Breastfeeding Is Best Public Health Policy. Why Is It Discouraged?
gvw_the_conversation
By The Conversation
Published 7 years ago on
July 15, 2018

Share

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

Photo of Joan Y. Meek
Opinion
Joan Y. Meek
Thus, the recent New York Times report of U.S. interference in the World Health Assembly’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 in developing countries, however. That’s created a dilemma for the U.S., which has not wanted to restrict the $70 billion infant formula business.
This comes at another price. Lack of breastfeeding worldwide is blamed for 800,000 childhood deaths 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 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 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 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.
In 1981, the World Health Organization adopted the International Code of Marketing of Breast-milk Substitutes. 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 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” 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, but disparities existed based upon socioeconomic and demographic status.
A Lancet series on breastfeeding indicated that six- and 12-month continuation rates for breastfeeding remain low in most countries. The WHO Global Breastfeeding Scorecard 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 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, especially secretory IgA, and other immune protective factors. Human milk provides human milk oligosaccharides, facilitating the colonization of the intestinal tract with probiotics and establishing a microbiome that protects against pathogenic 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 of postpartum hemorrhage, breast cancer, ovarian cancer, obesity, type 2 diabetes and heart disease, 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.
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 from improving breastfeeding rates.

What Has US Done To Support Breastfeeding?

Partnership between governmental and nongovernmental agencies resulted in the formal designation of the United States Breastfeeding Committee in response to “The Innocenti Declaration.” The Department of Health and Human Services developed a mass media campaign in 2008 to support and promote breastfeeding.
In 2011, the U.S. Surgeon General’s Call to Action to Support Breastfeeding 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 to better support and promote breastfeeding. Breastfeeding efforts at the community level have involved obesity prevention efforts.

Influence of Infant Formula Makers

Powdered infant formula must be mixed with clean water, which is often unavailable in many poor countries.
Dima Sobko/Shutterstock.com

As more infants were breastfed in the U.S., formula makers turned their sights to developing countries. This contributed to a global decline in breastfeeding rates, similar to that seen in the U.S.
Infants in developing countries 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.
The ConversationAs 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.
Joan Y. Meek, Associate Dean of Graduate Medical Education; Professor, Clinical Sciences, Florida State University
Disclosure: Joan Y. Meek is affiliated with the American Academy of Pediatrics as a member and chairs the Section on Breastfeeding, in an elected, non-paid position. This article represents her opinion and not those of the American Academy of Pediatrics.
This article was originally published on The Conversation. Read the original article.

DON'T MISS

23 for ’23: A Year in Photos

DON'T MISS

See How this Fresno roastery sends aid to Northern Thailand.

DON'T MISS

District Says Fresno Teachers Contract Proposal Would Bankrupt Budget Reserves by Year 3

DON'T MISS

Trump Vows to Ban Gaza Refugees, Expand Muslim Travel Ban If He Wins

DON'T MISS

The Supreme Court Orders Makers of Gun Parts to Comply with Rules on Ghost Guns

DON'T MISS

George W. Bush for Speaker? A Democratic Lawmaker Thinks It’s Possible

DON'T MISS

Former Navy IT Manager Gets Five Years for Hacking, ID Theft

DON'T MISS

Gunman Kills Two Swedes in Brussels, Prompting Terror Alert and Halt of Belgium-Sweden Soccer Match

DON'T MISS

Zakaria: The Best Response to Hamas Would Be to Keep the Saudi Deal Alive

DON'T MISS

Groundbreaking Human Brain Atlas Offers New Hope for Treating Neurological Disorders

UP NEXT

George W. Bush for Speaker? A Democratic Lawmaker Thinks It’s Possible

UP NEXT

What Does Destroying Gaza Solve?

UP NEXT

How Liberal California Compares to Florida, Texas on Social Media Regulation

UP NEXT

City of Fresno’s Israeli Flag Raising Draws Supporters and Protesters

UP NEXT

Former Fresno CC Coach Ed Madec Arrested for Allegedly Threatening to Kill Chancellor

UP NEXT

Trump Vows to Ban Gaza Refugees, Expand Muslim Travel Ban If He Wins

UP NEXT

Former Navy IT Manager Gets Five Years for Hacking, ID Theft

UP NEXT

Zakaria: The Best Response to Hamas Would Be to Keep the Saudi Deal Alive

UP NEXT

Newsom Signs Law to Slowly Raise Healthcare Minimum Wage to $25

UP NEXT

Groundbreaking Human Brain Atlas Offers New Hope for Treating Neurological Disorders

You May like

Trump Vows to Ban Gaza Refugees, Expand Muslim Travel Ban If He Wins

1 year ago

The Supreme Court Orders Makers of Gun Parts to Comply with Rules on Ghost Guns

1 year ago

George W. Bush for Speaker? A Democratic Lawmaker Thinks It’s Possible

1 year ago

Former Navy IT Manager Gets Five Years for Hacking, ID Theft

1 year ago

Gunman Kills Two Swedes in Brussels, Prompting Terror Alert and Halt of Belgium-Sweden Soccer Match

1 year ago

Zakaria: The Best Response to Hamas Would Be to Keep the Saudi Deal Alive

1 year ago

Groundbreaking Human Brain Atlas Offers New Hope for Treating Neurological Disorders

1 year ago

Newsom Signs Law to Slowly Raise Healthcare Minimum Wage to $25

1 year ago

Former Fresno CC Coach Ed Madec Arrested for Allegedly Threatening to Kill Chancellor

1 year ago

Jim Jordan’s Rapid Rise Cheered by Trump and Far Right. Could It Make Him Speaker?

1 year ago

HOT OFF THE PRESS

23 for ’23: A Year in Photos

1 year ago

1 year ago

Trump Vows to Ban Gaza Refugees, Expand Muslim Travel Ban If He Wins

1 year ago

The Supreme Court Orders Makers of Gun Parts to Comply with Rules on Ghost Guns

Photo of a hacker typing on a laptop

1 year ago

Former Navy IT Manager Gets Five Years for Hacking, ID Theft

1 year ago

Gunman Kills Two Swedes in Brussels, Prompting Terror Alert and Halt of Belgium-Sweden Soccer Match

1 year ago

Zakaria: The Best Response to Hamas Would Be to Keep the Saudi Deal Alive

1 year ago

Groundbreaking Human Brain Atlas Offers New Hope for Treating Neurological Disorders

1 year ago

Newsom Signs Law to Slowly Raise Healthcare Minimum Wage to $25

1 year ago

Oprah Winfrey Proposed 2020 Presidential Run with Mitt Romney, New Book Reveals

1 year ago

Bulldogs Get a Bye Week to Heal After Gutting Out Win at Utah State

1 year ago

Trump Has Narrow Gag Order Imposed on Him by Federal Judge Overseeing 2020 Election Case