The Myth of Breastmilk
Update 1/25/16 @ 1432
It seems that Dr. Narvaez has edited her original post in response to mine and other criticisms. The comment war is still going strong. You can view the original version of the article via Google’s cache.
The Myth of Breastmilk
Human breastmilk is best for the baby because it’s natural. Your body makes it and it’s meant for the baby, so why would you need to give your child anything else?
Glossing over the logical fallacy within that argument, there is another problem: namely, the connotation that artificial breast milk is in some way bad for your baby.
That’s the premise of an article on Psychology Today by Darcia Narvaez Ph.D. entitled: The Myth of “Breastfeeding is Optional” (note: the live version has been altered slightly in response to criticism from, among others, myself).
Dr. Narvaez’s premise boils down to this: breastmilk is the best substance for a child’s consumption because it is natural. It’s what humans have been doing for the entirety of the species’ existence until the last century. It has additional benefits aside from physical health, including emotional health resulting in bonding time with mothers. Formula, on the other hand, is dangerous because it has an associated higher risk of Sudden Infant Death Syndrome (SIDS), is unnatural and contains toxins.
Yes, she literally has written all of these. I’m going to take these one by one.
The Naturalistic Fallacy
First, let us take on the naturalistic fallacy. Narvaez’s main premise is that breast milk is best because it is natural. This is the literal definition of the naturalistic fallacy. Arsenic is natural. So are volcanoes. In fact, we we want to speak about “natural” it’s natural for us to live in the savanna, sleeping in crudely constructed nests or possibly huts, and to have our women and children die primarily in childbirth.1)Todman, D. (2007). Childbirth in ancient Rome: From traditional folklore to obstetrics. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47(2), 82–85. http://doi.org/10.1111/j.1479-828X.2007.00691.x
In her own words (emphasis added):
…breast milk, a 30 million year old substance with thousands of ingredients is supposed equivalent to a “scientific” formula with a couple of dozen of non-human ingredients
that are unregulated and contain toxins(only in 2014 did the Food and Drug Administration finally start to regulate it).
(Note: I’ve updated the quote to reflect the live version of the article as of 1432 on 1/25/16 while still showing the original words, the reason will be clear at the end of this article)
This is the second step in the naturalistic fallacy: nature is good and science is bad.
As an aside, the claim that formula contains toxins is complete nonsense. She even goes on to claim that formula is unregulated. She links to another article (by her) to provide evidence for this. It does not. In the second article she doesn’t even mention toxins (or regulations, but I’ll get to that later), the only thing is that in her citations she links to a scholarly article that indicates that BPA baby bottles may release an estrogen like substance that is damaging. Well, we already knew that (which is why most bottles are BPA free) and again this is the only evidence that Narvaez has given to back up her “formula contains toxins” claim.
That which can be asserted without evidence, as Christopher Hitchens was fond of saying, can be dismissed without evidence.
So in summation, infant formula is regulated by the FDA, and I haven’t been able to find any article (scholarly or otherwise) that indicated as such from anywhere other than Natural News and their ilk.
But Dr. Narvaez does on.
Randomized, controlled trials are presumed to be the only source of “truth.” (Of course it’s experiment-focused scientists who want you to believe this.) Obviously evolutionary science is dismissed here.
I find it extremely hard to believe that Dr. Narvaez, who holds a PhD in psychology (my field) and has published peer reviewed scientific journals (she teaches at Notre Dame University I might add) has such a dim view of “science”.
Yes, randomized controlled (double blind) trials are the only ways we can infer causation. This is the very foundational principle of scientific research and in all honesty I find myself wondering why anyone would take a scientist seriously who has such a dim view on her own chosen profession.
She goes on:
Experiment-focused science assumes we cannot know anything until a “proper” experiment is done. We cannot rely on the natural world to be intelligent –only experimental scientists know anything for sure (tell that to our ancestors and the billions of other creatures that missed out on experimental science). So for child raising, anything goes until we have an experiment. Of course you cannot ethically do experiments on babies. So, anything goes. Whoever has a stronger soap box or microphone or make-my-life-easy story will win.
Naturalistic fallacy all over again. Narvaez’s basic premise is that we were doing fine for billions of years but suddenly “science” has told us we’re wrong.
She also makes a straw-man of scientific experimentation on infants: you absolutely can do experiments on children and when it comes to food and drugs (you know, the thing the FDA regulates) they are not allowed to be implemented until after rigorous trials that have failed to show any negative effects. Once again the complete opposite of what Narvaez claims is actually what’s happening.
Yes, humans and our ancestors survived for billions of years without formula. And the death rate was a staggering 25 in 1000 for mothers and 300 in 1000 for infants, with an average life expectancy of 25 years.2)Todman, D. (2007). Childbirth in ancient Rome: From traditional folklore to obstetrics. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47(2), 82–85. http://doi.org/10.1111/j.1479-828X.2007.00691.x The evidence is overwhelmingly clear that science and scientific intervention has decreased the mortality rate at birth and increased life expectancy. And part of this, is formula.
Some women can’t breastfeed
Narvaez leaves out one crucial aspect of the need, yes the need, to have infant formula: some women can’t breastfeed. Mothers who have had double mastectomies, for example. Or my wife, whose milk never came in fully and who breastfed so often she was bleeding from both of her nipples trying to get the milk to come. It never did.
Breastfeeding was an uphill battle for us. We both wanted to breastfeed our child (well, you know what I mean) as much as possible because evidence does show that, all things being equal, the outcomes are better. But it didn’t happen. Our son was perfectly healthy when he was born eight months ago but although he had a good suck, my wife’s breast milk didn’t really flow in the hospital. We tried everything the multiple lactation consultants and three doctors had us do and nothing helped. Milk came, but at a trickle. At first we thought the baby was having trouble with the colostrum, a thicker version of milk that comes first. Our baby began to lose body weight by the end of the day because he wasn’t getting enough from the breast. We had to stay two extra days because his weight was so low. By the end of the first day we were told we needed to supplement with formula. After three days in the hospital his weight was back up to normal.
My wife breastfed almost constantly. And milk came, but not enough. A typical feeding in the first few months went like this: Baby fed on one breast until it was empty, then the other until it was empty. He was still hungry, so we had to bottle feed him. When my wife wasn’t breastfeeding she was pumping. Every two hours. Even at night, when the baby was asleep, she’d wake herself to pump. The most volume she ever got out of the pump was 2 oz. And then about three months in, the milk just stopped.
This happens in roughly 5-10% of mothers. And before anyone brings this up: we saw multiple lactation consultants and doctors. The baby had good latch. Everyone agreed that my wife’s technique was fine. They even hooked her up to a machine and measured the volume flow of her breast and confirmed that, yes, her supply was surprisingly low. It happens, and more often than one might think.
Suffice it to say that some women can’t breastfeed. Nowhere in her article does she mention this. Not once. I’m sure she would agree with this statement and I’m not saying that she believes that all women can and should breastfeed (well, maybe the should part) but I would have liked to see that caveat present for intellectual honesty at least.
Evolution knows best
She follows up these statements with more naturalistic fallacies and a bit of evolutionary psychology sprinkled in:
They fail to understand other types of knowledge gathering, like observation. Or, how with evolutionary processes, the natural world has “done the experimenting” over eons and provided us with many adaptations that are very intelligent. Nature provides many baselines for making judgments.
Anthropologists have studied small-band hunter-gatherer communities around the world, the type of society in which the human genus spent 99% of its history (more below in footnote). They have noted the norms for early childhood. For breastfeeding, it’s 2-8 years, with an average weaning age of 4 years (Konner, 2005).
We don’t live in the jungle. I honestly wouldn’t see anything necessarily wrong with breastfeeding after age 2. Honestly, I don’t. We over sexualise breasts (even though they are sexual organs, at least in our society) and I don’t want to give the assumption that breastfeeding is bad because we’ve moved past our jungle roots.
But we don’t live in the jungle. The infant mortality rate for aboriginal peoples is far higher than that of people living in Western nations. It’s still rather low for most aboriginal cultures I should note (although not for Australian aboriginal cultures where as many as 80% die under the age of 1.
This is just wild speculation at this point but perhaps having medically trained professionals and an alternative available when mothers can’t produce enough milk (due perhaps to malnutrition) might be increasing the survival rate of infants (and mothers) in modern societies. Just a thought.
The truth about breastfeeding
I’m done with Dr. Narvaez’s article. There’s a bit more (and the comments section has been a delight) but there is something that Narvaez got right: breastfeeding is the recommended strategy by doctors.
It’s true. Breastfeeding does have a decreased correlation with Sudden Infant Death Syndrome (SIDS). We don’t know why this is exactly, but the American Academy of Pediatrics recommends breastfeeding for this reason among others. It may be one tiny factor in several that reduce the risk of SIDS. Co sleeping (but not sleeping in the same bed) is also associated with a decreased risk in SIDS. But keep in mind that the SIDS rate in the US is 0.54 deaths per 1,000 live births. That equates to a 0.54% chance per infant, all things being equal. Vaccinations, sleeping on their backs and the use of pacifiers are all also associated with decreased SIDS risk.
Formula fed babies tend to be larger than breastfed babies, mainly because there is a lot more fat in formula. This is an artifact of the manufacturing and so far hasn’t been able to be controlled for. Manufacturers are increasingly improving upon formula but that doesn’t mean that it’s a perfect substitute for human milk in all aspects.
But most importantly: human breast milk contains antibodies3)Hanson, L. A., & Söderström, T. (1981). Human milk: Defense against infection. Progress in Clinical and Biological Research, 61, 147–159. (only for the first six months) that your baby can use to help fight off infection. This would be crucial in an aboriginal environment where there are no hospitals and, most importantly, no vaccines. Modern medicine, however, has helped to bridge the gap left when those antibodies are taken out. So although breast milk will increase health outcomes, it’s not like formula feeding will inherently result in an unhealthy baby.
The bottom line
Breast milk is preferred. No one is denying that and the AAP recommends it. If you can breastfeed, and if you want to, go ahead. Don’t be shamed for doing it in public.
But you also shouldn’t feel ashamed if you can’t, or even if you chose not to. There is no research that shows any real health deficit in formula feeding your baby in part or in full. The idea that formula is harmful because it is artificial is just plain bad science and, coming from an academic, is a dangerous idea to have.
In short: if you want to breastfeed, great! Do it, even in public. If you don’t (or can’t) breastfeed, great! Bottle feed even in public! Because although there are some benefits to breastfeeding, there are no real deficits to formula feeding. Your baby will be fine. Don’t trust articles, even ones written by people with letters behind their names, that say otherwise. They rely on naturalistic and correlational fallacies and defame science as being unnatural, all the while using their laptops to write imaginary words represented in pixels that travel across the world through invisible beams of energy and light.
Update 1/25/16 @ 1432
In response to certain criticism (my own as well as some from Dr. Amy Tuteur also known as The Skeptical OB) Dr Narvaez has changed her blog post. I’ve uploaded a screenshot of my original comment here.
Her response was as follows:
Thanks for updating me on the FDA finally regulating formula starting in 2014. Our prior review of breastfeeding research was done before that change. I revised that information in the post.
I also added a note about the naturalistic fallacy since it is frequently misunderstood and misapplied (and some of us, following MacIntyre, think it is a fallacy itself). It’s only a so-called fallacy when there is a one to one match up of fact to value. Putting a bunch of converging evidence together does not qualify.
I am becoming increasingly convinced that Dr. Narvaez is going full pseudoscience while attempting to retain a semblance of credibility. The FDA began regulating Infant Formula at least as early as 1980 according to FDA documents. Of course the regulations have evolved over time to reflect changing (and more strict) standards.
I should note that she removed the “toxins” part of her post and did not comment upon this. Perhaps she could not find a citation to support this and thus removed it entirely. Which is why I posted the internet archive of the original version of the article because my comments and much of what I’ve written don’t make sense without that phrase. That she edited the article to remove the pseudo-scientific statement about toxins is fantastic; that she does not mention it nor apologize for it is intellectually dishonest.
Regarding her comment on the naturalistic fallacy, this is what she added to her post:
Subnote: Some people mistakenly think that relying on nature’s “experiments” is a “naturalistic fallacy.” A naturalistic fallacy is when a person takes a fact, something that “is,” and makes it a “should” (e.g., females bear babies so females should bear babies). Taking a bunch of facts together, converging evidence, is not the same thing as the so-called fact-value distinction as there are multiple points of evidence used to support the “should.”
This is a very narrow definition of the naturalistic fallacy and I do not subscribe to this interpretation. The naturalistic fallacy was first introduced by G. E. Moore in Principia Ethica. The basic premise of this original use is simply that you cannot make a reductive argument to determine what is “good” or “right” based on what is naturally “pleasant” or “appealing”.
From this argument we are led to the is-ought problem first discussed by David Hume which can be defined as: you cannot derive what should be by what is.
Under this definition Narvaez is technically correct in that her statements do not represent this narrow definition of the Naturalistic fallacy. It was my fault for using imprecise language in my reply.
What I should have said was that she was making an Appeal to Nature, which is itself a logical fallacy. The appeal to nature is often conflated in the naturalistic fallacy as a form of shorthand because they are very similar. The fallacious argument goes like this: something is good because it is natural and something is bad because it is unnatural.
I hope I need not explain the reason why this is a fallacy.
I glossed over this part of her article in my original post but I feel it necessary to discuss it further (emphasis is hers this time):
Breastfeeding is what mammals do. Social mammals emerged more than 30 million years ago with extensive breastfeeding. Apes have on average four years of breastfeeding. Humans, as the most immature of apes at birth (25% of brain developed and more like a fetus in many ways), need the most intensive parenting for the longest duration to reach maturity (3 decades). This requires lots of good caregiving.
She goes on after the note she added, which is present in the quote above about anthropologists.
Her argument sums up to: It is natural to breastfeed for far longer in aboriginal and less technologically advanced cultures (cultures that are more similar to our early beginnings and our primate cousins and ancestors) compared to what happens in the Western World: up to 4 and sometimes even 8 years as opposed to 1 or 2 years at maximum.
She does not follow this up with the standard: “therefore breastfeeding is best because that is what our ancestors did and what humans who live similarly to what our ancestors did as well.” However, since the entire article is an advocacy for breastfeeding (and an advocacy against bottle feeding) we can take it as one of her supporting claims.
This is an appeal to nature, plain and simple. Her note that she added attempts to conceal the criticism I originally posted by using an obscure (although technically correct in the most obtuse sense) definition of the naturalistic fallacy. She’s attempting to distract from the issue.
Whether or not our ancestors (and our aboriginal brethren) breastfeed for longer periods of time and breastfeed exclusively has nothing to do with its superiority as a feeding method per se. If the argument was “aboriginal cultures are more healthy and child mortality is lower compared to western cultures that use formula” then this might be a valid argument. However the facts do not lie: in aboriginal cultures (the very cultures she is describing) infant mortality, although decreasing, is still higher than that of western cultures. Now this of course wouldn’t necessarily be evidence against breast feeding, it simply is NOT evidence for exclusive breastfeeding.
I’m going to comment again on her blog and see if she responds. She hasn’t really responded much to other comments and I think she only responded to mine because I provided evidence of an error, a quite egregious one at that. We’ll have to see what happens.
The featured image for this article is Sophia Newborn by Ray Dumas via Flickr. It is available under a Creative Commons Attribution-ShareAlike 2.0 Generic license.
References [ + ]
|1, 2.||↑||Todman, D. (2007). Childbirth in ancient Rome: From traditional folklore to obstetrics. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47(2), 82–85. http://doi.org/10.1111/j.1479-828X.2007.00691.x|
|3.||↑||Hanson, L. A., & Söderström, T. (1981). Human milk: Defense against infection. Progress in Clinical and Biological Research, 61, 147–159.|