In February 2014, an article was published in Social Science and Medicine titled "Is Breast Truly Best?" The piece, by Ohio State sociologists Cynthia Colen and David Ramey, has gained massive media attention, with sites like Slate and Daily Mail practically gloating "New study confirms it: Breast-feeding benefits have been drastically overstated" and "Breastmilk is 'no better' for a baby than bottled milk." As a breastfeeding advocate, the initial reports were enough to make me cringe. But then I waded through both the study and objective evaluations of the study, and, well, there's more to this than most media outlets are reporting, and it's far more complex than the title implies.
A lot to wade through for us non-academics
To start, the authors used information from the National Longitudinal Survey of Youth, 1979 Cohort, an exhaustive study started 35 years ago with the subjects still surveyed biannually to this day. Of the people surveyed, Colen and Ramey narrowed their research to U.S. children between the ages of 4 and 14 to see if breastfeeding had any influence in the outcomes of 11 different areas of two categories. They analyzed health-related outcomes: Body Mass Index (BMI), obesity, asthma. They analyzed behavioral outcomes: hyperactivity, parental attachment, behavioral compliance, and they analyzed academic achievement outcomes: Peabody Vocabulary Test, Peabody Reading Recognition, Peabody Math Ability, Wechsler Intelligence Scale and "scholastic competence." Of the 8,237 subjects analyzed from this sample, Colen and Ramey determined the breastfed kids fared better in every area but asthma.
Then, Colen and Ramey narrowed the sample to sibling pairs in which one sibling was breastfed but the other was not. Their reasoning was to attempt to eliminate anything that could have influenced prior findings, so breastfeeding was the driving factor of any outcome areas. Siblings share genes, early life experiences and socio-economic factors, making them a reasonable sub-set. Of the 1,773 siblings analyzed, no long-term effect of breastfeeding was found on any of the 11 outcomes reviewed. So, the authors summarized that there was no long-term benefit to breastfeeding, period.
It's not that simple
But the study is flawed in many ways. The study asks mothers if they nursed ever (with a yes or no response) and compares that information — which is almost useless. A mother who nursed one time could conceivably answer 'yes' to this question; however, no real long-term benefits of breastfeeding would be expected. The authors also analyzed findings based on duration of nursing, but don't qualify if that time was spent exclusively breastfeeding or a mixture of breast- and formula-feeding. For the purposes of this study, a mother could have continued to nurse once daily for five months, supplementing all other feedings with formula, and still fall into the "breastfed" category. And, nowhere in the study does it mention the average duration, or if any babies were nursed for an extended period of time. While these seem like minor points, they really aren't — particularly if you are going to come out with a sweeping conclusion like Colen and Ramey did.
The study was limited
Other factors of this study are a little concerning. The outcomes selected for comparison are a bit random. In fact, they aren't even the standard ones typically associated with breastfeeding outcomes. The World Health Organization recently did a similar study and included evaluations on cholesterol, blood pressure, Type 2 diabetes and cancer — areas not mentioned by the Colen and Ramey study. Their study only evaluated U.S. children, not children worldwide (although the article is receiving worldwide attention). The study mentions nothing at all about the long-term maternal benefits to breastfeeding, which are documented and vast. And it mentions nothing of the documented short-term benefits of breastfeeding to infants, which are without question.
The authors seem to have good intentions, if you can call it that. The paper concludes with the contention that there are larger social and economic factors at play that make it difficult for women who want to breastfeed to do so. It specifically mentions limited access to paid maternity leave and limited protected time and space given to working mothers to pump — and you'll get no argument from me here on these points. As a woman who spent over a year pumping at work (four months of which was with a baby who was exclusively breastfed), I know full well how difficult it can be to keep up with the demands of a full and overflowing breast. But to imply that being a breastfeeding advocate means you are ignorant or willfully ignoring these inherent difficulties (as the paper implies) is deceitful and disingenuous at best. The authors even liken those who study breastfeeding advantages/limitations as promoting a "cult of total motherhood," which is an odd statement to be made by scientists who are supposed to present an objective review of facts and findings.
More honesty, more support
Here's the bottom line: More than anything, we need to be supportive of how a woman chooses to feed her child — whatever that choice may be. This constant game of pointing fingers based on feeding method does nothing to strengthen how a woman feels about her choice. All mothers deserve honestly presented information so they can make the best possible decision for their family and situation. The Colen and Ramey study doesn't do that. Rather, they take incomplete data and limited result areas and present these outcomes as an all-encompassing conclusive statement: "no long-term benefit to breastfeeding," and it does it all with a sensational, controversial title at the helm.