Breastfeeding becomes controversial again even through breast is still best

A woman breastfeeds her child while waiting for health services outside a health center in Nampula, Mozambique.  Copyright 2017 Arturo Sanabria, Courtesty of Photoshare

This was originally published on Sept. 25, 2018 on Global lHealth TV.

Breastfeeding — one of the most documented and proven best practices in global health — has become controversial again.

In the mid-1970s, Swiss-based Nestlé corporation was accused of unethical methods of marketing infant formula over breast milk to poor mothers in developing countries. Legal challenges to these practices by Nestlé and other companies led to a boycott of Nestlé. This led to the 34^thWorld Health Assembly adopting an International Code of Marketing of Breast Milk Substitutes in 1981. Three years later, Nestlé agreed to the code, and the boycott ended.

In May, the U.S. delegation to the World Health Assembly shocked other delegates when they tried to water down a resolution to promote breastfeeding and limit misleading marketing of infant formula. When that failed, according to The New York Times, they threatened Ecuador, the sponsor of the resolution, with trade sanctions and withdrawal of military aid. Russia introduced a similar measure and it was ultimately approved in a slightly altered form that was supported by the U.S. The U.S. ambassador to Ecuador, Todd Chapman, later called reports that the U.S. threatened Ecuador “patently false and inaccurate.” 

President Donald Trump weighed in on the brouhaha, writing on Twitter: “The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”

The response of the U.S. government over its objections to the breastfeeding resolution came in an email from the Department of Health and Human Services to The New York Times: “The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children. We recognize not all women are able to breastfeed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”

“The events that unfolded at the World Health Assembly reflect the Trump administration’s deeply troubling disregard for evidence and its impact on an issue that shouldn’t be controversial: promoting what is best for babies,” wrote Cindy Huang, a senior policy fellow at the Center for Global Development, a think tank based in Washington, D.C.

I don’t think that anyone wants to deny formula to women who are unable to breastfeed for whatever reason (and there are certainly women who cannot). But because the benefits of breastfeeding are so compelling and well established, its advocates want to make sure that breastfeeding is promoted better, and that inaccurate and misleading marketing of formula is limited.

There is strong and convincing evidence regarding these benefits. Over 800,000 children’s lives could be saved every year if all children under 24 months were optimally breastfed, according to the World Health Organization. 

"Breastfeeding gives babies the best possible start in life," said Dr Tedros Adhanom Ghebreyesus, director-general of WHO. "Breast milk works like a baby’s first vaccine, protecting infants from potentially deadly diseases and giving them all the nourishment they need to survive and thrive."

Exclusive breastfeeding for the first six months provides many benefits for the baby and the mother including protection against gastrointestinal infections. It helps prevent diarrhea and pneumonia, two major causes of death in infants. It’s also an important source of energy and nutrients for children 6-23 months.

“Breast is best” even in emergency and disaster responses. Save the Children began investing in breastfeeding during emergency responses following the Haiti earthquake and now incorporates it into every emergency response plan.

And the benefits of breastfeeding extend well beyond infancy. Breastfeeding improves IQ and school attendance. Adolescents who were breastfed are less likely to be overweight and obese. Breastfeeding is associated with higher income in adult life. And the list goes on.

Few health interventions are as effective — and cost-effective — as breastfeeding.

Yet only about 40% of infants 0-6 months old are exclusively breastfed. No country in the world fully meets recommended standards for breastfeeding, according to a report by UNICEF and WHO.

Meanwhile, sales of infant formula are soaring, and expected to reach $71 billion next year, according to the Lancet. Reports of violations of the International Code of Marketing of Breastmilk Substitutes are numerous.

“Research continues to show that the industry’s aggressive marketing is associated with lower breastfeeding rates, as formula becomes more common around the world,” wrote Victor Aguayo, chief of the UNICEF Global Nutrition Program. “The data tells us that mothers who receive free formula samples when they are discharged from hospital breastfeed less, and that the widespread promotion of formula and other breast milk substitutes leads to misinformation about breastfeeding, influencing families’ feeding decisions in ways that impact children throughout their lives.”

Formula is a particular concern for families that do not have access to clean water.

WHO and UNICEF recommend:

§ Early initiation of breastfeeding within one hour of birth;

§ Exclusive breastfeeding for the first six months of life; and

§ Introduction of nutritionally-adequate and safe complementary (solid) foods at six months together with continued breastfeeding up to two year of age or beyond.

It seems that everyone, including the Trump Administration, acknowledges the benefits of breastfeeding so we should all work together to promote breastfeeding more energetically, while also allowing infant formula to be widely available through accurate and responsible marketing.