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The Case Against Breast Feeding
Hanna Rosin's article on breastfeeding in the latest Atlantic is excellent and would make a topical and accessible introduction to causality studies in an econometrics or statistics class. (And lest that sound damning it's also a great read.)
The general point will be familiar to the audience at Marginal Revolution. The studies that show breastfeeding leads to lower weight, fewer ear infections, less allergies, less stomach illnesses and so forth are almost all observational studies.
An ideal study would randomly divide a group of mothers, tell one half to breast-feed and the other not to, and then measure the outcomes. But researchers cannot ethically tell mothers what to feed their babies. Instead they have to settle for “observational” studies. These simply look for differences in two populations, one breast-fed and one not. The problem is, breast-fed infants are typically brought up in very different families from those raised on the bottle. In the U.S., breast-feeding is on the rise—69 percent of mothers initiate the practice at the hospital, and 17 percent nurse exclusively for at least six months. But the numbers are much higher among women who are white, older, and educated; a woman who attended college, for instance, is roughly twice as likely to nurse for six months.
Moreover, the better we control for other factors that might account for differences in child outcomes between mothers who breastfeed and those who do not, the less evidence there is for breastfeeding's benefits. Even looking at children within the same family (still far from the gold standard of randomization), shows many fewer benefits from breastfeeding than studies that look across families. Some modest evidence suggests a gain in IQ and better evidence suggests minor improvements in avoiding some diarrhea. Rosin does not discount these benefits (so the title of her piece is unnecessarily sensationalistic) but she very appropriately does point to opportunity cost.
The debate about breast-feeding takes place without any reference to its actual context in women’s lives. Breast-feeding exclusively is not like taking a prenatal vitamin. It is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.
One final point, Rosin's article is also usefully read as a study in propaganda and social psychology.
Posted by Alex Tabarrok on April 1, 2009 at 07:39 AM in Economics, Education, Medicine, Science | Permalink
Comments
That time-spent breast feeding ignores the fact it takes time to feed a baby from a bottle!
Posted by: Andrew at Apr 1, 2009 7:50:13 AM
"Let’s say a baby feeds seven times a day and then a couple more times at night. That’s nine times for about a half hour each, which adds up to more than half of a working day, every day, for at least six months. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing"
What does Rosin think happens in those families who don't breast feed? The other option isn't do nothing, it's feeding with a bottle. So, you slog downstairs at 3am, boil the kettle, sterlise the bottle, waste time trying to get the milk to the right temp and then after 10 minutes of mucking about, you feed your baby. This cost can be shared between partners, but overall the cost is much higher than breast feeding.
Posted by: Tom at Apr 1, 2009 7:50:15 AM
Statistical methodology aside, I can't help but be a little skeptical about a claim that feeding milk designed for a baby calf is as good for a human baby as mother's milk.
Posted by: Tom at Apr 1, 2009 7:57:54 AM
I agree that breastfeeding usually precludes a mother from being a significant income earner for the family, so in that way it is not free. However, the half a work day devoted to breastfeeding the infant is not purely unproductive either - especially in families with other children besides the breastfeeding infant. The breastfeeding mother can still be economically productive for the family with more than one child by providing low cost child care. Sure, it is not income generation, but it enables the family to eliminate costly daycare.
Posted by: Ray at Apr 1, 2009 8:04:16 AM
only free if a woman’s time is worth nothing
What is the babies' time worth?
(Not an entirely facetious question!)
Posted by: Pete at Apr 1, 2009 8:22:16 AM
Oh, wait, are trying to tell me that people guilt trip you into doing things that cost them nothing other than rhetoric but cost you lots of time? This must be an April fools' joke.
However, remember the future. We are also learning that early development has longer term effects than just ear infections. A gain in IQ is no small thing. Evolution wasn't for nothing. Don't let all those people die in vain!
Posted by: Andrew at Apr 1, 2009 8:31:29 AM
In other news... Studies say otherwise, but breasts are still attractive to me.
Posted by: Seth at Apr 1, 2009 8:41:31 AM
Andrew and Tom,
I think her point is that if you are breast feeding exclusively, only the mother can feed the child. If you are bottle feeding, the feeding tasks can be distributed to other people.
Of course, if we still had wet nurses, we could get around that problem.
Posted by: Xmas at Apr 1, 2009 9:35:24 AM
In those families that don't breast feed, the father can/may potentially assist with feedings. The result - lower opportunity cost for the mother versus breast feeding.
Posted by: Mark Tuttle at Apr 1, 2009 9:35:45 AM
I love that all of the comments so far are by men...
Posted by: Tracey at Apr 1, 2009 9:40:25 AM
C'mon Tracey, all the world loves milk.
Posted by: Seth at Apr 1, 2009 9:42:27 AM
We are missing the all important impossible to value bond that Breastfeding creates between Mothers and Children. For many Moms who do breastfeed, like my wife who Breastfed both of our children and loved the connection she was able to make with them, the "opportunity costs" are small. Once again, we forget the externalities that are hard to dollarize.
Posted by: joe at Apr 1, 2009 9:47:37 AM
"In those families that don't breast feed, the father can/may potentially assist with feedings. The result - lower opportunity cost for the mother versus breast feed"
Yes, but it takes ALOT longer bottle feeding, so the total cost for the family is much higher. I've just asked my wife, a highly experienced senior manager, about the opportunity cost of all this. "You, crashing around at 3am, waking me up? No thanks, that's a cost I don't want to bear."
Posted by: Tom at Apr 1, 2009 9:49:37 AM
The time and hassle of bottle feeding compared to breast feeding is much higher (my wife could breast feed her babies while both slept!). Another possible costs of bottles not noted, increased allergies. This is related, I suspect, to the most important point noted above. We are, by design, adapted to mother's milk (a friend who works on baboons expected to breastfeed for more than a year, as they do) not cows milk.
Posted by: R S at Apr 1, 2009 10:01:13 AM
I whole-heartedly agree that "It's only free if a woman's time is worth nothing." Not only does breastfeeding take the time of the mother, but it also takes a toll on her body. Though a portion of the population may be able to lose weight while breastfeeding, most of the women I have talked to (including myself) have gained weight as a result of an insatiable appetite while nursing. Of course, the cost of all that extra food for the mother can be taken into account when debating cost between breastfed or formula fed babies. I have used both methods with my own children. Obviously you've never fed a baby in the middle of the night any time recently, if you think you would go downstairs at 3 am and "boil the kettle, sterilize the bottle," etc. Either that, or you're managing your time extremely inefficiently and your methods are very outdated. Also, keep in mind that bottle-fed babies have shorter feedings, less frequent feedings, and within 6 months or so can self-feed with a bottle. If a mother chooses to devote her time and resources (in this case, her own body) to the benefits of breast-feeding and bonding with her child, I think it is an extremely admirable and self-less thing to do.
Posted by: Lisa at Apr 1, 2009 10:01:14 AM
I breastfed both my daughters. With my first one, I can assure you that breastfeeding sometimes promoted a bond, but after a while I loathed it and resented feeling pressured to do it. I wanted help, I wanted a break, and felt like my baby was sucking the life out of me. I would look down at her sucking away (forever...she would suck for comfort all the time) and just wanted to pull her off, hand her to someone else, and run for the hills. I did some breastfeeding, and some formula with my second, and had no such horrible feelings. But my Dr made me feel incredibly guilty for giving her ANY formula. Rosin's article was a relief for me to read. Why does it have to be so black and white? Why not some breasfeeding and some formula feeding? Give the moms a break!
Posted by: BN at Apr 1, 2009 10:07:24 AM
Hmmm. Parenting requires sacrifice. Who would have thought that?
The Atlantic article comes across to me as a cranky rant.
I am not saying that everyone should breastfeed. That should be up to the mother. I would encourage anyone embarking on it to review the evidence pro and con, consider your feelings, and make up their own mind. In the grand scheme of things there will be other more important parenting challenges.
Posted by: babar at Apr 1, 2009 10:29:05 AM
I breastfed two children--breastmilk exclusively for 6 months, then supplemented with formula for about another 3. Since I work full time, and worked full time after their first three months of life, I pumped breastmilk while I was at the office so that their caregiver could give it to them in bottles and so that their father could give them the occasional feeding.
The loss of productive working time, energy, and attention to anything but milk production was enormous. The sense of closeness to my children was enormous. I have no idea how I would meaningfully weigh the costs and benefits here.
The article, though, can certainly help serve as a useful response to some of the enormous social pressures on women to breastfeed for as long as possible regardless of costs of money, time, and convenience.
Posted by: Sarah S at Apr 1, 2009 10:39:35 AM
It was a whiney article that incited people against a preachy mother cult. No, it's not essential for your babies well-being to breastfeed, but..."playground spies" and "sitting half-naked in public for the tenth time that day" is dishonest hyperbole.
The article doesn't provide a case against breastfeeding. It provides a case for doing what works for you and your child. I thought the paranoid delusions were annoying and distracted from the authors main point.
Posted by: MostlyAPragmatist at Apr 1, 2009 10:47:51 AM
It's about time someone took on Big Breastmilk.
In our family's experience, sometimes breastfeeding isn't up to the mother. The mother may have a strong desire to breast feed, partly due to the relentless propaganda. But for some reason mother and child together may not be get the breast to "let down" despite intense effort and instruction. After a few dry diapers there is another relentless pressure from the hospital nurses to give formula. Which, as is drilled in to your head, ruins the whole thing because the baby gets lazy from the introduction of the artificial nipple.
This is where the guilt trip does its damage.
I think Rosin should look at the fish mercury IQ studies next...
Posted by: David at Apr 1, 2009 10:58:53 AM
If you really value your time, you won't sell it. So I would argue that breast feeding is certainly not "free", but that mothers who breastfeed actually value their time more than mothers who sell their time to employers for $30,$100 or $350 an hour. Certainly my wife would have valued the opportunity cost to not breastfeed at well above $250/hr. The reality is that breastfeeding is a luxury that many lower income women can't afford to do. Certainly as a society we do make value judgements on wealthier women who can afford to breast feed but choose not to. Their actions imply that children really aren't that valuable, which may be true but many find the implications disturbing.
Posted by: vanya at Apr 1, 2009 11:03:20 AM
Tom, in fact usually bottle feeding is quicker - it demands less muscle activity from the baby than breastfeeding (which both mother and baby have to learn to do - contrary to many of the myths about its ease and simplicity). And with bottlefeeding, babies are not encouraged to stay on the breast just for comfort. So typically a bottle is a lot quicker (especially when you've got into the 21st century and worked out that pre-made up formula and pre-sterilised bottles cut down on the midnight faffing in the kitchen!)
And Babar - typically it's not parenting that requires sacrifice. Often it's motherhood that requires sacrifice and that is what prompts these mixed feelings, well expressed by Sarah S and Lisa.
I typed out a whole answer on this before - in wholehearted support of the article as a 2x breastfeeding mother. I get that there are (or may be) benefits but the disbenefits to the mother are always entirely disregarded. Anyway, it obviously wasn't interesting enough to make it on here...
Posted by: Charlotte at Apr 1, 2009 11:08:31 AM
MostlyAPragmatist, what's dishonest about "sitting half naked in public..."? That was my experience at least at the beginning until I got the hang of doing it (which took six weeks). Many women will recognise the sentiment behind that comment.
Breastfeeding can be incredibly hard, incredibly painful (checkout the woman on the video clip who describes having to bite down on a wash cloth) and just basically awful. It can also be worthwhile and valuable. But it actually does the pro breast lobby no favours to pretend it's all marvellous. I would have appreciated more honesty about it - I still would have breast fed but lying about it doesn't help anyone. And it also doesn't help us evaluate it economically (though I have doubts about the point of doing that because the positives and negatives can never be effectively evaluated).
Posted by: Charlotte at Apr 1, 2009 11:25:29 AM
"This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing."
As many people hited, the relevant question seems to be: what is the cost of the next best alternative? The baby must be fed one way or another.
Note that the cost changes at the margin. The mother can easily get exhausted if she does around the clock feedings (newborns usually eat every 3 hours, around the colck; for some each feeding takes an hour - not much time for mother to sleep or do othetr things to stay sane!). So at some point the marginal cost of an extra feed is a LOT higherthan the average. If the father can do at least 2 feedings by bottle per day its usually very helpful.
The "optimal" answer depends on the mother/father earnings, but also prefferences, ability to tolerate weird schedules, ease of falling asleep, the baby, availability and cost of alternatives (family, daycare, etc.)... There is no one size fits all "right" answer.
Posted by: sd at Apr 1, 2009 12:34:06 PM
The guilt that women feel from... just about every choice they make (nor just breastfeeding) is mental illness.
Seriously.
Guys don't feel guilt about ANYTHING. We just don't think about these things.
I'm glad my wife breastfed the kids, I'm really proud of her. But I also agree that she couldn't work outside the home while breastfeeding(and she didn't), and everybody makes their own choices. Why feel guilty about those choices?
Mental illness, that's why.
Posted by: Buzzcut at Apr 1, 2009 12:38:29 PM
