Dear Editors,
        I see you have chosen to print another poorly researched, misleading
article about breastfeeding, this time by Marie McCullough.  My comments,
once again:

Ms. McCullough writes:
"In developing countries, children are breast-fed for two, three, even four
years."

Some women in the United States also breastfeed their children for two,
three, four years, or even longer, and this is within normal limits for the
species.

Ms. McCullough writes:
"Breast-feeding is such a complicated issue that many women who laud the new
recommendations doubt the statement will have much impact."

I also laud the new recommendations, and I think they will have an enormous
impact, IF pediatricians follow them.  Prior to the release of the new
recommendations, many pediatricians across the country were routinely
telling their patients that the AAP recommended twelve months as a maximum
duration of breastfeeding, and they were encouraging mothers -- sometimes
quite forcefully -- to stop breastfeeding at twelve months, even though the
mothers and babies wanted to continue and their babies were obviously
thriving.  Of course, the old AAP recommendations did NOT say that 12 months
should be the maximum duration of breastfeeding, but that is how many
pediatricians interpreted them.

The new recommendations are crystal clear that twelve months is the MINIMUM
duration, and that the AAP does not establish any upper limit to the
duration of breastfeeding.  This provides powerful support, from the
country's foremost pediatric medical organization, for women who have been,
all along, breastfeeding their children for two, three, four years or
longer.  I don't know if the new recommendations will have a major impact on
how long women nurse.  I do know that this is an important step toward
de-pathologizing what is normal human behavior -- to breastfeed your child
for several years, and I suspect that many women who did breastfeed their
children for several years will now "come out of the closet" and admit it to
their pediatricians, friends, relatives, co-workers, and neighbors.  In
fact, this has already been reported from different parts of the country.


Ms. McCullough writes:
"The new guidelines, published last week, double the minimum length of time
women are urged to breast-feed."

I am surprised that the Inquirer repeated this misrepresentation of the
recommendations.  Especially since I know that I, at least, told you this
was wrong, after Ms. Eisner published it in her editorial piece.  The old
AAP recommendations were 6-12 months, not 6 months.


Ms. McCullough writes:
"Still, science does not have clear answers to the key question: How long
should a woman breast-feed for maximum health benefits?"

Actually, the scientific research available in 1997 shows that the longer a
child breastfeeds up to the study limits of two years, the greater the
health benefits.  Where breastfeeding duration is part of the study,
children in the 18-24+ month category do better than those in the 12-18
month category, who do better than those in the 6-12 month category, who do
better than those in the 0-6 month category, who do MUCH better than those
never breastfed at all.  There is, to date, no research comparing the health
of children who were breastfeed for longer than two years to those breastfed
shorter than two years.  So we can't say for sure how long a child should be
breastfed for maximum benefits, but it is clearly at least two years.  There
is no reason to expect that the benefits suddenly stop the day the child
turns two.  And my research shows that the normal duration of breastfeeding
for humans is between 2.5 years and 7.0 years.


Ms. McCullough writes, quoting Suzi Garrett:
"Babies don't have a [ mature ] immune system until they're a year old, so
by breast-feeding, you're giving the baby your immune system," said Suzi
Garrett, breast-feeding coordinator for Women, Infants and Children, a
nutritional program for low-income mothers."

In fact, children's immune system are not mature at one year of age.  Many
components of the immune system do not mature until 6-7 years of age.  There
is research showing that the immune components of mother's milk are varied
and active during the first two years of breastfeeding, and some immune
components in mother's milk reach their highest levels during the second
year of breastfeeding.  In addition, as long as the mother is lactating,
whenever a disease organism is brought to her by her child (say from a day
care setting), the mother makes specific antibodies against that infectious
agent.  It doesn't matter if the child is six months old or six years old.
Thus, mothers continue to contribute to their child's health as long as they
are lactating.  See my web pages for references --
http://www.prairienet.org/laleche/dettwyler.html  Click on "Supporting
References".


Ms. McCullough writes, quoting pediatrician Buch:
"The main antibodies [ from the mother ] come early," she said. "You can
argue that a child is much less likely to have a [ bad ] reaction to
mother's milk than formula, but nothing I've seen in the scientific
literature supports this protracted need for breast-feeding."

Please tell Dr. Buch that I would be happy to send her copies of selected
chapters from the book "Breastfeeding: Biocultural Perspectives," that
provide the scientific support for normal durations of breastfeeding,
including my own research showing that the natural age of weaning in modern
humans should be between 2.5 years and 7.0 years.  Just because Dr. Buch
hasn't read the current literature is no reason to claim that such
scientific support does not exist.  Since 1979, the World Health
Organization has recommended a minimum of two years of breastfeeding for all
children (not just those in developing countries).  Their recommendations
are based on the consensus of panels of experts in infant and child
nutrition.  The very modest AAP recommendation of a minimum of twelve months
hardly qualifies as "protracted."

Ms. McCullough writes, of women who work outside the home:
"That means they must find a place to pump their milk by hand or machine
several times a day and then refrigerate it for later."

While frequent emptying of the breasts is necessary to establish and
maintain a good milk supply in the early months, it is quite possible for
older babies (say from 6 months on) to do "reverse cycle nursing" -- where
most of their caloric intake takes place during the 14-16 hours out of every
day when they are with their mother.  They breastfeed often in the early
morning, the evenings, and during the night (cosleeping children can nurse
on their own without waking mom up), and drink water or juice and eat solids
during the day.  And where pumping is necessary, the solution is to have a
private place to pump at the work place, and for the male colleagues to grow
up.  Both Ms. McCullough and Ms. Eisner's pieces on this topic have raised
the issue of how uncomfortable male colleagues feel -- but the discomfort of
male colleagues should pale in comparison to the health consequences of
using formula.  And both McCullough's and Eisner's articles have raised the
issue of being interrupted while pumping -- surely most of these office
workers have times when they need to be having private conversations with
clients or colleagues, or in my case, with students.  A closed door should
be respected, whether the person on the other side is pumping her breast
milk, or having a private conversation.


Ms. McCullough writes:
"Even if society becomes more supportive, each woman needs to decide how
long to breast-feed, if at all, experts say. She has to weigh the undisputed
psychological and health benefits against potential hassles -- including
cracked nipples, plugged milk ducts, embarrassing leaks, blouses that gap
over bulging busts. Whatever her choice, society should support it, experts
agree."

This argument only holds IF women are fully and completing apprised of the
costs of not breastfeeding, or of not breastfeeding for very long.  If a
woman is fully informed of the health and cognitive consequences to her
child of not breastfeeding, or of premature weaning, as well as the health
consequences for herself, and she freely chooses to place a low priority on
the health of her child . . . then she is certainly entitled to do so.  But
let's not pretend that she is choosing an alternative that is "just as good"
or even "almost as good."

If a woman truly cannot breastfeed, then she should not be stigmatized, of
course, and we should all be thankful that infant formulas are "adequate" to
keep children alive who otherwise would have died.  One of my three children
was not able to breastfeed beyond four months, and he was bottle-fed with
formula after that.  Without formula he would have died.  And I certainly do
not feel any guilt that we were not successful at our breastfeeding
relationship.  Formula has its use for extreme cases such as his.

But the vast majority of mothers in the US who don't breastfeed either
deliberately chose not to, or simply never even considered the choice they
were making, or its consequences.  They were told by their pediatricians,
and encouraged by the infant formula companies to believe, that
breastfeeding didn't matter, to believe that infant formula was just as
good.  I had one female college student who was unaware that breasts made
milk.  She just thought "Babies are fed with bottles and formula."

It is interesting that bottle-feeding with formula, which is legal and
common, is viewed as an almost equivalent choice by most health care
professionals, even though the scientific evidence shows that formula causes
numerous health problems.

Other maternal behaviors that cause harm to children which are either
illegal, or uncommon, are viewed as heinous.  Women are not supported in
their choice to use alcohol or cocaine during pregnancy, to smoke during
pregnancy and beyond, to refuse to have their children immunized, and to
refuse to use a car seat.  In fact, come to think of it, all 50 states have
laws mandating the use of car safety seats for young children.  And
researchers at Cornell just this week released a study declaring parental
smoking to be "a form of child abuse."    Campaigns to encourage timely
immunizations and car seat use and not drinking during pregnancy use guilt
as a motivating factor.  What makes formula use so different?  And let us
not pretend that the majority of mothers who use formula "can't" breastfeed
-- they either choose not to, or not to for very long, or they never even
considered it.


Ms. McCullough writes, quoting pediatrician Buch:
"What I say to my patients who feel they can't breast-feed whatever reason
is: Look at us. We were primarily a bottle-fed generation and we're going
great," Buch said.

Hmmmmm . . . . I guess Buch has also not been reading the medical research
about skyrocketing rates of many of the diseases that include formula-use as
a risk factor, such as allergies, asthma, cancer, diabetes, heart disease,
learning disabilities, and attention deficit hyperactivity disorder.  Our
society also suffers tremendously from violence and anti-social behavior,
and some psychologists think that the *lack* of close physical contact
during infancy that comes as a matter of course with breastfeeding
contributes to those social ills as well.  No doubt many individual people
do not suffer from the use of formula.  However, there are many other people
in the US who were bottle-fed who suffer from a whole host of health
problems they would not have if they had been breastfed, and it is likely
that we will not know for several more decades all of the negative health
and cognitive consequences of not being breastfed for the normal duration of
several years.

Please, editors at the Philadelphia Inquirer, refrain from printing any more
inaccurate and misleading articles about breastfeeding.

The answer to the question "Breastfeeding: What's Best?" is -- a minimum of
two years (WHO recommendations since 1979) and thereafter as long as both
mother and child wish.  If a woman chooses not to breastfeed, or not to
breastfeed for very long, let's just be very clear about what is at stake,
and not pretend that breastfeeding doesn't matter.




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Katherine A. Dettwyler, Ph.D.                         email: [log in to unmask]
Anthropology Department                               phone: (409) 845-5256
Texas A&M University                                    fax: (409) 845-4070
College Station, TX  77843-4352
http://www.prairienet.org/laleche/dettwyler.html