What if Pediatricians Treated Breastfeeding like Vaccination?
Do you stan public health or not, Doc?
You’ve seen the signs on the lawns all over town:
IN THIS HOUSE:
WE BELIEVE SCIENCE IS REAL
During the pandemic and subsequent lockdowns, adherence to THE SCIENCE became a new gospel. Family relationships imploded over ‘the science’ and the opening/closing of schools became the battleground for ‘the science’ around vaccination, etc.
Want to make a mom sound like a fringe lunatic? Call her an anti-vaxxer.
I’m not here to trudge up the dramatic sludge of the COVID vaccine debate or the condemn or rally around the aversion many crunchy moms have to vaccinating. I want to highlight that in the parenting world some science is considered sacrosanct, and other science is ‘judgey’.
Yes, I am, of course, talking about the science around breastfeeding. In a world where it seems that most doctors/nurses/medical staff/ people are zealous adherents SCIENCE it seems like breastfeeding is a major exception, particularly when viewed through a public health lens.
There’s no debating the science on this one: breastfeeding improves public health. In fact, the World Health Organization estimates that breastfeeding all babies until they are 2 years old could save the lives of more than 820,000 children each year.
As with every medical recommendation it’s not going to be “one size fits all” for every person. However the ferocity with which physicians pressure moms to, say, vaccinate their child in the name of public health is vastly disproportionate to the pressure put on moms by pediatricians to breastfeed.
Consider the Hepatitis B shot given to all newborns moments after birth. The US approved the hepatitis B vaccine in 1981--at the height of the AIDS crisis. When health official rolled out the shot, they promoted the shot specifically to combat sexual transmission of the Hep B virus among risky populations, a category the vast majority of newborns don’t fall into.
Over the last forty years the list of people who should get the shot has morphed dramatically: first, gay men, then injection drug users, and healthcare workers. Later it became hepatitis B-positive women’s children and then eventually all newborns. By 2000, 47 states had mandated the vaccine for all schoolchildren with little or no resistance from parents.
Of course, the refrain in favor of giving babies the hep B shot is: why risk it? On the strange and off chance that a mother’s hep B isn’t detected or that somehow your kid is going to get hep B off a used needle on a playground, if there’s no adverse effects, then why not get the jab?
My question is, why isn’t this same logic applied to breastfeeding, particularly in the context of a medical setting like a pediatrician’s office? Let's look at potential harm that comes from not breastfeeding, There is an increased risk of:
SIDS
Obesity
Gastrointestinal issues
Ear infections
Hospitalizations
And to moms? Increased risk of:
Postpartum depression
Breast cancer
Type 2 diabetes
What are the numbers of school aged children who are out there contracting hep B when compared to child obesity rates? What about postpartum depression in formula feeding moms?
So why the lack of pediatric ferocity around public health issues related to breastfeeding?
Does Your Pediatrician Even Breastfeed? Maybe but Likely Not
A 2018 study tracked breastfeeding rates among female physicians and the results were, um, mixed. To start, breastfeeding initiation rates for the physicians-moms (68%) were actually lower than the national average (83%). Of those who initiated, 41% made it to 12 months of lactating. The study doesn’t break down the rate among pediatricians but it seems to be an open secret that pediatricians aren’t exactly leading the charge, articles in Peds journals like “Breastfeeding in Medicine: Time to Practice What We Preach” and “Pediatricians Advocating Breastfeeding: Let's Start with Supporting our Fellow Pediatricians First” hint at an inability or unwillingness to buck the downward trend.
It’s an odd discrepancy and it could be caused by the very history and beliefs engrained in pediatricians since the beginning of the profession. Despite this, new mothers often turn to their pediatrician for advice and support around breastfeeding. But given the cultural and commercial ties of the profession to formula, new moms may want to think twice.
Formula is the Founding Father of Pediatrics
Did you know that the practice of pediatrics was created in large part because moms needed someone to “prescribe” a “formula” of artificial milk for their babies before actual commercialized formula came on the market?
It was the nascent study of infant nutrition and metabolism that started in the late 19th century that eventually morphed into a specialty among physicians. Infant feeding was a perfect first step into a pediatric practice. If you were successful in getting that infant feeding and healthy, you'd have that mother as a patient for the rest of the child’s life.
This coincided with the rise of industrialization and giant waves of migration, which set off the Progressive movement’s fixations on maternal and child wellness.
When the commercial pre-made formula did come out, the formula companies, just like pharmaceutical companies, focused on wooing the medical establishment in order to get their products into the hands - er mouths- of babies.
They sponsored events for doctors, took them out to fancy dinners and even built maternity wards in entire hospitals. The nursery model in hospitals was founded by formula companies (because when mothers and babies are separated, guess who profits most??). Formula advertising also elevated the role of the pediatrician to the ultimate arbiter of science and nutrition.
Yes, pediatrics exists because of formulas. I know that times have changed but how long does it take to erase decades of belief systems that are deeply entrenched in a culture?
Why Does the American Academy of Pediatrics Accept Formula Money?
The medical/formula industry relationship is less obvious today (the WHO code technically puts strict limits on how they can advertise) but it still persists. Doctors aren't SUPPOSED to give out free samples but they still do. Hospitals aren’t SUPPOSED to send you home with formula but many moms are sent home with some.
As of 2017, the American Academy of Pediatrics was receiving US$3.3 million from four companies every year, accounting for~3% of its annual budget. There’s definitely a conflict of interest going on and the ones who are suffering are the babies and their moms.
I’ve even seen doctors on Instagram promoting and being sponsored by formula, which is in direct violation of the WHO code. Not shocking, since the United States is the only country that never put it into law legally. Pediatrician-influencers are more likely to tout the “fed is best” messages of the formula companies. I have yet to find a pediatrician on social media using pressure to breastfeed the way they pressure to vaccinate.
Breastfeeding as Public Responsibility
What if breastfeeding was invested in like vaccines?
What if we started with the person most women look to for support and advice: their pediatrician.
The AAP endorsed Baby Friendly Hospital reforms, why don’t a similar set of measures exists for pediatricians' offices?
Does your pediatrician ever ask about your breastfeeding?
Does your pediatrician's office even have a comfortable seat for you to nurse your baby in?
We know that a physician's own experience with breastfeeding influences their own advocacy around the practice. A recent study found that fewer pediatricians believe that benefits outweigh the difficulties around exclusively breastfeeding than they did ten years ago. While the PUMP act helps lower some workplace barriers to pediatricians' ability to breastfeed, it’s not enough. A dedicated time to pump, a dedicated place to pump, and a dedicated place to store milk won’t mean much without a dedicated open culture and advocacy around breastfeeding among pediatricians. One that is not only free of commercial interests but vigilant against them.
I swear, the more I learn about the grossly unethical intersection between pharmaceutical companies, the v*cc/ne + formula lobbies, “trusted” medical organizations, and government agencies/programs, the more I have an insane amount of distrust in everything. You have to question E V E R Y T H I N G. Once you start digging into this stuff, you really can’t go back. Phew.
That we would live in an environment where breastfeeding is celebrated and regarded as (perhaps) sacred/inviolable -- and that you would be severely questioned if you didn't believe in it, sounds wonderful. I imagine it may have been this way in what is now the US, at some point in its history. Personally, I don't connect/agree with the comparisons to the vaccination program.
I thought this article was so interesting, the point of view of modern breastfeeding in Mongolia: https://www.naturalchild.org/articles/guest/ruth_kamnitzer.html. Refreshing take by the author.