Breastfeeding: A standard or an intervention? Review of systematic reviews

Clinical trials designed to answer treatment-related questions typically compare an intervention group that receives a drug or other intervention to a control group that serves as a standard against which results of the intervention are evaluated. An observed divergence from this trend in research papers on breastfeeding led us to hypothesize that the majority of breastfeeding research designs assign breastfed children to an intervention group rather than the control group, although breastfeeding is a physiological way of feeding infants that may be considered as a general standard. Headlines and abstracts of 760 publications identified in 2 databases were checked, and a total of 68 systematic reviews were included in our review with the goal to see if breastfed children were mostly considered as the intervention or control group. Our review showed that in 79,41% of papers breastfed children were regarded as the intervention group. The results of these papers were usually presented in a manner to show breastfeeding was beneficial in comparison to formula-feeding - as if breastfeeding was a health intervention. This way of data presentation probably helps to form attitude that formula-feeding is the norm and breastfeeding an optional choice, a "superstandard" with certain health benefits. Therefore, all available studies that regard breastfeeding should be interpreted with caution. We suggest that authors, while conducting and reporting clinical trials, regard breastfed children as the control group, and non-breastfed children as the intervention group.