Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for the ‘health equity’ Category

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