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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]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.[/quote]

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. [/quote]

[quote]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][/quote]

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.[/quote]

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

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)[/quote]

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): 
[quote] 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)],[/b] and non-Hispanic Asians [AOR=0·51 (0·36−0·72)].[/quote]

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 [i]breastfeeding[/i] (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  
[/quote]

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. [b]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. [/b]

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.[/quote]

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. [/quote]

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

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

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