Currently browsing posts about: Breast-feeding

Jennifer Grayson.  Unlatched: The Evolution of Breastfeeding and the Making of a Controversy.  Harper. 2016.

I thought this book had plenty to say and said it well (and has a great cover).  I did a blurb for it:

Unlatched is a deeply engaging, highly personal, well researched, and thoughtfully balanced account of how modern society has denormalized breastfeeding.  Jennifer Grayson does not expect every mother to follow her example and breastfeed babies for three or four years.  Instead, she asks us to consider how formula feeding became the norm and how government policies perpetuate it as the norm (see especially the stunning chapter on the Women, Infants, and Children program).  She argues compellingly that our challenge as a society is to restore breastfeeding as the default for feeding babies, and to provide the support—political as well as emotional–that mothers need to breastfeed successfully.

FoodQualityNews reports that the British Food Standards Agency (FSA) is all upset about ice cream made from breast milk.

Eeks.  It might violate food safety standards!

The Baby Gaga breastmilk ice cream is sold by a London firm called The Icecreamists.  The company has been forced to withdraw Baby Gaga in response to complaints that it might not be safe for human consumption.

The milk comes from 15 moms.  It is screened prior to sale, in part because breast milk can pass on things like hepatitis.

But nowhere in this account does it say whether the milk was pasteurized or how the ice cream tastes.  I want to know!

A recent commentary in the British Medical Journal (BMJ) is causing a furor among breastfeeding advocates in Great Britain.

Titled Six months of exclusive breast feeding: how good is the evidence?, its authors argue that four months is probably just as good and less likely to cause harm.

The current British recommendation is for six months of exclusive breastfeeding—meaning no added solid foods.  This is based on a systematic analysis of research first published as a Cochrane review in 2002 and updated in 2006.  It compared the health of infants breastfed for six months to those breastfed for three-to-four months, and concluded that the science demonstrated significant advantages to the longer breastfeeding period.

That analysis was the basis of breastfeeding recommendations by United Nations agencies, such as the World Health Organization and UNICEF.  In Great Britain, UNICEF UK has issued its own statement defending the six-months recommendation.

Adding to the furor, the British Guardian titled its article about the new commentary, “Six months of breastmilk alone is too long and could harm babies, scientists now say.”  A second account in the Guardian provided a more cautious interpretation of the science.

I can understand why breastfeeding advocates are so upset about the BMJ paper.  They are worried about promotion of infant formulas as substitutes for breast milk, especially in developing countries.  Infant formulas can be adequate, if not perfect, substitutes for breast milk under conditions where they can be properly diluted and refrigerated.  When those conditions are impossible, as is the case in many low-income areas, formulas can become contaminated with harmful bacteria.  Use of infant formulas has a long history of association with infant illness and death (I wrote about this in Food Politics).

Formula companies did and continue to promote their products as convenient—and preferable—substitutes for breast feeding.

As it turns out, several of the authors of the BMJ commentary consult for formula companies.

Those authors vehemently deny that their ties to formula companies influence their opinions.  That may or may not be so, but such ties strongly correlate with research results and opinions favorable to the corporate ally.

In the United States, pediatricians strongly advocate breastfeeding, but flexibly.  In 1997, the American Academy of Pediatrics (AAP)  policy statement said.

Exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhea and respiratory tract infection….Complementary foods rich in iron should be introduced gradually beginning around 6 months of age.

But the AAP noted,

Unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as 4 months of age, whereas other infants may not be ready to accept other foods until approximately 8 months of age.

As any parent of more than one child can tell you, babies differ.  Some are happy with exclusive breastfeeding.  Others want solid foods the instant they learn how to swallow.

The new commentary isn’t wrong, exactly, although it says nothing new.

It just isn’t helpful.  And that’s reason enough to be upset about it.

If the most important risk factor for chronic malnutrition is poverty, natural disaster is surely the most important for acute malnutrition.   Nutrition problems created by natural disasters usually can be alleviated by effective government action and, when necessary, international aid.

But the flood disaster in Pakistan is so huge, and affects so many people over such a large area, that it has become an object lesson in the consequences of international disinterest.  What aid has been forthcoming has been slow to arrive and not much of it comes from the United States.

One result is illustrated in today’s Guardian (UK):

Children at roadside shelter, Northwest Pakistan. Photo: Mohammad Sajjad/AP

The photo was forwarded to me by Patty Rundall, policy coordinator of Baby Milk Action.

It was sent to her by UNICEF, which has produced guidelines on infant feeding and a call for appropriate support for feeding young children in Pakistan.  Bottle feeding in unsterile environments is not healthy for infants.

The Washington Post points out that helping to alleviate this disaster is the right thing to do.  But it is also very much in America’s strategic interest.

If strategic interest is what it takes to get our government and others to move on this, let’s use it.

The Berkeley Media Studies Group has just released a “Framing Brief” with “how-to” advice for breastfeeding advocates.  The Brief argues that babies’ health is not a sufficient reason to get moms to breastfeed.

Instead, advocates need to help create environments that support breastfeeding.

This  and a previous report on breastfeeding issues, “Talking about Breastfeeding,” were commissioned by the California WIC Association with support from The California Endowment.

That these reports come none too soon is evident from a recent commentary that the International Code of Marketing of Breastmilk Substitutes (“the Code”) has become ineffectual.

The Code is an international agreement about what infant formula companies can and cannot ethically do to promote their products, based on substantial research that infant formula marketing undermines breastfeeding.

According to the study in the Archives of Diseases of Children, the Code has become

mired by a series of alleged violations and boycotts, which are counter productive to the code’s goal….[These include an] unrelenting series of disputes, predominantly relating to alleged violations of the code, which have provoked high profile acrimonious exchanges, boycotts and legal proceedings…[leading] to an atmosphere of mistrust that has now become embedded between key agencies.

The author focuses on disputes between the non-governmental group Baby Milk Action and infant formula manufacturer Nestlé (no relation).  He recommends that an  “ombudsman” or some other independent body be given authority “to arbitrate and ensure that actions taken by respective parties are in keeping with the spirit of the code.”

This is not a bad idea—if the body is truly independent. Take a look at the Baby Milk Action website and judge for yourself whether you think the group makes a compelling case for Code violations.  Some of them seem pretty obvious to me.

As I recount in Food Politics, infant formula companies have a long pre-Code history of putting sales before infant health.  Almost everyone I know thinks the situation has improved post-Code, but not nearly enough.

As I explain in What to Eat, formula companies have a business-model problem: there are only so many infants born each year and they only use formula for a limited time.

The companies only have two choices for growth: recruit more babies onto formula or extend the period of formula feeding.  The first strategy was well documented pre-Code and continues to be documented.  The second is illustrated by the now withdrawn product, chocolate toddler formula Enfagrow (see previous posts).

Breastfeeding advocates: read the new reports and get busy!

Update, July 31: Patty Rundall of Baby Milk Action has written a rebuttal to the commentary.  Other ideas?  You can forward them to her at prundall@babymilkaction.org.

Patty Rundall, of the British Baby Milk Action, a group that advocates for breastfeeding, and who also represents the Baby Feeding Law Group, which advocates for laws controlling marketing of infant formulas, sends this most interesting article from The Independent about the latest efforts by Nestlé (really, no relation) to prevent the UK Health Department from enforcing marketing restrictions on infant formulas. Will this saga never end?

The American Academy of Pediatrics has just issued an updated assessment of the benefits and risks of soy infant formulas. Its conclusion: soy formulas are fine for full-term infants and hardly ever cause problems but they also are hardly ever needed as a replacement for cow’s milk formulas. Never mind which is better. Breast feeding is still best of all.

Thanks to Kerry Trueman of Eating Liberally for pointing out the investigative report in today’s Washington Post revealing how lobbyists for the infant formula industry induced the Department of Health and Human Services to tone down ads describing health risks to babies that are not breast-fed. These anti-public health lobbying efforts emerged in the wake of Congressional Hearings demonstrating widespread political interference with statements of health officials that might adversely affect some company’s products or the Bush administration’s ideology. The Post article links to two letters from a lobbyist, Clayton Yeutter, who in classic “Revolving Door” action used to be Secretary of the USDA under George Bush I. My favorite statement in his April 21, 2004 letter: “For our government to give all those mothers [those who cannot breast-feed] a guilt trip would just be appalling.” He goes on to explain that the proposed campaign would “send a risk-oriented message to [women in the WIC program]…that most of them will find incompatible with what they’re being told by USDA, and will at best confuse them, at worst frighten them.” Those of us who have followed lobbying efforts by infant formula companies (I describe the resulting boycott of Nestle formulas in Food Politics and more recent lobbying activities in the baby food chapter of What to Eat), will not be surprised. Breast feeding may be good for babies, but it is not good for formula companies–and they know it.