Breastfeeding Medicine

Physicians blogging about breastfeeding

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Every time a baby goes to breast, the $70 billion baby food industry loses a sale

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On Sunday, the most shared story in the New York Times was about breastfeeding – specifically, about how the US government threatened multiple countries with trade sanctions and withdrawal of military support if they backed a resolution calling for more support for breastfeeding mothers and their babies.

According to the Times:

American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

Why would the US government stand in the way of global breastfeeding advocacy? There are a number of theories – but my money is on the $70 billion baby food industry – upon whom the US dairy industry relies to convert massive milk surpluses into profitable products. In a face-off between a powerful industry lobby and global maternal and child health, the powerful industry carried the day.

This is the critical take-home message for anyone who cares about the health of moms and babies: When it comes to global infant and young child feeding, industry profits take precedence over public health. Read the rest of this entry »

Written by astuebe

July 8, 2018 at 9:46 pm

Breastfeeding, advocacy and women’s rights

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In June 2015, I heard a fantastic talk by Keith Hansen, Vice President for Human Development at the World BankGroup, at the Academy of Breastfeeding Medicine summit. Hansen spoke eloquently about the importance of breastfeeding for both global health and economic development; he said, “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

I’d brought my teenage son with me to Washington, and when we met up for lunch, I shared Hansen’s quote. He responded, “If breastfeeding were invented today, there would be an outrage, because of feminism.”

It took me a few seconds to fully process this response, as I began to consider the implications of a newly-discovered practice that would require one half of the population to engage in thousands of hours of unpaid work, at all hours of the day and night, for the greater good. There would, indeed, be an outrage. Read the rest of this entry »

Written by astuebe

May 9, 2018 at 8:38 pm

It’s time to disarm the formula industry

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The WHO Code is turning 35, and this vital public health policy is more critical than ever. The World Health Organization Code of Marketing of Breast Milk Substitutes was passed in 1981 to regulate predatory marketing tactics by infant formula companies. After World War II, formula sales boomed in the US, reaching their apex in the 1970s – the year I was born, just 22 percent of babies were ever breastfed. As they saturated the US market, formula companies looked overseas to expand markets for their products. They promoted formula as a modern, advanced approach to infant feeding, and dressed up sales representatives as nurses in clinics, pushing their product in communities where breastfeeding had been the norm for generations, and where clean water was in short supply.

Companies raked in profits, and babies died in droves. International outrage led the World Health Organization to adapt the Code, which banned marketing of artificial breast milk substitutes to consumers.

The US has never adapted the code, but formula companies did not market directly to consumers until the late 1980s  – when, coincidentally, breastfeeding rates were rising in the US, cutting into formula profits. Today, families are inundated with formula marketing and free samples, and the formula market is big business in the US. Formula sales totaled US$4.8 billion in 2013 – that’s  $1220.69 in sales for each of the 3,932,181 babies born in the United States in 2013. Read the rest of this entry »

Written by astuebe

May 20, 2016 at 4:01 pm

Update: Research studies quantify risks of risk-based language

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Last month, I blogged on my growing discomfort with ‘risk-based language’ to support breastfeeding. I explained that rationale for risk-based language is that

… when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.

It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done.

In face, such a study has been done, by Lora Ebert Wallace and Erin N. Taylor, in the departments of Sociology and Anthropology and of Political Science at Western Illinois University. When they contacted me, they reminded me that I’ve blogged previously about their work on “shame” and “guilt” in discussions about breastfeeding. And – spoiler alert – they found that risk-based language did not increase breastfeeding intentions; rather, risk-based language reduced trust in the information provided. Read the rest of this entry »

Written by astuebe

May 4, 2016 at 11:23 am

Might there be risks of risk-based language?

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Six years ago, I wrote a blog reflecting on Diane Wiessinger’s seminal essay, “Watch your language.” “There are no benefits of breastfeeding,” I wrote. “There are risks of formula feeding.”

That post remains the most-viewed piece I’ve ever written, with more than 74,000 views as of this writing. I’ve taken the lesson to heart. I’ve published a peer-reviewed study on the increased risk of hypertension among women with curtailed breastfeeding, and I’ve flipped odds ratios in teaching slides and review articles to frame associations as the “risk of not breastfeeding” or the “risk of formula,” rather than the “benefits of breastfeeding.”

Weissinger’s 1996 essay rests on the position that breastfeeding is the physiologic norm, against which all other feeding methods should be compared. Moreover, she notes, mothers who are facing difficulties will be more likely to seek help to avoid a risk than to achieve a benefit:

When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a ‘special bonus;’ but she may clamor for help if she knows how much she and her baby stand to lose.

Thus, when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.

It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done. Read the rest of this entry »

Written by astuebe

April 13, 2016 at 3:51 pm

@nickkristof When Whites Just Don’t Get It: Breastfeeding is not a “personal behavior”

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In the past few weeks, I’ve found myself thinking a lot about privilege and parenthood. At the Breastfeeding and Feminism International Conference and the Kellogg #FirstFoods16 forum, I heard testimony from men and women of color who described structural barriers, indifference and outright hostility from health care providers and community members. These two meetings bracketed House Bill 2, in which the North Carolina state government legalized discrimination against trans, gay and lesbian individuals, and prohibited local municipalities from instituting a living wage.

These events and discussions drove home for me the multiple levels of sex, race, and class privilege that undermine the health and wellness of our nation’s families.

With these experiences fresh in my mind, this morning, I picked up the New York Times Sunday Review and saw Nicholas Kristof’s column, “When Whites Just Don’t Get It, Revisited.” Kristof reviews the burgeoning evidence of discrimination against people of color, from disparities in the quality of public schools serving children of color to experiments demonstrating that a job applicant named “Brendan” is 50% more likely to get a callback that an applicant with the identical resume named “Jamal.”

I was nodding in vigorous agreement, as Kristof affirmed the testimony I’d heard at Breastfeeding and Feminism and at the First Food Forum – until I hit this paragraph:

Reasons for inequality involve not just institutions but also personal behaviors. These don’t all directly involve discrimination. For instance, black babies are less likely to be breast-fed than white babies, are more likely to grow up with a single parent and may be spoken to or read to less by their parents.

In this aside about infant feeding, Kristof misses the crucial role of structural barriers that prevent women from breastfeeding – barriers that affect all families, but are especially severe for women of color. Contrary to popular belief, breastfeeding is not simply a “personal behavior” – it is constrained by the life circumstances and support (or lack thereof) that a woman receives from her family, her community, her employer, and her health care providers. Read the rest of this entry »

Written by astuebe

April 3, 2016 at 6:05 pm

How rooming in helps moms and babies

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Fifteen years ago, a friend of mine had her first baby at a prestigious Boston hospital. She was a resident in Ob/Gyn at the time, and a long labor ultimately ended with a c-section, and a healthy newborn boy. That evening, when she, her baby, and her husband were in their postpartum room, the nurse entered.

“It’s time to take the baby to the nursery!” she said.

My friend looked confused. “We’re planning to keep him in the room with us tonight.”

The nurse frowned. “Well, who’s going to take care of him? You just had a c-section.”

My friend gestured to her husband, who was sitting on the couch.

The nurse frowned again. “Well, you know these c-section babies can get a little junky,” she said, alluding to the mucous that babies not born vaginally sometimes cough up.

My friend replied, with emphasis, “We are going to keep our baby in our room tonight.”

The nurse shrugged. “Well, you’re a doctor. I guess if he aspirates, you can resuscitate him.” And she walked out of the room, shaking her head.

My friend used to tell this story, laughing darkly, as she recalled how she thought perhaps she should ask for the code cart to be wheeled into the room, just in case.

For the record, baby spent an uneventful night in mom’s room. But the routine separation of moms and babies – as well as other practices that have been shown to make it harder for families to get started breastfeeding – remains the default in many maternity centers in the US. Less than half of US hospitals provide routine rooming in for healthy moms and babies.

That’s bad news for babies, and it’s bad news for mothers, because these out-of-date practices make it harder for women to achieve their own breastfeeding goals. A study of nearly 2000 US mothers found that among mothers who received six of six best practices for maternity care, 97% achieved their personal goal to breastfeeding for at least 6 weeks. Among mothers who received zero of six, nearly 30% failed to achieve their personal goals.

TenStepsBlog

These practices – the World Health Organization Ten Steps to Successful Breastfeeding – have been shown to be effective in a randomized controlled trial, which is the gold standard for medical evidence. In the PROBIT study, researchers randomized 31 hospitals to the Ten Steps or to continuing usual care. The study enrolled 17,046 mother-infant pairs, all of whom intended to breastfeed. Dyads who received care in a Ten Steps hospital were more likely to be exclusively breastfeeding at 3 months (43.3 vs. 6.4%) and to be breastfeeding at 12 months (19.7 vs. 11.4%). Ten Steps care has a lasting impact on breastfeeding success. Read the rest of this entry »

Written by astuebe

March 3, 2016 at 11:20 am