Monday, April 05, 2010

Breast-Feeding And Death

A new study argues that:

The lives of nearly 900 babies would be saved each year, along with billions of dollars, if 90% of U.S. women breast-fed their babies for the first six months of life, a cost analysis says.

Ninety percent of U.S. women? Even the ones who don't have children? Sloppy writing. Or perhaps a Freudian slip, hmm? (Note also that less than 90% of U.S. women have children, so some women without children would have to breastfeed to get to that goal!)

But the writing becomes more than sloppy later on:

About 43% of U.S. mothers do at least some breast-feeding for six months, but only 12% follow government guidelines recommending that babies receive only breast milk for six months.

Dr. Larry Gray, a University of Chicago pediatrician, called the analysis compelling and said it's reasonable to strive for 90% compliance.

Bolding is mine. I know that "compliance" is a medical term but I have always hated it because it implies obedience to the dictates of an outsider; as if the patient is an unruly child refusing to clean her room or something similar. I really wish that the term was dropped. The minute it's used about me I start rebelling. Maybe it's the same with humans?

Now about the study itself. First, I was pretty stunned by the low figures about breastfeeding. The rates are much higher among my acquaintances.

Second, note that this study is a meta-study: It collects the mortality evidence from other studies, and those studies are not laboratory studies where women and children are kept for many years to make sure that nothing else differs between two randomized groups of mother-baby pairs except breastfeeding.

Why would it matter that the studies the meta-study used are based on data from observations rather than laboratory studies?

Because the rate of breastfeeding is very likely to be correlated with education, income, tough working schedules and so on, and those other variables may have some influence on the morbidity and mortality rates, too. Connecting all excess mortality and morbidity to breastfeeding may exaggerate its impact.

But it's the tone of that first sentence that really got me annoyed: "The lives of nearly 900 babies would be saved each year, along with billions of dollars, if 90% of U.S. women breast-fed their babies for the first six months of life, a cost analysis says."

Let's see if my annoyance is at all legitimate: Do we have studies where someone writes: "The lives of x people would be saved each year if drivers cut back on speeding by y%?" Or: "The lives of z Americans would be saved each year if gun ownership declined by q%? Or even: "The savings in medical costs and psychological suffering of U.S. women would be (add some humongous dollar amount) if 90% of sexual violence was eradicated?"

Perhaps we do, though I have not seen them. Perhaps a gigantic guilt-trip IS the way to get more mothers to breastfeed? But then why start the piece by doing just that and then end it with this?

But he also said mothers who don't breast-feed for six months shouldn't be blamed or made to feel guilty, because their jobs and other demands often make it impossible to do so.

"We'd all love as pediatricians to be able to carry this information into the boardrooms by saying we all gain by small changes at the workplace" that encourage breast-feeding, Gray said.

Bartick said there are some encouraging signs. The government's new health care overhaul requires large employers to provide private places for working mothers to pump breast milk. And under a provision enacted April 1 by the Joint Commission, a hospital accrediting agency, hospitals may be evaluated on their efforts to ensure that newborns are fed only breast milk before they're sent home.

The pediatrics academy says babies should be given a chance to start breast-feeding immediately after birth. Bartick said that often doesn't happen, and at many hospitals newborns are offered formula even when their mothers intend to breast-feed.

"Hospital practices need to change to be more in line with evidence-based care," Bartick said. "We really shouldn't be blaming mothers for this."

I may be overreacting. But if I don't overreact, who will? Because the guilt-trip aspect is very real even if the data is based on approximations and lots of "maybes".

Why not write this piece by turning it into a positive one? Why not start by telling about the miraculous powers of breast milk, about the ability of a mother to truly affect her baby's future health (if the data is strong enough for that)? Then show her how the society is going to help her do just that while letting her remain a person on her own right. One who is making good choices and practicing excellent parenting.
P.S. I have now started a file on articles having to do with mothers, health and the psychology of child-rearing. And the same for fathers, health and the psychology of child-rearing. It will be very interesting to see what that file gathers over time.