I hate the AAP

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Its pretty clear- 6 months exclusive breastfeeding and after that breastfeeding should be maintained along with complementary foods-no change from previous recommendations. It is giving the thumbs up for those who want to continue breastfeeding from year 1-2 and if mutually desired, beyond 2. And that mothers who feed beyond 1 year need additional support from their medical providers, so stop shaming women and telling them there is no benefit to breastmilk. As if at 12months day 1 it is no longer a viable source of nutrients.

Actually it's not clear. I remember when I was pregnant I looked to the AAP's website for guidance. Well this is all that it says now: "The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first six months. We support continued breastfeeding after solid foods are introduced as long as you and your baby desire, for 2 years or beyond," and "Beyond 6 months, we recommend continued breastfeeding alongwith adding nutritious complementary foods. Your baby does not need any infant or toddler formula."

So if I'm not continuing to breastfeed because I really really want to, but because I bought into the BS evidence they are pushing, 2 years is the only recommended end date that a person can glean from this.

Wow okay. So you think by support breastfeeding it means you have to? 2 years is not the recommend end date. It also says beyond 2 years. If you do not desire to do it then you dont need to. If you do desire, you shouldnt be shamed or told there isnt any benefit, because THERE IS. I can tell the people who havent BF or havent BF past 1 year because you have no idea regarding the medical communities approach to breastfeeding after a year. This is saying that breastfeeding past a year is not WRONG, should be supported., and has benefits.

ALL of this is with the understanding that breastfeeding is mutually desired. If you negate that part, then yes I can see how it isnt clear.

Let me be more specific. When I was pregnant and then subsequently breastfeeding, I based my "goals" on what would be best for my baby, based on medical advice from my own research as well as our pediatrician. At that time, the advice was to breastfeed for one year (and the "mutually desired" language was there in the AAP recommendation). And that is what I did. I also continued nursing for a couple more months after the one year mark (never got any judgement for that by the way). Reading the current AAP website, it just says to continue breastfeeding after 6 months with complementary foods. It doesn't say until when it is "recommended" to breastfeed, but it has the language about "supporting" breastfeeding through "2 years and beyond". Why list any number if ostensibly, they support breastfeeding for any length of time? Why not just say that?

It also says "Your baby does not need any infant or toddler formula" which is just bizarre, many babies do NEED formula because most women cannot pump enough at work to fulfill their babies' nutritional needs. Moreover, it's so weird to lump in toddler formula (which truly is unnecessary for most children), with infant formula, which is THE alternative to breast milk in the first year of life. They are very clearly discouraging the use of any formula at all, which implies they definitely want women to breastfeed through 12 months, and certainly don't say anything about cow's milk (I'm sure some will say well this page is about breastfeeding, and I think that's absurd, why make people look at two different pages for recommendations about feeding?). So no, they are not saying that "breastfeeding past a year is not WRONG" first of all because they never say anything about breastfeeding FOR a year. They only mention 6 months (as the point when you can introduce "complementary foods" (but definitely not formula) and 2 years.

https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Where-We-Stand-Breastfeeding.aspx

Even before the AAP statement my goal was to breastfeed for two years or as long as my baby wanted to (recognizing she may want to stop before 2 years) since there are clear benefits to breastfeeding to two years (I always said I was following the WHO recommendations.) That is why they, the WHO, and other health organizations (Canadian, etc) specify two years and beyond. I don't think studies have been done to define the upper limit but studies have found benefits to feeding > 12 months. For the health benefits to the mother, longer is better and there is a bit more evidence about that but that sometimes involves counting total time breastfeeding across multiple children.

Good for you that you have not been discouraged from breastfeeding for >12 months. To be honest I have been discouraged from breast feeding starting already at 3-4 months but it has definitely intensified after 12 months. I was formula fed, my dad was formula fed and many people I know thinks that formula feeding is a more rational choice than breastfeeding. That is why the AAP advocacy for breastfeeding is important.

Health organizations will propose guidelines what is "best" for the generic person. There is evidence that exclusive breastfeeding is the best. It doesn't mean it is best for everyone. Of course if someone has inadequate supply it is not best. If someone needs to be on medications incompatible with breastfeeding it is not best. If someone can't breastfeed and remained employed, it is not best. If there are mental health issues with breastfeeding it is not best. These are all very obvious and best discussed with one's physician.

I accept there are things I can't do for my child that would be "best" because I don't have the resources (financial and otherwise). Sometimes it stings a bit but I don't actively try to tear down these "gold standards." I accept they are best for the generic child (and may even be better for my child if I could do them) but still go ahead and make the best decision for my child based on my individual situation.

My Qigong master has a saying good, better, best. 100% formula is good, partial breastfeeding is better, exclusive breastfeeding is best. But the key is is that formula is still good and is good enough. (Good thing too because my child required supplementation!!!)

Guidelines are not for the lowest common denominator - they define what is ideal. And for the AAP their goal is to define what is ideal for the child. Go complain to ACOG if you want better guidelines for the mother. Perhaps the two organization should meet given that breastfeeding only exists in a dyad so having an organization dedicated to children's health solely in charge of breastfeeding recommendations shortchanges the mother part of the dyad.

+1

BF for two years is not and never has been the “gold standard”!!! that’s the point.

It has for the WHO for decades and also Health Canada.

It’s also the recommendation in Sweden. Pretty sure their water is fine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. [b]Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

[Anonymous]

And by the way, if you invest money into an intervention that helps White babies' outcomes more than Black babies' outcomes, you increase disparities. They really need to prioritize addressing structural and systemic racism in the health sector, and perhaps advocate for broader societal reforms (like reparations) if they want to reduce disparities in infant mortality. Breastfeeding is not going to do it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. [b]Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

The section you quoted said breastfeeding was associated with statistically significant reductions is infant death in the Black community, but not as significant as the reductions in other populations. That does not mean breastfeeding is less beneficial in that group unless you have another intervention that reduces your death rates by 17%, also bear in mind given higher overall infant mortality rates that 17% correlates to more living children.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. [b]Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

The section you quoted said breastfeeding was associated with statistically significant reductions is infant death in the Black community, but not as significant as the reductions in other populations. That does not mean breastfeeding is less beneficial in that group unless you have another intervention that reduces your death rates by 17%, also bear in mind given higher overall infant mortality rates that 17% correlates to more living children.

Yes, there are likely interventions that affect infant mortality in the Black community more than breastfeeding (for several reasons: one being that you cannot just snap your fingers and make it easier for Black women to breastfeed given the barriers they face which cannot be solved by adding more pumping spaces, but moreover because randomized studies show no effect of breastfeeding on infant mortality). They need to address the root causes of the disparity. There are a bunch of recommendations listed in this report, and while breastfeeding is a component of many of the programs, it is not their focus: https://www.americanprogress.org/article/eliminating-racial-disparities-maternal-infant-mortality/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

[Anonymous]

Focusing on “breastfeeding disparities” wrt racial equity is a farce. It’s exploiting racism to promote breastfeeding. Give me a freakin’ break.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

By the way, good point about the confidence intervals. I wish the AAP were as thoughtful as you, because in their policy statement, not only do they fail to mention the results by race from this study from 2022, instead they cite another study from 2004 that claims that breastfeeding reduces post-neonatal deaths in Black babies by a whopping 31% versus 21% for all infants. Yet if you look at the confidence intervals for Black and non-Black babies, they are also large and overlapping. http://www.eatsonfeets.org/docs/Breastfeeding_and_the_Risk_of_Postneonatal_Death_in_the_United_States.pdf

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

You know only one woman who was able to pump at work and continue breastfeeding their child? Really?

By the way, not all women work outside of the home. For those who don't, breastfeeding can be easier and more convenient.

[Anonymous]

Yes and that's why the AAP recommends TARGETED interventions. Also there is nothing in the policy statement that says that racial equity is a key justification for these updated guidelines. If it were, I'm sure they would spend more than 2 paragraphs on it. If they failed to note disparities that would have been so tone deaf and disturbing that they would have been rightly blasted for it. I don't think they are using racial equity as a rationale for their guidelines, I think they are giving a token amount of attention to racial disparities which is their greater failure not using racism to promote breastfeeding.

I agree that the equity analysis seems lazy - particularly since it fails to mention the contribution of racism and bias in health care to these disparities. Since AAP guidance is aimed at health care providers that is a key failing since it is actually something health care providers can do something about. (Vague allusions to structural racism are much less actionable.) Where is the discussion of that black women are more likely to be given formula or assumed to be uninterested in breastfeeding? Racism in health care was identified as an important factor in this study (very qualitative) on barriers to breastfeeding in African American women:

In this study, SMEs significantly stressed the importance of addressing fundamental issues related to disparities in breastfeeding. Provider stereotyping, judgment, racism, and equity concerns were salient throughout the findings. Key informants highlighted the realities of racism within healthcare organizations,
among providers, and within communities concerning breastfeeding initiation among African American mothers. Despite the “call to action” to support breastfeeding
initiation in African American women, accounts from key informants provided evidence regarding the continued presence of stereotyping, disparities in approaches
to care based on culture, and lack of access/resources in specific communities and locations.9

https://journals.lww.com/jpnnjournal/Abstract/2021/04000/Subject_Matter_Experts_Identify_Health_Equity.13.aspx

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

You know only one woman who was able to pump at work and continue breastfeeding their child? Really?

By the way, not all women work outside of the home. For those who don't, breastfeeding can be easier and more convenient.

Are you actually offended that I mentioned working women? We exist, we are real, we matter.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

You know only one woman who was able to pump at work and continue breastfeeding their child? Really?

By the way, not all women work outside of the home. For those who don't, breastfeeding can be easier and more convenient.

Are you actually offended that I mentioned working women? We exist, we are real, we matter.

And no, I did not say I know one woman who was able to pump at work. Read my post again.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

You know only one woman who was able to pump at work and continue breastfeeding their child? Really?

By the way, not all women work outside of the home. For those who don't, breastfeeding can be easier and more convenient.

Are you actually offended that I mentioned working women? We exist, we are real, we matter.

And no, I did not say I know one woman who was able to pump at work. Read my post again.

Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

You know only one working woman who was able to work and produce enough supply while pumping - that's what you said.

I'm also a working mother, so I'm aware that we exist.

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Anonymous wrote:There are two problems with the new statement:

1. It is very unclear. For a first time mom that buys into all the benefits of breastfeeding to the baby, but for whom it does represent a burden (as it does to many women), should she try to get to the 12 month mark? The 24 month mark? What is the goal, if the mother is doing it solely for the baby?

2. On the first point, I know some of you will say that women can make their own decision about this and that I am saying women do not have agency (lol). Well, if that's the case, then unfortunately this document is totally unhelpful. Once again, it grossly exaggerates the benefits of breastfeeding to both baby and mother. I am sorry, but as an example, the idea that breastfeeding reduces childhood obesity is absolutely, utterly absurd and unsupported by the research. It also suggests that breastfeeding has even greater benefits for Black babies, but the most recent research suggests the opposite. This document then uses these purported benefits to advocate for practices that may be harmful to babies, and which all mothers I know pretty much hate (like being required to room in at the hospital after major surgery, or keeping pacifiers away from babies), and have no proven benefits.

My reaction to this document is not just about the AAP's decision to "support" breastfeeding for 2 years, which I find disingenuous for a variety of reasons. It's that the document as a whole reads like a piece of propaganda written by KellyMom and then made to sound "scientific" by a couple of White doctors who footnote a Black pediatrician to justify their extremely lazy racial equity analysis.

Can you please cite your source for research suggesting breastfeeding is less beneficial to Black babies? That is 180 degrees from everything I’ve seen.

We found statistically significant associations between any breastfeeding and post-perinatal infant deaths among most racial/ethnic groups, with 25% reductions in overall post-perinatal infant mortality for the non-Hispanic White population, 17% reduction in non-Hispanic Blacks, and even greater protection in association with breastfeeding among Hispanic and non-Hispanic Asian populations (36% and 49% lower death rates, respectively). The reasons for a smaller effect size among non-Hispanic black population cannot be explained by further analysis of our data, but we offer two potential explanations. First, our analysis does not address the impact of breastfeeding duration and exclusivity, which is known to be significantly lower in the non-Hispanic Black population compared to all others except for American Indian and Alaska Natives.6 Thus, breastfeeding “dose” to the infant whose mother initiates breastfeeding is not equal by race. Second, the small effect size might be explained by other risk factors for which we were not able to fully adjust for. Social and structural determinants of infant death risks, such as poverty and structural racism, are more prevalent among non-Hispanic black population regardless of their breastfeeding status and thus may dilute the effect of breastfeeding. Given the high IMR in the US, any intervention that could reduce infant deaths would be worthwhile, even if itself alone does not reduce disparities proportionately.[b]

https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(21)00090-9/fulltext

They are basically admitting that breastfeeding interventions are not going to reduce the disparity in infant mortality and may increase it. Poverty and structural racism cause infant deaths (not because they stop women from breastfeeding, but by themselves), so you have to address those things if you want to reduce disparities. Not saying promoting breastfeeding is bad, though I'm sure you'll twist my words anyway, but I do think it is bad to sell it as a way to reduce disparities in infant mortality.

That’s quite a stretch from your assertion that “the opposite is true” about breastfeeding being more beneficial to Black infants.

Um no, they found the reduction in infant mortality for non-Hispanic Blacks was lower than for White, Hispanic and Asian groups. The opposite of breastfeeding being more beneficial is that it is less beneficial, which is what this study shows (I actually don't trust most observational studies like thus one, but it is cited by the AAP, they just don't mention the point about how it undermines their argument)

Actually they didn't. The reduction for non-hispanic Blacks and non-hispanic Whites is pretty much the same (there is great overlap in the confidence intervals):

In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55−0·74)], [b]non-Hispanic Whites [AOR=0·75 (0·69−0·81)], non-Hispanic Blacks [AOR=0·83 (0·75−0·91)], and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].

Also they note the limitation that they did not take breastfeeding duration or exclusivity into account. Longer breastfeeding duration and greater breastfeeding exclusivity in other studies has been associated with increased effect and we know that non-Hispanic blacks have shorter breast feeding duration compared to other groups which could explain any differences where they exist.

So definitely false that the "opposite is true."

BUT in general I do agree with you - if you want to address disparities in infant mortality - there are other much more important factors that should be addressed first. But in a statement primarily about breastfeeding (NOT infant mortality) - it is important to note breastfeeding disparities and the need to address them.
Although it's hard to imagine making any substantial headway into breastfeeding disparities without addressing societal and structural barriers

Do you get that there is a reason why Black women have lower breastfeeding durations and exclusivity for a variety of reasons that might mean that if you apply a breastfeeding intervention such as more "education" (I put it in quotes because in my experience "education" often includes providing false or misleading information), Black women will benefit less from that intervention because structural reasons (which are mentioned briefly, but very little detail is provided) will prevent them from breastfeeding for as long/exclusively as White women? The document never once acknowledges that breastfeeding is time consuming and very difficult to maintain for women who work outside the home, even under the best of circumstances. Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

Also, I understand this document is about breastfeeding. The authors have chosen to highlight racial equity as a key justification for needing this updated policy document. Frankly, I think the racial equity analysis is lazy and amounts to using communities of color to justify conclusions they would have come to anyway. I find that troubling.

You know only one woman who was able to pump at work and continue breastfeeding their child? Really?

By the way, not all women work outside of the home. For those who don't, breastfeeding can be easier and more convenient.

Are you actually offended that I mentioned working women? We exist, we are real, we matter.

And no, I did not say I know one woman who was able to pump at work. Read my post again.

Of the women I know with office jobs and lots of accommodations, I know exactly one that said pumping was fine. Everyone else hates pumping and could not produce enough supply, even under the best of circumstances. There are so many other things, like access to healthcare, that would be more likely to decrease infant mortality because they are actually doable in the real world.

You know only one working woman who was able to work and produce enough supply while pumping - that's what you said.

I'm also a working mother, so I'm aware that we exist.

Yes, that's what I said, not that I only know one woman who was able to pump at work.