Breastfeeding With a Grain of Salt: Study Fails to Link Directly to Infant Health

Breastfeeding does correlate with positive health outcomes, but causality hasn’t been demonstrated: better information and health care could be key, new study says

Mothers nursing their children in Ciudad Juarez, Mexico, to mark World Breastfeeding Week, which promotes global support for breastfeeding, August 4, 2018.
\ JOSE LUIS GONZALEZ/ REUTERS

Breastfeeding baby is entrenched as Virtuous and Natural – as opposed to bottle-feeding bairn with industrial powder mixed with tap water. Leaving inability to lactate aside, that’s Venal and Negligent. And breastfeeding is good for baby, no question about it: There’s a reason people didn’t evolve with a spear in one hand and BPA-free plastic bottles in the other.

But the data on breast versus bottle and health in the first year seems to have been skewed by the fact that mothers who intend to breastfeed (or who actually do) are in general better informed and get more medical attention, compared with mothers who meant to, and did, feed the child with formula, say a sociologist from the University at Buffalo and a public policy expert at the University of Connecticut, in a paper published in the Elsevier journal of Social Science & Medicine: Population Health.

Feeding newborns is a controversial issue. Breastfeeding is encouraged unquestioningly: Israeli hospitals provide novice moms with breastfeeding tutors, and the salespeople shoving free formula samples at the patients can look, well, skulky. So, on the one hand women are strongly urged to breastfeed, if they can, but not in public lest … I don’t know what. And let’s not even get into the issue of how long this feeding method should be sustained. The World Health Organization and American Academy of Pediatrics both recommend exclusive breastfeeding for the baby’s first six months, and even urge it as a matter of public health.

But Kerri Raissian of the Department of Public Policy and Jessica Houston Su of Buffalo’s sociology department suggest that with “the best of intentions,” the data suffers from material deficiencies.

Crucially, there was no difference in the health of babies born to women who exclusively breastfed, and women who said they would exclusively breastfeed, but didn’t and fed the kid on formula.

Emotional caveat: Only about 50 percent of women who intend to breastfeed actually can, the doctors explain. Not rarely, the inability to breastfeed is beyond the woman’s control.

Second, the study findings suggest that the benefits of breastfeeding reported in the vast majority of prior research may have been skewed.

“What we found is that intending mothers had more information about nutrition and diet,” Su explains. “They more frequently consulted their physicians; and had better access to information related to infant health than those moms who did not intend to breastfeed.”

Su stressed that they weren’t implying that just “intending to breastfeed” makes a difference to the baby’s health in its first year.

Actually, what seems to matter more to baby health is simply access to medical assistance. “By sinking so much energy into getting moms to breastfeed, we miss something very important: That access to health care and the ability to take medical advice is critically important to a mother and her infant,” said Raissian. “By exploring factors influencing better infant health outcomes, information from the study helps contextualize the trade-offs that a lot of mothers have to make when deciding how to feed their children.”

While on the topic, the scientists point out a glaring inconsistency in American policy. Israel has mandatory maternity leave as part of employment law. Not so the United States, where one may aspire to breastfeed, and may lactate, but may not have the luxury. And then, failing to breastfeed, the mother feels guilty.

“There is a high cost to this message, especially if the benefits of breastfeeding are overstated,” says Su, adding that the United States fails to provide the social networks to support the practice. “The U.S. is the only developed country with no federal paid parental leave, and only about 12 percent of mothers in the private sector have access to paid leave,” she stresses. “Paid maternity leave likely increases breastfeeding success, and also seems to have additional health benefits for mothers and infants. If we have concerns about disparities in infant health, we need social policies that support these recommendations and also go beyond simply encouraging breastfeeding over formula.”

The study was based on data from more than 1,000 participants in the Infant Feeding Practices Study II, designed by the U.S. Centers for Disease Control and Prevention, and the Food and Drug Administration.