Most people know that "breast is best" in the abstract. The idea that breastmilk is a superior food to commercial breastmilk substitutes is given lip service by OB-GYNs, pediatricians, the US Government and even the infant-formula manufacturers themselves, but the reality is that the United States has one of the lowest rates of breastfeeding duration in the developed world.
In the wake of Hurricane Katrina, our failure as a nation to support long-term breastfeeding and regulate the marketing and sale of breastmilk substitutes may contribute to a public health nightmare.
All the
evidence shows that there is really no comparison between breastmilk and artificial breastmilk substitutes (ABS). Ideally, every infant would recieve nothing but breastmilk (from the mother's or
wet nurse's breast or
donated milk in a
bottle/
supplemental nursing system) for the first six months and would continue to receive breastmilk through the first year and beyond.
In the US, the Department of Health's Healthy People 2010 project has as one of its goals:
16-19.
Increase the proportion of mothers who breastfeed their babies.
Objective
Increase in Mothers Who Breastfeed
1998 Baseline 2010 Target
Percent
16-19a.
In early postpartum period 64 75
16-19b.
At 6 months 29 50
16-19c.
At 1 year 16 25
Yet the most recent data suggests we are falling short of that goal:
The rates in that chart are derived from the state by state data that shows abyssimal rates in Louisiana:
What does this have to do with Katrina? Consider the statement issued last year by WHO, UNICEF, the Internatioal Committee of the Red Cross and the International Federation of Red Cross and Red Crescent Societies after the tsunami:
WHO, UNICEF, the ICRC and the International Federation note that donations of infant formula and other powdered milk products are often made, whilst experience with past emergencies has shown that without proper assessment of needs, an excessive quantity of milk products for feeding infants and young children are often provided, to the detriment of their well-being. WHO, UNICEF, the ICRC and the International Federation therefore reiterate that no food or liquid other than breast milk, not even water, is normally needed to meet an infant's nutritional requirements during the first six months of life. After this period, infants should begin to receive a variety of foods, while breastfeeding continues up to two years of age or beyond. The valuable protection from infection and its consequences that breast milk confers is all the more important in
environments without safe water supply and sanitation.
There is a common misconception that in emergencies, many mothers can no longer breastfeed adequately due to stress or inadequate nutrition, and hence the need to provide infant formula and other milk products. Stress can temporarily interfere with the flow of breast milk; however, it is not likely to inhibit breast-milk production, provided mothers and infants remain together and are adequately supported to initiate and continue breastfeeding. Mothers who lack food or who are malnourished can still breastfeed adequately, hence extra fluids and foods for them will help to protect their health and well-being.
If supplies of infant formula and/or powdered milks are widely available, mothers who might otherwise breastfeed might needlessly start giving artificial feeds.
This exposes many infants and young children to increased risk of disease and death, especially from diarrhoea when clean water is scarce. The use of feeding bottles only adds further to the risk of infection as they are difficult to
clean properly.
In exceptionally difficult circumstances, therefore, the focus needs to be on creating conditions that will facilitate breastfeeding, such as establishing safe corners for mothers and infants, or helping mothers relactate. Every effort should be made to identify ways to breastfeed infants and young children who are separated from their mothers, for example by a wet-nurse (if culturally acceptable).
For these reasons, any provision of breast-milk substitutes for feeding infants and young children should be based on careful assessment of needs.
These products should be used only under strict medical control and monitoring and in hygienic conditions, in accordance with the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions, as well as humanitarian agencies' policies and guidelines. There should be no general distribution. If donations have been given in a country, they can be mixed with a milled fortified staple for distribution as a complementary food to make porridge for children over 6 months of age.
In other words, the infants of Louisiana and the other states hit by Katrina are at risk. Even if you discount the benefits of breastmilk under ordinary circumstances, it becomes clear that in the event of a disaster like Katrina, non-breastfed babies are at a significant disadvantage compared to their nursing peers. It is unfortuneatly too late for the thousands of babies now at risk, but perhaps we can learn from this situation and take steps to prevent it in the future,
Of course, there are plenty of reasons why mothers don't breastfeed, reasons that are all too often chalked up to "parenting choice" as though choosing your child's primary nutritional source is akin to what color you paint the nursery. Rather than lumping "breast or bottle" in with "pink or blue" or "Graco or Fisher-Price" we need to treat this as a public health question and respond accordingly.
One of the easiest things to do, and one that would make an immediate difference, is the US enforcement of the International Code of Marketing of Breast-milk Substitutes. If you haven't been in a OB-GYN's office, or a pediatrician's or a baby supply store lately, you might be surprised at how pervasive the marketing for ABS is, and how complicit doctors and hospitals are in the distribution. The ICMBS was designed to prevent companies from giving out free samples, providing swag to health care workers, advertising their products with false claims of equivilancy to breastmilk and other marketing techniques.
Because the US stalled and only signed on to the code in 1994, 13 years after the rest of the developed world, and because we largely leave it up to the individual manufacturers to police themselves, it is difficult to go to an OBGYN's offce without having your name put on a list to get one of these:
or to have a baby in the hospital without being handed one of these:
or to shop at a maternity store without being signed up for one of these:
Then again, enforcing the Code might mean offending some of the country's biggest pharmeceutical companies and retailers...and what politician is willing to take them on?
In the meantime, babies will suffer.