The Curious Incident of the Press Release and the *Actual* Infant Feeding Research Paper

This article recently ran in the Daily Mail. It’s about a research paper from the University of Queensland, apparently asking why women don’t exclusively breastfeed despite recommendations. Quotes were taken from a press release issued by the university.

The article caught my attention as a member of IFA and because of my own experiences. It seemed to describe a study that argued for compassion and autonomy in infant feeding policy and for a focus on families not feeding methods:

‘The push for “breast is best” has been called “out of touch” by researchers’.

Hallelujah! I  believe that the current policy of promoting exclusive breastfeeding to all is out of touch with the experiences of families, most of whom will use formula at some point.

‘Putting pressure on mums to breastfeed when they are having trouble with milk supply or getting baby to latch on can lead to anxiety and depression’.

Yes! This was my experience. The aggressive breastfeeding promotion I experienced in pregnancy, followed by coercive care in hospital, led to feelings of shame and failure when breastfeeding turned out not to be the best option for my family. Ultimately this contributed to postnatal depression.

So, I went off to find this paper that seemed so in accordance with what I see happening in infant feeding practice and what I think needs to change…

And what I found was… a paper that bore no relationship to the Daily Mail article!

For example, compare this quote in the Mail: ‘The majority of mothers don’t exclusively breastfeed, usually for very good reasons, and the support they receive needs to reflect this’ with the following statements from the research paper: ‘a more nuanced understanding of non-exclusive breastfeeding could inform novel policies to increase the duration of exclusive breastfeeding,’ and ‘new approaches may be necessary to support mothers to meet their breastfeeding goals, and to achieve national and international targets.’

So, the focus of the study was, in fact, as usual, to encourage exclusive breastfeeding and increase breastfeeding rates. How confusing. How disappointing.

The data came from a bigger study, The Mothers and Their Children’s Health study. The researchers identified five different feeding practices from the data (in addition to exclusive breastfeeding), including ‘never breastfed’, ‘stopped breastfeeding before 6 months’ and ‘breastfed to 6 months but had formula’. Having analysed these groups, as far as the data allowed (it didn’t include detail on women’s feelings about feeding, or indeed their satisfaction or dissatisfaction around their feeding methods), the researchers proposed interventions that could be targeted to each group to encourage exclusive breastfeeding. For example, they suggested about one group: ‘The only intervention required for this group may be education about how to recognize infant-led cues in order to prevent introduction of solids before the infant is developmentally ready,’ and for another, ‘This is a priority group for intervention, which could focus on detecting problems early and providing targeted and effective support that is specific to the problems being experienced’.

To me, this is a very different agenda to that characterised in the Mail in this way: ‘the study highlights the need for personalised support specific to each mother’s situation.’ I had naïvely imagined that this ‘support’ and the ‘specific situations’ referred to may not involve exclusive breastfeeding. The researchers themselves identify that a large percentage of women don’t exclusively breastfeed for many different reasons!

And then there’s the link reported in the Mail and the press release between pressure to breastfeed and postnatal depression and anxiety. Points like this had strongly resonated for me when I came across the article: ‘Researchers say many mums report problems with feeding their babies and the social pressure to breastfeed can lead to postnatal depression.’

But this connection is not in fact discussed in the paper. While the data did include depression scores for the participants, these were not further mentioned, analysed or discussed, and no link to breastfeeding pressure is explicitly pointed out.

Curiouser and curiouser.

My first thought was that I’d found the wrong paper; that the researchers must have another paper for the same journal waiting in the wings (although it would be strange that it would have to come from such a different point of view). No. I’ve been assured this is the correct one.

So, why does the university’s press release quoted in the Mail appear to come from a completely different viewpoint to the research paper itself? Why does it seem to champion compassionate care and women’s autonomy, rather than national and international breastfeeding targets (disappointingly the focus of so many recent studies in infant feeding)?

I’m afraid I don’t know the answer to this! But like much in the world of infant feeding research, in my experience, this strange discrepancy is frustrating and confusing and raises many questions. (See also this article I co-authored with Ruth Ann Harpur in response to a study in which we were participants.)

The background to this strange situation may well be telling. I’d love to know what happened here. But at the very least, the findings on a connection between pressure to breastfeed and postnatal depression ought to be brought to light for the development of policy and practice and for the benefit of families.

Sue Haddon

This blog was adapted from a thread on Twitter.

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