Breastfeeding Medicine

Physicians blogging about breastfeeding

Why ‘Beetlejuice’ is a losing argument to bolster breastfeeding

with 14 comments

I’ve been thinking a lot about Similac’s recent recall of 5 million cans of formula thought to contain beetle parts, and what it means for breastfeeding advocacy. At first blush, it looks like a slam dunk argument to encourage more moms to breastfeed. Faced with a decision between bug-part-tainted powder and mom’s milk, surely more moms will want to breastfeed.

Chicago public health poster urges mothers to breastfeed rather than feed babies tainted cow's milk.

But history teaches us that tainted breastmilk substitutes are a losing argument for breastfeeding. In her fascinating book, “Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the Nineteenth and Twentieth Centuries,” historian Jackie Wolf chronicles the breast vs. bottle debate a century ago in Chicago. Child health advocates of this era faced a double crisis: more and more mothers couldn’t make enough milk, and were turning to cow’s milk that, in the early 1900s, was unpasteurized and often contaminated with visible chunks of animal feces.

Thousands of babies were dying, and advocates went to work to both encourage breastfeeding and clean up the milk supply. Within a decade and a half, milk was pasteurized, and, with the poop out of the cow’s milk, mothers figured that they didn’t need to breastfeed any more – and we began a decades-long decline in breastfeeding rates.

The problem was the apparent “epidemic” of failed lactation. Wolf quotes multiple pediatricians who decried the modern woman’s loss of milk producing capacity, attributed to the stresses of modern life. In fact, that epidemic was caused, in large part, by bad advice from pediatricians. In an era where industry and schedules was replacing productive work inside the home, mothers were advised that infants needed to be placed on a schedule, from their earliest days, so they would grow up to be responsible workers. Advised to feed every 3 to 4 hours, mothers’ milk supplies spiraled downward, forcing them to supplement. Clean cow’s milk become a public health imperative – and no one thought to consider how the medical profession and cultural norms had derailed breastfeeding physiology.

So what does this have to do with Similac and beetle parts? Much has been made of Senator Tom Harkin’s letter to Abbott about the recall and the need to clean up the formula supply chain. Clearly, we need to make sure than formula is free of contamination. But where are the calls to investigate the breastfeeding supply chain?

In the US, 75% of mothers start out breastfeeding, but a dismal 13% are able to meet AAP recommendations for 6 months of exclusive breastfeeding, and less than ¼ are still breastfeeding at one year. This is not a problem with maternal motivation: in a recent study of more than 2000 mothers, 60% of those who quit in the first year wanted to breastfeed longer than they did.

Many of the reasons that mothers quit could have been solved with adequate lactation support, skilled healthcare providers, and a culture that values mothers and babies. Yet every day, we fail women, whether through routine hospital practices that undermine moms or through workplace policies that force women to choose between nourishing their babies and supporting their families. We need to shine the spotlight to these “booby traps,” with the same urgency that politicians are investigating formula factory supply lines.

Tom Harkin might start in his home state of Iowa, where the CDC Breastfeeding Report Card for 2010 reports that maternity centers received a score of 61 out of 100 on the mPINC survey — a gentleman’s C — and none of the state’s live births occur in a Baby Friendly facility. Iowa has 2.2 board-certified lactation consulatants per 1,000 live births — below the national average — and has only one half of one FTE state employee dedicated to breastfeeding support. Along with 34 other states, Iowa has no legislation mandating employer lactation support. The issues here have nothing to do with how mothers want to feed their babies — these are systems problems that, like beetles on the assembly line, demand systems-level solutions.

The core public health problem with our epidemic of formula feeding is not that there are occasional recalls of tainted formula. The problem is that we are setting mothers up to fail, and then shrugging our shoulders and saying, “Once the beetles are out of the formula, what’s the big deal?”

Senator Harkin, you are chair of the Senate Committee on Health, Education, Labor and Pensions. Clean up the formula, please, but then, let’s tackle the breastfeeding supply chain. America’s moms are counting on you.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the Academy of Breastfeeding Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by astuebe

October 8, 2010 at 8:31 am

14 Responses

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  1. Well said.
    Not only does the workplace force mothers to choose between nourishing their babies and supporting their families, but also school and universities force parenting students to choose between nourishing their babies and obtaining their education.

    Karen Peters

    October 8, 2010 at 9:24 am

    • That is half-way true. It is really hard to focus on more than 3 credits in college when you have a breastfeeding baby to take care of. I managed 9 every semester, including the semester my son was born, with online classes and the help of family and friends to watch and play with him in between feedings so I can get some school work done. I miss spending some time with him, but I still nourish him with mama’s liquid gold just the same. I prefer the classroom style of learning rather than staring at a computer screen every day, but this will work for now.


      October 10, 2010 at 8:57 am

  2. Thank you Dr. Stuebe for this historical context and this very current data. We still, a century later, have much work to do in order to improve breastfeeding rates. Up-to-date information is the starting point; educating physicians and policymakers is next!

    Karla Shepard Rubinger

    October 8, 2010 at 10:14 am

  3. I have a full-time student at my local university, I am also a mother of two; one of which is 10 months and I’m still breastfeeding. If I can spend 90% of my time going to nursing school, studying, cleaning, cooking, and taking care of my family while STILL having the ability to make time to breastfeed, a woman who works an 8 hour shift can find the time to breastfeed. Even if it’s only twice a day.

    And I’ve also read, that only 3% of women actually CAN NOT breastfeed. The other 97% either do breastfeed, don’t want to breastfeed (eyeroll), or pretend like the’re not able.

    All of my heart wants to support things such as formula prescriptions – but any food is better than no food for a baby, right? I wish breastfeeding weren’t so taboo. I don’t even know.


    October 9, 2010 at 10:51 am

    • Camille, you are one of the fortunate mothers who CAN manage to do it all, and despite all the barriers, feed and nourish your baby. I was like that too. My first (of 4) was born when I was a neonatology fellow. They did not know what to do with me, and thought that 6 weeks maternity leave was quite magnanimous. Then I was back, working 36-40 hour shifts away from my baby, home for 8 hours of exhausted sleep (with my baby), then back for more. I was determined no formula would cross his lips–and none did. I pumped like no other. And carried my thermal bags of refrigerated bottles home for my husband and baby-sitter to feed him when I wasn’t there. I did it–23 years ago–but that does not make it right!!!

      We should not be throwing up barriers to our mothers to breastfeed. We should be enabling them to breastfeed their babies. Some women go back to work within a week or two of delivery–they have no choice! They work in fast food restaurants, as bus drivers, in fields and in places where there is no place for them to safely or cleanly pump or feed their babies. This is not right–we should not stand for this in this country.

      So I applaud women like you (and me) who figured out how to do it no matter what. (And I must tell you, it was at a price to myself that I only saw years after the fact.) But there are many women out there who really want to make it work, and because of circumstances, just cannot without our help and support as a society. We cannot just dismiss them and their babies. We need to advocate for paid maternity leaves and workplace lactation policies and lactation support that is part of preventive medical care so that all women and all babies can exercise the right to breastfeed and be fed mother’s milk.

      Kathie Marinelli

      October 13, 2010 at 10:59 pm

  4. Please try to get this blog published in a medical journal, or local physician magazines.

    Evelyn Scott

    October 9, 2010 at 1:17 pm

  5. It seems to me that the original problem hasn’t gone away– industrial living and fixed scheduling are simply not compatible with early child care and breastfeeding. People are simply more chained to the industrial model and attempt to shoehorn support for early child care and breastfeeding into it with mixed results.


    October 9, 2010 at 3:13 pm

  6. What a dirty rotten shame!!! Shame on American’s for
    such knowlege and poor understanding on the Health bennefits of Human Milk for Human Infants.
    We are the only Race who does not feed our off spring
    Species specific Milk. It Is Every Infants Birth right
    To Recieve His/Her Mother’s Milk.

    Jo Anne Kern

    October 9, 2010 at 7:48 pm

  7. It’s so disheartening that America is still not on board with breastfeeding. The hospital that I stayed in told me that colostrum wasn’t enough for my infant and that I needed to supplement with formula until my milk came in–REALLY?

    Clarissa Stagg

    October 9, 2010 at 9:42 pm

    • The nurses at the hospital where I gave birth tried to tell me the same thing and tried a couple of times to get my consent to feed my son formula. I told them no. My son was going to be breastfed ONLY. That didn’t work out so well once I started school but I did breastfeed him for his first two months. I would have liked to breastfeed for six months unfortunately I wasn’t producing very much milk and formula feeding has taken over more and more. It’s horrible in hospitals though, I was at one of “the best” hospitals in Manhattan/the city supposedly and when I said no formula and Liam cried to be fed more often, the nurses denied me access to the nursery for Liam because he would “disrupt the other babies” and the nurses didn’t want to deal with a nursery of crying newborns. Being in a labor and delivery unit meant my husband could not stay with me overnight nor could anyone else and I had just had a C-Section (mixture of he baby getting stuck in the pelvic girdle and me not dilating enough AND being a week late)- I couldn’t believe the nurses left me to fend for myself with a two day old newborn and no support because they disapproved of my decision to ONLY breastfeed. I couldn’t even get out of bed the first day under doctors orders and the second day was moving slow as a snail. I’m still so disgusted with the treatment I received from the nurses. When I reported the situation to my midwives they were shocked and allowed me to go home a day or two early. I was so desperate to get out of there and have the help I knew was waiting at home that I left with the stitches still in me and went in to my doctors office a few days later to have them taken out.


      March 3, 2011 at 8:01 am

  8. YES! Thank you. Shame doesn’t change behavior, it just makes ppl feel bad and inferior. SUPPORT and RESOURCES are what will make a difference.

    My Mother-in-law breastfed her babies in the 80s… which is great, but I remember her telling me once how the pediatrician had told her not to nurse more often than every FOUR hours. Then by the time my husband was 6 months he was so skinny the dr was then telling her to give him all the table food he wanted to give him more calories. Sadly, it seems some of that same advice is heard today….


    October 9, 2010 at 9:56 pm

    • Marcy,

      Couldn’t agree with you more. I know it sounds silly and old-fashioned, but I believe that if mothers are allowed to breastfeed (no workplace or healthcare-related barriers), and if they know in advance that they’ll receive the support that they need (technical, social, and emotional)… odds are they’ll beastfeed. All mammalian mothers are driven by the same very powerful instinct: to nourish their young. In the case of humans, that instinct has been so tragically suppressed.

      No need for the shame factor. Just make breastfeeding feasible, and it’ll happen.

      Jerry Calnen

      October 10, 2010 at 8:36 am

      • Yes, all mammalian mothers have the instinct to nourish our children. Unfortunately, many of these mothers are convinced that there is little to no difference between formula and breastmilk. They believe that the additives in formula (DHA and the like) make it equal to breastmilk, or maybe not quite as good, but certainly “good enough”. After all, they dont’ know anyone who’s been harmed by formula…or so they think.

        If we don’t get it out there that breastmilk isn’t “best”, it’s biologically normal and expected; that there are very real DANGERS in feeding infants formula, and that human milk is made for human babies, the rates are unlikely to change much.

        Combine the (technical, emotion, and social) support for breastfeeding mothers with very real, supported education about formula’s dangers, as well as a push to decrease the sexualization of the breast in our culture, and we may increase rates to an acceptable level.

        Lynne WG

        April 14, 2011 at 5:55 am

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