Don't listen to Trump, poverty is exactly the situation where breastfeeding may be ideal

Don't listen to Trump, poverty is exactly the situation where breastfeeding may be ideal
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The United States threatened nations in an effort to thwart a World Health Assembly resolution supporting breastfeeding, The New York Times reported Sunday. The next day, the President tweeted that this news was untrue.

While declaring that the United States supports breastfeeding, the President has taken a curious vantage point by stating “…we don't believe women should be denied access to formula.” If he is suggesting that infants are being starved because of policies surrounding infant feeding options, this sounds like a serious crime.

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Truth be told, there has never been a public health concern, in any nation, resulting from an infant being denied formula as is being suggested in the context of marketing regulations. As pediatricians and neonatologists, the crisis we contend with is not a denial of formula. It is a lack of understanding of the remarkable ease by which breastfeeding is derailed in the earliest phase of initiation and, subsequently, the chances of success are terminally interrupted.

 

He also mentions that “many women need this [formula] option because of malnutrition and poverty.” And yet, extreme poverty is exactly the situation where breastfeeding may be ideal. It is relatively inexpensive compared to formula, and safer than mixing powdered formula with contaminated water. In fact, in low-income countries, both breastfeeding success and access to formula exist.

There is no chance to initiate breastfeeding later. There is an element of “now or never.” Support of lactation in the immediate postpartum period is a must for success.

Globally, breastfeeding saves lives. It starts with the most vulnerable infants, such as those we care for in the neonatal intensive care unit, in technologically advanced situations. Mounting evidence shows the direct relationship between the use of breast milk and the strength of protection against morbidity in extremely preterm infants. The more breast milk a preterm infant receives for feedings, the stronger the protection. And these irrefutable benefits extend beyond our unique environment to the global realm and to infants born healthy. While our clinical management focuses on newborns and infants, we are also cognizant of the measured health benefits for breastfeeding women.

cRegardless, commercial formulas support infant growth and development.

There are different reasons infants are fed formula. Some women’s own health circumstances preclude the ability to produce any or sufficient milk. Maternal medical conditions and treatments may shift in favor of formula as the preferred source of feeding. The infant’s own medical condition may require a specialized formula. And quite simply, sometimes it’s a mother’s choice— and sometimes even fathers get to weigh in.

Women feeding their infants formula deserve only our support and guidance on how best to provide nutrition to a child during this early time of rapid growth and development. Ultimately, that’s our job as pediatricians — to support women and families in nourishing their children.

Still, let’s remember the relative ease with which we use formula in the United States. A family can purchase pre-mixed bottles, or they can prepare powdered formula with water that has a negligible risk of causing contamination and then infection in an infant.

This context of convenience likely contributes bias when United States representation enters a global discussion about breastfeeding and access to formula.

Apart from the global perspective, perhaps we can better tend to our own. There are considerable gaps in supporting families who have chosen to breastfeed in the United States. This is attributable, in part, to norms for maternity leave and how we support, or discourage, women in the critical time during which breastfeeding is established.

It is timely to also bring up the existing racial disparities in breastfeeding rates, likely stemming from differences in how mothers are supported. In our clinical work, we implement rigorous efforts to support lactation, whether the context is an infant feeding at the breast or expressed milk.

It takes input and support by every member of the health care team. It is truly intensive, and easily derailed by unclear and misinformed language. Even that expressed by politicians.

To be sure, there has been progress, and there is much to be celebrated in the ongoing success in supporting breastfeeding. Still, one might ask whether United States representatives are best positioned to take such a strong stance on the matter, and why such a reportedly aggressive one.

There is no role or reason for threats when it comes to discussions of feeding options for infants across the world. Fortunately, most of the policy wording remained unchanged. It’s worth remembering that it can take the slightest bit of uncertainty for a mother to forego breastfeeding, and it can take subtle alterations in wording of policy documents to alter chances of success on a global level.

Nana Matoba, MD MPH, is an assistant professor of pediatrics in Northwestern University’s Feinberg School of Medicine, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago. and a Public Voices Fellow through The OpEd Project. Daniel Robinson, MD MSc, is an assistant professor of pediatrics in Northwestern University’s Feinberg School of Medicine, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago.