“Breast is Best”: an outdated message?
August 30, 2020
Every August, World Breastfeeding Week (WBW) is being celebrated in more than 120 countries, as part of a health promotion campaign that has been going on for almost 30 years. Although this may not resonate with you, local and international health organizations continue to dedicate time and resources for it every year, and it still is pretty much a big thing in certain parts of the world.
But is this effort really necessary nowadays? Afterall, who cares? It shouldn’t be anyone’s business how parents choose to feed their babies, as long as they are being fed; and commercial substitutes in 2020 are so advanced that are just equivalent to the real thing, right?
Before getting into why it might be necessary to promote something that women have been doing naturally for thousands of years, let’s start with the basics: breastfeeding IS the best option. And here is why:
  • It’s healthier for the baby: Commercial formulas have been designed to “mimic” the nutritional contents of breast milk, and all products are regulated to ensure they contain the necessary amount of carbohydrates, proteins, vitamins, etc. That means formula-fed infants still get the necessary nutrients to grow healthy.

    So, what’s the big deal then? Well, there is a key component that these formulas cannot provide: antibodies.

    Newborns have underdeveloped immune systems and have a reduced ability to fight infections. However, antibodies from the mother can be passed through breast milk, protecting the baby from common illnesses. Breastfed babies have a decreased likelihood of respiratory and gastrointestinal infections, allergies and even dental caries!

  • It’s cheaper: While breastmilk is available “for free”, we could argue that producing it costs the mother around 400-500 kcal per day, which means she will have to invest a little more in food for herself. Even taking into account this, the economic burden is insignificant compared to having to purchase all the products associated with formula feeding. If we are to consider the savings in healthcare due to reduced illnesses, the financial difference is even greater.
So, with all of these in mind, why are so many infants still being fed commercial milks? It is estimated that only 41% of the 141 million babies born annually are exclusively breastfed until 6 months.
First of all, the intention of this post is not to shame or blame anyone who cannot or has decided not to breastfeed their children, so I will not get into the reasons why individual women may have chosen one option over the other. Instead, I am going to focus on the determinants that affect how women “freely” (ahem…) make this decision. Here we go:
  • Capitalism: The link here is very obvious: Breastmilk can feed babies but does not feed corporations. And while there has always been a real need for commercial substitutes to help in cases where breastfeeding was not viable (for medical reasons, for example), initially the market was hardly significant. That was, of course, until big companies decided to start marketing their products as superior to the real thing. (“The finest baby food that the skill and scientific knowledge of man can devise” was one of their slogans).

    And just like that, through corporate marketing, bottle feeding became a thing in the 60s and 70s. The same way that owning a TV, a washing machine or a car was considered a status symbol, being able to afford some fancy milk was too. Walking and breastfeeding was for the lower class, while driving and feeding your baby with a bottle was modern and sophisticated. As a consequence, in a few decades breastfeeding rates dropped from 70% to 15% in developed countries.

    In developing countries, the marketing strategy was even more aggressive. Companies like Nestlé started distributing formula for free to new mothers in maternity wards. After leaving the hospital, the product was no longer free, but since the mothers had started using it, their breastmilk production would have naturally decreased, and they would have no choice but to continue buying it. This approach was not only disastrous in terms of economic burden for the families, but it is also thought to have caused thousands of infant deaths in African countries.

    Luckily, we have come a long way in recent years. An International Code of Marketing for Breastmilk substitutes was developed as a consequence, and many countries have implemented legislation to prevent these type of practices.

    However, this is still a big business nowadays. The global infant formula market size is projected to be worth USD 104 BILLION by the end of 2026, and everyone wants a piece of the cake.

    Some companies are exploiting the COVID-19 pandemic by running online adverts appealing to fearful parents, and again the biggest manufacturer, Nestlé, despite being denounced and boycotted by NGOs continuously since the 1970s because of its unethical practices, has in 2020 started distributing its infant products in India and Pakistan as part of so-called “COVID relief” donations, going once more against international regulations.

    In light of this, we should really question if formula feeding is “just another option” to make life easier for families, or a manipulative attempt at profit making at any cost.

  • Fetishization of female breasts: In parallel with marketing pressures, new mothers also have to deal with cultural barriers and social scrutiny.

    I always like to tell the story of when I was part of a recruitment process for nurse assistants in South Sudan. One of the candidates of that day came into the room with a baby in her arms, and in the middle of the interview, without saying anything, opened her shirt, exposed her breasts and started feeding her child. The conversation did not stop even for a second, and the rest of the interview panel, all South Sudanese, both male and female, did not bat an eyelid.
    Can you imagine a similar situation in a Western country? Me neither.

    (In case you are interested, she got the job).

    Paradoxically, the objectification and hyper sexualization of female breasts in certain cultures have a negative effect on breastfeeding. In some Western countries, breasts are nowadays considered purely sexual and therefore obscene in public, and women are constantly told to cover up, to breastfeed at home, or even in the bathroom.
    Male partners are often not supportive either, as they often argue that they don’t like other men seeing what they consider should be solely for their enjoyment. (insert eyeroll here).

    Even in social media platforms, where a video of a woman twerking in a thong can go viral, a picture of a woman breastfeeding will be censured if it shows a bit of nipple.
    Although in many parts of the world breastfeeding in public is legal and accepted, in countries such as the US, it is common for mothers to still face scrutiny and backlash while doing it. Not surprisingly, breastfeeding rates in the US are only 51% at 6 months and 30% at one year.

  • Lack of adequate support for female workers: I often hear that women’s participation in the workforce is related to things like decreased fertility or breastfeeding rates. And while that might be technically true, this type of statement may give the impression that women developing professionally is somehow the problem, or that the solution is for women to stay at home, both of which I find problematic.

    Instead, we should pay attention to the real issue, which is that women have adapted to the needs of the workplace, while workplaces have not adapted to the needs of women.

    As an anecdote, I can recall I once signed a work contract stating that, should I get pregnant while employed, my employer would provide two weeks of maternity leave. Yes, you read that correctly. TWO WEEKS. How can a new mother follow the WHO recommendation of providing 6 months of exclusive breastfeeding while continue to work full time? Studies around the world have consistently shown a direct correlation between the length of maternity leave and breastfeeding rates.

    In addition, according to studies in the US, in the month a new mother returns to work, she is 2.2 times more likely to quit breastfeeding as compared to her non-working counterparts. Therefore, if employment conditions encourage women to continue breastfeeding as they go back to work, they may be more likely to continue breastfeeding duration as recommended.

    In the current conditions, it is not surprising that women choose, or are forced to choose, formula milk as the only viable option to feed their newborns without putting their career at risk.

The question now is… what to do about all of this?
I obviously don’t have a magic solution for such a complex problem, and it is clear that since the barriers are multiple, continued efforts are needed at all levels of society. Advocating for better parental leave, educating the public, passing legislation to protect public breastfeeding, and continuing to monitor and regulate corporate practices are definitely necessary. In addition, things like establishing donor breastmilk banks can provide a free and healthy alternative to formula, for mothers who are unable to breastfeed themselves. But there is still a lot of work to do.
That is why organizations such as WABA (The World Alliance for Breastfeeding Action) are still so necessary. WABA is a global network dedicated to the protection, promotion and support of breastfeeding worldwide, and together with the WHO and UNICEF, are the force behind the annual World Breastfeeding Week (WBW) that health organizations in many countries are promoting and celebrating every August. WBW is intended to create awareness, inform people about breastfeeding related issues, engage organizations across different sectors, and galvanize efforts towards a common goal.
So next time you hear about this annual celebration, or any other breastfeeding promotion campaign, just remember why it is still a big deal.
(Resources for individuals and organizations can be accessed here.)
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