Breast or Bust?

Today’s NY Times Science Times front page blares “Breast-Feed or Else.” Does the science support the ultimatum?

The Times article notes a new pattern of breastfeeding media support; not only are the benefits of nursing promoted, but formula-feeding is actually equated with harming your baby. Some of the rhetoric quoted in the Times is shocking:

“Just like it’s risky to smoke during pregnancy, it’s risky not to breast-feed after,” said Suzanne Haynes, senior scientific adviser to the Office on Women’s Health in the Department of Health and Human Services. “The whole notion of talking about risk is new in this field, but it’s the only field of public health, except perhaps physical activity, where there is never talk about the risk.”

A two-year national breast-feeding awareness campaign that culminated this spring ran television announcements showing a pregnant woman clutching her belly as she was thrown off a mechanical bull during ladies’ night at a bar — and compared the behavior to failing to breast-feed.

“You wouldn’t take risks before your baby’s born,” the advertisement says. “Why start after?”

Senator Tom Harkin, Democrat of Iowa, has proposed requiring warning labels, on cans of infant formula and in advertisements, similar to the those on cigarettes. They would say that the Department of Health and Human services has determined that “breast-feeding is the ideal method of feeding and nurturing infants” or that “breast milk is more beneficial to infants than infant formula.”

Most pediatricians today agree that the ideal first ex-utero nutrition for most babies is breast milk. The American Academy of Pediatrics, in its policy statement, “Breastfeeding and Use of Human Milk” (2005), concludes:

“Although economic, cultural, and political pressures often confound decisions about infant feeding, the AAP firmly adheres to the position that breastfeeding ensures the best possible health as well as the best developmental and psychosocial outcomes for the infant. Enthusiastic support and involvement of pediatricians in the promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth, and development.” There are many studies that support this conclusion; the AAP policy cites hundreds, including data that indicates breastfeeding may be associated with fewer infections, allergies, and autoimmune diseases, less risk of maternal and child cancer, and greater cognitive abilities/intelligence. As a holistic pediatrician, I work with many moms who don’t give a second thought to breastfeeding – it’s just what one does. Some will continue to 2 or 3 years old; these kids are among the healthiest I know.

But in reality, some women cannot nurse for a variety of medical reasons, or they may decide not to after weighing risks and benefits to the baby and to their own health. I have witnessed post-partum moms with severe bouts of depression, with associated suicidal and homicidal ideation, greatly exacerbated by their guilt from not being able to nurse. Where do we draw the line? So much of the decision to nurse is linked to generational and cultural factors that it remains an intensely personal decision for each and every woman. Our workplaces do not support full-time nursing for many women; most do not provide space or time for feeding and/or pumping and storage. I do agree that we should provide support for all women to nurse, and encourage those who can to do so. We should provide evidence when possible to support our cause. But warning labels and harsh ads? I don’t think that these methods are justified, no matter how much science supports the benefits of breastmilk.


  1. Aviva Jill Romm, noted herbalist/midwife, notes in email correspondence: “Anyone read Sandra Steingraber’s work? Recent studies suggest that breast milk is an increasingly pesticide, exogenous estrogen laden delivery system for our babies. So while we’re tackling the social issues, we need to simultaneously tackle the environmental ones.” I completely agree. For those interested in this issue, check out Florence Williams’ NY Times Magazine column from 1/05:

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