Bad Evidence Drives Bad Decisions and Bad Policy

There is a saying: “Bad evidence drives bad decisions.” Unfortunately there appears to be growing mountains of bad evidence (or misinterpreted evidence) when it comes to maternity care, and that bad evidence is being fed into bad policy that then results in bad practice and ultimately moms and babies who suffer. Sadly, some of the bad evidence is likely a result of a backwards cycle of evidence and policy where by a policy is developed based on ideology or theory, and then evidence is sought out to support the policy or practice after the fact.

It’s a logic (and arguably ethics) fail of elephantine proportions.

A failure that has yet again been demonstrated in yet another study, widely reported by the BBC: http://www.bbc.com/news/health-28851441 – this time finding that breastfeeding cuts depression risk.

The first big red flag – the thing that should cause policy makers and their brethren pause for thought is the real finding of this study (as opposed to the trumpeted headline) – which is the following: There is a large increase in the risk of depression in women planning to breastfeed who are then unable to do so.

Think about that for a moment, women who successfully breastfeed, who manage to fulfill their objective are seen to have a lower risk of depression (50 percent decrease in risk), while those who plan on, but ultimately find that they cannot, for whatever reason – suffer a large increase in risk of post-natal depression. It is remarkably similar to a recent study that found that women who had births that were unlike the births that they had ‘planned’ were at increased risk for post-natal depression.

So what are the policy implications of this study?

In the news article, the conclusion is drawn that mothers should be encouraged to breastfeed and that there are so many benefits, and that more support to breastfeed is needed, but those who “fail” should be identified as being at risk and health visitors should keep an “eye” on those women.

So in short, the policy response to this study is to keep doing what is likely causing the observed relationship between breastfeeding and depression. Applaud and support the “good mothers” who breastfeed, and further stigmatize those who either choose not to or find that they are unable to breastfeed.

I am dumb founded at the sheer lack of insight as to what ought to be done in response to this study. It seems incredibly clear to me that the right policy response, is to build resilience among all expectant mothers as many might find that for whatever reason they are either not wanting to or not able to breastfeed and by supporting them in the choices that best meet their needs and those of their babies. That would mean toning down the incredible amount of pro-breastfeeding/anti-formula propaganda that mothers are exposed to. That means sending different messages about the meaning of being a “good mother” – messages that focus on outcomes, not process and contribute to a feeling of confidence in what is to many a challenging and difficult new role.