Wednesday, August 13, 2008

Breastfeeding By the Numbers

Another round in the breastfeeding versus formula smack-down.

Over seventy percent of mothers try breastfeeding. About a third continue for 6 months, less than half of those for a year, according to a CDC study in the August issue of The Journal of Human Lactation. You'll remember The American Academy of Pediatrics recommends breastfeeding for one year, exclusively for 6 months.

American mothers fall short of the official guidelines. In fact, I suspect they breastfed even less than the reported rates. From my days in The Social Perception Lab, I know people overestimate their good behavior and traits. Women mostly likely fudge a bit on the breastfeeding questions. Especially with it being next to godliness. Also, women recalled their breastfeeding behavior retrospectively by as many as 3 years in the past - another cause for concern, namely the possibility of the fudging factor. Throw in another kid or two, potty training, a few playdates from hell, and no wonder some women might add another week or four in their answers.

Maybe the AAP goal is too lofty. Breastfeeding for one year? Exclusively for 6 months?

That's a high bar. I'm not an M.D., nor an employee or advocate of the formula industry, but I have to say it. Do women really need to be told over and over they should breastfeed longer? I'm not convinced the benefits justify the full-fledged breastfeeding offensive. What offensive? How about recent government-sponsored public service ads likening not breastfeeding to a pregnant woman smoking or riding a mechanical bull?

And another thing, maybe it's not a lack of support that prevent longer breastfeeding - maybe women don't want to! Maybe mothers, and okay, fathers, suspect what I've been saying all along, the benefits are not large enough or meaningful enough to justify the difficulty of continuing for six months, let alone one year. Why not set a more realistic goal? One more women can achieve- without the guilt.

BTW, I breastfed all three of my children - all for at least 3 months but short of the 6-month mark. Yes, I often wished there were more comfortable public places to sit and breastfeed - as opposed to the restroom or deserted parking garage - but even if there were I doubt I would have breastfed longer.

The study has generated lots of comments on Tara Parker-Pope's Well blog at The New York Times. You can read it for free right now on the journal's website. Get it while you can.



Forste, Renata & Hoffmann, John P. (2008). Are US Mothers Meeting the Healthy People 201Breastfeeding Targets for Initiation, Duration, and Exclusivity? The 2003 and 2004 NationalImmunization Surveys. The Journal of Human Lactation, 24(3). DOI: 10.1177/0890334408317617

6 comments:

psychomama said...

Hi Dr. Polly,
I wrote about this on my blog as well, and what struck me the most was the response in the comments section of the posting, all of the shame and guilt surrounding whether mothers chose to breastfeed. It seems like some of the people commenting were just continuing the possible bias you picked up from the researchers. I also appreciated your pointing out the problems with the construction of the study, namely the tendency for people to present themselves as they would like to be seen, rather than as how they really are (not to mention the falability of relying on memory). Anyway, thanks for writing such an interesting and enjoyable blog!
psychomama
www.psychobabbling.net

kateg said...

i agree with this post-- i breasted near-exclusively for six-seven months and only quit entirely at 11 months. I am a researcher with interests related to parenting and children. I was especially doubtful of the supposed extensive benefits of exclusive breastfeeding vs mixed feeding--there is something so puritanical about the supposed importance of not an ounce of formula passing baby's lips.

Polly Palumbo, Ph.D. said...

Welcome Kateg. Thanks for commenting. I'm impressed with your breastfeeding! So how and why did you do it? Okay, last question - what do you research?

Polly Palumbo, Ph.D. said...

Okay one more question, Kateg. Why do you think more researchers don't speak out on the puritanical anti-formula rhetoric?

kateg said...

i am an anthropologist studying caregiving in the home and healthcare workers in south africa. i think a lot of the reticence has to do with differing global health contexts for recommendations. mixed feeding and formula feeding is an issue where clean water is a problem, and its obviously problematic to recommend mixed feeding where there is a generalized HIV epidemic. That's how you get lactavists citing the WHO to argue that we all need to breastfeed our children exclusively for a year. Even more than that i have seen pediatricians who also have PhDs in epidemiology cowed by strident "educated" moms spouting non-evidenced based stuff about formula or allergies or what have you. I think the Anti-medical-establishment rhetoric is a very powerful discourse at silencing doctors and inhibiting evidenced-based, risk-aware practices. I personally chose mixed feeding so I could have a glass of wine occasionally without worry and leave my daughter with her father one day a week while I wrote or did fieldwork. I figured alcohol laced breastmilk was probably NOT better than a couple oz of formula here and there--i think though, that this kind of "weighing the options" is really discouraged by teh kind of totalizing discourse coming out of natural birth/lactavist/attachment parent circles. I say this as someone who co-slept some, babywears a lot and breastfed for almost a year. Nevertheless, I agree with Erica Jong that this stuff is conspiring into an anti-feminist backlash against moms. I am so sick of being made to feel like a bad mom if i don't hand-mash all my darling's food from hand-picked organic veggies and strain them through a cloth diaper. My pumpkin need mommy to go to work so we can afford baby food, regular food, rent and diapers!

Polly Palumbo, Ph.D. said...

Okay I so love your comments! Please come back or email me. You make so many valid points, especially about the very real differences between breastfeeding in impoverished countries and say, the US. The dirty water issue is huge.

I love the imagery of straining hand-picked organic fruits through a cloth diaper. Ridiculous. Thanks!