To Breastfeed or Not

In governmental and popular literature breastfeeding is praised as being the optimum solution to infant feeding. The Wikipedia article, for instance, is extensive and well-cited suggesting the following benefits to infants: superior nutrition, greater immune health, higher intelligence… the list goes on. For the mother, many long- and short-term health benefits are also cited.

In what has become quite a contentious article, Hanna Rosin for The Atlantic discusses what she calls “the ultimate badge of responsible parenting”, and suggests that “the actual health benefits of breastfeeding are surprisingly thin“.

The best commentary on the article I’ve seen comes from Alex Tabarrok at Marginal Revolution who discusses the econometrics of breastfeeding—although the comments are equally as enlightening, covering the problems with running scientific trials on breastfeeding (i.e. ethical issues with decreeing how a mother should feed her child) and more besides.

For now it appears that the jury is still out, edging towards breastfeeding due to small but significant benefits.

Given the massive, lucrative market available I fully expect that by the time I’m a parent the difference between formula and breast milk will be negligible, if not edging in favour of formula thanks to nutritional and scientific advances. Of course the psychological benefits of breastfeeding (if only to the parents?) may never be able to be duplicated.

via Overcoming Bias

Update: The BBC reports that Nutricia (owners of the Cow & Gate and Milupa brands) has been told to cease airing misleading adverts claiming that their follow-on milk could “support the immune system”:

Companies are not allowed to advertise formula milk for babies under six months old.

But some pro-breast feeding groups believe there should be a total ban on this kind of advertising.

The World Health Organization recommends that babies are given breast milk exclusively for the first six months and after that it should continue alongside food until the age of two.

In fact, according to the WHO:

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers.

7 thoughts on “To Breastfeed or Not

  1. Alex

    I think you’ve overlooked one huge difference- breastfeeding is free! Although I don’t have any exact statistics, my impression is that parents spend 1000-2000 total in the first year on formula alone.

  2. Lloyd Morgan Post author

    Ah, but is it?

    As Hanna Rosin discusses in the article, those who suggest that breastfeeding is ‘free’ are completely ignoring opportunity costs:

    The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.

  3. Alex

    Okay- that’s a good point. However, someone’s time is involved when giving formula as well- for the majority of the first year, whether breastmilk or formula, the parent or guardian is stationary, and unable to do other tasks. Giving nutrition to a baby is a time commitment either way. In addition, with the purchase of a breast pump -up to $300 dollars, but as low as $60 or so- it doesn’t necessarily need to be the mother providing the milk. She can pump at her convenience, just as she would plan a trip to the store and prepare formula at her convenience.

  4. Dan

    Lloyd, I love your site.

    However, I have to say that I have to question the idea that “by the time I’m a parent the difference between formula and breast milk will be negligible, if not edging in favour of formula thanks to nutritional and scientific advances.” It’s a little like saying, “I can’t wait for science to invent super-blood and then get a transfusion.” Human blood developed through evolution to fit perfectly into every aspect of human physiology. So did breast milk. Even if there are more robust economic incentives to develop formula than super-blood, to think that those incentives (in combination with all their other incentives, most notably short-term profitability) are all that’s needed strikes me as putting a little too much faith in scientific progress.

    It also seems ironic that as people become increasingly skeptical about heavily processed, artificial food and increasingly prefer organic and locally grown alternatives that there would be a long-term resurgence of the idea that formula companies (as distinct from all other food producers) would be able to manufacture exactly the right combination of chemicals to allow babies to develop optimally.

    Here’s the list of ingredients in Nestle’s Good Start Protect Plus (http://www.gerber.com/Products/Good_Start_Natural_Cultures_Formula.aspx#):

    GOOD START Protect PLUS Formula Powder Ingredients
    Whey Protein Concentrate (From Cow’s Milk, Enzymatically Hydrolyzed, Reduced in Minerals), Vegetable Oils (Palm Olein, Soy, Coconut, and High-Oleic Safflower or High-Oleic Sunflower), Lactose, Corn Maltodextrin, and less than 1.5% of: Potassium Citrate, Potassium Phosphate, Calcium Chloride, Calcium Phosphate, Sodium Citrate, Magnesium Chloride, Ferrous Sulfate, Zinc Sulfate, Sodium Chloride, Copper Sulfate, Potassium Iodide, Manganese Sulfate, Sodium Selenate, M. alpina Oil*, C. cohnii Oil**, Sodium Ascorbate, Inositol, Choline Bitartrate, Alpha-Tocopheryl Acetate, Niacinamide, Calcium Pantothenate, Riboflavin, Vitamin A Acetate, Pyridoxine Hydrochloride, Thiamine Mononitrate, Folic Acid, Phylloquinone, Biotin, Vitamin D3, Vitamin B12, Taurine, Nucleotides*** (Cytidine 5′-Monophosphate, Disodium Uridine 5′-Monophosphate, Adenosine 5′-Monophosphate, Disodium Guanosine 5′-Monophosphate), Ascorbyl Palmitate, Mixed Tocopherols, L-Carnitine, B. lactis Cultures, Soy Lecithin.

    * A source of arachidonic acid (ARA), naturally found in breastmilk
    ** A source of docosahexaenoic acid (DHA), naturally found in breastmilk
    ***Naturally found in breastmilk.

    Is that list really just a few incremental tweaks from matching millions of years of evolution?

  5. Lloyd Morgan Post author

    Indeed, Alex.

    However I would surmise that (in the long-term) formula and breast milk are relatively equal in terms of cost when opportunity costs, equipment and other miscellaneous expenses are taken into account (although I am speculating completely as I have no idea about the time and financial costs involved).

    But what of the costs to the child–small and/or exaggerated health benefits are still health benefits nonetheless? Even though the benefits of breastfeeding may not be scientifically proved beyond doubt, the smallest benefit is surely still worth expending time and money on.

  6. Lloyd Morgan Post author

    Dan,

    Thanks for the kind words and the comprehensive comment.

    I happily admit that I put a lot (and as you say, possibly too much) faith in scientific progress. I also completely agree with your breast milk-formula and organic-processed food comparison.

    However I really do think that 20 years from now formula and processed food will be excellent substitutions for their ‘natural’ counterparts–as I said, the markets are too lucrative for the companies to ignore, especially if they already have the resources available to spend on R&D.

    Indeed, even in 2001 the WHO concluded that some formulas were a nutritionally adequate and safe breast milk substitute for certain at-risk groups (i.e. HIV-positive mothers) (Infant and Young Child Nutrition: Global Strategy for Infant and Young Child Feeding (pdf)).

    As knowledge about the composition of breast milk increases (as it will), surely formula can only improve?

    The psychological benefits, however: that’s something that’s unlikely to be paralleled.

  7. Alex

    And I suppose my bias is clear- I use the term “at her convenience” because my workplace supplies a nursing room, rare indeed. While I very much agree there should not be stigma on formula and a woman who feels taxed by breastfeeding should not go through emotional distress trying to maintain the regimen, I do argue that it is a significant time committment either way.

    I think my problem with the article is her tone- believe it or not, it feels judgemental when she describes the woman from Montreal and says, “She just felt that breast-feeding would set up an unequal dynamic in her marriage—one in which the mother, who was responsible for the very sustenance of the infant, would naturally become responsible for everything else as well. At the time, I had only one young child, so I thought she was a kooky Canadian—and selfish and irresponsible. But of course now I know she was right.”

    The partner dynamic does not need to be dictated by breastfeeding. I didn’t like how Hanna Rosin drew a natural parallel from having to get up at night to breastfeed to having to choose the school your child goes to. That doesn’t make any sense to me.

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