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‘Nipple Nazis’ vs overwrought mums: the breastfeeding debate

Intrigued by recent research that shows longer-term breastfeeding may be linked to higher IQs, I shared an article about it on my Facebook page. I was promptly accused of “breast-is-best” fascism. It appears…

‘Nipple Nazi’ is probably a cathartic shout-out on behalf of women who feel ripped off by a message that delivers pressure without assuring them the means of living up to expectations. postbear eater of worlds/Flickr

Intrigued by recent research that shows longer-term breastfeeding may be linked to higher IQs, I shared an article about it on my Facebook page. I was promptly accused of “breast-is-best” fascism.

It appears I have now joined the ranks of the “Nipple Nazi”. Apparently, breastfeeding advocates have been pushing for breastfeeding with so much zeal that it has resulted in bullying and humiliation of stressed-out new mothers.

Some of these mothers and their supporters lambaste breastfeeding promotion by midwives, maternity hospitals and advocacy groups, such as the Australian Breastfeeding Association.

Clearly, these critics are not afraid to use harsh words to decry what they see as the pressure and shaming involved in the promotion of breastfeeding.

Is it that bad?

Before I explore why breastfeeding advocates are being likened to Nazis, it’s worth considering what this kind of vitriol would look like against a different public health campaign.

Are anti-smoking advocates fascists? Certainly, smokers grumble about being sent onto footpaths and taxed to the limits of their blackened lungs. But can you really imagine them saying, “Stop making us feel guilty for smoking. The message that smoking is bad is harmful to us. Please stop putting it out there.”

These statements seem absurd for one clear reason. When a particular lifestyle costs public money and raises mortality rates, the state and public health advocates make arguments without reference to the self-esteem of their target audience.

Certainly, the tone of the message matters – nobody is going to change their behaviour by being hit over the head. But fear, guilt, and shame have often been employed within campaigns to change behaviour, notably with regard to smoking. Sometimes people need to see how high the stakes are.

Hating on the message

I am not suggesting a scare campaign should be adopted to advocate breastfeeding. A positive campaign could do the job more effectively, and is necessary in the first instance to normalise the practice.

Images of mothers of all ages and lifestyles breastfeeding in a variety of situations could be accompanied by a list of the health benefits to both the mother and the child.

These health benefits are by no means insignificant. And yet it sometimes feels like we’re a nation of wise monkeys, covering our ears and eyes.

Reports of the development of a National Breastfeeding Strategy in 2009, for instance, incited great recrimination from women who thought the message was purposely designed to make them feel bad.

Rebecca Carmody, journalist and (then) new mother epitomised this sentiment. Carmody had believed in the benefits of breastfeeding, and her ultimate reversion to infant formula left her feeling guilty.

She turned her anger on those she saw as responsible for her bad feelings: breastfeeding advocates.

Surely a more socially responsible position one might reach after the disappointing end of a breastfeeding attempt would be to accept that she had done her best for her child and hope other mothers would still be encouraged to breastfeed.

Sitting with dissonance

But many women can’t reach this position because of the social expectations on mothers. First among these is the super-mum myth that makes mothers feel pressured and guilty about every aspect of their children’s development.

The breastfeeding-equals-higher-IQ article could be seen to play into this myth, despite the importance of its message. Pressure and guilt can make people lash out at whoever invokes these feelings.

Women may also not be at peace with breastfeeding promotion because the super-mum myth is rolled out alongside deeply ambivalent messages about our bodies and sexuality. We are exhorted to breastfeed and yet often made to feel distinctly uncomfortable when we do.

The plethora of closeted-away feeding spaces in shopping centres, and gadgets for protecting the general public from harmful glimpses of human tissue or fluid, encourage the notion of breastfeeding being a “private” practice too grotesque for public view.

Barely clad breasts on a billboard selling soft drinks are fine, of course.

Finally, exhortations and economic pressures to work outside the home and “contribute” through paid work demand elaborate breast milk expressing regimes in often-unfriendly workplaces, or preclude breastfeeding altogether.

“Nipple Nazi” is probably a cathartic shout-out on behalf of women who feel ripped off by a message that delivers pressure without assuring them the means of living up to expectations.

But the answer isn’t to demonise the message or the messenger.

Rather, we need to change our society, two breasts and one baby at a time. Feed everywhere. Don’t feel the need to hide or cover up. Let people get used to seeing us.

Design and promote breast-feeding friendly workplace practices. Implement maternity leave schemes that enable mothers to breastfeed for a year. And stop depicting parenting as a pointless economic drain.

There’s plenty of room in that mix to also be empathic and supportive to those for whom breastfeeding hasn’t worked out.

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  1. Julie Leslie

    GIS Coordinator

    This opinion piece does what a lot of articles on breastfeeding do: ignore the very real and very obvious physical cost of breastfeeding.

    You can give all the pats on the back you like (and greater support will probably increase breastfeeding rates somewhat), but breastfeeding is (initially) painful, results in chronic sleep deprivation and leaves you physically sub-optimum for the entire time you breastfeed. Producing milk left me feeling like I was dragging a parachute behind me all the time…

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    1. Dianna Arthur

      Environmentalist

      In reply to Julie Leslie

      Julie

      Good to hear you say, "Next time I'm not going to worry so much..."

      As I took that as the entire point of the article, that women should not be constantly judged and are given support whether they are able to breastfeed or not.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Julie Leslie

      This opinion piece also does some other things that a lot of articles on breastfeeding do:

      It exaggerates the health outcome benefits.
      As we discussed on the other thread, the health benefits of breast feeding are real, but they are relatively small, and not long-lasting. The best evidence is for a modest reduction in respiratory and gastro infections in the first year of life. The purported cognitive benefits are open to question, and, even if real, are do not last beyond childhood.

      It compares…

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  2. Rob Brooks
    Rob Brooks is a Friend of The Conversation.

    Professor of Evolutionary Ecology; Director, Evolution & Ecology Research Centre at UNSW Australia

    Interesting article. Thanks.

    Breastfeeding is big at TC today - I just posted a column about it too: https://theconversation.com/breastfeeding-in-kilimanjaro-conforms-to-evolutionary-theory-16855

    What I think is missing around this issue is the sense that breastfeeding can be hard work. Not necessarily consciously - breastfeeding has enormous convenience in addition to the many benefits - but physiologically. When mums have to or want to wean their kids, they aren't doing so out of laziness or inadequacy. I agree that keeping the benefits in plain sight is an important nudge, as is the ongoing fight to remove obstacles to breastfeeding.

    But your point about the pressure to be perfect, and the explicit and implicit judgment mothers face is very important too. In the end, mums have to get on with doing the best they can, with as little unsolicited advice and pressure as possible.

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  3. Dennis Alexander

    logged in via LinkedIn

    Just to add to the bottle bashing (sorry, couldn't resist the alliteration): A British report published on August 5 suggests women who nurse have a lower risk of Alzheimer's disease. http://www.nzherald.co.nz/health-wellbeing/news/article.cfm?c_id=1501238&objectid=10910028 I mean, research is research, we are all free to ignore it if we want, but that doesn't make it wrong. Yes, modern lifestyles and work demands (really, they are demands not requests) do make breast feeding difficult and it really does drain some/most/all nursing mothers and that is all the more reason, given the research, to pressure business and government (major employers) on why they should make it easier and more viable in the light of the research. After all, they pay in terms of carer demands when children get sick, when the next generation is not as high in IQ, and when mothers take their talents to more accommodating employers and/or work.

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    1. Olivia Hibbitt

      Medical Writer

      In reply to Dennis Alexander

      If you look at the study instead of a newspaper report you will see that this was an extremely small study with rather questionable results that, at best, show a weak correlation and no causation.

      As for all the other stuff in your post... almost everyone born in the later half of the century were fed on formula, including myself, I don't see a global population of weak, sickly idiots with the collective IQ of a pile of slime mould!

      I have yet to see any real evidence that, in developed countries, breastmilk is any better than formula for nourishing infants. If there is an effect it is so small that it is meaningless.

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    2. Dennis Alexander

      logged in via LinkedIn

      In reply to Olivia Hibbitt

      Olivia, I was breast fed, my wife was breast fed, our daughters were breast fed, our grand daughter is breast fed (1959-2012). That gives me 4:1 on actual examples. Point: you need to provide some data to support your assertion of "almost everyone born in the later half of the century were fed on formula". And I made no comparison to slime mould or weak sickly idiots and neither do the researchers. Yes, the studies can be classed as small scale, but all research starts somewhere. If you can get ethics approval to do a large scale longitudinal matched identical twin study with one breast and one formula fed, let me know and I'll be happy to audit the design, implementation, results and interpretation.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Dennis Alexander

      ''I mean, research is research, we are all free to ignore it if we want, but that doesn't make it wrong.''

      No, Dennis, surely you can accept that not all research is methodologically strong, and not all conclusions are valid?

      That's why we read the actual text of studies, including the methodology and data analysis. In this paper (which is being picked up by the press - probably from a press release), 81 elderly British women were interviewed - some of whom had dementia. They were asked about…

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Dennis Alexander

      Dennis

      In the US (I assume Australian patterns would be similar), breastfeeding initiation rates were about 70% at the turn of last century, dipped to under 30% int he 1950's and 1960's, and have since risen to over 70% in 2010.

      During that time, most measures of health and well-being have steadily risen.

      Again, breast feeding (in our society) does confer some health benefits, but they don't seem to be long-lived. In the impoverished world, without clean water, the story is very different.

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    5. Dennis Alexander

      logged in via LinkedIn

      In reply to Sue Ieraci

      All valid questions Sue, but it is not as if this is a well developed research area in modern terms. All research starts somewhere, some of it goes places, some of it doesn't. It is further research, including replication studies, that makes it wrong, not us ignoring it. And ethics approval for much of this stuff is getting harder to get because there are identifiable potential adverse outcomes for some participants, so epidemiological studies, self reports and other such methods are getting more common.

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  4. Olivia Hibbitt

    Medical Writer

    You lost me when you compared not breastfeeding to smoking, something depressingly common amongst the more zealous advocates of breastfeeding at any cost.

    Let's be clear about this. Smoking is associated with a 50% mortality rate. Formula is an acceptable way to nourish an infant.

    There are a great many reasons why a woman may not choose or be able to breastfeed. How is it helpful to tell a woman who couldn't breastfeed because she was on essential medicine that her child is going to be fat, stupid and always sick? And yes, I have personally witnessed this.

    How about, instead of the constant stream of poorly designed studies, we get an actual campaign going to fully support women who want to breastfeed do so successfully....and support woman who cannot do so safely?

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    1. Shelby Gull Laird
      Shelby Gull Laird is a Friend of The Conversation.

      Lecturer, School of Environmental Sciences at Charles Sturt University

      In reply to Olivia Hibbitt

      I have not only witnessed those attitudes, but I experienced them. There are many valid medical reasons why a woman may not be able to breastfeed or she may simply choose not to breastfeed. Asking a mother why she is not breastfeeding is really none-of-your-business and that mother must also not feel the need to justify her decision to every medical professional, colleague and random observer while out shopping. Along the same lines, a breastfeeding mother does not need to justify her breastfeeding in public to anyone or the reasons why she chose to breastfeed. It's her choice.

      Mothers and everyone else should try to be supportive of mothers without being judgmental. I fully support a mothers right to breastfeed wherever she would like, and I would appreciate it if breastfeeding mothers would fully support my right to make decisions (medical or otherwise) that are best for my family, including formula feeding.

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    2. Olivia Hibbitt

      Medical Writer

      In reply to Shelby Gull Laird

      I'm sorry you had to experience negative attitudes! I count myself lucky that twins (and a car crash birth) got me a 'get out of jail free' card from the sanctimummy brigade! Any wiff of disapproval I could whip out a quick - "do it with two and we'll talk" - it was usually enough to ward off the most annoying people!

      I agree completely with you. Support is what new parents need, not judgement. There are much greater issues in parenting than whether you feed your baby on breastmilk or formula!

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    3. Tom Hennessy

      Retired

      In reply to Olivia Hibbitt

      "Formula is an acceptable way to nourish an infant"

      You haven't been closely following the press.
      "Could too much iron be a bad thing for babies?"
      "In a new study from Chile, infants who already had high levels of hemoglobin proteins in their blood and were fed iron-fortified formula ended up with lower scores on tests of thinking and memory than those given low-iron formula"
      http://www.reuters.com/article/2011/11/12/us-iron-babies-idUSTRE7AB02820111112

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    4. Dennis Alexander

      logged in via LinkedIn

      In reply to Olivia Hibbitt

      "How about, instead of the constant stream of poorly designed studies, we get an actual campaign going to fully support women who want to breastfeed do so successfully....and support women who cannot do so safely?" Absolutely no disagreement: and I wouldn't even add "... do so safely" and 'cannot' doesn't have to have a reason, women shouldn't even have to say "I don't want to.". But you don't have to denigrate and attack the research to do that.

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    5. Olivia Hibbitt

      Medical Writer

      In reply to Tom Hennessy

      I don't follow the press. I read peer reviewed articles.

      Unfortunately even this website is not immune to overstating the results of research studies.

      When you actually access the study that many of these articles are talking about, you generally find a very different story to what was being reported.

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  5. Joe Gartner

    Eating Cake

    Will we now see the return of the wet-nurse as a lucrative nutritional support service for affluent mothers?

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  6. Kate Newton

    logged in via email @ymail.com

    I believe breastfeeding also lowers the mother's lifetime risk of breast cancer, and the longer she breastfeeds the better.

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    1. Olivia Hibbitt

      Medical Writer

      In reply to Kate Newton

      Yes, but pregnancy and childbirth increase your risk of cervical cancer...so you win some, you lose some!

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    2. Kate Newton

      logged in via email @ymail.com

      In reply to Olivia Hibbitt

      But the contraceptive pill also raises your risk of cervical cancer, so I guess that tends to counterbalance the risk from pregnancy.

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    3. Olivia Hibbitt

      Medical Writer

      In reply to Kate Newton

      Ah, but standing on your tip toes in a shower has been shown to increase your chances of knee cancer...so we are all screwed!

      Living raises your risk of cancer!

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    4. Dianna Arthur

      Environmentalist

      In reply to Olivia Hibbitt

      Really? I thought living raised your risk of death, then I have no medical training...

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    5. Olivia Hibbitt

      Medical Writer

      In reply to Dianna Arthur

      Nope, I read a report in The Daily Mail just the other day...scientists now have a pill for death....it was written down so it must be true!

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    6. Kate Newton

      logged in via email @ymail.com

      In reply to Olivia Hibbitt

      Hang on, I thought you had some serious info to impart. But now you are just being facetious. Lost the plot?

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    7. Olivia Hibbitt

      Medical Writer

      In reply to Kate Newton

      I'm trying to make the point that there are a great many things that have been shown to protect or cause cancer. Many have a very small increase on a very small absolute risk. Basing life decisions of what some paper says will give you cancer is probably not particularly productive.

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    8. Kate Newton

      logged in via email @ymail.com

      In reply to Olivia Hibbitt

      The finding that breastfeeding appears to protect you from breast cancer may be a small effect, but it is significant and consistent and is not just "some paper".

      Just because some research is overinterpreted and sensationalised by the media does not mean all research findings should be discounted. We certainly need to separate the wheat from the chaff, but that is our job as researchers.

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    9. Dianna Arthur

      Environmentalist

      In reply to Olivia Hibbitt

      A point well made. It was me who ran with the facetious ball. Apologies for not being serious enough - I have to do this a lot.

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    10. Olivia Hibbitt

      Medical Writer

      In reply to Kate Newton

      I'm not saying that it should be discounted, I'm saying that it should be viewed with the importance it deserves. It might be a significant effect, but a significant effect on a small absolute risk is still a small increase in risk.

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  7. Chris Saunders

    retired

    Bullying is rife in our society, so if you are interfering between a mother and her nurturing and are told to get the hell out of it, maybe the wise might conclude they may in part be contributing to the fraught situation, not improving it. Women do not need medical workers to take the strict nanny role. People do tend to get annoyed when they are lectured about the ‘bleeding obvious’. Smoking was a widely accepted social norm, to use the example of an anti-smoking campaign as an example of what…

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  8. Antony Read

    designer

    Well, as a gay man, who really has no experience in this matter, or qualifications, my observation that there is a lot of discussion what people should or should not do.
    Mothers should play their natural game, and from my observation Mothers seem to do the best they can.
    If they can breast feed, then good on them, If they can't, then good on them too, and if they don't want too, good on them as well.
    It does appear from my observation the does seem to some pomposity and competition about whether you do or don't breastfeed, and I don't get that. In my opinion that is bad, the sisterhood should be more supportive either way, and less judgemental.
    And as I said, I am a gay man with no experience, qualifications, this is my observation of the issue

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    1. Kate Newton

      logged in via email @ymail.com

      In reply to Antony Read

      Bit it might be a bit like "natural childbirth" - sounds like common sense until you've tried it. In that case various inconvenient problems can raise their ugly (in the context, large or ill-positioned) heads - for instance. Nature is great, and where would we be without it, but the idea that "nature" is somehow pre-eminent in motherhood matters in particular, seems to be an unwarranted assumption and ideologically suspect.

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  9. Rosemary Stanton

    Nutritionist & Visiting Fellow at UNSW Australia

    We need to respect any woman's decision not to breast-feed her baby. However, it would be good if that decision was an informed one and not one based on anecdotes or picked up from those who believe infant formula is the equivalent of breast milk. It isn't.

    The Australian Government/NHMRC's Infant Feeding Guidelines (released in 2013) has a wealth of information on the evidence-based benefits of breastfeeding (all referenced). The document is accessible at http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n56_infant_feeding_guidelines.pdf

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    1. Chris Saunders

      retired

      In reply to Rosemary Stanton

      A number of statements you make are ones that are frequently asserted and I wonder if their truth has ever been researched and ascertained.
      “... However, it would be good if that decision was an informed one and not one based on anecdotes or picked up from those who believe infant formula is the equivalent of breast milk.”
      Is this statement the result of research or is this surmised or anecdotal?
      “because our society is not structured to see breastfeeding to be the norm”
      Is this proven or surmised?
      “When breastfeeding is painful, it is usually due to incorrect technique.” I know this is the most frequent comment, but is it true?
      “Note, however, that very few women can't breastfeed for physiological reasons.” Ditto

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    2. Olivia Hibbitt

      Medical Writer

      In reply to Chris Saunders

      A lot of the research that has been done is pretty poor...and to be honest, a lot of it is based on the benefit of breastmilk for infants in developing nations.

      In developed nations the evidence that breastmilk is orders of magnitude better than formula is not great.

      The assertion that 'very few women can't breastfeed' is one that comes up all the time, and I have yet to see an actual source for it. In general it's used as a guilt device for women who are having breastfeeding issues...because it is SO helpful to know that your problems are just imaginary because 'very few women can't breastfeed'! We don't guilt diabetics by saying 'most people aren't insulin resistant, you just need to try harder to make your pancreas work'!!!

      Also, my pet HATE is people implying that women who formula feed must have made that decision based on anecdata and no critical thinking of their own. It's paternalistic nonsense!

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    3. Kate Newton

      logged in via email @ymail.com

      In reply to Olivia Hibbitt

      Although I take your points about the latent social /ideological pressures on women's choices and behaviour I find it hard to believe that the main research findings on the advantages of breast milk over formula are based on data from developing countries. All that research on the benefits of antibodies etc is surely not undermined by the effects of obvious extraneous variables. However not being an expert in this field I am open to information.

      The social pressures on women to behave in certain ways in each era are ridiculous and debilitating. I don't share your confidence that most women's choices are well-informed. There is so much propaganda out there that the idea of the well-informed layperson is almost a joke.

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    4. Chris Saunders

      retired

      In reply to Kate Newton

      With access to the internet and the further education of the modern woman the idea 'of the well-informed layperson' is not any longer a joke for those with influence of authority to hide behind. Then of course there's that good old friend, commonsense which leads most people to recognize a furphy when they see one, but are often too polite to point it out, and then of course good old instinct which being an 'innate propensity to certain seemingly rational acts performed without conscious design…

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  10. Andrew Watkins

    Neonatologist

    While not accepting any demeaning of mothers who choose to feed infant formula it might be worth exploring some other pressures, as manipulation works in both directions and nursing and medical staff ( to the extent that any try ) are pushing against an extremely well-funded and well thought out campaign of manipulation by infant formula manufacturers.

    In my own discipline infant formula is associated with an increased risk of infection, especially a particularly nasty one called necrotising enterocolitis…

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    1. Dianna Arthur

      Environmentalist

      In reply to Andrew Watkins

      " In the 1990's the Kennet government in Victoria handed over the education programme for maternal and child health nurses to an infant formula manufacturer. "

      Andrew this is one of the most cogent arguments for more women in politics and other positions of power. Not that every woman is more trustworthy than Kennett, but by increasing the odds we have a better chance of achieving something more resembling a democracy.

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    2. Olivia Hibbitt

      Medical Writer

      In reply to Andrew Watkins

      I don't think anyone would argue that the practices of some infant formula companies have been, and still are appalling. The marketing of formula to the developing world being one of the more dark episodes in their history.

      There is also some excellent evidence for the benefits of breastmilk in premature infants.

      However, many of the facts you quote about the benefits of breastmilk are based on some pretty shaky data. Observational studies can only ever suggest a correlation, never causation…

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Andrew Watkins

      Andrew Watkins - I agree that parents' choices should be ''properly informed and not manipulated.''

      Comparing feeding a child formula with smoking cigarettes does not do this. In fact, much of the lactivist propaganda is extremely manipulative.

      I respect your observation of the benefits of breast milk in premature newborns in NICU - this is accepted. It is also well acknowledged that, in the impoverished world, contamination and dilution of formula can be life-threatening.

      For full-term…

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  11. Miranda Buck

    logged in via Facebook

    The essential point is that women want to breastfeed their babies and many fail to meet their own breastfeeding goals. There are many reasons for that failure, but breastfeeding advocacy is not one of them.

    Preganancy mucks up your body and breastfeeding is designed as the normal way to fix problems like lingering glucose intollerance, high blood pressure and bone thinning, (women who breastfeed end up with slightly denser bones in later life, lower BP and better glucose tollerance, and breastfeeding…

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