Stop the Madness
For the second time in 8 days, the New York Times is running an opinion piece criticizing “polarizing messages” about breastfeeding and questioning the evidence linking breastfeeding with differences in health outcomes for mother and child.
Neither writer interviewed an epidemiologist or a scientist who has studied associations between breastfeeding and health outcomes, and neither writer acknowledged evidence-based reviews of the literature by the US Agency for Healthcare Research and Quality or the World Health Organization. Instead, they quote a retired physician who authors a controversial blog and journalist who wrote a piece on breastfeeding in 2009, and they conclude that breastfeeding isn’t that important after all.
Both Alissa Quart and Jane Brody go on to suggest that it’s unrealistic to recommend 6 months of exclusive breastfeeding, because too many women encounter insurmountable barriers that make these recommendations impossible to achieve.
And yet, for the second time in 8 days, a New York Times writer has chosen to ignore the major public health strategies currently in place to address these barriers:
- The Affordable Care Act requires workplaces to provide unpaid break time in a private space that is not a rest room so that hourly employees can pump.
- The Surgeon General’s Call to Action to Support Breastfeeding outlines 20 action steps ranging from support for individual mothers to paid maternity leave to stronger national leadership, all designed to help mothers achieve their own infant feeding goals.
- The Institute of Medicine’s “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation” recommends peer support programs, workplace accommodations and improved maternity care policies.
These documents do not make mothers feel guilty or berate them to try harder – rather, they outline specific policy recommendations that would address the very obstacles that Quart and Brody suggest make breastfeeding too difficult. But these documents are conspicuously absent from their critiques of current breastfeeding policy.
I appreciate that 6 months of exclusive breastfeeding is a lofty goal. I see mothers in my practice who struggle with breastfeeding, and we talk a great deal about the gap between what is recommended under ideal circumstances, and what is possible for this particular mom and baby. Sometimes, breastfeeding does not work.
But the answer is not to cast aspersions on the evidence and say breastfeeding doesn’t matter. Lactation is a normal part of human reproductive physiology. When this physiology is disrupted, the best evidence that we have indicates that risks increase for mothers and for infants. The fact that so many mothers and babies run aground reflects our failures as a society – and it underscores the urgent need to address those failures.
We need to make sure that mothers get accurate and evidence-based information during pregnancy so they can make an informed decision about infant feeding. We need to educate health care providers so that they can support that decision, both before and after birth. We need maternity hospitals to discontinue practices that undermine mothers and babies in the first days of life. We need paid maternity leave, on-site daycare, policies for babies-at-work, and barring those options, access to pumps so that mothers do not have to choose between earning a living and nurturing their children.
And we need journalists writing about breastfeeding to treat it as a real public health issue, not another round in the media-generated “mommy wars.” An essay reviewing the evidence on heart disease would source the science with a clinician-scientist, not a controversial blogger or a journalist. A commentary on management of hypertension would reference national recommendations for screening and treatment. But when it comes to breastfeeding, it appears that personal anecdote and armchair observations about “underlying issues” is sufficient to get published in the New York Times.
There are real, actionable policies that would enable more women to achieve their breastfeeding goals. As Regina Benjamin wrote in the Surgeon General’s Call to Action to Support Breastfeeding:
The time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding.
The time has come to stop the madness. We have work to do.
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 board of the Academy of Breastfeeding Medicine.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.