Breastfeeding is awesome.
Breast-Feed or Else
By RONI RABIN
Warning: Public health officials have determined that not breast-
feeding may be hazardous to your baby's health.
There is no black-box label like that affixed to cans of infant
formula or tucked into the corner of magazine advertisements, at
least not yet. But that is the unambiguous message of a
controversial government public health campaign encouraging new
mothers to breast-feed for six months to protect their babies from
colds, flu, ear infections, diarrhea and even obesity. In April, the
World Health Organization, setting new international bench marks for
children's growth, for the first time referred to breast-feeding as
the biological norm.
"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."
Child-rearing experts have long pointed to the benefits of breast-
feeding. But critics say the new campaign has taken things too far
and will make mothers who cannot breast-feed, or choose not to, feel
guilty and inadequate.
"I desperately wanted to breast-feed," said Karen Petrone, an
associate professor of history at University of Kentucky in
When her two babies failed to gain weight and her pediatrician
insisted that she supplement her breast milk with formula, Ms.
Petrone said, "I felt so guilty."
"I thought I was doing something wrong," she added. "Nobody ever
told me that some women just can't produce enough milk."
Moreover, urging women to breast-feed exclusively is a tall order in
a country where more than 60 percent of mothers of very young
children work, federal law requires large companies to provide only
12 weeks' unpaid maternity leave and lactation leave is unheard of.
Only a third of large companies provide a private, secure area where
women can express breast milk during the workday, and only 7 percent
offer on-site or near-site child care, according to a 2005 national
study of employers by the nonprofit Families and Work Institute.
"I'm concerned about the guilt that mothers will feel," said Ellen
Galinsky, president of the center. "It's hard enough going back to
Public health leaders say the weight of the scientific evidence for
breast-feeding has grown so overwhelming that it is appropriate to
recast their message to make clear that it is risky not to breast-
Ample scientific evidence supports the contention that breast-fed
babies are less vulnerable to acute infectious diseases, including
respiratory and gastrointestinal infections, experts say. Some
studies also suggest that breast-fed babies are at lower risk for
sudden infant death syndrome and serious chronic diseases later in
life, including asthma, diabetes, leukemia and some forms of
lymphoma, according to the American Academy of Pediatrics.
Research on premature babies has even found that those given breast
milk scored higher on I.Q. tests than those who were bottle-fed.
The goal of a government health initiative called Healthy People
2010 is to get half of all mothers to continue at least some breast-
feeding until a baby is 6 months old. Though about 70 percent of new
mothers start breast-feeding right after childbirth, just over a
third are breast-feeding at 6 months and fewer than 20 percent are
exclusively breast-feeding by that time, according to the 2004
National Immunization Survey. Breast-feeding increases with
education, income and age; black women are less likely to breast-
feed, while Hispanics have higher breast-feeding rates.
For women, breast-feeding can be an emotionally charged issue, and a
very personal one. Even its most ardent supporters acknowledge that
they have made sacrifices.
"It's a whole lifestyle," said Kymberlie Stefanski, a 34-year-old
mother of three from Villa Park, Ill., who has not been apart from
her children except for one night when she gave birth. "My life
revolves around my kids, basically." Ms. Stefanski quit working when
her first child was born almost six years ago, nursed that child
until she was 4 years old, and is nursing an infant now.
She said she wanted to reduce the risk of breast cancer for herself
and for her three daughters, referring to research indicating that
extended breast-feeding may reduce the risk for both mother and
Scientists who study breast milk almost all speak of it in
superlatives. Even the International Formula Council, a trade
association, acknowledges that breast-feeding "offers specific child
and maternal health benefits" and is the "preferred" method of
infant feeding. The American Academy of Pediatrics states in its
breast-feeding policy that human breast milk is "uniquely superior
for infant feeding."
Dr. Haynes, of the Health and Human Services Department, said, "Our
message is that breast milk is the gold standard, and anything less
than that is inferior."
Formula "is not equivalent," she went on, adding, "Formula is not
the gold standard. It's so far from it, it's not even close."
Formula manufacturers say infant formula is modeled on breast milk
and emphasize that it is the only safe alternative recommended by
pediatricians for mothers who cannot, or choose not to, breast-feed.
But while formula tastes the same way at every feeding, advocates of
breast-feeding say, the smells and flavors of human breast milk
change from day to day, from morning to evening, influenced by the
mother's diet. Many nutritionists believe that exposing an infant to
this bouquet of flavors early on may make for less fussy eaters who
are more flexible about trying new foods and more likely to eat a
healthy, varied diet.
"I think of human milk not just as food, but as a sophisticated and
intricate infant support system that has evolved over millions of
years to provide the infant with nutrition, protection and
components of information," said Dr. E. Stephen Buescher, a
professor of pediatrics at Eastern Virginia Medical School in
Norfolk, who heads the inflammation section in the school's Center
for Pediatric Research.
"It isn't just calories," Dr. Buescher said.
The protection that breast-feeding provides against acute infectious
diseases — including meningitis, upper and lower respiratory
infections, pneumonia, bowel infections, diarrhea and ear
infections — has been among the most extensively studied of its
benefits and is well documented, said Dr. Lawrence M. Gartner,
chairman of the American Academy of Pediatrics' breast-feeding
Breast-fed babies have 50 percent to 95 percent fewer infections
than other babies, Dr. Gartner said, adding, "It's pretty dramatic."
One reason for the reduction in the incidence and the severity of
infections is the antibodies contained in the mother's milk. "A lot
of this has to do with the mother and baby interacting," he
explained. "Whatever the baby is exposed to, the mother is exposed
to, and the mother will make antibodies within three to four days."
The baby absorbs them through breast milk.
Breast milk also protects the baby through other mechanisms. For
example, it contains agents that prevent bacteria and viruses from
attaching to cells in the baby's body, so the foreign agents are
expelled in the stool, Dr. Gartner said.
The protection is not ironclad, so breast-fed babies will often get
a mild infection that does not make the baby sick but acts almost
like a vaccine. "What we think is that human milk creates an
environment where you get your immunity without the cost of an
infection, the vomiting and the diarrhea," Dr. Buescher
said. "That's a bargain."
Neonatologists are urging the mothers of their tiniest patients to
express breast milk because premature and low-birth-weight babies
are particularly vulnerable to infections. Studies have found that
premature babies who get breast milk are discharged earlier from the
hospital and are less likely to develop necrotizing enterocolitis, a
potentially deadly disease.
Breast milk has also been shown to lift the cognitive development of
premature babies, presumably because it contains certain fatty acids
that aid brain development.
Experts say it is possible that human breast milk produces permanent
changes in the immune system, in a sense "educating" the baby's
immune system, Dr. Gartner suggested. That may explain why children
who were breast-fed appear to be at lower risk for autoimmune
diseases like Crohn's, asthma and juvenile diabetes. Several studies
also indicate that breast-fed children are at reduced risk for the
cancers lymphoma and leukemia.
Officials with the International Formula Council say there is not
enough evidence to prove a relationship between early feeding and
serious chronic diseases.
Dr. Myron Peterson, director of medical affairs for Cato Research, a
private independent research organization which reviewed the
literature on breast-feeding for the council, said that studies have
found a link between nursing and health benefits but that they do
not prove a causal relationship. "It's like the old statement about
the rooster crowing making the sun come up," he said. "If you did an
observational study on that, what would you say?"
An unpublished report the council commissioned from Cato says "it is
not scientifically correct to conclude the lack of exclusive breast-
feeding plays a causative role in the development of these diseases."
But scientists are so intrigued about the potential to protect
children from juvenile diabetes that a large 10-year multinational
study called Trigr (for Trial to Reduce Insulin-dependent diabetes
mellitus in the Genetically at Risk) is under way to find out
whether breast-feeding protects at-risk children from developing the
And public health officials, excited about mounting evidence
suggesting that children who were breast-fed are at lower risk of
being obese, have been promoting breast-feeding as a strategy to
combat alarming rates of childhood obesity.
The health benefits of breast-feeding may extend to mothers as well.
According to the American College of Obstetricians and
Gynecologists, extended breast-feeding reduces the risk of ovarian
cancer and breast cancer. New studies have also found that women who
breast-feed face a lower risk of adult-onset or Type 2 diabetes, and
they seem to be at lower risk for osteoporosis later in life.
Immediately after childbirth, nursing accelerates healing by
reducing the amount of bleeding and causing the uterus to contract
more rapidly back to its normal size. Making milk burns up to 500
extra calories a day, so nursing mothers get help shedding extra
pounds from pregnancy, experts say, especially if they nurse for an
Experts say lactation also seems to have a calming effect on the
mother, which may be an adaptive mechanism to ease the transition to
life with a new baby. Every time a mother nurses, she gets a spike
in oxytocin, which may have an antianxiety effect and help promote
bonding with the new baby, said Kathryn G. Dewey, a professor of
nutrition at the University of California, Davis, and an expert on
Nursing may even produce a euphoric feeling, she said.
Dr. Michael Kramer, a professor of pediatrics and of epidemiology
and biostatistics at McGill University's medical school in Montreal
who has been studying the health effects of breast-feeding among
infants in Belarus, found a strong protective effect against
gastrointestinal illnesses and a lesser protective effect against
respiratory infections. Dr. Kramer is still analyzing data on
obesity, I.Q., behavior and blood pressure.
"It can't do all of the things that are being claimed for it," Dr.
Kramer said, injecting a note of caution into the debate. "But it
probably does some of them."