Promoting Exclusive Breastfeeding: A Global Health Intervention

Yesterday in class we identified that a key public health issue to address worldwide is the promotion of exclusive breastfeeding for infants. We then discussed how aggressive infant formula marketing is problematic in developing countries. I wanted to elaborate here on my comment during class about this, and give some concrete information for you guys to find and reference as we finish the term and part ways.

First of all, I want to identify exactly what these regulations are that the formula companies are violating. It is an international policy organized by WHO in 1981 that is designed to hold formula companies accountable to their advertisement claims and ensure that mothers are not discouraged from breastfeeding.  Here is the full text of the code- "International Code of Marketing of Breast-milk Substitutes". You can see that much of this code is ignored even here in the US, so you can imagine how it might be for other countries without adequate health care and political strength.

Earlier in the term I wrote a post on this blog about maternal health, and I referenced the Unicef video: Formula For Disaster. It's only 30 minutes, and it is very much a clear example of why inappropriate promotion of formula results in poor health and economic dysfunction for developing communities.

None of this is to say that formula doesn't have a legitimate role to play in nourishing babies. To identify cultural, medical, and behavioral components of the decision to breastfeed or not is not the point here. The problem we're talking about is that families- here and in developing countries- receive the message that formula is the healthier choice for their baby; that breast milk is inferior and baby needs more nutrients than it can provide. This is simply not true. In fact, the exact opposite is true. Even now here in culturally liberal Pacific Northwest, one of the most common things I hear is that moms are convinced breast milk is not enough nutrition for baby for the entire recommended "exclusive breastfeeding" duration, or they can't produce enough milk to meet the baby's growth needs.  Lactation science is such that the mother's body produces more milk as the milk is used. If it seems like supply isn't meeting demand, it's probably because the baby isn't latching well and actually drinking the milk. Breastfeeding is a LEARNED BEHAVIOR; despite popular belief, babies and moms do not meet each other and automatically know how to breastfeed. This is why formula has gotten so popular, but once one begins supplementing feeding with formula, it is an uphill battle to maintain the natural production of breast milk.

As far as the WHO actual breastfeeding recommendations and why? WHO definitions of "exclusive breastfeeding" are that babies receive "no other food or drink, not even water, except breast milk...for [the first] 6 months of life." Here is more from WHO about why breast milk is so important:

"Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life... 

Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness... 

As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond." (Emphasis mine.) 

This research article (Stuebe, A. 2009. "The risks of not breastfeeding for mothers and infants" Reviews in Obstetrics and Gynecology) shares a little about why formula is not actually better than breast milk, and why its use should be discouraged unless medically necessary.

"There are...innate immune factors present in human milk that provide specific protection against pathogens in the mother’s environment. In addition, immune factors in milk provide protection against infections such as H influenzae, S pneumoniae, V cholerae, E coli, and rotavirus...

Not breastfeeding is associated with health risks for both mothers and infants. Epidemiologic data suggest that women who do not breastfeed face higher risk of breast and ovarian cancer, obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease...

Formula feeding is associated with adverse health outcomes for both mothers and infants, ranging from infectious morbidity to chronic disease. Given the compelling evidence for differences in health outcomes, breastfeeding should be acknowledged as the biologic norm for infant feeding."

So, what do we do about this particular global health problem? Well, we can each individually work on our own acceptance and support of mothers who breastfeed...even if their baby is getting to be a toddler. We can arm ourselves with knowledge about rights and where to go for breastfeeding assistance as problems arise (such as our local La Leche League, and Nursing Mother's Counsel of Oregon) because IT IS HARD FOR MOMS to breastfeed, especially in the beginning immediately after birth,  and then when they want to do other things like sleep, work, and go to school.

I hope that this post has expanded your awareness of why it is an important global health issue to promote exclusive breastfeeding for at least the first six months of life, and to supplement a toddler's diet with breast milk until age two, or even longer. Thank you for reading. It's been a great term, everyone. Happy Finals!