Here’s an article that’s hanging in our report room at work. It’s an interesting article. It speaks to me, in that I don’t know how much I want to breastfeed. Sure I’ll try it, but if I don’t like it, am I placing irreparable harm on my baby? And it speaks to how I practice nursing. I’m not “lacatation nazi” as they are known. If someone really wants to breastfeed, I will help them to the best of their ability. I will not offer a bottle or pacifier. But if someone changes their mind, I want them to realize that they are not failures. That the most important thing is to feed your baby, in whatever way you are comfortable.
In certain overachieving circles, breast-feeding is no longer a choice—it’s a no-exceptions requirement, the ultimate badge of responsible parenting. Yet the actual health benefits of breast-feeding are surprisingly thin, far thinner than most popular literature indicates. Is breast-feeding right for every family? Or is it this generation’s vacuum cleaner—an instrument of misery that mostly just keeps women down?
by Hanna Rosin
The Case Against Breast-Feeding
Image credit: Jose Luis Pelaez/Getty Images
Hanna Rosin and three friends discuss the science and culture of breastfeeding
One afternoon at the playground last summer, shortly after the birth of my third child, I made the mistake of idly musing about breast-feeding to a group of new mothers I’d just met. This time around, I said, I was considering cutting it off after a month or so. At this remark, the air of insta-friendship we had established cooled into an icy politeness, and the mothers shortly wandered away to chase little Emma or Liam onto the slide. Just to be perverse, over the next few weeks I tried this experiment again several more times. The reaction was always the same: circles were redrawn such that I ended up in the class of mom who, in a pinch, might feed her baby mashed-up Chicken McNuggets. In my playground set, the urban moms in their tight jeans and oversize sunglasses size each other up using a whole range of signifiers: organic content of snacks, sleekness of stroller, ratio of tasteful wooden toys to plastic. But breast-feeding is the real ticket into the club. My mother friends love to exchange stories about subversive ways they used to sneak frozen breast milk through airline security (it’s now legal), or about the random brutes on the street who don’t approve of breast-feeding in public. When Angelina Jolie wanted to secure her status as America’s ur-mother, she posed on the cover of W magazine nursing one of her twins. Alt-rocker Pete Wentz recently admitted that he tasted his wife, Ashlee Simpson’s, breast milk (“soury” and “weird”), after bragging that they have a lot of sex—both of which must have seemed to him markers of a cool domestic existence. From the moment a new mother enters the obstetrician’s waiting room, she is subjected to the upper-class parents’ jingle: “Breast Is Best.” Parenting magazines offer “23 Great Nursing Tips,” warnings on “Nursing Roadblocks,” and advice on how to find your local lactation consultant (note to the childless: yes, this is an actual profession, and it’s thriving). Many of the stories are accompanied by suggestions from the ubiquitous parenting guru Dr. William Sears, whose Web site hosts a comprehensive list of the benefits of mother’s milk. “Brighter Brains” sits at the top: “I.Q. scores averaging seven to ten points higher!” (Sears knows his audience well.) The list then moves on to the dangers averted, from infancy on up: fewer ear infections, allergies, stomach illnesses; lower rates of obesity, diabetes, heart disease. Then it adds, for good measure, stool with a “buttermilk-like odor” and “nicer skin”—benefits, in short, “more far-reaching than researchers have even dared to imagine.” In 2005, Babytalk magazine won a National Magazine Award for an article called “You Can Breastfeed.” Given the prestige of the award, I had hoped the article might provide some respite from the relentlessly cheerful tip culture of the parenting magazines, and fill mothers in on the real problems with nursing. Indeed, the article opens with a promisingly realistic vignette, featuring a theoretical “You” cracking under the strain of having to breast-feed around the clock, suffering “crying jags” and cursing at your husband. But fear not, You. The root of the problem is not the sudden realization that your ideal of an equal marriage, with two parents happily taking turns working and raising children, now seems like a farce. It turns out to be quite simple: You just haven’t quite figured out how to fit “Part A into Part B.” Try the “C-hold” with your baby and some “rapid arm movement,” the story suggests. Even Dr. Sears pitches in: “Think ‘fish lips,’” he offers. In the days after my first child was born, I welcomed such practical advice. I remember the midwife coming to my hospital bed and shifting my arm here, and the baby’s head there, and then everything falling into place. But after three children and 28 months of breast-feeding (and counting), the insistent cheerleading has begun to grate. Buttermilk-like odor? Now Dr. Sears is selling me too hard. I may have put in fewer parenting years than he has, but I do have some perspective. And when I look around my daughter’s second-grade class, I can’t seem to pick out the unfortunate ones: “Oh, poor little Sophie, whose mother couldn’t breast-feed. What dim eyes she has. What a sickly pallor. And already sprouting acne!” I dutifully breast-fed each of my first two children for the full year that the American Academy of Pediatrics recommends. I have experienced what the Babytalk story calls breast-feeding-induced “maternal nirvana.” This time around, nirvana did not describe my state of mind; I was launching a new Web site and I had two other children to care for, and a husband I would occasionally like to talk to. Being stuck at home breast-feeding as he walked out the door for work just made me unreasonably furious, at him and everyone else. In Betty Friedan’s day, feminists felt shackled to domesticity by the unreasonably high bar for housework, the endless dusting and shopping and pushing the Hoover around—a vacuum cleaner being the obligatory prop for the “happy housewife heroine,” as Friedan sardonically called her. When I looked at the picture on the cover of Sears’s Breastfeeding Book—a lady lying down, gently smiling at her baby and still in her robe, although the sun is well up—the scales fell from my eyes: it was not the vacuum that was keeping me and my 21st-century sisters down, but another sucking sound. Still, despite my stint as the postpartum playground crank, I could not bring myself to stop breast-feeding—too many years of Sears’s conditioning, too many playground spies. So I was left feeling trapped, like many women before me, in the middle-class mother’s prison of vague discontent: surly but too privileged for pity, breast-feeding with one hand while answering the cell phone with the other, and barking at my older kids to get their own organic, 100 percent juice—the modern, multitasking mother’s version of Friedan’s “problem that has no name.” And in this prison I would have stayed, if not for a chance sighting. One day, while nursing my baby in my pediatrician’s office, I noticed a 2001 issue of the Journal of the American Medical Association open to an article about breast-feeding: “Conclusions: There are inconsistent associations among breastfeeding, its duration, and the risk of being overweight in young children.” Inconsistent? There I was, sitting half-naked in public for the tenth time that day, the hundredth time that month, the millionth time in my life—and the associations were inconsistent? The seed was planted. That night, I did what any sleep-deprived, slightly paranoid mother of a newborn would do. I called my doctor friend for her password to an online medical library, and then sat up and read dozens of studies examining breast-feeding’s association with allergies, obesity, leukemia, mother-infant bonding, intelligence, and all the Dr. Sears highlights. After a couple of hours, the basic pattern became obvious: the medical literature looks nothing like the popular literature. It shows that breast-feeding is probably, maybe, a little better; but it is far from the stampede of evidence that Sears describes. More like tiny, unsure baby steps: two forward, two back, with much meandering and bumping into walls. A couple of studies will show fewer allergies, and then the next one will turn up no difference. Same with mother-infant bonding, IQ, leukemia, cholesterol, diabetes. Even where consensus is mounting, the meta studies—reviews of existing studies—consistently complain about biases, missing evidence, and other major flaws in study design. “The studies do not demonstrate a universal phenomenon, in which one method is superior to another in all instances,” concluded one of the first, and still one of the broadest, meta studies, in a 1984 issue of Pediatrics, “and they do not support making a mother feel that she is doing psychological harm to her child if she is unable or unwilling to breastfeed.” Twenty-five years later, the picture hasn’t changed all that much. So how is it that every mother I know has become a breast-feeding fascist? Like many babies of my generation, I was never breast-fed. My parents were working-class Israelis, living in Tel Aviv in the ’70s and aspiring to be modern. In the U.S., people were already souring on formula and passing out No NestlÉ buttons, but in Israel, Nestlé formula was the latest thing. My mother had already ditched her fussy Turkish coffee for Nescafé (just mix with water), and her younger sister would soon be addicted to NesQuik. Transforming soft, sandy grains from solid to magic liquid must have seemed like the forward thing to do. Plus, my mom believed her pediatrician when he said that it was important to precisely measure a baby’s food intake and stick to a schedule. (To this day she pesters me about whether I’m sure my breast-fed babies are getting enough to eat; the parenting magazines would classify her as “unsupportive” and warn me to stay away.) Formula grew out of a late-19th-century effort to combat atrocious rates of infant mortality by turning infant feeding into a controlled science. Pediatrics was then a newly minted profession, and for the next century, the men who dominated it would constantly try to get mothers to welcome “enlightenment from the laboratory,” writes Ann Hulbert in Raising America. But now and again, mothers would fight back. In the U.S., the rebellion against formula began in the late ’50s, when a group of moms from the Chicago suburbs got together to form a breast-feeding support group they called La Leche League. They were Catholic mothers, influenced by the Christian Family Movement, who spoke of breast-feeding as “God’s plan for mothers and babies.” Their role model was the biblical Eve (“Her baby came. The milk came. She nursed her baby,” they wrote in their first, pamphlet edition of The Womanly Art of Breastfeeding, published in 1958). They took their league’s name, La Leche, from a shrine to the Madonna near Jacksonville, Florida, called Nuestra Señora de La Leche y Buen Parto, which loosely translates into “Our Lady of Happy Delivery and Plentiful Milk.” A more forthright name was deemed inappropriate: “You didn’t mention breast in print unless you were talking about Jean Harlow,” said co-founder Edwina Froehlich. In their photos, the women of La Leche wear practical pumps and high-neck housewife dresses, buttoned to the top. They saw themselves as a group of women who were “kind of thinking crazy,” said co-founder Mary Ann Cahill. “Everything we did was radical.” La Leche League mothers rebelled against the notion of mother as lab assistant, mixing formula for the specimen under her care. Instead, they aimed to “bring mother and baby together again.” An illustration in the second edition shows a woman named Eve—looking not unlike Jean Harlow—exposed to the waist and caressing her baby, with no doctor hovering nearby. Over time the group adopted a feminist edge. A 1972 publication rallies mothers to have “confidence in themselves and their sisters rather than passively following the advice of licensed professionals.” As one woman wrote in another league publication, “Yes, I want to be liberated! I want to be free! I want to be free to be a woman!” In 1971, the Boston Women’s Health Book Collective published Our Bodies, Ourselves, launching a branch of feminism known as the women’s-health movement. The authors were more groovy types than the La Leche League moms; they wore slouchy jeans, clogs, and bandanas holding back waist-length hair. But the two movements had something in common; Our Bodies also grew out of “frustration and anger” with a medical establishment that was “condescending, paternalistic, judgmental and non-informative.” Teaching women about their own bodies would make them “more self-confident, more autonomous, stronger,” the authors wrote. Breasts were not things for men to whistle and wink at; they were made for women to feed their babies in a way that was “sensual and fulfilling.” The book also noted, in passing, that breast-feeding could “strengthen the infant’s resistance to infection and disease”—an early hint of what would soon become the national obsession with breast milk as liquid vaccine.
The Case Against Breast-Feeding
In the early ’90s, a group of researchers got together to revise the American Academy of Pediatrics’ policy statement on breast-feeding. They were of the generation that had fought the formula wars, and had lived through the days when maternity wards automatically gave women hormone shots to stop the flow of breast milk. The academy had long encouraged mothers to make “every effort” to nurse their newborns, but the researchers felt the medical evidence justified a stronger statement. Released in 1997, the new policy recommended exclusive breast-feeding for six months, followed by six more months of partial breast-feeding, supplemented with other foods. The National Organization for Women complained that this would tax working mothers, but to no avail. “The fact that the major pediatric group in the country was taking a definitive stance made all the difference,” recalls Lawrence Gartner, a pediatrician and neonatologist at the University of Chicago, and the head of the committee that made the change. “After that, every major organization turned the corner, and the popular media changed radically.” In 2004, the Department of Health and Human Services launched the National Breastfeeding Awareness Campaign. The ads came out just after my second child was born, and were so odious that they nearly caused me to wean him on the spot. One television ad shows two hugely pregnant women in a logrolling contest, with an audience egging them on. “You wouldn’t take risks before your baby is born,” reads the caption. “Why start after?” The screen then flashes: “Breastfeed exclusively for 6 months.” A second spot shows a pregnant woman—this time African American—riding a mechanical bull in a bar while trying to hold on to her huge belly. She falls off the bull and the crowd moans. To convey the idea that failing to breast-feed is harmful to a baby’s health, the print ads show ordinary objects arranged to look like breasts: two dandelions (respiratory illness), two scoops of ice cream with cherries on top (obesity), two otoscopes (ear infections). Plans were made to do another ad showing rubber nipples on top of insulin syringes (suggesting that bottle-feeding causes diabetes), but then someone thought better of it. The whole campaign is so knowing, so dripping with sexual innuendo and condescension, that it brings to mind nothing so much as an episode of Mad Men, where Don Draper and the boys break out the whiskey at day’s end to toast another victory over the enemy sex. What’s most amazing is how, 50 years after La Leche League’s founding, “enlightenment from the laboratory”—judgmental and absolutist—has triumphed again. The seventh edition of The Womanly Art, published in 2004, has ballooned to more than 400 pages, and is filled with photographs in place of the original hand drawings. But what’s most noticeable is the shift in attitude. Each edition of the book contains new expert testimony about breast milk as an “arsenal against illness.” “The resistance to disease that human milk affords a baby cannot be duplicated in any other way,” the authors scold. The experience of reading the 1958 edition is like talking with your bossy but charming neighbor, who has some motherly advice to share. Reading the latest edition is like being trapped in the office of a doctor who’s haranguing you about the choices you make. In her critique of the awareness campaign, Joan Wolf, a women’s-studies professor at Texas A&M University, chalks up the overzealous ads to a new ethic of “total motherhood.” Mothers these days are expected to “optimize every dimension of children’s lives,” she writes. Choices are often presented as the mother’s selfish desires versus the baby’s needs. As an example, Wolf quotes What to Expect When You’re Expecting, from a section called the “Best-Odds Diet,” which I remember quite well: “Every bite counts. You’ve got only nine months of meals and snacks with which to give your baby the best possible start in life … Before you close your mouth on a forkful of food, consider, ‘Is this the best bite I can give my baby?’ If it will benefit your baby, chew away. If it’ll only benefit your sweet tooth or appease your appetite put your fork down.” To which any self-respecting pregnant woman should respond: “I am carrying 35 extra pounds and my ankles have swelled to the size of a life raft, and now I would like to eat some coconut-cream pie. So you know what you can do with this damned fork.” About seven years ago, I met a woman from Montreal, the sister-in-law of a friend, who was young and healthy and normal in every way, except that she refused to breast-feed her children. She wasn’t working at the time. She just felt that breast-feeding would set up an unequal dynamic in her marriage—one in which the mother, who was responsible for the very sustenance of the infant, would naturally become responsible for everything else as well. At the time, I had only one young child, so I thought she was a kooky Canadian—and selfish and irresponsible. But of course now I know she was right. I recalled her with sisterly love a few months ago, at three in the morning, when I was propped up in bed for the second time that night with my new baby (note the my). My husband acknowledged the ripple in the nighttime peace with a grunt, and that’s about it. And why should he do more? There’s no use in both of us being a wreck in the morning. Nonetheless, it’s hard not to seethe. The Bitch in the House, published in 2002, reframed The Feminine Mystique for my generation of mothers. We were raised to expect that co-parenting was an attainable goal. But who were we kidding? Even in the best of marriages, the domestic burden shifts, in incremental, mostly unacknowledged ways, onto the woman. Breast-feeding plays a central role in the shift. In my set, no husband tells his wife that it is her womanly duty to stay home and nurse the child. Instead, both parents together weigh the evidence and then make a rational, informed decision that she should do so. Then other, logical decisions follow: she alone fed the child, so she naturally knows better how to comfort the child, so she is the better judge to pick a school for the child and the better nurse when the child is sick, and so on. Recently, my husband and I noticed that we had reached the age at which friends from high school and college now hold positions of serious power. When we went down the list, we had to work hard to find any women. Where had all our female friends strayed? Why had they disappeared during the years they’d had small children? The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing. That brings us to the subject of pumping. Explain to your employer that while you’re away from your baby, “you will need to take breaks throughout the day to pump your milk,” suggest the materials from the awareness campaign. Demand a “clean, quiet place” to pump, and a place to store the milk. A clean, quiet place. So peaceful, so spa-like. Leave aside the preposterousness of this advice if you are, say, a waitress or a bus driver. Say you are a newspaper reporter, like I used to be, and deadline is approaching. Your choices are (a) leave your story to go down to the dingy nurse’s office and relieve yourself; or (b) grow increasingly panicked and sweaty as your body continues on its merry, milk-factory way, even though the plant shouldn’t be operating today and the pump is about to explode. And then one day, the inevitable will happen. You will be talking to a male colleague and saying to yourself, “Don’t think of the baby. Please don’t think of the baby.” And then the pump will explode, and the stigmata will spread down your shirt as you rush into the ladies’ room. This year alone I had two friends whose babies could not breast-feed for one reason or another, so they mostly had to pump. They were both first-time mothers who had written themselves dreamy birth plans involving hot baths followed by hours of intimate nursing. When that didn’t work out, they panicked about their babies’ missing out on the milky elixir. One of them sat on my couch the other day hooked up to tubes and suctions and a giant deconstructed bra, looking like some fetish ad, or a footnote from the Josef Mengele years. Looking as far as humanly possible from Eve in her natural, feminine state. In his study on breast-feeding and cognitive development, Michael Kramer mentions research on the long-term effects of mother rats’ licking and grooming their pups. Maybe, he writes, it’s “the physical and/or emotional act of breastfeeding” that might lead to benefits. This is the theory he prefers, he told me, because “it would suggest something the formula companies can’t reproduce.” No offense to Kramer, who seems like a great guy, but this gets under my skin. If the researchers just want us to lick and groom our pups, why don’t they say so? We can find our own way to do that. In fact, by insisting that milk is some kind of vaccine, they make it less likely that we’ll experience nursing primarily as a loving maternal act—“pleasant and relaxing,” in the words of Our Bodies, Ourselves and more likely that we’ll view it as, well, dispensing medicine. I continue to breast-feed my new son some of the time—but I don’t do it slavishly. When I am out for the day working, or out with friends at night, he can have all the formula he wants, and I won’t give it a second thought. I’m not really sure why I don’t stop entirely. I know it has nothing to do with the science; I have no grandiose illusions that I’m making him lean and healthy and smart with my milk. Nursing is certainly not pure pleasure, either; often I’m tapping my foot impatiently, waiting for him to finish. I do it partly because I can get away with breast-feeding part-time. I work at home and don’t punch a clock, which is not the situation of most women. Had I been more closely tied to a workplace, I would have breast-fed during my maternity leave and then given him formula exclusively, with no guilt. My best guess is something I can’t quite articulate. Breast-feeding does not belong in the realm of facts and hard numbers; it is much too intimate and elemental. It contains all of my awe about motherhood, and also my ambivalence. Right now, even part-time, it’s a strain. But I also know that this is probably my last chance to feel warm baby skin up against mine, and one day I will miss it.
The Case Against Breast-Feeding
Pediatricians have been scrutinizing breast milk since the late 1800s. But the public didn’t pay much attention until an international scandal in the ’70s over “killer baby bottles.” Studies in South America and Africa showed that babies who were fed formula instead of breast milk were more likely to die. The mothers, it turned out, were using contaminated water or rationing formula because it was so expensive. Still, in the U.S., the whole episode turned breast-feeding advocates and formula makers into Crips and Bloods, and introduced the take-no-prisoners turf war between them that continues to this day.
Some of the magical thinking about breast-feeding stems from a common misconception. Even many doctors believe that breast milk is full of maternal antibodies that get absorbed into the baby’s bloodstream, says Sydney Spiesel, a clinical professor of pediatrics at Yale University’s School of Medicine. That is how it works for most mammals. But in humans, the process is more pedestrian, and less powerful. A human baby is born with antibodies already in place, having absorbed them from the placenta. Breast milk dumps another layer of antibodies, primarily secretory IgA, directly into the baby’s gastrointestinal tract. As the baby is nursing, these extra antibodies provide some added protection against infection, but they never get into the blood.
Since the identification of sIgA, in 1961, labs have hunted for other marvels. Could the oligosaccharides in milk prevent diarrhea? Do the fatty acids boost brain development? The past few decades have turned up many promising leads, hypotheses, and theories, all suggestive and nifty but never confirmed in the lab. Instead, most of the claims about breast-feeding’s benefits lean on research conducted outside the lab: comparing one group of infants being breast-fed against another being breast-fed less, or not at all. Thousands of such studies have been published, linking breast-feeding with healthier, happier, smarter children. But they all share one glaring flaw.
An ideal study would randomly divide a group of mothers, tell one half to breast-feed and the other not to, and then measure the outcomes. But researchers cannot ethically tell mothers what to feed their babies. Instead they have to settle for “observational” studies. These simply look for differences in two populations, one breast-fed and one not. The problem is, breast-fed infants are typically brought up in very different families from those raised on the bottle. In the U.S., breast-feeding is on the rise—69 percent of mothers initiate the practice at the hospital, and 17 percent nurse exclusively for at least six months. But the numbers are much higher among women who are white, older, and educated; a woman who attended college, for instance, is roughly twice as likely to nurse for six months. Researchers try to factor out all these “confounding variables” that might affect the babies’ health and development. But they still can’t know if they’ve missed some critical factor. “Studies about the benefits of breast-feeding are extremely difficult and complex because of who breast-feeds and who doesn’t,” says Michael Kramer, a highly respected researcher at McGill University. “There have been claims that it prevents everything—cancer, diabetes. A reasonable person would be cautious about every new amazing discovery.”
The study about obesity I saw in my pediatrician’s office that morning is a good example of the complexity of breast-feeding research—and of the pitfalls it contains. Some studies have found a link between nursing and slimmer kids, but they haven’t proved that one causes the other. This study surveyed 2,685 children between the ages of 3 and 5. After adjusting for race, parental education, maternal smoking, and other factors—all of which are thought to affect a child’s risk of obesity—the study found little correlation between breast-feeding and weight. Instead, the strongest predictor of the child’s weight was the mother’s. Whether obese mothers nursed or used formula, their children were more likely to be heavy. The breast-feeding advocates’ dream—that something in the milk somehow reprograms appetite—is still a long shot.
In the past decade, researchers have come up with ever more elaborate ways to tease out the truth. One 2005 paper focused on 523 sibling pairs who were fed differently, and its results put a big question mark over all the previous research. The economists Eirik Evenhouse and Siobhan Reilly compared rates of diabetes, asthma, and allergies; childhood weight; various measures of mother-child bonding; and levels of intelligence. Almost all the differences turned out to be statistically insignificant. For the most part, the “long-term effects of breast feeding have been overstated,” they wrote.
Nearly all the researchers I talked to pointed me to a series of studies designed by Kramer, published starting in 2001. Kramer followed 17,000 infants born in Belarus throughout their childhoods. He came up with a clever way to randomize his study, at least somewhat, without doing anything unethical. He took mothers who had already started nursing, and then subjected half of them to an intervention strongly encouraging them to nurse exclusively for several months. The intervention worked: many women nursed longer as a result. And extended breast-feeding did reduce the risk of a gastrointestinal infection by 40 percent. This result seems to be consistent with the protection that sIgA provides; in real life, it adds up to about four out of 100 babies having one less incident of diarrhea or vomiting. Kramer also noted some reduction in infant rashes. Otherwise, his studies found very few significant differences: none, for instance, in weight, blood pressure, ear infections, or allergies—some of the most commonly cited benefits in the breast-feeding literature.
Both the Kramer study and the sibling study did turn up one interesting finding: a bump in “cognitive ability” among breast-fed children. But intelligence is tricky to measure, because it’s subjective and affected by so many factors. Other recent studies, particularly those that have factored out the mother’s IQ, have found no difference at all between breast-fed and formula-fed babies. In Kramer’s study, the mean scores varied widely and mysteriously from clinic to clinic. What’s more, the connection he found “could be banal,” he told me—simply the result of “breast-feeding mothers’ interacting more with their babies, rather than of anything in the milk.”
The IQ studies run into the central problem of breast-feeding research: it is impossible to separate a mother’s decision to breast-feed—and everything that goes along with it—from the breast-feeding itself. Even sibling studies can’t get around this problem. With her first child, for instance, a mother may be extra cautious, keeping the neighbor’s germy brats away and slapping the nurse who gives out the free formula sample. By her third child, she may no longer breast-feed—giving researchers the sibling comparison that they crave—but many other things may have changed as well. Maybe she is now using day care, exposing the baby to more illnesses. Surely she is not noticing that kid No.2 has the baby’s pacifier in his mouth, or that the cat is sleeping in the crib (trust me on this one). She is also not staring lovingly into the baby’s eyes all day, singing songs, reading book after infant book, because she has to make sure that the other two kids are not drowning each other in the tub. On paper, the three siblings are equivalent, but their experiences are not.
What does all the evidence add up to? We have clear indications that breast-feeding helps prevent an extra incident of gastrointestinal illness in some kids—an unpleasant few days of diarrhea or vomiting, but rarely life-threatening in developed countries. We have murky correlations with a whole bunch of long-term conditions. The evidence on IQs is intriguing but not all that compelling, and at best suggests a small advantage, perhaps five points; an individual kid’s IQ score can vary that much from test to test or day to day. If a child is disadvantaged in other ways, this bump might make a difference. But for the kids in my playground set, the ones whose mothers obsess about breast-feeding, it gets lost in a wash of Baby Einstein videos, piano lessons, and the rest. And in any case, if a breast-feeding mother is miserable, or stressed out, or alienated by nursing, as many women are, if her marriage is under stress and breast-feeding is making things worse, surely that can have a greater effect on a kid’s future success than a few IQ points.
So overall, yes, breast is probably best. But not so much better that formula deserves the label of “public health menace,” alongside smoking. Given what we know so far, it seems reasonable to put breast-feeding’s health benefits on the plus side of the ledger and other things—modesty, independence, career, sanity—on the minus side, and then tally them up and make a decision. But in this risk-averse age of parenting, that’s not how it’s done.
Hanna Rosin is an Atlantic contributing editor and the author of God’s Harvard: A Christian College on a Mission to Save America (2007).