Breastfeeding Medicine

Physicians blogging about breastfeeding

Fallout from IQ study ignores barriers to breastfeeding

with 17 comments

A recent study linking longer breastfeeding with higher IQ in adulthood seems to be pushing some people’s buttons. The study followed several thousand children, recruited in the early 1980s, through adulthood, and assessed years of education, IQ, and income in their early 30s. Compared with those who were not breastfed, individuals who had been breastfed for at least a year earned about $100 more each month, completed an additional year of schooling, and had IQs that were 3.76 points higher. These estimates accounted for multiple sociodemographic founders, increasing the chance that the differences were due to breastfeeding itself, rather than to other confounding factors.

On its face, this study adds to the ample evidence that how babies are fed is an important predictor of health and wellbeing. Yet several in the media have gone the great lengths to pick apart they study and its methods. The Independent’s Matilda Battersby took on the study with a pointed commentary, entitled “So breastfeeding improves your child’s IQ? Try telling that to the women who physically can’t.”

In her commentary, Battersby writes, “What none of these studies or news reports ever seem to acknowledge is quite how difficult breastfeeding actually is.” She goes on to compare her first weeks of breastfeeding to sitting “for hours at a time with a needle sticking in their nipple.” She writes, “Around 69 per cent of mothers breastfeed their babies at birth, but this falls to 23 per cent at six weeks – and for a very good reason. It is tough.”

I suspect that Battersby wanted to assuage the very real feelings of guilt and regret experienced by women who were unable to achieve their feeding goals. But as Shannon Tierney has so eloquently written, “Things can matter, without being the only things that matter. Breastfeeding matters, and it still matters even for women who cannot do it.”

Battersby goes on to write, “while we’d all like to think we’re doing the best for our bambinos we’re stuck between the Earth-motherish pressure to be constantly attached via a teat to our sprogs, versus the “Put it away, dear” mentality – thank you, Nigel Farage – which suggests that breastfeeding is embarrassing and dirty.”

And here, for me, is where her argument falls apart. The “breastfeeding problem” is not that studies have found that breastfeeding is different from formula feeding – rather, the problem is our collective failure to convert those data into a sustained commitment to provide women with the care and support that they need to achieve their infant feeding intentions. It’s the system that did not provide Battersby with help to resolve her pain during the hours of “needles sticking in her nipples.” It is Nigel Farage, and our collective cultural neglect of – and often open hostility toward – mothers and children.

That hostility was evident in The Atlantic, where Adrienne Lafrance dissected the IQ study’s limitations in a piece headlined, “About That Breastfeeding Study.” Her attention to potential confounding, generalizability, and epidemiologic methods seems incongruous with last spring’s gleeful reporting of the breastfeeding sibling study, which was widely reported as “confirming” that breast-feeding benefits have been drastically overstated.

Indeed, Lafrance references coverage of the sibling study in her essay, noting parenthetically:

(There’s also enormous pressure on moms to breastfeed, so much that the choice has been politicized far beyond what may be best for individual babies and their moms, but that’s another story.)

Lafrance wants to convince us that breastfeeding really isn’t important, and that studies suggesting otherwise are part of a lactivist conspiracy. What’s missing completely from this analysis is a critique of cultural assumptions and institutional barriers that prevent women from achieving their infant feeding intentions. What if, rather than dissecting the limitations of “that study,” these writers instead explored how the status quo forces so many mothers to choose between their productive and reproductive roles?

Indeed, there’s tremendous irony in Lafrance’s use of the word “politicized,” given the power and influence of the formula industry. According to the Wall Street Journal, infant formula in the US is a $5 billion market, and spending on advertising climbed 70% from 2009 to 2013. Abbott Labs leads the pack with 29% of the market, targeting new mothers and mothers-to-be with clubs, free gifts, and free samples. Every time a baby goes to breast, a formula company loses a sale. It takes little imagination to link formula company interests with political decisions that undermine breastfeeding mothers. I saw it first-hand in Massachusetts in 2006, when then-governor Mitt Romney overturned a Public Health Council decision just days before a major formula-manufacturer announced plans to build a factory in the state. The true “politicization” of infant feeding choices is not lactivists– it’s from vested interests that systematically undermine mothers who want to breastfeed their babies.

As beautifully stated by the Analytical Armadillo in a critique of Battersby’s essay, “It’s precisely because so many women have no choice but to use formula that it becomes a much more emotive issue.”

So why, then, do women in the US tolerate living in one of only two countries in the world that provides no legal mandate for paid maternity leave? When we return to work, why do we settle for unpaid pumping breaks, rather than on-site childcare and babies-at-work? Why do we accept dysfunctional postpartum care that treats mothers and babies like pin balls, bouncing among multiple specialists, none of whom are considering the needs of mother and baby together? Why do we allow companies to distribute infant formula marketing material in hospitals and health care settings, when we know these materials introduce families to costly, branded products that are no better then generics, and when “breastfeeding support” information is crafted to confuse and mislead families? When will we come together to protect every mother’s right to breastfeed for as long as mutually desired by her and her baby?

Rather than minimize breastfeeding, we need to direct our attention to the obstacles that prevent women from achieving their own breastfeeding goals. Our problem is not the evidence that breastfeeding is different from formula feeding. Our problem, as noted in the fabulous book, “Beyond Health, Beyond Choice,” is that “too little serious attention is given to addressing the many social, economic, and political factors that combine to limit women’s real choice to breastfeed beyond a few days or weeks. The result: women’s, infants’, and public health interests are undermined.”

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and associate professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine and of Maternal and Child Health at the Gillings School of Global Public Health. She is a member of the board of the Academy of Breastfeeding Medicine. You can follow her on Twitter at @astuebe.

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

Written by astuebe

March 22, 2015 at 3:52 pm

17 Responses

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  1. I am an IBCLC in my own practice in Sydney Australia and we know only too well how much support woman need when embarking on breastfeeding, the consistent support is vital correct use of all the wonderful products available now make it possible for Muns who are finding it a huge challenge. Unfortunately even though the studies keep coming out the evidence piles up my patients are unable to get medical insurances be it private or government to cover lactation. Meaning the benefits of breast feeding still seem to go unnoticed by many government organizations. However if you look at there policies it seems they are insisting women are breastfeeding. A conundrum to me !!!

    glynis howard

    March 22, 2015 at 4:21 pm

  2. Once again, Dr. Stuebe, you say what needs to be said. I am a lactation consultant who works in a breastfeeding medicine specialty practice and wonders/worries about all of the above. If only misplaced anger could be redirected towards acknowledging and addressing the problems you cite! Thanks to you and anyone else who does anything to move past the arguments and towards solutions.

    Sue Iwinski

    March 22, 2015 at 7:03 pm

  3. If only the barriers were removed for the very medical staff that’s supposed to be preaching it to their patients.

    Laura Gurney

    March 22, 2015 at 9:29 pm

  4. Another gem, pulling it all together and telling it like it is. Thank you, Dr. Stuebe.


    March 23, 2015 at 6:34 am

  5. I have limited knowledge of the science of the nutritional element and how it’s effect relates to IQ but I have observed for many years that formula fed babies have parents whose goal is to not hold their child but get the bottle propped so they can be left alone to drink. The second milestone is when the baby can hold the bottle themselves. It is obviously impossible to
    breast feed without holding your baby lovingly and cuddling for as long as it takes. This nurturing has to have a great impact, considering that it may add one or more years of close lovingly contact that doesn’t happen when the baby is left alone to feed themselves. I breast fed my children for 28 and 18 months and who can say what impact it had but is sure was wonderful for me…and they are wonderful too!

    Brenda Oliver

    March 23, 2015 at 7:18 am

    • This is an unfair (and borderline offensive) generalization of formula feeding parents. It is comments like this that perpetuate mommy wars and cause formula feeding parents to get defensive when studies like this come out. Just do a quick google search for #bottlebonding and you will find several different threads and photos of people enjoying bonding moments with their children while bottle feeding. In fact, if you ask a formula feeding parent about bottle propping, they’d likely spout off information about the dangers of doing so such as ear infections and choking.

      I breastfed for 3 months before switching to hypoallergenic formula and can tell you that I certainly was never in a rush to ‘get the bottle propped.’ Feedings would take place on the lap of either myself or my husband, even after our son wanted to hold the bottle on his own. As a working mom, I cherished that time we’d spend together.

      Yes, breastfeeding your child is a nurturing act. But does it completely predict whether parents will nurture their child in other ways? Nope.


      March 23, 2015 at 1:21 pm

      • “This is an unfair (and borderline offensive) generalization of formula feeding parents. It is comments like this that perpetuate mommy wars and cause formula feeding parents to get defensive when studies like this come out.”
        Amy, I couldn’t agree more. Not to pile on here, but I too, cringed when I read the comment above: “but I have observed for many years that formula fed babies have parents whose goal is to not hold their child but get the bottle propped so they can be left alone to drink.” . In my experience working with parents, who are often doing a combination of breast and bottle feeding while resolving challenges, or who bottlefed previous babies, or who decide to wean from the breast, MOST parents are loving, responsive and attentive to their babies, no matter HOW they feed them. (The rare exceptions can be those that have mental health issues, whether it be current mood issues, and/or inadequate nurturing/role modeling when they were children. For SOME, it can be difficult to give what you never received yourself.)

        Sue Iwinski

        March 23, 2015 at 10:02 pm

  6. While I agree that women often lack adequate support to achieve their breastfeeding goals, I am troubled by the overarching sentiment that women MUST have a breastfeeding goal to begin with. What many people react to when studies like this are released is the fact that it diminishes your choice as a mother to feed your child in the way you see fit, or in a way that is most beneficial to your family. It becomes a competition. If you don’t breastfeed – whether it’s because you can’t or choose not to – you surely don’t want what’s best for your child.


    March 23, 2015 at 12:46 pm

    • I agree with this comment.

      Furthermore, even with help and support, many women are unable to breastfeed exclusively and many more are unable to do so without significant difficulty.

      I think that the support available for breastfeeding women is underestimated by Dr Steube and that the “The Breast is Best” and “Formula is harmful” message is pretty loud and clear. Breastfeeding is supported by the Surgeon General, the CDC and the AAP. Most hospitals have lactation programs and WIC has a breastfeeding budget of over 80 million, Baby Friendly and NICHQ is partly supported by the CDC. Insurance is supposed to help cover the costs of lactation help and equipment. There are many local and grass roots organizations supported by volunteers and grants from sources including the Kellogg Foundation (who has given away millions for this cause).

      And–just judging on things that I have read and from my years as a nurse, the biggest reason women quit breastfeeding is not because they feel that society and the medical profession does not support them, it is because,they have had a difficult time with supply or because it has been painful. Many of these women have had help and support, and desperately wanted to breastfeed. I have never spoken to a woman or read on a blog that the main reason for stopping breastfeeding because of formula marketing or a free formula sample.

      I really don’t think that women’s breastfeeding goals are being undermined by the system. –I feel that women are being somewhat undermined by the lactation community. They are often under the impression that all women can breastfeed,given that they try hard enough, that low milk supply is in their head, and that feeding their children formula will result in chronic disease and low IQ. And although as the author state, breastfeeding is important, the research is mixed on many of the benefits

      And as most of us know, when breastfeeding doesn’t work, it can be really hard on women psychologically, as Dr Stuebe pointed out in an earlier posts like “Guilt, Shame and the Common Ground” and “How Often Does Breastfeeding come undone”

      Anne Catherine

      March 23, 2015 at 1:49 pm

    • I completely agree that the statement above perpetuates the “mommy wars” and I would say that it is offensive. I have no doubt that the decision to formula feed has nothing to do with a lack of love or dedication to their child but more, as this article points out, from a lack of breastfeeding support or perhaps from a lack of knowledge as to the overwhelming benefits of breast milk. I do, however, believe that every parents goal should be to breastfeed/ provide human milk for as long as possible. The scientific evidence is clear that formula is not the same as breast milk, and no matter how hard the formula companies try it will never be as good. That does not mean that formula is “bad” or “poison” or that a child will not thrive if given it, it is simply not the best. Shouldn’t every parents goal be to give what is best for as long as possible?


      March 23, 2015 at 5:03 pm

    • I agree with this comment. Not everyone needs a breastfeeding goal.

      Furthermore, I think women are encouraged to make these goals with information that is kind of misleading. Although promoted as such by most medical organizations, research concluding that breastfeeding can help prevent chronic conditions like asthma, diabetes, and obesity is mixed at best.

      Most women are also unaware of the fact that even with lactation help and support, sometimes breastfeeding just does not work (see an earlier post by Dr Steube, “How often does Breastfeeding Come Undone”).

      Breastfeeding goals are great, and women deserve support, but these goals should be made with unbiased, evidence based, education on the risks and benefits, as well the realization that breastfeeding can be very difficult and painful for many women, and some are physically unable to produce enough milk.

      Another post by Dr Steube, “Guilt, Shame and the Common Ground” discusses how hard it can be women are unable to meet their goals. Again, I feel that there would be less guilt and shame if women knew that they weren’t necessarily putting their children at risk for chronic health problems by discontinuing to breastfeed, and that breastfeeding success was not a given.

      Anne Risch

      March 25, 2015 at 8:23 am

  7. Excellent piece, Dr. Stuebe!

    Leslie Daly

    March 26, 2015 at 8:27 pm

  8. […] Read the entire article by clicking here. […]

    Breastfeeding Study

    April 13, 2015 at 9:39 pm

  9. Being a formula fed baby myself, I don’t see a problem with formula other than the corporate politics and possible contamination risks (the same kind we deal with at the store for our own food). I myself however, believe that it is my right and duty to my child to give her what I believe is the best for her, and breastmilk seems the best choice to me, so long as I can provide it.

    There are so many reasons I chose to breastfeed, among them being closer to my baby, and the cost of formula vs just eating for myself and producing my own milk. Not to mention, I take pride in the fact that I carried my child inside me for 40wks and I have the capability of producing her food as well. Many mothers would love to be able to do what I can do, and I don’t want to waste what precious resources I can provide. Breastfeeding is hard. It isn’t for everyone. Bottle feeding is just as difficult. In some ways, more difficult than breastfeeding.

    Sure, formula is nothing like breastmilk. Synthetic anything is never as good as the real thing. But there is nothing wrong with formula. On that same note, there is nothing wrong with breastfeeding. Covered, uncovered, publicly, privately, pumped, or on the breast. Instead of fighting over all this trivial crap, I think we ought to just feed our babies, and fight for the rights to do so, be it bottle or breast. Good mothers do what they think is best for their babes, no matter what that decision is, or how it differs from the next mother.


    April 24, 2015 at 12:34 am

  10. Very interesting read. I plan on breastfeeding, but it is very hard trying to have a career and breastfeeding at the same time. I know many companies provide a private room for women to pump breast milk, but my company is one who does not do that. So I just might have to make the hard choice of choosing my job or breastfeeding my child.

    Ms Brooks

    May 11, 2015 at 5:24 pm

  11. What a great post! I was a long term breastfeeder for all my children and they weaned to the cup and never got formula. The issue to me though is that some women simply don’t want to breast feed. Both my daughters-in-law did not breast feed beyond the first few weeks because they chose not to. It was not lack of support or lack of milk or anything else. I was unhappy about their choice and I wished it was not so. I did everything I could to encourage them, but in the final analysis it was their choice and theirs alone. They simply didn’t want to and were afraid to be un front with me about it until I made sure they understood I accepted it was their choice. Sometimes we just have to respect some women simply don’t want to breastfeed. When faced with that choice, no amount of support, information, assistance, help or guidance will make a bit of difference. The human infant’s brain is plastic enough we can make up those few IQ points at some other place in development such as one of my daughter-in-law’s intense toddler stimulation program and the other one’s full time stay at home mothering. As my grandchildren grow I have to say they are better moms than I was in many other ways.


    July 12, 2015 at 6:36 pm

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