how the public discourse on breastfeeding in this country is absurd

This op-ed from a West Virginia doctor is probably the best ARTICULATION OF WHAT'S WRONG with the public discourse on breastfeeding that I've ever read. In his piece, he takes a recent NYT op-ed to task.
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Everyone wins when breastfeeding is promoted


Today's Viewpoint: by Dr. Dan Foster

I WAS quite surprised this summer after reading a New York Times editorial of July 2, “About Breast-Feeding...”. I thought I might be in a time warp, recalling the April Fools Day prank by the Harvard Lampoon in 1968, when in isolated parts of the country the front page of the Times was replaced by an exquisite reproduction. If memory serves me, one of the most prominent articles on that page reported the finding of a talking walrus in the Central Park Zoo.

The recent editorial was written in response to a hard-hitting June article in the Times on a new government-sponsored advertising initiative advocating breastfeeding. Although the tone of the article created considerable controversy, the content was factual and attempted to articulate clearly the risks of exclusive formula feeding and the sad statistic that the United States has the lowest prevalence of breastfeeding in the industrialized world. West Virginia, not surprisingly, ranks near the bottom of all states.

The premise of the July piece was to look for middle ground amidst the increasing emotionalism and contentiousness of this debate. Now, I have always been a proponent of the “middle ground.” Unfortunately, although much of the editorial seemed reasoned and helpful in dealing with a complex issue, there were some comments and oversights that struck me as uncharacteristically out of touch for this media giant.

For instance, to imply that the American Academy of Pediatrics may be unable to determine which “studies” related to the long term benefits of breastfeeding are credible is the height of presumption. Even more surprising was the statement that “Experts on both sides agree that formulas are safe and nutritious. Millions of Americans have thrived on them and are doing quite nicely as far as we can see.” While it is undeniable that a large majority of Americans in the immediate post-World War II generation, including me, were bottle-fed (our parents didn’t know what we do now), such logic is much like saying that, despite enduring years of cigarette addictions, secondhand smoke, and seat belt nonuse, most citizens continue to have a satisfactory existence. Additionally, there was absolutely no mention of the compelling evidence showing that nursing mothers have a nearly 25 percent reduction in the risk of both breast and ovarian cancer.

The official AAP policy statement on newborn nutrition unequivocally recognizes “breastfeeding as primary in achieving optimal infant and child health, growth, and development,” obviously elaborating on the significant infant mortality advantage for babies who are nursed. It goes on to state, “Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.” Yet, “the ultimate decision on feeding the infant is the mother’s.” The document further acknowledges that, although breastfeeding is the gold standard, there are specific unusual situations where it is inappropriate or impossible. There clearly is no intention to make the mother feel guilty, only to make certain that she has made an informed choice.

As a physician and a public policymaker, I am constantly challenged to find ways to improve the quality and affordability of healthcare. Unquestionably, the simple promotion of breastfeeding is one of those unique opportunities where everyone wins — mother, baby, and the rest of society (with the possible exception of the pharmaceutical companies producing the formula).

Because of the influence (manifested in many ways) of the representatives of these formula makers with hospitals, obstetricians, pediatricians and their office staffs, mothers-to-be and new mothers too frequently are not getting properly balanced information. Rather than being educated consistently and unthreateningly of the real benefits of nursing to them and their babies, they often are told nothing or, even worse, a message that subtly leads them to believe that formula is an equally acceptable alternative. Furthermore, those who do initially choose breastfeeding, all too often, are not receiving the support they should from their healthcare providers when they encounter common problems. This seeming disinterest and inattentiveness contribute significantly to some less than stellar health outcomes for our next generation.

We can and must do better. As a first step, we should encourage all hospitals offering maternity care in the state to strongly consider the institutional changes required to receive the Baby Friendly Hospital designation established by the World Health Organization. Businesses, too, can do their part by providing more assistance to the ever-increasing number of young mothers in the workforce. Perhaps, most importantly, federal and state governments should seek out and enact proven policies that will enable our society to reach an acceptable level of breastfeeding. Our children and grandchildren should expect nothing less.

As for the editorial, it’s my feeling that any attempt to create doubt and confusion when none exists is an unconscionable act, particularly for those who should know better. Perhaps the Times should stick to reporting the news and commenting eloquently on matters of fact and opinion, rather than suggesting that their editorial board can determine the statistical validity of scientific research. That should be left to the experts. If it continues to do otherwise, I don’t think I’ll be able to get the “talking walrus” story out of my mind.

Dr. Foster is a Charleston physician and state senator.