Credit where credit’s due
(February 2016)
On January 30, 2016, an article was published in the Lancet reporting the conclusions of a review of 28 systematic reviews and meta-analyses of studies related to the outcomes and statistics of breastfeeding. The key findings were remarkable in their significance to both infant’s and women’s health as well as the global state of health and economy.
I was particularly interested to see what was said about the UK because in my experience a common defence of a trend away from breastfeeding in high income country is that the risks from formula feeding are not applicable to regions with safe water supply. In practice and when formula milk is made up appropriately this is probably correct however I don’t feel this view adequately addresses the risks of not breastfeeding.
I was saddened to read that with rates of less than 1%, the UK has the lowest breastfeeding rates at 12 months in the world. This is just part of the story though.
I decided then to identify the facts in the article associated with high income countries (HIC) in order to attempt to separate the argument that the benefits of breastfeeding are irrelevant in these regions. Unless stated specifically, the data from the studies relate to HIC as a set, derived from 127of the identified 139 HIC in the world.
Picture source: http://www.unicef.org/nutrition/index_24824.html
Despite the fact that I am already sold on the value of breastfeeding, the list above still makes for astonishing reading. Furthermore despite my commitment to evidence based practice, this is the nemesis that I do battle with on a regular basis and am sure many health care professionals shy away from it too. I worry on two fronts; that emphasising the benefits of breastfeeding comes across as pressure, that highlighting the risks of formula feeding comes across as scare tactics. I also worry that by not fully addressing these issues, I am not fulfilling my obligations as a health professional to promote good health and protect public health.
I have been accused on one occasion of pressurising a woman into breastfeeding. It transpired that my talking about the reduction in SIDS and hospital admissions is tantamount to emotional blackmail. Now I have no idea if she did breastfeed in the end having only had one antenatal contact with her, but it caused me to reflect and ask myself some questions. Should I have shared those statistics? Is it appropriate to withhold that information for any reason? Is it her right to know information which may have an effect on hers and her baby’s health?
There is no doubt that statistics are used on a daily basis in health and maternity care to pressurise people (Take a look at the #MatExp campaign to see the many and varied discussions on language and empowerment), and there are always different ways to look at statistics, for example the rates of SIDS are approx. 0.36 per 1000 births in England and Wales. This is very low (around 249 per year) and so a reduction on this low number by 36% is tiny (though statistically significant) but the topic is emotive. I take a gentle but direct approach to infant sleep safety, discussing it openly in my antenatal classes and my experience has taught me that parents actively want to talk about it.
As for the rest, how do we share it? That is a genuine question! Locally, nationally, globally? Faced with these statistics you would think the Governments would be outraged, would pour resources into this lifesaving and (cynically?) moneysaving activity? Why aren’t they standing chest to chest with the formula companies and demanding they be held accountable for the systematic erosion of society and women’s confidence in breastfeeding and breastmilk? Why has the campaign to do this become a fringe activity? That you are seen as a anti-choice activist when these things are said? I can’t help wondering if women are not universally in possession of the facts because we are withholding them for fear that they (the women) will think we are emotionally blackmailing them into breastfeeding against their choice. Is that not just as patriarchal as the people who believe women are not entitled to bodily autonomy and choice? At what point do we start giving women credit for making a true informed decision about infant feeding? At what point do we fully acknowledge that this is a collective societal problem and not just about individual isolated choice. Choice is never in absolute isolation, ‘we’ all have a responsibility.
References
Victora, C. et
al. 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 387:475-490 [Online]http://press.thelancet.com/breastfeeding1.pdf
The Lullaby Trust https://www.lullabytrust.org.uk/
I was particularly interested to see what was said about the UK because in my experience a common defence of a trend away from breastfeeding in high income country is that the risks from formula feeding are not applicable to regions with safe water supply. In practice and when formula milk is made up appropriately this is probably correct however I don’t feel this view adequately addresses the risks of not breastfeeding.
I was saddened to read that with rates of less than 1%, the UK has the lowest breastfeeding rates at 12 months in the world. This is just part of the story though.
I decided then to identify the facts in the article associated with high income countries (HIC) in order to attempt to separate the argument that the benefits of breastfeeding are irrelevant in these regions. Unless stated specifically, the data from the studies relate to HIC as a set, derived from 127of the identified 139 HIC in the world.
Picture source: http://www.unicef.org/nutrition/index_24824.html- The higher the domestic income, the lower the breastfeeding prevalence
- Ever breastfeeding is associated with 36% reduction in Sudden Infant Death Syndrome
- Ever breastfeeding also associated with 58% decrease in necrotising enterocolitis
- Half of diarrhoea cases (reducing hospital admission for this by 72%) and a third of respiratory cases (reducing hospital admission for this by 57%) could be prevented by breastfeeding.
- Protection against ear infections for children under 2 years.
- Breastfeeding for longer reduces chance of obesity by 26%
- 35% reduction in Type 2 diabetes
- Possible protective effect against Type 1 diabetes
- No significant protective effect against cholesterol or high blood pressure in later life
- An association with 19% reduction in risk of childhood leukaemia
- Even allowing for confounding factors, an increase in IQ
- Each 12 month period of breastfeeding reduces the mother’s chance of developing invasive breast cancer by 4.3-7%
- 30% reduction in ovarian cancer related to longer breastfeeding
- The review noted no evidence of reduction in osteoporosis related to breastfeeding
- BMI is 1% lower for every 6 months breastfeeding completed (British study of 740,000 women)
- Current breastfeeding rates prevent an estimated 19,464 annual breast cancer deaths globally
- In HIC, an estimated an additional 22,216 women’s lives would be saved if breastfeeding increased from current levels to 12 months per child
Despite the fact that I am already sold on the value of breastfeeding, the list above still makes for astonishing reading. Furthermore despite my commitment to evidence based practice, this is the nemesis that I do battle with on a regular basis and am sure many health care professionals shy away from it too. I worry on two fronts; that emphasising the benefits of breastfeeding comes across as pressure, that highlighting the risks of formula feeding comes across as scare tactics. I also worry that by not fully addressing these issues, I am not fulfilling my obligations as a health professional to promote good health and protect public health.
I have been accused on one occasion of pressurising a woman into breastfeeding. It transpired that my talking about the reduction in SIDS and hospital admissions is tantamount to emotional blackmail. Now I have no idea if she did breastfeed in the end having only had one antenatal contact with her, but it caused me to reflect and ask myself some questions. Should I have shared those statistics? Is it appropriate to withhold that information for any reason? Is it her right to know information which may have an effect on hers and her baby’s health?
There is no doubt that statistics are used on a daily basis in health and maternity care to pressurise people (Take a look at the #MatExp campaign to see the many and varied discussions on language and empowerment), and there are always different ways to look at statistics, for example the rates of SIDS are approx. 0.36 per 1000 births in England and Wales. This is very low (around 249 per year) and so a reduction on this low number by 36% is tiny (though statistically significant) but the topic is emotive. I take a gentle but direct approach to infant sleep safety, discussing it openly in my antenatal classes and my experience has taught me that parents actively want to talk about it.
As for the rest, how do we share it? That is a genuine question! Locally, nationally, globally? Faced with these statistics you would think the Governments would be outraged, would pour resources into this lifesaving and (cynically?) moneysaving activity? Why aren’t they standing chest to chest with the formula companies and demanding they be held accountable for the systematic erosion of society and women’s confidence in breastfeeding and breastmilk? Why has the campaign to do this become a fringe activity? That you are seen as a anti-choice activist when these things are said? I can’t help wondering if women are not universally in possession of the facts because we are withholding them for fear that they (the women) will think we are emotionally blackmailing them into breastfeeding against their choice. Is that not just as patriarchal as the people who believe women are not entitled to bodily autonomy and choice? At what point do we start giving women credit for making a true informed decision about infant feeding? At what point do we fully acknowledge that this is a collective societal problem and not just about individual isolated choice. Choice is never in absolute isolation, ‘we’ all have a responsibility.
References
Victora, C. et
al. 2016. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 387:475-490 [Online]http://press.thelancet.com/breastfeeding1.pdf
The Lullaby Trust https://www.lullabytrust.org.uk/
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