The Overblown Breast is Best Mantra

Kavin Senapathy

“As a new mom in 2011, parenting unfolded before me like an obstacle course, an uphill battle of picking the right choices from an ocean of wrong ones. In the complex quest for credible parenting information, one choice seemed clear, backed by seemingly incontrovertible data: When it comes to feeding your baby, breast is best.”

— Me, SELF Magazine, 2017

If I’ve learned one thing in the years I’ve spent covering health, food, medicine, and parenting from an aggressively science and evidence-backed standpoint, it’s that people want simple answers to complex problems and that we want to feel good about these choices. That’s perhaps no more apparent than in the parenting world.

From fertility to pregnancy to birth, women have always received well-meaning advice on how do it best. With the internet, advice that once came from family members, friends, and books now hits bleary-eyed parents in Facebook groups, memes, and newsfeeds.

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Enjoying its place at the top of everything a good mom is supposed to do, along with avoiding the dreaded C-section, buying the most natural products, and steering clear of screen time, is a three-word, seemingly science-clad adage that parents who have had babies in the past couple decades have all heard: Breast is best. It refers to the prevailing notion that breastfeeding exclusively—meaning no other food for the first several months of a baby’s life—is superior to formula feeding.

It was an adage that I keenly took to heart in January 2011 when my daughter came into the world, righteous attitude and all, with her umbilical cord wrapped twice around her neck. Throughout my pregnancy, I’d heard in no uncertain terms that breastfeeding is natural, leads to better health outcomes from infancy through adulthood, and on top of all that, breastmilk is free while formula costs hard-earned cash money that lines the pockets of the corrupt infant formula industry.

It turned out that breastfeeding is neither as easy nor as inexpensive as I thought, and, as usual, a three-word mantra hardly captures the body of data and the relevant, nuanced social issues. I’ve covered infant feeding in my work for years, which has involved speaking to a slew of experts and parents and reading a piles of studies and other literature. I also had my own fraught relationship with breastfeeding both of my kids for around a year each. In my science-backed opinion—a stance that I share with a growing number of experts and parents—the prevailing “breast is best” narrative is not only heavily woo-adjacent, it’s nothing short of a global injustice to parents and babies. It takes the issue of how babies are fed—which affects all of us because, well, children are our future—and reduces it to a three-word slogan that leaves out a whole lot of important information and impacts a lot of people in myriad ways. That’s why I’m giving a talk at CSICon 2019 on the overblown breast is best mantra.

For those coming to CSICon this year, I’ll be covering a few issues surrounding the infant feeding discussion during my talk, including:

Correlation vs. causation when it comes to breastfeeding and infant outcomes

Inferring causation out of correlation is an easy trap to fall into, as many a skeptic will often explain. Believe it or not, that’s one of the fundamental problems with the widespread narrative about the science on infant feeding. There are ethical barriers to conducting randomized controlled studies on infants, so the vast majority of data on infant feeding outcomes is observational.

It is true that breastmilk does seem to lead to better outcomes. As I wrote in a piece at answering the question “Is Breastfeeding Really Best and Is Formula Harmful?”:

“Breastfed infants fare better on the whole than their formula-fed counterparts, both in the U.S. and globally. The U.S. Department of Health and Human Services (HHS) explains that breastfed babies have a lower incidence of asthma, leukemia, obesity, ear infections, eczema, lower respiratory infections, necrotizing enterocolitis (a disease that affects the gastrointestinal tract in premature babies), sudden infant death syndrome (SIDS), and type 2 diabetes. According to the World Health Organization (WHO), higher IQ, greater school attainment, and higher salary in later years are also associated with breastfeeding. (Note:  IQ as a measure of intelligence is problematic in several ways.)

But with the exception of necrotizing enterocolitis—there is strong evidence that an exclusively human milk diet significantly reduces the risk of this devastating intestinal disease that mostly occurs in premature infants—the data don’t actually show that breastmilk itself leads to widely-touted improved outcomes in childhood and adulthood.

So why do breastfed babies do so much better if it isn’t breastmilk itself conferring these improved outcomes?”

The answer is that parents who breastfeed for an extended period tend to differ from those who don’t breastfeed in several important ways. In the developed world, breastfed babies tend to have parents with more education, more financial security, and better access to healthcare compared to the parents who don’t breastfeed or breastfeed for a short duration. Moms who breastfeed are also less likely to smoke and promote healthy habits for their children.

In less economically developed nations, babies who receive formula are more likely to be exposed to pathogens from contaminated water than those who breastfeed.

It’s also worth noting that those who end up formula feeding are more likely to have had concerns about their infant’s weight gain in the early days of life compared to those whose newborns maintained a healthy rate of weight gain on a breastmilk-only diet—newborns typically lose a few percentage points of body weight before starting to grow. Babies who lose too much weight, or don’t gain at a healthy rate, are at higher risk of complications than those whose weight loss remained within healthy limits, and those complications can have long-lasting effects.

The more I studied the academic literature on infant feeding, the more my heart broke to see the real picture. It is mind blowing that so many parents believe that breastfeeding is one huge way to ensure our kids end up healthy, happy, and successful, but what really matters most is who your parents are and the socio-economic circumstances into which a baby is born.

The only randomized controlled infant feeding trial was done in Belarus—which of course raises its own issues that I won’t get into here—and began in the 1990s. Researchers followed the study subjects from infancy through adolescence and found that they ended up with similar incidence of asthma and allergies, obesity, and behavioral issues, among other outcomes. Sibling studies—which eliminate some of the confounders I mentioned—also suggest that the purported benefits of breastfeeding for full-term, healthy babies are vastly overblown. 

There’s a lot to go into when it comes to “breast is best,” and I plan on covering several factors that are crucial to the big picture. Meanwhile, I’ll leave you with some of my work on infant feeding, all meant for a general audience.

For one, the WHO-UNICEF Baby Friendly Hospital Initiative (BFHI), launched in 1991 based on the prevailing “breast is best” mantra, has drawn mounting criticism from experts. I unpacked some of that criticism in detail for the SciMoms piece I mentioned earlier, Is Breastfeeding Really Best and Is Formula Harmful?” This piece also explores some of the actual costs associated with both formula and breastfeeding.

I took a closer look at the data and went into some of my personal experience giving birth at a BFHI accredited hospital, and shared stories from other parents, in “Are ‘Baby-Friendly’ Hospitals Worse for New Mothers? at SELF.

It’s also crucial to stress that formula companies have acted in unconscionable ways, but that doesn’t mean that formula itself is a bad thing. I went into some of that history in the script for this video for SciShow all about the science around breastmilk and formula.

It turns out that those suggesting that formula is harmful—most who advocate for formula avoidance do seem to truly believe that—have inadvertently caused harm themselves. A story of mine for The Daily Beast on how “The ‘Breast Is Best’ Breastfeeding Campaign Is Misguided examines some of this harm and argues in favor of policies that allow for safe use of formula.

Ultimately, for me at least, the issue of bodily autonomy trumps the science on infant feeding. Even if higher breastfeeding rates did have a measurable positive causal effect on children (they don’t), it’s up to those with breasts to decide what to do with them. In a piece at Forbes, I make the case for “Formula Feeding As An Informed Choice—a choice that shouldn’t require any excuse other than “this is what I decided to do.”

I’ll be at CSICon in Las Vegas, this October 16–20, to talk about how and why we got to the “breast is best” era and why I advocate for fully informed choice when it comes to how we feed our babies. I hope to see you there.

Kavin Senapathy

Kavin is an author and public speaker covering science, health, medicine, agriculture, food, parenting and their intersection. Her work appears regularly at Forbes, SELF Magazine, Slate, and more. Her chapter in the recent MIT Press book “Pseudoscience” is entitled “Swaying Pseudoscience - The Inoculation Effect.” When she’s not writing and tweeting, she’s busy being a “Science Mom”—also the name of a recent documentary film in which she’s featured—to a 7-year-old and 5-year-old.