Breastmilk vs 'formula' food
Pat Thomas1st April 2006
Humans have been breastfeeding for nearly half a million years. It’s only in the last 60 years that we have begun to give babies highly processed convenience food called ‘formula’. Pat Thomas investigatesThe health consequences - twice the risk of dying in the first six weeks of life, five times the risk of gastroenteritis, twice the risk of developing eczema and diabetes and up to eight times the risk of developing lymphatic cancer – are staggering. With UK formula manufacturers spending around £20 per babyWomen do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.
promoting this ‘baby junk food’, compared to the paltry 14 pence per baby the government spends promoting breastfeeding, can we ever hope to reverse the trend?
All mammals produce milk for their young, and the human species has been nurturing its babies at the breast for at least 400,000 years. For centuries, when a woman could not feed her baby herself, another lactating woman, or ‘wet nurse’, took over the job. It is only in the last 60 years or so that we have largely abandoned our mammalian instincts and, instead, embraced a bottlefeeding culture that not only encourages mothers to give their babies highly processed infant formulas from birth, but also to believe that these breastmilk substitutes are as good as, if not better than, the real thing.
Infant formulas were never intended to be consumed on the widespread basis that they are today. They were conceived in the late 1800s as a means of providing necessary sustenance for foundlings and orphans who would otherwise have starved. In this narrow context – where no other food was available – formula was a lifesaver....
...Many formulas are also highly sweetened. While most infant formulas do not contain sugar in the form of sucrose, they can contain high levels of other types of sugar such as lactose (milk sugar), fructose (fruit sugar), glucose (also known as dextrose, a simple sugar found in plants) and maltodextrose (malt sugar). Because of a loophole in the law, these can still be advertised as ‘sucrose free’.
Formula may also contain unintentional contaminants introduced during the manufacturing process. Some may contain traces of genetically engineered soya and corn.
The bacteria Salmonella and aflatoxins – potent toxic, carcinogenic, mutagenic, immunosuppressive agents produced by species of the fungus Aspergillus – have regularly been detected in commercial formulas, as has Enterobacter sakazakii, a devastating foodborne pathogen that can cause sepsis (overwhelming bacterial infection in the bloodstream), meningitis (inflammation of the lining of the brain) and necrotising enterocolitis (severe infection and inflammation of the small intestine and colon) in newborn infants.
The packaging of infant formulas occasionally gives rise to contamination with broken glass and fragments of metal as well as industrial chemicals such as phthalates and bisphenol A (both carcinogens) and, most recently, the packaging constituent isopropyl thioxanthone (ITX; another suspected carcinogen). Infant formulas may also contain excessive levels of toxic or heavy metals, including aluminium, manganese, cadmium and lead.
Soya formulas are of particular concern due to the very high levels of plant-derived oestrogens (phytoestrogens) they contain. In fact, 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.
For years, it was believed that the risks of illness and death from bottlefeeding were largely confined to children in developing countries, where the clean water necessary to make up formula is sometimes scarce and where poverty-stricken mothers may feel obliged to dilute formula to make it stretch further, thus risking waterborne illnesses such as diarrhoea and cholera as well as malnutrition in their babies. But newer data from the West clearly show that babies in otherwise affluent societies are also falling ill and dying due to an early diet of infant convenience food.
Because it is not nutritionally complete, because it does not contain the immune-boosting properties of breastmilk and because it is being consumed by growing babies with vast, ever-changing nutritional needs – and not meeting those needs – the health effects of sucking down formula day after day early in life can be devastating in both the short and long term.
Bottlefed babies are twice as likely to die from any cause in the first six weeks of life. In particular, bottlefeeding raises the risks of SIDS (sudden infant death syndrome) by two to five times. Bottlefed babies are also at a significantly higher risk of ending up in hospital with a range of infections. They are, for instance, five times more likely to be admitted to hospital suffering from gastroenteritus.
Even in developed countries, bottlefed babies have rates of diarrhoea twice as high as breastfed ones. They are twice as likely (20 per cent vs 10 per cent) to suffer from otitis media (inner-ear infection), twice as likely to develop eczema or a wheeze if there is a family history of atopic disease, and five times more likely to develop urinary tract infections.
In the first six months of life, bottlefed babies are six to 10 times more likely to develop necrotising enterocolitis – a serious infection of the intestine, with intestinal tissue death – a figure that increases to 30 times the risk after that time.
Even more serious diseases are also linked with bottlefeeding. Comparedwith infants who are fully breastfed even for only three to four months, a baby drinking artificial milk is twice as likely to develop juvenile-onset insulin-dependent (type 1) diabetes. There is also a five- to eightfold risk of developing lymphomas in children under 15 who were formulafed, or breastfed for less than six months.
In later life, studies have shown that bottlefed babies have a greater tendency towards developing conditions such as childhood inflammatory bowel disease, multiple sclerosis, dental malocclusion, coronary heart disease, diabetes, hyperactivity, autoimmune thyroid disease and coeliac disease.
For all of these reasons, formula cannot be considered even ‘second best’ compared with breastmilk. Officially, the World Health Organization (WHO) designates formula milk as the last choice in infant-feeding: Its first choice is breastmilk from the mother; second choice is the mother’s own milk given via cup or bottle; third choice is breastmilk from a milk bank or wet nurse and, finally, in fourth place, formula milk...
The same young doctors, nurses and midwives who were pioneering this medical model of reproduction are now running today’s health services. So, perhaps not surprisingly, modern hospitals are, at heart, little different from their predecessors. They may have TVs and CD players, and prettier wallpaper, and the drugs may be more sophisticated, but the basic goals and principles of medicalised birth have changed very little in the last 40 years – and the effect on breastfeeding is still as devastating.
In many cases, the healthcare providers’ views on infant-feeding are based on their own, highly personal experiences. Surveys show, for instance, that the most important factor influencing the effectiveness and accuracy of a doctor’s breastfeeding advice is whether the doctor herself, or the doctor’s wife, had breastfed her children. Likewise, a midwife, nurse or health visitor formula-fed her own children is unlikely to be an effective advocate for breastfeeding.
More worrying, these professionals can end up perpetuating damaging myths about breastfeeding that facilitate its failure. In some hospitals, women are still advised to limit the amount of time, at first, that a baby sucks on each breast, to ‘toughen up’ their nipples. Or they are told their babies get all the milk they ‘need’ in the first 10 minutes and sucking after this time is unnecessary. Some are still told to stick to four-hour feeding schedules. Figures from the UK’s Office of National Statistics show that we are still topping babies up. In 2002, nearly 30 per cent of babies in UK hospitals were given supplemental bottles by hospital staff, and nearly 20 per cent of all babies were separated from their mothers at some point while in hospital.
Continued inappropriate advice from medical professionals is one reason why, in 1991, UNICEF started the Baby Friendly Hospital Initiative (BFHI) – a certification system for hospitals meeting certain criteria known to promote successful breastfeeding. These criteria include: training all healthcare staff on how to facilitate breastfeeding; helping mothers start breastfeeding within one hour of birth; giving newborn infants no food or drink other than breastmilk, unless medically indicated; and the hospital not accepting free or heavily discounted formula and supplies. In principle, it is an important step in the
promotion of breastfeeding, and studies show that women who give birth in Baby Friendly hospitals do breastfeed for longer.
In Scotland, for example, where around 50 per cent of hospitals are rated Baby Friendly, breastfeeding initiation rates have increased dramatically in recent years. In Cuba, where 49 of the country’s 56 hospitals and maternity facilities are Baby Friendly, the rate of exclusive breastfeeding at four months almost tripled in six years – from 25 per cent in 1990 to 72 per cent in 1996. Similar increases have been found in Bangladesh, Brazil and China....
Not good enough
After more than two decades, it is clear that a half-hearted advocacy of breastfeeding benefits multinational formula manufacturers, not mothers and babies, and that the baby-food industry has no intention of complying with UN recommendations on infant-feeding or with the principles of the International Code for Marketing of Breastmilk Substitutes – unless they are forced to do so by law or consumer pressure or, more effectively, both.
Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.
Without support, many women will give up when they encounter even small difficulties. And yet, according to Mary Renfrew, ‘Giving up breastfeeding is not something that women do lightly. They don’t just stop breastfeeding and walk away from it. Many of them fight very hard to continue it and they fight with no support. These women are fighting society – a society that is not just bottle-friendly, but is deeply breastfeeding-unfriendly.’
To reverse this trend, governments all over the world must begin to take seriously the responsibility of ensuring the good health of future generations. To do this requires deep and profound social change. We must stop harassing mothers with simplistic ‘breast is best’ messages and put time, energy and money into re-educating health professionals and society at large.
We must also stop making compromises. Government health policies such as, say, in the UK and US, which aim for 75 per cent of women to be breastfeeding on hospital discharge, are little more than paying lip service to the importance of breastfeeding.
Most of these women will stop breastfeeding within a few weeks, and such policies benefit no one except the formula manufacturers, who will start making money the moment breastfeeding stops.
To get all mothers breastfeeding, we must be prepared to:
- Ban all advertising of formula including follow-on milks
- Ban all free samples of formula, even those given for educational or study purposes
- Require truthful and prominent health warnings on all tins and cartons of infant formula
- Put substantial funding into promoting breastfeeding in every community, especially among the socially disadvantaged, with a view to achieving 100-per-cent exclusive breastfeeding for the first six months of life
- Fund advertising and education campaigns that target fathers, mother sin-law, schoolchildren, doctors, midwives and the general public
- Give women who wish to breastfeed in public the necessary encouragement and approval
- Make provisions for all women who are in employment to take at least six months paid leave after birth, without fear of losing their jobs.
Such strategies have already proven their worth elsewhere. In 1970, breastfeeding rates in Scandinavia were as low as those in Britain. Then, one by one, the Scandinavian countries banned all advertising of artificial formula milk, offered a year’s maternity leave with 80 per cent of pay and, on the mother’s return to work, an hour’s breastfeeding break every day. Today, 98 per cent of Scandinavian women initiate breastfeeding, and 94 per cent are still breastfeeding at one month, 81 per cent at two months, 69 per cent at four months and 42 per cent at six months. These rates, albeit still not optimal, are nevertheless the highest in the world, and the result of a concerted, multifaceted approach to promoting breastfeeding.
Given all that we know of the benefits of breastfeeding and the dangers of formula milk, it is simply not acceptable that we have allowed breastfeeding rates in the UK and elsewhere in the world to decline so disastrously.
The goal is clear – 100 per cent of mothers should be exclusively breastfeeding for at least the first six months of their babies’ lives.
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