The New York Times reports today that the US government actively opposed a recent World Health Assembly resolution on breastfeeding. Before the vote, widespread consensus was expected; the resolution acknowledged the value of human milk and expressed concern about unethical marketing practices for breastmilk substitutes. Under ordinary circumstances it would have passed with little debate. The story makes clear that these are anything but ordinary circumstances. It's astonishing, even here in the post-astonishment era. Highlights:
- Not only did the US oppose the resolution, its representatives threatened supporters from smaller countries with economic retaliation and withdrawal of military support
- This bullying behavior stopped only after Russian intervention
- The US did, however, succeed in watering down the language of the resolution
- The HHS, when contacted by the NYT reporter, spouted a script that comes straight from the industry playbook
I used to write a lot about breastfeeding in this space, but not so much lately. This is where I'm coming from:
Human milk makes a modest but statistically robust difference in health and neurodevelopmental outcomes across a surprisingly wide array of domains and disorders. Both parts of that assertion are important. Because the differences are modest, I fully support the right of an individual woman to make the infant feeding choices that work best for her and her family, free of side-eye and second-guessing. The world will be a better place when we give each other the benefit of the doubt more regularly. At the same time, because the differences are statistically robust and affect so many different kinds of outcomes, effective individualized breastfeeding support is a non-negotiable public health imperative. If a woman wants to breastfeed, let's find a way to help her make it work. No one reading this post should feel guilty for any reason, unless she is a Nestle or Abbott Labs executive.
But they, my friends, can go right ahead and feel guilty. The infant formula industry has done immense damage to breastfeeding relationships around the globe. You've seen this picture, right, taken the day before faulty information about milk supply resulted in a child's death? We can argue here in the developed world about exactly how important breastfeeding might be, but those discussions are entirely out of place in the developing world. Human milk saves lives everywhere; it is a particularly critical component of efforts to protect maternal-child health in poorer areas. The World Health Organization has been instrumental in responding to unethical formula marketing practices. The idea -- the very idea -- of the WHO Code as some kind of optional frippery that we've moved beyond now -- oh, man, I'm having a little Screwtape-centipede moment here.
Let's talk about that quote from the HHS employee, who said:
"The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children." The hurdles involved are pre-existing hurdles, placed decades ago to prevent industry from sabotaging breastfeeding. I am relying on news coverage of the incident because I can't find the text of this resolution on the WHO site, but WHO resolutions focus on public policy recommendations -- not mandating individual behavior. I cannot imagine how this could be an accurate assertion.
"We recognize not all women are able to breast-feed [sic] for a variety of reasons." True, and yet infant formula manufacturers have moved a lot of product over the years by making breastfeeding seem harder, more complicated, more awkward than it actually is. The research on this highly effective strategy goes back at least 25 years.
"These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so." The situations in which equivalent amounts of infant formula* are better than human milk for a baby's health include the following: infants with galactosemia and other inborn errors of metabolism, moms receiving chemotherapy or other genuinely dangerous medications, moms (in the developed world) with HIV, and...um...not a whole lot else. Infant formula companies have tried for years to persuade us that their product can save women from the uncertainties of breastfeeding (how much is my baby really getting? are there EVIL TOXINS in my milk?) and from the indignities of contact with the nipple nazis, but it is new and startling to hear their marketing strategies in the mouth of a representative of the United States Department of Health and Human Services.
*Phrased that way to acknowledge that formula supplementation can be immensely important when appropriate quantities of human milk are not available. I see you, moms with supply issues. I am also never going to stop being mad at the industry that creates supply issues in some women to foster dependence on its product.
There is no new science driving this change in US policy. There is global scientific consensus on the importance of breastfeeding for mothers and children. We can disagree on the magnitude of the odds ratios, but the body of evidence in support of breastfeeding is staggering. The only possible motivation I can imagine here is behind-the-scenes industry lobbying.
If they get what they want, babies will sicken and die. They will die preventable deaths-- of diarrheal illnesses in Bangladesh, of SIDS here in the US.
This is not okay.
Tomorrow morning I am going to call my reps. I am going to ask them to issue a statement in support of the government's role in protecting and promoting breastfeeding in time for World Breastfeeding Week, August 1-7. I am going to ask them to call for an investigation of formula industry lobbying, because it seems clear that money is doing the talking here. The US position at the World Health Assembly was anti-science, anti-maternal/child health, anti-common sense, anti-economic responsibility. Did you know it's estimated that every dollar invested in breastfeeding will generate $35 in economic returns?
Let's push back.
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