It is no longer news that the US delegation to the World Health Assembly attempted to undermine a worldwide resolution in support of breastfeeding1. Another member nation, Ecuador, stepped up to sponsor this non-controversial resolution, but the US threatened severe trade sanctions and withdrawal of military support, and ultimately Russia brought the resolution forward and it passed.
The resolution contained language in support of “…effective implementation of measures aimed at giving effect to the International Code of Marketing of Breast-milk Substitutes…” which many suspect was the trigger for the US delegation’s otherwise inexplicable behavior. Adopted by the World Health Organization in 1981, the Code aims to protect families, mothers and infants from marketing and commercial promotion of breast-milk substitutes (aka infant formula). 2 Formula “dumping” (provision of free or low cost samples of formula to vulnerable populations) and aggressive formula marketing are associated globally with decreased breastfeeding. The multi-billion dollar infant formula industry has a clear and vested interest in continued access to worldwide formula markets, and the Code is an interference.
Russia’s willingness to advance the Resolution on Infant and Young Child Feeding was critical. The Resolution lays out the rationale, member state obligations, and technical framework for protecting, promoting and supporting breastfeeding worldwide. The United States Breastfeeding Coalition (USBC)’s e-newsletter Weekly Wire, called “Staying Abreast” (available free and online at http://www.usbreastfeeding.org/enews) lists this week 14 national organizations, including the American Academy of Pediatrics & American College of Obstetricians and Gynecologists, that have published statements in support of breastfeeding, in opposition to the actions of the US Delegation, and in response to embarrassingly uninformed tweets from President Trump and Health and Human Services spokespeople.
The tweets, widely available on any media, include very misleading statements. President Trump apparently was worried that women would be denied access to formula, which has not yet been a global health problem. He apparently thought that women need formula “because of malnutrition and poverty,” which reveals a personal knowledge gap that one can only hope his advisors are rushing to remediate. Infants can become malnourished by not breastfeeding, particularly if the water supply is unsafe or unsanitary, and mothers can become impoverished if they allocate precious financial resources to infant formula, rather than breastfeeding, which is free.
As readers already know, breastfeeding is actually likely the most cost-effective global health intervention known. Optimal breastfeeding means exclusive breastfeeding through 6 months, followed by introduction of safe and appropriate complementary feeds and continued breastfeeding to at least one year of life. Optimal breastfeeding decreases the risk of both all-cause and infection-related mortality for infants and older children in a dose-dependent manner.3 Women’s health, too, benefits from breastfeeding, which reduces risk of breast cancer and type 2 diabetes, and reduces cardiovascular risk.4 Rollins and colleagues offer the staggering estimate that the cost of not breastfeeding is estimated at $302 billion worldwide annually.5 Now there is a business opportunity that surely is worth protecting, promoting and supporting!
1. Infant and Young Child Feeding. World Health Organization Seventy-First World Health Assembly. <http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_ACONF4Rev1-en.pdf> accessed 7/11/2018.
2. International Code of Marketing of Breast-milk Substitutes. World Health Organization. Geneva, 1981. <http://www.who.int/nutrition/publications/code_english.pdf > accessed 7/11/2018.
3. Sankar MJ, Sinha B, Chowdhury R, Bhandari N, Taneja S, Martines J, Bahl R. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):3-13.
4. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al; Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90.
5. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al; Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491-504.