Why breast isn't always best

The evidence suggests the health benefits of breastfeeding are negligible at best. What does the taboo around saying so tell us about attitudes to parenthood today?

In the modern pantheon of Things You Can't Say, “it's okay not to breastfeed” has a prominent place. Breastfeeding, the story goes, makes babies happier, smarter, and healthier. Breastfed babies have higher IQs and more social mobility and are less likely to develop everything from ear infections and allergies to diabetes and leukemia. They're skinnier. They even wet the bed less in adolescence.

Sure, the vast majority of parents end up turning to infant formula at some point during the first six months. But this usually follows some effort to breastfeed and is almost always accompanied by an explanation of why breastfeeding was not possible under the particular circumstances.

Even formula companies, which have a vested interest in reducing breast feeding rates, concede that breastfeeding is better for babies and claim that their particular brand most closely approximates breast milk.  It's quite remarkable, when you think about it.  Imagine Coca-Cola advertising, “it's healthiest to drink water, but if you choose to drink soda, drink Coke.”

Three falsehoods

The “breast is best”mantra is all the more striking if you actually read the research comparing breastfed and bottle fed babies in the developed world. Almost all of it finds the health benefits of breastfeeding to be nonexistent, marginal, or impossible to disentangle from other aspects of a baby's life. The better a study is designed — the more it accounts for other health-promoting behaviors breastfeeding mothers and their partners are likely to engage in — the less breast feeding seems to matter at all.

And yet, in the moral crusade that breastfeeding promotion has become, formula is likened to nicotine and mothers who formula feed are essentially blamed for raising children more likely to be sick and a burden on public resources. How did we arrive at such a miserable state of miscomprehension and self-righteousness?

The answer rests on three fundamentally false beliefs: that every time scientific research finds a relationship between two phenomena, one necessarily causes the other; that people who behave responsibly and are willing to make difficult choices can prevent virtually all risk, including health risks; and that breastfeeding is free.

The truth is far more complicated. The overwhelming number of statistical relationships in epidemiological research are not causal. Personal responsibility is unobjectionable, in theory, but much more difficult to define and exercise given the structural constraints that limit people's choices, our limited knowledge of what actually constitutes healthy behavior, and the inevitable negotiation of trade-offs that is modern life.

Breastfeeding, moreover, can be expensive. Extensive evidence demonstrates that many women feel guilted into breastfeeding and that the process often entails profound physical, emotional, and economic costs for mothers and families. But we tend not to recognize these costs because we think it's just a mother's job to eliminate all risks, including those that are small, unlikely, and costly to prevent.

What science can't do

In Is Breast Best?, I invite readers to imagine if men had functioning mammary glands. Would breastfeeding seem as urgent? Or would we say that its benefits were marginal, at best, and that they certainly did not warrant the kinds of sacrifices breastfeeding demands? Would we say that breastfeeding is convenient and free, or would we be acutely in touch with its disruptions and costs?

When I've suggested that both breastfeeding and bottle feeding involve risks and benefits and that these must be weighed in individual context, I've been compared to Holocaust deniers and advocates of cold fusion. I've been called a lesbian and a feminist, as if these terms signal some pathology that automatically disqualifies anything I argue. I've been told, effectively, “you can't say that.”

The trouble is, we'd like to believe that science gives clearer instructions than it can and that mothers have a lot more control than they actually do. But there is no universal, low-risk way to feed babies or parent (or to live, for that matter). Transferring “it's okay not to breastfeed” to the pantheon of Things Every Parent Should Know might help us begin to understand that.

Joan Wolf is author of 'Is Breast Best?' and Visiting Fellow at the University of Kent's Centre for Parenting Culture Studies. She is giving an Open Lecture at the University of Kent on Wednesday at 6pm.You can find details here.