BY THE NUMBERS: WHERE WE STAND ON BREASTFEEDING RESEARCH & WHY

During both of my breastfeeding journeys, I was glued to Google...and enormously frustrated. As a researcher and data expert myself, I was shocked by how little actual research and data exists on breastfeeding, breast milk, and postpartum life for nursing moms. Search after search, all I found was conflicting information, extreme recommendations without any data backing them, and a complete absence of info for many questions about breastfeeding, breast milk, and supply beyond the newborn phase.

After hearing Katie Hinde's famous Ted Talk about how little research there is on breastfeeding and breast milk, I wanted to investigate myself. Sure enough, according to Jstor.org, one of the largest databases of journals and research, the numbers are startling.

Breastfeeding, breast milk, and human milk have a fraction of published articles and research reports of others foods, even lettuce is better studied. We are not talking about small differences, coffee has 187,000 more publications and reports than breast milk, human milk, and breastfeeding combined!

Around 140 million women give birth every year around the world, how are there under 18,000 publications and reports on the topic?

Why is something as ancient as breast milk so poorly researched? When you dig into this gap more, the drivers are frustrating and this frustration was the main reason I founded Milk & Fire. I wanted to design smart and high-quality products for nursing moms that also fund more breastfeeding research on questions most relevant to moms in the thick of their journeys.

The Research versus The Questions Nursing Moms Ask Most

Let's take a closer look at the research that does exist in those 17,285 publications and reports. How do the questions that have been formally researched compare to the topics most relevant to nursing moms? Surely, scientists would research topics that are most important to moms and create a positive breastfeeding experience? Sadly, no.

I analyzed where the existing formal research and journal publications focus with the help of one of my favorite AI tools that maps research publications, Iris.AI (also an amazing female founder!). Then using Google search analytics, I researched the top questions around breastfeeding and breast milk that moms are searching for information on in high volumes.

 
As you can see, the questions studied and questions that are top of mind for moms do not match at all! Most of the formal research focused on the baby in the hospital (skin to skin at birth, Preterm impact, potential for passing on disease) and around the scientific composition of breast milk.

For moms, the questions on the list are ones that most of us can remember and relate to from our own breastfeeding journey after leaving the hospital. What is causing this pain and how can I make it go away? What happens to my milk supply if I get pregnant again? What can I eat and drink to increase my supply?
What is normal? What tips and tricks can make breastfeeding easier, especially on the go? They are also questions that lack formal data to address but do have many people on the internet with advice and points of view from a sample size of one (aka it worked for them, so they extract that it must be true for all).

For the small amount of existing research on these questions, the results are often buried in formal journal articles that are not translated from research jargon and academic papers down to meaningful tips and actions for moms.

What is Driving the Low Research Numbers and Gap to What Matters to Moms?

1. Research Funding Follows Profit

The federal share of research funds dropped below 50% for the first time starting in 2015. This means that a large proportion of research is funded by for-profit ventures. In short, research follows profit opportunities in many cases.

Researching a topic often needs to lead to commercial benefit so the cost of the study carries a return on investment - even academic institutes feel this pressure, many professors have spoken about the pressure that even their academic research should lead to inventions that can be sold or licensed to companies. Understanding questions around breastfeeding supply, tips, pain just is not very profitable.

Increasing the supply of crops and understanding the health benefits of food for marketing to sell more is profitable research. Increasing the supply of breast milk does not directly link to increased profits. In fact, many of the studies on breast milk's nutritional composition and bioactivity are linked to formula companies trying to replicate the magic of breast milk in infant formula.

2. Controlled Environments Help Control Variables

Breastfeeding is messy for study design. Each mother + baby relationship has a wide range of variables. Milk also adjusts as temperature changes or a baby catches a cold or throughout the day. Statistically controlling for that many variables to draw conclusions based on significant differences is challenging and requires large-scale, costly studies.

It is easier to control variables and collect data in a hospital setting. This may explain why a large chunk of the existing research is in the hospital environment.

However, the hospital stay is only the first few days of what many moms hope will be weeks, months, or years of breastfeeding. While I do agree with my favorite fortune cookie that says "the secret to success is in getting started", it is not enough to properly support moms on their journeys. Journeys full of twists, turns, and significant changes for the bodies of nursing moms and the baby.

3. Cultural Lack of Focus on Postpartum Moms

Moms are not the focus of attention after birth at the hospital, the focus is on the baby. As Alison Stuebe, an associate professor of maternal-fetal medicine at UNC-Chapel Hill and a lead researcher on the 4th Trimester project said, "The baby is vulnerable and has resources devoted to it, and American culture doesn't appreciate that the mother is recovering from a process."

Almost half of women who give birth are still in pain weeks later, yet most moms only have one short postpartum visit 6 to 8 weeks post-birth. According to the Commonwealth Fund, around 52% of maternal deaths happen up to a year postpartum, and nearly two-thirds of deaths are attributed to preventable causes. It is no wonder in a culture that puts so little emphasis on the mother postpartum that there is little to no research on breastfeeding after leaving the hospital.

4. Gender Disparity in Science

Similar to other STEM professions, women are underrepresented in science and research publications.

And where women are underrepresented, issues that matter to women are underrepresented. Penn Medicine Researchers found that of the 5,554 articles published in 5 leading academic medical journals between 2015 and 2018, 35.6 percent had a female primary author, and 25.8 percent had a female senior author. During this period, the articles with women as a primary authors were referenced in other academic articles a median of 36 times, compared 54 citations of articles with male primary authors.

Compounding the issue, according to a PNAS review of the data, female scientists have a 19.5% higher risk of leaving academia each year than male scientists, resulting in few senior female scientists driving an agenda that might apply to women's health. This disparity no doubt contributes to the low amount of research studies on breastfeeding and breast milk.

Let's Demand Better Data for Nursing Moms Together

Our mission is to help overcome these cultural and environmental biases to demand better data for nursing moms. Stay tuned for future blog posts where we will dive into what academic research does exist on these top questions from moms and how we can translate the formal research reports to information that empowers nursing moms every day.

A portion of every purchase from Milk & Fire also goes towards new research on breastfeeding on topics that matter for moms.

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