Breastfeeding4Health: Respecting the Mother/Child Dyad in Infant and Young Child Feeding

The word is getting out!!

2011-08-28T12:21:00.000-04:00

Did you all see the great commentary inWeNews?
http://www.womensenews.org/story/reproductive-health/110825/when-breast-best-not-enough

Kimberly Seals Allers explores why the message that we in the know threw out in 1990 - "Breast is Best" - but that is still used by many well meaning folks just doesn't work.

At CGBI we fully acknowledge and accept that women's lives are complex: the pressures on my generation that remains today; bring home the bacon, fry it up in the pan, and always be sexy for your man" still persists. Our daughters thought that they would live our dreams - full partnerships in family care issues, jobs that allow paid maternity leave, health care systems that listened to them - but we simply aren't there yet, and not for the foreseeable future. So, for the most part for many women, it all still falls to the women/the mothers to figure out how to create a balance between the economic, social and health realities in families.

Breastfeeding saves lives. No question. Formula feeding carries risks for excess short and long term illness. The costs to our society of creating barriers to breastfeeding are measurable.

Many thanks to Ms Allers for getting the word out!!

Marketing, Consumer Preferences and Clam Chowder

2011-08-01T15:38:00.005-04:00

Efforts to limit infant formula marketing are often criticized as anti-“choice”- going against a mother’s right to choose how to feed her own baby. But even as manufacturers claim to be supporting the decisions that families make for themselves (a plausible claim to consumers who feel impervious to advertising), Steven Pearlstein of the Washington Post reminds us that consumer preferences have always been shaped by commercial interests.

Pearlstein, a Washington Post business columnist, writes that “most of our preferences are learned and largely formed by social norms and expectations that producers have a strong hand in shaping.” Speaking to marketing professors and a behavioral economist, Pearlstein discusses how consumers come to align their preferences with perceived social norms. So while consumers might feel immune to ads, and commercial products a mere reflection of what people want, those products are more often a response to manufactured desires.

Pearlstein doesn’t discuss infant formula specifically; he discusses the evolution of US consumer preference for things like clam chowder, beer, and cars. But just as US consumers gradually trained themselves to prefer thicker, ultimately less tasty versions of New England clam chowder, and SUVs over minivans, it stands to reason that families adjust infant feeding decisions based on those ideas about lifestyle, family dynamics and health that the marketplace helps create. In the case of infant formula, creation of social norms through marketing is particularly troubling because they often utilize the health care system to create false perceptions of endorsement.

Pearlstein notes that consumer preferences “are anything but fixed, susceptible to changes in technology, culture, fads and the business strategies of companies competing in the marketplace.” So while we might bemoan the lack of a culture of breastfeeding in the US, there’s reason to hope that we could help to bring one about by working to create the right kinds of cultural shifts.

Read the rest of Pearlstein’s column at:

http://www.washingtonpost.com/business/economy/why-we-live-with-the-dreaded-thick-chowder-and-other-inferior-products/2011/07/25/gIQACqmWhI_story.html

World Breastfeeding Week 2011 Calls on us to COMMUNICATE!!!!

2011-08-01T15:37:00.000-04:00

Dear Friends:
Have you read about World Breastfeeding Week (WBW) 2011? Celebrated either the first week in August, to commemorate the 1990 Innocenti Declaration, or the first week in October (for everyone who was on vacation in August), WBW is nearing 20 years old this year. But before it leaves its teenage years, WBW this year is dedicated to communicating about breastfeeding with youth.
http://worldbreastfeedingweek.org/
Now, many of us are not as twittery or e-face friendly as we might be, so this week - ASK THE KIDS!!
They can spread the word. They have heard you talking about breastfeeding since before they were born and probably are lactation consultant ready already!!
Enjoy all the activities this week - and remember the future! Talk to a young person about breastfeeding.

Hugs to you all.
Miriam

Discovered, rediscovered, and re-re-discovered....breastfeeding reduces risks of malocclusion

2011-07-05T19:48:00.000-04:00

Dear Friends:

When everything old is new again....

Back in the 1980s, I followed up on a hint from a friend's father - who was a dentist - that in the 1930s or so, a Dr Temple Fay had noted an association between lack of breastfeeding and malocclusion. With the help of Dr Gerry Hendershot and others, we explored a national data set and found...yep, there was an association of breastfeeding and a lower rate of malocclusion that appeared to be dose related. Today, again, colleagues have assessed the issue, with hands on observation of the bite, and lo, we still see the association, with confirmation of the dose response.

So, do you think we can mention this as another benefit of breastfeeding/risk of not breastfeeding? Orthodonture is expensive....

Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition
This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary tooth development.
Infant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from Sao Paolo. Children were grouped according to breastfeeding duration: non-breastfed, shorter than 6 months, interruption between 6 and 12 months, and longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite.
Results showed children who were non-breastfed had significantly more chances of having anterior open bite compared with both children who were breastfed, and in the subgroup without history of non-nutritive sucking, with the children that breastfed longest associated with a 3.7 times lower chance of having anterior open bite than non-breastfed children.
CC Romero, H Scavone-Junior, DG Garib, FA Cotrim-Ferreira, and RI Ferreira. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci, April 1, 2011; 19(2): 161-8.

Media coverage of our successes - Synergy helps!!

2011-05-05T11:27:00.001-04:00

Media is the Message!! That's what we used to say during those 'glory' days of my youth, with anti-establishment, bra-burning and Woodstock....
AND
Media is still the message - the media are even more powerful today, with videos, blogs, print media, etc. etc. all celebrating and supporting each other. To normalize breastfeeding, it must be seen as normative in the media, and readership - the community - needs to be inspired to act. Media can create community demand for change.

However, we also need to be aware that more and more media outlets are owned by fewer and fewer entities, and that some corporate entities may not be as breastfeeding supportive as we might like. Hence, getting good coverage for breastfeeding can be a challenge but is also increasingly important for creation of community demand for breastfeeding supportive health services.

Therefore, today more than ever, it is so important that we ensure all kinds of media coverage as we get the news out about our individual progress towards breastfeeding support goals.
AND
I would suggest that we must also consistently present our successes as part of the greater community of increasing breastfeeding support. Yes, it is vital for our facilities to individually announce their successes, but it may be just as important to place it in context, so that the readers see - It is great that our local facility is doing well in working towards a healthy norm,

Let's celebrate our successes, and get all the media coverage we can. AND let's make sure that the message we get out there is that this is part of the new world of acceptance of a breastfeeding norm, rather than an outlier... Are we now Baby-friendly? but of course!! The Ten Steps are normal quality of care, and WE HAVE NOW SUCCEEDED IN GETTING ON THAT TRAIN!!
After all, what we hope to see someday is that there is no reason to certify that the Ten Steps are in place, but that rather it will be normal care everywhere

How do we normalize toddler feeding?

2011-04-01T15:23:00.000-04:00

I was delighted to be turned on to this website, with toddlers being toddlers...and breastfeeding.
http://www.drmomma.org/2011/02/joy-of-nursing-toddlers-photo-gallery.html#comment-form
True, we are having enough difficulty getting solid momentum to support women in their breastfeeding in the postpartum period, and in creating a social environment that embraces the breastfeeding mom...but let's be optimistic and ensure that we continue to support breastfeeding into the toddler years. The immune system still needs help, and toddler hugs are the best. This is an important developmental period for continued confidence building, and the breastfed kiddo may be more independent because they have the firm base in attachment and trust... Remember, bottles at this slightly older age are fraught with excess exposure to infections and dental decay issues. But good old human milk has those healing factors...Evolutionarily, as well, while other mammal young feed from mom until they are entirely on adult food, why should we not give our babies the same advantage?
So, next steps? Well I think we might change our header pix to include some older children and their moms breastfeeding. Other thoughts?

Washington Post writes on the dangers of overfeeding breast milk, but....

2011-03-22T17:59:00.000-04:00

Interesting article, http://www.washingtonpost.com/national/parenting-an-overweight-child-can-be-difficult/2011/02/22/ABkG8N8_story.html but it left out the first way to allow the infant to learn to control its intake: breastfeeding. The infant will not over-suckle on its own - only if the milk is expressed and fed in a bottle in control of someone else, can that readily occur. If the exclusively breastfed infant seems large in the first few months, that is good chub stored up for those locomotive months, when they will slim down nicely.

Breastfeeding is the ultimate good eating training : start out with the more watery milk charged with good carbs and protein, goes on to be the fatty portion at the end - from soup to dessert!

Bon Appetit!!

International Women's Day -- Are we respecting women yet?

2011-03-08T11:32:00.001-05:00

As we 'celebrate' international women's day, so many images come to mind from the last 45 years of active work on women's issues: women uniting in song and purpose, young women arm- in-arm on their way to school, women nurturing thier children... and their parents, women active in family and social lives, women just being happy to be who they are, women strong and standing tall - proud of being all that a woman can be - including being a daughter, sister, life partner, and parent with all the good that these may entail.

But many of the images that come to mind are not pretty.

Yes, we have improved on some fronts: more women receive closer to equal pay in western countries, for the moment more women are out of purdah, and some imporvements have been made in some parts of the world on the abominable situation in terms of reproductive health. In todays Huffington Post, Susan Blaustein nicely covers the potention of the Millennium Cities Initiaitve (http://www.huffingtonpost.com/susan-m-blaustein/fasttracking-womens-empow_b_832378.html). The problem is that these cities are few and far between. Further, it is not clear that the support planned or offered has actually been developed by the women of those cities.

What do women want?

My guess is that there are many answers to that question as there are women in the world, so please allow me to share what I have observed over these many years. Women worldwide want the same basics as men: food, shelter, clothing, safety, and a chance to be part of their community, to contribute, and to maintain and/or improve their lot in life.

Many years ago, I offered a session at the International Women's Conference on "Women as Women: Not women as men." the concept was to support and celebrate uniquely female attributes and functions: menarche, pregnancy, birth, breastfeeding, etc. While it was given a place in the pre-conference, the conference itself carefully avoided such things...preferring to discuss workplace and war. Certainly, as more than half of the world, women are heavily involved and impacted by these two conditions, and they should be addressed. But - what about women as women?

Today, on the International Women's Day, I yearn for the image of each woman being supported to be herself inside the skin of a woman - to have the ability to produce the next generation, to be hormonally wired for nurturing, to have her face in the sun, to be strong and productive and intelligent contributors with a insy-beensy special twist that is part of being a woman. And if we celebrate women in this manner, how can we tolerate lack of girl's education, isolation from the life-saving vitamin D rays of the sun and a fair share of food, fear of violance provoked simply because they are female, rarity of freely available quality reproductive health services, scarcity of paid maternity leave for maternal recovery and for breastfeeding the next generation, active exclusion of women's roles from economic modelling, and so on and so on?

We may have come a long way, baby, but we sure have a long way still to go....

With warm wishes to all of you out there, women and men, who are fighting the good fight for both equality and celebration of the special uniqueness of women and men in our world, your faithful servant, Miriam

Fighting the obesity epidemic - kids are not doomed in the womb...

2011-01-19T13:16:00.000-05:00

Breastfeeding's role

Raleigh News and Observer
Modified/Published Tue, Jan 18, 2011 02:00 AM

Thank you for the wonderful series on how to address the obesity epidemic.

Concerning "Doomed from the womb?", certainly obesity during pregnancy is associated with many risks for a mother's health. However, it is important for moms who are fighting the battle of the bulge to know that they are not dooming their children from birth.

While the rate of height increase is indeed pretty much set in the womb, this is not so with the rate of weight increase. We have a window of opportunity to modify this at birth and to set the new baby on the path to proper weight gain. An important step on the path is supporting every mom in considering and succeeding in early and exclusive breastfeeding. Those dangerous overfeeding behavior habits are just not possible with breastfeeding. The breastfeeding baby will take only what it needs for good growth.

Exclusive breastfeeding is good for mothers and infant health, and it is an available intervention to help prevent a continuing cycle of obesity. Obese moms who exclusively breastfeed their babies can set the next generation on a path to a healthier rate of weight gain.

Some of my academic friends in the UK seem to think that we should return to 4 months of exclusive breastfeeding....

2011-01-14T14:08:00.002-05:00

Dear Readers of the BMJ, or the article "Six months of exclusive breast feeding: how good is the evidence?" BMJ, 2011; 342 by Mary Fewtrell, David C Wilson, Ian Booth, and Alan Lucas:

With thanks to my friends and respected colleagues for addressing the importance of six months of exclusive breastfeeding, it would seems that their argument considers breastfeeding primarily as a replacement for formula feeding. The health benefits for the mother, both short and long term, are not explored, and the risks and expense of formula feeding, even in industrialized settings, are brushed aside.

For the most part, this article actually presents substantial additional data supporting six months for the infant and child health outcomes while noting the few findings that might speak against it. One possibly new issue raised, based on a single Swedish study, is coeliac disease; the article itself notes that gluten load, rather than timing, might well be the culprit. Concerning iron stores, we know that much of this problem could be addressed with proper delay of cord clamping, giving infants greater iron stores from birth, or if still needed, later micronutrient supplementation might be considered. This birth-related issue and other maternal issues are disregarded: six months (vs. four) exclusive breastfeeding has many advantages for maternal health and birth spacing in less developed and industrialized countries alike. Also, the large body of published research on later maternal and child obesity, cancer and related diseases is barely considered. In sum, there is little here to argue against the definition of optimal feeding practice, for mother and child, to remain exclusive breastfeeding for six months.

As to the research from developed countries, such research on exclusive breastfeeding in developed countries is very difficult to interpret in part due to small self-selected numbers and in part due to inadequate definitions of breastfeeding practices. The WHO nutrition section and other nutrition groups tend to define the term exclusive breastfeeding only in its role as a food, and therefore the definition of exclusive breastfeeding generally includes the feeding of expressed milk and/or pasteurized donor milk. Such milk feeding may not be creating the same physiological, hormonal and gut floral/fauna responses in the mother and child as is created by direct breastfeeding, and, in situations where there may be considerable separation of mother and child, the immune composition of the milk may no not address the child's environmental exposures. We are far from understanding the differences in health outcomes for mother and child with the use of pumps and expressed milk, a very common practice in the US. Other concerns, such as delayed exposure to food flavors, would not appear significant, given recent research that has confirmed that breastfed infants are already exposed to the flavors of foods ingested by mother through her milk.

On a different issue, it may also be important to correctly the statement on US government support. USG policy has noted the importance of six months, rather than 4-6, since the preparation of the US DHHS Blueprint for Action on Breastfeeding, published in 2000, and has been supporting six months exclusive breastfeeding for more than 5 years with the Healthy People goal for the Nation to increase exclusive breastfeeding through six months.

Finally, it might be noted that three of the four authors declare receiving funding from the infant food industry, which would benefit from policy that dictated a significant increase in the need for infant formula.

Rather than calling for truncation of exclusive breastfeeding, limiting its myriad of positive immediate health, child spacing and long-term health effects, let us instead call for 1) delayed cord clamping for iron stores, with iron supplements as needed in later infancy, 2) research on the impact of exclusive breastfeeding vs. expressed milk feeding on the health of both mothers and their children, and, most of all, 3) unbiased, informed, and mother-centered support - clinical, social and economic - so that women may make an unbiased, informed infant feeding choice, and succeed in six months of exclusive breastfeeding.

Sincerely,

Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM, The Carolina Breastfeeding Institute (CGBI) Professor, and Director, CGBI
Note: Labbok is on the Board of the Academy of Breastfeeding Medicine and North America Representative on the Board of Directors, World Alliance for Breastfeeding Action

Headlines again emphasize that it is all Mom's fault...

2010-09-16T14:55:00.001-04:00

The CDC has issued its report card, and again offer an excellent analysis of the situation, highlighting what must be done to enable women to succeed with breastfeeding.

What does the media say as a title or first sentence?
"CDC: Many Moms Breastfeed but Drop Off"
"...while 75 percent of newborns get breastfed right after birth, mothers give up quickly."

Let's blame the victim, why don't we?!?

Mom's are not giving up or dropping off. WE THE PEOPLE are giving up and dropping out of sight. Our society and our health system and our cultural priorities are undermining women's best intentions from the get-go, and then, we blame them for the failure. Has this become the American way?

WE THE PEOPLE are failing to support women who intend to breastfeed. If every woman in the US were supported and empowered to achieve her breastfeedign intentions, we would see a sea-change in practices nearly instantly.

What should we be doing, rather than pointing our fingers at mom?
1.All hospitals should have in place the practices outlined in the Ten Steps to breastfeeding in maternity settings, written and published by WHO AND SIGNED ON TO BY US GOVERNMENT OFFICIALS 20 years ago. (By the way, WE THE PEOPLE said that every effort would be made so that all hospitals in the US would have all the Ten Steps in place by 1995.)
2.Fight for paid maternity leave, at least for several weeks. Research has shown the clear health benefits of prenatal and post partum leave for both mother's and infant's health. Those health benefits and concommitant reduced health care costs would surpass the cost of a minimum wage package for care. (And, by the way, we are the only developed country that offers no paid maternity leave.)
3. We need to provide co-located childcare, so that moms can be in contact with their infants to continue breastfeeding. The new law allows for milk to be expressed during the work day, but we do not know the differential impact of feeding expressed milk vs breastfeeding on the maternal and child health outcomes.
4.The major infant nutrition intervention provided by WE THE PEOPLE is WIC, a vitally important program for those in need. However, this program markets formula brands (see US Government Accountability Office. Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect Against Use of WIC Name. 2006; i-40)
5. We need media to show breastfeeding as the normative method of feeding in all TV shows and films, and to not accept brand placement for infant feeding bottles, pumps and formula.
6. We need to reimburse Lactation Consultant services, so that these are not reserved for the wealthy alone.
7. We need to stop blaming the victim and point the finger instead in the right direction - back at ourselves, at WE THE PEOPLE who created a social and healthcare milieu that forces each woman to fight a lonely battle to breastfeed her child.
Thoughts?

World Breastfeeding Week: Global/Local Celebration August 1 RIght Here in Carrboro!!

2010-07-29T18:39:00.002-04:00

Press release
FOR IMMEDIATE RELEASE
Contact:
Emily Taylor, MPH, CD(DONA), LCCE
919-630-4460
emilytaylor@unc.edu

World Breastfeeding Week: Global/Local Celebration August 1

Local Organizations Join Forces to Celebrate a Breastfeeding-Friendly Community

On Sunday, August 1, 2010, on the first day of the annual World Breastfeeding Week, the Carolina Global Breastfeeding Institute and the Birth and Breastfeeding Congress will host a FREE community event to celebrate our breastfeeding-friendly community and its contributions to families, the community, the state and the world. Weaver Street Market located at 101 East Weaver Street in Carrboro from 11 am – 1 pm, during Jazz Brunch. (In case of rain: 12-2P, Carrboro Yoga Company)

Dr Miriam Labbok, Professor, and Director of the Carolina Global Breastfeeding Institute in the Department of Maternal and Child Health, Gillings School of Global Public Health, UNC-Chapel Hill, noted, “This year’s global theme, “Breastfeeding! Just Ten Steps: The Baby Friendly Way” commemorates the 20th anniversary of the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, signed by 30 countries, including the USA.” She added, “We are happy to honor those in our community and beyond who are contributing to this global effort.” Labbok also noted that CGBI developed materials that are being used worldwide this year, many of which are available at http://worldbreastfeedingweek.org.

Birth and Breastfeeding Congress members will host information tables for parents and activities for children of all ages. Exhibitors include: Carolina Global Breastfeeding Institute, Hillsborough Yoga, La Leche League of Orange County, North Carolina Breastfeeding Coalition, Triangle MotherCare, UNC Birth Partners, UNC Family Medicine, and others, as well as celebrity attendees.

Participants are invited to join in a Silent Auction with incredible items including yoga packages, postpartum doula services, mother-baby care items and more!

North Carolina Breastfeeding Coalition will present The 2010 Breastfeeding-friendly Business & Worksite Award(s) to 17 local businesses and 14 local employers. In addition, the Carolina Global Breastfeeding Institute will present an award to the Women’s Birth and Wellness Center of Chapel Hill on its achievement of the Ten Steps to Successful Breastfeeding.

This event is one of thousands of World Breastfeeding Week events occurring around the globe, as organized by the World Alliance for Breastfeeding Action. For more information, see: www.worldbreastfeedingweek.org.

# # #

A list of the ten steps is available online http://www.unicef.org/newsline/tenstps.htm.

Established in 2006, the Carolina Global Breastfeeding Institute aims to further statewide, national and global health through increased understanding and support for optimal infant and young child feeding. Labbok is its founding director.

For more information about the program or the event, contact Emily Taylor at 919-630-4460
or email emilytaylor@unc.edu
Carolina Global Breastfeeding Institute: "Nurturing Our Future"
Normalizing optimal infant and young child feeding and related reproductive health to achieve maternal and child health, and promoting attention to the mother/child dyad, by:
• Educating future leaders
• Carrying out applied research and technical assistance
• Developing and implementing breastfeeding-friendly health care approaches
• Facilitating change
Emily Taylor, CGBI director of projects, says that CGBI is involved in a number of projects related to WHO’s Ten Steps. With funding from The Duke Endowment and Kate B. Reynolds Charitable Trust, CGBI is working to implement and study the program in North Carolina. The Institute also collaborates with the Perinatal Quality Cooperative of North Carolina http://www.pqcnc.org/?q=node/9 and the N.C. Division of Public Health to institute steps that would allow for exclusive breastfeeding in hospitals and allow hospitals to measure the success of such programs. The John Rex Endowment has sponsored CGBI to work with breastfeeding in child care in Wake County, an activity that included the development of 10 complementary steps for childcare that have been included in national dissemination. To further complement these activities, CGBI has also been actively involved in creating and supporting the State Division of Public Health “North Carolina Maternity Center Breastfeeding-Friendly Designation.” NC DPH and the NC Hospital Association will co-host webinars for hospitals interested in learning more during WBW.

Labbok, who led the effort to launch the Ten Steps program in the United States in 1991 went on to oversee the updating and revision of this initiative while at UNICEF. She also serves on the steering committee of the World Alliance for Breastfeeding Action, the international group that has sponsored the annual World Breastfeeding Week since its inception in 1997. A member of several national expert working groups on breastfeeding policy and practice, CGBI also has spearheaded guidelines about breastfeeding that will be included in a national handbook for child care centers.

Learn more about the Carolina Global Breastfeeding Institute on their Web pages. http://www.sph.unc.edu/breastfeeding/

UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, http://www.sph.unc.edu/school/communications_371_6012.html (919) 966-7467 or ramona_dubose@unc.edu.

OMG! Once again, the media jumps on a poorly controlled study ...

2010-07-16T10:59:00.000-04:00

Dear Friends and Colleagues:
Have you seen the huge coverage of the Katz study that concludes that all babies should have at least one bottle of cow's milk formula a day for the first 15 days of life to avoid the approximately 1/200 risk of the IgE mediated allergy to cow's milk later in life?
Please note: this study is not controlled for parental decisions, breastfeeding pattern, maternal cow's milk intake, etc. In fact, it is very logical that parents with cow's milk sensitivity will avoid giving their child cow's milk early in life, and such sensitivities are genetically mediated. Next, small amounts of cow's milk in a sensitive child might cause a reaction, causing parents to avoid cow's milk thereafter. Finally, the child who can tolerate 15 days of cow's milk is most likely that child who is not going to have a sensitivity.

In sum, the finding really is: If a child can tolerate a daily dose of cow's milk for the first 15 days of life, they are unlikely to be sensitive to cow's milk.

The title of the piece is misleading and media loves a controversy. Let alone any possible support of its promulgation by the formula industry.

Sigh.

Why Exclusive? yes, we know that partial breastfeeding has some sort of weird association with increased pneumonia...

2010-06-25T10:30:00.003-04:00

Have you read the new study that shows that breastfeeding for at least six months reduced incidences of respiratory illness in infants, but that there is a slight increase if only partially breastfed?

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-3256v1

Actually, this is not surprising. Every since we started studying the difference between exclusive and partial, we have seen this unexpected slight increase in pneumonias with early partial breastfeeding.

Why, you might ask? I could postulate many possibilities: that even some formula use ends up with microbuli to the lungs promoting infection; partially breastfed infants are more likely to be in day care; it is necessary to have exclusive breastfeeding for proper gene expression; the anti-inflammatory impact of breastfeeding is muted, so that we see the symptoms more. All of these are possible, and perhaps each contributes a little. Or maybe there are other mechanisms, but we keep seeing this. We even picked it up in the early studies of the Lactational Amenorrhea Method (LAM) in Chile!

All in all, it just keeps showing up - not for diarrhea, where any breastfeeding helps, but for pneumonia.

Since pneumonia is the major cause for hospitalization in the the first year of life in the US and in North Carolina, this is yet another reason that we must work for exclusive breastfeeding - not partial, not expressed milk feeding, but exclusive breastfeeding - for the early months.

Thoughts?

Headlines can misinform....

2010-03-27T13:50:00.005-04:00

As we all know, folks believe what they read, especially if it agrees with what they want to be true. So when a headline that states "Long-Term Breast-Feeding Tied to More Aggressive Cancers" (which, by the way, I could not find on PubMed to read critically), http://www.healthday.com/Article.asp?AID=637427 I am concerned.

In fact, in this news coverage, there is little comment on the fact that Dr S Butt reports on a subgroup representing only about 3.6% of the entire sample. Without reading the study, one must wonder why this small percent chose to feed their children so differently than their fellow Swedes. When dealing with a tiny subgroup such at this, it is vital to explore this question. We often see odd findings in outliers in large study populations. For example, are these folks with family histories of breast cancer? Are they eating a different diet or living in a different area from the vast majority? Are they an ethnic subgrouping? And, as the researchers note, it could be that women who breastfeed long have such aggressive cancers (rather than having more and other cancers) but do they do better with them?

Without the answers to these questions, such findings are only useful as an idea for further exploration, but should not be presented to the public in such a manner to be potentially misunderstood and misleading.

We all thank that site for all they do to help keep the public informed - while we also add a word of caution...

Robert Wood Johnson acknowledges life before age 2 y!

2010-03-05T15:44:00.002-05:00

Study Finds Early Childhood Links to Disparities in Obesity Rates
www.rwjf.org
New research reveals surprising facts about simple behaviors that may alter a child's health legacy for life. In addition, Elsie Taveras, M.D., M.P. H., lead author of the study, found that national efforts to address the problem may be missing the most important period - before age 2...

Thank you, RWJF, for your recognition of the importance of the first two years of life as a vital time for intervention to ensure later health and nutritional status. With thanks to Elsie Taveras for this particular approach, the issue, i.e., that the first two years is a vital component of later health and nutrition status, has been demonstrated for years now using a variety of study designs, and has been widely published. Research and meta-analyses on early infant feeding show that formula feeding and/or lack of exclusive breastfeeding are associated with later overweight. Whether it has to do with recognition of satiety, or hormonal influences or ability of the body to handle foods, or all compounded by cultural and societal pressures, the outcome is constant. AND we know what to do to enable change among those who care for this age group. The literature includes many successful interventions.

Ann Conlon-Smith notes that breastfeeding is indeed the great equalizer - no matter what your background, you have the opportunity to give your children the best start on life. Thanks, Ann, this is so true. Hmmm, but here,unfortunately, it is true UNLESS your economic situation or your family or your hospital or your workplace undermines or disempowers you. So lets rally and ensure that each mother has social and economic support to succeed with what is best for her and for her child.

NWA testifies to the importance of the Ten Steps and Code

2010-03-03T16:31:00.001-05:00

The National WIC Association's Kiran Saluja, Deputy Director of PHFE WIC, was asked to testify about WIC and breastfeeding issues before the House Committee on Education and Labor, chaired by WIC Champion George Miller (D-Concord) Tuesday, March 2, 2010, to discuss federal child nutrition programs - WIC, child care food, and school meals - that are up for Reauthorization.

She noted that an important place to start to help WIC succeed in its breastfeeding support and promotion efforts would be to fix the breastfeeding - broken hospitals!

"While I recognize this may be beyond the purview of this Committee, I am compelled to ask you to work collaboratively with your colleagues on the Energy and Commerce Committee and Ways and Means Committee to pass legislation that requires that all hospitals that receive Medicaid funds adhere, at a minimum, to a set of model policies that do not sabotage breastfeeding, and at best initiate steps to become a Baby Friendly Hospital.... another important way to help WIC promote and support breastfeeding would be for the Committee in collaboration with your partners in Congress to make a determined effort to eliminate or sharply curb the blatant direct marketing of infant formula, which violates the WHO code and targets vulnerable low income women of color."

Here in North Carolina, CGBI is working with many partners to further The Ten Steps that are the essence of the Baby Friendly Hospital approach across the state, in partnership with the State Department of Public Health, and are planning a interstate working meeting on this issue. In addition, we are continuing to raise the issue of the dangers to health of direct marketing of commercial formula.

Please support these efforts in any way you can.

Mary Rose Tully: In Memoriam

2010-01-21T14:23:00.005-05:00

Mary Rose Tully, our friend, colleague, and comrade-in-arms in defense of mothers and babies everywhere, passed away at 3:30 AM, January 20, 2010 on her 42nd wedding anniversary after five months of nearly constant suffering with pancreatic cancer, surrounded by her husband Doug, son Chris and his wife Tania, her mother Rose Weber, and many of her siblings. Mary Rose received her MPH from our department, was of the very first Lactation Consultants certified in the US. She served as Director of Lactation Services at UNC Hospitals, Adjunct Associate Professor, Department of Maternal and Child Health, and Co-founder of the Carolina Global Breastfeeding Institute, Gillings School of Global Public Health.

She made us promise - twice - that anything we do to memorialize her would be a continuing celebration of life. And we will be making plans and decisions with her ongoing input, as Dr. Alison Stuebe suggested, by asking ourselves, "WWMRD" - "What would Mary Rose do?" So smile and sing and remember the good times and the good works - her suffering is over.

We remember her as the one with the constant smile and unfailing energy who prioritized the mothers and babies, and saw no reason that we could not change the world today. She received much personal reward from her work, and wide recognition, with at least two prestigious awards: the first Human Milk Banking Association of North America life-time achievement award, and the Wake County Volunteer Award/ North Carolina Volunteer Award, which recognized her as one of the top volunteers in her home county. She always did more and expected more of herself than of others. She was so willing to share the honorifics. The following is a quote from her comments at the award ceremony is typical of her: "I am truly privileged to live in a state that values contributions to maternal and child health so highly. The work I have done through the years has been done with many others on a team or committee. What I have accomplished has only been possible through collaboration with other dedicated volunteers and my very supportive family."

Mary Rose’s family is setting up two funds in her memory: Her family has asked that in lieu of flowers, donations may be made to two different funds:
1.) A Mary Rose Tully Memorial Fund to benefit her seven year old granddaughter Anika and for un-paid medical bills. Checks may be sent to the Mary Rose Tully Memorial Fund, c/o Karen Britt Peeler, Attorney at Law, P.O. Box 12154, Raleigh, NC 27605.
2.) The Mary Rose Tully Training Initiative at the Global Breastfeeding Institute Please visit http://www.sph.unc.edu/make_a_gift/ or mail a check made out to this fund to Attn. Peggy Dean Glenn, UNC Gillings School of Global Public Health, Office of External Affairs, 107 Rosenau Hall, Campus Box 7400, Chapel Hill, NC 27599-7400.

All of the CGBI staff will miss her. Personally, there is a gap in my life that I feel every day in so many ways. To help others, we will be setting up a part of our website for WWMRD questions to be triaged for response to her many many friends and colleagues.

This comment deserved to have its own posting!

2009-09-03T11:34:00.001-04:00

Jennifer Yourkavitch comments:
"My husband, enraged, sent the following note to Isotoner Customer Service (customeraffairs@totes.com) and the CEO (awalters@northlich.com):

To Whom it May Concern:

One would think that someone with sense at your company would have done something to prevent an issue like this from even going to court, let alone the state Supreme Court. It's a nice victory in the court of law, but in the court of public opinion I think this makes Totes/Isotoner look backward, discriminatory, insensitive, and at worst hostile to infant nutrition.

A wiser course would have been to implement a policy to allow lactating women to have scheduled breaks, create a space for them to lactate in private, and generally support people who are trying to follow American Academy of Pediatrics and World Health Organization guidance for feeding children in the best possible way--the way they have been fed since humans have been having children. It is the utmost act of love for a parent to nourish their child the best they possibly can. Frankly, I think this mother will have a much happier and productive life away from the toxic atmosphere of your company.

If I were on the Totes/Isotoner Board, I would have recommended firing the manager who made this choice and compromised the brand image of the company in the press, not the lactating mother.

I am systematically divesting my home of all of your products, and will never purchase anything from your lines of products again. I am exploring canceling relationships with firms that carry your products.

Sincerely,

Robert Carty
Father, Husband

Lawyer alert!! Isontoner fires worker for taking milk expression breaks...

2009-09-03T11:06:00.002-04:00

The judges say that lactation has nothing to do with child bearing...
Can you imagine?
A woman was fired for taking breaks to express milk with a 5 month old baby and the judges pronounce that this is not covered as pregnancy-related.
I would like to see those judges try non-pregnancy-related breastfeeding.
(I know, I know, anyone can lactate, but really....)

My friend and colleague Mary Overfield suggests boycotting. Reasonable.
However, if we are ever going to fix the mess we are in we need the lawyers to get in on this somehow.
Ideas?

http://www.columbusdispatch.com/live/content/local_news/stories/2009/08/28/LACTATE.ART_ART_08-28-09_B1_8EET5UK.html?sid=101

WABA World Breastfeeding Week and the US Breastfeeding Committee

2009-07-31T15:29:00.003-04:00

Sitting here at the US Breastfeeding Committee, I am happy to share that, in honor of WABA's World Breastfeeding Week theme on breastfeeding and emergencies, FEMA announced that it will be modifying its approach to this issue. This reinforced for me the power of WABA's work, when translated at the national level into advocacy.

Congratulations to USBC, FEMA and WABA on this important first step.

Other exciting announcements were made by CDC representatives who are constantly pushing the envelop and call for much more and better data collection that will drive breastfeeding program improvements, and the many other civil servants in government agencies (AHRQ, HRSA MCH/B, FDA, OWH and USDA) who continue to fight for the best start on life for our children, and for those changes in programs and policies that are necessary to enable each woman to succeed in her intention to breastfeed as the only logical choice for her health and her child's health, development and welfare.

Food Poisoning Journal says mothers should be warned about E Sakazakii in powdered formula

2009-07-20T08:44:00.004-04:00

The Food Poisoning Journal asks that all pregnant women and new mothers be warned about E Sakazakii in powdered milk, while the Examiner warns against use of most available water...
Perhaps we should work for legislation to put these in all antenatal training materials?

http://www.foodpoisonjournal.com/2009/07/articles/food-poisoning-watch/e-sakazakii-infection-from-powdered-infant-formula-know-the-risks/

http://www.examiner.com/x-10728-Twin-Cities-Water-Examiner~y2009m7d16-Is-fluoride-in-baby-nursery-water-safe-for-infant-formula-and-newborn-babies

Show me...

2009-07-01T10:09:00.003-04:00

Just found this sort of feminist down under blog on breastfeeding thanks to Linda Smith.

Hemispheres unite!!

http://viv.id.au/blog/20090625.5497/gone-too-far/#respond

PS I always found a baby bottle with formula sitting around to be a bit offensive....

When will they ever learn? Handing out formula creates mixed feeders... and highest feeding risk for HIV+ moms

2009-06-19T12:23:00.002-04:00

Dear friends:
When will they ever learn? Handing out formula for HIV+ moms in low wealth settings is not only risky, but potentially deadly.
Botswana's government meant well when they started handing out formula, but how many crises will be necessary until they stop?
Stock outages, massive diarrheal disease, and more stock outages, and yet it continues.
Please, my friends, help spread that word that such programs breed disaster.

http://www.mmegi.bw/index.php?sid=1&aid=5&dir=2009/June/Thursday18

Outcome of the meeting in DC...

2009-06-16T16:42:00.002-04:00

The meeting ended Friday afternoon, with reports from each working group. According to the organizers, the papers and the outcomes will be published in a supplement to Breastfeeding Medicine.
I think it will be interesting reading.

UN meeting 'Advancing global health in the face of crisis' - only UNICEF speaks to breastfeeding as essential

2009-06-16T16:35:00.002-04:00

With thanks to my old friends at UNICEF, in this high level forum, only UNICEF Executive Director Ann M. Veneman mentioned breastfeeding in her panel discussion on "Protecting vulnerable populations."
Notes on her presentation included the following. I added the bolds.
9.2 million children die before the age of 5 years, and that 93 per cent live in Africa and Asia. Around 3 million die in the first 28 days of life. A woman in the Niger had a 1-in-7 lifetime risk of maternal mortality, compared to Ireland, where the risk was much lower 1 in 40,000. When searching for a solution, it was important that policy-makers understood the link between maternal and newborn health. For a start, adequate nutrition for the mother was key to good health in their babies. In turn, early childhood nutrition was important, because one third of deaths in children under 5 were thought to be caused by malnutrition. Poor nutrition also made a person more likely to die of diseases such as malaria, while lack of breast-feeding contributed to 1.4 million deaths. She noted that pneumonia and diarrhoea were among the biggest killers among children –- diseases that were linked to HIV/AIDS, various tropical diseases and the flu. During a time of financial crisis, it was more important than ever to ensure that women and children, along with other vulnerable populations, had access to preventive and basic health services.
read more at: She explained that 9.2 million children died before the age of 5 years, and that 93 per cent lived in Africa and Asia. Around 3 million died in the first 28 days of life. A woman in the Niger had a 1-in-7 lifetime risk of maternal mortality, compared to Ireland, where the risk was much lower 1 in 40,000. When searching for a solution, it was important that policy-makers understood the link between maternal and newborn health. For a start, adequate nutrition for the mother was key to good health in their babies. In turn, early childhood nutrition was important, because one third of deaths in children under 5 were thought to be caused by malnutrition. Poor nutrition also made a person more likely to die of diseases such as malaria, while lack of breast-feeding contributed to 1.4 million deaths.
She noted that pneumonia and diarrhoea were among the biggest killers among children –- diseases that were linked to HIV/AIDS, various tropical diseases and the flu. During a time of financial crisis, it was more important than ever to ensure that women and children, along with other vulnerable populations, had access to preventive and basic health services.

Read more at:

http://www.reliefweb.int/rw/rwb.nsf/db900SID/MYAI-7T33XZ?OpenDocument

Meeting continues

2009-06-11T18:14:00.001-04:00

I am happy to report that our group - Workplace - was innovative and creative in developing issues. Tomorrow we will do the hard work: develop the action plan!
Wish us luck!

M

Sitting at a meeting in DC...What will we need to do provoke action?

2009-06-11T15:29:00.002-04:00

Recently I have had the opportunity to attend several meetings that MAY have a real impact on the future of breastfeeding...a bit of deja vu...and a bit of hope.
Back in the 1990s following the Innocenti Declaration, there was a spate of activity in an ill-fated effort to implement the four operational targets: a national multisectoral committee and authority; Ten Step in hospitals; Code of Marketing, and; maternity protection laws. The US promised to implement all by 1995...dot, dot, dot...

BUT some good things did arise from that era: the USBC - a collaboration of health organizations with interest in the issue; the Academy of Breastfeeding Medicine to engage physicians in education on breastfeeding; more hospitals practicing more of the Ten Steps, and the family leave act, so that women cannot be fired for taking some leave. Yes this is progress, but miles to go.

A few weeks ago, I was invited to speak at 2 starkly contrasting USG meetings: one entitled A Call for Action on Breastfeeding, the other - Medical eligibility criteria for contraceptive use - my role, the focus on contraceptive use during breastfeeding. The Call for Action, with several of our federal supporters hosting, was full of creative and innovative ideas and ways to increase action on bresatfeeding. I left that one totally enthused and having faith in our breastfeeding-supportive Feds!!!

The second did not go quite like that...although the report is not out, Dr Bob Hatcher went ahead and announce "any contraceptive can be used from birth" or some such, in the OB/Gyn News. It is very interesting what emerges when the audience members have a pre-existing agenda.

So what do we do to get a true representation of leadership so that we can really achieve change?

Today I am sitting in a meeting called by Ruth Lawrence and Cindy Howard in the name of their journal,Breastfeeding Medicine, sponsored by Kellogg, and self-named "First Annual Summit" on breastfeeding. No organizations or professional groups were invited, so USBC is not here, APHA is not here, among others. So far, we have heard at least 12 speakers, with no time for questions and no program insights. That is not to say that the speakers have not been interesting - they have been quite good: Larry Grummer-Strawn and David Meyers represented their agencies well - intelligent, informative, and insightful. Yay! the other speakers covered a variety of issues - what WIC does, how to lobby, cultural considerations, growth, media. All were good speakers and most quite informative. I am not clear what new will emerge from this handpicked group, but I look forward to the working groups to see what 45 physicians, 12 PhDs, and 13 sundry others (not an LC in sight) will have to say about the nuts and bolts of workplace, public education, healthcare systems and support services - also professional education -and how to create program change nationwide. Well, about 25 of us actally have some real program development roles, so perhaps we can help. We are going to the workgroups now...All remains to be revealed! Here's looking for the best.
Will write more tomorrow!

Martek hexane-derived DHA manufacture may have resulted in fire?

2009-05-25T16:37:00.002-04:00

I don't know how to verify this, but I read a report that the Kentucky State Fire Marshall confirmed that a 2003 explosion of a wastewater pretreatment facility was the result of the Martek Biosciences Corporation releasing hexane from its plant. Martek was using these chemicals to produce DHA.

While DHA is a natural ingredient found in human breastmilk that promotes eye and brain development, the Martek product is not natural, but chemically derived from dried biomass, algae, I believe.

Can anyone confirm or refute this report?

More on PBM...

2009-05-22T12:40:00.002-04:00

Joe Shields, who is director of public relations for PBM, got back to me, providing the following additional information:

"Thank you for reaching out to PBM regarding the responsible marketing of infant formula.... I just posted a formal response to a May 15 blog posting on the site [Note from blogger: unfortunately, it is too long for blogspot, so I am including some of it here.] for the organization’s consideration ....We believe that mother’s milk is the best source of nutrition for babies. Moms should try breastfeeding because it is considered best for babies by our company and leading experts. In fact, the American Academy of Pediatrics recognizes it as the gold standard in infant nutrition....If parents choose to supplement mother’s milk with baby formula, we believe they should not have to overpay for formula. That’s why we make store-brand formulas for retailers ...as many leading store-brand formulas cost up to 50% less than national brands. In fact, parents can save up to $600 a year by choosing a retailer’s store brand infant formula...The reason why our store-brand infant formulas are less expensive is because we do not give out free formula to hospitals. [Bolds added] We believe only mothers and health-care professionals should make infant-feeding decisions, which is why we do not want to influence that decision-making process at the time of birth."

I am going to be in contact - maybe we can get Marsha involved - and will keep you posted!

BFing good for moms - fine brief by our friend Joan Meek

2009-05-15T11:33:00.000-04:00

http://www.healthnewsdigest.com/news/Women_s_Health_260/Breastfeeding_Linked_to_Better_Health_for_Mothers_Too.shtml

Who is this masked man?

2009-05-15T11:18:00.004-04:00

"Baby Food Co. Seeks To Bar Nestle's Use Of 'Gentle'...Law360, New York (May 13, 2009) -- Infant formula maker PBM Products LLC has asked a federal court to bar Nestle SA and its Gerber Products Co. unit from using the trademarks "gentle" or "gentle plus" to sell baby formula while PBM pursues its case accusing the Swiss company of infringing the three-year-old mark."

Those of us who grew up in the era of Superman and Zorro know that an ostensibly meek and mild character can put on a mask and become a major force for good.

Who is this PBM who is taking on the giants?

From their website I learned that they live in the land of Ben and Jerry's, otherwise known as Vermont, and state: PBM Nutritionals is the only infant formula facility in the US that adheres to both FDA guidelines and a stringent set of quality-assurance regulations set by the International Organization for Standardization.

So I thought I would give them a call and discuss the Code...and I found a very friendly group!
I will keep you posted...

LA Times: PBM is stepping up to the plate against Mead Johnson's ongoing false and misleading advertising

2009-04-30T09:53:00.002-04:00

Lawsuit filed over Enfamil infant formula ads
01:48 PM PT, Apr 29 2009

Infant formula company PBM Products is suing a competitor, trying to stop what the company calls a "false and misleading" ad campaign.

PBM filed suit in U.S. District Court in Virginia against Mead Johnson Nutrition Co. and Mead Johnson & Co., a division of Bristol-Myers Squibb Co. Mead Johnson makes the Enfamil LIPIL Infant Formula product.

The suit accuses Mead Johnson of using false implications to undermine confidence in the store-brand formulas that PBM supplies to Wal-Mart, Target and other retailers.

"Mead Johnson stands behind our products, our science, and our marketing," said spokesman Pete Paradossi. "We do not comment on issues in litigation."

PBM alleges that Mead Johnson's national ads tout the Enfamil product as being the only one that contains two specific nutrients, DHA and ARA, that promote brain and eye development in infants. According to the suit, some of the ads suggest that store-brand products will result in fuzzy vision and slower brain development.

But according to PBM, the the store-brand formulas are nutritionally comparable, if not identical, to Enfamil. Court documents filed by the company are available here and here.

-- Tiffany Hsu

Two new quotables: The Case for Breastfeeding Reality and more on moms..

2009-04-21T11:27:00.003-04:00

Dear Friends:

I was honored to be approached for some input by Jennifer Block who is an excellent writer. "Jennifer Block is the author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care (Da Capo 2007), and the blog Pushedbirth.com. Her articles and op-eds have appeared in the Village Voice, ELLE, The Nation, Mothering, the L.A. Times, and the Guardian. She's based in Brooklyn, NY." She did a piece on Babble, the blog for contemporary moms.

Please see what I call her Case for Reality at: http://www.facebook.com/ext/share.php?sid=185174650054&h=WZvQh&u=YlFYT&ref=nf

I think SHE should be the editor of the Atlantic Monthly.

Another nice finding was this piece on women's health impact of breastfeeding.
http://news.bbc.co.uk/2/hi/health/8008678.stm

Huffington Post seems to be covering breastfeeding issues nicely

2009-03-04T13:13:00.000-05:00

With thanks for this commentary on formula risks:

http://www.huffingtonpost.com/birgitta-lauren/how-safe-are-infant-formu_b_171512.html

Abbott supporting corporate breastfeeding: good or bad news?

2009-03-04T10:44:00.004-05:00

A recent corporate program to support breastfeeding in the workplace is backed by Abbott/Ross. Is this a good or a bad thing?

Our friend Melissa Bartick, MD speaks out on this quite eloquently
http://www.huffingtonpost.com/melissa-bartick/ipeaceful-revolutioni-let_b_171570.html

Whenever a formula company makes statements in support of breastfeeding, but still includes its logo on every page, this is not good will - this is advertising for formula.

In addition, coming on the heels of a rather fine "Business Case for Breastfeeding", this effort can well breed confusion as to which is which. The Federal Business Case is well done, with no formula advertising, but the Abbott piece will be widely distributed, perhaps more widely than the excellent Federal materials.

Clever marketing strikes again, undercutting breastfeeding.

Inaugural Address: Hope and responsibility

2009-01-20T14:50:00.002-05:00

Dear Friends:

It is a pleasure to share with you two of the many possible excerpts from today's Inaugural Address. These two are of particular relevance and we go forward with our goals to enable women and families everywhere to Nurture Our Future:

“It is kindness…selflessness…courage… but also a parent’s willingness to nurture a child that finally decides our fate”

"America is a friend of each nation and every man, woman and child who seeks a future of peace and dignity"

Excerpts from the Inaugural Speech of US President Barack Obama, January 20, 2009

GREAT New Yorker Article!!!!!!!!!!

2009-01-14T17:45:00.000-05:00

http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore?currentPage=all

Consumers Union calls for more testing of commercial infant formula

2009-01-12T12:52:00.002-05:00

This is from the link :http://www.infozine.com/news/stories/op/storiesView/sid/33080/

With New FDA Infant Formula Test Data, Consumers Union Urges Expanded Testing, Recalls
Sunday, January 11, 2009

"Citing new data about infant formula that was quietly posted by the Food and Drug Administration over the holidays, Consumers Union (CU), publisher of Consumer Reports, urged FDA to move quickly to expand testing of infant formula for melamine and related compounds, and to recall all contaminated products.In a letter to HHS secretary-designate Daschle and current FDA commissioner Von Eschenbach, CU called FDA’s November risk assessment, which allows infant formula containing up to 1 part per million of these chemicals on the market “highly flawed.”Consumers Union noted that FDA posted new test data on infant formula on December 22, which showed that a melamine derivative, cyanuric acid, had been found in two additional samples of formula-- bringing the total to 4 contaminated samples out of 89 tested. “That is almost 5 percent of tested samples contaminated, a relatively high rate,” stated Urvashi Rangan, Ph.D., a senior scientist at Consumers Union. Three of the four positive samples found by the FDA are Enfamil with Iron or Enfamil Lipil with Iron milk-based powder, and the fourth is Nestle Good Start Supreme with Iron milk-based liquid.“The FDA needs to step up and expand melamine testing. The failure to properly inform people about these findings undermines consumer confidence in a fundamental product that millions of parents depend on,” Rangan said.FDA states that the amount of melamine and related compounds found in the formula, which range from .137 to .412 parts per million, are safe. However, Consumers Union called the FDA risk assessment from November 2008, which stated that up to 1 part per million of melamine in formula is safe, “flawed” and said it ignored key scientific data. An FDA risk assessment issued just eight weeks previously in October 2008 had stated that no amount of melamine in formula could be considered safe.“In its October assessment, FDA cited both a cat and a rat study in which a combination of melamine and one of its derivatives, cyanuric acid, caused kidney damage in the test animals at the lowest doses administered. FDA could not identify a ‘no effect’ level for these two compounds in combination, “ stated Michael Hansen, Ph.D., also a Consumers Union senior scientist.“Now FDA has found melamine in one sample of Nestle formula, and cyanuric acid in three samples of Mead Johnson’s Enfamil formula. What if a parent fed both of these formulas to their baby? These two chemicals appear to be far more toxic in combination than either one is separately. Yet FDA has set its safety limit based on exposure to just one of these chemicals alone,” stated Hansen."

FDA testing - to date - of melamine or cyanuric acid in US manufactured infant foods...

2009-01-11T17:34:00.005-05:00

Four out of the 89 US Manufactured Commercial Infant Formulas tested by the FDA were positive for Melamine or Cyanuric Acid with variable amounts. But what amount is "safe"?

3/20 Mead Johnson formulations
1/5 Nestle formulations
0/37 Abbott Labs formulations
0/ 37 PBM formulations (Parents choice and unlabelled)

Three Mead Johnson products: 2 Enfamil Lipil w Iron and 1 Enfamil w Iron, 12.9 oz can milk-based infant formula powder(ENFLIP QGN89 0744 18508 A AND ENFLIP QGN91 0440 18608B AND QGN92/ USE BY 1 NOV 2009) Mead Johnson Nutritionals were Negative for Melamine and Positive for Cyanuric Acid.
One Nestle product: Nestle Good Start Supreme with Iron 250 ml can milk-based liquid infant formula (8267572123 / USE BY 23 DEC 2009) was Positive for Melamine and Negative for Cyanuric Acid.

None of the less expensive , so-called generic, brands were found to contain even trace amounts of either contaminant.

The levels found were considered safe because FDA set the standard based on the assumption that these levels are safe...hmmm.

New formula advise merits very careful discussion before use

2009-01-07T13:51:00.002-05:00

An article published in Letters in Applied Microbiology noted that

--"Cronobacter is a recently defined genus of bacteria and was previously known as Enterobacter sakazakii. " (New name for E sakazakii!!)
--"These bugs will grow at 25°C or 37°C, but less so when the formula is made up using apple or grape juice than when made up using water or milk."

It is startling and amazing that such advise would be offered without careful study of the implications of adding additional fructose to the formula.
It may kill Cronobacter by being acidic, but what will the considerable amount of extra sugars do to the infant? Excess sugars breed other problems and other bacteria in the gut, let alone the nutritional issues....

"Selling breastfeeding in the US is a minefield"

2009-01-06T15:32:00.002-05:00

I wanted to thank the person who made this comment. Yes it is a minefield. But the questions I think we need to ask are: how does something so positive become an object of explosive response? and how do we create the proper message for the proper audience?

The minefields we encouter are composed of normal human emotions, among them are fear of change, and need for acceptance/lack of self-efficacy.

Fear of Change: We currently live in a bottle feeding culture: breastfeeding is change. We currently still live in a somewhat Victorian culture with body exposure having only one general interpretation - sex. We currently burden new mothers with an unbelievable set of expectations to return to work, etc: breastfeeding is an economic change as well.

Need for Acceptance/Lack of Self-Efficacy: Storms occur when widely different weather fronts come into contact. This is the situation in the US with infant feeding. On one hand, we have the glorious, shiny labels and commercials of the formula industry saying all is well and this is what your friends do. On the other hand, we have breastfeeding advocates who have clear visions of what they and their friends are doing. When these come in contact, we get stormy weather. Everyone seeks acceptance and when there are two "camps" folks tend to join one or the other. If each woman were fully enabled to learn about infant feeding, what it means in daily life, what it means in terms of thier child's health, what it means in terms of their risks of diabetes, breast cancer, etc.

Carolina Breastfeeding Institute, among many others, seeks to enable and empower each individual to come out of the storm and decide for herself based on unbiased information concerning her and her family's health, lifestyle, goals, and rights. My thought is that we need to use all possible information if we wish to be heard by all audiences.

New Studies underscore the need for PAID MATERNITY LEAVE in the US

2009-01-05T10:16:00.002-05:00

Studies suggest that, adjusted for socio-demographic and health factors, taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.

One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work. The authors also note that the US falls far behind other developed countries on paid maternity leave. In most other cultures women are expected to rest in preparation for this major life event. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of salary.

Concerning breastfeeding, 82 percent of mothers established breastfeeding within the first month after their babies were born. Women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding. Also, having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.

Guendelman S, Pearl M, Graham S, Hubbard A, Hosang N, Kharrazi M.Maternity leave in the ninth month of pregnancy and birth outcomes among working women. Womens Health Issues. 2009 Jan-Feb;19(1):30-7.

Guendelman S, Kosa JL, Pearl M, Graham S, Goodman J, Kharrazi M. Juggling work and breastfeeding: effects of maternity leave and occupational characteristics. Pediatrics. 2009 Jan;123(1):e38-46. Summarized and adapted from:
http://www.eurekalert.org/pub_releases/2009-01/uoc--slm122308.php

M-J's golden bow - reinforces the need for us to clarify OUR Golden Bow and to rebirth efforts to promote, support AND PROTECT breastfeeding in 2009!

2009-01-02T11:00:00.004-05:00

What can be done when our industry "friends" use similar symbols?!?

First:

We must continue to use our own bow, with is symmetrical and present it with the meanings that we apply to it:

1. It is symmetrical both ways, indicating the importance of both the mother and child.

2. The knot is large, as it indicates the support of father, family and society without whose support breastfeeding cannot succeed.

3. One streamer is for continued breastfeeding with age-appropriate complementary feeding

4. The other streamer is for 3-5 yrs. birth spacing to allow this baby to be the baby as long is needed and to allow for maternal health and nutrition recovery.

Second:

Breastfeeding needs better protection from wealth and power lobbies. the Code is not legislated in most countries, and even where legislated, rarely fully enforced.

We need a rebirth of effort on all fronts in 2009.

Profits for commercial formula industry will increase this year....

2009-01-02T10:53:00.003-05:00

“The price of powdered skim milk, used in infant formula, dairy products and processed foods, has fallen to roughly 80 cents a pound today from about $2.20.”

http://www.nytimes.com/2009/01/02/business/02dairy.html?_r=1&em

Commercial formula now costs about $7-12 a pound. The profit was huge, but now will be unbelievable...

This, in all probability will lead to increased profits by formula industry giving them immense amounts to spend on advertising in the near future…stay tuned.

New Years Resolution?

2008-12-31T11:27:00.004-05:00

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?

2008-12-31T10:54:00.003-05:00

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...

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

2008-12-30T12:33:00.002-05:00

"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.

National Quality Forum endorses exclusive breastfeeding

2008-12-15T13:08:00.003-05:00

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

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

2008-12-08T08:49:00.003-05:00

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...

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

2008-12-01T14:47:00.003-05:00

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...

Fourth Breastfeeding and Feminism Meeting -- Save the Date

2008-11-10T11:21:00.001-05:00

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?

2008-11-10T11:00:00.003-05:00

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

2008-11-10T10:53:00.005-05:00

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!!

Breastfeeding, Feminism, and the Reproductive Continuum

2008-08-08T09:30:00.003-04:00

Thematic series based on the Symposium last year:
http://blogs.openaccesscentral.com/blogs/bmcblog/

Full proceedings of Breastfeeding and Feminism: Reproductive Health, Rights and Justice is now available at:
http://www.sph.unc.edu/mch/symposium_on_breastfeeding__feminism_5130_4470.html

Enjoy!

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

2008-07-18T13:37:00.002-04:00

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, RansjÃ¶-Arvidson AB, Wiklund I, Henriksson P, UvnÃ¤s-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.LÃ©ger-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

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

2008-06-13T17:45:00.001-04:00

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.

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

2008-05-30T22:47:00.001-04:00

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…

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

2008-05-19T11:07:00.004-04:00

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

2008-05-19T08:56:00.001-04:00

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.

Where are the SIDS resources to support breastfeeding?

2008-05-01T10:49:00.002-04:00

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.

Naomi is blogging!

2008-04-27T12:51:00.002-04:00

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.

NPR: where do you find your health experts?

2008-04-10T17:49:00.003-04:00

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

Congress has stepped in to challenge BPA!!

2008-01-18T12:23:00.000-05:00

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.

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

2008-01-07T13:53:00.003-05:00

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.

ACLU supports Breastfeeding in Art - and in life

2008-01-04T11:04:00.000-05:00

[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.

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

2007-12-14T09:10:00.001-05:00

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.

Well deserved award given to the Infant Formula Industry

2007-12-11T09:55:00.000-05:00

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.

Let's get LAM right!

2007-11-18T14:10:00.000-05:00

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

Tuscon speaks out on co-sleeping!!

2007-11-09T12:38:00.000-05:00

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.

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

2007-11-02T11:29:00.000-04:00

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)

MomsRising has the right idea!

2007-10-31T13:10:00.001-04:00

Please visit
http://salsa.democracyinaction.org/o/1768/questionnaire.jsp?questionnaire_KEY=431
and let them know that breastfeeding deserves a high profile in thier excellent work!!

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...

2007-10-28T12:05:00.000-04:00

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

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

2007-08-16T18:09:00.000-04:00

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.

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

2007-07-26T12:37:00.001-04:00

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.

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

2007-07-23T12:41:00.001-04:00

"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...)

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

2007-07-18T22:46:00.000-04:00

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.

2007-07-06T00:19:00.000-04:00

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

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

2007-07-03T10:16:00.000-04:00

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?

Expired Formula? Not just a nutrition risk.

2007-06-28T10:33:00.000-04:00

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.

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

2007-06-23T18:17:00.000-04:00

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.

Ready to debate and achieve consensus on the way forward?

2007-06-18T10:05:00.000-04:00

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

2007-06-18T09:44:00.000-04:00

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.

Nice article on co-sleeping and breastfeeding: Response

2007-05-24T12:07:00.000-04:00

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.”

Nestle response proves, yet again, that they violate Code

2007-03-01T13:30:00.000-05:00

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.

Fifth Significant Commercial Infant Formula Danger for 2006

2006-12-13T11:03:00.000-05:00

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

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

Given that the WIC breastfeeding support is supported by kick-backs, called "rebates", from the formula companies - which must be significantly overpaid for the formula by the government in order to be able to supply these "rebates" at the level of millions of dollars to each state. Isn't this situation worth some exploration?
"
FDA warns Nestle infant formula fails nutrition standards
By Jennifer Corbett Dooren
Last Update: 11:44 AM ET Dec 12, 2006
WASHINGTON (MarketWatch) -- The U.S. Food and Drug Administration warned Nestle S.A. (NSRGY) that a sample of its Good Start infant formula failed to meet minimum nutrition standards for calcium and phosphorus.
The Nov. 27 warning letter was posted Tuesday on the FDA's Web site.
The letter stemmed from a May inspection of a Nestle facility located in Eau Claire, Wis.
The FDA said on May 26, 2006, it collected a sample of Nestle brand Good Start Infant Formula with Iron, 13 fluid ounces, and tested it. The agency said the formula fell just short of the required FDA standards for calcium and phosphorus and also was less than the amount stated on the formula's label...The FDA said Nestle was in violation of federal regulations and was required to respond to the FDA detailing steps it has taken or will take to correct the problem. A message left with a spokeswoman for Nestle's U.S. unit in Glendale, Calif., wasn't immediately returned."

Reasons why formula use is associated with increased salmonella

2006-12-05T13:18:00.000-05:00

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

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

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

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

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

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

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

Perinatal circumstances and suicide: breastfeeding not considered

2006-12-01T15:13:00.000-05:00

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

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

Open letter to the Philippines:

2006-11-28T10:43:00.000-05:00

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

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

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

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

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

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

Delta is no more ready than anyone else

2006-11-20T19:02:00.000-05:00

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

While we are tweaking AFASS...

2006-09-27T15:17:00.000-04:00

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

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

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

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

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

Best,
M

USBC carries the message

2006-09-08T15:16:00.000-04:00

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

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

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

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

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

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

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

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

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

2006-08-14T14:23:00.000-04:00

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

Dear Editor:

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

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

Excerpt:
RWINKWAVU, RWANDA

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

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

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

2006-07-28T10:09:00.000-04:00

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

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

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

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

Best wishes,
Miriam

2006-07-10T15:37:00.000-04:00

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

Dear Sen. McGovern:

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

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

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

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

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

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

Sincerely,

Miriam H Labbok, MD, MPH

2006-07-07T15:29:00.000-04:00

State offering new formula

Richmond, Va.

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

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

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

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

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

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

New York Times Editorial Apologist for Breastfeeding

2006-07-03T17:08:00.000-04:00

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

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

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

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

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

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

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

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

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

Global warming and breastfeeding

2006-06-15T12:51:00.000-04:00

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

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

Here's the jist of it:

Breastfeeding causes no plastic or pharmaceutical waste production.

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

Breastfeeding demands no fossil fuel for its preparation.

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

Also, while not in the article,

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

AND

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

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

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

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

Flurry about breast bullies: Who are the real bullies?

2006-06-15T12:47:00.000-04:00

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

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

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

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

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

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

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

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

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

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