I agree with Marsha that "we need to differentiate between exclusive
breastfeeding and mixed feeding."  In any study or paper exclusive breastfeeding has
to be defined.  The study by Li, R et al in Pediatrics 2003 on the "Prevalence
of Breastfeeding in the United States:  The 2001 National Immunization
Survey," admits to 2 major limitations.

    "although the strict definition of exclusive breastfeeding specifies that
no other liquids or solids except breast milk are given to the infant, this
study allows water feeding for exclusive breastfeeding."

The other limitation was small sample size.  For me, another limitation in
this study is that we are not provided with the exact questions (there was 3
questions) asked of the mothers.  I think it critical that we know exactly what
the questions were because the wording can effect the response.  I also know
from working within the WIC Program and doing home visits during that time that
often what I thought was the situation through conversations over the phone
was not the situation when I got there.   I gradually learned to change my
approach over the phone. (this survey used random-digit dialing to survey
households followed by a mail survey).  With the immunization part of the survey, they
were able to verify the verbal response with records.  How does one verify
"exclusive" breastfeeding?

It is very hard for me to believe that in the US that some 59% of infants are
exclusively breastfed in the early postpartum period. (graph from Li et al's
study).  But then my definition of exclusivity does not include water
supplementation.  I often found in working with mom's that other family members would
remind the mom that the baby had actually had formula in the nursery or that
dad or grandma had given the baby some formula when mom wasn't there.  In fact,
it is truly hard to believe in this amount of exclusivity in the USA because
of the heavy marketing of infant formula to pregnant/post partum women and
within the hospital setting.


Exclusivity and its definition are important factors in understanding infant
health.  One might even wonder whether the use of medications and vitamins for
infants might change gut flora significantly and thus effect the positive
effects of exclusivity.  (Magda Sach's writings  brought this to my attention).
How do antibiotics effect the exclusively breastfed infant?   How do vitamins
effect the exclusively breastfed infant--particularly since alot of vitamins
are now gmo'd.  No studies on this that I know of but interesting ideas to
explore.

We know from various studies that there is a "dose-related" response to
breastmilk, the more breastmilk an infant receives the better the health outcome.
Thus, it is good to know that we are improving those breastfeeding stats. Yet,
I will suggest that we may have hit the "glass ceiling" in regard to making
improvements in breastfeeding stats.  That glass ceiling is the influence and
money of the infant formula and drug industry.  It is also a ceiling that is
being plastered with the biotech ideology that wants ultimate control of
fertility (through cloning) and mammary functioning (the mammary gland as a
bioreactor for the drug and infant formula industry).   It is the age-old envy of
women's ability to bring forth life and sustain it.  Men, as usual, think they can
do a better job than we can.....
Valerie W. McClain, IBCLC

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