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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. 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