Wednesday, December 13, 2006

Fifth Significant Commercial Infant Formula Danger for 2006

I believe that this FDA report is fifth significant/reported commercial infant formula danger in 2006 alone, the 3rd or 4th in the US: metal fragments in two different instances, chemicals, too much iron, no vitamin C, now too little calcium and phosporus (reported by the FDA 7 months after its discovery, if I am reading the article below correctly)...

The US goverment, through USDA/WIC is the largest single purchaser of formula in the US, and perhaps globally. One would hope that the monitoring and regulation would be more timely and more effective.

Given that the WIC breastfeeding support is supported by kick-backs, called "rebates", from the formula companies - which must be significantly overpaid for the formula by the government in order to be able to supply these "rebates" at the level of millions of dollars to each state. Isn't this situation worth some exploration?
"

FDA warns Nestle infant formula fails nutrition standards
By Jennifer Corbett Dooren
Last Update: 11:44 AM ET Dec 12, 2006
WASHINGTON (MarketWatch) -- The U.S. Food and Drug Administration warned Nestle S.A. (NSRGY) that a sample of its Good Start infant formula failed to meet minimum nutrition standards for calcium and phosphorus.
The Nov. 27 warning letter was posted Tuesday on the FDA's Web site.
The letter stemmed from a May inspection of a Nestle facility located in Eau Claire, Wis.
The FDA said on May 26, 2006, it collected a sample of Nestle brand Good Start Infant Formula with Iron, 13 fluid ounces, and tested it. The agency said the formula fell just short of the required FDA standards for calcium and phosphorus and also was less than the amount stated on the formula's label...The FDA said Nestle was in violation of federal regulations and was required to respond to the FDA detailing steps it has taken or will take to correct the problem. A message left with a spokeswoman for Nestle's U.S. unit in Glendale, Calif., wasn't immediately returned."

Tuesday, December 05, 2006

Reasons why formula use is associated with increased salmonella

CBS reported on a new study by T Jones et al in Peds found that there was less risk of salmonella in breastfed babies. (see news article below - bolds were added)
May I share with you my surprise that they report that "the reason is not clear" for the lowered incidence among breastfed babies? Here are just a few reasons they may wish to consider:
1. Breastfed babies are protected against bacteria, including salmonella.
2. Breastfed babies are not exposed to formula, which is factory sterile, not sterile in the sense often assumed.
3. Any formula use would increase the chance of exposure to pathogens, so what surprises me is that it is not seen as often in those who use powdered formula as opposed to concentrate. I would be curious to review sample size and other variables associated with the choice of concentrate or powder. (Perhaps it is that open concentrate is stored in the refrigerator with other foods, while powder may be stored away from other foods? or is the concentrate in a can, in which case, the can opener may be a source of contamination?)

I am looking forward to reading the complete article, as perhaps the new reported misunderstood, and perhaps these are discusse inthe article..


CBS, Dec. 4, 2006 Salmonella Risk Factors For Babies (WebMD) Salmonella infection strikes babies more than any other age group, and many of these cases may be preventable. Researchers from the CDC, FDA, and seven state health departments report that news in Pediatrics. The scientists included Timothy Jones, MD, of Tennessee's health department. The study looked at 442 infants in eight states diagnosed with salmonella infection before their first birthday. There are different types of salmonella bacteria; Jones' team focused on nontyphoidal salmonella not linked to an outbreak.
The babies' most common symptoms were diarrhea and fever. They typically recovered within a week; however, two babies died as a result of their infection. The babies' parents completed extensive questionnaires about their child's animal exposure, food, and drink in the five days before salmonella infection. For comparison, the researchers gave similar questionnaires to parents of 928 babies the same age who were not affected by the bacteria.

Key Differences
The interviews showed six key differences between babies who got salmonella infection and those who didn't:

1. Breastfed babies were less likely to get salmonella infection. The reason for that isn't clear, but Jones' team says other studies have shown similar results.
2. Exposure to reptiles upped babies' chance of infection. Reptiles can carry salmonella. The CDC recommends that homes with kids under 5 years old not include reptiles.
3. Babies who rode in a shopping cart next to meat or poultry were more likely to get infected. Putting meat and poultry in a part of the cart away from kids might help; so might better packaging, the researchers note.
4. Babies over 3 months old who traveled outside the U.S. were more likely to get infected.
5. Babies who drank concentrated liquid infant formula were more likely to get salmonella infection. The reason for that isn't clear. Concentrated formula is sterile, but tainted water, unhygienic preparation, or poor storage of opened cans might be a problem, say the researchers.
Salmonella infection wasn't linked to ready-to-drink liquid infant formula or powdered infant formula.
6. Babies older than 6 months were more likely to get salmonella infection if they attended day care with a child who had diarrhea.

More studies are needed to make recommendations about salmonella prevention in babies, write the researchers.


SOURCES: Jones, T. Pediatrics, December 2006; vol 118: pp 2380-2387. News release, American Academy of Pediatrics.

Friday, December 01, 2006

Perinatal circumstances and suicide: breastfeeding not considered

A recently published study (Riordan D et al. Perinatal circumstances and risk of offspring suicide: Birth cohort study The British Journal of Psychiatry (2006) 189: 502-507) found that a higher suicide risk as young adults was associated with having been born 1) to a mother of higher parity and younger age (<25 years), 2) with parents of non-professional occupations and 3) with low birth weight (<2500 g).

Given the literature that has shown the association of lack of breastfeeding with increased anxiety in childhood, and given that lack of breastfeeding is more prevalent in the same populations that were shown in this study to be associated with increased risk of suicide, it is a pity that this study did not history of breastfeeding as a possible variable, not in the discussion. It is very possible that breastfeeding is an important confounder in these findings, and certainly should have been discussed.

Tuesday, November 28, 2006

Open letter to the Philippines:

Congratulations to Mountain Province on their innovative approach to "Baby-friendly". The new UNICEF materials created with WHO when I was Sr. Advisor, UNICEF HQ, support these creative efforts to ensure that every baby has the best start on life.

And congratulations to the Government of the Philippines for its efforts to override the commercial pressures of the formula industry to disrupt the legal process of a legitimate government to ensure the best for its children.

Thank you for caring about our children, our future!!

BONTOC, Mountain Province, Philippines -- Acknowledging that breast milk is still best for babies and the most nutritionally complete food the baby would ever eat, significant steps were undertaken by the government in promoting breastfeeding through baby-friendly hospitals where rooming-in after birth and exclusive breastfeeding are practiced to reverse the trend of artificial feeding. In the province, all the hospitals are certified as mother-baby friendly facilities, meaning these health institutions are implementing the Milk Code (Executive Order 51), Rooming-in Act (Republic Act 7600), and other breastfeeding policies.

Dr. Imelda Sabog, medical specialist IV of the Bontoc General Hospital (BGH), said a mother who gives birth is normally advised to breast-feed her baby within one hour after birth. For a baby born through caesarian, he or she is endorsed for wet nursing (lang-ay) while the mother is still under the effect of anesthesia. This means the baby would be brought to a nursing mother or health worker for breastfeeding. The hospitals prohibit the entry of any milk formula. Even the cooperative pharmacy within the hospital compound is not allowed to sell infant formula. No food or drink is given to newborn infants other than breast milk unless medically indicated.

The hospital is also strictly practicing rooming-in where the babies and mothers remain together 24 hours a day as soon as possible after birth. Before the mothers and their babies are discharged from the hospital, health workers advise the mothers to exclusively breast-feed their babies for six months. The same advice is also given by health workers to mothers who gave birth in their own homes. Breastfeeding counseling is not only for mothers who already gave birth but also given to pregnant women when they go for pre-natal checkup.

Monday, November 20, 2006

Delta is no more ready than anyone else

Delta is not alone:
The incident wherein a breastfeeding mother would be put off a flight is symptomatic of our society's lack of respect for women and, even more so, lack of respect for their roles as mothers.
Our future as a nation, and as individuals, is highly dependent on how we raise our next generation; until our society fully supports the role of good mothering as a priority -- by providing paid maternity leave, third party payment for lactation support, proper health worker and other service personnel training, and respect for the maternal role as well as other roles for women --our children will not be enabled to be all that they could be.
We really must start today, and everyday, to overcome misplaced social stigma, and to achieve a global milieu that fully supports women as women, mothers, and colleagues, along with their many additional roles.

Wednesday, September 27, 2006

While we are tweaking AFASS...

One poster at the World AIDS conference in Toronto noted that reports such as Mashi and the diarrhoea outbreak in Botswana secondary to provision of free formula for HIV+ mothers provide evidence “that the [AFASS] guidelines may actually increase risk to the mother/baby dyad as well as other infants in the community.” (Liles and Tompson 2006)."

More than a decade ago, when the spectre of passage via breastfeeding was just starting, I wrote a policy while at USAID, noting that unless we were going to provide premixed small bottles of sterilized formula, we were at risk of not only depriving infatns of the many protective componenets of breastfeeding, but we were also putting them at risk of exactly what happened in Botswana.

Since we did not succeed in creating recognition of the dangers of the current path, at this juncture, I think we need to unite around the concept that supporting exclusive breastfeeding for all children, with special counsling for those tested HIV-positve, is the only logical approach to decreasing transmission and increasing child survival among the untested, while offering specialized counseling.

Exclusive breastfeeding support among those not tested should result in more savings of lives than tweaking AFASS for those who are tested. The numbers are clear on this.

Some real training, or a good job aid, is always helpful, but the use of that training or job-aid is essential.
While I wish you good luck with the job aid, I wonder if there could not be some dedicated action to saving the lives of the children whose mothers are either HIV-negative or untested? They remain the majority worldwide.

Best,
M

Friday, September 08, 2006

USBC carries the message

On the Job, Nursing Mothers Find a 2-Class System (September 1, 2006)

“On the Job, Nursing Mothers Are Finding a 2-Class System” (front page, Sept. 1) highlights the unequal treatment of breast-feeding mothers in the workplace.

With no national legislative policies in support of paid maternity leave and no recognized right to breaks for nursing or expressing milk on the job, women in the United States face big obstacles to following current national recommendations for feeding their babies.

A goal of the United States Breastfeeding Committee is that “every woman, regardless of her employment status, will have the opportunity to breast-feed and/or provide breast milk for her child.”

Legislators and business leaders must help extend this opportunity to women on all rungs of the employment ladder.

Employers benefit when their employees breast-feed. Aetna, for one, reported a return on investment of $2.18 for every $1 spent supporting lactating workers.

This is a win-win-win scenario for employer, employee and the country.

Audrey J. Naylor, M.D.
Chairwoman, United States
Breastfeeding Committee
Washington, Sept. 4, 2006

Monday, August 14, 2006

The most well-meaning folks are still pushing formula for HIV+ moms in the most vulnerable settings

Response to: “Rwanda: A time for healing”,08/13/2006, Thomas Simonet,
Special to the Post-Dispatch, St. Louis Missouri - excerpt included

Dear Editor:

Partners for Health is a wonderful group that has accomplished near miracles, and Dr. Stulac is clearly an outstanding human being in many ways, willing to sacrifice her time and energies to those in the most vulnerable situations in the world.
However, there is one area,I am afraid, where the organization's approach is perhaps not fully considered: the founder of this group promotes formula use for all children of HIV-positive mothers in settings such as Haiti and Rwanda. This approach can do more harm than good in settings such as this. Dr Stulac started an infant formula program for HIV-positive mothers, and unfortunately, her good works and intentions may be undermined by this approach; today, 3 major studies (Coutsoudis et al in South Africa, Iliff et al in Zimbabwe, Thior et al in Botswana) have shown that exclusive breastfeeding in the early months results in more HIV-free survival in populations such as the one she serves, without the expense, time, and maternal effort to prepare and feed infant formula. In most studies, the mother’s health has not been shown to suffer from breastfeeding, and the money saved might be better used for food for her and her family, and for HIV prevention and treatment.

My warmest regards to Dr. Stulac and all who spend their lives trying to make this a better world.

Excerpt:
RWINKWAVU, RWANDA

Success stories inspire [Dr. Sara] Stulac's work in this battered African country. Most people know Rwanda because of the horrific ethnic genocide of 1994, in which as many as 1 million people died. In the aftermath, the economy flat-lined, and many social ills got worse…Now, the nation, still among the poorest in Africa…One of them is Partners in Health, a Boston-based nonprofit that has taken on some of the toughest health woes in the world …"I thought, if I were going to do this with anyone, these people are making a difference," she said. "They're doing it the right way. They have the right philosophy."

In Rwanda, the group is building a new hospital in Rwinkwavu, a hilly corner several miles from the nearest paved road. On a Saturday morning this summer, Stulac's overflowing pediatric ward made clear the medical challenge…. [One major challenge is] the "ATM trio" - AIDS, tuberculosis, malaria - of preventable, treatable in
fections that kill millions of people annually around the world. … Because AIDS can be transmitted through breastfeeding, Stulac helped start an infant formula program for HIV-positive mothers. But the women have no source of clean water, and formula made from local wells can cause life-threatening diarrhea."So, we started this program, myself and the social workers," Stulac said. "All babies born to HIV-positive mothers get a regular supply of infant formula, but they also get a little kerosene stove and a thermos and a bottle we use to boil the water in and a casserole pot so they can prepare clean and safe water for their children."… "It's just a really good community," Stulac said. "The people here are seeing their friends and neighbors and family members getting better. It gives them a lot of hope."

Friday, July 28, 2006

Why the constant call for infant formula in emergencies, the most dangerous setting for its use?

I just read “For him, combat zone is office-Relief worker from Capital Region says human needs outweigh dangers in Lebanon" By PAUL GRONDAHL, Staff writer Albany Times Union, Thursday, July 27, 2006 in which he covers the good works of the Catholic Relief Services/Caritas in Lebanon.
While noting that "Suffering civilians are suffering civilians, and we intend to help them'' he notes, “The need is acute for water, food, infant formula, medical supplies and sanitary products” and that “The logistics of distributing relief supplies in a country whose infrastructure has been reduced to rubble and where trucks face the danger of being bombed [is] an ongoing challenge.”
So I wrote to the fine reporter who covered this humanitarian activity as follows:

Dear Paul:
I am startled and concerned about the constant call for infant formula whenever there is an emergency. The use of infant formula in emergency settings is a high risk activity, where fuel and cleanliness are rare and diseases rampant. These are times when the anti-infection components of human milk are even more important, and associated with increased survival.

While I do not have the data for Lebanon, the data from surrounding countries show that the vast majority of infants are breastfed throughout the first year. In an emergency, the mother can produce more milk as the child needs, if she is protected and fed - which should be a priority. It is cheaper, easier and safer to feed the mom, and breastfeed the infant, for the health and survival of them both.

Please let me know if there is any way to get this message out to the readership.

Best wishes,
Miriam

Monday, July 10, 2006

10 July 2006
Open letter to:
Sen. George McGovern
Stevensville, MT

Dear Sen. McGovern:

With great respect for you, and for the causes you have defended, I was surprised to read your letter to the New York Times entitled, “Breast Milk and AIDS” 6 July 2006. You are well known for your support for women's issues, so perhaps it has not been brought to your attention that breastfeeding is an emerging women’s issue.

Human milk is the best nutrition, as you note, but it is much more than nutrition alone. Breastfeeding is probably saving more than 5 million lives today, and could save at least 1.3 million more lives every year. What other healthcare intervention can say the same?

There are so many breastfeeding-associated factors that protect infants and young children against disease and chronic ailments that it would be impossible to list them here. The result is that, in some settings, the risk of dying from not breastfeeding is greater than the risk of contracting AIDS from breastfeeding. In the United States as well, breastfeeding saves lives and, due to its immunological components, reduces disease significantly when compared to formula feeding.

Why is this a women’s issue? The common sense approach would be free choice. But, to make it truly possible for women to choose and to succeed with breastfeed in the United States-- without having to make significant socio-economic sacrifices or to fight their health care providers – we should level the playing field. This is do-able -- many northern European countries have accomplished this years ago -- with four actions: full, information on feeding options without commercial bias; social and political support for paid maternity leave; health worker education and standards of care that support breastfeeding; and third party payment for lactation support and care. Countries and societies have supported these changes so that women and families could freely choose what they know to be best for their children.

We claim to be the nation that supports “motherhood and apple pie”. Once we really begin to offer women and families a free and informed choice in this manner, only then can we claim that we are supporting their nurturance of the next generation, and taking a balanced, “middle of the road” approach.

Thank you for your ongoing support of women, and for all Americans who aspire to be all that they can be.

Sincerely,

Miriam H Labbok, MD, MPH

Friday, July 07, 2006

State offering new formula

Richmond, Va.

"The Virginia Department of Health says a new company is being used to provide formula for the program. Under the new contract, the program will receive more than 24-point-five (m) million dollars a year in rebates on cans of formula purchased through the program... More than 30,000 infants in the program use the formula..." http://www.wjla.com/news/stories/0706/342098.html Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Please, someone, tell me how the formula companies can afford these multi-million dollar "rebates", which are, of course, tax deductible for them, if the state were really getting the lowest possible pricing?

And how could be this massive over-pricing be occurring if the industry is not colluding on pricing?

I’m not sure, but I think that this means that Virginia residents’ tax dollars are being overspent by at least $24.5 million, and, then, on top of this, our federal tax dollars are paying for the tax deduction claimed by the company against this gift/rebate to the state.

As a result, Virginian tax payers are paying twice, and the formula companies are earning twice.

And the formula companies are getting richer – just read the market news...


Monday, July 03, 2006

New York Times Editorial Apologist for Breastfeeding

The New York Times editorial on breastfeeding: “About Breast-Feeding...” Week in Review, p.9, 2 July 2006, http://www.nytimes.com/2006/07/02/opinion/02sun2.html, reduces the important public health implications of breastfeeding to something to consider only in a situation with “all things being equal” and then purports to support a middle ground. This editorial comments on a proven public health intervention - breastfeeding - as though it were one of two equal viewpoints, the other being formula feeding, and provides the casual observation that folks are doing okay without it, dismissing its value. To this reader, this does not appear to be a “middle of the road” stance, and, simply put, it is irresponsible. The issue that was originally raised was one of misplaced guilt and responsibility surrounding breastfeeding, but this editorial reduces this editorial reduces the issue of breastfeeding to something to consider only in a situation with “all things being equal”.

This editorial expresses scientific opinion that can impact negatively on the health of its readership and that is, at best, ill-informed and misleading. If a "middle of the road" option were defined in this piece, it certainly is not supported by the final sentence: "Millions of Americans have thrived on [infant formula] and are doing quite nicely as far as we can see." This sort of statement would be similar to saying that "millions of Americans have smoked and are doing quite nicely". As a medical epidemiologist, I concur that both of these statements are true, but each one belies the importance of the preventive health message.

In epidemiology, it is common that not every study, or every individual's anecdotal observation, will reveal the marked impact of an important intervention. Rather, reporters and scientists, alike, should rely on the evidence. When there is "biological plausibility" and the majority of the evidence points in the same direction, even if some studies do not achieve statistical significance, there is indeed cause for concern. Every person who smokes does not get heart disease or lung cancer, and yet we strongly discourage smoking because we have studied the consequences. Every non-breastfed child does not become ill, and every non-breastfeeding mother does not get breast cancer, but we know that the probable risks of these consequences for the mother and the child are increased, and therefore we should strongly support breastfeeding.

Why do we see these differences in health outcomes, despite agreement that formula is generally nutritious? Because breastfeeding is not nutrition alone. Every baby is born deficient in terms of its immunological maturity, and the milk from its mother carries the necessary immune factors needed until the baby's system can mature. And every baby is born with susceptibilities, and breastfeeding can lessen the risks for many, or delay onset until the child is old enough to handle it. In addition, there are many additional factors that help the infant adapt to the world outside, and that change with the child's needs over time, that are only found in mother's milk.

We who were not breastfed may well be among the "millions of Americans doing quite nicely", but what would our situations have been if we had been breastfed? There is a wealth of scientific evidence that we could have been healthier in many ways: perhaps brighter, perhaps thinner, with better vision and straighter teeth and, perhaps, less likely to have a chronic disease such as cancer. We can only decry that our mothers were not supported to feed us in the manner that is proven to reduce the risks of childhood illnesses, and which would have had, according to most studies, long term consequences for both her and for us.

Why didn’t our mothers and grandmothers breastfeed? There were many social pressures on women to work during the war. And in the 1950s, when women were encouraged to stay home, the commercial pressures may have taken over. For example, my infant formula-sponsored baby book, the one that my mother was given when I was born, stated, more or less: Congratulations on your new baby. Your hormones are going wild, and you may feel like doing something bizarre, like putting your baby to your breast. Resist. Your doctor knows better.

The commercial sector no longer makes such statements, but we are the progeny and the students of the generations of well-meaning women who received this sort of counsel from the medical profession and media, alike. Any woman who succeeds with optimal infant feeding in our society is deserving of respect and applause.

To return to the editorial, what is the "middle of the road" on this issue, anyway? Perhaps a middle ground might emerge where there is a situation in which women were enabled to truly make a choice. What would that look like? To make a fully informed choice, a woman and family would have ready access to accurate information, free of commercial bias, and, if she chooses the healthful option, she is enabled to breastfeed by a society that supports women by providing third party payment for breastfeeding support, training all healthcare workers in the basics of breastfeeding health, ensuring maternity leave and/or workplace support for continued breastfeeding, and offering constant encouragement in giving every infant the best start on life.

When our society has achieved this support for women of all circumstances, dedicating at least as much in the way of resources to breastfeeding support as the commercial sector provides for advertising the nutrition-only breastmilk substitute, then, perhaps, we will be able to define a "middle of the road."


Thursday, June 15, 2006

Global warming and breastfeeding

In Al Gore's book from the 1980s, he highlights breastfeeding as one way to serve the earth's ecology.

We found this intriguing when first read years ago, so we wrote up the concept in an article for a conference on Breastfeeding as a Women's Issue held at Georgetown University in the early 1990s.

Here's the jist of it:

Breastfeeding causes no plastic or pharmaceutical waste production.

Breastfeeding causes no dairy pollution, including methane and waste run off.

Breastfeeding demands no fossil fuel for its preparation.

Breastfeeding helps space births, especially if the Lactational Amenorrhea Method is used, which lets the mom know when other birth control is needed to ensure adequate spacing.

Also, while not in the article,

Lack of breastfeeding causes excess illness, demanding excess use of antibiotics, not always used properly, contributing to development of resistant strains.

AND

Lack of breastfeeding also causes excess mortality globally, and, yes, here in the United States. Somehow, excess mortality does not seem like a good thing, ecologically, or any other way.

Finally, to end on a lighter note, non-breastfed babies produce smellier, more copious stools.

So, for the environment of the earth (and for the environment of those who live with the baby) breastfeeding is the way to go.

Now, if only our social systems would support it...

Flurry about breast bullies: Who are the real bullies?

Where is this anger coming from? Let's trace it to the source...

Several persons and media are describing feeling bullied by breastfeeding support work and ad campaigns.

From my perspective, the anger at feeling "bullied" is fully justified. But why not trace it to the proper source?

Folks support breastfeeding because, indeed, it is the physiological norm, and the undisputed way to reduce short and long term child illness as well as to reduce risks of some cancer and chronic diseases for moms. Lack of breastfeeding is associated with immune system deficiencies and risk of contamination that cannot be corrected by any formula anywhere.

But why are so many folks feeling bullied? May I opine that we are indeed being bullied, and we should look to the source of the problem, not to those who are trying educate. The bullying is not coming from the dissemination of correct information, or from the (albeit watered-down) ad campaign. We are all feeling bullied because our nation and society, and our social norms, are among the slowest in the world to truly support women, mothers, and optimal mother and child health.

In northern Europe, women experience humane delivery care, and then they (and their partners) have leave that is paid for up to a year, and trained lactation consultants are readily accessed. In other settings, extended families step in to support the new mom, freeing her of other work so that she may be exclusively there for her infant for at least 42 days. In these societies, breastfeeding is the norm. And it is reflected in child survival and maternal health statistics.

What happens in our society? After an invasive hospital delivery, we are bundled off home in 24-48 hours, where the world of family and friends expect to stop by and see the baby, and you are expected to be the congenial host. And of course, you are expected back at work in a few days. And there are no creches or day care that will allow you to be near your baby. Your are forced to suffer, consciously or unconsciously, the separation anxiety that is normal for a new mother, when separated from the sight, smells and sounds of her newborn.

So, yes, we are being bullied. But not by those who support women to succeed with breastfeeding. We are being bullied by those who deny us the right to practice what is best for ourselves and our children.

Yes, women in the US deserve a good deal of slack, because we are expected to be all things to all people, but we are not supported by policy, law, workplace, or society to be true to our educated decisions.

Keep up the good fight, my friends! But, please, let's be clear on who is the "enemy".

Guilt about breastfeeding: Who should be experiencing it?

Recent articles (Breast-feed or Else, NYTimes 13 June 2006) and news coverage (NBC 14 June 2006) have been emphasizing the guilt “imposed” on women who choose not to breastfeed. Where is this coming from, and why, when guilt is slathered on if obese persons don’t exercise and diet, or if women smoke or drink during pregnancy, is the issue considered so negative only in the breastfeeding arena?

While the Center is preparing an academic article on this subject, please allow me to share some preliminary thoughts.

Lack of breastfeeding, especially early and exclusive breastfeeding, in the US is associated with excess disease and mortality. Indeed, there should be feelings of guilt that we are allowing excess disease and death in the United States, when we know how to avoid it. So wherefore do we always hear the cry against “guilt”? No doubt, this is a huge issue, but it is also misused to a great extent in discussions about breastfeeding support.

Guilt occurs when you do something you know you should not, or when you do not do something that you know you should. Guilt is a major motivator to do the right thing.

Concerning breastfeeding, however, it is not mother who should be experiencing the guilt, but rather the guilt should be experienced by a mix of health care systems, third party payers, workplace and society that makes it nearly impossible for a mother to succeed in breastfeeding: we have virtually no guarantee of paid maternity leave for most workers, professional lactation consultant services are rarely covered by health insurance, and we are bombarded with slick ads for the ease, perfection, and father-friendliness of commercial formulas.

As to fear of making women feel guilty by telling them that breastfeeding is normal and protects them and their babies against disease – what is the alternative? Should we deny new mothers correct health information and guidance?

My congratulations to every mother in the United States who succeeds with doing the best thing for her child by early and exclusive breastfeeding! She is beating the odds. And my support, respect, and encouragement for women who attempt to breastfeed, but who are beaten down by the constraints and obstacles that our society sets out for her. She should not feel guilty, but rather should feel proud of her efforts.

Fostering the idea that supporting breastfeeding is bad because it makes women feel guilty is blaming the victim, and then denying her solace. Instead, our society, our legislators, our workplace standard-makers, and our health system should be the bearers of the guilt in this case. Rather than a guilty mother, we should have a supported mother, and if not supported, than these other entities should be the guilty ones.

The answer is to truly support and enable every woman to succeed with the feeding approach that is best for her and for her child. With social, workplace and health-worker skilled support, for most, this will be to exclusively breastfeed. Unfortunately, in the United States today, societal realities still make it necessary to take on the short and long term health risks and therefore, to not breastfeed, or only partially breastfeed. In every case, complete and accurate information and support is every mother’s right, so that she may reach her decision free of guilt and free of commercial bias, and enabled by her workplace and society.

Action is needed at every level of our society, if we truly wish to enable each woman to make an informed choice and then to succeed with that choice. The following areas of action were just reconfirmed by the 59th World Health Assembly (WHA59.21, Agenda item 11.8 27, May 2006, “Infant and young child nutrition 2006”) at the World Health Organization, based on the 1990 and 2005 international Innocenti Declarations. The major actions called for worldwide equally apply to the United States, and include a call, with urgency, for:

  1. Renewed support for Baby-friendly Hospital Initiative, which requires all health workers in contact with mothers and babies to have at least basic training in breastfeeding support,
  2. Renewed support for the International Code of Marketing of Breast-milk Substitutes, which call for ethics in commercial marketing of infant formulas.
  3. Attention to maternity protection by the workplace, including paid leave and related support.
  4. Consideration of additional policy, law and regulations that would enable women to succeed in optimal feeding.

These documents also raise the issue of fostering societal and community support through social marketing, such as the US Campaign, and including breastfeeding skills and knowledge in the education of all health workers.

These actions are do-able, and would be a logical response on the part of our society to relieve itself of the guilt it should experiencing for creating obstacles to the best health choices for women and their infants.

Saturday, April 08, 2006

The world sits idly by...

Just a question, or two:

Having recently heard Steve Lewis speak on the gender inequity that has allowed HIV to spread and become the horror it is, I can't help but consider a few other inequities in societal response...

Given that a problem with one Tylenol tablet can be broadcast around the world within days, why is the FDA announcing something so important to women and babies - the metal particles in commercial formula - more than 2 months after the recall began, and even longer since the problem was first detected?

How can we as a society tolerate more than 2 months of infant exposure to this sort of thing - the third major recall for contaminants this year, I believe - without reform and improved oversight of the commercial formula industry? How can it be that the CDC warnings about E Sakazakii still are not in the public domain, and certainly are not on the powdered formula container labels?

How can it possibly be that when I ask an audience of physicians and nurses to raise a hand if they believe canned powdered formula is sterile, nearly all raise their hands?

How can a mother, or her family, make an informed choice when all she hears about are "gentle loving proteins" and other misinformation?

And how can she ever succeed in breastfeeding against work pressures and illegality of feeding her baby in public? And unarmed with the skills to overcome the many other obstacles that will be placed in her way?

And how can funders continue to place the valuable research dollars into product development - e.g., trying to make cows produce a few of the components of human milk, trying to create a commercial food for months 6-24 - without supporting the, if you will, "complementary" breastfeeding necessary for proper health and development and immune function?

It is also my understanding that the excess use of formula caused by the misunderstandings related to transmission via breastfeeding have just resulted in another child mortality crisis in one country in southern Africa - I will look into it and post my findings...

And why is it that the fiscal input always seems to be targeted towards fixing the problems created by misuse of man's creations, rather that using the products that are available to us without harming the environment? Why are we putting our resources into packaging and ads rather than supporting optimal local feeding of every child?

Rhetorical, I know... Please excuse my little rant-burp. I will now continue to address these issues with the balance necessary for forward momentum, but sometimes one needs to just write it all down...

We have come so far, but we have so much further to go...

Wednesday, March 29, 2006

The Golden Bow Initiative

The Global Golden Bow Initiative: UNICEF launched this symbol, derived from earlier symbols, and an associated educational campaign on the 12th anniversary of the Innocenti Declaration (2002).

In 2004 the World Alliance for Breastfeeding Action (WABA) created the Golden Bow Initiative and it became the symbol of World Breastfeeding Week.



Today, the University of North Carolina School of Public Health endorses this symbol of support for optimal infant and young child feeding.

Why is the Golden Bow endorsed by the University of North Carolina School of Public Health as the symbol for the protection, promotion and support of optimal infant and young child feeding?

Meaning and Purpose: Many social change efforts have used a symbol to create a sense of belonging to a unified movement. The Golden Bow serves this purpose: it is unique in that it is both a symbol for social change, and it carries many meanings within its own design. The Golden Bow is a lesson in the protection, promotion and support of breastfeeding, young child feeding and maternal health.

Gold:
The use of the golden color for the bow symbolizes that six months of exclusive breastfeeding is the gold standard for infant feeding, against which any alternative should be judged.

A Bow:
Why do we use a bow, rather than the looped ribbon of most campaigns? Each part of the bow carries a special message:
One loop represents the mother and one represents the child.
The ribbon is symmetrical, telling us the mother and child are both vital to successful breastfeeding – neither is more important, and both must be supported.
The knot is the father, the family and the society. Without the knot, there would be no bow; without support, breastfeeding cannot succeed.
The streamers are the future: one for continued breastfeeding for 2 years or more with appropriate complementary feeding, and the other for adequate delay of the next birth to give the mother and child time together, to recover and to grow, and to give the mother the time she needs to provide active care for the health, growth and development of this child.

By wearing the Bow, you are stating your commitment to create and sustain change!
Wear it proudly -- Take action today.

For additional information, visit:
www.sph.unc.edu/mhch/ciycfc or www.unicef.org/programme/breastfeeding or
www.waba.org.my/forum2/goldenbow.html

To obtain or purchase a UNC Golden Bow, and an explanatory bookmark, please contact CIYCFC@UNC.EDU

SIDS and other controversies...

The SIDS issue - whether or not to cosleep - is so misunderstood. I think that the Academy of Breastfeeding Medicine (www.bfmed.org) has an excellent statement on the issue.

On this issue, and on many others, there seems to be a constant struggle between three corners of the health triangle: individual patient care, best interest of the public, and the need for simple behavior change messages that allow individuals to help themselves.

Proper counseling for SIDS prevention at the individual level is much more than "back" sleeping or don't cosleep or use of pacifiers. The best interest of the public is served when all factors are properly weighed in a risk/benefit equation, and recommendations include consideration of more than a single issue. Unfortunately, good research can be "translated" poorly, with the resulting messages giving incomplete and even misleading information for individual behavior change.

What can we do to ensure that all three corners of the health triangle are included in thinking? I have only recently been introduced to the concept of translational research, the art and science of combining the evidence from many disciplines, and interpreting it into the language of program, policy and behavior change.

Having worked in many countries, and having worked poorly in many languages and cultures due to poor "translation", and having spoken to skilled interpreters about translation, my conclusion is that we might better aim for "interpretational" research, because it is often necessary to go beyond translation of the words in order to truly achieve full understanding.

Bringing together the evidence from many disciplines and interpreting it into language/messages that, if acted upon, benefit the audience, is the best any interpreter could hope to achieve. Contributing to all parts of the health triangle demands translation, interpretation, and evaluation of impact.

Addressing all three parts of the public health triangle - individual care, public health improvement, and enabling self-care through program, policy and public messages for change - using interpretation and testing of the evidence, may be the best way forward.

Tuesday, March 21, 2006

Welcome to my blog site

I have been encouraged to start a blog to share musings on how societies support the next generation by enabling the mother/child dyad to suceed in the best start on life: optimal infant and young child feeding, with optimal women's nutrition and maternal health.