When the British Medical Journal two weeks ago published a review paper, an opinion piece, on the nutritional INadequacy of the World Health Organization’s recommendation that infants exclusively breastfeed for six month, a wave of media coverage followed. As often happens, the adequacy of the publication was of less importance in media coverage than the potential audience share that fear-based headlines could pull in.

A few articles did point out that the review acknowledges that 3 of 4 authors “have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past three years.” This seems like a very interesting point worth pursuing, especially in light of the historical context of marketing breastmilk replacement products globally and the original catalysts to the WHO recommendations.

Just planting a doubt in a mother’s mind can sometimes be enough to change behavior. The use of fear, uncertainty, and doubt (FUD) through careful so-called research or careful framing but avoidance of research is a tried and true propaganda technique. Unfortunately, it works.

Backlash Against Poor Research

Responses to the review on the British Medical Journal (BMJ) website, including those by researchers active in the field, by physicians, by activists, and by interested observers, bring up interesting points about the quality and content of the view as well as about the context. Research is not conducted in a vacuum. Researchers have life experiences, personal interests, and paid positions to protect. Peer review is intended to bring up issues within the design and execution of the research, but it seldom addresses the hidden push and pull that subtly shapes outcomes and reports. Having spent a good portion of my life in graduate school and specifically addressing the biases of scientific research in my doctoral work, I know how flexible the concept of “truth” can sometimes be. Sometimes intentionally, sometimes not.

The BMJ will no doubt publish formal responses. There will probably be women who were looking for a reason not to keep breastfeeding who find it in superficial news stories. Serious breastfeeding research will continue. And, policymakers will keep looking for ways to support exclusive breastfeeding as the best way to feed babies.

The review was published January 13, 2011. Since then, on January 20, 2011, the U.S. Surgeon General issued a “Call to Action to Support Breastfeeding.” This is not a quick response but an extensive report from the U.S. Department of Health and Human Services. They have made it easy for community members to understand what they can do to support breastfeeding.

“A study published last year in the journal Pediatrics estimated that the nation would save $13 billion per year in health care and other costs if 90 percent of U.S. babies were exclusively breastfed for six months. . . . ‘I believe that we as a nation are beginning to see a shift in how we think and talk about breastfeeding,’ said Dr. Benjamin. ‘With this “Call to Action,” I am urging everyone to help make breastfeeding easier.’”
Everyone Can Help Make Breastfeeding Easier, Surgeon General Says in “Call to Action”

Health Canada also has a very short open period for comments on “Nutrition for Healthy Term Infants – Recommendations from Birth to Six Months,” their “evidence-informed recommendations to assist health professionals in communicating consistent guidance on infant nutrition to Canadian parents and caregivers.”

Policymakers understand that breastfed babies are healthy babies, and, among all of the other benefits, healthy babies save money. Your reasons and mine for breastfeeding might be closer to home, but it is easy to see that the support is widespread outside circles where there is profit to be made from breastmilk substitutes or early weaning foods.

When it comes down to it, most women aren’t reading research papers. They want to do the best for their babies, and they trust their healthcare providers and others in positions to support their choices. Yesterday, January 25, 2011, TIME Magazine published an article about U.S. Surgeon General Regina Benjamin’s call for community support of breastfeeding: “It takes a village to help moms succeed.” We may not want to be swayed so easily, but the messages we get in the media about parenting influence us. Not all of those messages are negative. I embrace those messages that ask us to support women rather than isolating them in fear, uncertainty, and doubt.

Next week, we’ll look at research into breastfeeding support.

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