The Bartick Study and Breastfeeding Disclaimer Syndrome

I had a blast from the past the other day.  I logged into Typepad to find a new comment (an actual, genuine comment, I mean, not a spam comment, which I get all the time), on my post from back in 2006 debunking the Stats.org anti-breastfeeding article.  (Do please check that post out if you’ve time and haven’t yet read it, by the way – it’s one I’m proud of.)  The reason this was a blast from the past is not just because I haven’t read that post in a while, but because the commentator is one who not only commented on here several times in the past but also inspired a couple of my previous posts before dropping off the blogging scene a few years ago, to be sorely missed by many of us.  At least I’m assuming it’s the same one – she has a different blog, but the personal details, expressed views, and thoughtful and intelligent writing style all match the Jamie I remember (female, by the way, and no connection to my son of the same name).

So, not only does Jamie seem to be back (yay!) but she also had a request for a post from me, which I am also pleased about because I love getting post requests.  Jamie would like to know my response to the Bartick study.

The Bartick study, for those who haven’t heard, is the one that apparently worked out that $13 billion could be saved in healthcare costs in the USA if enough babies were breastfed.  My reaction to that was pretty much “Wow, that sounds good (um, must get round to reading it some time).”  Since even someone as wordy as I am can’t get much of a blog post out of that, I’ve decided instead to write about my reaction to other people’s reactions to the study. Jamie linked to an article from ABC News discussing the study, and it raised several points that I think are worthy of comment.

Firstly, Goldin seemed to be damning breastfeeding with faint praise when she described the research as showing ‘some suggestions’ that breastfeeding had benefits.  The evidence is, in fact, considerably stronger than Goldin is making it sound.  I wrote quite a bit more about this, but this point was only really meant to be an aside and I ended up writing so much about it I felt it was distracting attention from what I meant to be the focus of this post, so I snipped all of that and saved it for a potential future post, if anyone’s interested.  Meanwhile, see this old post of Annie’s at PhD in Parenting for a good layperson’s summary of the best paper on the topic.  (The paper she describes, by the way, is the one that was used as the source for the figures used in the study that’s causing all the current upset; so Bartick et al were in fact using fairly sound figures as to the rates of benefits from breastfeeding, despite what’s been elsewhere alleged.)

Secondly, the article criticised the Bartick study on the grounds of not taking into account the costs to society of providing the support that would be needed to get breastfeeding rates up and subtracting that from the $13 billion.  True enough, but it seems to me to be missing the point.  I think the point of the study was not meant to be “Whoopee!  We just found a way to make $13 billion out of thin air without lifting a finger!” but “We can afford to invest a hell of a lot of money in providing support for breastfeeding mothers and making the necessary changes in maternity leave laws, and still come out ahead of the game financially.”  Surely the real lesson of the study’s findings is that investing money in breastfeeding support is a win-win situation?

Thirdly, the commenters’ views seemed to carry a strong hint of what I once dubbed Science Myth 2 – the idea that it’s well out of order for a researcher to (gasp! the nerve of them!) come up with findings you don’t like.  Maybe I’m misinterpreting what was said there, because I’m only too aware of the risks of reading too much into quotes that may have been taken out of context, but Goldin’s and Beard’s comments did seem to be coming across as anger, not with any actual example of an interpretation of the study that they’d heard and disagreed with, but with the study itself.  (McKenna’s attitude came across as rather more sensible.)  If the ABC article misrepresented Goldin and Beard in that regard, my apologies.  A much stronger example of this attitude came from Lenore Skenazy’s ‘Quit Picking On Moms Who Don’t Breastfeed’.  Uh, Lenore?  Examining a legitimate research question is not the same as ‘picking on’ anyone, and – stop me if I’m wrong about this – I’m pretty sure no-one’s used “Irresponsible Parents Continue To Formula Feed” as a headline either, outside your imagination.

(You know – now that I think about it, this whole phenomenon of taking research you don’t like as a personal attack does seem to be something I cannot remember ever coming across before joining the mommyblogging world.  I used to spend a lot of time on an abortion rights debate group, and the members of that group would merrily ignore or misrepresent any research that didn’t suit whatever their particular views happened to be, and occasionally a researcher who’d found something that other people didn’t like would be accused of bias.  But I simply can’t remember anyone on the group, or in other debates I’ve come across, displaying that same sense of being personally affronted by research they didn’t like.  Am I wrong?)

The fourth point is the main one I wanted to write about, and is in fact something I’ve hoped for some time I’d eventually be able to get round to writing a post about; a phenomenon I’ve come to think of as ‘Breastfeeding Disclaimer Syndrome’.

Breastfeeding Disclaimer Syndrome (I’m not wedded to the name, by the way – if you have a better idea, I’m quite open to suggestions) is my term for the way in which people seem to feel the need to follow up any positive statement about breastfeeding with immediate disclaimers about the importance of recognising that of course many women can’t do it and they should not be made to feel guilty.  Sometimes this reaction comes from others; a surprising amount of the time, it comes from the person who made the initial positive statement, as though we can’t say anything about the benefits of breastfeeding without immediately qualifying it with the disclaimers about it not being univerally possible.

What interests me about this is that I don’t remember ever seeing this happen with any other public health issue.  I don’t, for example, see reports of studies on the benefits of exercise being responded to with hasty defensiveness about the importance of remembering that some people are quadriplegic and can’t exercise and some people have such long working hours it’s just impossible for them to find time to exercise and some people just find it really really difficult and painful and that amount of stress can’t be good for anyone either so we shouldn’t blame people who find a sedentary lifestyle works better for them and it’s important not to make anyone feel guilty about it.  People can accept both that exercise can be good for you and that there are various reasons why someone may not actually follow that advice, without the conflict between those two facts ever being any sort of particularly big deal.  So why the difference?

I can think of several reasons.  One, of course, is the whole “But think of the chiiiiiiiiildreeeeeeen!” factor that makes any debate about parenting decisions so particularly heated – nothing hits people’s hot buttons quite as hard as any suggestion that you may have been doing less than the best for your children.  One is the all-or-nothing attitude of breastfeeding activists, which I really do think often shoots them in the foot; the overwhelming emphasis on six-months-of-exclusive-breastfeeding that so often obscures recognition of all the benefits you can get from any amount of breastfeeding from any length of time.  If you feel guilty about your lack of exercise, you can appease the guilt with relatively simple measures like walking to the shops instead of taking the car; if public health announcements about the importance of exercise were all focusing on the importance of going to the gym for a complete workout every day for six months, I suspect we’d get a lot more of the same sort of overt defensiveness about exercising as we do about breastfeeding.

A third, major, reason is that breastfeeding is unique among healthy lifestyle measures in another way; it’s a one-shot deal.  With any other healthy lifestyle measure you care to think of – exercising more, drinking less, eating better, stopping smoking – we can appease our guilt over not doing as well as we know we should by picturing the hypothetical but will-definitely-happen-someday future in which we clean up our act and do things a lot better.  This may not get us very far in terms of here-and-now improvement, but it does at least ease any guilt we feel to the point where we don’t feel the need to get freaked-out defensive over it.  But, in the case of breastfeeding – with the little-known and time-limited exception of relactation – we don’t get do-overs.  Any child we didn’t breastfeed when we had the chance is going to stay non-breastfed. And it is very, very difficult to accept the idea of having done things in a way that you not only wish you hadn’t, but that you will never have the chance to go back and do right.  Of course, that’s something every human living has to deal with at multiple points in their life for all kinds of reasons, but add in the think-of-the-chiiiiiiiiildreeeeeeen emotiveness factor and the guilt can become overpowering.  And I think that’s why we get so much emphasis on the need to remember all the reasons why women may end up not breastfeeding despite really wanting to.  It’s our way of wanting to ease that pain by (rightly) giving women credit for their good intentions and best efforts.

The trouble with that particular temporary ease-off of the painful emotions involved in not managing to breastfeed is that it doesn’t look at how the whole thing could be made better for women struggling with the same problems in the future.  Sure, it’s important to recognise that many women can’t breastfeed.  You know what’s even more important?  Recognising that a much larger number of women could breastfeed if they had proper support and help when they needed it and a more breastfeeding-friendly culture.  Instead of putting all that energy into disclaimers, why not put it into clamouring for the importance of making the changes that would help more women breastfeed?

The article linked to in that last sentence, by the way, is a piece by none other than Melissa Bartick, the lead author of the much-maligned study in question.  While she does have the occasional unfortunate tendency to meander off the point into unrelated thoughts of her own fantasy birthing experience (look, by all means get your partner to cut the cord if that’s what you both want and by all means don’t do that if it isn’t what you want, but, either way, it’s not going to make a blind bit of difference to your chances of breastfeeding successfully, so let’s leave that decision in the realm of personal preference where it belongs and get back to the topic under question, please), she also raises a heck of a lot of good points.

So.  Work with me here, guys.  I’m throwing out these ideas as to why people react as defensively as they do to any kind of breastfeeding promotion, but I’d love further thoughts on where to go with this in terms of getting away from that attitude and, instead, seeing research like this as something we can use as a positive force for change.  Any thoughts?