TCS Daily

An Infantile Policy

By Sally Satel - June 7, 2005 12:00 AM

The World Health Assembly, the rule-making body of the World Health Organization (WHO), recently finished its annual meeting by adopting a resolution to promote exclusive breast feeding for a baby's first six months.

There is no question that breast feeding by a healthy mother is ideal for infants. No formula, after all, can perfectly duplicate the immune protection that is conferred to newborns by maternal antibodies in breast milk. Of great concern to the World Health Organization is that powdered formula can carry bacteria if not prepared correctly. Thus, the resolution also required clearer labeling on this hazard.

Yet the breast-is-best message can backfire. In fact, in the developing world -- where WHO resolutions matter most -- breast feeding can sometimes be hazardous under special circumstances and it would be lamentable if the resolution were to discourage women from using prepared formula and health officials from making it available. Indeed, in some circumstances, it is life-saving.

Perhaps the most obvious is HIV/AIDS. Clinics in Africa routinely give a six-month supply of formula to prevent newborns from being infected. In one study from Nairobi, Kenya and published in JAMA in 2000, the use of breast milk substitutes prevented 44% of infant HIV infections. To be sure, trade-offs must be acknowledged. For example, if a woman is so poor that she can't afford formula, it is dubious that she will be living under conditions that permit her to prepare it safely. Thus, in Malawi, among the poorest countries in Africa, doctors advise even HIV positive women to breastfeed because access to clean water is so limited. But in better-off Botswana, HIV mothers are advised to use formula.

To be fair, WHO recognizes that there may be medical obstacles to breast feeding and thus the bottle may be necessary. But the slant of the resolution is on protecting babies from the risks of formula -- while giving very short shrift to its benefits -- and the political message from advocates is that formula feeding is bad because it makes corporations grow fat. Says Baby Milk Action, "[we are] very worried about the commercial exploitation of HIV by the baby milk companies." The International Baby Food Action Network described itself has having "counterbalanced the power of some of the world's largest companies." Mothering Magazine, a U.S. publication promoting "natural" living condemns the "strident societal and economic impact wielded by the formula industry."

Demonization of formula is worrisome. In Chihuahua, Mexico, for example, it has been invaluable. Thirty percent of Chihuahua's population comprises members of the indigenous Tarahumara and infant mortality is high due to diarrheal diseases and other childhood infections. The mothers of a particular village called Teguerichi are so poor they could not consume enough calories to make milk reliably. Thus, when their babies became dehydrated from diarrheal disease, they could not compensate to replace to baby's fluid and nutritional needs. Since the introduction of fortified milk by the Fundacion Tarahumara, the tribe in this village has seen fewer deaths among its infants -- from three per month to less than one or none.

Health is not the only consideration. Another virtue of bottle feeding is its popularity among women who live in developing markets. Studies of new mothers in developing nations such as Nigeria, Sri Lanka and Vietnam demonstrate, for example, that work outside the home is the primary barrier to exclusive breastfeeding. The freedom of bottle feeding allows women to work, to contribute the financial security of their families and the economic advance of their community.

Furthermore. not all mothers will want to nurse in any case -- and that should be their decision. In developed countries, especially, pressure to breast feed does not have life or death consequences, but it can be annoying. Adelia Hallet, an Australian journalist and sole income earner for her family, became frustrated when she could find not one book on bottle feeding in her library (but 47 on breast feeding). Other new mothers in Australia have complained about being browbeaten by what one has mischievously called "the breastapo" -- a network of judgmental, relentlessly pro-breast feeding nurses and hospital staff who were part of UNICEF and WHO's Baby Friendly Hospital Initiative to ensure that all maternity clinics and hospitals "become centers of breastfeeding support."

In the first world, breast v. bottle is a personal decision to be made by informed women. But their counterparts in developing and third world nations depend on health officials and politicians to do more -- to recognize that emphasis on breast feeding, compounded by a suspicion of Big Formula, can risk promoting an unhealthy one-size-fits all nutrition policy for infants.


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