Let’s be honest: When it comes to President Trump, those of us paying any attention are either with him or against him. So when the U.S. recently failed to support the World Health Organization’s nonbinding resolution that called for protecting breastfeeding and restricting promotion of formula, we began what by now has become a ritual exercise in what social scientists call confirmation bias.
We either cheered his determination to call out fake science, quash overly-powerful multinational organizations and stand up for American industry, or we lamented that he makes no distinction between fiction and reality, hates women and children and represents business above all else.
Make America great again, send us back to the dark ages. Nothing new here.
Except that whichever team you’re on, the WHO’s resolution, which ultimately passed, is wrong-headed, potentially harmful and in need of serious revision. No meaningful piece of infant feeding advice works for all families everywhere; it is futile to pretend that women in urban Egypt, sub-Saharan Africa, rural Sri Lanka and New York City should all feed their babies the same way. Women and their families in widely varying contexts need to weigh carefully the tradeoffs of breastfeeding or formula feeding, much as they make other critical decisions.
But, the WHO and myriad pro-breastfeeding groups will claim, the science on infant feeding is virtually unanimous. Breastfed babies are healthier, smarter and more socially successful than those who were formula fed throughout the life course, and formula feeding is dangerous. So they say.
The problem, as I have demonstrated in “Is Breast Best: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood,” is that this research is poorly designed, executed and interpreted — and then grossly misrepresented among scientists and between researchers and the public.
In areas without regular access to clean drinking water, breastfeeding can be a weapon against infant morbidity and mortality, and there, it should be part of a larger political discourse about hunger and the care of children. At the population level, breastfeeding reduces gastrointestinal infections in babies; in some environments, particularly those with higher income, the benefit will be negligible.
And breastfeeding might reduce some cancers in women; those with a history of breast cancer in their family might consider this as they weigh the pros and cons of formula and breast milk.
But the WHO statement that only breastfeeding is healthy makes a mockery of medical research.
Fear of formula has become a public health problem. Breastfeeding advocates, including those representing the WHO, present formula as akin to poison. So-called “baby-friendly” hospitals keep formula under lock and key and require women who choose it to sign a waiver acknowledging that even a single use can cause abnormal changes in a baby. Ample evidence indicates that many women leave hospitals woefully underprepared to formula feed. They are unsure how to choose a formula, how to mix bottles, or how often or how much to feed babies. They report that nurses do not listen, pressure them to breastfeed and sometimes humiliate them if they ask for formula.
You don’t have to be Pollyanna about the formula industry to be troubled by WHO the resolution. These companies were responsible for an untold number of baby deaths in the 1970s, when they deliberately misinformed women in the global south about how to use formula. Today, they state “breast is best” before claiming their product is closest to breast milk as part of an ongoing rehabilitation campaign.
They want to make money. But their greed does not change the basic fact: The United States’ goal in rejecting the resolution, “to protect women’s abilities to make the best choices for the nutrition of their babies,” should, on its face, be unobjectionable.
Wolf is author of “Is Breast Best? Taking on the Breastfeeding Experts and the New High Stakes of Motherhood” and associate professor of Women’s and Gender Studies and Texas A&M University.
