Breast-Feed or Else (page 2)

Public health leaders say the weight of the scientific evidence for breast-feeding has grown so overwhelming that it is appropriate to recast their message to make clear that it is risky not to breast-feed.

Ample scientific evidence supports the contention that breast-fed babies are less vulnerable to acute infectious diseases, including respiratory and gastrointestinal infections, experts say. Some studies also suggest that breast-fed babies are at lower risk for sudden infant death syndrome and serious chronic diseases later in life, including asthma, diabetes, leukemia and some forms of lymphoma, according to the American Academy of Pediatrics.

Research on premature babies has even found that those given breast milk scored higher on I.Q. tests than those who were bottle-fed.

The goal of a government health initiative called Healthy People 2010 is to get half of all mothers to continue at least some breast-feeding until a baby is 6 months old. Though about 70 percent of new mothers start breast-feeding right after childbirth, just over a third are breast-feeding at 6 months and fewer than 20 percent are exclusively breast-feeding by that time, according to the 2004 National Immunization Survey. Breast-feeding increases with education, income and age; black women are less likely to breast-feed, while Hispanics have higher breast-feeding rates.

For women, breast-feeding can be an emotionally charged issue, and a very personal one. Even its most ardent supporters acknowledge that they have made sacrifices.

"It's a whole lifestyle," said Kymberlie Stefanski, a 34-year-old mother of three from Villa Park, Ill., who has not been apart from her children except for one night when she gave birth. "My life revolves around my kids, basically." Ms. Stefanski quit working when her first child was born almost six years ago, nursed that child until she was 4 years old, and is nursing an infant now.

She said she wanted to reduce the risk of breast cancer for herself and for her three daughters, referring to research indicating that extended breast-feeding may reduce the risk for both mother and daughters.

Scientists who study breast milk almost all speak of it in superlatives. Even the International Formula Council, a trade association, acknowledges that breast-feeding "offers specific child and maternal health benefits" and is the "preferred" method of infant feeding. The American Academy of Pediatrics states in its breast-feeding policy that human breast milk is "uniquely superior for infant feeding."

Dr. Haynes, of the Health and Human Services Department, said, "Our message is that breast milk is the gold standard, and anything less than that is inferior."

Formula "is not equivalent," she went on, adding, "Formula is not the gold standard. It's so far from it, it's not even close."

Formula manufacturers say infant formula is modeled on breast milk and emphasize that it is the only safe alternative recommended by pediatricians for mothers who cannot, or choose not to, breast-feed.

But while formula tastes the same way at every feeding, advocates of breast-feeding say, the smells and flavors of human breast milk change from day to day, from morning to evening, influenced by the mother's diet. Many nutritionists believe that exposing an infant to this bouquet of flavors early on may make for less fussy eaters who are more flexible about trying new foods and more likely to eat a healthy, varied diet.

"I think of human milk not just as food, but as a sophisticated and intricate infant support system that has evolved over millions of years to provide the infant with nutrition, protection and components of information," said Dr. E. Stephen Buescher, a professor of pediatrics at Eastern Virginia Medical School in Norfolk, who heads the inflammation section in the school's Center for Pediatric Research.

"It isn't just calories," Dr. Buescher said.

The protection that breast-feeding provides against acute infectious diseases — including meningitis, upper and lower respiratory infections, pneumonia, bowel infections, diarrhea and ear infections — has been among the most extensively studied of its benefits and is well documented, said Dr. Lawrence M. Gartner, chairman of the American Academy of Pediatrics' breast-feeding section.

Breast-fed babies have 50 percent to 95 percent fewer infections than other babies, Dr. Gartner said, adding, "It's pretty dramatic."

One reason for the reduction in the incidence and the severity of infections is the antibodies contained in the mother's milk. "A lot of this has to do with the mother and baby interacting," he explained. "Whatever the baby is exposed to, the mother is exposed to, and the mother will make antibodies within three to four days." The baby absorbs them through breast milk.

Breast milk also protects the baby through other mechanisms. For example, it contains agents that prevent bacteria and viruses from attaching to cells in the baby's body, so the foreign agents are expelled in the stool, Dr. Gartner said.