Metropolitan Digital

The Conversation

  • Written by Joan Y. Meek, Associate Dean of Graduate Medical Education; Professor, Clinical Sciences, Florida State University

Breastfeeding has long been the gold standard for infant nutrition. The American Academy of Pediatrics[1], American Academy of Family Physicians[2], American College of Obstetricians and Gynecologists[3], and World Health Organization[4] all recommend it.

Thus, the recent New York Times[5] report of U.S. interference in the World Health Assembly[6]’s attempt to adopt the resolution that “mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes” alarmed many concerned about public health.

As a pediatrician and a nutritionist, I have provided direct patient care to breastfeeding mothers and children and also advocated for breastfeeding policies and practices. The scientific research in support of breastfeeding is overwhelmingly clear, and most mothers in the U.S. have heard that message and learned from it. Marketing and sales of infant formula have surged[7] in developing countries, however. That’s created a dilemma for the U.S., which has not wanted to restrict the US$70 billion infant formula business[8].

This comes at another price. Lack of breastfeeding worldwide is blamed for 800,000 childhood deaths[9] a year.

Mother’s milk, for thousands of years

Direct breastfeeding and exclusive human milk feeding were the only sustainable infant feeding for thousands of years. Initial efforts prior to the 1800s to provide alternative animal milk sources[10] for infant feeding resulted in greater risk of disease, often from infection, dehydration and malnutrition, as well as death.

The ability to sterilize and evaporate cow’s milk in the early 1800s allowed for preparation of alternative infant feedings, however. Throughout the rest of that century, different brands of alternate feedings, almost all based upon cow’s milk, proliferated.

The American Medical Association first called for standards for safety and quality[11] in 1929. With more women working outside of the home during and after World War II, the use of infant formula become more common. Formula makers began to market formula as a convenience item to allow for a freer lifestyle and to replace breastfeeding. U.S. breastfeeding rates began to drop, hitting an all-time low of 24.7 percent initiation[12] in 1971.

Medical professionals were not trained to support breastfeeding at this time, but mothers demanded to reclaim breastfeeding through a grass-roots movement. The resurgence of breastfeeding in the U.S. has been attributed in particular to efforts of founders of La Leche League International[13].

In 1981, the World Health Organization adopted the International Code of Marketing of Breast-milk Substitutes[14]. All participants of the United Nations-affiliated World Health Assembly support breastfeeding and limit the marketing of alternative feedings, or infant formula, except the U.S.

The code restricts inappropriate marketing of infant formula to families and prevents formula companies from providing free formula to consumers or health care facilities. The code also calls upon all countries to enact legislation to enforce it. The code specifically does not restrict access to formula to those families who need or request to use it.

Also, the International Baby Food Action Network[15] was formed to protect a mother’s right to breastfeed and an infant’s right to be breastfed, as well as to monitor compliance with the code. The WHO and UNICEF subsequently developed “The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding”[16] in support of maternal and child health in 1990.

Among infants born in the U.S. in 2014, the most recent national data available, 82.5 percent were breastfed initially[17], but disparities existed based upon socioeconomic and demographic status.

A Lancet series on breastfeeding[18] indicated that six- and 12-month continuation rates for breastfeeding remain low in most countries. The WHO Global Breastfeeding Scorecard[19] also shows that no country is highly compliant on all indicators that monitor support and protection of breastfeeding.

Why breastfeeding matters

The benefits of breastfeeding[20] for children and mothers are irrefutable. Initiation of skin-to-skin contact immediately after delivery, with early onset of breastfeeding within the first hour of life, supports newborn stability and provides protective immunoglobulins[21], especially secretory IgA, and other immune protective factors. Human milk provides human milk oligosaccharides[22], facilitating the colonization of the intestinal tract with probiotics[23] and establishing a microbiome[24] that protects against pathogenic[25] bacteria.

In contrast, formula-fed infants face higher rates of gastrointestinal diseases, respiratory infections and a higher likelihood of sudden infant death syndrome. Longer term, they have a higher risk of obesity, type 2 diabetes, asthma and certain childhood cancers when compared to breastfed cohorts.

Also, mothers who fail to breastfeed according to current recommendations face higher risks[26] of postpartum hemorrhage, breast cancer, ovarian cancer, obesity, type 2 diabetes and heart disease[27], including hypertension and myocardial infarction, or heart attack. About 20,000 cases of preventable death from maternal cases of breast cancer are attributed to lack of breastfeeding, according to the Lancet series[28].

Some of the poorest countries have the lowest breastfeeding initiation and duration and could gain the most in terms of health impact and economic benefit[29] from improving breastfeeding rates.

What has the US done to support breastfeeding?

Partnership between governmental and nongovernmental agencies resulted in the formal designation of the United States Breastfeeding Committee[30] in response to “The Innocenti Declaration.” The Department of Health and Human Services developed a mass media campaign[31] in 2008 to support and promote breastfeeding.

In 2011, the U.S. Surgeon General’s Call to Action to Support Breastfeeding[32] recognized key elements required to support breastfeeding, including health care, families, communities and employment. The Centers for Disease Control and Prevention has supported quality improvement initiatives aimed at changing maternity care practices[33] to better support and promote breastfeeding. Breastfeeding efforts at the community level have involved obesity prevention efforts.

Influence of infant formula makers

Breastfeeding has been the best public health policy throughout history Powdered infant formula must be mixed with clean water, which is often unavailable in many poor countries. Dima Sobko/Shutterstock.com[34]

As more infants were breastfed in the U.S., formula makers turned their sights to developing countries. This contributed to a global decline[35] in breastfeeding rates, similar to that seen in the U.S.

Infants in developing countries[36] face the greatest risk from malnutrition, diarrhea, dehydration and death when fed formula that is contaminated by bacteria or parasites from unclean sources of water, or when bottles or nipples are not cleaned regularly in hot, soapy water. Diarrheal diseases and resultant dehydration are a leading cause of death in infants in poor countries, where breastfeeding may be lifesaving.

Good quality infant formula can be necessary and lifesaving when mother’s milk is not an option and pasteurized donor human milk is not available. However, the formula industry stands to gain the most financially when breastfeeding fails. The formula industry should not be influencing public health policy. The U.S. delegates to the World Health Assembly must lead the way in support of health policies based upon science.

As a member of the global community advocating for optimal public health and improving maternal child health outcomes, the U.S., I believe, bears responsibility to support evidence-based practices. In the area of breastfeeding support, the U.S. lags behind other resource-rich nations with a lack of universal health care, lack of paid maternity leave, and employment policies that do not provide universal support for employed mothers to continue breastfeeding.

References

  1. ^ American Academy of Pediatrics (pediatrics.aappublications.org)
  2. ^ American Academy of Family Physicians (www.aafp.org)
  3. ^ American College of Obstetricians and Gynecologists (www.acog.org)
  4. ^ World Health Organization (www.who.int)
  5. ^ New York Times (www.nytimes.com)
  6. ^ World Health Assembly (www.who.int)
  7. ^ Marketing and sales of infant formula have surged (www.ncbi.nlm.nih.gov)
  8. ^ US$70 billion infant formula business (www.nytimes.com)
  9. ^ 800,000 childhood deaths (www.thelancet.com)
  10. ^ provide alternative animal milk sources (www.ncbi.nlm.nih.gov)
  11. ^ standards for safety and quality (www.ncbi.nlm.nih.gov)
  12. ^ 24.7 percent initiation (web.archive.org)
  13. ^ La Leche League International (www.llli.org)
  14. ^ International Code of Marketing of Breast-milk Substitutes (www.who.int)
  15. ^ International Baby Food Action Network (www.who.int)
  16. ^ “The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding” (www.unicef.org)
  17. ^ 82.5 percent were breastfed initially (www.cdc.gov)
  18. ^ Lancet series on breastfeeding (www.thelancet.com)
  19. ^ WHO Global Breastfeeding Scorecard (www.who.int)
  20. ^ benefits of breastfeeding (pediatrics.aappublications.org)
  21. ^ immunoglobulins (www.medicinenet.com)
  22. ^ human milk oligosaccharides (www.ncbi.nlm.nih.gov)
  23. ^ probiotics (www.ncbi.nlm.nih.gov)
  24. ^ microbiome (www.ncbi.nlm.nih.gov)
  25. ^ pathogenic (www.merriam-webster.com)
  26. ^ risks (www.ncbi.nlm.nih.gov)
  27. ^ heart disease (www.ncbi.nlm.nih.gov)
  28. ^ Lancet series (www.thelancet.com)
  29. ^ economic benefit (www.thelancet.com)
  30. ^ United States Breastfeeding Committee (www.usbreastfeeding.org)
  31. ^ mass media campaign (webarchive.library.unt.edu)
  32. ^ U.S. Surgeon General’s Call to Action to Support Breastfeeding (www.surgeongeneral.gov)
  33. ^ maternity care practices (www.cdc.gov)
  34. ^ Dima Sobko/Shutterstock.com (www.shutterstock.com)
  35. ^ global decline (www.who.int)
  36. ^ Infants in developing countries (www.who.int)

Authors: Joan Y. Meek, Associate Dean of Graduate Medical Education; Professor, Clinical Sciences, Florida State University

Read more http://theconversation.com/breastfeeding-has-been-the-best-public-health-policy-throughout-history-99663

Metropolitan republishes selected articles from The Conversation USA with permission

Visit The Conversation to see more

Entertainment News

Phish’s 2018 Fall Tour to Conclude with Four Performances at MGM Grand Garden Arena

LAS VEGAS (May 15, 2018) – Phish, the American rock band known worldwide for its dedicated fan base, recently announced a 14-date Fall tour which will conclude in Las Vegas with four performances at...

Dave Damiani and The No Vacancy Orchestra are “Bending The Standard”

Tina Sinatra, Dave Damiani & Landau Murphy Jr. celebrate 100 years of Frank Sinatra in Los Angeles There have been stories about independent filmmakers, but how about the independent big band...

Billboard Chart-Topping Saxophonist VANDELL ANDREW Returns With New Single

From the vantage point of 30, his age and the name of his infectious, sensually grooving new full length album, Vandell continues to be fueled by the impressive roar of accolades and achievements th...

Metropolitan Business News

Marketing Impact of Having Online Product Reviews

Whether they are searching online for a service or a specific product, in many cases customers tend to look for online product reviews. They often want to make a comparison to other products or simply...

NYC-BASED PUBLIC TELECOM GIANT TCC TELEPLEX LAUNCHES

“TOMORROW’S HIGH TECH DIGITAL NETWORK TODAY” WITH ITS REVOLUTIONARY, MULT-MEDIA AND SERVICES DRIVEN IAP “EVERYTHING” KIOSK The TCC Teleplex IAP Kiosks Include a High-Res 360-Degree Webcam, a 22-...

HOW TO PREPARE FOR RETIREMENT: Finding and Living Your “It”

The name of my Woburn, MA financial services firm is Summit Financial Partners for a very good reason – because the clients I work with have either reached their retirement summit (i.e. they’re ready ...

How to build a distinctive Brand Voice

Nearly four decades ago, I made a presentation that captured considerable attention in the marketing community. The subject was ‘Brand Voice.’ The concept is widely used today by branding profess...

ADROLL RELAUNCHES BRAND WITH NEW COMPANY VISION

AdRoll, the growth platform for ambitious commerce businesses, has today announced an exciting new phase in the evolution of the AdRoll brand for its 37,000 customers worldwide. Recognising its uniq...

Global Shop Solutions Customer Load King Goes Live with Manufacturing Factory of the Future

THE WOODLANDS, TX, February 22, 2018 – After nearly 9 months of preparation, Load King, a world leader in store fixture manufacturing, has successfully finished their manufacturing factory of the fu...