Breast is best, so says the World Health Organization (WHO). Breastfeeding versus formula has long been a cultural debate, but it recently became political when WHO called on governments to approve a resolution to “protect, promote and support breastfeeding,” while limiting the promotion of milk substitutes.
The U.S. Opposes The WHO’s Breastfeeding Resolution
The move was based on studies that say breast milk has an overwhelming advantage over formula in sustaining infant health. It also sheds light on the aggressive and often inaccurate marketing by the corporate giants of the baby food market, which is why, in a bid to protect them, the Trump administration pushed back on the resolution with equal aggression.
The resolution was eventually passed, but a satisfying solution to the debate has yet to be found. If breast really is best, what happens when a mother can’t breastfeed? Most women have access to formula, but not all women have access to the clean water needed to reconstitute the powder. And, even then, those in poorer areas with safe water supplies dilute the expensive milk substitute, putting their children at risk of malnutrition.
This is why WHO wants to halt formula advertising in countries where clean water is sparse and poverty is rife, since research reveals that in 2016 the deaths of 823,000 children and 20,000 mothers could have been avoided through breastfeeding. Further investigation carried out by Save the Children earlier this year found that formula companies skirt around regulations, and press mothers and healthcare professionals to choose powdered milk. Worse still, formula marketing is concentrated in the world’s poorest regions where malnourished mothers may produce breast milk, but not enough to feed their children.
Why Is Breast Best?
A Lancet series in January 2017 stated that breast milk “makes the world healthier, smarter, and more equal.” It contains water, fat, protein, carbohydrates, minerals, vitamins, enzymes, growth factors, and essential fatty acids. Essentially, everything a baby needs. Plus the makeup of a mother’s milk changes from feed to feed to support her child’s growth.
What’s more, breastfed infants have significantly fewer respiratory, ear, and gastrointestinal infections, and those in low and middle-income countries have only 12 percent of the risk of death as infants who are not breastfed. The pressure is therefore on mothers to make it happen.
Yet up to five percent of all women are unable to produce enough milk, and around two percent cannot physically lactate. As for those who can, only a fraction (14 percent) sticks with it for up to four months, let alone the recommended six.
Efforts to breastfeed, it seems, can be derailed in the earliest days of an infant’s life, and the slightest uncertainty could cause a mother to forego it altogether. New mothers need to be encouraged and empowered; yet with so many of the world’s health professionals banging the breastfeeding drum, a woman can feel like she’s failed if she can’t do it. Her confidence can quickly be lost.
Nevertheless, according to the WHO Global Strategy for Infant and Young Child Feeding, virtually all women can breastfeed provided they have accurate guidance from their healthcare providers, and sufficient support from their families and communities.
So Why Can’t I Breastfeed?
Both medication and medical conditions can provide barriers to breastfeeding. Stress and exhaustion can also halt the supply of milk, especially when induced by efforts to force it. Other limiting factors include polycystic ovary syndrome, hypothyroidism, insufficient milk gland tissue, and the impact of breast surgery.
Size, however, does not matter. Larger breasts have more fat rather than milk-producing tissue. Smaller breasts may not be able to hold as much milk, but this can be resolved by more regular feeds. Topping up with formula presents as the quick fix, but mother’s milk is produced on demand and breasts need to be stimulated in order to maintain supply.
Furthermore, a mother’s health is a major factor in whether or not she will be successful in breastfeeding. If she’s malnourished, she won’t be able to produce milk—as is the case in the poorest regions where formula marketing is most aggressive. Investment therefore needs to be made not in disingenuous advertising, but in proven nutritional guidance, along with adequate and consistent healthcare, for both mother and baby.
Women are told to breastfeed, but not told how to do it, which is why new mothers must seek the support they need wherever they can, be that from family, a Facebook group, a lactation consultant, or other moms. WHO recommends that breastfeeding mothers in difficult situations remain together, but breastfeeding mothers in all situations should stick together.
It’s not more formula that’s needed, but a societal and cultural shift in how we look at breastfeeding, in how we blame the mother if her milk doesn’t come, in how women and children have become the pawns in a political chess game.