Kathy Dettwyler wrote, on the topic of comparative risks:

<< It is estimated that between 300 and 3,000 children die each year in the
US from causes DIRECTLY RELATED TO BOTTLE-FEEDING WITH FORMULA/LACK OF
BREASTFEEDING. >>

Two questions about this.

First, Kathy, who estimates this?  and based on what? (OK, that's a double
question.)

Second, I'm trying to work through the relative risk numbers you suggested.

<<If you knew ahead of time that your child's chance of getting HIV from you
was 14-30% and your child's chance of being one of those kids who die from
formula was 14-30%, then it would be a toss-up.  If the chance of dying from
formula was less than 14%, then I suppose the choice should be for formula,
even though I think much more is affected when breastfeeding doesn't happen
than just the health risks.>>

 Let's say for the sake of argument that "only" 14% of babies bf by HIV+
mothers would seroconvert because of bf .    Now let's compare that to
mortality from lack of bf in the US, using -- again, for the sake of argument
-- your bigger number from up above, of 3000 deaths a year attributable to
lack of bf.

Now 3000 would be 14% of 21,429  -- that is, if almost 22 thousand kids were
formula fed in the US every year and 14% of them would die because of it,
we'd get that 3000 annual death toll.    However, needless to say, the number
of unbreastfed kids in the US every year is many multiples of 22,000 -- I
have no idea how many, though I'm sure some on the list will have a better
idea.   Maybe ten times?   Probably more if we count all the ones who are
weaned by 3 months etc, but if ten times were the right order of magnitude,
then the percentage likelihood of a random kid dying from lack of bf would be
something like 1.4%, rather than something like 14%.

So -- with all these hypotheticals and estimates built in -- the comparison
is between something like a 14% chance of your kid dying from bf with HIV, as
against something like a 1.4% chance of dying from lack of it.

<<But to repeat, the problem is that the risks of formula for any specific
child are unknown ahead of time.>>

This is obviously true -- every kid has a different likelihood, and we
(usually) don't know which is which.  We have to use whatever information we
have and take our chances.   And so the best information we can put together
is that our kid has about 10 times the likelihood of dying of HIV as he does
of dying of lack of bf.   Or to put it another way, we can't be confident
whether this will be true for this particular kid, but we can be confident
that many more kids in this situation would die of HIV than of lack of bf.

That seems qualitatively different from the mom who wasn't going to bf with
HepC despite strong evidence that it would *not* harm her baby.   Here there
is no such strong evidence.  This is not reflexively abandoning bf, it is
working the odds as best you can.

Most of the time a person who understands the risks of failing to feed their
child human milk will bf.  But sometimes not.  And in the US at least I don't
think we run substantial risk of undermining bf culture (I wish...) by
saying, This is one of the very few cases where a mother is better advised to
run the risks of artificially feeding her child, because though real they are
fewer than the risks of not doing so.

(Carol, this is your cue to say:  Get that baby donor milk!   And right, too.)

Elisheva Urbas
lay bf activist in NYC, at a window overlooking Broadway
where only a few weeks ago The Great White Way was pale with salt and frost,
and today it was full of drifting magnolia petals

             ***********************************************
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. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html