Advantages of Breastfeeding: What we Know, What we Exaggerate

Are all the advantages of breastfeeding we hear about true? Are the health effects really as important and significant as we are led to believe? The answer to these questions? Well, it’s both yes and no.

On April 27, 2010, I had the privilege of talking with Dr. Michael Kramer, Scientific Director of the Canadian Institutes of Health Research (CIHR) Institute of Human Development, Child and Youth Health, to talk about the science of breastfeeding. Dr. Kramer is one of Canada’s foremost experts on this topic and has published numerous scientific papers on the health effects of breastfeeding.

I wanted to discuss the science with Dr. Kramer ~ to better understand what we know for sure, what gets exaggerated, and where we need to know more. Here is some of what I learned.

Health Advantages of Breastfeeding: What we Know

In my conversation with Dr. Kramer, I learned about the areas where the scientific evidence on the advantages of breastfeeding is solid. The following is a summary of “what we know for sure” regarding the health advantages of breastfeeding.

1. (No) health advantages of not breastfeeding

With one exception, there are no health outcomes where not breastfeeding has been shown to be superior to breastfeeding. While this might be an obvious point for many of us, I reiterate it because it’s one of the most solid findings in the science on breastfeeding.

Caveats:

• The one exception to this finding is among women with HIV. HIV can be passed along to babies thorough breast milk. As such, for mothers in developed countries like Canada, the general recommendation is that mothers with HIV not breastfeed their babies.
• The other thing to remember about this finding is that it refers specifically to physical health effects. In other words, this finding does not include studies that might examine various personal, psychological, emotional, practical, etc. advantages of breastfeeding and not breastfeeding (which, of course, are also important and meaningful factors to consider).

2. Health advantages of breastfeeding for babies

• Breastfeeding offers significant protection against infection, such as gastro-intestinal infections, respiratory infections, ear infections. These immunological benefits tend to increase with the duration and exclusivity of breastfeeding. It is also known that these protective effects are limited to the period of actual breastfeeding (i.e, until the baby is weaned).
• Breastfeeding offers significant protection against sudden infant death syndrome (SIDS — sometimes also referred to as sudden “crib death”). Again, the protective effects of breastfeeding against SIDS are limited to the actual period of breastfeeding, and appear to be stronger with greater exclusivity and duration of breastfeeding.
• Breastfeeding also seems to offer advantages in terms of neuro-cognitive development. Specifically, breastfed children score a couple of points higher, on average, on IQ scales. Dr. Kramer did indicate, however, that it is not currently clear whether this effect is due to something in the breast milk, something related to the act of breastfeeding, or something else pertaining to the characteristics/behaviors of these families. Further research is needed to learn more about this relationship.

3. Health advantages of breastfeeding for mothers

• One advantage is that exclusive breastfeeding has a contraceptive effect. While perhaps not as important in developed countries, this is a very meaningful and significant health advantage for mothers in much of the developing world.
• The second main finding is that breastfeeding offers protection against breast cancer. This protection seems to increase with the duration and number of children breastfed (i.e., the effect is cumulative).

Lastly, Dr. Kramer mentioned that breastfeeding seems to have a small effect on weight loss (i.e., that breastfeeding mothers tend to lose their pregnancy weight slightly faster than mothers who do not breastfeed). It was stressed, however, that this effect is very slight. Therefore, we should take care not overstate this as a main health advantage of breastfeeding.

What we Exaggerate

The above points, then, are mainly the “yes” part of the answer to the question “are all the advantages of breastfeeding we hear about true?”

The “no” part of the answer pertains to most of the other things we hear about as reasons for why “breast is best.”

Like the claim that breastfeeding protects against obesity, asthma or allergies for example. In my conversation with Dr. Kramer, he indicated that the balance of the evidence does not support the hypotheses that breastfeeding offers health advantages against obesity, asthma or allergies.

This is similarly the case for many other areas of the science (e.g., breastfeeding and diabetes, breastfeeding and various forms of cancers in children, breastfeeding and IBD, etc.). These hypotheses are still very much part of the “gray area” in the science.

The bottom line for so many of these other hypothesized health advantages of breastfeeding is that the quality and quantity of studies is just not sufficient to be able to say anything definitive one way or the other.

Concluding Thoughts

The Motherhood Cafe supports the societal promotion and protection of breastfeeding as a reproductive right. However, my concern is that ~ in our efforts to promote breastfeeding ~ many of the claims about the advantages of breastfeeding get exaggerated.

We start idealizing breastfeeding, and we start overstating what the science says about advantages of breastfeeding and the risks of not breastfeeding.

This, in turn, feeds into the creation of a social environment where mothers feel way too much pressure and guilt, uncertainty and worry, and competition and judgment regarding infant feeding and breastfeeding.

I want this to change.

Importantly, Dr. Kramer confirmed my own concern that the perceived differences between breastfeeding and bottle feeding (in terms of overall physical health effects) is greater than the actual differences suggested by the scientific literature. However, this shouldn’t discount the importance of the many known health advantages of breastfeeding.

In other words, “what we know for sure” is enough to confidently support and encourage breastfeeding from a child and maternal health perspective.

That said, the decisions mothers make regarding if and how long to breastfeed are varied and complex. They also necessarily tend to involve much more than just a simple weighing of the science on health effects.

It is therefore unfortunate and unnecessary ~ not to mention counter-productive and even harmful ~ to try to encourage breastfeeding by over-idealizing the practice, by overstating the science, or by allowing a culture of fear, pressure and judgment to flourish around the issue of infant feeding.

The goal of the Motherhood Cafe is, therefore, not to try to get more mothers to breastfeed. It is, rather, to support mothers in their infant feeding practices and decisions; to help them navigate the challenges of motherhood with as much capability and confidence as possible.

To this end, I asked Dr. Kramer about the importance of breastfeeding duration and exclusivity ~ knowing full well that the vast majority of mothers don’t make it for the full recommended time.

(The Motherhood Cafe also knows that the reasons we have for not fully following the current WHO guidelines for duration and exclusivity are valid, varied, often complex, and personal).

Dr. Kramer’s opinion: if, for whatever reason, six months of exclusive breastfeeding (with continued breastfeeding up to and beyond a year) is not going to work, an excellent option is to try to get a few months of exclusive breastfeeding (with continued “partial” breastfeeding after that to about a year). This amount of exclusivity and duration is likely provide 90-95% of the full effect of the health advantages of breastfeeding described above. Just good to know, I thought…

Acknowledgments: I would like to extend my thanks to Dr. Michael Kramer for giving so generously of his time to speak with me and for sharing his expertise and knowledge.