AIDS Awareness ribbons; Photo by Subhadip Mukherjee

WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant’s chance of survival.

2. CNN reports on the on-going story of the group of women who stepped in to breastfeed an infant when his mother passed away after giving birth. It’s been 11 months that baby Moses has been nursed by over 20 women. The baby’s father, Robbie Goodrich, said, “It’s been such an incredible outpouring of community love for this child of mine.”

3. Sinead at BreastfeedingMums covers the tragic story of a mother who fell asleep sitting up while breastfeeding her baby and accidentally smothered the child. As Sinead says, it’s important to pay attention to the guidelines for safe co-sleeping.

Post from: Breastfeeding 1-2-3

Myths about Breastfeeding and Poverty

1. Myth: If a breastfeeding woman is malnourished due to poverty, she should be told to wean and be given formula for her baby.

The truth is that a malnourished mother still produces sufficient breast milk, and breast milk is the perfect food for an impoverished baby who desperately needs the immune protection that breast milk provides. The Breastfeeding Answer Book explains:

Research from developing countries and other parts of the world indicates that even mothers who are mildly malnourished produce an adequate supply of good quality milk for their babies and that only under famine or near famine conditions will a mother’s nutrition affect her milk supply or the composition of her milk (Perez-Escamilla 1995; Prentice 1994). Even in famine conditions, milk production may be only slightly affected if the mother has body stores from which to draw energy for milk production (Smith 1947). In some developing countries where food supplies are limited, babies of women given nutritional supplements have not been found to gain more weight than babies of women whose diets were not supplemented (Prentice 1983).

This is not simply an issue in developing countries. The Breastfeeding Answer Book continues:

Some low-income mothers are discouraged from breastfeeding by health professionals, social workers, and others who question whether their diets are adequate. But if the mother is malnourished to the extent that it affects her milk supply, it is much less expensive to feed the mother nutritious food than to buy formula for her baby. Human milk is also healthier for the baby and increases his resistance to illness.

So what should a malnourished and/or low-income mother do if she is given free formula? Consume it herself! Dr. Jack Newman says she can add it to baked goods so she will receive extra nutrition and the baby will still benefit from human milk.

2. Myth: Poor people are more likely to breastfeed.

Given that it costs an average of $1,200 to $1,500 per year to feed a baby formula, it is tempting to assume as a pure function of economics that mothers living in poverty are more likely to breastfeed. Unfortunately that is not true. The National Health and Nutrition Examination Survey from 1999-2006 found:

Breastfeeding rates were lower for infants in low income families. Breastfeeding rates were examined by income status group. Income status was defined using the poverty income ratio (PIR), an index calculated by dividing family income by a poverty threshold that is specific for family size (3). Low income was defined as PIR less than or equal to 1.85, and high income was defined as PIR greater than 1.85. For the total population, the proportion of infants who were ever breastfed was lower among infants whose families had lower income (57%) compared with infants whose families had higher income status (74%).

Those statistics are for babies who were “ever breastfed.” When you look at data for the percentage of babies being breastfed at six months of age, the numbers are even worse. Childtrendsdatabank.org summarizes information from the National Immunization Survey:

Mothers living below the poverty line were less likely to breastfeed in 2004. At six months, 30 percent of mothers living below the poverty line breastfed their six-month-old infant, and of those living between 100 percent and 185 percent of the poverty line, 33 percent breastfed. In comparison, mothers living at 185 percent to 350 percent of the poverty line and those above 350 percent of the poverty line breastfed at rates of 38 percent and 46 percent, respectively.

The U.S. Breastfeeding Committee reports that $578 million per year in federal funds is spent by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to buy formula for families who could be breastfeeding.

But surely the impoverished in less industrialized nations are breastfeeding? An article in the International Breastfeeding Journal answers that question:

Although there is a conventional wisdom that poverty ‘protects’ breastfeeding in developing countries, poverty actually threatens breastfeeding, both directly and indirectly. In the light of increasingly aggressive marketing behaviour of the infant formula manufacturers and the need to protect the breastfeeding rights of working women, urgent action is required to ensure the principles and aim of the International Code of Breastmilk Substitutes, and subsequent relevant resolutions of the World Health Assembly, are implemented.

Read on to learn more about the insidious use of formula marketing around the world.

3. Myth: Formula is marketed only to those who can afford it.

Many people boycott the formula maker Nestlé in protest of its marketing practices. The original Nestlé boycott started in 1977 in response to Nestlé’s unethical, aggressive and patently harmful marketing of artificial baby milk in Third World countries. The company engaged women to dress up like nurses and distribute free samples that lasted just long enough to dry up a mother’s own breast milk. Impoverished women who could not afford to purchase enough of the expensive artificial milk would resort to diluting it with excess amounts of water which led to infant malnutrition. Furthermore, artificial milk prepared with unsanitary water supplies led to unnecessary illness. Add in the fact that the infants were not protected by the antibodies present in human breast milk and children were suffering and dying needlessly as a consequence of Nestlé’s deceptive marketing tactics. While the boycott was suspended temporarily in the 1980s, renewed efforts are underway in 20 countries around the world. Nestlé’s marketing practices continue to violate the World Health Organization’s (WHO) International Code of Marketing Breast-milk Substitutes (PDF document).

UNICEF states: “If all babies were fed only breastmilk for the first six months of life, the lives of an estimated 1.5 million infants would be saved every year and the health and development of millions of others would be greatly improved.” I repeat: 1.5 million innocent lives per year.

For more on the harm from unethical marketing of formula, read the policies of the International Baby Food Action Network and Baby Milk Action.

4. Myth: Breastfeeding is expensive and requires a lot of special equipment and clothing.

When it comes right down to it, all breastfeeding requires are mother and baby. No one needs special nursing pillows, foot stools, clothing, covers, or breast pumps in order to breastfeed. If a mother wants such things, there are free and low-cost options. Hand-expression of breast milk is quite effective as an alternative to pumping. There are several money-saving substitutes for traditional nursing clothing, and many do-it-yourself breastfeeding projects. If a woman needs help with breastfeeding, there are many free resources around the world. Accredited volunteer breastfeeding counselors offer free breastfeeding support through La Leche League in 68 countries!

Visit Kellymom and check out the “Financial costs of not breastfeeding . . . or the cost benefits of breastfeeding.”

5. Myth: Breastfeeding only saves the cost of formula.

There are all sorts of savings attributable to breastfeeding. I already mentioned the obvious — that breastfeeding actually saves babies’ lives. It also saves the cost of additional health care expenses, lost work hours, and environmental impact. The U.S. Breastfeeding Committee’s paper on the Economic Benefits of Breastfeeding (PDF) contains these amazing facts:

For private and government insurers, a minimum of $3.6 billion must be paid each year to treat diseases and conditions preventable by breastfeeding.

If a parent misses 2 hours of work for the excess illness attributable to formula feeding, greater than 2,000 hours—the equivalent of 1 year of employment—are lost per 1,000 never-breastfed infants.

110 billion BTUs of energy ($2 million) used each year in the United States for processing, packaging, and transporting formula.

550 million formula cans, with 86,000 tons of metal and 800,000 pounds of paper packaging, added to U.S. landfills each year

Conclusion

In conclusion, I offer this quote from the late James P. Grant, past Executive Director of UNICEF:

Breastfeeding is a natural safety net against the worst effects of poverty. If a child survives the first month of life, the most dangerous period of childhood, then for the next 4 months or so, exclusive breastfeeding goes a long way towards cancelling out the health difference between being born into poverty or being born into affluence. It is almost as if breastfeeding takes the infant out of poverty for those few vital months in order to give the child a fairer start in life and compensate for the injustices of the world into which it was born.

Other Carnival Entries on Poverty and Breastfeeding

Please enjoy these carnival entries as they become available:

~ Motherwear Breastfeeding Blog: How Breastfeeding Fights Poverty
~ BreastfeedingMums: Lack of Knowledge Affects Breastfeeding Rates
~ Babyfingers: Interview with a WIC Counselor
~ Mama Knows Breast: Breastfeeding Can Fight Poverty

Post from: Breastfeeding 1-2-3

La Leche League (LLL) and the World Alliance for Breastfeeding Action (WABA) joined together today in celebration of World Health Day 2008. The theme chosen by the World Health Organization for World Health Day 2008 is Protecting Health from Climate Change, and LLL and WABA put together a statement showing how breastfeeding protects both health and the environment. In particular, the statement notes how:

~ Unlike formula-feeding, breastfeeding requires no manufacturing plants
~ No packaging for breast milk is needed
~ Both corn- and soy-based formulas require heavy use of farmland for feeding, grazing and harvesting
~ The livestock sector generates significant greenhouse gas emissions and is a major source of land and water degradation
~ Because nursing mothers are often menstrual period-free for many months, they (1) contribute to slowing the population growth through natural child spacing, and (2) do not use sanitary products and thus save money, resources, and landfill space
~ Formula preparation in the home requires containers and fuel consumption to heat and sterilize water

In addition to the ways in which breastfeeding benefits the environment, it is quite clear how breastfeeding helps protect both the health of the child and the mother. It may not seem obvious at first, but breastfeeding goes a long way in “protecting health from climate change”!

Post from: Breastfeeding 1-2-3

Until recently, the international growth charts were based on data collected in the 1970s in the United States largely from babies fed infant formula and not breast milk. Subsequent studies showed that the charts did not accurately reflect the general growth curve of predominantly breastfed babies, whose weight rises more steeply than the curve in the early weeks, and may dip slightly after the three-month mark. These discrepancies led to concerns that health care professionals might recommend supplementation or cessation of breastfeeding when those measures simply were not warranted. Unfortunately there is a dearth of information regarding when and how to intervene with respect to weight gain. Even in situations when some intervention clearly is necessary, it would be appropriate and advisable to recommend additional breastfeeding support and other methods that interfere the least with the breastfeeding relationship.

In response to the discrepancies in the growth patterns of formula-fed and breastfed babies, the World Health Organization (WHO) undertook a new study of 8,440 babies in six countries representing various regions of the world: Brazil, Ghana, India, Norway, Oman, and the United States. The babies’ mothers did not smoke during pregnancy or after the birth, and they intended to breastfeed exclusively for at least four months (the recommendation at the time; now the recommendation is six months of exclusive breastfeeding). The six-year WHO Multicentre Growth Reference Study (MGRS) culminated in 2003 and resulted in the publication of several new growth charts in April 2006 (complete publication of the WHO Child Growth Standards is available on Amazon.com):

Length/height for age (recumbent/lying-down length or standing height)
Weight for age
Weight for length
Weight for height
Body Mass Index for age (BMI for age)
Motor development milestones for the six gross motor milestones: sitting without support, standing with assistance, hands and knees crawling, walking with assistance, standing alone and walking alone.

Charts or tables are for boys or girls and may refer either to percentiles or “z-scores.” I’ve only ever had a pediatrician use the percentile chart, but I was curious what the z-score charts mean. Perhaps the mathematically inclined will understand the explanation that a z-score or “standard deviation score” is defined as “the deviation of an individual’s value from the median value of a reference population, divided by the standard deviation of the reference population (or transformed to normal distribution).” Basically this is the number of standard deviations a data point is away from the average.

Medical professionals and parents in the United States may wish to note that the Center for Disease Control pediatric growth charts were developed in the year 2000 and do not reflect the WHO child growth standard. The CDC website says:

The Department of Health and Human Services (CDC and NIH) and the American Academy of Pediatrics convened an expert panel in June [2006] to consider using the new WHO charts versus the CDC charts. The panel compared the 2000 CDC growth charts to the new WHO charts and examined how U. S. children might be assessed differently using the two references. Guidance will be developed for appropriate use of these growth charts for monitoring growth within the US Population.

As to whether the 2000 CDC growth charts are appropriate for exclusively breast-fed babies, the CDC says:

The 2000 CDC growth charts can be used to assess the growth of exclusively breast-fed infants, however when interpreting the growth pattern one must take into account that mode of infant feeding can influence infant growth. In general, exclusively breast-fed infants tend to gain weight more rapidly in the first 2 to 3 months. From 6 to 12 months breast-fed infants tend to weigh less than formula-fed infants.

The 2000 CDC Growth Chart reference population includes data for both formula-fed and breast-fed infants, proportional to the distribution of breast- and formula-fed infants in the population. During the past two decades, approximately one-half of all infants in the United States received some breast milk and approximately one-third were breast-fed for 3 months or more.

The lesson in all of this? If a mother is being told that her exclusively breast-fed baby needs supplementation, she should ask further questions about which chart is being used to monitor her baby’s growth and whether that chart is appropriate for an exclusively breast-fed baby. It might be helpful to print out the appropriate WHO chart to discuss with the baby’s pediatrician.

Even now infant growth charts are relied upon too heavily to monitor infant growth, and that reliance is resulting in inappropriate recommendations by health care professionals. A recent study in the United Kingdom concluded:

Babies were weighed more often than officially recommended, with weighing and plotting being at the core of each clinic visit. The plotted weight chart exerted a powerful influence on both women’s and health visitors’ understanding of the adequacy of breastfeeding. They appeared to rate the regular progression of weight gains along the chart centiles more highly than continued or exclusive breastfeeding. Thus weighing and visual charting of weight constituted a form of surveillance under the medical gaze, with mothers actively participating in self monitoring of their babies. Interventions, by mothers and health visitors, were targeted towards increasing weight gain rather than improving breastfeeding effectiveness. Improvements in training are needed for health visitors in weighing techniques, assessing growth patterns – particularly of breastfed babies – and in giving information to women, if the practice of routine weight monitoring is to support rather than undermine breastfeeding.

Sachs, Magda, Fiona Dykes and Bernie Carter. “Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies’ weight charts.” International Breastfeeding Journal (2006): 1-29.

Post from: Breastfeeding 1-2-3