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The Real Breastfeeding Issue Goes Far Beyond Mere Guilt

by Cynthia Good Mojab, MS

Thursday, July 25, 2002
The Oregonian

The less a woman breastfeeds, the greater her risk of breast cancer. So concluded a landmark meta-analysis in The Lancet medical journal, as reported on the front page of The Oregonian ("Study finds key factors to lower risk of breast cancer," July 19). 

News like this is often met with concern about inducing guilt in women who don't breastfeed. But in no other area of health are people seen as needing emotional protection from the knowledge of risk. In fact, concealing risk is unethical and violates the principles of informed consent. 

Women are told of the risks of alcohol and cigarettes to their unborn children. Smokers are told of tobacco's hazards to them and to those who breathe their second-hand smoke. Yet the known dangers of formula feeding are rarely disclosed to parents in a straightforward manner. 

Instead, parents hear about the "benefits" of breastfeeding, as though they are perks above and beyond what mothers could want for themselves and their children. These "benefits" are measured against the poorer health outcomes of formula feeding–-outcomes so common in the United States that they are seen as the "norm" by which we measure health. 

These outcomes are culturally but not biologically normal. Breastfeeding is biologically normal. Breastfeeding for longer than a few months is biologically normal, even if it is not culturally normal in developed countries today. The increased incidence of breast cancer among women who do not breastfeed or who minimally breastfeed is just one in a long list of risks that formula feeding poses to mothers and children. 

Because of these hazards the American Academy of Pediatrics recommends at least one year of breastfeeding per child and the World Health Organization recommends at least two years. 

Mothers cannot make informed decisions without full information. Still, women can know all the risks of formula feeding, have the desire to breastfeed, and not breastfeed. When this happens-–and it often happens-–it is very likely because of insufficient information and support. 

Breastfeeding, though biologically normal, is a learned skill. Many of us grew up with no breastfeeding role models. We commonly have no reliable breastfeeding advisers in our own families. Most physicians have little training and experience with breastfeeding. Hospital routines regularly pose unnecessary barriers to breastfeeding. Most U.S. workplaces fail to support breastfeeding. Many states have actually had to enact legislation clarifying that women have the right to breastfeed in public! 

In such a challenging environment, breastfeeding initiation rates are low, breastfeeding duration is short, formula feeding is the cultural norm and breast cancer rates are increased. 

This issue isn't about guilt. It's about respecting the right of women to make informed decisions about their and their children's health. It's about stopping the unethical marketing of human milk substitutes by formula companies who profit from our declining health. It's about hospitals engaging in evidence-based practices that support breastfeeding, and medical schools including sufficient training on the importance and management of breastfeeding, and employers enacting policies that keep women from having to choose between making a living and breastfeeding their children. 

A woman's decision not to breastfeed must be respected. But women are routinely deprived of the chance to decide based on all of the facts. And when they decide that they want to breastfeed, they routinely face social and institutional barriers that undermine breastfeeding and increase the risk of illness, disease and death for children and women. A higher risk of breast cancer is just one of those risks. 

Cynthia Good Mojab is a breastfeeding researcher and co-author of Breastfeeding at a Glance: Facts, Figures and Trivia about Lactation. Further information is available through her Web site ( and from La Leche League International at 800-LA-LECHE or

© Cynthia Good Mojab, 2002. All rights reserved. 

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