Here below is a commentary published the current issue of The Ribbon
(vol. 8, issue 2), which is the newsletter of the Program on Breast
Cancer and Environmental Risk Factors at Cornell Unversity. It was
written in anticipation of the release of the Environmental Working
Group's study but does not refer to it directly.
You can also download the essay as a pdf file by going to
http://envirocancer.cornell.edu and clicking on "newletters."
There are no copyright restrictions, so feel free to distribute if
you find useful.
warmly, Sandra
To Breastfeed or Not to Breastfeed is Not the Question: Why
Risk-Benefit Analysis is the Wrong Way to Look at the Problem of
Breast Milk Contamination
By Sandra Steingraber
Two years ago, I published Having Faith, an exploration of various
environmental threats to human fetuses and infants. A few weeks
before I began the ten-city tour to launch the book, I gave birth to
my second child: a blond, ten-pound baby boy who cheerfully agreed
to serve as my audio-visual aid during my travels.
What I needed him for was breastfeeding. Across the nation, during
every press conference, interview, photo shoot, and booksigning, I
openly nursed Elijah. I did this not only when he really needed to
eat in the middle of a presentation but even when I had to wake him
up to perform. Therefore, my media clip files from this tour are
full of pictures of me with my blouse unbuttoned. (My sister pointed
this out.)
Exhibitionism, however, was not my motivation for all these public
displays of lactation. Fear was.
The last chapters of my book-which I spent much of my residency here
at Cornell completing-address the ongoing adulteration of human
breast milk with chemical contaminants. These include insecticides,
PCBs, flame retardants, fungicides, wood preservatives, termite
poisons, mothproofing agents, toilet deodorizers, dry-cleaning
fluids, gasoline vapors, and dioxins. Some are known human
carcinogens; some are known immune suppressors; some are powerful
endocrine disrupters. All are fat-soluble. Many can persist for up
to half a century in human tissues.
What I was afraid of was waking up in the morning after a public
lecture and reading a headline along the lines of "Cornell Prof Says
Mother's Milk Poisoned." I was afraid that raising the topic of
breast milk contamination would scare other mothers away from nursing
and back to the bottle. And yet I still felt strongly that we needed
to have an informed public conversation about the presence of
persistent toxic chemicals in breast milk. We cannot solve public
health problems by keeping secrets.
How, then, could I talk about breast milk contamination from a
pro-breastfeeding perspective? How could I ensure my words would not
be taken out of context? The answer, I decided, was to speak the
words while nursing my own child.
It is a strategy that I still employ. But now that Elijah is nearing
his second birthday, he is no longer the portable, predictable
traveling companion he once was. (On our last hotel check-in
together, he fell headfirst into the bathtub before I could even get
the suitcase rolled through the doorway.) So, he now stays home with
his father, and, instead, I pass a jar of expressed breast milk
around the room while I talk.
In all of my presentations on breast milk contamination, one of my
main messages is that risk-benefit analyses do not shed much light on
the problem. Yes, it's true that mother's milk is, almost always, a
superior food source for infants than its inferior pretender, infant
formula. Breastfed infants have fewer respiratory infections,
diarrhea, middle-ear infections and die less often from Sudden Infant
Death Syndrome. Breastfed infants grow into children who suffer less
than their bottle-fed counterparts from juvenile diabetes, rheumatoid
arthritis, obesity, dental malocclusions, and some leukemias. They
respond more vigorously to vaccinations. They have better hearing
and visual acuity. They develop balance and gross motor coordination
more quickly.
It's also true that breast milk commonly violates Food and Drug
Administration action levels for poisonous substances in food. Were
it regulated like infant formula, the breast milk of many U.S.
mothers would not be able to legally sold on supermarket shelves.
Any discussion of breast milk contamination--either in the popular
press or in the scientific literature--is almost invariably followed
by a reassuring statement to the effect that breastfeeding is,
nevertheless, the best method of infant nourishment. In other words,
if you piled up all the positive, health-promoting virtues of
mothers' milk--as described above--and balanced them against all the
known and possible dangers created by its burden of toxic chemicals,
the scales of health would still tip in favor of the breast.
The reason I believe that these kinds of risk-benefit analyses are an
unhelpful approach to the problem of chemical contaminants in breast
milk is that they offer no solutions. The usual recommendation that
follows from them-"just keep nursing because the benefits outweigh
the risks"-means that we nursing mothers should take no action until
our milk becomes so contaminated as to pose as many risks to
pediatric health as formula. In other words, until breast milk, like
formula, kills 3,000 U.S. infants a year. (This figure is the best
estimate of the annual number of infant deaths-from infectious
diseases and other causes-attributable to lack of breastfeeding.)
Risk-benefit analyses imply that as long as one danger
(breastfeeding) is less than another (failure to breastfeed), we
should accept the lesser danger--even though it still necessitates
endangering our children. The narrow duality of the risk-benefit
equation leaves no room for the proposition that the feeding of
babies should be a risk-free activity. Period.
Furthermore, the scientific knowledge on which risk-benefit
assessments rest is unbalanced. While the benefits of breastfeeding
are measurable (the number lives saved can be derived from records of
births and deaths), the risks are not. All those who have conducted
quantitative risk assessments have been frustrated by this asymmetry.
The earliest risk assessments compared lives saved from infectious
diseases with an estimate of the number of additional cases of cancer
that might be caused by the exposure to carcinogenic chemicals in
breast milk. No other health risks were considered. The conclusion
was that fewer children would die from breast milk-induced cancers
than from formula-induced infections, thereforeŠbreast is best.
These analyses were published before we understood that environmental
chemicals can contribute to all kinds of problems other than cancer,
such as damaged immunity, hormone disruption, and altered brain
development.
Later risk assessments have tried to account for problems other than
cancer, but they assumed that the high levels of exposure during the
brief period of breastfeeding would be counterbalanced by lower
levels of exposure later in life. These assumptions have now been
questioned.
Thus, recent researchers who attempt to balance risks against
benefits come to much more troubled conclusions than their
predecessors. Of course, in the United States, where we keep no
systematic records on breast milk contaminants, risk-benefit
assessments cannot even be attempted.
Beyond the lack of simple monitoring data lie further complications.
For example, an emerging body of evidence suggests that some common
chemical contaminants interfere with milk production (possibly by
inhibiting the pituitary hormone called prolactin). How would we
include poor lactational performance in a risk-benefit equation? The
problem here is not that the contaminants pose a direct, quantifiable
toxic threat to the infant (which they might also do), but that the
contaminants threaten to deprive the infant of mother's milk
altogether. I think most nursing mothers would find any threat to
our ability to make milk a serious threat indeed--whether risk
assessments can account for it or not. And so far, they have not.
. I believe that breastfeeding is a sacrament of motherhood that
cannot be reduced to a risk-benefit equation--even if we did have all
the data to create one. By taking breastfeeding out of a
risk-benefit framework and placing it into a human rights context, we
avoid stultifying breast-versus-bottle discussions. In this last
effort, we are assisted by a few powerful legal precedents. For
example, the Convention on the Rights of the Child, which was adopted
by the United Nations General Assembly in 1989, recognizes
breastfeeding as an essential component of the right of the child to
"the enjoyment of the highest attainable standards of health." Many
states, including New York, also consider the right of a woman to
breastfeed a civil right.
Surely, the toxic contamination of breast milk--to the degree that it
routinely violate laws governing contaminant levels in commercial
foodstuffs and threatens a woman's ability to produce sufficient milk
to feed her child--is also a violation of these rights. The presence
of toxic chemicals in breast milk compromises its goodness and lowers
its capacity to heal, promote brain growth, and orchestrate the
development of the immune system. Even if, thus compromised, the
benefits of breastfeeding still outweigh the risks of not
breastfeeding, the contamination of breast milk infringes
nevertheless on a child's right to attain its full capacity as a
human being and to enjoy the right to safe food and security of
person.
And out of this conviction, I unbuttoned my shirt for Bill Moyers.
Thank you, Elijah.
[end]
.
--
--
Sandra Steingraber, Ph.D.
Distinguished Visiting Scholar
Division of Interdisciplinary Studies
307 Job Hall
Ithaca College
Ithaca,NY 14850-7012
[log in to unmask]
www.steingraber.com
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