The Risks of NOT Breastfeeding?

I recently read an article from the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill entitled The Risks of Not Breastfeeding for Mothers and Infants. Like numerous other articles on the subject, the report discussed some of the many benefits to breastfeeding for both mother and child:

For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome.

None of this is new information. Numerous other similar articles and research can be found to support the above statements. What surprised me about the article was the very specific language used in the article. Phrases such as "the risk of formula feeding" are found throughout this article. The authors explain their choice of words here:

Public health campaigns and medical literature have traditionally described the “benefits of breastfeeding,” comparing health outcomes among breastfed infants against a reference group of formula-fed infants. Although mathematically synonymous with reporting the “risk of not breastfeeding,” this approach implicitly defines formula feeding as the norm. As several authors have noted,^7–9 this subtle distinction impacts public perceptions of infant feeding. If “breast is best,” then formula is implicitly “good” or “normal.” This distinction was underscored by national survey data showing that, in 2003, whereas 74.3% of US residents disagreed with the statement: “Infant formula is as good as breast milk,” just 24.4% agreed with the statement: “Feeding a baby formula instead of breast milk increases the chance the baby will get sick.”¹⁰
These distinctions appear to influence parents’ feeding decisions. In 2002, the Ad Council conducted focus groups to develop the National Breastfeeding Awareness Campaign, targeted at reproductive-aged women who would not normally breastfeed. They found that women who were advised about the “benefits of breastfeeding” viewed lactation as a “bonus,” like a multivitamin, that was helpful but not essential for infant health. Women responded differently when the same data were presented as the “risk of not breastfeeding,” and they were far more likely to say that they would breastfeed their infants. Given these findings, this review will present differences in health outcomes as risks of formula feeding, using breastfeeding mother-infant dyads as the referent group.
I quite agree with this point of view. Many mothers are under the assumption that formula feeding is the "normal" thing to do. How many new mothers have not even attempted to breastfeed their babies because they think of the practice as being something odd? We all know that "breast is best" but formula feeding is pretty good...right? Not so say the authors who point out that there are significant risks to formula feeding.

We live in such a "politically correct" nation that people seem to fear offending others above all else. Even doctors and researches seem to feel the need to sugar coat information for fear of offending new mothers. Doctors seem unwilling to admit that there are risks to formula feeding because they don't want to offend mothers who use formula. I am not saying that mothers who formula feed should be made to feel guilty. But I am saying that researches and doctors should not be shy about giving women the facts they need so that they can make informed choices.

We live in one of the richest nations on the planet. Yet the US is home to some of the unhealthiest kids in the world. That doesn't seem to make sense to me. Why are our children so unhealthy compared to other developed nations? Could it have something to do with the fact that breastfeeding in the US is still not the norm?

The article also talked about the role of hospitals and obstetricians in helping women to breastfeed successfully. Basically the conclusions were that hospitals and obstetricians are not doing enough to help women breastfeed. Research tells us that the vast majority of women are capable of producing more than enough milk for their babies and nurse their babies with no issues. And this makes sense. How else would our species have survived for this long if that was not the case. However, poor advice and lack of information seem to sabotage many women's attempts at breastfeeding. According to the U.S. Centers for Disease Control, 73.9% of new mothers initiate breastfeeding when their babies are newborns. However, only 13.6% are exclusively breastfeeding at 6 months as suggested by the American Academy of Pediatrics. (The American Academy of Pediatrics, who has some of the most conservative breastfeeding recommendations around, recommends "exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.")

So why are so many mother's "failing" at following these recommendations? I agree with the author that much of it has to do with lack of support from health care professionals. I saw this from my own personal experiences having a child. Where I delivered my children, the lack of knowledge from the nurses and staff about breastfeeding was both shocking and shameful. I overheard many nurses and lactation consultants suggesting that breastfed babies only need to be fed every four hours just like bottle fed babies. I overheard them repeatedly trying to supplement breastfed babies with formula. All of these efforts, while well intentioned, are sure fire ways to sabotage a new nursing mother's supply. Milk is made on a supply and demand basis. If you take away the demand (by separating the baby from the mother, putting the baby on an unnatural feeding schedule, or taking away the babies desire to nurse by feeding them in other ways) you will then of course affect the mother's supply.

So where can a mother find good advice on breastfeeding? Well, until things change in this country, much of the initiative has to be taken by the mother. Here are some good sources on breastfeeding information-

Online Sources:
1) http://www.kellymom.com/ See specifically this information here.
2) http://www.llli.org/

Great Books: