I'm definitely in favor of using language that assumes breastfeeding
as the norm and other milks for babies as less appropriate and less
safe, to be used only when necessary.  But I don't think the
comparison between the immune deficiency caused by HIV and the immune
deficiency resulting from not being breastfed after birth are
equivalent, and I think it is a particularly poor pedagogical choice
for use in a group teaching situation with parents, because you can't
be at all sure that everyone understands what you are trying to get
across.  Also, would I be likely, as a first-time mother, to seek help
from someone who gave me the impression that I was trying to give my
child AIDS if I had resorted to using formula milk even once? I doubt
it, frankly.

Pamela, you wrote:
"And, as an aside, acquiring HIV through breastfeeding kills about
300,000 babies per annum. Formula-feeding kills about 1.5 million, so
is much more risky, including for the 85% of breastfed babies of
untreated HIV+ mothers who don't acquire the virus in spite of
breastfeeding.   There's no doubt about it - formula-feeding IS risky
and I believe that those of us who know the difference between breast
and bottle have a responsibility to be clear."

To be clear (and meaningful), if we insist on using such a dramatic
comparison, we'd need to express these facts as relative risks.  What
proportion of all babies who are formula fed, die because of it, and
what proportion of breastfed babies of HIV-positive mothers die
because of that?  Three hundred thousand babies is five times the
number BORN in all of Norway in a year so I might not use that here to
show how much lower the risk of death is, compared to formula feeding.
 That there are five times as many deaths from formula feeding as from
HIV infection acquired through breastfeeding doesn't tell me enough
about the relative risks, and none of it says anything that would have
real meaning to a mother living where I do, nor indeed in most of
Europe, I shouldn't think.

There is a time and a place to use dramatic analogies but IMO group
teaching with parents is not one of them. (Testifying in front of a
parliamentary subcommittee on marketing of breastmilk substitutes
might be though!) This is not at all to say that I think we should
misrepresent the facts, nor blur the distinction between breastfeeding
and bottle feeding, nor the distinction between breastfeeding
expressed milk and man-made substitutes; but surely we can get the
point across without resorting to shroud-waving at parents. My
sympathies to the poor ABA counsellor who was so unfortunate as to
have said this in the presence of someone looking for an excuse to
slam breastfeeding and breastfeeding support, it must be awful for her
now, but it is even worse if she doesn't realize she set herself up
for it. Sorry if that sounds brutal; it's what I think.

By coincidence, today I was asked by the publisher of a handbook for
new parents to consider revising parts of the chapter I have written
in it for the past 12 years, about breastfeeding.  The chapter was
revised drastically last year, and the publisher reports that 'many'
people find what I wrote about bottle feeding, inflammatory.  I wrote
(in Norwegian of course) this in the beginning of the chapter, where
the main differences between breastfeeding and formula feeding are
listed in ways many of you might consider apologistic:
"All substitutes for breastfeeding, including feeding the mother's
expressed milk by bottle, require more work and resources. Besides the
milk itself, one needs clean water, facilities for boiling it, a
refrigerator, bottles and teats. A signficant additional work burden
is placed on the family when breastfeeding fails."

And I thought I had chosen my words carefully, to avoid sounding
inflammatory - I didn't say 'when mothers stop breastfeeding too soon'
or 'when mothers choose not to breastfeed', I said 'when breastfeeding
fails'.  The book editor wonders if I could tone that down, because
'not being able to breastfeed is such a source of sadness'.

!!!!

They also wanted to change what I wrote about HIV and breastfeeding. I
wrote 'In Norway, HIV+ mothers are advised not to breastfeed.'  They
want to change it to 'Mothers who are HIV+ are cautioned not to
breastfeed because of the risk of infection to the baby,' as though
that is a universal recommendation everywhere in the world.  And they
question whether the WHO recommendations as set down in the global
strategy document on infant and young child feeding, are meant to
apply in industrialized countries too. The only part of the
recommendations I mention are about exclusive BF for six months and
then continuing breastfeeding through the second year of the child's
life and beyond, to show that the Norwegian recommendations are pretty
moderate in comparison, with 6 mos exclusive BF and then 'continued BF
up to one year of age or longer if the mother and child want to'.
More than half of Norwegian children are completely weaned off the
breast by their first birthdays anyway, even though we have been
saying this stuff for nearly 12 years now.

Sigh.  Is it any wonder there is a huge commotion when someone says
out loud to a group of parents that formula has an effect not unlike
HIV?

Rachel Myr
Kristiansand, Norway

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