Breastfeeding has long been the gold standard for infant nutrition. The , , , and all recommend it.
Thus, the recent report of U.S. interference in the '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. in developing countries, however. That's created a dilemma for the U.S., which has not wanted to restrict the .
This comes at another price. Lack of breastfeeding worldwide is blamed for a year.
Direct breastfeeding and exclusive human milk feeding were the only sustainable infant feeding for thousands of years. Initial efforts prior to the 1800s to 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 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 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 .
In 1981, the World Health Organization adopted the . 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 healthcare 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 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 in support of maternal and child health in 1990.
Among infants born in the U.S. in 2014, the most recent national data available, , but disparities existed based upon socioeconomic and demographic status.
A indicated that six- and 12-month continuation rates for breastfeeding remain low in most countries. The also shows that no country is highly compliant on all indicators that monitor support and protection of breastfeeding.
The 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 , especially secretory IgA, and other immune protective factors. Human milk provides , facilitating the colonization of the intestinal tract with and establishing a that protects against 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 of postpartum hemorrhage, breast cancer, ovarian cancer, obesity, type 2 diabetes and , 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 .
Some of the poorest countries have the lowest breastfeeding initiation and duration and could gain the most in terms of health impact and from improving breastfeeding rates.
Partnership between governmental and nongovernmental agencies resulted in the formal designation of the in response to "The Innocent Declaration." The Department of Health and Human Services developed a in 2008 to support and promote breastfeeding.
In 2011, the recognized key elements required to support breastfeeding, including healthcare, families, communities and employment. The CDC has supported quality improvement initiatives aimed at changing to better support and promote breastfeeding. Breastfeeding efforts at the community level have involved obesity prevention efforts.As more infants were breastfed in the U.S., formula makers turned their sights to developing countries. This contributed to a in breastfeeding rates, similar to that seen in the U.S.
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.
As 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 healthcare, lack of paid maternity leave, and employment policies that do not provide universal support for employed mothers to continue breastfeeding.
, MD, MS, is associate dean of graduate medical education and professor of clinical sciences at
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