Joan B. Wolf is an assistant professor of women’s studies at Texas A&M University and the author of the controversial new book Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood.
Q: The Canadian Paediatric Society recommends that babies be exclusively breastfed for the first six months of life. In your book, you argue that human breast milk is being falsely touted as a magical elixir.
A: The discourse surrounding breastfeeding is extraordinary. We’re told it can protect against everything from ear infections and diabetes to leukemia and heart disease, and can even improve social skills.
Q: Various studies have concluded that babies fed “non-human milk” have a higher incidence of respiratory disease, including pneumonia and bronchitis, diarrhea and other digestive illnesses, ear infections (up to four times more), urinary tract infections, meningitis and sudden death syndrome. One study says that during a baby’s first three months, exclusive formula feeding increases infant mortality by 61 per cent. Can all these studies be wrong?
A: They are all misleading because they are based on associational or observational research. You look at two variables and realize there is a connection and make the case that the connection is causal. But the leap to causal inference is in most cases not justified by the evidence.
The primary problem with breastfeeding research is this: these studies compare babies who have been breastfed with babies who were formula-fed. But they can’t control for critical confounding variables—something associated with breastfeeding that is itself also associated with better health outcomes. For example, one thing we know is that women who are middle class or more highly educated are more likely to breastfeed. So more recent studies say, let’s control for class and education and see if they make a difference, and in some cases they do. But none of the studies have been able to control for the decision to breastfeed. This is to say that mothers who choose to breastfeed usually do so because they have been persuaded that it has health benefits. These are the kinds of mothers who are willing and able to go the extra mile to provide the healthiest environment for their child.
Q: So you don’t believe breastfed babies are healthier?
A: I’m willing to go on record saying that on average breastfed babies are healthier. But that doesn’t mean breast milk causes better health. Women who breastfeed are more likely to do other things that will make their babies healthier. In the developed world, the differences in health outcomes are small enough that it’s reasonable to believe that differences in maternal or caretaker behaviour can cause them.
For example, if babies who are breastfed are less likely to have ear infections, is it the benefit from breast milk or the behaviour of the caretakers? If I make sure that anyone who comes to my house is not sick, that they wash their hands before they handle the baby, and if I don’t take my kids to the grocery store when it’s packed full of people on their way home from work and I sanitize the grocery cart, I am doing all sorts of things that could prevent my child from contracting a virus. Ear infections usually come after a virus that causes fluid to build up in the ear. So the question is: what is beneficial, that I am undertaking healthy behaviours or that I am breastfeeding? If I adopted all those behaviours and fed my baby formula, would you see any difference? We don’t have the answer to that question.
Q: Are there any medical beneﬁts to breast milk itself?
A: We do have very good evidence that breast milk reduces gastrointestinal infections. The milk is ingested, goes into baby’s gut, and antibodies from the mother’s milk fight the bacteria in the gut. What we don’t have is any evidence that those antibodies have any effect anywhere else in the body. And whether reducing GI infections in itself justiﬁes the discourse about breastfeeding—that if you don’t breastfeed all these terrible things will happen to your baby—is a question we need to ask.
Q: You write that the modern pressure on women to breastfeed “literally embodies social anxieties about risk, health and motherhood”—many of which have little to do with infant feeding per se. What do you mean?
A: I think we are a society that is consumed with risk. There is a degree of scientific sophistication in our lives that we don’t understand. That breeds, paradoxically, anxiety and a sense that we can control anything if we can just have the right information. The idea that we can prevent terrible things from happening to our children is very appealing. Science tells us how to behave, how to be the healthiest, and the information we get on breastfeeding is in keeping with that. What we don’t seem to realize in the case of breastfeeding is the science does not provide evidence for the claims that are made.
Q: Nothing I’ve ever written has received so much emotional response from readers as the time I wrote about my struggles breastfeeding my first son. My point was to say, this can be hard; take the breastfeeding class before the baby comes. But I was accused of discouraging people from nursing. There was a lot of anger in the letters. Why is this topic so emotional?
A: There is a certain defensiveness about the “natural” element of it. If you have to explain that it isn’t natural, there is work involved, then part of the force of the argument for why you should breastfeed disappears.
Q: You write that in recent decades we’ve replaced “good enough” mothering with “total motherhood”—a moral code in which mothers are exhorted to “optimize” every aspect of their children’s lives, beginning with the womb. Part of this is the “all-encompassing physical and emotional commitment” that it takes to breastfeed an infant every few hours, night and day. Are we putting too much pressure on mothers?
A: Yes, we are holding mothers accountable for outcomes that are completely beyond their ability to control. We expect mothers to work to prevent any risk to their children, regardless of how marginal the risk or what the cost or trade-off is to the mothers themselves. Every mother is out there trying to demonstrate that there is virtually nothing she wouldn’t do for her child.
Q: It’s interesting that you use the word “demonstrate.” One difference I’ve found between having a baby this past year and having my first five years ago is that now all my mommy friends are Facebooking while nursing. Not many status updates about bottle-feeding, though. Who are we demonstrating to?
A: We are demonstrating it to other mothers and also to ourselves. The more we sacrifice, the better the evidence that we are doing the best for our child.
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