Rumours of breast and bottle

The health benefits of breastfeeding are stuff of commonsense, and are increasingly endorsed by science. But when someone claims that breastfed babies grow up into smarter and wealthier adults, it does raise a few eyebrows. That’s precisely the suggestion of a recent controversial study from Brazil that tracked about 3,500 newborns over a period of 30 years and concluded that the longer the weaning period, the higher the intelligence and earning ability in later years.

The study, which graces the cover of the latest issue of The Lancet Global Health, has sparked off a fresh row in a highly polarised debate between the champions of breastfeeding who seek a ban on formula foods and a band of feminists who believe that the global frenzy over breastfeeding undermines the politics of women’s rights. It’s true that in recent decades governments, international agencies, and media have come together to canvass for breastfeeding. In the UK, for example, working class women are “bribed” to breastfeed their babies; in India, doctors are forbidden by law to promote formula. There is even a World Breastfeeding Week observed every August.

Part of this is fuelled by an essentialist view of motherhood, in part by the greens’ campaign against commercial infant milk substitutes and in part by the fact that a large number of babies, mostly in the developing world, die young because they don’t get enough breast milk. But the greatest advertiser by far is the science-media nexus. Media is full of stories of how breastfeeding makes children healthier and smarter, and conversely, how formula milk renders them vulnerable to diseases, such as stomach infections, allergies and asthma.

How credible are these stories? Let’s consider the Brazilian study. Despite its reasonably good design, it has been criticised on many counts. First, many people view IQ tests as a flawed and misleading measure of intelligence. If anything, they reflect social class and cultural biases more than true intelligence. Linking breastfeeding with increased intelligence therefore may seem over the top. Second, half the subjects in the study dropped before it was concluded, which weakens the validity of its conclusions.

Lastly, even though social class was not a confounding factor as poor and relatively privileged mothers breastfed their babies alike, the fact remains that across cultures mothers who suckle their babies more and longer tend to be better educated and wealthier than those who don’t, or for some reason cannot. In fact, last year a study at the Ohio State University in the US found that many of the much-touted long-term advantages attributed to breastfeeding may have lot more to do with the social and material wellbeing of the women who opt to nurse their babies than with breast milk itself. 

Correlation, as they say, doesn’t imply causation, a crucial distinction the media often fails to appreciate. By this reckoning, many believe that the only credible benefit of breastfeeding is that it protects the child against stomach bugs. They dismiss other benefits as unproven or contradictory, and assert that in most studies of the Brazilian kind, taking full measure of the socio-economic moorings would narrow the “gap between breast and bottle”.

No one, not even the radical feminists, denies some health benefits of breastfeeding. But to turn it into a panacea and a natural law that all women must subscribe to regardless of their will or constraints makes for bad politics. Indeed, for all we know, the secret behind children who turn out better may lie not in the supposed ambrosial properties of some chemical found in breast milk but in the happy and mysterious conspiracy of innumerable elements such as a hike in the hills, granny’s improbable tales, an inspiring book, violin lessons or first love, that ultimately determine the style and substance of one’s life. DOWN TO EARTH