grass to make milk, women need meat (produced by industrial farming), vegetables and fruit (produced by industrial agriculture) and fish (caught by practices that are destroying the oceans).

Moreover, how green is the plastic used in breast pumps? How green is the electricity and batteries used to power them? How green are nursing bras made with synthetic fibers? How green are special clothing, breastfeeding pillows and other breastfeeding accessories?

Dr. Azad concludes:

A cost analysis of common childhood infectious diseases that can be prevented through breastfeeding (gastroenteritis, necrotizing enterocolitis, respiratory tract infections, and acute otitis media) found that a 10% increase in exclusive breastfeeding until 6 months and sustained breastfeeding until 1 year could save the US healthcare system $312 million per year.

That sounds impressive until you consider that breastfeeding itself has become the leading risk factor for newborn hospitalization. An astounding 1 in every 71 exclusively breastfed babies will be hospitalized leading to approximately 40,000 preventable hospital admissions per year at a cost of hundreds of millions of dollars. That doesn’t even include the downstream costs of neonatal brain injuries from dehydration and severe jaundice.

The bottom line is that breastfeeding matters only to approximately 1% of babies in industrialized countries. There is no evidence — and Dr. Azad fails to provide any evidence — that it has a substantive impact on the other 99%.