TCS Daily

Best for Mothers, Best for Babies

By Sandy Szwarc - May 12, 2005 12:00 AM

New mothers are besieged by people telling them what is "best" for their babies -- and pressures to breastfeed have become among the fiercest of all. Ardent breastfeeding advocates once just made mothers feel guilty if they didn't breastfeed, accusing them of laziness or being unloving. Now, they've resorted to frightening vulnerable new moms with unsound scares about formula. They are pushing to restrict the capacity of women in developing countries to decide for themselves whether to breast or bottle feed. It's an agenda that jeopardizes the welfare of millions of mothers and babies.

While breast milk is universally recognized as the natural, ideal food for babies which offers some immunological protection, its promotion has gone far beyond proven benefits. Conversely, formula offers a nutritious option that has benefited millions of women and babies. While unsafe preparation in regions without sanitary water imposes risks, claims of formula's dangers have gone beyond science.

UNICEF and the World Health Organization have made "reinforcement of a 'breastfeeding culture' and its vigorous defense against incursions of a 'bottle-feeding culture'" official policy through a 1990 document called the Innocenti Declaration. While our modern American culture might not be perfectly conducive to breastfeeding, the other side of the coin is that it has been good for women and given us more options to better our lives and those of our children. Feeding a newborn on demand every one to three hours isn't a viable option for most women who must work to support of their families, especially those in lower paying jobs, or who are in school. Today's fathers increasingly share in parenting. And orphans in our country are fed, rather than left to starve.

As countries develop economically and women are employed, infant health and nutrition improves and the use of formula increases. But women in developing countries are not only being denied information, they are increasingly being forbidden any choice to use formula.

In response to pressures from special interest groups, in 1981 the World Health Organization approved the "International Code of Marketing of Breast-milk Substitutes" and subsequent amendments. As a global health initiative, it urges member countries to enact government regulations to promote and support exclusive breastfeeding (no other food or drink can be given) for all babies the first six months. "Thereafter, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond."

The Code also gives governments control over all information about infant feeding and restricts access to any information about formula except from a government health worker. No information, advertising or promotion for formula can be made to the general public or educational materials be donated unless requested by government authority. All information given to women must say breastfeeding is superior and note its benefits, while stating the "health hazards of unnecessary use of infant formula and other breast milk substitutes." Formula cannot be said to be nutritionally comparable to breastfeeding or be depicted in a positive way on labels.

Intensifying the global breastfeeding agenda, WHO and UNICEF developed the Global Strategy for Infant and Young Child Feeding in 2003. It declares that "exclusive breastfeeding from birth is possible except for few medical conditions" and lack of exclusive breastfeeding is a critical factor in infant and child deaths and illnesses, "poor school performance, reduced productivity, and impaired intellectual and social development." It also makes giving formula to a baby an offense that must be reported to government authorities. "Infants who are not breastfed, for whatever reason, must receive special attention from the health and social welfare system, since they constitute a risk group."

To get a sense of how far the health police have gone, consider the following from a UNICEF report:

        "In Iran, the Government has taken control of the import and sale of breastmilk 
        substitutes. Formula is available only by prescription, and the tins must carry 
        a generic label - no brand names, pictures or promotional messages 
        are allowed. In Papua New Guinea, the sale of feeding bottles, cups, [nipples 
        and pacifiers] is strictly controlled, and there is a ban on advertising 
        these products as well as breastmilk substitutes."

Women in developing countries who can't breastfeed and who are without access to or the ability to purchase formula can only feed their babies substitutes like cow's milk, rice water, cornstarch and water, which are nutritionally inferior. Such supplements also increase risks for diseases in areas where sanitary water is unavailable, a problem affecting one in five children. Yet the Code bans donations of free or subsidized formula, even in prepared form, in any part of the health care system. Women want safe alternatives for their babies, so a thriving and risky black market for substitutes has emerged as the promotion and use of formula becomes increasingly restricted.

On May 16th, the UN will vote on a resolution that will place warning labels on infant powdered formula, saying it contains pathogens that can result in death. This is a blatant attempt to frighten mothers about formula. Powdered formulas are not sterile and if mixed and left to stand at room temperatures, bacteria can grow. Premature babies in intensive care units have developed rare infections from E. sakazii bacteria. But the FDA states it is not aware of any such infections among healthy term babies in home settings and the European Food Safety Authority stated in February that present exposures do not lead to illness in healthy babies.

Needlessly frightening women about formula and stigmatizing those who feed it to their babies is an agenda that endangers many women and babies. Formula can be life-saving for babies whose mothers are struggling to survive, need to work and are trying to pursue educations to improve opportunities for themselves and their children. In developing countries children's livelihoods most depend upon their mothers and helping women out of poverty is the highest imperative, said Dr. Ann Tinker with Save the Children. A 2005 report by the Pan American Health Association stated women's ability to make decisions and control the necessary resources to ensure their own livelihoods is urgently needed as it directly corresponds to child mortality. Women deserve the freedom to choose what is best for them and their families, and sound information to make that choice.


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