There was a recent article in the Guardian (UK) suggesting that the research on breastfeeding versus formula isn’t all that strong and that really formula is just as good. I’m sure many formula feeding parents were thrilled to read such a thing and have wished to see such an article for a while. But I would caution them to be very, very careful of what you wish for.
The main argument in this piece is from a professor of gender studies, Joan B. Wolf, who states that breastfeeding studies are not randomized controlled trials and this is the problem. What does this mean? It means that you can’t take 100 women and randomly assign who will breastfeed and who won’t and then look at outcomes. This is the ideal way to do research when possible so that you avoid other factors in their lives that may influence the outcomes.
However, it’s not always possible and generally that is accepted in the medical literature. Researchers do similar research on risk factors for cancer, for health outcomes for smoking, bad diet, etc. And we don’t see people claiming that these results aren’t valid, do we? Well, in fact, the tobacco company tried to argue against the link between smoking and cancer using the same argument. People chose what group they belong to and so how do we know that it wasn’t other lifestyle factors that led to their heightened risk of cancer? That is the argument being used here.
First, let me say that there is reason to suspect that’s not the case, and that’s that even with research that uses self-selection, we have incredible statistical tools that help us control for variables we expect to be confounding. The greater risk of negative health outcomes associated with not breastfeeding (which, contrary to Dr. Wolf arguing is “small”, costs the US over $13 billion a year But that’s not the real reason my back got up with this article. Yes, she’s right that we can’t use randomized control trials, but she’s wrong that it means we have to throw the research out – that’s an easy argument to make. It’s her implication of what the problem is that isn’t being controlled for that should make every mother angry… “Women who choose to go through the labour of breastfeeding have made a commitment to go the extra mile for the sake of their baby’s health,” says Wolf. “They are likely to be doing all kinds of other things too. Their homes are clean. They wash their hands. They will be reading more, talking more, serving more fruit and vegetables …” Translation: If you’re using formula, you’re just a worse mom. You’re too lazy to clean your home, wash your hands, read, talk, serve good food, etc. Only moms who care would do these things. Personally I think we need to be very, very careful about going down this road. The hidden argument is that formula itself isn’t so bad at all, but it’s the moms who are screwing up. Given this is all in a book that’s supposed to help mothers, I fail to see how this does so. It works if you want to maintain the status quo where there are low wages, crap maternity leaves and many families have two working parents to make ends meet. Blame mom and laud formula as an equally good alternative. Any problems with it must stem from a deficient mother (note sarcasm here on my end). But why not change the system? Why not argue that US policies are the problem, not breastfeeding research? Dr. Wolf also manages to imply she knows what is and is not worth the effort for mothers: “We are in danger of ignoring the drawbacks of breastfeeding, says Wolf, such as the potential loss to women’s earnings… One of the greatest lies promoted by breastfeeding advocates is that breastfeeding is free. But it’s not free if you count mother’s labour. For many you could say it has an extraordinary cost and is probably not worth the effort of continuing to do it.” Financially, she may be right. But I don’t believe many mothers who switch to formula so they can return to work to make a salary just to pay bills and not spend time with their children in the first year of life appreciate this. Yes, you have a choice to either pay your bills or care for your child. When you look at the cost-benefit ratio like this, breastfeeding in and of itself probably isn’t worth the effort. But let me throw this out there… what if you lived in a country where you were given a year’s maternity leave? Paid too. Nothing huge in payments, but enough to live. And your job was guaranteed to be there for you when you returned. What’s worth the effort? What’s the loss? You have the ability to focus on your child, on breastfeeding, on whatever it is that makes the early days with a parent so important. You also have your job waiting if that is a part of what you want or need in your life. Now some women will choose to stay home after that year, but many won’t and they will have benefited from the time at home with their child, all without sacrificing their careers. Dr. Wolf’s argument also misses one of the key things that many of us hear time and again: Women want to breastfeed, but through a lack of support, institutional blocks, and work, they can’t or don’t. This is very different than not being worth the effort, and this is what we need to work on. There needs to be more support and policies in place that give women the chance to breastfeed. Without that, we are doing all mothers a disservice. This is why I will never stop saying the problem lies within the system. But I’ll take it a step further. Even if you don’t want to support changing things so that you live in a more family-friendly (and woman-friendly) society and you like the status quo, why not push to make breastmilk more readily available for moms who can’t or don’t want to breastfeed? We know that breastmilk was made for human babies, it what they expect to be eating, and no matter how good we make artificial alternatives, it will not be the same. And as we seem to have learned with all our other processed and genetically modified foods, I doubt it’ll be better. So why don’t we try and get them that? Why must we have doctors and feminists so intent on supporting mass corporations making a profit at the expense of families? The saddest part to me is that these comments are always made as if they are said with mothers in mind. And yet that’s not true. If they had mothers in mind, we would be talking about a whole new way of living, not blaming moms for the fact that research supports breastfeeding. If you are interested in writing to your US representative to request longer and paid maternity leave, we have a research-based letter you can download, print, and mail. You just need to enter your information and your representative’s information. You can download this letter here. [Image credit: The Daily Mail]
[1] Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2009; 125: 1048-56. [2] Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Lactation and the risk of epithelial ovarian cancer. International Journal of Epidemiology (1993); 22: 192-7. [3] Brock KE, Berry G, Brinton LA, Kerr C, MacLennan R, Mock PA, & Shearman RP. Sexual, reproductive and contraceptive risk factors for carcinoma-in-situ of the uterine cervix in Sydney. The Medical Journal of Australia (1989); 150: 125-30 [4] Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet (2002); 360: 187-95. [5] Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Prolonged Lactation and endometrial cancer. International Journal of Epidemiology (1995); 24: 499-503
I too thought her article was seriously lacking, but this obsession the ‘liberated’ woman has with paid maternity leave is beyond what I can get behind. Back when feminists actually were for equality of the sexes the rally cry was “equal pay for equal work”. Now they are demanded very unequal treatment, special rights for special interest groups. What’s ‘wrong’ with women being “forced” to return to work and stop breastfeeding isn’t that the mean ole business men don’t want to pay women to stay home with their kids, disrupt their businesses with unproductive workers that can’t replace, or give out equal pay for unequal work, it’s that mom’s think they need to leave their nurselings and return to work. Want to rail against something it should be the materialistic push that demands a dual income, the largely false assumption that two incomes are somehow needed for a family. The answer isn’t forcing businesses or the government to treat women unequally, it equallity. Equality, however, isn’t ‘sameness’. Women do a job men can never do. We bear, nurse, raise the kids, the hand that rocks the cradle rules the world. Men, who are equally able to provide for their family, but in a different way, do it by bringing home the money. Want to raise breastfeeding rates, especially longterm? Then you should be pushing against marriage penalties in taxes, insurances, and against a society which belittles women’s basic femininity by saying we should be in the workplace, should be the ‘same’ as men instead of equal to them, instead of at home with our children.
I personally see both as valid. I know women who want to return to work and so having the extended leave (not necessarily paid for by employers, but like in Canada by unemployment insurance which you had to have paid into for a certain period of time) allows for the basics of breastfeeding and bonding. However, I also agree that we have far too materialistic a society which has some people believing they must return to work to survive and that is not always the case. Though I believe more people are realizing this and having one parent stay at home when possible and so desired. However, I would also argue that far too many jobs no long have fair pay for the work being performed and that is another problem.
But if a woman wants to return to work, that is her choice, and I would prefer that something be in place to ensure the child has the best start – including breastfeeding and bonding.
I think equality has been extremely misconstrued in terms of childbearing and breastfeeding and the raising of children. You claim businessmen don’t want to pay women to stay home with children, but the raising of children benefits everybody, including those businesses. Equality isn’t about being the same, or erasing our differences– it’s about making those biological differences costless. Imo, it’s a sad world where the financial gain of businessmen trumps the right of children to the best nutrition possible and the formation of a close attachment to their primary care-giving parent.
It’s not the financial gain of business trumping the right of a child to be raised properly, it’s the wish of career minded women to be both primary caregiver *and* hold a job completely contrary to the obligations of primary caregiver. The ‘mean ole businessman’ argument ended when equal pay for equal work was legally obtained decades ago. Now it’s just self-obsessed parents, of both genders, who’d rather ‘have it all’ than do one role masterly. You can be a jack of all trades or a master of one.
What you (perhaps without realizing) insinuate is that highly educated women should not have children. If you look at nearly any career in scientific research, for example, you will find that there are precious few choices that aren’t completely contrary to the obligations of a primary caregiver. However, if I were to take several years off after my Ph.D. with the policies in place, my degree will be rendered completely useless. It’s not having it all, it’s making sure that those who spend time contributing to society in ways that don’t involve our uterus don’t have to do so at the detriment of their ability to raise a family. Under your model, the most prolific would remain the least educated and I don’t consider that a good model for society. Having children does not dampen my ability to perform scientific research, but with the current way we treat families and new mothers, doing scientific research dampens my ability to be present for the year(s) during which my children should be forming healthy maternal attachment. I respect that some women don’t want to do that, but men have never had to choose between career and family– it’s not gender equality to expect women to have to make that choice.
It’s not without realization at all. But there are very few careers where taking a 6-12 month sabatical will destroy you career-wise. That’s the real labor-intense breastfeeding time. After that *either* parent needs to chooseto abandon the ‘have it all’ modern mindset and stay home and properly raise the children. While I find women more generally suited, given biology/physiology for this task, certainly that is a choice both men and women must make. If the wife wants to be the primary wage earner, to pursue a high end career, and get the figurative money’s worth from their education then let the husband take over as primary caregiver. Mom can pump to maintain full length breastfeeding, or feed on off-work hours (even have dad bring baby to work during lunch). But I will unabashedly stand behind the age-old notion that one parent needs to stay home and raise the kids. Gender equality says it can be man or women, not that the need of the children disappear. And having the ‘leaSt educated’ be the ‘most prolific’ is an incredibly biased viewpoint. Education has almost nothing to do with intelligence, nor does education somehow disappear or lose it’s worth if it’s not used to make money. Furthermore we, in today’s USA, have a serious bloat of higher education. Janitors with degrees, nurses with phds. It’s ridiculous to think that every, even most, member of society need an advanced degree. The precentage of the population that *needs* to spend 8-12 years in school followed by permanent and focused attention to their profession is very minimal, the glut of people who do not fall into that category pursuing the livestyle achievements of that category has led to spiraling debt, labor issues, an inflation of requirements for simple jobs, and a foistering of the elists, misogynistic notion that people need an ‘education’ to matter to the community and that especially women who contribute to society ‘with our uterus’ are backward clods, and shame on us if we want to be mothers after we receive and education because then it’s ‘wasted’. It is people who speak like you who perpetuate misogyny.
Actually, there are tons of careers where you can take the sabbatical– most of which don’t require much in the way of education in the first place. So either women have to choose a lesser career during their studies in the hopes that they will find a partner and mate or they have to completely give up the career they spent 10 years getting an education for. I agree that there are too many people getting too many degrees, but that doesn’t erase the fact that there are women who are highly qualified and suited to careers requiring a decade of education. Is it really fair to ask them not to have children or would it be better for society and more fair to have decent maternity policies? Or is there a 1 Ph.D. per family rule? Staying home to raise the kids is an incredibly fluid process– wtf am I supposed to do all day while they’re in school once they reach that age? Knit sweaters? Because currently scientific research fields look down on both part-time workers, resume gaps, and job sharing– and that needs to change. The only way it’s going to change is if society as a whole values keeping highly-qualified mothers happily in the workforce– and that starts with decent mat leave. I had to go back to work crying every urination because I still wasn’t healed. And despite your insistence, no, in many areas it’s not possible for one person to stay home. We cannot survive on $22k/year (DH and I make the same, we’re both still in training and I will not put my kids’ health at risk by having them ‘later in life’). We don’t have tv or cellphones, our cars are from the 80-90’s and payed off, we live in the middle of nowhere in a house that was falling apart before we fixed it ourselves. Once I quit, he will be on a 25mo clock to get a ‘real’ job before my kid would go back into daycare anyway and I would have to take the first crappy job I could find to keep us in food and heat after burning bridges with the only science employer in the area. My parents sacrificed to stay home with me and my brother– and I wish they hadn’t because now they have to work until their bodies quit, at which point I’m going to have to find money somewhere for their food, rent, and healthcare. Lucky you that you can sit on your high horse about how people can stay home if they weren’t so greedy because it means you have no sense of the realities a lot of these people you consider to ‘just want it all’ are facing.
Hi, I'm Kelly Schaecher the woman who organised the breastfeeding sit in in Bristol England in your photo for this article. The American lack of maternity rights and leave is horrible. I'm American but have been living in the UK for 7 years and I am so glad and feel so fortunate that I had my baby here in the UK. I do not understand why American women do not get together and get political about this.
I absolutely agree! I hope for a more family and woman friendly society!
Thank you Tracy Cassels for a thoughtful response to Dr. Wolf. I listened to Dr. Wolf speak on a radio program and I was appalled at her attitude toward breastfeeding – an attitude which she claimed was backed by the research. It was contrary to my personal experience and to that of my friends and acquaintances. Also, I was disturbed by her ‘air of authority’ toward the issue – so common with academics, especially with those who are defensive of their own choices – this may or may not be the case with Dr. Wolf as she did not share how her children were nourished as infants.
I appreciate your list of references and look forward to exploring these resources to obtain more information – thanks again.
I appreciate Tracy Cassels response to Dr. Joan Wolf's position on breastfeeding. I listened to Dr. Wolf speak on a radio program and I was quite activated by her claims and suggestions – she certainly did not speak to my experience, e.g., 'their homes are clean, they was their hands…' chuckle. I"m delighted to have a list of references too. Thanks Tracy!
It won’t let me reply to Ashley above: I love how you assume I’m rich. My parents raised a family of four on about 22k a year, my husband, after years of scrimping, finally has a 38k salary, but 2 years ago it was less than 25k, before that it was below 20k. I’m disabled. We do what we have to do to make do on one salary. So did my parents. My mom worked from home after we were school age (and in fact before then too) and my life is filled with working families, all well below ‘rich’, none of us have high horses to sit and gaze down at the ‘realities of life’ we don’t have to face. We just make do because it’s best for the children.
Yeah, your parents lived in a different time and chances are you bring in some form of disability income. I don’t assume you’re rich– I assume your husband makes enough to support a family in your area, which is obviously the case, but isn’t so for a lot of people. *You* make the assumption that people who ‘need’ two incomes don’t exist and are actually just too addicted to their iWhatevers and mansions to chose their kids instead. Some of those people are just addicted to health insurance and a place to live.
I bring in nothing from being disabled. And I’ll believe that people live in an area where one income just won’t cut it when you show me a city with no single parents.
You show me a single parent making it on $22K/year in an area with a 34k poverty lne and I’ll show you someone getting child support payments, WIC, medicaid, or gov’t assistance.
Ummm 1 you need less money with less kids. I lived all my childhood with one of my single parents. My mom actually had another kid so it was 2 kids, we lived in a nice suburban area, lacked nothing really…we didn’t have roommates. Surprisingly enough ALL her friends were single moms as well, who lived in the samekind of nice suburban houses. This is with no financial assistance and no child support (my dad bought school clothes and gave money when he could, but nothing from my sisters dad) I currently live on a single income of 30k, where I am a SAHM with 1.5 kiddos, and we have more thanenough money to afford plenty of luxuries(which I say as typing this out on my latest tablet). You do not need 35k a year which by the way is middle class not poverty, and you do not need 2 incomes. People work to afford stuff they don’t need and then complain about never getting a vacation. When I have my baby and do my bonding with it, then I will work to earn for my family, then my husband will be the SAHD.
And just FYI, I know anecdote =/= data, but every single parent I know here lives in 4-6 bedroom apartments with as many other people as possible. I’ve been in apartments where they erected plywood to split the living room into 2-3 parts to make more ‘bedrooms’ to fit more people in to lower the shared rent costs. And I’m not going to bring my child up in a place where I have to put them to bed to the sounds of our roommate’s one night stand on the other side of a plywood partition.
bri- Everything depends on where you live. In our county, 35k is the poverty line. That’s not opinion. That’s fact. That’s based on calculations some fancy financial people did to determine the cost of ‘essentials’ in our area. And most of it comes down to rent/mortgage here, which is why people are living together.
Where do you live? Because that’s VERY high – I’d be interested in reading more. Where are the numbers in the US for poverty lines? I’m in Vancouver, one of the most expensive cities in the world and ours is lower than that!
Question (edit): Is that for a family? For a single person? Poverty lines in Canada vary by the number of people in the household (obviously).
I really think it’s time we started to talk about how feminism has sold us out. Sure, most women now work outside the home, and some of them actually get paid pretty well. However, we are back to the point where unless those women stay married to their husbands, they lose out — because most families have two incomes. And with higher income women working for pay, the cost of daycare has skyrocketed, leaving lower income families stuck with choosing either welfare or having to switch out (one parent works at night) unless they have retired parents near who can care for their kids. Women still do the majority of the child care — even if it’s not their own kids — and women in most families still do most of the cooking, cleaning, doctor’s appointments, other household management tasks on top of working full time. How is this freedom? Go to Palau, and talk to the women there — it is still a matrilineal society (despite the efforts of all the Christian missionaries). Women care for each other there. When a women has a baby, she is given a “hot shower” where all the women in her family care for her and help her heal from birth. Most women are mothers — time to honor mothers more (without making it into a compulsive role). Women may do more of the “female” tasks because we choose to or because society says we must, but regardless, we need support from one another. We don’t get that. Our mothers, aunts, grandmothers, and female friends don’t honor us much when we give birth. That should change.