Monday Health & Wellness: New Study on Is Breast Truly Best? A Response |

Monday Health & Wellness: New Study on Is Breast Truly Best? A Response

admin March 10, 2014

Yes, that’s Nathan nursing in the picture above.  He’s 1 year old today — can you believe it?!  Here’s his birth story…and why he’s still (mostly) exclusively breastfeeding now.

Very recently, a new study came out of Ohio State University.  This study is entitled, “Is Breast Truly Best? Estimating the Effect of Breastfeeding on Long-term Child Wellbeing in the United States Using Sibling Comparisons.”  This study is by Colen, et al.  It has been showing up all over the internet, with a number of people triumphantly stating that clearly, breastfeeding’s benefits have been overrated and we should stop pushing women to breastfeed if they don’t want to.

Naturally, lactivists and other breastfeeding supporters are responding to this study negatively.  There’s a large body of evidence showing the benefits of breastfeeding; why does this one study negate all of that?

I want to dive into some of the details of the study (I was able to obtain the full text) and see what’s really going on here.  I also want to discuss why this study has been so widely embraced when it’s just one study, with divisive results.

Why So Well Embraced?

Breastfeeding is possibly one of the most controversial decisions that a woman makes for her baby in the earliest months of life.  There is enormous pressure to breastfeed, yet quite a lack of support for it.  Women are judged for not breastfeeding, yet are also judged for breastfeeding in public or breastfeeding past a certain age.  There’s really a lot of pressure and a lot of judgment no matter what feeding choice is made.

Because of the lack of support, most women don’t continue to breastfeed past a few months.  Around 75% of women initiate in the hospital, but this drops down to 49% at 6 months (just 16% exclusively).  (source)  A lot of women feel like they “failed.”  This feeling is increased when women are questioned about why they did or didn’t breastfeed, what happened, and made to feel that they “didn’t try hard enough.”  All of this pressure occurs during a rather fragile postpartum period, which can increase the strong feelings about the situation.  As a result, many women feel angry or bitter about the circumstances, especially if they didn’t meet their personal goals, even years later.

It is understandable that women who may feel upset about their own breastfeeding history may look for something to vindicate them.  That is, information that makes them feel like by not breastfeeding, they didn’t really fail and their babies are just fine.  Anything that makes them feel better, they are going to take seriously.  (And everyone does this at some point, with something — it’s called confirmation bias, and it’s a powerful psychological condition.)  Women who are looking for this result are unlikely to question the study.  (And women who believe the opposite are likely to question or outright reject the study, whether or not it deserves that.)

To the women who have struggled with breastfeeding and have been hurting, I have to say to you: you have not failed.  You have done the best you can for your baby.  In no way do you need to feel like you weren’t “good enough” or like you and your baby will suffer because of your circumstances.

But also, it’s very important for researchers to conduct accurate studies.  These studies do not and cannot judge individual circumstances.  They are very important for overall trends.  They are very important for informing public policy.  They are important for helping to provide the support needed so that more moms who want to, can breastfeed successfully.  If we can’t get an accurate picture of the benefits and what it takes to help moms, then we can’t fix the system.  In seeking that information, we are not judging the moms who are struggling.

Learn more about breastfeeding benefits and troubleshooting for moms who are struggling in Breast to Bib: Modern Alternative Mama’s Guide to Feeding Your Baby.  There is lots of information about early feeding, complementary feeding, why some moms can’t breastfeed, and what to do if you can’t.

With that in mind, let’s turn to the actual study.

What Does the Data Say?

When I was initially reading the press releases and extended abstract, a number of red flags stood out.  This study didn’t appear very well done.  It was also not done by a medical professional, it was done by a sociologist — who is going to have a different skill set and will be looking at different benefits.

The study looked at both groups of children between families, and what is called “discordant sibling sets,” which means families in which one child was breastfed, and one child was not.  They found that the benefits were clear when examining the data between families, but fell to statistically insignificant levels when children were compared within families.  They concluded that this means other factors — parental attachment, socioeconomic status, parental education levels, etc. — were more heavily involved in the health or success of children than was feeding method in infancy.

Unfortunately, the study was poorly designed and cannot support this conclusion.  Let’s look at some of the issues.

Fails to Consider Breastfeeding a Biological Norm

First and most importantly, this study, like many others, fails to recognize that breastfeeding is the biological norm.  (Of course, this study wasn’t intending to look at biological aspects, but social ones.)  Breastfeeding is the normal way that infants are intended to be fed.  Anything else needs to be compared with that in mind: does it measure up?  Instead, the two feeding methods were considered basically equal.  It’s incredibly important to study the biological norm first to figure out why it produces good outcomes, and then to figure out how other scenarios can come as close as possible.  But nothing will ever be the equivalent of the biological norm.

(That said, there are circumstances with individuals where the biological norm isn’t possible or feasible.  There are women who physically can’t breastfeed, or who require medication that is contraindicated during breastfeeding.  This is where the data on “as close as possible” would be helpful.)

Based on Survey Data

Surveys are not a very robust study methodology.  That is, there were very few objective means of measurement in the study.  Most information was gathered through interviews or self-reporting.  People can lie, misremember, etc.  Of course, it’s not really possible to design a study that is truly “unbiased” when it comes to breastfeeding because we can’t randomly assign people to feeding methods.  We can’t do it in a blind fashion (it’s obvious who’s breastfeeding and who is using a bottle, and pumped milk isn’t an option as direct breastfeeding has additional benefits over pumping).  We can’t control for all other variables.

However, using more objective means of measurement would have improved the conclusions — for example, medical records rather than parental recall.

Parental Reporting is Inherently Biased

This is actually a huge issue for this study.  Many mothers feel guilty when they don’t treat their children “equally.”  Mothers who breastfed one child and not another may want to believe (or at least, report) that they are equally bonded to both children, that both are equally healthy, and so on.  What mother is going to say “This child clearly suffered because I did not breastfeed him?”  (There are those who will — but they appear to be in the minority, from what I’ve experienced.)  It’s taboo to show favoritism, so the “bonding” issue will be especially biased.  Looking at these subjective factors within families dramatically increases the likelihood of this type of bias.

Does Not Control For Other Variables

There are so many other variables which can affect a child’s physical health, emotional health, scholastic achievement, etc.  This study does not control for them or even address them.  These include:

  • Birth circumstances (were the children born early vs. late, vaginally or via c-section, with or without anesthesia, with or without early skin-to-skin, etc. — can vary dramatically between siblings)
  • Birth order (closely-spaced siblings can mean the mother’s health is poorer with the later-born sibling, and that that sibling’s health is poorer too, irrespective of breastfeeding)
  • Disability (did any child have one, and did it impact breastfeeding?)
  • Parenting practices (many parents change practices after their first child because of experience, and this can impact bonding, achievement and even physical health — think changes in sleeping, discipline, carrying, etc.)
  • Parent-child relationship (every parent-child pair is complex, and their personalities can impact their relationship irrespective of feeding method)
  • Complementary feeding practices (when were other foods introduced, how, what were they? this, too, can strongly impact health)

This is not an exhaustive list, just a handful of the ones I first thought of.

Does Not Define Breastfeeding Clearly

This is a major issue.  We know from other studies that both duration and exclusivity, especially the latter, impact how beneficial breastfeeding is.  This study defines breastfeeding only as yes/no.  This means that a child who receives breastmilk for three days is “yes.”  It means that a child who is half-breastfed, half-formula fed for three months, then exclusively formula-fed, is “yes.”  It means a child who is exclusively breastfed for 9 months is “yes.”  We would expect to see very different outcomes among these different groups, but in this study, they are all lumped together.  By including children who had “any breastmilk” instead of having more clearly defined parameters of duration and exclusivity, the benefits would likely drop dramatically.

(It is even possible that mothers who breastfed their first babies part-time for a few weeks, then switched to formula, and chose not to even attempt breastfeeding with future babies, would be included in the “discordant sibling pairs.”  Even though this would not be a true measure of the benefits of breastfeeding vs. formula.)

Does Not Look At Young Children/Infants

This study only looks at longer-term effects.  It does not look at effects in the first year, which are clearly documented and real.  Estimations show hundreds or thousands of infants have been literally saved because of breastfeeding in those first several months.  This study aimed to “look beyond” that time, which is fine.  But to ignore those benefits and claim that breastfeeding “really isn’t all that beneficial” is an extreme overreach.

Ignores Many Potential Benefits/Poorly Selected Criteria

The study looks at 11 measures — body mass index, obesity, asthma, hyperactivity, parental attachment, behavioral compliance, reading comprehension, vocabulary recognition, math ability, memory-based intelligence, and scholastic competence.

First, there are very few objective measures of physical health.  Body mass index and obesity are basically measuring the same characteristic.  Asthma was parent-reported and not based on medical records.

Second, I don’t think anyone has ever claimed that breastfeeding increases “behavioral compliance.”  That, and many social-emotional factors are dependent on many other factors beyond breastfeeding and most fully acknowledge this.

Third, they completely failed to take into account:

  • Auto-immune disorders
  • Cancer
  • Gut health/flora
  • Allergies
  • Autism
  • Frequency of illnesses
  • Ear infections
  • Diarrhea illnesses
  • Reduction in maternal cancer
  • Postpartum depression in mother (or any maternal factors)
  • etc.

Had they been more focused on physical health than social-emotional issues, the study may have shown an entirely different result.  Physical health is a better measure of the benefits of breastfeeding, in a general sense.

Fourth, they didn’t look at potentially different breastfeeding outcomes between healthy and unhealthy women — although this was really beyond the scope of the study.  We would expect that benefits would be somewhat reduced in unhealthy women (that is, women with autoimmune conditions, allergies, etc.) but not negated.

Deleted Multiples

The study authors chose to remove all sets of twins and triplets from the data analysis.  This would have controlled more carefully for genetic differences, parenting experience, etc.  Although it’s unlikely to have included “discordant” pairs, it would have been interesting to see.

Learn more about children’s health and all of the different factors that go into it (gut health, allergies, asthma, vaccines, feeding, etc.) in A Practical Guide to Children’s Health.  The book is well-cited, with over 300 sources, most primary sources like medical journals.  The book also includes a number of helpful tips, like how to read labels at the grocery store, superfoods, and home remedies.

New Study on Is Breast Truly Best?

Concerning Quotes

This study contains a number of concerning quotes within the text.  I’ve highlighted a few of them here, and explain why they are concerning.

“If more than two children are born to the same mother, we include all of them in the sibling sample and adjust sampling weights accordingly by dividing the average custom weight for all siblings in a given family by the total number of siblings in that family.”

Why are the siblings’ weights being combined this way?  If, for example, two children were fed by the same method and one was obese and one was not, that would show that a factor besides feeding method affected the issue.  When weights are combined and averaged, then it may appear that “all” children with a particular feeding method were or were not obese, erasing the implications of other variables.  Of course, since this study doesn’t really control for other variables anyway, this isn’t surprising.

“…we sought to limit the extent to which our results would be biased by reverse causality that could stem from instances in which sicker or more “difficult” children have a harder time breastfeeding, especially for extended periods of time.”

The authors may have avoided the early period so that they would not have to deal with difficulties with breastfeeding, but that doesn’t mean they didn’t occur.  A child may not have been breastfed because of other health issues or concerns, and these factors may have impacted health more so than whether or not the child was breastfed.  They are deliberately ignoring this issue.

“…each mother serves as her own “control” by embodying both the observed and unobserved social processes that determine whether or not she breastfeeds her child as well as the biological and behavioral implications that stem from this decision.”

Regarding a mother as her own “control” is extremely problematic in this case.  Mothers are programmed to see and especially, share publicly, the positives in their relationships with each child.  Self-reporting isn’t going to be more accurate when comparing two children.

“[Breastfeeding] often requires that women dramatically reduce their hours working outside the home, have jobs with maximum flexibility, and/or rely heavily on wages from partners to make up for lost income. This is a sacrifice for all women, regardless of how much they want to do it or how important they think it is.”

This is a rather elitist attitude towards breastfeeding (and this attitude is sprinkled liberally throughout the entire paper).  It’s clear the author believes that the barriers to successful breastfeeding are difficult or impossible for many women to overcome.  She believes that it is difficult to impossible for women who work outside the home to breastfeed successfully.  This negative attitude clearly biases her results, and also has serious implications for public policy.  We shouldn’t be promoting the idea that to successfully breastfeed, you need to have ideal circumstances.

“…this multifaceted approach will allow women who want to breastfeed to do so for as long as possible without promoting a cult of “total motherhood” in which women’s identities are solely constructed in terms of providing the best possible opportunities for their children…”

I take serious issue with this statement.  The author appears to be saying that exclusive breastfeeding is only possible if a woman’s identity is centered around being a mother and providing for her children.  In fact, many women can and do continue to have a “life” or identity outside their children, work outside the home, etc. and are able to exclusively breastfeed.  In fact, the way this is worded, the author seems to believe that women who are breastfeeding at all may be entirely wrapped up in their children and have no outside identity!  This is a very dangerous attitude, indeed.

Positive Points

The study is not entirely useless.  There are some positives to take away from it, as well.

First, that mothers who cannot or do not breastfeed don’t need to beat themselves up.  Their children are not likely to do significantly worse in a general sense, especially in social/emotional measures.

Second, it also shows that breastfeeding isn’t everything.  There are a number of other factors that go into positive outcomes for families.

Third, it emphasizes the need to change policies to better support women who are struggling with breastfeeding.  Many women do “fail” because there is little societal support, in terms of positive attitudes, better maternity leave, better access to IBCLCs, etc.  Working to change this would increase breastfeeding rates without high-pressure campaigns.

Media Implications

Unfortunately, despite all of these problems, the media has ignored the issues and has run with it — proclaiming that breastfeeding really isn’t all that great or all that necessary.

This study and the language contained within it could seriously set back efforts to increase breastfeeding rates, and even the acceptance of breastfeeding. (Of course, that may have been the goal — which is really sad, given the hundreds of other studies showing benefits!) Many women may believe that breastfeeding is simply not worth the “hassle” (as well as believing that it is a hassle, as the author seems to).  A lot of women will remember the negative media coverage of breastfeeding and will not ask questions — they will simply choose not to breastfeed, believing that the benefits truly are minimal.

It’s incredibly irresponsible, given the poor design of the study, and the fact that it is only one study, that so many are proclaiming it changes things and that policy should be written based on it.  This is poor science at its finest!

This is the second poorly designed, poorly concluded study to come out of Ohio State University in the last few months.  (The other was one claiming that milk sharing is not beneficial and potentially dangerous, which other studies don’t support.)  I am local to OSU and am aware that many of their policies are fairly anti-breastfeeding, anti-natural birth, etc.  It’s very sad that they keep publishing these studies!

The Bottom Line

This study was so poorly designed that no real conclusions can or should be drawn from it.  I expected that, but only found it worse and worse as I read through it.

We do need to understand that what creates physical, emotional, and social health in people will never be known (definitively).  We will never get a full and complete read on the benefits of breastfeeding, either.  People are too individual and their health is impacted by too many variables to ever separate them out and absolutely prove that one particular factor was responsible for a particular outcome, especially anything as complex as academic achievement or mother-child bonding.

We can assume that since breastfeeding is the biological norm, that it is the ideal way to feed babies.  We may never know the exact nature of all the benefits.  That’s okay.

Women shouldn’t use this study as an excuse to feel good about not breastfeeding.  They shouldn’t use it to point to women who tout the benefits of breastfeeding and tell them they are wrong or that they shouldn’t bother.  Neither should women use any other study to try to make women feel bad because they don’t breastfeed.  It’s too individual a situation to fling studies around to “prove” what a mother did was right or wrong.  No study or statistic can ever address an individual’s circumstances.  A woman’s choice is her choice, and if we want to increase breastfeeding rates, then we’ll increase the available support, not shame.

Pick up your copy of A Practical Guide to Children’s Health to increase your knowledge of all the factors that contribute to a child’s positive health — including feeding methods, the vaccine debate, antibiotics, gut health, organic clothing, bath and body care, and more.

How do you feel about this breastfeeding study?


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  1. Thank you SO MUCH for this breakdown of this study. Should moms who can’t breastfeed beat themselves up about it? No. But let’s not act like formula is equal to the biological norm. And I know from personal experience that the benefits of bonding are not overrated. I did not bond with my son at all when he was first born because he was immediately taken away to the NICU. He was tube fed and then, later, bottle fed. I felt no bond with him. I didn’t even really feel like he was my baby. Until we managed to solidify our breast feeding relationship and bond through breast feeding.

    And I’m sure babies who die because their formula is improperly mixed or mixed with dirty water don’t think breast feeding is overrated!

    I wish people would stop mentioning this study as a way to validate themselves. Didn’t breastfeed your baby? Fine. But don’t try to use this study to make me seem crazy for continuing to breastfeed my toddler. The benefits of breast feeding are countless – and increase with duration!


    • Hi Laura,

      Thanks for sharing your story. I agree, people need to stop using studies as justification for their decisions — do what’s right for you, but quit trying to ‘prove’ it was really better (or try to force someone to think the same!).


  2. Thank you for this thorough and thoughtful consideration. I am completely in agreement!


  3. […] this Ohio State U study about breastfeeding. I found Modern Alternative Mama’s take helpful: New Study on Is Breast Really Best? A Response. I like her perspective that “there is enormous pressure to breastfeed, yet quite a lack of […]


  4. Thank you so much for this!! I really appreciate your breakdown of the study, since I wasn’t able to obtain the entire thing myself. This post really answered some major questons for me about the study… (ie,, how they defined breastfeeding and how they measured things like maternal child bonding, etc.).


  5. Wow. This is a really, really excellent article. I’ve posted it on Facebook. Sadly, our culture is very hard on women — it’s hard no matter what choices you make. As an older mom, I am trying to encourage younger moms to think about the facts, to trust themselves, and keep their mother-baby relationship at the forefront, rather than what other people think, what the books say, etc.


  6. This study does have many flaws, but even the WHO agrees that in wealthy industrialized societies, there is no significant long term benefit to breastfeeding. Here is a link to that meta-study if you would like to read it:

    The thing that makes me the craziest in the breast v bottle debate is the assumption that bottle-feeding means less bonding with the baby. My son was exclusively formula fed until he was a year old. I never once handed him the bottle to hold. I never once propped the bottle. It is possible to nurse a baby with a bottle and I did. I held him close, we had skin to skin contact and when I fed him, I JUST fed him. Since I was holding the bottle, I did not have a free hand to hold my phone or a tablet or a book. At two years old, he is very closely attached to me and to his father.


    • Hi Tarynkay,

      There are a couple of flawed studies suggesting that breastfeeding isn’t really all that beneficial. Most studies show quite a bit of benefit. Sure, moms who don’t breastfeed can still bond with their babies and have healthy babies. But that doesn’t mean we shouldn’t explore and share the benefits of breastfeeding.


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Hi, I’m Kate.  I love medical freedom, sharing natural remedies, developing real food recipes, and gentle parenting. My goal is to teach you how to live your life free from Big Pharma, Big Food, and Big Government by learning about herbs, cooking, and sustainable practices.

I’m the author of Natural Remedies for Kids and the owner and lead herbalist at EarthleyI hope you’ll join me on the journey to a free and healthy life!

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