The message ‘breast is best’ is quite widely mentioned, as are the ‘benefits of breastfeeding’.
Is breast really ‘best’, and are there measurable ‘benefits’ of breastfeeding?
When breastfeeding is acknowledged as the biologically ‘normal’ way to feed babies, there is a shift in focus from benefits to risks.
Breastfeeding becomes the control or benchmark, to which other forms of infant feeding are compared.
In this way, instead of there being benefits of breastfeeding, there are risks of not breastfeeding, or risks of formula feeding.
This can be hard to hear for those who didn't breastfeed, but it's an important — and technically correct — distinction to make. It's not to offend, but just how it should be viewed.
So what does the scientific research actually tell us about the health outcomes associated with infant feeding? Here are some health outcomes for which there is convincing scientific evidence.
Risk Of Infections
Not breastfeeding increases the risk of infection. For example, according to Australia’s National Health and Medical Research Council (NHMRC), not breastfeeding increases the risk of:
- Gastrointestinal infections by 178%
- Hospitalisation for lower respiratory tract infections within the first year by 257%
- Ear infections by 100%
There are various ways in which formula feeding increases the risk of infection such as due to the lack of anti-infective factors found in breastmilk.
Some research even suggests that not breastfeeding increases the risk of infection into childhood.
Sudden Infant Death Syndrome (SIDS)
There’s also convincing evidence that not breastfeeding increases the risk SIDS. The NHMRC indicates that not breastfeeding increase the risk of SIDS by 56%. SIDS and Kids have already updated their safe sleeping guidelines due to extensive studies over many years that all drew the same conclusion.
The ways in which formula feeding increases the risk of SIDS are explained here.
Putting this increased risk into perspective, in Australia, the risk of SIDS is around one in 3000 births. Therefore, if all babies were not breastfed, a 56% increase in SIDS would mean that the risk of SIDS would increase to around 3 in 6000 births.
Necrotising Enterocolitis (NEC)
NEC is a condition seen mainly in premature babies where parts of the gut undergo tissue death. NEC is a leading cause of death in premature babies.
The NHMRC indicates that not breastfeeding increases the risk of NEC by 138%.
The ways in which breastmilk are important to help prevent NEC are discussed here.
The NHMRC indicates that not breastfeeding increases the risk of childhood obesity by 32%.
The ways in which not breastfeeding may be implicated in the development of obesity are described here.
Obviously, the development of obesity is multifactorial. Breastfeeding is not magic, it is just one possible factor amongst many factors that may influence one’s weight. Other factors include genetics, food preferences, food availability, physical activity and sedentary behaviour etc.
Recent research also found that protein in baby formulas may be too high, which could be contributing to the childhood obesity links with formula use.
Breastfeeding is important for the optimal development of brain structure and function. Hence, not being breastfed increases the risk of lower intelligence scores which may last into adulthood.
On average, not being breastfed leads to around a 4 or 5 IQ point reduction as compared to being breastfed. Four of five IQ points may not seem like all that much on an individual level but if all children were breastfed, such an increase on a population level is significant.
It's important to remember that intelligence comes in many forms. Social and emotional intelligence are also important.
There are many ways a mother who bottle feeds can assist in her baby’s brain development. For example, she can hold her baby close to her with as much skin-to-skin contact as possible for feed times. She can also alternate which arm she holds her baby in for feeds, so her baby’s alternate visual fields get stimulated.
The ways in which not being breastfed may lead to lower intelligence are discussed here.
Breastfeeding Mothers And Links To Cancer
Let’s not forget or ignore the benefits of breastfeeding for mothers.
The NHMRC indicates that if a mother doesn’t breastfeed, she has a 4% increased risk of breast cancer and a 27% increased risk of ovarian cancer.
It’s important to note that many of these health outcomes are dose dependent. This means that the less exclusive breastfeeding that occurs within the first 6 months and the less the total duration of breastfeeding, the increased the risk.
Public Health Messages And Individuals
Public health messages and research about infant feeding focus on risks related to large groups of people (populations). Scientific research points to the importance of breastfeeding for various health outcomes. This is why breastfeeding is promoted, as it should be.
Sometimes however, individual circumstances override population level risks. For some individual families, formula feeding may be the best option. Therefore, it is erroneous to say that breast is best. Read five surprising facts about the breast is best message here.
It's important for health professionals to meet mothers where they are at, provide them with unconditional positive regard and empathy, and help them make fully informed decisions. A lactation consultant is trained and experienced in breastfeeding issues, especially an IBCLC (the gold standard training for lactation). Their role is not to force you to keep breastfeeding if another option is best — they will support you all the way.
At the first sign of trouble, speaking to a consultant or a breastfeeding support organisation (like the Australian Breastfeeding Association) is a wise move.