Breastfeeding in Developed Countries

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AHRQ Report

Agency for Healthcare Research and Quality (AHRQ) 2007 Report, Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries

The IFC International Formula Council (IFC)* and its members commend the efforts of the US Department of Health and Human Services (HHS) to examine the benefits of breast-feeding. IFC agrees breast-feeding is the ideal infant feeding, and that it offers specific child and maternal health benefits. However, we are concerned about the lack of scientific support for the conclusions of the HHS-funded Agency for Healthcare Research and Quality (AHRQ) 2007 report, Effectiveness of Breast-feeding on Maternal and Infant Health Outcomes. This report is anticipated to play a key role in the U.S. government's breast-feeding policy. But public health will not be advanced on the basis of this report because it does not accurately and without bias reflect current scientific evidence on breast-feeding and health outcomes. Therefore, we strongly recommend that the report not be relied upon to influence public policy. The AHRQ report's two fundamental conclusions are sound:

• "Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings."
• "There is a wide range of quality of the body of evidence across different health outcomes."

However, concern remains that the procedural short cuts used in the report's assessment compromised the scientific review process and yielded biased results. Specifically, the AHRQ report:

• Failed to examine the quality of most of the articles included in the reviews evaluated,
• Utilized an inconsistent methodological approach in considering the meta-analyses and reviews, for example sometimes evaluating existing meta-analyses and systematic reviews and at other times seemingly rejecting existing reviews and conducting new meta-analyses,
• Ignored the significant overlap of articles that repeatedly appear across the quoted meta-analyses and reviews, perpetuating errors and invalid interpretations, and
• Included certain health outcomes and studies and excluded others without explanation.

This report is largely based on a representation of dated studies that often lacked consistent definitions of breast-feeding and controls for confounding variables that could introduce bias. Thus, it is important that any promotion of this report convey its results, conclusions, and limitations in a fair and balanced way and clearly identify that causality can not be inferred based on these findings. In both acute and chronic disease, multiple environmental and genetic factors play a significant role in disease development. The AHRQ report inappropriately considers breast-feeding as an isolated factor. For many of the health outcomes addressed, there may be other, more important interventions, which could have a far greater impact on public health.

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*The International Formula Council is an association of manufacturers and marketers of formulated nutrition products, e.g., infant formulas and adult nutritionals, whose members are based predominantly in North America. IFC members are: Abbott Nutrition; Mead Johnson Nutrition; Nestlé Infant Nutrition; and Wyeth Nutrition.