20 April, 2006

Breast is best

I see that although some cad voted to ban breasts in our latest poll, no one's elected to ban breast-feeding so far. Hurrah for that, since breastfeeding is almost undisputably an unmitigated good.* Aside from the obvious nutritional benefits, breastmilk contains lysozymes and immunoglobulin A antibodies, which protect the infant from bacterial (etc.) infection until it can develop an immune system of its own. No formula (the favorite alternative to breastmilk), as far as I know, provides the same, which at least partially accounts for the significantly higher rates of mortality and manifold increase in hospitalization rates amongst formula-fed babies. This, incidentally, is what prompted a bunch of people to call for a boycott against the Nestle corporation for marketing formula in third-world countries. Since formula is usually sold in powdered form and must be reconstituted with possibly contaminated water, this is a significantly greater risk to the child, compared to breastmilk, which is free, provides immune protection, and has other ancillary benefits as well.

There's some indication that breastfeeding has other, long-term benefits, as well, including general mental development, possibly reducing obesity, and reducing the likelihood of childhood cancers.

It's unfortunate, then, that breastfeeding rates are less than 100%. In the United States there's a particularly high class discrepancy in breastfeeding rates that's believed to be a product of a combination of lack of education on the subject (which, frankly, is dismal - even the Mayo Clinic says blithely that formula is "perfectly acceptable" as an alternative to breastmilk without discussing its failures), time and work pressures, and, unfortunately, the availability of the WIC formula credit.

We're still at a vast improvement from the 1950s, when breastfeeding went completely out of vogue and was actively frowned upon by ignorant boob doctors. But as more women are forced into (or choose to enter) the workplace, hopefully this positive trend won't backslide.

Post scriptum: Yes, menstruation won in the poll. No, no one is surprised.

* The one bad thing I'm aware of is that dioxins, which are fat-soluble and accumulate in the mother's body throughout her life, can only be excreted through fatty discharges, viz., breastmilk. The mother's first-born will thus receive her mother's full complement of accumulated dioxin while nursing. Not a great way to start off life, but it's probably still better to breastfeed.

Parse that as you like.


Other negatives of breastfeeding are: it takes resources from the mother (which can be a problem if she doesn't get enough to eat) and it can transmit HIV from the mother.

On both counts, formula is often worse. Certainly it costs more than an equivalent number of calories for the mother, so in terms of overall family nutrition/budget-management, breast-feeding is better. And while an HIV-positive mother in a rich country (i.e. well-nourished, with safe water, and quick access to hospitals in case the baby gets diarrhea) should feed her child formula, astonishingly in places where this isn't true, breast milk containing HIV is better than formula . Explained here , but also I think the WHO advocated this at some point.

I love the idea of a Nestle formula ad that says "in some cases, may be better for your baby than breastmilk with HIV." And to be fair to the Mayo clinic, the harms to children from formula are far smaller in rich countries. 

Posted by aram harrow

In terms of infant health, it's pretty clear that breastfeeding, even for malnourished mothers, can provide adequate nourishment to the infant. It certainly IS harder on the mother, but in a dire situation malnourishment will have a much, much greater impact on the child than it will on the mother.

You're right that the harms to children from formula are far smaller in rich countries, but they're nevertheless demonstrable and they exist. It's at least appropriate for a responsible health institution to recommend and advocate the, by far, healthier course of action. 

Posted by saurabh

Sorry if I was unclear. Yeah, even for malnourished mothers breastfeeding is better. But I wanted to point out that dioxins are not the only negative. 

Posted by aram harrow

At Boston Medical Center, the maternity department is completely formula-free. All mothers who deliver there have sessions with lactation counselors before they are discharged. Breast feeding *does* have a lot of benefits, but it's apparently not as "instinctive" an act as it sounds. Many women have trouble learning how to feed, when to feed, what to do about the pain, etc. I think a lot of hospitals find it easier just to throw formula at an already overwhelmed mother than to counsel her. And the overwhelmed mother, particularly if she is poor, is probably more likely to accept the formula than use up mental energy listening to a lactation counselor. 

Posted by DearDarlingDidi

On the subject of what's "instinctive", one thing I was going to write about but didn't was a phenomenon called "nipple confusion", apparently quite a problem these days. When a baby sucks a breast, it has to perform a particular action - it pulls a good portion of the breast tissue into its mouth and forms a funnel with its tongue, which it then uses to massage the milk out of the nipple. By comparison, a bottle nipple works simply by gravity - all baby has to do is keep its mouth open, and milk pours in. So bottle fed babies sometimes suffer from "nipple confusion" - that is, they are no longer able to breastfeed properly because they're used to the bottle. 

Posted by saurabh

it wouldn't serve us well to have too many behaviors wired in great detail. autonomic systems and balance and such are useful foundations. but "style" is going to vary by living environment, social role, individual choice, etc. without the ability to rearrange behavior according to obvious social expectation (direct or indirect), a person does not get second and third invitations to dinner. it seems like many of the fictions of society are maintained as truths by virtue of children taking to them "naturally."

nipple confusion doesn't necessary go against this. one of the sites i skimmed said that the kid learning the wrong tongue action and having trouble changing comes from the drastic difference in the use of the tongue. when suckling, the tongue gets more milk. on bottle, it's used to keep from choking on the heavy flow of milk. so take kid from bottle to breast and see if the little sucker is willing to risk its life on a bet that there's been a paradigm shift. 

Posted by hibiscus

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