There's a lack of US leadership on breastfeeding

There's a lack of US leadership on breastfeeding
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In July, the World Health Assembly in Geneva made news when delegates passed a resolution promoting breastfeeding. The controversy wasn’t that the resolution passed (it was expected to, without fanfare), but rather that it almost didn’t due to the energetic efforts of a surprising antagonist.

The U.S. delegation — ignoring all scientific evidence proving the benefits of breastfeeding — pushed for the removal of language asking governments to “promote, support, and protect” breastfeeding

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They also wanted another clause struck that urged policymakers to restrict promotion of food products that global public health officials have identified as having deleterious health effects on infants.

 

The food products are infant formulas, which, when combined with untreated water (as they often are in developing countries), can be deadly. A 2016 study in The Lancet calculates that universal breastfeeding could have saved the lives of more than 823,000 children and 20,000 mothers and resulted in more than $302B in savings in 2012.

Moreover, in the developing world, where mothers can’t afford formula, they try to stretch it through dilution, severely depleting its nutritional value, leading to thousands of additional infant deaths.

News outlets reported how the Americans pressed the breastfeeding resolution sponsor Ecuador to drop it or face trade sanctions and withdrawal of U.S. military aid. When Ecuador folded, more than a dozen African and Latin American nations decided not to introduce the resolution for fear of U.S. retaliation, according to observers from Uruguay, Mexico and the U.S., who spoke to the media. According to The New York Times, U.S. delegates also threatened to cut funding for the World Health Organization (WHO); investing $845 million last year, the U.S. is WHO’s largest donor.

Finally, Russia, an unlikely champion, introduced the resolution. “We feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world,” a Russian official told the Times.

U.S. actions demonstrate a sea change, a shameful lack of leadership in promoting health for all. What happened to the U.S.’s preeminent role as a champion for public health throughout the world?

“What you are seeing here is the collusion of the U.S. government with the infant formula industry,” Rafael Perez-Escamilla, a professor at the Yale School of Public Health, told Vox. Vox wasn’t alone: Nearly all media covering Geneva drew the connection between the U.S. Delegation and representatives present from manufacturers, including Nestlé.

The $70 billion formula industry, dominated by a few American and European companies, has seen sales flatten in wealthy nations as more women embrace breastfeeding. But, sales will rise 4 percent in 2018, according to Euromonitor, mostly in developing countries.

Aggressive and controversial marketing of infant formula by companies like Nestlé is reported to have contributed millions of infant deaths in low- and middle-income countries from 1970 to 2017, according to research published this year by the National Bureau of Economic Research.

On the other hand, the benefits of breastfeeding are well documented. The National Institutes of Health maintains that breastfeeding provides essential nutrition, protection against common childhood infections and better survival during a baby's first year, including a lower risk of Sudden Infant Death Syndrome.

Research also shows that very early skin-to-skin contact and suckling has physical and emotional benefits for infants, as well as for mothers, who may see their maternal sensitivity increase.

Other studies suggest that breastfeeding may reduce risk later in life for allergies, asthma, obesity, and type 2 diabetes. The public health and medical bodies that support breastfeeding include the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, The U.S. Department of Health and Human Services Office of Women's Health, U.S. Surgeon General, and UNICEF.

The World Health Organization (WHO) recommends that infants be breastfed within an hour of birth, exclusively breastfed for their first 4 to 6 months and receive breastmilk for up to two years. A 2015 analysis of mortality data found substantially lower risk of mortality in children who are exclusively breastfed for their first 5 months when compared with children who are partially breastfed or who receive only formula. 

Children’s increased disease risk from lack of breastfeeding is not limited to poor countries. According to the U.S. Surgeon General, full-term infants who do not receive breastmilk have a 100-percent increase in incidence of ear infections; 47 percent in eczema; 178 percent in diarrhea and vomiting; 257 percent in hospitalization for lower respiratory tract diseases in the first year of life; 67 percent in asthma; 32 percent in childhood obesity; 64 percent in type 2 diabetes mellitus; 23 percent in acute lymphocytic leukemia and a 56 percent increase in infant sudden death syndrome, among other health risks.

Among non-breastfeeding mothers, there is a 4 percent increase in incidence of breast cancer and a 27 percent increase in ovarian cancers. Mothers who breastfeed find it easier to lose weight after pregnancy and may have lowered risk for diabetes and several other diseases.

The Geneva resolution is one of several breastfeeding initiatives the administration is fighting, also siding with infant formula interests on international guidelines for “follow-up” formulas marketed for babies older than six months. The administration’s stance — especially in light of the lobbyists surrounding the Geneva meeting — is a shameful retreat from international policy consensus.

It’s a situation that cries out for leadership, which may be coming. A bill supporting the WHO resolution was introduced in July by Rep. Adam SchiffAdam Bennett SchiffHillicon Valley: YouTube disables 200+ accounts over Hong Kong misinformation | Lawmakers sound alarm over Chinese influence efforts | DHS cyber agency details priorities | State AGs get tough on robocalls | DOJ busts online scammers Nadler asks other House chairs to provide records that would help panel in making impeachment decision YouTube disables over 200 accounts amid protests in Hong Kong MORE (D-Calif.) and referred to the Committees on Energy and Commerce and Foreign Affairs.

This bill deserves bipartisan leadership and universal support. Congress can redress the administration’s action on this key international health policy issue. Supporting the bill is essential for the health and life of babies and mothers the world over. It’s on Congress now to unite to do the right thing.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at University of California Los Angeles.