Among the many effects of the novel coronavirus, the pandemic has truly exposed our nation’s deficiencies; one of them being emergency unpreparedness.
Years ago, Federal Emergency Management Agency (FEMA) called Hurricane Katrina “the single most catastrophic natural disaster in US history.”
In preparation for the storm, the government organized an alternate site for the Super Bowl but failed to employ an infant feeding in emergencies (IFE) plan, Healthy Children Project Executive Director Karin Cadwell reports. In the aftermath of the catastrophe, pets and exotic animals were accounted for, but mothers and infants were separated from one another as hospitals were evacuated.
HCP’s Cindy Turner-Maffei says that the lack of well-developed plans for protecting IYCF during emergencies was one of the most worrisome findings of the U.S. WBTi Assessment.
She explains: “Scores above two points were rare, and most of the points scored regarded funding allocation for emergencies, not for specific inclusion of the needs of infants and young children in emergency plans.”
“Panel members were struck by the fact that few of the states and territories that had recently experienced significant disasters were among those with significant scores for Indicator 9,” Turner-Maffei continues. “Ironically, some states and territories have well-elaborated plans for the care and feeding of household pets in shelters, but none for infants and young children.”
Although there are always crises occurring, since being thrust into a global pandemic, our nation has had to reevaluate how we care for families with babies and young children. Especially in marginalized populations, poverty, health inequities, and other burdens are amplified during an outbreak or other emergency.
Carolina Global Breastfeeding Institute states, “Any crisis presents an opportunity for positive, sustainable change and coordinated involvement of all. #COVID19 taught us that we are all affected and an immediate societal response is required.”
In an effort to increase awareness and preparation, 1,000 Days— a non-profit working to improve nutrition and ensure women and children have the healthiest first 1,000 days–compiled a list of five things we need to know about breastfeeding in emergencies in a 2018 blog post:
1. Breastfeeding is the safest, most nutritious and reliable food source for infants under the age of six months.
2. Breastfeeding decreases the risk of infection and disease, which is vital to survival in emergency settings.
3. Breastfeeding mothers need (even more!) support during emergencies.
4. When breastfeeding is not possible, immediate support is necessary to explore feeding options and protect the health of vulnerable infants.
5. Preparedness is key to ensure babies everywhere have the best opportunity to survive and thrive.
Dr. Savage points out that one of the biggest concerns about breastfeeding counseling during emergent situations is actually getting the counseling to parents. Specifically during the Covid-19 pandemic, Drs. Savage and Salim emphasize that separating mother and baby is not necessary to prevent the spread of the infection from mother to child, and make clear that care providers should follow WHO and UNICEF guidelines.
This week, we honor the very diverse experiences of Indigenous families and “address the inequity and injustice of Indigenous parents and their abilities to practice their roles in accordance to the tribal communities they descend from.” [https://www.facebook.com/NativeBreastfeedingWeek/]
There are so many ways to celebrate, to uplift, to support, and as white lactation care providers and maternal child health advocates, ways to learn, humble ourselves, and do better.
The official Native Breastfeeding Week Facebook page actively includes ways to engage in Native Breastfeeding Week. There are sunrise honor prayers, a Virtual 5K Move, Q&A sessions, platforms for sharing personal accounts, and much more.
“For generations, our families have known that breastfeeding nourishes baby’s mind, body, and spirit, and also reduces the risk of cancer and cancer risk factors for birthing people,” American Indian Cancer Foundation’s Communications Specialist Tina MacDonald, BA (Leech Lake Ojibwe) shares. “During Indigenous Milk Is Medicine, we aim to educate and support Native families across the nation by providing them with culturally-tailored breastfeeding webinars and resources.”
The Indigenous Birth and Breastfeeding Collective of North Dakota will host the Indigenous Breastfeeding Counselor Training in Standing Rock August 26 to 30. The course is taught by Camie Jae Goldhammer, MSW, LICSW, IBCLC (Sisseton-Wahpeton) and Kimberly Moore-Salas, IBCLC (Navajo) and covers topics like historical trauma, the impact of birth on breastfeeding, water rights and its relation to breastfeeding, food sovereignty, maternal mood disorders and much more. The course is open to those who self-identify as Indigenous. Find more information here.
Inform people about the links between breastfeeding and the environment/climate change
Anchor breastfeeding as a climate-smart decision
Engage people and organizations for greater impact
Galvanize action on improving the health of the planet and people through breastfeeding
Can breastfeeding really affect climate change and create a cleaner, healthier environment?
Our planet’s health is closely tied to human health, and so there is a growing interest in learning how to protect the health of the environment.
Among the many things humans can do to protect the environment, breastfeeding is one of the most important. Breastfeeding is the best example of a clean, eco-friendly action to protect and improve the health of planet Earth.
Breastfeeding is the ultimate natural, sustainable resource. It requires no raw materials needed for processing and no energy consumption in production or transportation. It does not produce any material waste or by-products, does not require any packaging materials, water resources or electricity, and creates no pollution of the air or water. Lactation is a perfect partner for environmental health and the ultimate example of “eating local”.
Parents who express their milk and feed from bottles or other methods also provide a more planet-friendly feeding method than artificial feeding. Formula manufacturing requires energy, material and transportation.
The carbon footprint of breastfeeding gives us another glimpse into the environmental impact of breastfeeding. Wikipedia defines carbon footprint as “the total greenhouse gas emissions caused by an individual, event, organization, service, or product, expressed as carbon dioxide equivalent.” In simple terms, it’s a measurement that shows us something’s impact on the health of the environment.
The carbon footprint of breastfeeding is based on the production and transportation of food for the mother based on the RDA of an additional 500 kcal/day recommended during breastfeeding. According to research from the United Kingdom, the carbon footprint of breastfeeding is estimated at 5.9 (this varies between countries).
In comparison, the carbon footprint of formula feeding— which is based on the use of resources, animal and factory production emissions and transportation of the formula as well as supplies, preparation and storage of formula at home— is estimated at 11.0 (again varying between countries). On average, feeding breast milk substitutes had a higher impact on the climate than breastfeeding in all countries studied. This certainly demonstrates the positive impact on the environment when the infant feeding choice is breastfeeding.(Bodkin, 2019 Meade, 2008)
The International Baby Food Action Network (IBFAN) supports optimal infant feeding practices and advocates for universal implementation of the International Code of Marketing of Breastmilk Substitutes, an international health strategy recommending restrictions on the marketing of all formulas and supplies intended to discourage breastfeeding. In 2015 IBFAN developed their statement on breastfeeding and the environment:
“Breastfeeding protects our health and our planet – right from the start, breastfeeding is the first step towards protecting human health, short- and long-term. It is also the first step towards protecting the health of our environment and conserving our planet’s scarce natural resources. We need to start at the beginning, with infants and young children. Our babies and children are in no way responsible for climate change and environmental degradation, but instead they suffer the disastrous consequences.” (IBFAN, 2015)
It’s clear that breastfeeding is the most climate-friendly option for infant feeding, but does the environment have an impact on breastfeeding? The answer is yes.
For decades scientists around the world have studied the impact of environmental contaminants on the mammary gland, and on mothering behaviors. For instance, a study from the Journal of Health Science demonstrated that rats exposed to dietary bisphenol A (BPA) in early pregnancy showed cellular injury to the mammary glands as well as lower prolactin levels. (Miyaura, 2004).
What’s more, Rochester Medical Center studies reported in Science Daily demonstrated damage to rat mammary glands to the extent that some mother rats were unable to nourish their pups after exposure to dioxins. Researchers noted that some rats were able to recover mammary function by late pregnancy. (Lawrence, 2009).
In 2013, a study in the Journal of Neurotoxicology and Teratology showed a decrease in maternal behaviors in Wistar rats (less grooming, protection and nuzzling), a concerning finding but not yet demonstrated in humans. (Boudalia, 2013}.
Studies like these are the basis for ongoing research looking into possible negative impacts on human lactation. The studies are also the basis of much education related to how to create a safer environment while protecting lactation.
An unpublished study from Wright State University looked at mothers with self-described low milk supply and the relationship between environmental contaminants. The 78 mothers in the study were four weeks to eight months postpartum and were all given education on reducing exposures to environmental estrogens (personal care products, food hormones and plasticizers).
Results were seen in one to five weeks and ranged from the mothers stating her “breasts were fuller,” the “babies seemed more satisfied,” and fewer needed supplementation. Some found a doubling of supply (noted with pumping during work hours). Seven had no noticeable increase in milk supply, and of those only two weaned from breastfeeding. The rest continued supplementation. (Walls, presented 2009).
In a Mexican study of young Yaqui tribe women, those who moved from native land to new chemical based agriculture, had less alveolar tissue compared to the young women who remained with the tribe and practiced traditional, non-chemical farming techniques.
Many of the agri-chemical exposed young women were found to have larger than normal breasts, but less glandular tissue (referred to as “empty breast” syndrome) and many were unable to breastfeed their infants which is viewed as an integral part of mothering in their culture. (Hansen, 2010).
On the surface, these studies can seem discouraging until we really weigh the risks and benefits of breastfeeding in a polluted world.
First, human milk contains properties that have been shown to mitigate some negative, environmental effects. (Williams, Florence, NYT)
For instance, human milk contains bio-active components which specifically control and resolve inflammation, promote a thick, healthy gut lining to support an optimum functioning immune system and provide the most nutritious food for optimum general health for infants and children.
Emeritus Director of the Carolina Global Breastfeeding Institute Miriam Labbok, MD, MPH, IBCLC stated “The fact that studies of child [health] outcomes in highly polluted areas are still better for the breastfed infant . . . would seem to indicate that certain factors in the production of human milk and in the milk itself, immunological and other, may mediate the potential harm of the ambient pollution.”
She went on to say, “… No environmental contaminant, except in situations of acute poisoning, has been found to cause more harm to infants than does lack of breast-feeding. I have seen no data that would argue against breastfeeding, even in the presence of today’s levels of environmental toxicants.”
Sandra Steingraber, biologist and author of Living Downstream and Having Faith: An Ecologist’s Journey to Motherhood agrees: ”We haven’t yet compromised breast milk to such an extent that it’s a worse food than infant formula…..”
The American Academy of Family Physicians (AAFP) has also published that certain components of human milk act to increase the infant’s elimination of some toxins and to protect the infant’s developing brain, central nervous system, and body as a whole.
WABA’s statement on breastfeeding and environmental contaminants echoes this sentiment and encourages breastfeeding as the safest feeding choice despite maternal exposure to contaminants.
Their statement reads: “Is the presence of these chemical residues in breastmilk a reason not to breastfeed? No. Exposure before and during pregnancy is a greater risk to the fetus. The existence of chemical residues in breastmilk is not a reason for limiting breastfeeding. In fact, it is a reason to breastfeed because breastmilk contains substances that help the child develop a stronger immune system and gives protection against environmental pollutants and pathogens. Breastfeeding can help limit the damage caused by fetal exposure.” (WABA, 2005.)
The World Health Organization’s (WHO) review on contaminants and human milk states definitively, “The benefits of breastfeeding far outweigh the toxicological disadvantages that are associated with certain POPs” (persistent organic pollutants).
To reiterate, considering the safety of human milk even when contaminants have been detected, neonatal intensive care researcher Fani Anatolitou (2012) states, “the detection of any environmental chemical in breast milk does not necessarily mean that there is a serious health risk for breastfed infants. No adverse effect has been clinically or epidemiologically demonstrated as being associated solely with consumption of human milk containing background levels of environmental chemicals”.
It is important to understand that many of the measurements of POPs in human milk are not clinically meaningful, hence are not a cause for alarm. Even more importantly, as mentioned earlier, a number of components of human milk act to counter potential risks of contaminant exposure (Anitolitou, 2012). The Centers for Disease Control and Prevention (CDC) points out that effects of exposure have only been detected in a breastfeeding infant when the mother was extremely ill.
As lactation care providers we are in a unique position to not only support the optimum health of infants and children, but also be a part of creating a healthier environment for the children to grow and thrive.
American Academy of Family Physicians (AAFP). (2018). Breastfeeding, Family Physicians Supporting (Position Paper). Downloaded 17. Jan. 2018 from https://www.aafp.org/about/policies/all/breastfeeding-support.html
American Academy of Pediatrics (AAP), Section on Breastfeeding. (2012). Breastfeeding and the use of human milk (Policy Statement). Pediatrics 129(3), e827-e841. DOI: 10.1542/peds.2011-3552.
AMERICAN ACADEMY OF PEDIATRICS The Transfer of Drugs and Other Chemicals Into Human Milk Committee on Drugs https://pediatrics.aappublications.org/content/108/3/776/T7
Anadón, A., Martínez-Larrañaga, M. R., Ares, I., Castellano, V., Martínez, M. A. (2017). Drugs and chemical contaminants in human breast milk. In R. C. Gupta (Ed.), Reproductive and Developmental Toxicology (2nd Ed., pp. 67-98). London, UK: Academic Press.
Anatolitou, F. (2012). Human milk benefits and breastfeeding. Journal of Pediatric and Neonatal Individualized Medicine 1(1), 11-18. DOI: 10.7363/010113.
Arnardottir,H. et al. Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology, October 2015 DOI: 10.1038/mi.2015.99
Bodkin, H. Breastfeed to save the planet, scientists say as study exposes infant formula damage to environment https://www.telegraph.co.uk/science/2019/10/02/breastfeed-save-planet-scientists-say-study-exposes-infant-formula/
Boudalia, S. et al. A multi-generational study on low-dose BPA exposure in Wistar rats: Effects on maternal behavior, flavor intake and development. Neurotoxicol Teratol 2013 Nov 20. pii: S08920362(13)00217-1. doi:10.1016/j.ntt.2013
Climate Change and Health June 2015 https://ibfan.org/docs/climate-change-2015-English.pdf
Dadhich, J, Lellamo, A. Report on Carbon Footprints Due to Milk Formula: a Study from Selected Countries of the Asia-Pacific Region
BPNI/IBFAN Asia, New Delhi (2015). http://ibfan.org/docs/Carbon-Footprints-Due-to-Milk-Formula.pdf, Accessed 24th Jan 20
Goldman, A. Anti‐inflammatory Properties of Human Milk. September 1986. https://doi.org/10.1111/j.1651-2227.1986.tb10275.x
Hoffman K, et al. Lactational exposure to polybrominated diphenyl ethers and its relation to social and emotional development among toddlers..Environ Health Perspect. 2012 Oct;120(10):1438-42. doi: 10.1289/ehp.1205100. Epub 2012 Jul 19.PMID: 22814209
Joffe, N. Support for breastfeeding is an environmental imperative. Oct 2, 2019. www.bmj.com › content › bmj
Karlsson, J.O. The carbon footprint of breastmilk substitutes in comparison with breastfeeding. Feb 2019. Journal of Cleaner Production. https://doi.org/10.1016/j.jclepro.2019.03.043
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Murínová, P et al. Partitioning of hexachlorobenzene between human milk and blood lipid..Environ Pollut. 2017 Oct;229:994-999. doi: 10.1016/j.envpol.2017.07.087. Epub 2017 Aug 1.PMID: 28778790
Natural Resources Defense Council. 2005. Healthy Milk, Healthy Baby. Chemical Pollution and Mother’s Milk. New York, NY: National Resources Defense Council. http://www.nrdc.org/breastmilk/chems.asp
Pan IJ, Paediatr Perinat Epidemiol. 2010 May;24(3):262-71Lactational exposure to polychlorinated biphenyls, dichlorodiphenyltrichloroethane, and dichlorodiphenyldichloroethylene and infant growth: an analysis of the Pregnancy, Infection, and Nutrition Babies Study. doi: 10.1111/j.1365-3016.2010.01114.x.PMID: 20415756
Poore and Nemecek, 2018. Reducing food’s environmental impacts through producers and consumers. Science, 360 (6392) (2018), pp. 987-992. https://doi.org/10.1126/science.aaq0216
Stigum H, et al. A novel model to characterize postnatal exposure to lipophilic environmental toxicants and application in the study of hexachlorobenzene and infant growth..Environ Int. 2015 Dec;85:156-62. doi: 10.1016/j.envint.2015.08.011. Epub 2015 Sep 19.PMID: 2639804339
Terri Hansen, Today correspondent. Pesticide exposure deprives Yaqui girls of breastfeeding – ever, Feb 28, 2010. https://www.sej.org/headlines/pesticide-exposure- deprives-yaqui-girls-breastfeeding-ever
Tran CD, Dodder NG, Quintana PJE, Watanabe K, Kim JH, Hovell MF, Chambers CD, Hoh E Organic contaminants in human breast milk identified by non-targeted analysis.Chemosphere. 2020 Jan;238:124677. doi: 10.1016/j.chemosphere.2019.124677. Epub 2019 Aug 26.PMID: 31524616
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Vermeulen, B.M. Campbell, J.S.I. Ingram. Climate change and food systems. Annu. Rev. Environ. Resour., 37 (1) (2012), pp. 195-222
WABA Towards Healthy Environments for Children Q. Frequently asked questions (FAQ) about breastfeeding in a contaminated environment https://www.waba.org.my/whatwedo/environment/pdf/faq2005_eng.pdf
“…In a world as complex and interconnected as the one we live in, the idea that one person has the answer is ludicrous. It’s not only ineffective, it’s dangerous because it leads us to believe that it’s been solved by that hero, and we have no role. We don’t need heroes. We need radical interdependence, which is just another way of saying we need each other.”
In reference to the despicable maternal child health outcomes for birthing and lactating Black Indigenous People of Color (BIPOC), Seals Allers implores us to stop having “this very individualized conversation about what is happening to Black women.”
“There is so much involved,” she says. “There is no single solution, and there never was a single source of the problem.”
It’s a tangle that calls for more than reduction, reusing and recycling.
Through an equity lens, Seals Allers uses Bruce Bekkar’s, MD, et al research to ask questions like “Why are there factories mostly in Black and Brown neighborhoods? Why were Black and Brown people driven to heavily populated urban areas?”
The association between air pollution and heat exposure with preterm birth, low birth weight, and stillbirth in the U.S., demonstrated in Bekkar’s research, is heavily influenced by systemic racism.
Flavelle goes on, “Adrienne Hollis, senior climate justice and health scientist for the Union of Concerned Scientists, said the problems could not be tackled in isolation. ‘We need to look at policies that provide equitable opportunities for communities of color,’ Dr. Hollis said. ‘If you address structural racism, I think you’re going to start getting at some of these issues.’”
Seals Allers echoes: “Stop problematizing Black women; look at the systemic solutions.”
Unsurprisingly, the “solutions” we tend to generate include pouring millions of dollars into synthetic milk instead of investing in breastfeeding and lactating people themselves.
“It’s very disturbing,” Seals Allers comments in her Facebook stream. “The solution is not around empowering women, it’s not about getting women breastfeeding, it’s about finding synthetic solutions. [There’s ] such a disconnect.”
Equally concerning in this case, is that the investment into a proposed solution for poor health outcomes related to not breastfeeding, comes from a climate change investment fund. Human milk is arguably the most sustainable food on our planet; why are sub-optimal, artificial substitutes getting so much funding instead of promoting policies and programs that support direct breastfeeding or pasteurized donor human milk?
The conundrum goes beyond the years of milk feeding onto complementary foods which offer corporations new opportunities to target families with Ultraprocessed Foods (UPF). Like artificial milk substitutes, UPFs pose environmental threats: processing takes natural resources and generates waste. Moreover, UPFs are often heavily marketed in underserved communities, so poor health outcomes continue to be compounded.
Healthy Children Project’s Cindy Turner Maffei recently attended a webinar sponsored by the Breastfeeding Promotion Network of India (BPNI) and the Nutrition Advocacy in Public Interest (NAPI) on UPFs and their relation to obesity, diabetes, and other health dangers.
“Presenters from India, Brazil, and Australia shared insights on the health impacts of UPFs, about the market and social forces at play, and also what we can do to advocate reduction in use of these engineered foods,” Turner-Maffei reports. “Brazil in specific has incorporated decreasing UPFs into their dietary guidelines and restricted use of government funds to purchase these foods for school food programs.”
BPNI has also created a WBW action folder. The document contains information on the carbon footprint of breastmilk substitutes and offers interventions required to support breastfeeding at four levels: policy makers, civil society and breastfeeding advocates, hospitals and doctors and parents.
Nothing is relevant if we don’t have a hospitable planet. Breastfeeding and appropriate, unprocessed complementary feeding are the roots of a healthy ecosystem that all humans benefit from.
“Knowing that in-person support of mothers had been curtailed due to coronavirus, we created the app to put our teaching videos right into the hands of mothers and families worldwide,” a Global Health Media newsletter reads.
The app features 28 videos in 21 languages which can be streamed, downloaded to an offline library, or shared with friends and family. Topics covered include birth, breastfeeding, newborn care, small baby care, and complementary feeding. The app is currently available for Apple iOS phones and soon for Android phones.
The app will continue to be updated with new videos and more languages.
In Fall 2020, we can anticipate the release of Kimberly Seals Allers’ and her team’s app Irth(as in Birth without the ‘B’ for bias), a “Yelp-like” review and rating app for hospitals and physicians made by and for Black women and birthing people of color.
Irth recognizes that implicit bias is a significant barrier to fair treatment for all; specifically contributing to high Black maternal mortality and Black infant mortality rates, a Tara Health Foundation press release points out.
The app will allow users to access identity-based reviews which will empower them with peer-based information for health care decision-making.
The videos feature parents from Guatemala, Malaysia, Sweden and Zimbabwe sharing their perspectives on parenting and breastfeeding during the COVID-19 pandemic.
“The pandemic poses challenges that affect infant feeding both through the lack of support for breastfeeding parents from the healthcare system, workplace and society at large coupled with the exploitation by the breastmilk substitute industry to market their products to vulnerable populations,” WABA’s Thinagaran Letchimanan explains.
Parents’ stories demonstrate challenges and triumphs, commonalities and differences and highlight the overall need for support.
The WABA statement emphasizes that “parents should have access to support from all levels of society to enable a successful breastfeeding journey” and looks forward to World Breastfeeding Week 2020 as an “important opportunity for society to galvanise actions in support of breastfeeding for a healthier planet.”
“There is an ongoing need to advocate for breastfeeding as a public health intervention that saves lives and prevents infections and illness in the population at large especially in the context of COVID-19,” Letchimanan emphasizes. “Essentially we need to create a warm chain of support for breastfeeding that considers the needs of all breastfeeding families. Join us in celebrating WBW2020!”
It’s easy to argue that technology has the potential to disconnect us– eyes cast over glowing screens, swiping, scrolling digits– but the pandemic has offered a new outlook on how to connect meaningfully through technology. Tools like Birth & Beyond, Irth and WABA’s campaigns promote connection and a shared goal to achieve better health outcomes for families, communities and ultimately our planet.
There are of course products to be leary about, such as ‘smart’ diapers embedded with RFID chips that notify caregivers electronically when baby has a wet or dirty diaper. “Convenience” seems valued over connection.
In response to these inventions, Healthy Children Project’s Karin Cadwell PhD, RN, FAAN IBCLC, ANLC replies, snark on point, “This way you don’t have to interact so much. You have the remote to inform you of cries and the diaper to tell you [when] wet. Perfect! The babe can enjoy the $15,000 nursery room and you can watch TV uninterrupted.”
As lactation care providers, we can help families achieve balance by directing them to reputable resources and channeling technology use for connection rather than distraction or detachment.