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.

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.


Miriam H. Labbok, MD, MPH
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
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

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 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,

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.

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?