Dear Sara,
 
You've caught me with this question right before leaving on vacation for about two weeks :-))  Luckily, I save practically everything and am quickly able to share portions of a response from 2007 to the infamous question about the elusive 5% milk insufficiency situation.  The bottom line is that this, to my knowledge, has still never been researched, replicated, and validated.  If anyone knows of any such research, definitely let me know!  
 
I have been no-mail on LACTNET for many years, so I don't know if this response will go through.  Sara, you may need to copy and post this response for me.  Please share any further comments or questions with me received from LACTNET.  Just be aware that I will not be able to respond to anything further until after the beginning of April, due to our vacation.
 
Sincerely,
 
Betty Crase
[log in to unmask]
  
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-----Original Message-----From: [log in to unmask]: Sat, 13 Jan 2007 7:04 pm  
...I have spoken on "The Elusive 5% Insufficient Milk Syndrome," among many other "Hot Topics," many times over the years.  (As the Director of the LLLI Center for Breastfeeding Information [CBI],) I researched the 5% and prepared the original selected bibliography in the mid 1990s after the publication of the infamous Wall Street Journal article on July 22, 1994 by Kevin Helliker, entitled "Dying for milk. Some Mothers, trying in vain to breast-feed, starve their infants."
 
The article was published during the LLL of Texas Area Conference where I was a speaker...  I had to develop a press release for LLLI while I was there because the media went wild.  The frenzy over breastfeeding mothers starving their babies went on for months and was used time and again to justify the use of infant formula and not making mothers feel guilty.  It was "interesting" (read suspicious) that the article was published on the front page of a major business newspaper--not in a credible scientific journal--right before World Breastfeeding Week.  There is almost always something bad about breastfeeding published right before World Breastfeeding Week!
 
Talk about having to delve back into the research to check references in publications (when the 5% actually WAS referenced)...  Oftentimes, it was not referenced, but just accepted as the truth, such as in the1983 Neville and Neifert reference text, LACTATION. PHYSIOLOGY, NUTRITION, AND BREASTFEEDING, which led me to other earlier publications with and without references, which led to even earlier publications...    I also made phone calls to the researchers and authors who had used the 5% in their work--like Marianne Neifert who used the 5% "statistic" all the time to justify her focus on Insufficient Milk Syndrome (IMS) and Dana Raphael, author of THE TENDER GIFT: BREASTFEEDING.  I had a fascinating conversation with Dana Raphael in which she said she had no idea where the 5% came from, and she shouldn't have quoted it!  What I discovered was that everyone was just quoting everyone else who had used the figure; NO ONE HAD RESEARCHED AND VALIDATED THE STATISTIC.  Most researchers/authors in the 1980s and 1990s, for example, simply quoted Neifert.  The 5% had taken on a life of its own.  
 
I finally traced the original 5% quote, not back to any research, but to a REMARK in an opening presentation given by JC Spence, MD, FRCP, at the Annual Meeting of the British Medical Association, Phymouth, in 1938, recorded in the British Medical Journal on Saturday, October 8, 1938, volume 2, entitled "The Modern Decline of Breast-Feeding:"
 
"Concerning the normal mechanism of lactation there remains one other question. What percentage of women are incapable of breast-feeding because of physical abnormalities?  Less than one cow in a thousand fails to lactate.  Is the greater number of women who fail due to inherent structural faults or to environmental causes?  In many rural districts in this country at least 95 percent of women successfully establish their lactation.  There is no reason to think that with proper management the proportion of urban women capable of doing this is less than it is among rural women.  An endocrine mechanism which has allowed a woman to conceive and give birth does not at that stage fail to provide for lactation.  There remain a few, less than five percent, in whom it is physically impossible to establish lactation either because of diseased or malformed nipples, or because the infant cannot suck on account of mental defect or of cleft palate or other physical.   All women who are not handicapped by these physical defects can breast-feed their infants if they desire to do so and if they are not prevented by an unsuitable environment."
 
So there was have it!  Actually, the presentation by Dr Spence was excellent.  He was very pro breastfeeding, distressed by the increasing use of the bottle and rubber teat: the lack of interest in breastfeeding and understanding about proper clinical management from his physician and nurse colleagues (nurses were criticized as being in too much of a hurry to pop a bottle in a newborn's mouth); an increasing amount of advertising for breastmilk substitutes; lack of support for mothers when they return home; the roles played by fear, doubt, anxiety, and lack of interest on milk production; and so on and so on.  Does all this sound familiar?  Remember, it's from 1938.  BUT out of all that he said, it was the 5% that "stuck" and was picked up and quoted and referenced over and over again in subsequent years to the point that it became a "fact of lactation nature" needing no research substantiation.
 
The above example is a good case for having accessibility to the historical research literature in order to check citations in journals and books.  Such accessibility certainly was facilitated by already having many of the pertinent articles and books on hand in the CBI.  It was a challenge to get to medical and university libraries to search out some of the resources, a challenge that should be much easier today with electronic searching and online sources of full articles.  Having the selected bibliography to provide to the media was incredibly helpful.  Note that throughout the investigation, I wasn't trying to discount that some women couldn't breastfeed due to anatomical or hormonal problems; I was focused on getting to the root of the specific 5% figure.  Whenever a specific number is quoted, it gives the impression that there is research behind the number.  In this case, there was no research, just a remark in a speech by a physician at a prestigious medical meeting. 
 
Thanks for allowing me to relive a very turbulent, but rewarding time in the CBI.
 
Betty





-----Original Message-----From: Furr, Sara <[log in to unmask]>To: 'Lactation Information and Discussion' <[log in to unmask]>Cc: [log in to unmask] <[log in to unmask]>Sent: Tue, Mar 19, 2013 8:55 amSubject: RE: Source of the stat on % of women not being able to make enough milkBetty Crase, friend, LLL Leader, former LLLI Board member, former Director of  the LLLI Center for Breastfeeding Information and former staff person at the AAP  researched this topic in depth some years ago.  I’m copying her on this, hoping  that she will respond with her thorough answer on the origins of the elusive 5%.  ____________________________________________ Sara Dodder Furr, MA, LLLL, IBCLC Quality Improvement Program Specialist  DHHS - Public Health, Licensure Unit  301 Centennial Mall South Nebraska State Office Building , 3 with PO 94986 Lincoln, NE 68509 (402)471-4973 | [log in to unmask]  -----Original Message----- From: Lactation Information and Discussion [mailto:[log in to unmask]]  On Behalf Of LACTNET automatic digest system  Date:    Tue, 19 Mar 2013 15:47:02 +1100 From:    Karleen Gribble <[log in to unmask]> Subject: Source of the stat on % of women not being able to make enough milk  Can anyone help me out. 5% gets thrown around a lot. What's the source? 


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