Breastfeeding for a Healthier Planet
The Green Parent 18 Jan 09
I chose to breastfeed when I was expecting my first baby, after doing a little research. My motivation for doing so was that breastfeeding was the best choice for my baby’s and my own health. I was quite unaware that my decision had any wider implications affecting anyone beyond my own family. I have since discovered that breastfeeding is not just good for mums and babies but it’s important for the future of the planet too. It’s not simply a personal matter - breastfeeding affects both economics and ecology.
The fact that breastfeeding is best for health is incontrovertible. Let’s examine the financial picture rather than the actual health implications; although such an examination necessarily touches on the risks to health from formula feeding.
The financial picture
If all babies were breastfed for at least three months the reduction in the incidence of gastroenteritis alone would save the NHS in England and Wales over £35 million each year. Formula fed children are twice as likely to be admitted to hospital with a chest infection within their first seven years compared with children who were breastfed for at least the first three months. Formula fed babies are five times more likely to suffer from urinary tract infections during their first six months than their breastfed counterparts. Then there is the expense of treating those who suffer from a greater incidence of ear infections as well as from any of the various ailments that the formula fed child is more likely to fall a prey to throughout his life. Many parents just seem to expect their children to suffer ear infections and tummy bugs in the normal course of events.*
Women all over the world who breastfeed their babies enrich their local economies by reducing health care costs.
Mothers are biologically designed to breastfeed
Breastfeeding conserves energy. Mothers have to be close to starvation before they are unable to lactate sufficiently to nourish their babies. The number of extra calories required for the mother’s body to make milk is frequently overestimated. Mothers put on an extra layer of fat during pregnancy which is laid down for the purpose of making milk once the baby arrives. Lactating helps to burn off that extra fat without the mother needing to eat substantially more than she otherwise would do. Studies show that women who breastfeed may have a lower risk of breast and ovarian cancers and that their babies are less likely to die of cot death or suffer from allergies or obesity in later life.
Human milk is a living and changing substance that is designed to provide all the nutrients a baby needs in exactly the right proportions. It requires no preparation, is delivered at the right temperature, in the right amounts with no waste, and is free of charge. Lactation suppresses the body’s hormonal response to stress so many mothers find they are better able to cope with anything that life throws at them during the time they are nursing. When you nurse a baby you can feel your body letting go of tension and stress as you relax with your baby. This necessary slowing down repeatedly throughout the day (and night) and the extra tactile stimulation encourages a smooth bonding between mother and baby. Neuropsychologists are suggesting now that the increased amount of loving touching which happens during breastfeeding is important for brain maturation.
Breastmilk is the superior infant food
Breastmilk sustains the baby for at least the first six months of his life without the need for any other complementary food. In fact, it should be the main source of a baby’s nutrition for the first year of his life. The World Health Organisation's infant-feeding recommendation as stated in the Global Strategy on Infant and Young Child Feeding states:
“As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.”
Note this is a global recommendation and not restricted to third world countries.
THE ENVIRONMENTAL IMPACT
Cattle and crops
Cows’ milk infant formula, unlike human milk, has a significant negative impact on the environment. Cows cause considerable erosion to the soil. Dairy farmers cut down rainforests to raise cattle, wiping out resident species and depleting the amount of oxygen being produced. Cows' waste products account for 20% of the world's annual methane emissions. Methane is a major contributor to the greenhouse effect. Cows’ faeces can contaminate local groundwater.
Artificial baby milk can also be made from soya beans. Soya milk formula is a poor substitute for human milk and soya beans require a lot of pesticides and fertilizer to grow (not to mention land), which cause a lot of pollution. All this notwithstanding, major lending institutions encourage the production of soya beans, as well as the raising of cattle, as a way for poor countries to pay off their debts.
Breastfeeding is contraception
As well as the problems caused to the land by lots of cows, the manufacturing of formula milk leads to too many human births. Exclusive breastfeeding is the world’s most effective form of contraception. Breastfeeding delays a mother’s return to fertility and so it’s important in curbing overpopulation. A common myth about the use of contraception by breastfeeding mothers is that lactation alone cannot be depended on to prevent pregnancy. In fact, the Lactational Amenorrhea Method (LAM) has been found to be better than 98 percent effective. Three main criteria must be met in order for LAM to be effective: i) the baby should not be receiving any supplemental foods or artificial infant formula, ii) the baby must be less than six months old, and iii) the mother must not have resumed her menstrual cycle.
The ecological destruction brought about by formula milk doesn’t stop with the manufacturing process. Transporting milk to processing plants (often a considerable distance) and transporting the final product to consumers (usually from overdeveloped countries to developing countries) requires enormous amounts of energy further adding to pollution and to the depletion of global resources. Then there is the energy necessary to manufacture and sterilise the equipment that mothers need to bottle-feed. The bottles and teats have to be produced then repeatedly sterilised by the mother in boiling water. This is often a problem in under developed countries, where the water is dirty and there may not be enough wood to burn or enough money to pay for electricity to heat the water for long enough to kill bacteria.
All the packaging, tins and advertising materials, all the bottles and rubber nipples required for the use of formula milk must eventually be disposed of, contributing to long-term landfill problems. By contrast mothers’ milk produces no waste. Even a breastfed baby’s solid waste is inoffensive and smells reasonably pleasant!
Deaths caused by formula feeding
According to the World Health Organisation 1.5 million infants die every year because they are not adequately breastfed. “These facts are not in dispute.” United Nations Children’s Fund (UNICEF). Breastfeeding confers both active and passive immunity to protect a baby against infection. Artificially fed babies are more vulnerable, because artificial feeding provides none of the antibodies and anti-infective agents that are provided by breastmilk.
Where water is unsafe, babies are up to 25 times more likely to die if they are bottle fed. Diarrhoea is the biggest killer of children worldwide. Millions of babies become seriously ill directly as a result of drinking formula milk. Artificial milk is very expensive, often costing more than half the entire family income. Inevitably bottle feeding contributes to family malnutrition. Mothers living in poverty try to make the milk go further sometimes by over diluting the powder or they use cheaper alternatives, such as powdered whole milk, which is nutritionally unsuitable for a baby.
Powdered baby milks, even in unopened tins or packets, may contain pathogenic bacteria such as Salmonella and Enterobacter species. These bacteria thrive in warm milk, multiply rapidly and can result in meningitis, necrotising enterocolitis, septicemia and even death.
Bottle baby disease is the name given to the deadly combination of diarrhoea, dehydration and malnutrition which is the result of unsafe bottle feeding. While the risks are greatest in areas of the world with hot climates, lacking refrigeration and adequate fuel to prepare the product safely, breastfeeding reduces the risk of illness in all countries. Even in the UK, a bottle-fed baby is up to ten times more likely to be admitted to hospital with gastro-intestinal illness than a breastfed one.
“Marketing practices that undermine breastfeeding are potentially hazardous wherever they are pursued” UNICEF.
Companies selling formula milk try to persuade health workers and mothers to bottle feed in order to increase their profits. Their persuasion comes in the form of advertising and misinformation. They send sales reps into hospitals to promote their milks and they sponsor health workers, conferences and even health facilities. The International Code of Marketing of Breastmilk Substitutes aims to protect all mothers and babies from inappropriate marketing practices.
The Code bans all promotion of breastmilk substitutes, bottles and teats. However aggressive marketing continues on a wide scale. Despite the assurances of the baby feeding industry, which claims now to support the International Code, companies continue to violate it in a systematic manner and attempt to undermine its implementation. Just visit any UK supermarket or open a parenting magazine and you’ll see what I’m talking about. The promotion of baby milks pervades our bottle feeding culture.
The UK Government has international obligations to implement the International Code and Resolutions, recognised by EU Directives on formula marketing. Leading health bodies in the area of infant feeding and MEPs have been calling for full implementation since their introduction. These are minimum standards to be implemented in their entirety in all countries to protect breastfeeding and ensure breastmilk substitutes are used safely if they are needed.
It doesn’t look as though breastfeeding is being protected in the UK. According to a UK government survey, 90% of mothers who stopped breastfeeding before six weeks said they wanted to breastfeed for longer, as did 40% of those who breastfed for six months. In Sweden 98% of mothers initiate breastfeeding3, compared to 76% in the UK. In the UK, rates decline rapidly with fewer than half of babies (48%) breastfed at six weeks. Our rates are almost the lowest in Europe. In Sweden over 70% of mothers are still breastfeeding at six months.
Formula companies do not provide accurate information on differences between brands and essential information on how to reduce risks, particularly with respect to the temperature of the water required for safe preparation, and how long the milk may be kept once made up. Parents who use formula need protection and independent sources of information free from commercial pressure**.
According to Nielsen Research Multimedia, baby food companies spent £7,626,847 on advertising formula and baby food in 2006/07. This is an increase of 36.6% on the previous year. In contrast the government spent £729,011 on promoting breastfeeding in 2006/07, representing a decrease on the previous year. Clearly there is no money to be made from breastfeeding!
The formula companies all publish persuasive information, which helps perpetuate the myth that formula milk is almost as good as the ideal mother’s milk. Follow-on milk for babies over six months old was invented solely to circumvent the ban on advertising infant formula and adverts for this product abound in parenting magazines, on the radio and the TV. Market research has revealed that most people seeing these ads do not realise they are for babies who are over six months. This is not surprising because they have similar packaging and logos to the infant milks and often the babies look younger than six months. Trading Standards fails to uphold complaints against such advertising.
For most of us in most areas of life the ideal is unobtainable and second best is fine. For instance, we don’t always eat a perfect diet ourselves or take the recommended amount of daily exercise. The advertising of formula milks relies on making breastfeeding appear to be an unreasonable goal and plays on women’s fears about sore nipples and the possibility of not making enough milk.
A lot of the time the health profession is powerless to dispel the myths surrounding breastfeeding that have grown up with the rise of advertising since the 1950s and that have become an integral part of our culture. There is some excellent support in the National Health Service for breastfeeding – but finding it is a bit of a lottery. Individual health workers often have inadequate, or no, training in breastfeeding management and/or no personal experience of what is normal in a breastfed baby and what isn’t. It is easier to recommend supplemental top-ups with formula than it is to find a solution to a breastfeeding problem if you have no relevant knowledge yourself. No one wants to make a mother feel guilty for failing to establish breastfeeding, particularly a health worker who has been helpless to support. Yet health professionals don’t worry about giving pregnant smokers the facts about the dangers or insisting that babies are taken home from hospital in suitable restraining car seats. Perhaps those women who suffer guilt after giving up on breastfeeding should instead be experiencing anger that they haven’t had the right information and support?
In a recent study The World Cancer Research Fund found that three quarters of British women are unaware that breastfeeding reduces the mother's risk of breast cancer, despite convincing scientific evidence to support the idea. This means that many new mothers are making choices about whether to breastfeed without knowing breastfeeding can help reduce cancer risks for both them and their child. Breastfeeding lowers the mother's risk of breast cancer by 4.3 per cent for every year of breastfeeding, meaning that if every child in Britain were breastfed for an extra six months there would be around 1,000 fewer cases of the disease every year. It has been known for some years that breastfeeding reduces the risk of breast (and other cancers) and mothers should be entitled to have this information readily available to them when they are deciding how they want to feed their babies.
What is formula milk?
The recipe for formula is dictated by the price and availability of ingredients and the recipe for one product can vary from batch to batch. You might assume that the production of infant formula would be heavily regulated: in fact, there are no requirements to control what goes into it. Most of the ingredients in infant formula are incredibly cheap. Powdered milk contributes only one-sixth of the total cost. Soy protein isolate used in soy-based formula is even cheaper. Most commercial formulae are based on cows’ milk, which has to be modified for infant consumption. The protein and mineral content have to be reduced and the carbohydrate content increased, usually by adding sugar. Milk fat is hard to absorb, particularly by an immature digestive system and it is removed and substituted with vegetable, animal or mineral fats. Vitamins and trace elements are added, but not always in their most easily digestible forms. So, in a crude sense, the formulae could claim to be ‘nutritionally complete’ having the full complement of vitamins and minerals added to a nutritionally inferior product. Many formulae are also highly sweetened, while being advertised as ‘sucrose free’ most contain high levels of other types of sugar.
Formula may also contain unintentional contaminants introduced during the manufacturing process. Some may contain traces of genetically engineered soya and corn. Packaging of infant formula occasionally gives rise to contamination with broken glass and fragments of metal as well as industrial chemicals. Infant formulae may contain excessive levels of toxic or heavy metals, including aluminium, manganese, cadmium and lead. Concentrations of phytoestrogens detected in the blood of infants receiving soya formula can be 13,000 to 22,000 times greater than the concentrations of natural oestrogens. Oestrogen in doses above those normally found in the body can cause cancer.
In China last year over 6,000 babies fell ill, some critically and some died, because the toxic chemical melamine was deliberately added to brands of baby milk to falsify protein levels
Long Chain Polyunsaturated Fatty Acids (LCPUFAs) have been added to many infant formulae for the benefit of eye and brain development. They are derived from algae and designated as DHA and ARA. Although evaluated as not dangerous, the claimed benefits for LCPUFAs were found not to be substantiated when evaluated by independent academic body, the Cochrane Library.
Anaemia is uncommon in the breastfed baby. Although the amount of iron in human milk is small, it is well absorbed-between 20 and 40%, as opposed to the 4 % absorbed from iron-fortified formula. The high lactose and vitamin C levels in breastmilk aid in the absorption of iron. Breastfed babies do not lose iron through their bowels, as do babies fed cows’ milk, which has been found to cause intestinal fissures.
Formula milk companies play on mothers’ fears to exaggerate the problem of iron deficiency to promote iron-fortified formula. A very large proportion of the studies examining the evidence for iron supplementation of babies were industry-funded. Babies on iron-fortified formula get 22 times as much iron as breastfed infants – putting their health at risk. Iron-fortified formula is more expensive than no-iron formula and presumably more profitable.
Many parents care very much these days about feeding their children fresh, healthy options rather than overly processed food but then make assumptions about the nutritional value of formula based on marketing rather than science.
How you feed your baby isn’t just another lifestyle choice like deciding where to live or where to go on holiday. Of course parents should be free to choose how they feed their own babies, but in order for that choice to be a free one, they need first to hear the facts that might influence their decision.
*The Breastfeeding Manifesto www.breastfeedingmanifesto.org.uk is aiming to improve awareness of the health benefits of breastfeeding and its role in reducing health inequalities.
**Protecting breastfeeding - Protecting babies fed on formula Why the UK Government should fulfil its obligation to implement the International Code. Baby Milk Action www.babymilkaction.org
Hard Sell Formula: Strategies used by the baby food industry in the UK Baby Milk Action
Breaking the Rules, Stretching the Rules 2007 IBFAN. Evidence of violations of the International Code of Marketing of Breastmilk Substitutes and subsequent resolutions.
Baumslag, N and Michels, D. L. Milk, Money and Madness: Culture and Politics of Breastfeeding
Palmer, G. The Politics of Breastfeeding (Issues in Women's Health)
Barbara Higham is a breastfeeding counselor and co-edits Breastfeeding Matters, La Leche League GB’s mothers’ magazine. She lives with her partner Simon and three children, Felix (11), Edgar (7) and Amelia (3) in Ilkley, Yorkshire.