Why There Are No Winners in the Battle of Breast vs. Bottle

Every morning, I receive Google alerts for several terms: breastfeeding, formula feeding, infant formula, breastmilk, etc. And every morning, I brace myself, waiting for the inevitable headline that will cause panic among bottle feeding moms or re-ignite the mommy wars (as if they ever need reigniting -- they're like one of those trick birthday candles, always sparking back to life even after you've wasted all your breath) or force me to take some semblance of a "position" on an issue that is hardly ever black and white.

One might expect that this morning, seeing news of a study out of Ohio State that found no statistically significant advantage to breastfeeding for numerous childhood outcomes including obesity, asthma and various measures of childhood intelligence and behavior, I would've been singing like a Lego figurine ("Everything is awesome! Everything is cool!"). As the study explains:

"Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child's outcome would be if he/she had been differently fed during infancy...

Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p

Source: Colen and Ramey, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling Comparisons. Social Science & Medicine, Available online 29 January 2014

I will admit that the comments made in several news outlets by the lead author of this study, Cynthia G. Colen, have made me want to run through the streets, acting as a one-woman ticker-tape parade in her honor. (Case in point: "I'm not saying breastfeeding is not beneficial, especially for boosting nutrition and immunity in newborns. But if we really want to improve maternal and child health in this country, let's also focus on things that can really do that in the long term -- like subsidized day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.") But I'm not celebrating the results of this study, any more than I'd celebrate one that said formula feeding caused children to sprout green hair from their chiny-chin-chins and opt to live under bridges.

Why? Because this shouldn't be a freaking contest.

The backlash that comes out of studies like these makes it feel like someone came out with research that claimed fried Oreos were just as healthy as raw kale. Instead, we should be approaching it as if someone came up with a way to make a vitamin supplement that would offer similar benefits to kale for those who hated the taste. One is natural, one is synthetic; one is manufactured, one exists organically. But for those of us who don't or can't eat raw kale on a daily basis, a good substitute is a godsend. (And maybe helps us justify those fried Oreos. A girl can dream.)

Now, a study showing comparable effects of the supplement to the organic kale would not negate the fact that kale, grown in your own garden, is a nutritious, amazing thing -- and tastes quite delicious to those of us who have a palate for it. If we started telling the kale aficionados that the supplement was better in some way, that would be a problem. But if the people who loved kale insisted that the supplement wasn't a valid option and was somehow morally wrong, that would be a problem, too. Chances are, if we were really talking about kale, nobody would care all that much. The people who liked kale would eat it, and those who didn't, might opt for the supplement -- feeling confident due to the research that suggested the supplement was a viable option.

But we're not talking about kale. We're talking about breast milk. And that, apparently, is where we all fall apart, and are rendered completely incapable of rational, measured discussion.

What the Golen/Ramsey study shows should not be controversial. The results should be reassuring evidence that formula feeding does not condemn a child to a life of obesity, poor health and lackluster intelligence; proof that whether a woman chooses, or is capable of, feeding a baby from her breast is not what defines her as a mother.

Imagine, for a minute, if we didn't compare breast and bottle, but rather celebrated BOTH as valid, safe, healthy options for mothers and babies. Accepting that formula has legitimacy - that there is a reason it was invented (out of a need and a desire for a safe breastmilk substitute ), and a reason why a woman may decide that a substitute is preferable - should not threaten those of us who celebrate breastfeeding. Yes, we should continue to rage against predatory formula marketing, especially in the developing world. Yes, we should speak up and speak out when companies (hello, Delta ) retreat to 1953 when they express their breastfeeding policies. (For that matter, we shouldn't need breastfeeding policies - if children are allowed, breastfeeding should be allowed. End of story.) Yes, we should ensure that women are entitled to adequate pumping breaks, and given solid breastfeeding assistance, and are supported by solid research regarding medications and breastmilk and best practices from pediatric professionals. But none of that means formula has to be Public Enemy No. 1. None of that means parents who formula feed should be left floundering due to an embarrassing lack of support and education. And for the love of god, none of that means we should be smugly celebrating when formula fed babies are shown to fare poorly, or gleefully rejoicing when and if the opposite occurs.

This is one study, with its own set of limitations and biases, like any other study in the modern canon of infant feeding research. But it's a good study, artfully designed, and one that raises some extremely important questions about how the emphasis on feeding babies might be distracting us from the real work of supporting better maternal and childhood outcomes. Because speaking of retreating to 1953, it's awfully easy to shove the responsibility for future generations onto women's chests, rather than addressing true social inequities that can impact children's lives. Maybe if we stopped wasting energy trying to prove how evil formula is, and just accepted it as part of life - not a slap in the face to our mammary glands, or an excuse for idiots to treat nursing mothers as horribly as they do now - we would have more energy to understand and destroy these inequities.

Or, you know, we could do what we always do and spend time looking for vague connections to the formula industry to discredit the study authors. Because that's a really great way of helping families thrive.