Wednesday, December 31, 2008

New Years Resolution?

Dear Friends:
As we start the new year, please think about our children, our future, and about families here at home in the US, as well as around the globe.
As you know, my work has always been towards truly enabling women to make unbiased evidence-based decisions concerning how they will nurture and space their children, and to succeed with the best health-supportive actions. Therefore, I have always prioritized research and program change, rather than the so often vain attempts to fight the power of commercial industry in the US and globally.
However...
it seems that here in the US there has been insufficient progress in terms of government and public action to ensure that our children receive the best start on life. While some individuals in USG and state level nutrition leadership are sincerely and actively pushing to learn more about feeding practices and to bring this information to the attention of the public, the greater HEALTH community sits relatively silent. Breastfeeding support efforts of the health care community as a whole and the public health community, specifically, have done little to challenge commercial formula industry's efforts to misinform, lobby, pay off hospitals and government programs, and use legal protection for their efforts to prioritize their profits over the health of our children.
The 2008 news is not all bleak: we have new survey information showing increases in initiation of breastfeeding and data on hospital practices, and new clinical guidance from the USG supporting breastfeeding, and USDA/WIC is launching a massive effort to ensure that WIC provides increased support for breastfeeding while continuing to be the single largest purchaser of commercial, overpriced, rebated formula in the world.
However, the news today includes yet another insight to commercial formula industry efforts to prioritize their income over the health of the public. (post below)
As we start the new year, is there any way we might increase the pressure on commercial infant formula companies to support the health of the public, rather that work against it? Formula is a decent product - if needed - but this industry constantly uses their massive income and resources to mislead the public and to lobby to sustain poor health practices. Their rationale is that they must make money for their stockholders.
Will our new administration have the ..... to stand up to rampant industrial abuse of public health? Will they fight for paid maternity leave so that mothers will have the opportunity to be mothers to their children? Will there be government support to institute and regulate the Ten Steps for breastfeeding-friendly practices in US hospitals? And, will the government establish the multi-sectoral approach (Dept of Education, Dept of Labor, FDA, FTC,etc) to supporting breastfeeding - all four of these actions called for in the Innocenti Declaration signed by the USG in 1990?
What should we resolve to do in the New Year in this regard?
Please comment and let others know what you think we can do, and let me know if I can help in any manner.
Best wishes for the new year....M

Mead-Johnson does it again - GREAT supporters of public health, no?

FDA notes that Mead-Johnson and Nestle have trace melamine in thier infant formulas. Over the past years, dozens of severe cases of commercial infant formula contamination have been reported in the press, and who knows how many additional cases have occurred? This year in the US, we have had deaths and disease from E sakazakii found in powdered formula, and other illnesses from poor preparation.

Now:
http://www.nj.com/business/ledger/index.ssf?/base/business-11/1230702320204430.xml&coll=1
"The New York-based company also lobbied Congress on a bill that would ban the use of a plastic-hardening chemical called bisphenol-A in children's food packaging. The chemical has been used to seal food containers, including baby formula.
Bristol-Myers, the maker of Enfamil infant formula, lobbied to inform Congress that the materials used to line infant formula cans are safe. A 2007 report by government toxicologists said the chemical contributed to irregular development and noncancerous growths in animal studies."
Excuse my sarcasm, but....Isn't it good to know that we are partnering with such a fine supporter of the health of the public? Canada, among others, has taken steps to ban this dangerous chemical from food packaging use...it is currently found in many see through plastics, and leaches out particulary with temperature changes...

Tuesday, December 30, 2008

Mead Johnson for sale - marketed based on the suffering of children...

"Morningstar analyst Debbie Wang says that despite its age, the firm [Mead Johnson] has continued to innovate and grow. She also likes the company's global footprint, especially in emerging markets in East Asia. News reports of deaths from melamine-tainted Chinese infant formula should only help firm up Mead Johnson's brand, she says. (W)e expect the company will take advantage of recent events involving tainted Chinese formula and dairy products in that market as parents turn to foreign brands that offer greater assurance of quality," she wrote in an Oct. 9 note.

Please note, my friends, that Mead Johnson products, along with Nestle, in the US were found to have trace melamine....

Why is Bristol-Meyer selling off this lucrative arm? Maybe they sense the fact that mothers are becoming better informed...Let's hope.

Monday, December 15, 2008

National Quality Forum endorses exclusive breastfeeding

The National Quality Forum (NQF) is a not-for-profit public/private membership organization created to develop and implement a national strategy for health care quality measurement and reporting. NQF was created as a mechanism to bring about national health care policy improvement.

Therefore, it is a boon to breastfeeding that this group calls for all healthy babies (non-NICU) to be exclusively breastfed throughout their hospital stay and at discharge. They note that this will mean facility, integrated system, and/or community quality improvement changes.
We of the breastfeeding support community know that institution of the Ten Steps will certainly pave the way!
Kudos to NQF for the recognition of this important intervention as part of perinatal care standards. To see all the perinatal quality improvements, see:
http://www.qualityforum.org/news/releases/102708-endorsed-measures-pc.asp

Monday, December 08, 2008

News coverage of watered-down formula disturbed me in many ways...

It was very sad, indeed, that a young mother watered down WIC formula to make it last a month. To me, this highlights so many issues that are not being well addressed, and that were not well addressed in the coverage:
1. WIC was designed as a supplemental program, and is not meant to meet all the needs for a month. Was this mother properly informed about this? Clearly not. She may have received some information, but it clearly was not communicated.
2. Since WIC is a supplemental program, is there discussion with the client about planning for the end of the month? Is each client counseled to develop a plan and have the plan checked with the nutritionist?
3. Was sufficient attention given to informing this mother and all mothers about the cost savings of breastfeeding?
4. Some blogs following the news coverage assume that she may have tried breastfeeding and not succeeded. There is nothing in the press coverage on this. If it so, then the support she received may not have properly addressed her issues. Was the possibility of breastfeeding fully considered by those who treated her baby? Did they try to help her re-lactate?
5. Is every mother informed of the risks of formula use by WIC, along with risks and benefits of breastfeeding?
6. Why doesn't media highlight the risks of formula use in general in the coverage of these disasters? In no society is the mother at fault when she is deserted in this manner with misperceptions and misinformation.
I find it terribly sad that we leave young mothers to fend for themselves without proper information and support, and then we label them as ignorant or as failures. It is our fault, we who design and oversee these programs; we who endorse a society that is product driven, rather than health driven; we who think of ourselves and our own, and not of those who are lost in the commercial media blitzkrieg; we who have forgotten that the beginning of life dictates so much about the future generation and how they will go forward...

Monday, December 01, 2008

Melamine, E sakazakii, BPA hit the US... and iron

Having promised you - and me - that I will not spend inordinate time bashing the formula industry's practices, and that I would spend my time building the environment that enable breastfeeding, I am still struck that, due to the realities of commercial formula, there is often little difference between the two.

The formula industry advertises its product as "safe." There is no such thing as a totally safe commercial product for a vulnerable population. Pharmaceuticals undergo much greater quality control and sterility in processing, and yet mistakes are made.

The mix of dehydrated cow's milk and additives is an excellent medium for bacterial growth. The surprise is that outbreaks are not more often diagnosed - perhaps this stems from the belief that frequent diarrhea and infections are "normal" in infants. We clearly have an under-reporting of negative episodes.

So, back to the product on hand - the one with traces of melamine, occasional deadly and frequent less illness-creating factors. It's an okay food for human beings who are built to take a lot. But infants, as resilient as they may be, do not have adult defenses. We need a much lower tolerance for recalls and contaminants in the foods we feed to infants than we have today.

Unfortunately, we seem to add stuff to formula all the time. Iron is a fine addition for the older child, but is good food for gut infections in the youngest. Now, research is showing damaging impact of too much iron on the brain in the early weeks/months. Does your WIC program use formula with iron at all ages?

Next post will be back to what we can do creatively to ensure an enabling environment...

Monday, November 10, 2008

Fourth Breastfeeding and Feminism Meeting -- Save the Date

Fourth BREASTFEEDING AND FEMINISM SYMPOSIUM: FROM BIRTHPLACE TO WORKPLACE
Thursday and Friday, March 26 - 27, 2009

Venue:
The University of North Carolina at Greensboro Reduced-rate accommodations are available at the Greensboro Marriott Downtown
Hosted by:
The University of North Carolina at Greensboro, Center For Women's Health and Wellness,
The University of North Carolina at Chapel Hill, Carolina Breastfeeding Institute

Please email CWHW@uncg.edu for more information.
Applying for Continuing education credits
Visit www.uncg.edu/hhp/cwhw or www.sph.unc.edu/breastfeeding

From Birthplace To Workplace will build on the following principles addressed at previous symposia:
· Breastfeeding is public health imperative and an important aspect of reproductive health, as well as a reproductive right and a social and biological process;
· Women must have the right of self-determination to breastfeed freely and without constraint;
· It is important to re-orient the paradigm in which breastfeeding is viewed as a “lifestyle choice” to a paradigm in which it is a “human right” and a “social justice issue” so as to ensure the social, economic and political conditions necessary to promote success; and
· Women’s decisions to breastfeed should not result in the loss of their economic security or any rights or privileges to which they are otherwise entitled.

The 2009 symposium brings a feminist lens to ensuring the social, economic and political conditions necessary to secure breastfeeding for all women from the birthplace to the workplace. Working together in a transdisciplinary manner, with social scientists, health workers, lactation and feminist advocates, employers, and policy makers, we will create a policy agenda for action.

Speakers to include:
· Sarah Amin, Co-director, WABA; Gender and Maternity Protection Action Kit
· Cathy Carothers, co-director of EVERY MOTHER, INC; The Business Case for Breastfeeding
· Deborah Cassidy, Human Development and Family Studies, UNCG; Child care accessibility and quality
· Miriam Labbok, Professor, UNC-CH; Evolutionary, biological and economic perspectives on mothering and maternity leave
· Jake Marcus, Public Interest Lawyer; Breastfeeding, Reproduction and the Law
· Beth Olson, Food Science and Human Nutrition, Michigan State University; Work culture and breastfeeding
· Ana Parilla, University of Puerto Rico; Medicalization of Birth as Violence against Women
· Marian Ruderman, Center for Creative Leadership, Greensboro; Emerging research on work-family balance
· Christina Smillie, creator of the “Mother-Baby Dance” materials
· Paige Hall Smith, Director, Center for Women’s Health and Wellness, UNCG; Women’s experiences with breastfeeding and work
· Emily Taylor, Carolina Breastfeeding Institute; Achieving Exclusive Breastfeeding
· Mary Rose Tully, Director, Lactation Services, UNC Hospital; 42 days of intimacy
· Alison Stuebe, Director MTM, UNC Healthcare; Transitioning home
· Penny Van Esterik, York University, Toronto (KEYNOTE); Global, feminist and anthropological perspectives on motherhood

Travels and thoughts for coming winter: Wherefore PUBLIC health?

The last few months I have been at meetings on top of meetings: Vermont WIC; U of VM; VELB; ABM/EURO Annual Symposium; ABM/EURO 'What every physician needs to know' meeting; WABA Breastfeeding 6-24+; Core Partners WABA, representing ABM as the physician's arm of WABA; WABA Steering Committee; ABM/International 'What every physician needs to know' meeting; ABM/I Board meeting; ABM/I Annual meeting; APHA Intersectional Council; APHA IH Section meetings, and; APHA.

One might ask - why?

I guess, at this stage of life and career, I see a vital need for demand creation for public support for public health.

Public health has become a buzz word for pushing products. Especially where some private sector sees a potential for profit. There certainly is a role for these products: immunizations, vitamins, bed nets, and essential drugs, such as antibiotics and HIV tx. These are public/private efforts because the private commercial sector has a vested interest. AND it is great when these interests collide.

Truly, public health must receive public funding. They "get" this in many countries outside of the US, where breastfeeding is fully supported, Code is law, and maternity leave is paid and of sufficient duration. Funny, but these same countries have much lower infant and maternal mortality than we have....

So what do to? I came home to the US just in time to vote and see my vote counted here in North Carolina. We have sweeping POTENTIAL for change in how our government views the public.

Now is the time to press for recognition of preventive health action with public funding....stay tuned!!

Transdisciplinarity makes International Health Special

I have not posted for a while due to unbelievable amount of travel since mid September. But now I'm back, and lots to report on...

As a lifelong international MCH professional, as a faculty member, and as citizen of the world, I am so excited about chairing IH Section these next 2 years. To me, what is so special about international health is that it is a transdisciplinary field. The term “transdisciplinary” may be new to some of you, so here’s the definition, developed by Piaget (yes, the same Piaget), translated by yours truly: “concerning interdisciplinary discourse, we hope to see a higher level emerge, “transdisciplinarity,” which would not settle for interactions or reciprocities between specializations, but which would internalize such interaction within an overall construct, and break down the walls between disciplines.”

While APHA International Health Section members present themselves with interests such as “community-based health” or “MCH” or “health systems,” as international health workers we all recognize that enabling health for all will demand comprehensive, multi-level, and transdisciplinary thinking.

My goals for the IH Section over the next few years are 1) to enhance our student-professional networking, 2) to continue to strengthen our voice in APHA advocacy for support and funding for our important work, and 3) to work with the committees and members to develop a simple but effective strategic plan to help ensure continuity of effort.

Please consider joining the APHA IH Section at: http://www.apha.org/about/membership/ and don't forget to indicate IH as your primary or secondary Section!!

Friday, August 08, 2008

Friday, July 18, 2008

Thank you, Dr.Ellen McIntyre, for Recent research findings...

Age at First Introduction of Cow Milk Products and Other Food Products in Relation to Infant Atopic Manifestations in the First 2 Years of Life: The KOALA Birth Cohort StudyBianca E.P. Snijders, PhD, Carel Thijs, MD, PhD, Ronald van Ree, PhDc and Piet A. van den Brandt, PhDPEDIATRICS Vol. 122 No. 1 July 2008, pp. e115-e122DOI: 10.1542/peds.2006-0772 2007;119;137-141 Pediatrics den BrandtIs pacifier use a risk factor for acute otitis media? A dynamic cohort study.

Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG.Fam Pract. 2008 Jun 17;. [Epub ahead of print]Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18562333Related Articles: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=pubmed_pubmed&from_uid=18562333

Short- and long-term decrease of blood pressure in women during breastfeeding.Jonas W, Nissen E, Ransjö-Arvidson AB, Wiklund I, Henriksson P, Uvnäs-Moberg K.Breastfeed Med. 2008 Jun;3(2):103-9.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18563998

Knowledge of Iraqi primary health care physicians about breastfeeding.Al-Zwaini EJ, Al-Haili SJ, Al-Alousi TM.East Mediterr Health J. 2008 Mar-Apr;14(2):381-8.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18561731

The Effects of an Infant-Feeding Classroom Activity on the Breast-feeding Knowledge and Intentions of Adolescents.Walsh A, Moseley J, Jackson W.J Sch Nurs. 2008 Jun;24(3):164-9.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18557676

Kangaroo care and breastfeeding of mother-preterm infant dyads 0-18 months: a randomized, controlled trial.Hake-Brooks SJ, Anderson GC.Neonatal Netw. 2008 May-Jun;27(3):151-9.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18557262

Partial breastfeeding protects Bedouin infants from infection and morbidity: prospective cohort study.Bilenko N, Ghosh R, Levy A, Deckelbaum RJ, Fraser D.Asia Pac J Clin Nutr. 2008;17(2):243-9.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18586643

Exploring the barriers to exclusive breastfeeding in black and minority ethnic groups and young mothers in the UK.Ingram J, Cann K, Peacock J, Potter B.Matern Child Nutr. 2008 Jul;4(3):171-80.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18582351

Maternal obesity and initiation and duration of breastfeeding: data from the longitudinal study of Australian children.Donath SM, Amir LH.Matern Child Nutr. 2008 Jul;4(3):163-70.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18582350

The association of infant feeding with parent-reported infections and hospitalisations in the West Australian Aboriginal Child Health Survey.Oddy WH, Kickett-Tucker C, De Maio J, Lawrence D, Cox A, Silburn SR, Stanley FJ, Zubrick SR.Aust N Z J Public Health. 2008 Jun;32(3):207-15.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18578817

Infant feeding intentions of Scottish adolescents.Foulkes JL, Dundas KC, Denison FC.Scott Med J. 2008 May;53(2):9-11.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18549062

HIV, infant feeding and more perils for poor people: new WHO guidelines encourage review of formula milk policies.Coutfoudis A, Coovadia HM, Wilfert CM.World Hosp Health Serv. 2008;44(1):45-8.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18549034

Sharing breastmilk: wet nursing, cross feeding, and milk donations.Thorley V.Breastfeed Rev. 2008 Mar;16(1):25-9.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18546574

Alcohol, pregnancy and breastfeeding; a comparison of the 1995 and 2001 National Health Survey data.Giglia RC, Binns CW.Breastfeed Rev. 2008 Mar;16(1):17-24.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18546573

Long-term breastfeeding; changing attitudes and overcoming challenges.Gribble KD.Breastfeed Rev. 2008 Mar;16(1):5-15.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18546572

Codeine: death of a breastfed newborn. Paracetamol first choice for breast-feeding women.Prescrire Int. 2008 Apr;17(94):67.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=

Effect of a prenatal nutritional intervention program on initiation and duration of breastfeeding.Léger-Leblanc G, Rioux FM.Can J Diet Pract Res. 2008 Summer;69(2):101-5.Link: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&dopt=Abstract&db=PubMed&list_uids=18538064

Associate Professor Ellen McIntyre OAMManager & Conference ConvenorPrimary Health Care Research & Information Service (PHC RIS)Department of General PracticeFlinders University, GPO Box 2100, Adelaide SA

Friday, June 13, 2008

RWJF asks for public comment as to how to achieve a Healthier America...

Public Comment
Presented at the Robert Wood Johnson Foundation Commission to Build a Healthier America
Raleigh, North Carolina Field Hearing
June 12, 2008

Good Afternoon. My name is Miriam Labbok. I am a Preventive Medicine Physician Epidemiologist, and a Professor of the Practice of Public Health at UNC School of Public Health, Department of Maternal and Child Health. Previously, I have served on the faculties of Johns Hopkins and Georgetown, and worked at USAID as a Medical Officer and served as a Senior Advisor at UNICEF headquarters. I have worked in more than 50 countries, and more than 20 states. I am pleased today to be working in North Carolina.

You may be wondering whether this international maternal and child health background is relevant to our discussion. Today, we live in a global community, and there is much that we might learn from the work of other countries. We are not that different from others in terms of our problems; while we have excellent medical centers, unfortunately, in some pockets, our infant mortality rates and inequities equal that of some developing countries.

North Carolina, with its 8 million some citizens, and 100 counties, is larger than many countries around the world and equally complex. And with its demographics, and with its “mountains, prairies, and ocean white with foam”, it also might be considered a microcosm – a laboratory - for the United States.

Since 1978, the world has accepted a definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. It also had been accepted as a fundamental human right.

Therefore, I am asking you to come with me on a paradigm (pair o’ dime) shift. In our discussions today, we have concentrated on pre-school children, those over 2 year old. However, the reality is that health and development are biologically inter-generational. May I propose that we shift this discussion from concentrating on fixing what is already broken, to attention to avoiding breakage in the first place? To do this, we must consider primary prevention and equity. We must shift ourselves into the reality that parents/mothers are the prime providers and educators, and that the period of minus 12 to plus 24 in the life every child is the time when the health, growth and development trajectories are set.

What should we do? One thing that is clear is that we must address readiness for pregnancy and the vital issue of breastfeeding. There is abundant research that confirms that breastfeeding impacts on at least 18 major health problems, including diabetes, obesity, breast cancer, respiratory disease hospitalizations (all of which carry major heavy health care costs, let alone the associated pain and suffering), and many others. Teenage mothers, who already are at risk, suffer more bone loss if they do not breastfeed their infants. LACK OF BREASTFEEDING is costing our nation billions of dollars and untold individual suffering and untimely deaths. We calculate that improved breastfeeding in North Carolina could prevent 100 infant deaths or more, about the same number as are currently lost to SIDS. Consider, what would we be willing to pay for a treatment that yielded all of these benefits?

LACK OF BREASTFEEDING IS A “SILENT CATASTROPHE” and it is going unnoted by those who are in a position to create needed changes.

First, let us consider: Who doesn’t breastfeed? The answer is, “Nearly everyone”. But breastfeeding is especially rare among the young, African American, low educated, and in the southeastern US. WIC and selected hospitals have begun to make changes to increase initiation, however, sustained and exclusive breastfeeding remain rare. If we only consider equity, here in North Carolina, infant mortality rates are more than twice as high in the African American population compared to whites, but the rate of continued and exclusive breastfeeding is about half that of whites.

Why don’t mothers breastfeed? There is “asymmetrical information” provided by the media, and by aggressive advertising of commercial infant formula to parents and to health professionals, alike. We have a health care workforce unskilled in breastfeeding support: there is no dedicated breastfeeding curriculum in our medical schools. There are also social pressures and work pressures on women. But the overriding issue is that, with all of these failures, our worst is that we undercut mothers’ self-efficacy, and breastfeeding success is, to a large degree, a “confidence game”.

What is needed? Here in North Carolina, our Blueprint for Action to Protect, promote and support breastfeeding has not as yet been implemented. It provides eight recommended actions. One that we are beginning to develop now is the call for a statewide breastfeeding-friendly maternity effort. This is timely, as the National Maternity Practices in Infant Nutrition and Care (mPINC) Survey findings were just published TODAY. They provided a clear message for North Carolina and for the country: we have a lot of work to do to create breastfeeding-friendly practices. In North Carolina, we score just below average for the nation (again – a microcosm…), and our breastfeeding initiation rates are also just below average. In practices associated with breastfeeding continuation and exclusivity (labor and delivery, immediate postpartum contact, post discharge support), we score below average. And, yes, in North Carolina, we lag behind the nation in breastfeeding continuation and exclusivity.

We need to ensure that our health care workers are trained in the skills necessary to support breastfeeding, that there is coverage of the population by availability of lactation consultants and other skilled workers, and that these skills are covered by insurance. We need the political will to regulate aggressive formula advertising and manipulation of the health system – we did it for cigarettes, we can do it again. We need social marketing and K-12 educational exposure to breastfeeding as normal and healthy; we need community and church commitment to our mothers and children. And we must gain workplace support, such at that reported here by Dan Gauthreux. Perhaps most of all, we must foster the role of that primary provider and primary educator, by insisting on paid maternity leave – a right guaranteed in virtually every other developed country in the world.

Can we do it? Yes. It would pay for itself. The reduced costs of health care when all of these diseases and causes of death are reduced would more than cover the costs of providing the needed changes, as well as paid maternity leave.

The bottom line is: do we care about our children, our future? If we do, we must act now to stem the impact of this SILENT CATASTROPHE, and act to enable all women to have accurate information upon which to base their decision to breastfeeding and to succeed with that decision.

Thank you for considering this shift, and supporting intervention for the period of minus 12 to plus 24 months.

Friday, May 30, 2008

Another formula recall: not to worry, only air in the cans...

Last June, 2007, this blog noted 7 major recalls in the previous year or two, and at least one emergency level lethal outbreak (Botswana) directly from formula. We noted at that time that the recalls seemed to emerge long after the problem started. Just today, the following recall has been announced:

“About 13,000 cans of Calcilo XD Low-Calcium/Vitamin D-Free Infant Formula with Iron, manufactured by Abbott Nutrition of Columbus, Ohio, because small amounts of air may have entered the cans, causing oxidation. Consumption of highly oxidized foods can cause nausea, vomiting and diarrhea ...The cans were distributed between June 2006 and April 2008. For more information, call the company at 1-800-638-6493”.

Since June 2006?! Have these companies heard of quality control?

Clearly, this is a specialized formula, and probably was only used in children with other major health risks, so it is not a big worry…except to those children who already had other major health risks…

Monday, May 19, 2008

TarHeels Bus Tour - a very special week - and much more to be learned.

This past week 30 or so new faculty from UNC had the unique opportunity to tour the parts of the state most folks don't get to see, and to better understand the role of UNC faculty in the advancement of our state. Each of us experienced this trip through our own set of prisms - the journalist came away with questions about teaching social journalism; the environmentalist made contacts for future exploration; the political scientists explored ideas that I can only begin to understand; and all of us who work internationally saw parallels and new issues as yet unexplored. All of us came away with a new vision of the state, the history and political complexities, and the way money is spent in the name of the public good.

From the perspective of the reproductive health continuum, surprisingly little was said. In Hendersonville we discussed the aging of the population, in Kannapolis and points west we discussed individual metabolism, school age and organic nutrition; and in Rocky Mount we discussed breast cancer awareness.

We hardly touched on the epidemic of infant mortality in North Carolina, that leaves us 44th among all states in terms of infant survival. ( United Health Foundation, 2007 Report. URL: http://www.unitedhealthfoundation.org/ahr2007/infantmort.html#Table37) We did not discuss coverage of reproductive freedoms, nor the health impact of high fertility rates. So here are some data:
  • Infant mortality is the death of a baby in its first year of life. Minority babies in NC are more than two times more likely to die before their first birthday, with a reported infant death rate of 13.6 in 2006, vs 6.0 for White infants.
  • Breastfeeding reduces mortality due to the four leading causes of infant death in North Carolina: pre-maturity/low birth weight, SIDS, respiratory diseases and sepsis.
  • Lack of breastfeeding increases breast cancer, diabetes, and obesity in moms.
  • While the percentage of all North Carolina mothers who report “ever breastfed” in 2005 are comparable to national figures, 86% of Hispanic mothers in North Carolina reported they “ever breastfed” while only 76% of White and 48% of Black mothers reported ever breastfeeding. State and national rates for initial breastfeeding are similar for the White population, the rates for Hispanics in NC are slightly higher, and breastfeeding among African-Americans nearly 8 percentage points lower in NC compared to the US.
  • According to an unpublished report produced by the Center for Infant and Young Child Feeding and Care/UNC, “The Potential Impact of Improved Breastfeeding on Associated Health Disparities: Brief for Perinatal Mortality Committee of the Child Fatality Task Force”, anywhere from 5%-17% fewer infant deaths could occur as a result of increases in breastfeeding.
  • Pregnancy rate is about 90 for minorities and about 77 for Whites in NC.
  • Fetal death rates are more than twice as high for Minorities.
  • The majority of abortions in NC are provided in only nine counties, predominantly in the Southwest and Northeast of the state, occur among minorities, and among women with at least a high school education.
  • Since both pregnancy rates and abortion rates are higher among minorities, one may infer that there is an unmet need for family planning in NC, especially among minorities.

Just some addition thoughts to add to our considerations of the needs of North Carolinians, and how we might support the state.

Formula sweetened with sucrose called "organic"? http://www.nytimes.com/2008/05/19/us/19formula.html?th&emc=th

Somehow, parents are not understanding as yet that the only organic food for infants is their mother's milk, directly from the breast. This is known as breastfeeding. The cost is mother's time, a bit of her excess fat, and sometimes a bit of expert advice. It is naturally sweeter than formula because of the natural lactose.
Yes, we need a healthy alternative for those who physiologically are unable to breastfeed, less than 1%. We do not need a better formula; current cow's milk formula are okay in these rare situations.
But what we really need is paid maternity leave with guaranteed job return, as is available in every other "civilized" nation in the world, insurance coverage for lactation support, increased number of milk banks and donors for those children unable to breastfeed, and a society that respects for the role of mothering as valid and prized.
The one comment on human milk in this article fails to note that it is safely and healthfully, and organically, sweetened.

Thursday, May 01, 2008

Where are the SIDS resources to support breastfeeding?

Still MORE research showing how important breastfeeding is if we wish to tackle SIDS deaths.

http://afp.google.com/article/ALeqM5iE57zlWu3pVtk1bNliRqmkhXT17A

Why are SIDS monies only used to buy and promote cribs?
Where are the resources to promote breastfeeding?

It seems sometimes that our society's 'quick-fix' mentality twists too many of our health funding decisions.

Supporting breastfeeding takes more thought than handing out cribs.
Supporting breastfeeding takes more caring than popping a pill.
Supporting breastfeeding takes women - real women with real complex lives - into account while buying a bednet is easy.

Which of these saves the most lives? Hands down, exclusive breastfeeding could be the number one child life saver worldwide, and could bring US infant mortality rates closer in line with our European neighbors'.

We need the political will, as we will never have the commercial sector will, to do what is necessary to support breastfeeding: 1) coverage of lactation support services by all third party payers, 2) paid maternity leave, 3) monitoring, control and sanctions for misleading or asymmetrical advertising by infant formula and foods manufacturers, 4)healthworker training on support skills, and 5) social acceptance of breastfeeding women wherever women are allowed to be.

Sunday, April 27, 2008

Naomi is blogging!

Dear Reader:

If you have a chance, you may wish to visit Naomi Baumslag's blog
http://live.baumslag.com/

She is the author of Milk Money and Madness and other books that highlight women and public health and infant feeding and other important issues.

Thursday, April 10, 2008

NPR: where do you find your health experts?

Dear Day to Day:

I am disappointed in your presentation yesterday on Michael Kramer’s epidemiological study of a community breastfeeding intervention.Dr. Speisel misrepresented the study and its findings. The study he mentions was not designed to study the impact of breastfeeding per se; the study is examining the long-term impact of a hospital based intervention to increase breastfeeding. In other words, the results do not reflect breastfed children vs non-breastfed children, but rather looks at populations whose mothers were exposed to breastfeeding support in the maternity vs those whose mothers did not receive breastfeeding support in the maternity. In the areas with support, infants were more likely to breastfeed (19.7% vs 11.4% at 12 months, exclusively breastfed at 3 months, 43.3% vs 6.4%; and at 6 months, 7.9% vs 0.6%). With this small but significant increase in breastfeeding, the group with the maternity intervention were less likely to experience 1 or more gastrointestinal tract infections (9.1% vs 13.2%) and atopic eczema (3.3% vs 6.3%).

In Dr Michael Kramer’s earlier finding on this study, when the children were younger, a clear difference was found in the health impacts in the regions with and without breastfeeding support, but Michael does not compare breastfed vs not breastfed, he compares areas that had a maternity-based intervention and areas that did not. However, given that the breastfeeding rates in the two groups were different but by no means a comparison of breastfeeding vs not breastfeeding, it is not surprising that findings may be muted or confusing when the children are more than 5 or 6 years old. There are many other studies that do so.

Dr. Speisel’s contention that it is impossible to use epidemiological techniques to compare breastfed to non-breastfed children shows a lack of understanding of epidemiology. Good methodology is not limited, as he suggests, to randomized case-control studies.

If you were truly interested in reporting on this study, it would have been appropriate to interview the author.

Downplaying the importance of breastfeeding for health and survival in the US is in contrast to the AHRQ meta-analysis on this subject, HHS Health Goals for the Nation, and the wealth of studies on this subject. I consider the choice to give a non-expert air time to express an opinion that can damage public health practices is, frankly, somewhat irresponsible.

Incidentally, I am not able to find a single peer-reviewed publication in a PubMed Search under his name, nor am I able to find Dr. Speisel’s name listed in the Yale Medical Faculty directory.

As a contributor to NPR I expect better reporting and accuracy.

Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM
Professor of the Practice of Public Health,
Director, Center for Infant and Young Child Feeding and Care
Department of MCH, School of Public Health
The University of North Carolina at Chapel Hill
former UNICEF Senior Advisor on Infant and Young Child Feeding and Care
former Division Chief at USAID in charge of Nutrition and Maternal Health
former Director of Breastfeeding Research at IRH, Georgetown University Medical School

Friday, January 18, 2008

Congress has stepped in to challenge BPA!!

This article is from The Associated Press January 17, 2008, 7:06PM ET and is excerpted/reprinted here for educational purposes only. Bolds added.
Congress probes baby formula packaging By MATTHEW PERRONE
WASHINGTON
House Democrats are investigating whether a chemical used to package baby formulas poses a risk to infants, despite assurances by U.S. regulators that it is safe for kids and adults.
Reps. John Dingell and Bart Stupak sent letters Thursday to seven companies that make baby formulations, questioning whether they use bisphenol A in the lining of their cans and bottles. The companies include Hain Celestial Group, Nestle USA, Abbott Laboratories and Wyeth. The chemical at issue has been used to package foods for over 50 years, but consumer advocates said last year that trace amounts that leak into food could be dangerous to babies.
Concerns about the chemical caused Canadian retailers to remove bottled water and other plastic containers from store shelves last month.
FDA is reviewing the safety of the chemical but said last November it "sees no reason at this time to ban or otherwise restrict its use."
In a letter to FDA, Dingell and Stupak, both Michigan Democrats, ask commissioner Andrew von Eschenbach to explain how the agency determined bisphenol's safety.
"At best,
the scientific community has concerns about the safety of bisphenol A," said Stupak, in a statement. "Our primary goal is to protect infants from a potentially harmful chemical."
An expert panel of researchers assembled by the National Institutes of Health said last August that the chemical's "impact on human health is a concern, and more research is clearly needed."
..."Parents using infant formula should not be alarmed because the bisphenol used in infant formulas and other food packaging exists in trace amounts," said Marisa Salcines, spokeswoman for the International Formula Council. "No change in infant feeding practices are necessary at this time."
A spokesman for Wyeth said Thursday the company does not use the chemical to package any of its baby formula products. Calls placed to other companies Thursday evening were not immediately returned.

Monday, January 07, 2008

US News and World Report - where do you find your health experts?

Note to Editors of US News and World Report and Amanda Gardner:
Thank you for your article on breastfeeding and atopy, that starts out with the latest research on the subject:http://health.usnews.com/usnews/health/healthday/080107/breast-feeding-seems-to-protect-against-some-allergies.htm You first quoted the respected researcher, Dr. Frank Greer. However, you then offer extensive rebuttal and the last word Jennifer Wu who, while a well published researcher in her field, is neither a researcher nor an expert on this subject matter, nor even a pediatrician who could offer clinical comment.
While it is reasonable to provide alternative “opinions”, please ensure that those identified have equivalent expertise in the same subject matter. I do not believe that anyone involved in research on this issue would have given these quotes. Hence you may be misinforming the public on this important health issue.
Further, the alternative opinion, in this case, is not what is accepted in the field. The Agency for Healthcare Quality and Research hosted a comprehensive review of the topic. See: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf, p. 16 and more, excerpt below.
Atopic Dermatitis. One good quality meta-analysis of 18 prospective cohort studies on full term infants reported a reduction in the risk of atopic dermatitis by 42 percent (95% CI 8% to 59%) in children with a family history of atopy and exclusively breastfed for at least 3 months compared with those who were breastfed for less than 3 months. The meta-analysis did not distinguish between atopic dermatitis of infancy (under 2 years of age) and persistent or new atopic dermatitis at older ages.
Thank you for your ongoing attention to ensuring the accuracy of your reporting in your most respected magazine.

Friday, January 04, 2008

ACLU supports Breastfeeding in Art - and in life

[I have edited and added brackets to this ACLU letter from Vince Gonzales, Pres. Lubbock Chapter, ACLU, sent out by Linda Smith]
ACLU of Texas, Lubbock Chapter, Denounces City of Lubbock Censorship of Lahib Jaddo artwork.

January 2, 2008, Lubbock, TX: The ACLU of Texas, Lubbock Chapter, was and is greatly disturbed by the recent action to censor certain sketches designated for exhibit at the Buddy Holly Center. The ACLU is opposed to censorship in all its forms, and believes that the right to choose what we see, hear, and read is one of our most vital freedoms. But more importantly, we have heard the outcry in our community regarding the logic, or rather illogic, of censoring the sketch of a nursing mother and child, and the message such censorship sends to our community.

Scott Snider, a member of the City Manager’s Office for the City of Lubbock, decided that artwork depicting a nursing baby was unacceptable for display at the Buddy Holly Center during the First Friday Art Trail, because he deemed it inappropriate for a general viewing audience without actually viewing the art. It's interesting that U.S. federal law protects nursing on all federal grounds, and Texas law explicitly protects the right of a nursing mother to nurse anywhere she has a right to be, which makes a clear case that neither federal law nor Texas law consider breastfeeding to be an act that is "inappropriate for a general viewing audience." Mothers are free to breastfeed in offices, parks, libraries, amusement parks, churches, and everywhere else, where they are likely to be seen by a much wider "general viewing audience" than the Buddy Holly Center, and that is supported by federal and state law. ...

Formula-feeding increases risk of death from sudden infant death syndrome, certain types of childhood cancers, necrotizing enterocolitis, allergies, asthma, diabetes and obesity later in life, and many more ailments. [At least] 500 babies a year in North America die as a direct result of being formula-fed. Promoting the myth of breastfeeding being indecent has serious ramifications for the most vulnerable members of our society. ...

[T]he policy set in place by Mr. Snider and the City of Lubbock government is decidedly anti-breastfeeding and thus anti-family. Now that this issue exists, it has come to our attention that mothers throughout the community have been discriminated against and made to fell as second-class citizens for doing what is best for their children, breastfeeding.

In summation, .. neither federal nor state law considers breastfeeding an obscene activity or something that needs to be shielded from children or the workplace; The City of Lubbock would be hard-pressed to find a better arbiter of decency than the law itself. If the laws protect the right of a mother to breastfeed in a public park a few feet away from children, I fail to see how a sketch of a breastfeeding baby is a greater risk to a "general viewing audience." If the laws protect the right of a mother to breastfeed sitting at her desk in an open-concept office, I fail to understand how a sketch presents a risk to those viewing at work. If we are to rate artwork as acceptable based on a standard of if they will offend a small segment of people, then I suspect a vast majority of artwork would have to be deemed unacceptable.

To that end, at 6 p.m. Friday, January 4, 2008, in cooperation with the Lubbock Chapter of the ACLU, Birth Without Borders Intl., financial support of Dr. Gary Miracle and Tobyn Leigh, and the moral support of Mothers Acting Up, a nurse-in will be held in Lubbock, TX. The time has been chosen to allow working mothers (who face unique problems when breastfeeding their children) to participate. The location will be announced Friday morning.