Mother’s milk
Social scientist Joan Wolf takes issue with studies on breast-feeding's health benefits
By Ruth E. Kott, AM07
Photography by Lisa Sterling
Not all mothers enjoy breast-feeding, says Wolf, and the evidence of its health benefits has been overstated.
“Breast-feeding plays a critical role in nature’s plan for ensuring that human babies survive and grow,” writes La Leche League in the advocacy organization’s book The Womanly Art of Breastfeeding. "Artificial feeding—formula feeding—is a substantial departure from nature's plan.”
Such language is common regarding breast-feeding; the idea that nursing is the healthiest option for a baby gets repeated from women’s groups to Congress. Politicians and advocacy organizations have tried to legislate a preference for breast-feeding: In 2006, for example, Democratic Iowa senator Tom Harkin proposed a bill to place warning labels on formula saying that breast milk is healthier. In February the IRS added breast pumps and breast-feeding supplies to its list of tax-deductible medical expenses.
These policy decisions are based on abundant studies—more than 15,000 since 1990—on breast-feeding, many of which find that breast-fed babies are healthier. But in her 2011 book, Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood (New York University Press), Joan Wolf, AM’92, PhD'97, argues that much of that research is flawed.
Wolf is an assistant professor of women’s and gender studies at Texas A&M University, not a pediatrician. She looks at the breast-feeding studies much like ones that ask whether race matters in the way people vote, she says. She scrutinizes the design of the research and how it's been executed and “then how it’s been reported, both to scientists and to the public.”
“There is a lot of associational research,” she says, that suggests that, on average, breast-fed babies are healthier. Yet there’s no good evidence, she argues, “that demonstrates that breast-feeding itself makes the difference,” except when it comes to reducing gastrointestinal infections. In those cases, Wolf agrees, studies have undeniably shown that breast-fed babies ingest certain antibodies that fight bacteria in the GI tract.
In many studies, she says, researchers don’t control for factors such as socioeconomic level and mother’s behavior. In a 2002 Journal of the American Medical Association article examining breast-feeding’s effect on a baby’s intelligence, for example, the investigators found a “significant positive association between duration of breast-feeding and intelligence.” They point out, however, that the association may have to do more with mothers spending time with their children in general rather than the breast milk. “The more tightly these studies control for confounding variables,” says Wolf, “the less breast-feeding seems to matter.”
Other studies that claim breast milk lowers respiratory infections or obesity have the same causational problems. These effects could just as easily be explained, says Wolf, by mothers who don’t take their babies to the supermarket at 5 p.m. when it’s crowded and full of germs, mothers who wash their hands before picking up their baby, or mothers who feed their children healthy diets.
“I’m certainly not opposed to breast-feeding,” says Wolf, who won’t discuss whether or not she breast-fed her two sons. But not all women are able to nurse, whether it’s because the baby doesn’t latch, it’s painful for the mother, she doesn’t have time, or she simply doesn’t like it. In those cases, says Wolf, the pro-breast-feeding studies, without appropriate scientific evidence, make the mother feel inadequate.
Americans’ focus on breast-feeding’s health benefits is part of a cultural phenomenon that Wolf calls “total motherhood,” in which mothers are responsible for predicting and preventing anything bad or risky that might happen to their children, at times sacrificing their own well-being. Total motherhood creates unreasonable expectations of mothers, Wolf argues. And despite the conventional wisdom, breast-feeding is not free, she says. There are time costs (only mothers can breast-feed, while others can help with bottle-feeding), potential economic costs (working-class mothers who are paid by the hour may not get allowances for pumping breaks), and emotional costs, the “strain of being essentially the only thing keeping your baby alive.”
As a feminist, Wolf found her way to this subject while studying feminism’s response to infant feeding. “The plan was to spend a short time going through at least some of the research on breast-feeding,” she says. "What I thought would be a couple of weeks turned into a year of reading the medical literature.”
It’s a topic that people feel particularly passionate about. “It’s hard to have a nuanced perspective on breast-feeding,” she says. In the current "national conversation, you’re either for breast-feeding or you’re against it.” She’s heard plenty of vehement responses to Is Breast Best? “I’ve been accused of being tantamount to a Holocaust denier,” says Wolf, who also wrote Harnessing the Holocaust: The Politics of Memory in France (Stanford University Press, 2004). “People have said that claiming the breast is not necessarily best is essentially the same as advocating cold fusion.” Yet she’s also heard from lactation consultants and advocates who believe that the national conversation about breast-feeding has become “completely irrational,” and they’re glad that “there’s a measure of rationality or sensibility being returned to the discourse."
With her book, she’s trying to shed light on a complicated issue. “Ultimately, women have to make a decision about how they’re going to feed their babies and their children in the context of all of the other decisions they’re making,” Wolf says. “It’s simply wrong and misleading to suggest that women are doing irreparable damage to their babies by not breast-feeding.”