Women and children have been let down for decades...

Kathriona Devereux looks at new papers by the The Lancet, which unravel why the majority of women around the world choose to breastfeed, but are prevented from doing so
Women and children have been let down for decades...

The Lancet medical journal has launched new papers unravelling the reasons why women are being prevented from breastfeeding.

I FOUND myself at the Royal Society of Medicine in London last week talking about crying babies. Not British politicians bracing themselves for the latest wave of scandals but actual human crying babies. I was moderating the launch of a new series of papers by the medical journal The Lancet which unravel the reasons why the great majority of women around the world choose to breastfeed but are being prevented from doing so. Less than half of infants globally are breastfed as recommended.

Infant feeding is a highly emotive and divisive subject because so many families have not breastfed in the past or have experienced trauma in trying to breastfeed or stopping sooner than they expected to.

No one who has formula fed their children wants to hear that outdated phrase “breast is best”, implying they didn’t do the best for their children. Breastfeeding is the biologically normal way to feed babies, the science and understanding of the exquisite immunological, nutritional and developmental components of breastmilk continues to mount. Which is why no one who desires to breastfeed takes the decision to switch to formula lightly and deep hurt and anger can surface when there is public discussion about breastfeeding or the marketing of infant formula.

The suggestion that a slick ad on TV promoting formula is the reason a mother stops breastfeeding is understandably offensive. The anger is justified because the reasons are much, much deeper and complex.

The Lancet series of papers details the myriad reason why breastfeeding doesn’t work out for so many. From under resourced maternity and health services; poor labour law and maternity protection; poor, or no, education and training of medical professionals in the fundamental biological function of breastfeeding; to societies not valuing or counting the unseen work of caring for small babies – if breastfeeding was counted in economic balances sheets as a food producing activity it would be worth $3.6 trillion a year.

The Lancet papers highlight how, “the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business—generating revenues of about $55 billion each year.” These sales are counted in GDP balance books but the work of women in breastfeeding babies is not.

Global transnational food companies spend at least $3.5 billion a year on marketing convincing us to buy their brands. It’s not just TV and social media ads. The papers detail the various strategies used by formula manufacturers to target parents, health-care professionals, and policy-makers including “lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws” and challenging food standard regulations.

Unless you are of child bearing age you’ve possibly not seen the ads that pop up on social media when you’ve just discovered you’re pregnant suggesting you join the industry sponsored “pregnancy club” or watch industry sponsored pregnancy exercise videos.

Or the ads targeted at new moms (the algorithms know!) suggesting their brand of formula might be the solution to “intense crying” or “arching back”.

Formula companies position themselves as caring experts, there to listen. They pay for industry sponsored “carelines”, they sponsor health professionals and academic institutes. They do all this to make money from dried, processed cow’s milk. A product that could, arguably, be sold much more cheaply if families weren’t paying for the elaborate marketing campaigns that drive sales.

Without all that effort and spend families who use formula would simply follow public health advice which is for those who can’t or choose not to breastfeed to use infant first milk until babies are 12 months when they can then start drinking full fat cow’s milk along with the solid family foods they started at 6 months.

Stage 1 milk is all that babies need if they are not breastfed. That’s it! None of the other Stages 2,3 and 4 malarkey that companies have designed to keep customers coming. And there is very poor evidence that the colic, hungry baby, anti-reflux types of formula work either (crying and frequent waking is, unfortunately, normal behaviour as babies adjust to life outside the womb!). Also, the cheapest own brand formula doesn’t have an enormous marketing budget built into its price tag.

A screen grab from The Lancet report.
A screen grab from The Lancet report.

Unnecessary follow-up formulas and toddler milks comprise 69% of the world’s formula sales by volume, therefore most formula sales are “superfluous to human need, unnecessarily use scarce natural resources, and cause otherwise avoidable environmental harm”.

These new papers are not about infant formula as a product or criticising families who can’t or choose not to breastfeed, what they show is that women and children all around the world have been let down for decades by a capitalist system concerned with making lots of money from dairy milk regardless of the impacts on infant and maternal health or the environment.

While polarised arguments of breastfed vs formula fed are commonly framed I would argue that all women and families, regardless of how they feed their babies, should direct their anger at the companies who extract enormous wealth from families around the world, families who can ill afford to pay for formula.

In Indonesia, for example, the cost of purchasing an economy formula brand equates to 15% of a working parent’s average monthly salary, money that can no longer be used to purchase essential household items and services, such as food, medicines, and health care.

Previous Lancet research has calculated that if all children were breastfed as recommended more than 800,000 child deaths a year from malnutrition, infections and childhood illnesses and 22,000 maternal death from breast cancer could be prevented. 

Those shocking numbers haven’t made governments or wider society sit up and pay attention to the issue but perhaps the estimated annual economic losses of US$341 billion associated with not breastfeeding will motivate change.

Ireland needs to take a good hard look at our role in this global system. We produce 13% of the world’s infant formula and need to face up to the realities of what those exports do when they leave our shores.

The Lancet authors argue that the global rise of commercial milk formulas has involved “transforming feeding babies into objects of commerce and trade”. How comfortable are Irish taxpayers knowing that our money supports and incentivises such a system?

Legislation that stops these marketing practices along with proper investment in the health of children and women, recognition of the caring work of women and increased taxation of the formula industry is needed.

Ireland needs to lead in reforming business practices that have placed the delivery of shareholder profit and growth as more important than the health and lives of babies.

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