Breastfeeding Medicine

Physicians blogging about breastfeeding

The well-being of mothers and children is not a tradeable commodity

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Breastfeeding is the foundation of public health and economic development. All major medical organizations recommend 6 months of exclusive breastfeeding, followed by continued breastfeeding through the first one to two years of life and beyond.

Evidence continues to mount that disrupting optimal breastfeeding contributes to disease burden and premature death for women and children. Globally, optimal breastfeeding would prevent 823,000 child deaths each year. In the US, enabling optimal breastfeeding would prevent 721 child deaths and 2619 maternal deaths each year, as well as 600,000 ear infections, 2.6 million gastrointestinal illnesses, 5,000 cases of maternal breast cancer and more than 8,000 heart attacks.

Optimal infant feeding is also essential for economic development. Being breastfed is associated with a 3 to 4 point increase in IQ, leading to better school performance and workplace productivity. As stated by the World Bank’s Keith Hansen, “If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

Breastfeeding is vital and essential to protect the world’s children, the most vulnerable who cannot speak for themselves.  Given the essential role of breastfeeding in global health and wellbeing, it is imperative that every nation supports policies and programs that enable women and children to breastfeed. It is therefore deeply troubling that the United States delegation to the World Health Assembly actively undermined efforts to enable optimal breastfeeding, as reported by the New York Times.

Contrary to assertions by U.S. officials, the World Health Assembly resolution did not attempt to restrict access to infant formula; rather, the resolution called for enforcement of the International Code of Marketing of Breastmilk Substitutes.  Marketing of artificial breastmilk substitutes is a major deterrent to optimal infant feeding. The $70 billion baby food industry has long engaged in a global effort to replace breastfeeding with commercial formulas, to the detriment of global maternal and child health.

In settings where clean water is not available, infant formula is a major cause of death from diarrheal disease. These acute risks of formula-feeding become relevant in high income countries during natural disasters, or when the water supply is contaminated with heavy metals. Moreover, aggressive marketing efforts to replace breastfeeding with infant formula expose both mothers and children to morbidity and mortality.

When mother’s own milk is not available, the preferred alternative for infant feeding is donor human milk. Human milk is tailored to the physiology of human infants. Artificial breast milk substitutes should be considered the last resort.

Poverty or malnutrition is not an indication for formula feeding; rather, social policies that separate mothers from children precipitate formula feeding and worsen poverty and malnutrition. The United States is the only high income country without any provision for paid parental leave; consequently, 23% of employed women return to the workforce within 10 days of birth. The appalling absence of social policies to enable women to nurture their children undermines breastfeeding and perpetuates poverty and malnutrition.

Breastfeeding and breast milk are life sustaining, unique human physiologic events that cannot and should not compete with or have an equal with other commodities or corporate profits.  Maternal and child health is not a trade issue.

The Academy of Breastfeeding Medicine calls upon legislators and policy makers to:

1) Recognize that enabling mothers to breastfeed is fundamental to human health and must be foundational to all national and global policy;

2) Support enforcement of the WHO Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions;

3) Enact paid family and medical leave, consistent with the International Labour Organization’s standards on maternity protection;

4) Ensure that social policies and programs enable every mother to nurture her child and engage in optimal infant and young child feeding.


Written by bfmed

July 12, 2018 at 6:43 am

One Response

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  1. Our advocacy methods may be wanting in this most important area of preventative medicine. I would like to put forward an advocacy approach for consideration.

    Manufactured infant formula use denies our babies the evolutionary advantage of the early nutritional, antimicrobial, immuno-regulatory, anti-inflammatory and oxytocin release benefits provided by breastfeeding. The evolutionary gains from breastfeeding have been unfolded and understood through modern science and have evolved as the result of over 300 million years of Darwinian natural selection.
    It is through the wonderful course of natural selection where the slow replacement of one gene by another, and with the provision that the mutation is helpful, that a tiny reproductive advantage is conferred which has enabled us to become human.

    The process of natural selection has been responsible for a brain almost four times the size of our nearest primate cousin. A reduction in maternal pelvic dimensions necessitated by the evolving human upright stance led to the need for our new-born young to have the least developed brain of any primate and to deliver prematurely so that the comparatively large head could safely pass through the mother’s pelvis.

    The importance of the knowledge that our babies are born with a brain one third adult size, and during the first 90 days of life achieve a brain – growth of 64% to reach over half adult size, favours the concept of exterior gestation. Mothers’ milk has co-evolved with the human brain and has provided the only nutritional and immunological support for the developing exterogestate during over 99% of our evolutionary history and its requirement in our early mammalian life has provided a unique fuel for an orderly human biological process. Evolution is determining and breast-milk is an outcome of natural selection for evolutionary success. Formula feeding of our precious babies is a worldwide – risk to their vulnerability and to their mothers by denying them the safety of fundamental evolutionary benefits, and these benefits come through the normality – providing substance, the mother’s milk and the physiological resetting of breast histology. Why should we be surprised that exclusive formula – feeding has been found to be associated with a 25% reduction in white matter in two-year olds with the consequence of reduced IQ and lifetime earnings and an increased incidence of invasive breast cancer in their mothers

    The science of epidemiology has led to improved safety for living. John Snow who linked the 1850 London cholera epidemic to a single contaminated water pump and Ignaz Semmelweis who in Vienna around the same time associated the failure of accoucheurs to hand wash after carrying-out autopsies to puerperal sepsis are well recognized public health breakthroughs. Interestingly, in spite of such findings, it was not until the 1880’s that Louis Pasteur was able to convince the world that the “germ theory” should replace the “bad air theory” of disease. Looking for factors that do harm has alerted us to tobacco and lung cancer, and fast- food to the pandemic of modern metabolic diseases. Many of us will have seen the graphics of auto-immune and allergic disease published by the Swiss institute of allergy and asthma and other researchers (see links below). They all send a message that autoimmune disease incidence is increasing rapidly. Modern understanding excludes contaminated water and unwashed-hands as the cause. What has seen an upsurge during the time-span of these graphics has been the evolutionary illogical but increasing generational use of artificial formula (non-human) milk feeding of our precious babies.

    DOI: 10.1056/NEJMra020100

    One often hears doubts expressed regarding there being a relationship between being breastfed and protection from autoimmune disease. —“I received only my mother’s milk and yet I have asthma and allergic rhinitis”. — We now know that epigenetic research provides a scientific explanation for how immune disease can be vertically transmitted across generational borders, for example from grandmother or grandfather to grandchild. Exclusive breastfeeding should be expected to provide correction over several generations for such epigenetic accidents.
    Species specific prebiotic oligosaccharides numbering in the hundreds have evolved in mothers’ milk over millions of years and have favoured the evolution of gut colonization, through providing nutrition for unique probiotic bifidobacteria, lactobacilli and bacteroides species. Thus, the essential evolutionary – based step for immune homeostasis and protection from auto-immune disease has been fulfilled. In consequence, family history and the documentation of and timing of any and even once – only use of microbiome altering infant- formula milk, are mandatory essentials for research accuracy and value in the investigation of auto-immune disease.

    Illuminating research on where we stand with generational loss of protective immunity reads from Australian – scientist Maureen Minchin in “Milk matters, infant feeding and immune disease.” The chart on page 100 guides us to an understanding of the natural history of how the transgenerational progression of allergic disease eventuates. This is John Snow and Ignaz Semmelweis territory at its best.

    Need-it to be said again “the protection, promotion and support of breastfeeding” is the world’s most important health-issue and embraces the prevention of and unhappiness caused by a wide range of physical and behavioural disease. Support will rely on the accurate reporting of science which is the correct and most successful way of freeing society from commercially – influenced misleading marketing practices. It is basic that the control group used be that driven by millions of years of an evolutionary standard namely exclusive breastfeeding. How else can an experimental- group receiving artificial formula be correctly investigated? How else can our lactation scientists or similarly our blood scientists look for a safe replacement for the evolutionary norm? Referring to “the advantages of breastfeeding” and using plugs such as “breast is best” or “breastfeed if you can” encourage unscientific debate, trivialisation, disturbed maternal confidence and act as a cover-up for manufactured formula risks. I do like President J F Kennedy’s take on this—“Belief in myths allows the comfort of opinion without the discomfort of thought”. There is no debate regarding the breathing of atmospheric air and likewise breastfeeding being also an evolutionary-norm is free from debate. Why do we continue to help favour the formula industry and regrettably political and societal- unreason by naming breastfeeding as a research-group, and displaying its normal evolutionary attributes as potentially unachievable benefits? For example, compare the destabilizing dictum “Breastfeed if you can” to the advertised perception of the normality of the colourfully tinned and supposedly germ-free artificial product within safe arms- reach on the supermarket shelf. The large-scale industrial formula manufacturers have an inherent commercial interest in the selection of formula as the control group, good science should not.

    Grief, shame and feelings of guilt are emotions shared by us all but do not bear relationship to advocacy. Betrayal- sense in our mothers is surely the very understandable emotion in a society which continues to disguise the truth about the health hazards of artificial infant formula and fails dismally to provide evidence based professional help and paid maternity leave for our mothers. Advocacy in health – issues should be founded on good evidence-based science delivering the truth and making us accountable. Just consider, if control- group common sense was used in our scientific breastfeeding literature, this would point the way to a legally mandatory – duty of care for our mothers and babies based on good science and evolutionary imperatives and no longer on myths and misunderstandings dating from our scientifically impoverished past.

    Diane Wiessinger’s essay “Watch your language” (Journal of Human lactation vol. 12, no 1;1996) should be regarded as a bench mark study which helps us to better understand scientific correctness and integrity. Absolutely nothing is more important than the health and welfare of our children and their children.


    George Anthony Mobbs

    October 15, 2018 at 2:40 pm

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