Some comments about our recent series on breastfeeding came to the defense of formula, challenging the notion that formula is unhealthy. There should be no argument over this. It's like comparing the light of the sun with that of a match.
The evidence is overwhelming regarding the quality difference between formula and breastfeeding. Mother's milk, developed through evolution with thousands of ingredients to build the human brain, body and immune system, is incomparable with a man-made product of a couple dozen ingredients that are non-human and in wrong proportions. Although one might argue that the onus for evidence is on formula, it really is an impossible task to make a replacement for breastmilk. We must face the fact that there is no comparability between breastmilk and formula.2-4
In the comments to our tough post, we were happy to receive a link to this websitethat shows how formula breeds pathogenic bacteria in the infant gut (the locus of most immune system functions), unlike breastmilk which populates the gut with helpful bacteria. We were happy to receive news of this book (you can download excerpts-- the first excerpt has even longer lists of disadvantages of formula for both mom and baby than our lists).
The first bottomline is that breastmilk is the evolved standard for human babies. Anything else is detrimental to their best growth and development.Unless it is an emergency.
James Akre, author of The Problem with Breastfeeding: A Personal Reflection, was kind enough to email. (See more about his book here.) As Akre points out in his book, infant formula is emergency food. It's always good to have emergency provisions on hand, but they are NOT for everyday use.
But right now, infant formula is used in US hospitals everyday with normal infants without question. Ignorance, unintentional or otherwise, and easy access to formula seem to be sources of these ongoing harmful practices.
A second bottomline is that we are social mammals. Our development is greatly shaped by caregivers and early experience, a part of which is breastfeeding our children and being breastfed.2 We have not evolved away from being mammals and what mammals need. Our ancestral parenting practices match up with the needs of social mammals and emerged more than 30 million years ago.
What are those ancestral caregiving practices? They include meeting the needs of the young child promptly so the child's brain does not get stressed (because we are born developmentally many months earlier than other animals, the external situation in year 1 needs to mimic the womb for optimal growth). They include nearly constant touch in the first years of life to keep DNA synthesis and growth hormone active. They include multiple supportive caregivers of both mom and baby.2,5 (I write about these needs in other blog posts. One summary post here.) Extensive breastfeeding is another need that is required for a well-functioning body and brain.
Although research has barely begun to scratch the surface of the contents and benefits of breastmilk, it shows how overwhelmingly important breastmilk is for brain and body development.6 Our posts during all of breastfeeding week were devoted to succinctly summarizing dozens of research papers regarding links to health and wellbeing. Most studies are correlational but there are experimental studies too and formula, not surprisingly, always loses when compared with breastmilk.
The third bottomline is that the "breast is best" advocacy approach is not working well enough.7 It implies that formula is 'good enough' and fosters misconceptions and ignorance among the public and health professionals, and perpetuates ingrained cultural and institutional practices. Just as anti-smoking advocacy has taken up the dangers of tobacco, a 'formula is risky' approach has been advocated. We took up this approach and tried to address the misconceptions and ignorance about infant nutrition. Of course, a professional in infant nutrition could do it better, and we wish they would!
The fourth bottomline is that this is a community issue. Our educational posts were directed at all members of the community. Everyone should be educated about the dangers of formula and benefits of breastmilk so that the taken-for-granted baseline shifts to breastmilk, away from formula.
If breastmilk is the goal, how can we support mothers to give breastmilk to their children? We need to make breastmilk as easy to find and use as formula is today. Women who struggle with health and other issues should not have to feed their children formula.
We were so sorry to hear stories of the difficulties many women have with breastfeeding due to postpartum depression, prior trauma, and other issues. Clearly, society needs to make sure to provide supportive structures for all women from the time they are born (the caregiving noted above). When women are pregnant and after birth, there should be as much community support for mom and baby as our ancestors experienced. Raising a child takes the whole community.
We need to reorganize our communities so that workplaces and public places are arenas for breastfeeding. Perhaps we need to make breastmilk something like a 'take-out' food for young children, ubiquitous and inexpensive--the next fast "slow food."
Taking into account issues of mental health and other breastfeeding barriers, the future lies in establishing breast milk banks and milk sharing opportunities so that all mothers and fathers and family members can provide BREASTMILK for their children, NOT formula except as a last resort (in an emergency). Hospitals should have large supplies of breastmilk on hand for babies whose mothers cannot breastfeed (formula should be used only in a real emergency).
Jim Akre notes that milk sharing, a longstanding practice in human history, is taking off through the internet. It offers moms a way to find breastmilk for all children. See more here. We should start to reconsider wet nursing, women offering breastfeeding to other women's babies. This was a common practice in our history and is commonly available in hospitals outsides the USA. But it could be community or church/temple-based.
The status quo in hospitals needs to be changed, as the CDC report points out. Hospitals need to be baby-friendly in not automatically doing things to interfere with breastfeeding (e.g., giving formula/sugar water/pacifiers to newborns, separating mom and baby, inducing pain to baby, preterm inductions or cesareans, etc). The medical establishment should make human milk available to all newborns and infants. Let's support milk sharing and breast milk banks in every community's hospitals.
Our support of human beings needs to improve. It is clear that childrearing and breastfeeding are more of a mental and physical challenge for mothers than they should be in a great nation. We all can change that with more support for mothers, children and families across the board. (I have written about this in other posts.)
The experts should be leading us on these changes. Otherwise, we concerned child advocates and citizens will have to keep raising our voices.
A COUPLE MORE SPECIFIC RESPONSES
When saying that 99% of women can breastfeed, we were citing the World Health Organization's Infant Feeding Bulletin (1990)8 for this statistic. Here are two direct quotes from the bulletin:
1) "In societies where breastfeeding is regarded as a natural physiological function and the only way to nourish an infant, and where it is highly valued and therefore strongly encouraged and supported by society in general and families in particular, lactation failure is virtually unknown."7
2) "Based on limited clinical experience in industrialized countries, it appears that a maximum in the range of 1-5% of women experience lactation failure on purely physiological grounds."8
After the feedback, we've decided that in the future we should revise it to about 95% and make it clear that we mean physiologically speaking.
When citing research studies showing effects of breastfeeding, we made sure that only those that controlled for education and income were cited. In our own work, we are finding effects of breastfeeding, after controlling for maternal education and income, on the development of conscience and inhibitory control in 3 year olds. In a longitudinal study, after controlling for income and education as well as maternal responsiveness to the child, initiating breastfeeding at all was predictive of non-aggression at age 2.
THANKS TO COMMENTATORS
Thanks to those who gave constructive comments to improve our communications and posts. We showed a lack of understanding and empathy when we used cavalier language towards mothers. We thank those who gave us stories about their and others' challenging situations to educate us and increase our empathy. Unless a person has experienced something herself, the empathy for that experience can be lacking (e.g., being a widow), and clearly that was the case for me here.
One other misunderstanding apparent in the comments was about who blogs for Psychology Today. Not every blogger for PT is a therapist. Some of us are researchers, including myself. Therapy is only one of dozens of areas in psychology. The field of psychology is the study of human behavior in all its complexity.
My area of research is child and adult moral development. I link the faltering of morality in the USA at least in part to early life experience that undermines optimal brain and emotion development. I write as a developmental researcher concerned for child and social outcomes. I have a lot of passion for helping children and sometimes passion can lead to stepping on toes which happened in this case. I am sorry for that.
NOTE: co-authored with Stephanie Sieswerda and Elizabeth Ledden
POSTS IN THIS SERIES
Post #1discusses why you should care about breastfeeding, no matter who you are.
Post #2 discusses assumptions about infant formula that are wrong.
Post #3discusses myths about infant formula.
Post #4discusses the TREMENDOUS benefits of doing what is normal: breastfeeding.
Post #5 addresses myths about breastfeeding.
**Check out our YouTube video on breastfeeding vs. formula.**
Post #6 discusses real truths about breastfeeding.
Post #7 provides links to resources for breastfeeding.
Post #8 summarizes the prior posts' main messages in blunt terms.
1. Center for Disease Control (2011). Breastfeeding Report Card-United States. http://www.cdc.gov/breastfeeding/data/reportcard.htm
2. Hrdy, S. (2009). Mothers and others: The evolutionary origins of mutual understanding. Cambridge, MA: Belknap Press.
3. Isaacs, E.B., Fischl, B.R., Quinn, B.T., Chong, W.K., Gadian, D.G., & Lucas, A. (2010). Impact of breast milk on IQ, brain size and white matter development. Pediatr Res., 67(4), 357-62.
4. Nathavitharana KA, Catty D, McNeish AS. IgA antibodies in human milk: epidemiological markers of previous infections? Arch Dis ChildFetal Neonatal Ed. 1994;71:F192-F197.
5. Mason, K. O., & Kuhlthau, K. (1989). Determinants of child care ideals among mothers of preschool-aged children. Journal of Marriage & the Family, 51(3), 593-603.
6. Horta BL, Bahl R, Martinés JC, et al. Evidence onthe long-term effects of breastfeeding: systematicreview and meta-analyses. Geneva: World Health Organization; 2007:1-57.
7. Berry, N.J., & Gribble, K.D. (2008). Breast is no longer best: Promoting normal infant feeding. Maternal and Child Nutrition, 4, 74-79.
8, Akre, J. (1991). Infant feeding: the physiological basis. Bulletin of the WHO 1989. World Health Organization, Geneva, 67(suppl.).