Monday, December 31, 2007

More questions about LAM

Thanks to Marianne Vanderveen-Kolkena for raising these questions. Perhaps you have shared her concerns...

Dear Marianne: Thank you for your interest in LAM. You raise relevant questions and I will do my best to answer:

1. Question: As far as I remember, I was taught that it is also necessary not to leave to many hours between feedings, so a night feeding ought to be part of the daily routine.In your explanation, I didn't find anything about not spacing feedings to wide apart. If you would breastfeed exclusively, but had a baby that sleeps through the night, then you could have an ovulation without bleeding first, right...? What is your opinion on this..?

Answer: The definition of Full Breastfeeding used in the LAM research was: feeding on demand, with no frequent intervals of >4 hours during the day or 6 hours during the night. The genesis of this definition would take a book of writing, but in the clinical trials of LAM, this is what we told women IF they asked. As to sleeping through the night, many women would consider 6 hour interval as sleeping through the night. Some women reported a midnight feed, and a 6 am feed, for example, and felt that they were sleeping through the night. Many women in the study occasionally had intervals of 8 hours at night, and this was not associated in any way with fertility in our study. Our recommendation is to feed physiologically, and on cue, and, if this is done, babies will wish to feed at least once during the night.

2. Question: Isn't is so, that estrogens have a higher chance of bringing the menstrual cycle back, if prolactin doesn't peak regularly enough?

Answer: This actually is a physiologically complex question. Here goes: Prolactin rise is associated with successful breastfeeding, and successful breastfeeding is associated with fertility suppression. There are some who assert that there are additional and alternative mechanisms that also are associated with the fertility suppression, mediated by the hypothalamus. Estrogen rise is associated with lack of regular rises in prolactin, however, estrogen rise is not necessarily a proxy for fertility return. In a fully lactating woman, a small estrogen rise is met with a paradoxical re-suppression of signs of fertility. For adequate ovulation to occur, there needs to be regular pulsatility of LH and FSH as well as declines in the rate of breastfeeding and its many hormonal effects. Estrogen, per se, does not bring back the cycle, but is a part of the cycle, and estrogen withdrawal causes the bleed. So, in a nutshell, if breastfeeding continues to be full, the chance of a small estrogen rise exists, but it is generally not adequate for ovulation. In general, in a fully lactating woman, a withdrawal bleed will occur prior to the first fertile cycle, and this phenomenon is the basis for LAM.

Thank you for your interest in LAM!!

Friday, December 14, 2007

Children's author rejects formula money - how can we in public health accept it?

Industry news is that Nestle is planning to purchase Bristol-Meyer-Squibb nutrition products. This will include Mead Johnson, if it goes through, returning us to asymmetry in the US formula market, with Nestle owning 2 of the 3 major producers.
Meanwhile, authors of children's and teen books have rejected Nestle monies. How can we, who say we support the health of the public, still be seen to partner with the infant formula industry?
What was necessary for us to stop accepting tobacco money? Was it the number of deaths? If so, we should have stopped working with the formula industry decades ago....

Nestlé Children's Book Prize winner refuses Nestlé money - Sean Taylor rejects cheque
Press release 12 December 2007

See on-line version for links to supporting documents and images of Nestlé baby food marketing malpractice at:
http://www.babymilkaction.org/press/press12dec07.html

Children's author, Sean Taylor, was announced today as the Gold Medal Winner of the Nestlé Children's Book Prize, under-5 category, for his book When a Monster is Born illustrated by Nick Sharratt (Orchard Books). In an open letter Mr. Taylor indicated that he would not accept the prize money for the award which is sponsored by Nestlé. He commented:

"Being on the short list for the 2007 Nestlé Children’s book Prize is a significant honour for me, especially since so many children around the country have been involved in choosing the winning books. And I am delighted to accept the award offered to me.

"However, because of questions surrounding Nestlé’s marketing of breast-milk substitutes, I do not feel able to accept the prize money.

"This has not been a decision I have taken lightly. It has involved conversations with Baby Milk Action (a campaign group against Nestlé), Nestlé themselves, and an authoritative third party with experience in the field (who wishes to remain nameless)."


Baby Milk Action is concerned by Nestlé’s record of aggressive marketing of baby foods, which contributes to the unnecessary death and suffering of infants around the world. Companies should be abiding by international marketing standards adopted by the World Health Assembly, but Nestlé, the market leader, continues to produce systematic and widespread violations of the marekting requirements. These are defended at the most senior levels of the company.

According to Nestlé Global Public Affairs Manager, Dr. Gayle Crozier Willi, Nestlé is 'widely boycotted'.

Nestlé is also accused of failing to act on reports of child slavery in its cocoa supply chain.

In his letter, Mr. Taylor commented: "In the light of these conversations, it is apparent to me that many of Nestlé’s controversial activities took place in the past and that the company has taken steps to improve its practice." However, a new global monitoring report launched this month shows on-going aggressive practices. Nestlé defended the practice of branding babies in China from birth shown on the website just yesterday.

Mr. Taylor concluded:

"Nevertheless, it is my view that their interpretation of the International Code of Marketing of Breast-milk Substitutes sets up the risk that profit is put before infant health. And, in addition, it seems that the actions of some of their employees on the ground are inconsistent with company policy as set out in the Head Office.

"For these reasons I do not feel that Nestlé are the most appropriate sponsors for this major children’s book prize."


For the full text of the letter and further comment see Baby Milk Action Campaigns Coordinators blog via the on-line version at:
http://www.babymilkaction.org/press/press12dec07.html

Nestlé is sponsoring the children's book prize organised by the Booktrust. The book prize is a scheme where short-listed books are distributed to a number of schools, whose students vote for their favourites. Campaigners say Nestlé involvement is an attempt to divert criticism from its activities, improve its image amongst students and reposition itself as a responsible company.

Mike Brady , Campaigns and Networking Coordinator at Baby Milk Action, said:

"The global monitoring report just launched by the International Baby Food Action Network (IBFAN) shows that Nestlé's claim to have changed only goes as far as tactics - the strategy of undermining breastfeeding to increase sales of formula remains unchanged.

"I appreciate the difficult situation Mr. Taylor was put in by the choice of Nestlé as a sponsor for this prize and applaud him speaking out publicly about his concerns. Let us hope the organisers and the public take notice and Nestlé will again appreciate that its cheque book does not buy it a good image. It must abide by internationally-agreed standards."


The main element of the sponsorship appears to be providing public relations services to the prize through the PR company, Spreckley's.

Spreckley is a specialist in:

"CRISIS AND ISSUES MANAGEMENT – All businesses face problems at some point and the best strategy is to be prepared. We can help clients devise a crisis and issues strategy plan, as well as providing counsel and advice when incidents arises."

In addition to its aggressive marketing of baby foods, Nestlé has been taken to court in the United States by the International Labour Rights Fund (ILRF) for failing to act to end child slavery in its cocoa supply chain in the Ivory Coast (click here for details). Nestlé has also refused to support moves to bring farmers within the Fairtrade scheme in Ivory Coast, meaning registered farmers are unable to sell all of their produce within the scheme. Nestlé buys the surplus on the open market at lesser prices, according to ILRF. If cocoa is bought within the Fairtrade scheme the farmers are guaranteed a fair prize and are paid a community surplus used to ensure children go to school.

In 2003 the Booktrust scrapped plans for a Nestlé teenage book prize after leading authors said they would refuse to accept it. This has gone ahead with a charitable trust backing it instead.

Tuesday, December 11, 2007

Well deserved award given to the Infant Formula Industry

The IFM group has received an award for its successful effort to downgrade the OWH ad campaign!!
Scroll down to the bronze award at this Web site:
http://www.alternet.org/mediaculture/70039/?page=entire
My response:
With thanks to Diane Farsetta for presenting the infant formula industry with the Bronze Falsies Award, this is only the tip of the iceberg. This industry not only actively fights excellent health messages with the clout of its lobbyists and big profits, it also has an ongoing apparent policy of false advertising (e.g., many formula companies have been reported to the FTC for false advertising; their response has apparently been to continue the ads to their planned obsolescence and then to offer a quiet apology to the FTC), has threatened sovereign governments that have attempted to mute the false claims (e.g., India; Peru; and in Philippines the US Chamber of Commerce sent a letter to the President of that country threatening the withdrawal of all US business unless the government allowed the ongoing misleading formula advertising claims), and continues practices in the US known to undermine breastfeeding (e.g., "rebates" to WIC so that WIC moms - who do not receive suffienct supplies but rather a supplemental supply - will feel loyal to their brand, along with other practices reported in a GAO report; handing out “free” bags to new moms as they leave the hospital – a practice studied and shown to undermine breastfeeding, etc, etc.) There many other practices I have experienced or observed here and abroad over the years. Clearly when it comes to infant feeding messages, profit wins over our children’s health, and the asymmetry of messages in the media continues.



If you would like any additional information ,please let me know, or contact my colleagues at NABA-REAL.

Sunday, November 18, 2007

Let's get LAM right!

Sheila Kippley, a long time colleague from my days doing research on NFP, reviewed the breastfeeding information in the new CCL manual, The Art of Natural Family Planning: Student Guide. She points out that "There are two statements that are seriously incomplete and therefore possibly misleading. 1) “Some studies show that 97% of mothers who exclusively breastfeed can be assured of postpartum infertility for at least six months” (page 161). 2) “Exclusive breastfeeding: Generally, highly infertile during the first six months postpartum” (Reference guide, page 254; italics in the original)." (see http://www.nfpandmore.com/ for more detail)

While exclusive breastfeeding will reduce the risk of pregnancy, it is not a reliable method of family planning. Neither is amenorrhea (i.e., no menstrual periods) alone. Both are proxies for reduced fertility, but neither alone achieves an efficacy that would be acceptable to families not planning a pregnancy.

What is LAM? It is a method based on the physiology of lactational infertility. IF you are fully breastfeeding (exclusivity is not necessary) AND IF you have not had a menstrual-type bleed after 8 weeks postpartum, AND IF you have not started regular complementary feeding, your risk of pregnancy is less than 2% by lifetable analysis.

How does this risk compare to other family planning methods? This risk is comparable to data reported for some oral contraceptives, and better than most barrier methods.

How do we know this? LAM underwent clinical trials in at least 10 countries, including the United States, Germany and Italy. Additional sites were in Indonesia, Egypt, Nigeria, Mexico, Chile, Pakistan, Philippines, Rwanda, and Ecuador, among others. Trials had consistent findings of 0-2% pregnancy rates.

Which organizations note and support these findings? At least WHO and ACOG note these findings and present LAM as an acceptable introductory method postpartum. It is an accepted method in several countries around the world.

Why is it not more widely known and utilized? There is no one profiting from it, and hence no one investing in advertising it. Further, promoting its use means that you must trust a woman to follow the criteria. Unfortunately, this trust is not as yet the norm among clinicians, but hopefully it is increasing.

What can I do to support the use of LAM? Create a demand! Ask your providers about it. If they are uninformed, send them to the WHO Medical Eligibility Criteria for contraceptive use and/or to ACOG Clinical Review, 12(1), Jan/Feb 2007, or www.fhi.org/en/RH/FAQs/lam_faq.htm, or...google it!!

Please contact me if you have further questions on LAM: labbok@unc.edu

Friday, November 09, 2007

Tuscon speaks out on co-sleeping!!

Thanks to Laura Aldag for her Guest Opinion on co-sleeping. (http://www.tucsoncitizen.com/daily/opinion/68115.php) Her opinion may be driven by the realities of the millennia of co-sleeping, but it also should be noted that breastfeeding reduces the risk of SIDS by at least 40% (Agency for Healthcare Research and Quality meta-analysis, 2007); there has been no study that shows any increased risk of SIDS with the healthy breastfeeding co-sleeping as described by Laura. In fact, researchers such as Jim McKenna and Helen Ball would argue that safe co-sleeping is quite possible.Let's stop painting everything in black and white, solidarity vs co-sleeping, and begin to recognize that there are probably thousands of co-sleep patterns, many of which may be safer than solitary sleep. We simply do not as yet have any study that fully examines this issue, and we should not generalize to all forms of co-sleeping from the limited data that are available today. In other words, let's not throw out the baby with the bathwater....Let's not throw the baby out of bed based on incomplete research on SIDS.

Friday, November 02, 2007

Interesting approach being used in the UK - Thanks to Patti Rundall

Breastfeeding reduces cancer risk says comprehensive scientific review -Will the UK Government act now to control formula marketing?
Press release 31 October 2007

The World Cancer Research Fund (WCRF) report Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective published today states strong evidence shows that breastfeeding protects mothers against breast cancer and babies from excess weight gain. Excess weight gain is linked to increased risk of cancer. The report comes at a critical time as the UK Government is deliberating on strengthening legislation on the marketing of breastmilk substitutes.The report adds to the overwhelming medical advice to the Government to take a tough and effective line with the manufacturers of breastmilk substitutes (such as infant formula and follow-on formula) and ensure that parents are provided with truly independent information instead of misleading commercial promotion.

All the leading health professional bodies dealing with infant and young child health (members of the Baby Feeding Law Group and the Breastfeeding Manifesto Coalition submission is Protecting breastfeeding - Protecting babies fed on formula) and the Government’s Scientific Advisory Committee on Nutrition (SACN) are calling for the Infant Formula and Follow-on Formula Regulations to be brought into line with marketing requirements adopted by the World Health Assembly and implemented in many other countries. The Government has received 1,341 submissions to the consultation and will be presenting finalised legislation to Parliament in November.The World Cancer Research Fund report includes 10 recommendations from a panel of 21 world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can reduce the risk of cancer.

Recommendation 9 states : "It's best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods. Strong evidence shows that breastfeeding protects mothers against breast cancer and babies from excess weight gain."Recommendation 1 states: "Be as lean as possible without becoming underweight. Convincing evidence shows that weight gain and obesity increases the risk of a number of cancers, including bowel and breast cancer."

"There is convincing evidence that breast feeding protects against pre-menopausal and post-menopausal breast cancer. There is also limited evidence that it protects against cancer of the ovary. There is also evidence that being breastfed probably protects babies from becoming overweight or obese in later life." Authors think that "breastfeeding lowers the levels of some cancer-related hormones in the mother’s body, which reduces the risk of breast cancer. At the end of breastfeeding, the body gets rid of any cells in the breast that may have DNA damage. This reduces the risk of breast cancer in the future.According to a Government survey, nine in ten mothers who gave up breastfeeding within six weeks said they would have preferred to breastfeed for longer, as did 40% of those who breastfed for at least 6 months." (ref: Page 211 Infant Feeding Survey 2005)

Sunday, October 28, 2007

MomsRising has the right idea!! did you know that the US is one of only 4 countries that do not have paid maternity leave: The others?? Read on...

MomsRising is challenging the 2008 Presidential candidates to answer to America's moms.

They are working on mother-friendly issues including health care, getting toxics out of toys, flexible work options, child care, afterschool programs, paid family leave, maternal hiring discrimination, and paid sick days
They are developing the resources to create the demand for xxx and will be working to help ensure that all moms are able to vote!

If you are interested, go to:
https://salsa.democracyinaction.org/o/1768/shop/custom.jsp?donate_page_KEY=2907

They note:
"American mothers are acutely aware that they and their children are struggling. A full quarter of families in our nation with children under six are living in poverty. One in eight children doesn't have any health care coverage at all. 40,000 kindergarteners are home alone after school because of the lack of affordable after school programs. Childcare services are prohibitively expensive and too often of poor quality. Today, the U.S. is one of only four countries that doesn't have paid leave for new mothers. The others are Papua New Guinea, Swaziland and Liberia. We also lag behind in paid sick days and flexible work options so we can participate in our children's schools and be at home before and after school hours. A full three-quarters of mothers are in the workforce, yet mothers are 79% less likely to be hired than non-mothers with equal resumes and job experiences. Single mothers make just 60 cents to a man's dollar. Studies show that wage gaps like these narrow when family-friendly policies and programs--like paid family leave and subsidized childcare--are in place. We can do better for our children, our families, and ourselves. Let's insist that all of the candidates make "family values" talk be about helping real families. Let's use our combined Mom-Power to make sure that whoever wins has the best policies for families and a mandate for change."

Please consider this among your charitable giving to make the MomsVote '08 campaign a reality. MomsRising.org is a non-partisan organization and, as such, will not be endorsing a candidate. The MomsVote '08 campaign is designed to put all of the candidates on notice that moms are a powerful, voting constituency. MomsRising.org will work to ensure that family-friendly policies are at the front and center of each and every candidate's agenda.
-Your donations make the work of MomsRising possible. To donate today on our new, secure website go to: http://salsa.democracyinaction.org/dia/track.jsp?v=2&c=F6Aku%2FhP8rdbrDG0nCFkRO71D%2BxYycHU

Thursday, August 16, 2007

Who would use this stuff on their babies if they had an option?

Copied and edited from
Toxic Plastics Chemical in Infant Formula
See http://www.ewg.org/reports/bpaformula

Executive summary

August 8 2007. Laboratory tests of canned infant formula conducted by the Food and Drug Administration (FDA) and a certified commercial laboratory reveal that a plastics chemical called bisphenol A (BPA) leaches from metal can linings into formula at levels which, according to new EWG analyses, would expose some bottle-fed infants to BPA in excess of doses that caused serious adverse effects in animal tests. There are no government safety standards limiting the amount of BPA in infant formula.

EWG's analyses of BPA levels in ready-to-eat and concentrated formula, paired with government data on infant formula consumption show:

-One of every 16 infants fed ready-to-eat canned formula would be exposed to BPA at doses exceeding those that altered testosterone levels, affected neurodevelopment, and caused other permanent harm to male and female reproductive systems.

-Infants fed concentrated formula mixed with water would also be exposed to potentially unsafe amounts of BPA, in excess of standard government safety margins. While water added to concentrated formula lowers BPA concentrations in the final mixture, our analyses still show that one of every 16 infants fed concentrated formula would be exposed to BPA at doses within a factor of 2 of harmful doses.

-At the highest BPA levels found in formula, 17 parts per billion (ppb), nearly two-thirds of all infants fed ready-to-eat formula would be exposed above doses that proved harmful in animal tests (Figure 1).

These analyses, coupled with exposure estimates in other studies, demonstrate that bottle-fed infants likely face higher BPA exposures than any other segment of the population, and highlight the urgency of setting standards for this chemical to protect babies who are overexposed through canned formula.

Figure - BPA has been found in infant formula at levels ranging up to 17 parts per billion, a concentration at which nearly two-thirds of infants would exceed doses shown to harm test animals.
Source: EWG analysis of BPA exposures based on government and commercial lab tests of BPA in formula, and formula consumption rates and body weights measured in government surveys... Estimated single-day exposures are compared against BPA dose of 2.4 ug/kg/d linked in lab studies to alterations in testosterone levels and referenced as "toxic dose" ... Note that results shown above will underpredict infants exposed above even lower doses found harmful in animal studies, including a dose of 2.0 ug/kg/d linked to permanent damage of reproductive system from in utero exposures.

Failures to protect infants from BPA risks.

FDA last assessed the safety of BPA in infant formula in 1996, based on tests of 14 infant formula samples (Bailey 1996). Dozens of peer reviewed studies published since that time reveal adverse effects of BPA at exposures dramatically lower than those known at the time to be harmful, and, significantly lower than exposures for infants drinking BPA-contaminated formula.
Yet despite scientists' dramatically altered understanding of low-dose BPA toxicity, FDA has not tested additional samples of infant formula for BPA, and has failed to reassess the safety of BPA-contaminated infant formula since its original assessment 11 years ago. FDA does not require infant formula manufacturers to test their products for BPA, and has not set standards or even guidelines for BPA contamination in formula.
Instead, in 2006 the federal government launched a BPA health risk assessment under the National Institutes of Health's (NIH's) Center for the Evaluation of Risks to Human Reproduction (CERHR). From the outset the assessment process has been plagued by concerns over scientific credibility and conflicts of interest:
The contractor in charge of the assessment both helped form the panel, which lacks BPA experts, and prepared the initial draft assessment for the panel's review. This contractor was subsequently fired by CERHR over concerns about potential conflicts of interest, but the panel was allowed to continue with its initial membership, working from the draft assessment prepared by the fired contractor.
In external review comments submitted to the panel, BPA experts revealed that the CERHR assessment appears to contain nearly 300 errors of fact and interpretation; is biased, inconsistent, incomplete; and clearly fails to meet the most basic scientific standards. [see EWG's full review]
What could have been the first opportunity in a decade to advance public health protections for this problematic chemical instead ended in CERHR issuing a final assessment on August 8, 2007 that fails to support stronger public health safeguards for bottle-fed infants, pregnant women, and other at-risk populations.
BPA has been detected in thousands of people worldwide, including 93 percent of 2,500 people in the United States. More than 100 peer-reviewed studies have found BPA to be toxic at low doses, some similar to those found in people, yet not a single public health agency has updated safety standards to reflect this low-dose toxicity.
This country's toxics law, the Toxic Substances Control Act, fails to require that chemical companies prove thier products are safe before they are sold, even when these chemicals end up in people's bodies, as is the case for BPA. This law was passed in 1976, and 31 years later is the only major public health and environmental statute in this country that has never been updated. This panel certainly has not done their part to help fill the gaps in this broken system of public health protections.
As a result of these policy gaps, BPA is now one of the most widely used industrial chemicals, is found at unsafe levels in people, is allowed in unlimited quantities in a broad range of consumer products including infant formula, and is entirely without safety standards. BPA provides irrefutable proof that our system of public health protections must be strengthened to protect children and others most vulnerable to chemical harm.

Resources
Lab tests of canned food — BPA contamination in more than half of 97 name-brand canned foods: http://www.ewg.org/reports/bisphenola
EWG comments to CERHR summarizing nearly 300 errors of fact and interpretation in BPA assessment identified by BPA experts: http://www.ewg.org/node/22333
Related News:
NIH Panel Releases Conclusions About Compound BPA's Effect On Reproductive DisordersKaiserNetwork.org August 10, 2007
Some Risk Linked To Plastic ChemicalLA Times August 9, 2007
Is This Bottle A Hazard To Your Health? One Review Of Chemical Warns Of Huge Risks; Another Says Nothing To Worry AboutSeattle Post-Intelligencer August 9, 2007
Federal Panel Sees Little Risk To Bisphenol-AInside The Bay Area August 9, 2007
Plastic Chemical Safety WeighedWeb MD August 9, 2007
PAGE: 1 2 3 4Executive SummaryPrint full report.

Thursday, July 26, 2007

Did you all see the coverage of the Botswana commercial formula-induced diarrhea disaster? a year after the event?

A formula-induced diarrhea disaster has been recognized by the international press - more than a year after it happened. http://www.washingtonpost.com/wp-dyn/content/article/2007/07/22/AR2007072201204.html?referrer=emailarticle

But the positive aspect is that it has been noticed and reported by the Washington Post.

It is interesting that most of the respondent emails sent to the post mention that it is "not the formula but the water". The article notes that breastfed babies were 1/50th as likely to suffer from this when compared to formula-fed. Dear friends: It may have been the water that concentrated the bacteria, but it was breastfeeding that saved the lives.

Thanks to Craig Timberg and the editors of the Washington Post for publishing this article.

However, why did they choose to blame UNICEF, and applaud CDC in relationship to the event? Yes, it was a CDC person who found the epidemic, but CDC also was encouraging - and may still be - countries to provide formula to all HIV+ moms. UNICEF, on the other hand, as noted in the article, discouraged this activity following the pilot tests, mentioned in the article as "programs" of provision. Botswana is an independent nation, and has every right and responsibility to make its own health decision, but this decision was against the advice of UN agencies, especially UNICEF.

I felt obliged to post the following:

Dear Mr. Timberg and Editors:

As the last Senior Advisor for Infant and Young Child Feeding at UNICEF HQ, from 2001-2005, I believe that it is quite important to note that UNICEF was not supportive of the provision of free formula to HIV+ women during these years. UNICEF supports government policies, attempts to help governments achieve well-informed health and other programming, and encourages World Health Organization (WHO) health policies.

In the 1990s, UNICEF did initiate some formula studies; these were pilot studies to assess whether or not it was safe to supply formula in these endemic settings where other infectious diseases kill many children, and where breastfeeding is the major defense available against them. UNICEF concluded by 2001 that it was not safe, nor feasible, in many settings in developing countries. These basic findings were accepted by 9 UN agencies, who then, following a global conference on the issue held at a meeting of the World Alliance for Breastfeeding Action, published a booklet "HIV and Infant Feeding: Framework for Priority Action." This booklet outlined the importance of establishing support for exclusive breastfeeding, reconfirming the Code of Marketing that advises against free supply of formula, and calling for increased counseling to ensure that each woman, HIV+ or not, was properly advised concerning infant feeding in the context of her own setting.

The Government of Botswana made a very difficult choice, and chose to follow the advice of others, including the respected US Center for Disease Control and Prevention and certain other US experts instead - not the advice of UNICEF HQ and other UN organizations. Botswana is not alone in this decision; virtually all countries in Central and South America and the Caribbean have made the same choice: to provide free formula for all children of HIV+ mothers, without fully taking into account the possible impact of the loss of the breastfeeding protection against other diseases. The support provided by UNICEF in Botswana was for the government-made decision, and UNICEF support Botswana's efforts to ensure a fair bidding process.

UNICEF has consistently supported WHO guidance that formula should be used to prevent vertical transmission only where it is affordable, feasible, acceptable, sustainable and safe. Clearly, it was not safe in these conditions. In fact, formula provision is not safe in at least some parts of most countries around the world; anywhere where ambient levels of infectious disease are high, or where the recognition of the importance of exclusive breastfeeding can be appropriately balanced against the risks.

I believe in mothers and their desire to do what is best for their children. The call to accept a free supply of an expensive commodity, especially where resources are limited, is very hard to resist. If donors were truly determined to offer a choice, they should be providing the mothers who choose to breastfeed support for exclusive breastfeeding as well as other commodites of an equivalent cost - perhaps other foods to feed herself and her family.

Sincerely,

Miriam H. Labbok, MD, MPH
FACPM, IBCLC/RLC, FABM
Professor of the Practice of Public Health
Director, Center for Infant and Young Child Feeding and Care
Department of Maternal and Child Health
School of Public Health, CB#7445
The University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7445
http://www.sph.unc.edu/mch/ciycfc
The Center for Infant and Young Child Feeding and Care in the School of Public Health at UNC-Chapel Hill was established January 2006 and exists to further statewide, national and global understanding and support for the mother/child dyad as key to the achievement of optimal infant and young child feeding and associated reproductive health.

Monday, July 23, 2007

Wait until August 4, 2007, then TSA will accept cigarette lighters, and, by the way, human milk, on flights...

"In an effort to concentrate resources on detecting explosive threats, TSA will no longer ban common lighters in carry-on luggage starting August 4, 2007. Torch lighters remain banned in carry-ons....
...
...
...
TSA is also modifying the rules associated with carrying breast milk through security checkpoints. Mothers flying with, and now without, their child will be permitted to bring breast milk in quantities greater than three ounces as long as it is declared for inspection at the security checkpoint."

(Makes you think, doesn't it, that lighters for cigarettes were considered the priority in the articles...)

Wednesday, July 18, 2007

In case you didn't know: appropriate continuous support during labor, and immediate skin-to-skin postpartum have the best outcomes.

The Cochrane meta-analyses have done it again. Kudos for two new publications.
A summary may be found at http://www.newswise.com/articles/view/531475/?sc=dwhn.

Also, thanks to Virginia Thorley for alerting me to these two new and very useful papers.

1)Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. The Cochrane Database of Systematic Reviews 2007, Issue 3.
This review confirms the importance of early skin-to-skin just in time for World Breastfeeding Week, which is dedicated this year to early initation of breastfeeding. In fact, I was just chatting with Nils here at the LLLI Physician's Seminar- which, by the way, it excellent as always - who continues his inspiring work in this area.

2) Hodnett ED, et al. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2007, Issue 3.
This important study confirms what Marshall Klaus has been telling us for years: women who have a midwife, doula or a supportive family member with them throughout labor are more likely to have a shorter labor, less likely to use painkillers during labor and more likely to be satisfied with their childbirth experience, compared to those who receive regular hospital care.

For those of you who may not be familiar with the Cochrane Reviews: The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Friday, July 06, 2007

Dear Friends:

I have received a series of very negative comments from "anonymous" that have been calling me radical and have been very supportive of, if I may paraphrase: "Nestles, with its generous nature, funds so much excellent research."

I would encourage "anonymous" to provide a name if he or she is convinced of the ideas they put forward.

Meanwhile, I will publish some of them, so that we may have a bit of the flavor of those who wish to keep their names hidden.

Best wishes,
Miriam

Tuesday, July 03, 2007

IFC floods media with the statement: "Breastfeeding Not Associated with Reduced Risk of Adult Obesity"

IFC - International Formula Council - is issuing press releases concerning a recent study that found no relationship between breastfeeding, or formula feeding, and adult overweight.
This analysis was part of the Nurses Study - an extremely large prospective study - and found no significant relationship with the breastfeeding of the nurse and her adult BMI, etc.
In fact, it is likely that there are many intervening variables that may impact on adult obesity.

HOWEVER
THERE ARE SEVERAL REASONS THAT THIS STUDY SHOULD BE VIEWED WITH CAUTION:
1. This particular aspect of the Nurses study was based on a retrospective recall by the nurses' mothers concerning their feeding of the nurse.
2. Breastfeeding duration and timing of the introduction of evaporated milk formula or commercial formula when the nurse was an infant was recorded from a sample of nurses' mothers. Most of this recall was for events that occurred more than 40 years earlier.
3. Validity of recall among women with multiple children deteriorates over time, let alone decades.
4. One group of women who were less likely to have been breastfed or breastfeed were eliminated (i.e., those with cancer).
5. The reported rates of breastfeeding and exclusive breastfeeding are much higher (i.e., significantly very over-reported) if compared to the breastfeeding rates in that era.

And, by the way, many other large studies and meta-analyses continue to show the association between breastfeeding and less childhood overweight.

Now, please tell me why the IFC is pushing the finding from this study?

Thursday, June 28, 2007

Expired Formula? Not just a nutrition risk.

I found this little note on the web from Arizona with an interesting twist on corporate irresponsibility. Expired formula is not only a nutrition risk, but expired powdered formula may well be a breeding ground for bacteria, leading to possibly major - or even lethal - health consequences. While most expiration dates are on the conservative side, blatant abuse caught repeatedly could well be a sign of additional abuses.

Bashas' + Babies = A Risky Formula
Posted : Wed, 27 Jun 2007 23:54:00 GMT
Author : Hungry for Respect

PHOENIX, June 27 /PRNewswire/ -- A study found widespread stocking of expired infant formula at Bashas'-owned stores in Arizona. The study was based on an investigation conducted by Hungry for Respect, a coalition of grocery store employees, their union and community groups. ...Hungry for Respect's investigation found that a staggering 58% of the Bashas' Supermarkets stores visited and more than half of the Food City stores visited in the Phoenix, Tucson and Yuma areas stocked expired infant formula...The investigation also found that 10% of the Bashas' upscale AJ's Fine Food stores visited sold expired formula.
Infant formula is required by the US Food and Drug Administration to have a "use by" date so that parents don't mistakenly feed their babies formula that has lost its nutritional value. Formulas consumed after the "use by" date may not provide the nutrition levels required by the FDA.

Saturday, June 23, 2007

Two more commercial infant formula recalls in the last year...

This makes about 7 major recalls in the year and a bit, and at least one emergency level lethal outbreak (Botswana) directly from formula...

Thank you, Associated Press, for covering these problems.
When will the policy makers realize that breastfeeding is the only physiologically normal way to feed human infants? when they do, we will see paid maternity leave, insurance reimbursement for lactation services, and legal protection against aggressive and misleading marketing on the part of these large firms.

1) Huge Recall Of Similac Baby Formula
Abbott Recalling About 300,000 Bottles That May Lose Vitamin C Over Time (CBS) WASHINGTON, Sept. 15, 2006
(AP) The Abbott health care company is recalling hundreds of thousands of bottles of infant formula distributed nationwide because they might not have enough vitamin C.

2) June 20, 2007: 07:41 AM EST
MANILA (AP)--The Philippine government has ordered the recall of millions of cans of infant formula made by U.S.-based company Wyeth because they may have been contaminated at a Philippine warehouse during a storm last year, officials said Wednesday.

Monday, June 18, 2007

Ready to debate and achieve consensus on the way forward?

Please visit:

http://www.sph.unc.edu/mch/symposium_on_breastfeeding__feminism_5130_4470.html

and register for this exciting event - before the price goes up!!

Solids as the first complementary food? Hmmmm

Re: Pureed food 'isn't natural for babies - Unicef nutrition expert sparks controversy with attack on spoon-feeding from tins and jars. Amelia Hill, social affairs correspondent, Sunday June 17, 2007, The Observer
http://www.guardian.co.uk/medicine/story/0,,2104953,00.html

There seems to be an increasingly heated debate as to the best first foods to be introduced to the exclusively breastfed child at 6 months or so. Research by Kay Dewey and others has convinced me that the most appropriate first foods should be high in high quality protein, iron- and nutrient-rich. But what is the best way to introduce them? and would the answer vary by individual status, setting, and caretaker time conflicts?

I am responding only to the statement that appeared in a recent Observer article that seemed to state that UNICEF is against spoon feeding and pureed foods, and in favor of solids. This is an area that arguably deserves much increased evidence-based attention, not only in terms of foods, but also in respect to manner of feeding, continued intensity of breastfeeding, settings, maternal time availability and scale-up.

While moving directly to solids is an interesting notion, I think it is important to clarify that this statement was issued by one country's BFHI Deputy Director, and that this is not UNICEF policy, as far as I know.

I was recently asked to review a British video on a solid, non-ground or treated, food introduction approach - perhaps the one referred to in the article - and to me, it does seem a feasible alternative - for a self-selected population who fully understands how to do it, what to expect, and with regular health status monitoring. But what can be recommended globally?

It may very well be true that much of what is available out there for purchase has problems, but statements on what is "natural" can be off base, as well. Traditionally, it is thought that humans pre-masticated foods for their infants, adding natural enzymes and achieving a ground version of the food; while this may be natural, it is unlikely to return as the norm.

In fact, I may not be entirely up to date on UNICEF policy as I have been here at Carolina for over a year, but my guess is that there has been no such statement from UNICEF/HQ, which supports WHO policy. My understanding of WHO policy, as outlined in the Global Strategy, is that it encourages a continuum of appropriate complementary foods, starting with 1) local foods, prepared for nutrient density and infant consumption, possibly with nutrient supplement where needed, followed by 2) locally produced community or commercial foods, followed by 3) national or international manufactured foods.

There is also now a very well considered document online on treatment of malnutrition in the community, that may add to this discussion.

In Great Britain, availability of nutrients may not be a big issue, but in settings where nutrient load in local solids is poor, and where infants are already behind in growth due to compromised intrauterine development and depleted maternal stores, moving directly to harder to consume, less nutrient dense foods would not be optimal. The current guidance on the best complementary food is that it be high in protein and iron and nutrient rich. Unless foods are ground, and possibly pretreated with enzymes, cooked or otherwise made more ready for digestion, it would be difficult for the infant to successfully consume and absorb all the nutrients it needs. Therefore, in my opinion, some preparation and/or supplementation of staples is indicated in these situations for best growth.

AND where caretakers are already overwhelmed with other tasks, feeding may be the only time that there is any responsive interaction with the child. This also should be encouraged.

I know that these statements may be a bit of an outlier from the IBFAN and WABA statements' clarity on complementary foods. However, this is my considered opinion, based on my experience as a Pediatrician and in the field, and based on the evidence that has been shared with me by well-schooled colleagues.

Thanks to IBFAN and WABA for keeping the word out there and circulating it. Patty Rundall, who brought this to wide attention, is an invaluable resource to those of us seeking to enable all women and caretakers to make the right decisions.

Thursday, May 24, 2007

Nice article on co-sleeping and breastfeeding: Response

Holly Johnson wrote a wonderful and balanced piece (excerpts below). The responses she received are not based on the same kind of careful research that went into the article.
These points may help defining some of the issues raised by her responders:
1. Babies generally sleep next to the mother, away from the father.
2. Most babies have an alternative sleeping place (floor on a mat, for example) when the parents have other activities to attend to.
3. Babies do respond very well, from the start, when they are disturbed. The mother is aware of the baby's movement. However, if a parent is impaired by drugs or alcohol, all bets are off, and the baby should not co-sleep.
4. Studies show that a baby that sleeps away from parents is breastfed less often at night. This can have varying results.
5. Bottom line - in the US, we have moved far away from optimal parenting due to social and economic pressures. We do our best. Be kind to each other and to yourselves. We are all trying to cope.

Thanks to all who care about mothers and children.
05/24/2007 10:59:04

Excerpts from 05/23/2007: There are benefits to sharing a bed with your infant. So why don’t we hear about it? By Holly A. Johnson For The Journal Times

Is your baby sleeping through the night? If you’re a parent, you have undoubtedly been asked this question. According to Dr. Jennifer Thomas, a pediatrician at Wheaton Franciscan Healthcare All Saints, the question of whether your baby sleeps through the night is “a value judgment of parenting.” You have a good baby if she sleeps through the night and a bad baby is he doesn’t, Thomas said. It didn’t become “normal” for a baby to sleep through the night until the 1950s, according to Dr. James McKenna, an anthropologist and director of the University of Notre Dame Mother-Baby Behavioral Sleep Lab, when bottle-feeding with formula exceeded breast-feeding in popularity.

Lack of bed sharing information: Hospitals usually don’t give information on safe bed sharing. … Polls have found that up to half of parents bring their infants into bed with them for all or part of the night.

What is co-sleeping? Not all organizations and health-care professionals are working from the same definition of co-sleeping and bed sharing. According to McKenna, co-sleeping is the infant and caregiver sleeping within sensory range of each other. “So, room sharing is a form of co-sleeping,” he said. Bed sharing means that the infant sleeps in the adult bed with at least one parent.

Bed sharing and breast-feeding Bed sharing can be a boon to breast-feeding mothers, allowing mothers to respond more quickly to baby’s distress. And, even though breast-fed babies tend to wake more often during the night, the quantity of sleep is comparable to bottle-feeding (and non-bed sharing) parents because both infant and mother returned to sleep more quickly. The increased sensitivity of breast-feeding mothers also seems to prevent them from injuring the infant during sleep.

Bottle-feeding and baby’s sleep McKenna said he found differences between bottle- and breast-feeding families when it came to the sensitivity and positioning of mothers with their infants. Therefore, for bottle-feeding families, “sleeping is best alongside the bed, not in the bed,” said McKenna. Co-sleeping furniture may be a viable alternative to bed sharing, but none has been tested by the Consumer Product Safety Commission.

Anti-bed sharing The AAP discourages bed sharing, noting that it “is more hazardous than the infant sleeping on a separate sleep surface.” Some physicians think the AAP (and several SIDS prevention groups) have gone too far in discouraging bed sharing. Japan has a very low incidence of SIDS, and they sleep with their babies, said Thomas. “So, the problem is not just bed sharing.” When deaths occur in a bed the whole practice is condemned, Thomas said. “We never say that about a crib.”

Thursday, March 01, 2007

Nestle response proves, yet again, that they violate Code

Although I have not been privy to the Harvard Crimson article on the Nestle boycott, I received a copy of an editorial responseby Nestle spokesperson, Gayle Crozier Willi. The response demonstrates that, indeed, Nestle violates the Code.
The following is in response to some of the comments made by Nestle:
Nestle statement: We does not promote formula in association with the AIDS pandemic.
Accurate statement: While today, Nestle ostensibly supports the WHO statement, in the early years, prior to the WHO statement, Nestle hosted and offered to host meetings on HIV. Today, despite the assertion of support for the statement (http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/consensus_statement.pdf)
and for the Code(), the Nestle spokesperson/advocate misrepresents the statement and the Code. For example, the WHO statement says "Exclusive breastfeeding is recommended for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected women is recommended." This recommends the use of safe alternatives to breastfeeding only under specific circumstances, and commercial formula are not the only alternative. To be safe, many factors must be in place, and safe preparation is much more than labeling, especially where women's illiteracy rates are high. Exclusive breastfeeding is therefore recommended where the use of formula carries high risks, which would include a majority of women in the developing world.

Nestle Statement: "Nestle sells formula at low prices to governments, for use in official programs for the prevention of transmission of HIV from mothers to babies, only at the request of such governments."
Accurate statment: This, too, is a Code violation, as the Code calls for purchase of commercial formula by competitive bid and not to accept low cost of free supplies. Further, while noting "success" in South Africa, she fails to comment on the use of this same product - which was never tested in an immune compromised setting prior to its promulgation for Africans - the local stock-outages, and the associated deadly diarrhea outbreak in Botswana, right next door.

Nestle Statement: no incentives to health workers, good labelling, support code.
Accurate Statement: Nestle has been documented as supplying commodities to clinicians under the guise of "research" in conditions where research is not feasible. In addition, the Code specifically calls upon manufacturers to comply in all countries, whether or not the Code is legislated in that country.Further, Nestle has been involved in challenging the laws that support the Code in at least one country. Finally, the Code specifically calls for language on the label that offers the risks and benefits of choosing to use formula, not just a throw-away phrase that breastfeeding is best. In my personal experience, when alerted to a violation, the effort by Nestle was not to undo the violation, but rather to justify it, and to offer the country the opportunity to make their Code laws more lax.

Comment: Nestle and other formula companies together are a multi-billion dollar industry, and can afford to buy the best advertising and slickest language in their public relations. It is important for consumers to be aware of the misrepresentations that are made, and to closely monitor products that can have such a negative impact on the health and development of our children, our future.