Prof. Michael Kramer, widely known within the breastfeeding world for the PROBIT study (Promotion of Breastfeeding Intervention) from Belarus recently gave a fascinating interview to Montreal’s Radio Noon.
He was invited specifically to comment on Courtney Jung’s book Lactivism, which argues that the benefits of breastfeeding are oversold.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who breastfeed DO NOT love their babies more than those who don’t.[/pullquote]
It would be fair to say that Dr. Kramer is a lactivist. The PROBIT study showed definitively that breastfeeding leads to fewer colds and episodes of diarrheal illness across a population of babies under one year of age. It failed to demonstrate any of the other myriad benefits often claimed by lactivists. Dr. Kramer believes that he also demonstrated that breastfeeding increases cognitive development, although that finding was contradicted by a more recent US study by Colen et al. that showed that any increase in IQ from breastfeeding disappears when the data is corrected for confounding variables like maternal education and socio-economic class.
The interview is remarkably nuanced. There’s no transcript, but I’ve linked to the audio file. It’s a short interview and I encourage everyone to listen to it.
Here’s what I took away from Dr. Kramer’s remarks:
Kramer bluntly acknowledges that “the pendulum has swung too far” in claiming benefits for breastfeeding that simply don’t exist. He agrees with Jung that aggressive promotion of breastfeeding is making women feel guilty unnecessarily.
In Dr. Kramer’s view, the benefit of breastfeeding in preventing infections is real, but not of great importance in industrialized countries. He feels strongly that breastfeeding promotes cognitive development though he acknowledges that a large US review of the literature does not confirm that claim. He also believes that breastfeeding reduced the risk of SIDS.
Dr. Kramer is emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma. When asked why lactivist organizations continueto insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that about the fact that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.
Kramer is refreshingly honest in acknowledging that public health officials underestimate the difficulties of breastfeeding. When asked whether the public health community can present the actual scientific evidence instead of the selected evidence that it prefers to present, he ruefully explains that “no one likes shades of gray,” preferring black and white pronouncements instead.
Dr. Kramer is still a very enthusiastic lactivist, going to far as to claim that Canadian babies are much healthier in 2016 than they were 30 years before and that the improvement is the result of increased breastfeeding rates. I’m not aware of any data that shows that Canadian babies are much healthier than they were 30 years ago (let alone data that shows that breastfeeding is the cause) and Dr. Kramer doesn’t allude to any such data.
All and all, Dr. Kramer’s remarks were an eloquent plea for moderation: by exaggerating the benefits of breastfeeding and minimizing the difficulties, lactivists risk making mothers feel unnecessarily guilty and harming the relationship between women and their healthcare providers. He finds much to agree with in Courtney Jung’s book, though he fears that her highlighting of the actual facts about breastfeeding will decrease women’s efforts to breastfeed.
I agree with Dr. Kramer that the exaggeration of benefits of breastfeeding have got to stop. I would go further and state that it is long past time to end the clumsy efforts to humiliate women who can’t or don’t breastfeed. The T-shirt in the image above is a particularly ugly example. Breastmilk is NOT love turned into food. Women who breastfeed DO NOT love their babies more than those who don’t! Breastmilk is food turned into manipulation. Lactivists and their organizations, especially the Baby Friendly Hospital Initiative, have made the harassment, inconveniencing and embarrassment of women a cornerstone of their efforts to promote breastfeeding. Their claims are empirically false, their efforts are repugnant and their plan is beginning to backfire.
Dr. Kramer recognizes this. I wonder how long it will take for the rest of the lactivist community to recognize it, too.
