I breastfed both my children. It would be wonderful if that meant I also decreased their risk of leukemia, which is precisely what a recent meta-analysis of 18 studies suggests. We will get to the science of what that study found in a minute, but first, I want to address a different question: even if breastfeeding does reduce a child’s risk of leukemia, what does that actually mean? What is the effect – in real life – of having a study that tells us a child is very slightly less likely (we’ll get to the numbers shortly) to develop leukemia if they were breastfed instead of formula fed?
The study itself is just a study, published in JAMA Pediatrics today. It is impartial. It confers no judgment. But oh, what we do with studies such as these in our society… the judgment can be stifling, to say the least. Too often, studies like which trumpet a specific benefit of breastfeeding end up as weapons, directly and indirectly, with which to berate or shame women, whether they want to breastfeed, or can breastfeed, or not.
I communicated with Dr. Alison Stuebe, an OBGYN and assistant professor of maternal and child health at the University of North Carolina School of Medicine who has studied and written extensively about breastfeeding, and with Suzie Barston, author of Bottled Up and blogger at Fearless Formula Feeder. Both regard themselves as advocates, though coming at the issue of infant feeding from somewhat different places. Stuebe is a breastfeeding advocate; Barston is an advocate for moms who partly or fully formula feed, regardless of the reasons. Yet both independently pointed out the problematic first line of this study’s conclusion: “Breastfeeding is a highly accessible, low-cost public health measure.”
Um, no, actually, it’s not. Not really, they said.
“Unfortunately, in the United States, breastfeeding is not ‘highly accessible’ for many women,” Stuebe said, and early weaning is common. “To achieve six months of breastfeeding, women must overcome routine maternity practices that undermine breastfeeding, lack of paid maternity leave, poor support from health professionals and outright hostility for feeding their babies outside the home.” (I’ve already written about the hostility that can come with breastfeeding in public.)
But that’s not all, Stuebe continued. “Moms also struggle with physiological problems with breastfeeding, including pain and low milk supply, for which we have few evidence-based treatments,” she said. “The problem is not that moms need more motivation to breastfeed – the problem is that too many moms lack the resources and support to make it possible within the constraints of their daily lives.” Stuebe also pointed out that formula companies’ marketing deliberately undermines mothers’ confidence in their ability to feed their babies, making some moms question whether their breastmilk can do all the things (such as decrease gas and spitting up, for example) that formula companies say their products can do.
That said, formula saves lives for women who are unable to breastfeed or whose babies are unable to receive breastmilk, as Barston’s child was. “Women have clearly gotten the message that ‘breast is best’ – in fact, reduction of leukemia risk is one of the benefits public health posters like to emphasize, as it packs an emotional punch,” Barston said. “This is not new news. And if women weren’t finding it easy or possible to breastfeed for 6 months before, this reiteration of old news isn’t going to change that.”
What this study might do, however, is just make moms using formula, or moms who otherwise cannot meet their breastfeeding goals, feel worse all over again.
“I fear this will simply be yet another reason to beat moms over the head with the ‘breast is best’ stick, which clearly does not help anyone,” Barston said. “The reasons women fail to meet breastfeeding recommendations will still exist tomorrow. They will still exist six months from now. You’re not talking about a woman’s desire to do the best for her child. You’re talking about reality where her body or her baby may not always cooperate.”
And then there’s the idea that breastfeeding is “low cost,” an assertion that does not “assign value to the time that mothers spend breastfeeding,” Stuebe pointed out. For example, mothers who return to work but want to continue breastfeeding should have a breast pump covered by insurance, but that’s not always how it plays out. Then, even though she is legally guaranteed unpaid break time to pump, she has to stay at work longer to get in her full work day, which means paying for more childcare. “This is not ‘low cost.’ It’s a substantial cost, borne by the mother so that she can follow medical recommendations to breastfeed her baby,” Stuebe said. “If a mother opts not to return to work in order to sustain breastfeeding, she forfeits her income and professional advancement, which, again, is not ‘low cost.’