Weighing the Implications of ‘Breast is Best’

Despite our intricate civilizations and complex societies, humans are mammals at their core, products of the same evolutionary lineage as our fellow hominids. Among having hair and being warm-blooded, breastfeeding is the natural way mammals feed their young, and humans are no different. In 2018, a resolution on this crucial part of mammal life reached the floor during the World Health Assembly in Geneva. The resolution was seemingly good-natured, stating that natural breastfeeding should be encouraged over formula products and that governments should strive to regulate misleading advertisements on formula breast milk substitutes [1]. Approving the resolution seemed like an obvious choice; years of scientific research on the health benefits of natural breast milk have given rise to the motto “breast is best” in the pediatric community. While the resolution was endorsed by many nations, the United States opposed the proposal, even threatening to “unleash punishing trade measures and withdraw crucial military aid” from Ecuador, the nation that proposed the resolution [1]. Uncovering why the United States not only rejected the proposal but did so as intensely as it did, calls for an analysis of the interplay between the benefits of formula and those of breastmilk. The question becomes more complicated, however, upon dissecting the ramifications of pro-breastfeeding campaigns.


Science is all but settled on the health benefits of breast milk. While scientists have observed a myriad of benefits from nursing with breast milk over formula, little is known about the biological mechanisms behind many of these benefits. Breastfeeding is widely associated with postnatal disease reduction, such as “up to a 30% reduction in the incidence of type 1 diabetes mellitus” or a “reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure” [2]. These benefits become especially important when discussing breastfeeding in preterm infants, in which physicians observe “fewer hospital readmissions for illness with breastfed infants in the year after NICU” (neonatal intensive care unit) discharge, as well as “a significant reduction (58%) in the incidence of necrotizing enterocolitis” - a life-threatening infection that can rupture the wall of the infant’s intestine [2]. Further into infant development, breastfeeding exclusively has also been found to have a positive effect on the development of infants’ white matter, which “facilitates the rapid and synchronized brain messaging required for higher-order cognitive functions” [3]. However, like many observations on the relationship between breastfeeding and infant health, “the mechanisms underlying these...differences remain unclear” [3].


Deciphering the United State’s fervent rejection of the resolution brings an elaborate history of formula industries and their marketing into the debate. A widespread concern from those who oppose formula advertising from companies like Nestle is their history of advertising in “areas without clean water”, which has led to thousands of infant deaths [4]. At the surface, the United State’s fervent advocacy seems to be in an effort to appease the “$70 billion [formula] industry…dominated by a handful of American and European companies” [1].


Nevertheless, skepticism towards the efficacy of pro-breastfeeding campaigns is not completely unfounded. Since 1981, a long history of “the World Health Organization[‘s]....resolutions aimed at increasing breastfeeding rates” has left many mothers for whom natural breastfeeding is not an option in the shadows [4]. In the opinion of many mothers, pro-breastfeeding initiatives have often grown aggressive at the patient-care level, demonizing formula to new mothers who are rightfully seeking what’s best for their baby [5]. Many hospitals, adamant in promoting breastfeeding, keep their formula under “a lock and key”, out of sight from patients, and oversimplify breastfeeding as a natural process absent of the difficulties that many mothers face in feeding their infants [4]. In this sense, pro-breastfeeding campaigns can often stigmatize the use of formula, whereas for some mothers formula is their only option.


Though breastfeeding is a natural process for all mammalian mothers, many mothers cannot or should not breastfeed. For example, dependency on illegal drugs or medication can alter breast milk composition and lead to adverse effects for newborns. The transmission of illicit drugs through breast milk can cause “irritability...growth problems, neurological damage, and even death” for infants [5]. Additionally, certain medications can cause side effects such as “a decrease in milk supply” or the production of breastmilk that is harmful to the baby [6]. Breast milk also has the potential to be a site of infectious disease transmission, as diseases like HIV or active tuberculosis can be carried through breast milk [5]. Soreness, difficulty with babies latching, and other common problems can also pose obstacles to breastfeeding [4].


A balance must be struck between the promotion of breastfeeding as a healthier alternative to formula and the active effort to not demonize formula for mothers who should not or are unable to breastfeed. The United States could move in the right direction by requiring longer or paid maternity leave for mothers; this strategy has been promoted by the Surgeon General as a way to promote higher breastfeeding rates among mothers [6]. In 2004, “California was the first state in the United States to implement a paid family leave”; research into the program’s effect on breastfeeding rates found “an increase of 10–20 percentage points for breastfeeding at several important markers of early infancy” [6]. Additionally, employers and public institutions should work towards destigmatizing breastfeeding in public or professional spaces, making breastfeeding more accessible for mothers. Research into lactation-friendly workspaces has shown “that for every $1 invested in creating and supporting a lactation support program (including a designated pump site that guarantees privacy, availability of refrigeration, and appropriate mother break time) there is a $2 to $3 dollar return” in net profits [2]. On the other side of the debate, while it is crucial to regulate advertising by formula companies to prevent adverse post-natal outcomes, more work must be done to improve the doctor-patient relationship in terms of providing accurate information on formula feeding, especially during a time as vulnerable as after child-birth.


References:

1) Jacobs, A. (2018, July 08). Opposition to BREAST-FEEDING resolution by U.S. Stuns World health officials. New York Times. https://www.nytimes.com/2018/07/08/health/ world-healthbreastfeeding-ecuador-trump.html

2) Eidelman, A., Schanler, R., (2012). Breastfeeding and the Use of Human Milk. American Academy of Pediatrics, 129 (3) e827-e841. doi.org/10.1542/peds.2011-3552

3) Deoni, S. C. L., Dean, D. C., III, Piryatinsky, I., O’Muircheartaigh, J., Waskiewicz, N., Lehman, K., Han, M., & Dirks, H. (2013). Breastfeeding and early white matter development: A cross-sectional study. NeuroImage, 82, 77–86. doi.org/10.1016/j.neuroimage.2013.05.090

4) Jaffe, S. (2018, July 10). WHO’s Language on Breastfeeding Really Is Flawed. Slate. https://slate.com/technology/2018/07/whosbreastfeeding-resolution-really-is-flawed.html

5) Murray, D. (2021, February 17). Can All Women Breastfeed? VeryWell Family. https://www.verywellfamily.com/why-some-women-cantbreastfeed-4153606#:~:text=nu rse%20their%20children.-,Overview,aren%27t%20compatible%20with %20breastfeeding

6) Huang, R., & Yang, M. (2015). Paid maternity leave and breastfeeding practice before and after California’s implementation of the nation’s first paid family leave program. Economics & Human Biology, 16, 45– 59. https://doi.org/10.1016/j.ehb.2013.12.009

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