‘Infant formula is an example of human ingenuity’

Joan Wolf, author of Is Breast Best?, answers your questions on everything from America’s breast obsession to the cowardice of formula companies.

<b>(1) If a lactivist, psychologist, doctor and criminologist entered a room with 50 adults, 25 of whom were breastfed and 25 of whom got bottles, would he/she be able to figure out which ones were which, by using any criteria whatsoever?

(2) Do you think this is really just an excuse to keep talking about breasts in our breast-obsessed country?

(3) And if you could list the top three things a mom can do to give her kid a healthy head start before he’s six months old, what would they be?
Lenore Skenazy, US

(1) No. I mean, a doctor might look at a middle-class and well-educated person and accurately guess, based on what we know demographically about who breastfeeds and the consistency of certain variables across generations, that this person had been breastfed. They might then speculate that a Hispanic person or a young person from Oregon is more likely to have been breastfed. Likewise, I would guess that a person who lives in Massachusetts is more likely to have voted for Obama than a person who lives in Texas. This is obviously correlational reasoning, and it works.

But if, as I suspect, what you’re really asking is whether these 50 people reveal health or behavioural differences that any of these professionals could link to breastfeeding itself, the answer is no. And if we were to allow them to ask 20 questions about each person in order to make an assessment based on their particular area of expertise, I’d be shocked if ‘how were you fed as a baby?’ was on anyone’s but the lactivist’s list.

(2) I don’t. Though I think breastfeeding does become part of a lot of other conversations about breasts in not very helpful ways. Look, breasts are sexual for a lot of men and women, and I think this is a perfectly wonderful thing in principle. But when breasts are reduced to their sexual purpose, public breastfeeding gets cast as an indecent public sex act. Which is absurd when you think about it, because women’s breasts and sex are everywhere in public (advertisements, television, popular music, etc). On the other hand, when breastfeeding advocates try to completely de-sexualise breasts and claim that their only ‘natural’ purpose is lactation, this doesn’t resonate with most women, either. As I’ve said, I think the fever-pitch of breastfeeding discourse is rooted in all kinds of things that are not about sex. But I also think it’s impossible to talk about breastfeeding without becoming part of a broader discourse about sex.

(3) As for the best things for a mom to do to give her kids a healthy head start, any answer I could give to this question would be hopelessly vague. Love and respond to your baby, but don’t equate crying with failure on your part. Do the best you can, and get help when you need it. I believe it was the eminent psychologist Jerome Kagan who said that too often parents forget that babies are designed to develop normally. 

I am always struck by just how defensive the formula companies are about their products, even though we are long past the days when babies were given plain milk powder. They seem pretty sophisticated these days. Isn’t it time for formula companies to be more assertive?
Alec Norris, Scotland

I agree that this defensiveness is quite remarkable. I wrote in the Independent not long ago that the industry’s approach was tantamount to Coca-Cola saying, ‘It’s healthiest to drink water, but if you’re going to drink soda, choose Coke’. But scientists who work in the formula industry are constrained by the same methods that limit researchers everywhere, and they make the same mistakes in interpretation. They are not immune to the misconceptions about risk, health, and total motherhood that I discuss at length in Is Breast Best?. And they are still answering for the reprehensible behavior of Nestle in the 1970s, which really was not that long ago. So I think formula companies have made a calculated decision that, at this particular moment in time, it would be bad for business to challenge the conventional wisdom that breast is best.

Have you considered for how long women have been bottle feeding their babies? And have you compared this period with the length of time that women have been breastfeeding? Do you draw any conclusions from this?

Are you aware of the dangers of bottle feeding when it is difficult to boil water or the water is contaminated?
James Grieve, UK

When I look at the history of infant feeding, I see that women have been looking for ways out of breastfeeding from the beginning of time and that many babies died because there were no healthy alternatives. And I conclude that infant formula is a remarkable example of human ingenuity that, when used properly, has enhanced the lives of untold numbers of families.

Formula feeding without reliable access to clean water is dangerous. My book is based on developed countries where this is rarely an issue.

Why would anyone promote breastfeeding if it were not the best thing for babies? What possible interest could that serve?
Amanda Price, UK

I think we oversimplify humans when we assume they’re driven only by money or power. Of course these are powerful motivations. But we are also inspired to do good things, to fight for peace, end poverty, promote equality, etc. The vast majority of people who advocate breastfeeding care deeply about children and families and are trying to make the world a better place. I don’t think you have to be driven by self-interest to be wrong.

Why do you think it is that the needs and desires of mothers are always counterposed to the needs of babies when it comes to breastfeeding? It’s almost as if they are treated as mutually exclusive. Nancy McDermott, US

I think the discourse is actually framed around the idea that babies have needs and mothers have desires. Anything that might conceivably enhance babies’ development is perceived as necessary, and anything that might better women’s lives is seen as discretionary. Thus a mother might want to sleep or work, but a baby must have unrestricted access to mom. This obviously ignores the ways in which mothers’ and babies’ needs and desires are inextricably bound up with each other.

Generally speaking, we have a hard time grasping that everything is negotiated in social context. Instead, we ask, all things being equal, what’s the better option? This is the essence of the epidemiological research on breastfeeding, which tends to frame the world in terms of either-or situations (eg, breast or bottle, baby or mom). But the truth is that all things are never equal. There is no objective or universal environment in which baby-feeding takes place. The world is a complex place, and science, to which we turn for guidance on these kinds of questions, is often designed in ways that ignore that complexity.

Why are policymakers so wedded to promoting breastfeeding when the evidence for its overwhelming superiority isn’t very strong?
Nancy McDermott, US

As far as most policymakers are concerned, the evidence for breastfeeding is very strong. When you think about how many scientists themselves are immune to the limitations of their research, it is hardly surprising that politicians, very few of whom have the skills or time to read the science, don’t know what it actually says. Like most people, policymakers also don’t understand what the short and long-term costs of breastfeeding can be for mothers and their families. Ultimately, it’s hard to argue against healthy and free.

How do you strike the balance on who gets taken seriously in debate when the science isn’t really clear-cut? For example, I think you have a point on breastfeeding, but I think anti-vaccine people shouldn’t get a platform. What’s the line between excluding wacky viewpoints and censorship?
Sarah Savage, Australia

This is a brilliant question, and one that I wrestle with constantly. The reality is that the principle of free speech, which most of us think is a good thing, will invariably give a platform to people who can do enormous harm, and we have to count on reasoned debate to distinguish good critical thinking from groundless and often dangerous bunk. I realise that platitudes about free speech and public discourse are not a very satisfying answer, but honestly, I don’t have anything better to offer.

With so much emotional investment in breastfeeding in the medical profession and among campaigners, can we ever get more balanced advice?
Mary Andrews, Ireland

I hope so.  But I think it will take a long time. 

Ironically, I think it is the most zealous breastfeeding advocates – those who make dubious claims about breastfeeding’s benefits – who will help people begin to see through the hysteria. For example, a recent Save the Children report estimated that 830,000 babies would be saved every year if they were breastfed in the first hour of life. The contortion of data required to arrive at that number is breathtaking. At best, it is grossly misleading; at worst, it is a deliberate attempt to scare mothers in the developed world into breastfeeding. Increasingly these mothers, and healthcare professionals as well, are challenging this kind of claim, and this is a critical step in creating a reasonable discourse about baby-feeding.

Joan Wolf is associate professor of women’s and gender studies at Texas A&M University and author of Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood.

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