Potential consequences of invoking ‘natural’ in health promotion: Part 1 of 2

Ever since a Pediatrics article and an Evidence Based Birth publication showed up at her desk on the same day, Healthy Children Project’s Cindy Turner-Maffei, MA, ALC, IBCLC has been pondering the relationship between them, and the impact of lessons on how we communicate about biologic functions such as breastfeeding, and also about risk surrounding biology.

The Pediatrics Perspectives article reports on the unintended consequences of claiming breastfeeding is natural. The Evidence Based Birth article describes a rise of exclusively breastfed babies with life-threatening hemorrhagic disease due to avoidance of Vitamin K shots in Tennessee.

“The term natural has a lot of values packed into it,” Turner-Maffei begins. “Also, risk:benefit ratio is a difficult concept to convey in a practical sense.”

Similarly, the authors of the Pediatrics article entitled Unintended Consequences of Invoking the “Natural” in Breastfeeding Promotion write that “‘natural’… lacks a clear definition.”

Perhaps this is why, when I spoke with Turner-Maffei, our conversation took several directions. In part one of two posts, she’s contributed great insight on several abstract ideas that warrant ongoing investigation.

Turner-Maffei reiterates the Pediatrics publication authors’ concern about breastfeeding promotion that praises breastfeeding as the natural way to feed infants because the “messaging plays into a powerful perspective that ‘natural’ approaches to health are better.” The authors claim this promotion may actually be “ethically problematic… and… may ultimately challenge public health’s aims in other contexts, particularly childhood vaccination.”

Manifesting the authors’ concern, Rebecca Dekker’s, PhD, RN, APRN notes that when parents were asked why they had declined Vitamin K, their reasons included: concern about an increased risk for leukemia, a belief that the injection was unnecessary and “unnatural,” and a fear that their infant would be exposed to toxins in the shot.

Surely, our bodies and our planet can benefit from lifestyles with less harmful toxins; still, just because something is “natural” doesn’t make it intrinsically good for you.

“Rattlesnakes are natural, but you don’t want to step on one,” Turner-Maffei points out.  “I’d rather step on a plastic bottle than a rattlesnake any day.”

When it comes to maternal child health advocacy it’s sometimes easier to be a purist, touting a Breast is Best message.

“But it’s not that kind of world,” Turner-Maffei says.

She admits that she’s “done the purist thing,” once believing that moms who choose not to breastfeed weren’t doing what’s best for their children. She’s since changed her viewpoint.

“It’s too rigid, too unfair, not a justifiable position,” she explains. “Parents make infant feeding decisions based on their own unique situations; it’s no one’s right to judge them on the basis of infant feeding choice.”

Instead, we need to “look at our own mythology around lactation,” Turner-Maffei advises.

Not long ago, many in the lactation community fought back against Vitamin D recommendations for the exclusively breastfed infant, for instance.

“We tend to resist news that implies that breastmilk doesn’t have everything a baby needs,” she comments. “Most of the time [breastmilk] is great, but it can’t help with Vitamin K and most of the time, not Vitamin D.”

Interestingly, Dekker poses this question: “If all infants are born with low Vitamin K levels, is it really a deficiency or is this the natural design of human beings?” She includes three theories including a survival of the fittest scenario, the potential that an infant’s clotting system needs time to mature, and the potential that there is an unknown reason that leads to low Vitamin K transmission from mom to baby.

Dekker adds, “You could also make the argument that it doesn’t really matter why babies are born with low levels. The point is that they are born with low levels of Vitamin K, and that some babies will die from Vitamin K deficiency bleeding if they do not receive supplemental Vitamin K at the beginning of life. Most will not bleed. But some will, and some will experience brain injury or death. And these injuries and deaths are 100% preventable.”

Stay tuned next week for discussion on cognitive processes and flexibility. In the meantime we wonder, what other “natural” things can you think of that might not necessarily be healthy or beneficial?

Miracle Milk™ campaign shares power of human milk through storytelling

It’s Miracle Milk™ May! This year, Best for Babes’ (BfB) Miracle Milk™ campaign is bringing it back to the basics with a grassroots effort to share the power of Miracle Milk™ through storytelling. Throughout the month, Best for Babes encourages us to talk about the power of human milk and breastfeeding in our communities as well as digitally through social media.

In years past, Best for Babes hosted the Miracle Milk® Stroll, the only national consumer-driven nonprofit for the human milk cause. In the midst of a transition searching for an Executive Director, the organization has modified its campaign format.

Best for Babes’ media specialist Kelly Doherty and manager of the 2017 campaign points out that some very committed Stroll organizers from years past are still hosting Strolls in their communities.

Dover, Delaware 2016 Miracle Milk Stroll
Credit: Katie Phillips Photography [https://www.facebook.com/KatieTPhillipsPhotography/]
As part of the digital campaign, you’ll find memes on Best for Babes’ Facebook page posing specific questions about breastfeeding like “What is the best piece of advice you have for a nursing mom?” and “What don’t you know about donating human milk?”

Doherty says that reaching out to potential milk donors is just as important as getting Miracle Milk™ to babies in need.

“If you’re a person who had great milk production and an easy nursing relationship, you don’t even realize what you could be providing to babies in need,” she says.

Prompting conversations about human milk is the first step in an effort to make donor human milk and the Human Milk Banking Association of North America (HMBANA) as mainstream as formula companies. Best for Babes co-hosted Public Citizen’s 2017 Day of Action to Protect Parents and Babies in an effort to promote commercial-free infant feeding information.

Best for Babes is an organization dedicated to diverse family experiences and supports safe infant feeding methods. Join the cause. Join the conversation!

Health over profits

“The only legitimate way to prevent commercial influence is to refuse commercial funding.” — Kathleen C Parry, Catherine Sullivan, Alison M Stuebe; Health professional associations and industry funding—reply from Parry et al

It was almost a year ago that I wrote about my ethical conundrum over ice cream and how it relates to infant feeding. It led me to become involved with Public Citizen’s Commercial Alert’s 2016 WHO Code Day of Action. This year on May 18, Public Citizen’s Commercial Alert is teaming up with  Reaching Our Sisters Everywhere, 1,000 Days, and Best for Babes to host a Day of Action to Protect Parents and Babies.

Health Over Profits

Because families deserve access to commercial-free infant feeding information so that they can make informed decisions, the organizations are asking us to take action.

Here are their suggestions on how to take part:

  1. Take photos or videos holding a homemade sign. “Protect Parents and Babies – Keep Marketing out of Healthcare Facilities,” “Infant Health over Corporate Wealth!” or

“Follow the Code” are suggestions. Include your kids and show it if you’re expecting!

  1. Post your photos on the event page.

(By posting photos to this page, you agree to let us publish elsewhere, including company’s pages).

  1. Post photos/videos/personal messages to the pages of Code violators:

Similac US (Abbott’s brand)

Enfamil (Mead Johnson’s brand)

Nestlé (owner of Gerber Good Start)

The Honest Company

Where to share:

Facebook, Instagram and Twitter

We will share your event page posts to the company pages throughout the day.

Last year, activists shared over 100 photos as part of the event.

WHO, UNICEF and IBFAN also presented the first joint global report on the status of the Code in 194 countries last year. The report presents the legal status of the Code, including to what extent Code provisions have been incorporated in national legal measures, and provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Find it here.

As the IBFAN organization responsible for monitoring the Code in the U.S., the National Alliance for Breastfeeding Advocacy (NABA) is calling on us to help in reporting incidences of Code violations. Help with Code monitoring here.

The Breastfeeding Promotion Network of India (BPNI) enacted The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act (IMS) in 1992 which includes several clauses regarding the promotion of milk substitutes, sponsorship, labeling, etc. Non-compliance is a criminal offense. This organization’s accomplishments battling predatory marketing of infant formula companies are something to aspire to!

If you’re looking for Code- compliant companies to support, Best for Babes established The C.A.R.E. Code Alliance which awards companies for upholding the Code.

The World Health Organization recently released The International Code of Marketing of Breast-Milk Substitutes – 2017 Update: Frequently asked questions. USBC points out that the purpose of this booklet is to provide easy-to-read detailed information on specific questions related to the Code, including what products are covered by the Code, infant formula labeling, and information about implementation and monitoring. It is intended for policy-makers, health workers and others concerned with the Code, as well as the general public.

Public Citizen created a petition telling infant formula makers to stop using hospitals as marketing tools. Sign it here. Last year, I wrote to pediatric clinics in my area suggesting they adopt breastfeeding-friendly policies.

This year, I’m writing to one of my favorite television networks after I noticed sponsorship from a formula company.  I’ve included it below should you have any interest in using it as a template for your own letter-sending.

May 3, 2017

Public Broadcasting Service

2100 Crystal Drive

Arlington, VA 22202

To Whom it may concern:

I am writing to express my concern with your sponsorship from Enfamil. Accepting funding from a company that preys on the health of mothers and babies interferes with the quality of your programming and dilutes the integrity of your network.

Please allow me to inform you about the predatory marketing of formula companies like Enfamil and its detrimental effects.

Formula companies have a knack for undermining women’s efforts to breastfeed (1), a behavior essential to public health (2). For decades, [formula] “companies raked in profits, and babies died in droves (3),” until international outrage led the World Health Organization to pass the International Code of Marketing of Breast-Milk Substitutes in 1981 to regulate predatory marketing tactics by infant formula companies (4). Still, the United States is one of very few countries to uphold the Code (5).

Highly regarded health organizations like the American College of Obstetricians and Gynecologists (ACOG) state that families should receive noncommercial, accurate and unbiased information to make informed decisions about how to feed their infants and children (6). 

By running Enfamil’s advertisements, specifically their Enfagrow follow-on formula, you are feeding corporate greed (7) while simultaneously allowing them to heavily influence and encourage families to purchase products that offer no additional value to a balanced diet (8).

Surely a generation of PBS viewers fed on what is essentially powdered bovine hormonal secretion and corn syrup solids won’t enjoy a healthy future. With young children of my own who are delighted by your programming on PBS Kids, I am deeply disappointed to see funding by such a heinous company and hope you’ll consider cutting ties with their mission.

Jess Fedenia

(1)  Seals Allers, Kimberly . The Big Let Down . New York : St. Martin’s Press, 2017.

(2)  “A Call to Action on Breastfeeding: A Fundamental Public Health Issue.” American Public Health Association . 06 Nov. 2007. <https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/29/13/23/a-call-to-action-on-breastfeeding-a-fundamental-public-health-issue>.

(3)  Solomon, Stephen. “THE CONTROVERSY OVER INFANT FORMULA.” The New York Times . 6 Dec. 1981. <http://www.nytimes.com/1981/12/06/magazine/the-controversy-over-infant-formula.html?pagewanted=all>.

(4)   Stuebe, Alison, MD, MSc. ” Physicians blogging about breastfeeding It’s time to disarm the formula industry.” Breastfeeding Medicine . 20 May 2016. <https://bfmed.wordpress.com/2016/05/20/its-time-to-disarm-the-formula-industry/>.

(5) “Marketing of Breast-milk Substitutes: National Implementation of the International Code Status Report 2016.” World Health Organization .<http://apps.who.int/iris/bitstream/10665/206009/1/WHO_NMH_NHD_16.1_eng.pdf>.

(6)  Optimizing support for breastfeeding as part of obstetric practice. Committee Opinion No. 658. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016;127:e86–92.

(7) Baumslag, Naomi, MD,MPH. “Tricks of the Infant Food Industry.” World Alliance for Breastfeeding Action .<http://waba.org.my/news/tricks.htm>.

(8) “’Growing-up’ formula: No additional value to a balanced diet, says EFSA.” European Food Safety Authority. 25 Oct. 2013. <http://www.efsa.europa.eu/en/press/news/131025>.

March for Moms on Mother’s Day

It was a former Our Milky Way interviewee who really got me thinking about how maternal child health affects us all. In response to how he became interested in the field he said, “I first became interested when I was born, I suppose, as are most infants.” An obvious, perfectly sensical response. Maternal health affects every single one of us.

Tragically, the United States suffers the highest maternal mortality rate of all industrialized countries. Women of color die at four times the rate of white women.

This Mother’s Day, March for Moms will host its first rally to shed light on the dismal state of maternal health in our nation. The peaceful rally takes place in Washington D.C. at the Jefferson Memorial from 1 to 4 p.m. on Sunday, May 14.

“March for Moms is nonpartisan and does not represent interests of any singular professional group, entity, or association,” as stated on Lamaze International for Parents. “They represent consumers and health providers to voice a shared platform, demanding national dialogue to improve care for mothers and babies.”

The event is family-friendly and will include professional kite flyers, children’s activity tables and breastfeeding and diaper changing tents. An impressive list of speakers will present at the gathering including Chanel Porchia-Albert, CD, CLC, Founder of Ancient Song Doula Services (ASDS) and MFM Advisor.

My speech will address the impact of the infant and maternal mortality on African American women and families living within the United States,” Porchia-Albert writes on the ASDS Facebook page. “This speech means even more as the infant and maternal mortality extends beyond just birth outcomes but speaks to the many young men such as Jordan Edwards, Tamir Rice, and so many countless African American women, men and children.”

March for Moms explains the rise of our maternal mortality rate and poor health outcomes through these key issues:

  • Perinatal depression
  • Healthcare inequities and disparities
  • Premature birth
  • Maternity and family leave policies
  • Lack of access to healthcare

Before and after the Mother’s Day Rally, March for Moms will lobby at the Hill and Senate for the importance of increased focus and funding for maternal health issues. Volunteers are needed. Sign up here. View active and passed legislation pertaining to maternal health here.

Find more event details here. You can also watch this video.

If you cannot attend the rally, you can still join the crusade and advocate virtually at the March for Moms Thunderclap.

The Milk Mob optimizes infant feeding support in the outpatient sector

We have heaps and heaps of evidence to show the importance of human milk, breastfeeding and support for breastfeeding families yet, the United States lags pitifully behind in providing proper support to ensure the mother-baby dyad can breastfeed successfully. Bringing light to this deficit, Anne Eglash, MD, IBCLC, FABM, founder of the non-profit The Milk Mob, poses this question: Can you identify any other health behavior besides breastfeeding that the majority of mothers and babies are engaged in for which medical professionals are not educated?

In the U.S., an impressive 80 percent of mother-baby dyads leave the hospital breastfeeding; still, very few outpatient medical care providers and staff are equipped with evidence-based education and training that support healthy infant feeding.

When medical care providers lack the tools to support breastfeeding, families often seek lactation care outside of their pediatrician, OB or family physician which “…places the United States population at risk for racial and ethnic disparity in breastfeeding support since families with more resources will have a greater chance of accessing lactation care in their communities.” [https://themilkmob.org/breastfeeding-friendly-medical-systems/]

Dr. Eglash founded The Milk Mob in 2014 with the mission to optimize support for breastfeeding families in the outpatient sector by building Breastfeeding Friendly Medical Systems and Communities through education and collaboration.

Training breastfeeding champions

The organization offers the Outpatient Breastfeeding Champion Training, a basic, clinically-focused, 16 hour course for medical or community breastfeeding supporters. To date, the organization has trained about 1,000 Breastfeeding Champions.

Dr. Eglash has found that staff working in the front lines have great interest in learning the skills to help breastfeeding dyads.

The Milk Mob is currently working to train WIC staff as Breastfeeding Champions in five Midwest states. In an effort to disseminate the training, the Outpatient Breastfeeding Champion Training functions with an Instruct the Instructor model. Participants complete the initial training, then complete an instructor’s course, so that they are equipped to teach small groups in their own communities. This approach cultivates culturally-appropriate and relevant instruction.

Through The Milk Mob, Dr. Eglash provides a variety of continuing education including The Breastfeeding Medicine Podcast, The Clinical Question of the Week, and breastfeeding handouts so Champions can stay up to date with current policies and new research. Dr. Eglash says that the outpatient breastfeeding program has been a stepping stone to The Lactation Counselor Training Course for many of its participants.

Educating providers

The Milk Mob offers separate breastfeeding education modules for healthcare providers: a one- day primary care breastfeeding medicine basics training and a three-day advanced breastfeeding medicine training.

Interestingly, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetrics and Gynecology (ACOG) all have formal statements advising breastfeeding education during specialty training.

“But the staff of the medical schools and residencies don’t have the education to provide the comprehensive education,” Dr. Eglash explains.

A host of problems succeeds. For one, when a medical student or resident learns about lactation and breastfeeding support from someone other than a physician, the education is out of context; that is, they do not learn how to incorporate breastfeeding support into their care, Dr. Eglash explains. With this approach, students and residents get the illusion that lactation is not something they need to learn, she continues. Further, lactation professionals and physicians have different scopes of practice.

When physicians do provide lactation training, the education reflects what they’ve learned about breastfeeding: the information is often inaccurate and the message about the importance of breastfeeding is diluted.

“[Students] are learning from someone who may not value breastfeeding because that instructor was never showed the value of breastfeeding,” Dr. Eglash adds.

Fortunately, as a clinical professor, Dr. Eglash witnesses residents’ enthusiasm to learn about breastfeeding. Many of them are having children of their own and are influenced by their own birth and breastfeeding experiences. At this pivotal point, Dr. Eglash says that the future will depend on making sure we have the means to educate medical students and residents, so that when they begin to practice, they will be able to “hit the ground running.”

The Milk Mob recently released the 6th edition of The Little Green Book of Breastfeeding Management for Physicians and Other Healthcare Providers, a pocket-sized reference manual for the most commonly asked questions that breastfeeding families have throughout the course of lactation.

Encouraging community collaboration

The mother-baby dyad requires support prenatally, immediately postpartum, in the outpatient sector and as they integrate into the community as a new couplet. Establishing a continuum of breastfeeding support throughout this journey is another component of the Breastfeeding Friendly Medical System.

A unique example is that of the collaboration between the Aurora WIC program in Milwaukee, Wis. and Aurora Sinai Medical Center. In fact, the WIC office is housed inside of the hospital. This setup facilitates daily communication and consistent messaging between staff and accessibility for families.

Facilitating conversations

The Milk Mob will host its first Art & Science of Breastfeeding Conference on May 12, 2017.

The conference attempts to connect bench scientists and clinicians, coupling “both the art of infant feeding with new and emerging scientific explanations of clinical phenomena that we observe when working with breastfeeding dyads.” [https://themilkmob.org/art-science-2017/]  

“If we could start having more conversations between the bench and clinical science folks, we will move along further in what we are doing,” Dr. Eglash says.

Visit The Milk Mob here.

Register for the conference here.