Breastfeeding is collaborative.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is collaborative.

A breastfeeding dyad is a beautiful, fascinating, complex organism. Mother and bab(ies) attend and respond to one another facilitating nourishment, the flow of hormones, immunity, learning and bonding, comfort, fun, an all-encompassing sensory experience that has generational impacts on social, emotional and physical health.

Photo by Luiza Braun

In this intimate depiction of a breastfeeding dyad, a world of collaborative intricacies occur: the undulation of baby’s tongue to help with milk removal, the contraction of myoepithelial cells thanks to oxytocin elicited by baby, the removal of milk to signal mother’s body to produce more, to name a few.

It’s clear that breastfeeding is so much more than “the healthiest feeding choice” nutritionally speaking. Take the following anecdotes for example.

Nikki Lee offers her commentary to this case report on infant botulism in an exclusively breastfed baby explaining how interactive feeding can save a baby’s life.

https://unsplash.com/@luizabraun

“One doesn’t have to ingest honey to contract botulism. Exclusively breastfed babies can get botulism. Some parts of the continental US have c.botulinum in the soil; construction stirs up the soil, and the germ floats in the air. The breastfeeding mother is the one to notice that the baby’s suck isn’t as strong. This is a reason that breastfed babies survive botulism, because they get diagnosed and treated sooner than bottle-fed babies.”

In this case, breastfeeding offered early detection of breast cancer in the mother because of her baby’s refusal to nurse from one side. This phenomenon is known as Goldsmith’s Sign.

To demonstrate the importance of  the relationship that breastfeeding affords, we might consider the implications of separation. Lee again offers insight on the implications of mother baby separation in this piece.

Zooming out to view breastfeeding less individualistically and instead as a global food security system, we must recognize the collaboration necessary to support the breastfeeding dyad and abandon the idea that breastfeeding is a solitary act, a “one-woman job”.

https://unsplash.com/@luizabraun

In Breastfeeding as a ‘Resilient’ Food Security System: Celebrating…. And Problematizing Women’s Resilience in the face of chronic deprivation as well as emergencies, Dr. Vandana Prasad, MBBS, MRCP (Ped) UK, MPH describes breastfeeding as “wholly community-based”. Dr. Prasad continues that breastfeeding is potentially universally accessible and sustainable because it  “depends wholly upon the status of time, energy, health, nutrition and general availability of women”. This achievement, breastfeeding as definitely universally accessible and sustainable,  would require collaborative efforts by “governments, decision-makers, development partners, professional bodies, academia, media, advocates, and other stakeholders” working together, as Dr. Tedros Adhanom Ghebreyesus writes.

In the U.S., WIC has created an interactive resource “to help reinforce the important role that family and friends play in supporting breastfeeding moms.” The resource invites WIC staff to “click through the prompts with parents, grandparents, and others discussing when and how to offer helpful support so that mom and baby continue to thrive.”

At an organizational level, the United States Breastfeeding Committee (USBC) uses a collective impact approach to manage multi-sectoral collaborations, working to protect, promote, and support breastfeeding and human milk feeding.

Source: United States Breastfeeding Committee.

Internationally, the Global Breastfeeding Collective calls on donors, policy makers and civil society to increase investment in breastfeeding worldwide.

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As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: Who is your s/hero in the field of maternal child health?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

Enhancing national network of nonprofit donor milk banks and diversifying nation’s production of infant formula to secure infant nutrition in U.S.

The Infant Feeding Action Coalition USA, Inc. (IN.FACT.USA) has put together a piece detailing the global recall of contaminated Abbott powdered formulas.

In February 2022, the largest U.S. infant formula manufacturer recalled three brands of its powdered formula and one breastmilk fortifier and shut down its main manufacturing facility in Sturgis, Michigan following reports of Cronobacter infections in infants who had consumed formula manufactured at the Sturgis plant. It’s noteworthy that the initial recalls were voluntary–not required by the US Food and Drug Administration (FDA)— and they only came after nine babies died between September 2021 and January 2022 from infections.

Let’s focus on that, the death of these babies, Tameka L. Jackson-Dyer, BASc, IBCLC, CHW  urges in her Great Lakes Breastfeeding webinar Feed the Baby: Lactation, Contamination, and the American Formula Crisis.

One infant death is one too many. Initially, two deaths were reported; however, Freedom of Information requests and whistleblower action revealed that not only two, but another seven infants in the U.S. were reported to have died after consuming powdered infant formula manufactured at the Abbott factory.

“During the same period, 25 severe infections categorized as ‘Life Threatening Illness/Injury’ and 80 instances of ‘Non-Life Threatening Illness/Injury’ were reported among infants who were fed these formulas,” The Abbott Powdered Formula Scandal also points out.

“Until Cronobacter infections require mandatory notification, the number of cases of illness or deaths will never be known. Neither will their extent in the 37 countries which imported the potentially contaminated Abbott formula.”

In The Four Pillars of Infant Nutrition Security in the United States, author Amelia Psmythe Seger points out that  “The U.S. has not regulated the marketing practices of the commercial milk formula industry, unlike 70% of the world, which has implemented at least some part of the WHO’s International Code of Marketing of Breast-Milk Substitutes. In the absence of regulation, these marketing practices are predatory.”

Psmythe Seger goes on to urge, “Diversify the nation’s production of infant formula. Plainly it is a mistake to allow 42% of the infant formula in this country to be produced not only by one company but by one factory of that company. Infant formula companies are part of an infant food security system, but we don’t have to be so dependent on that industry.”

[For more on commercial influence, you can watch USBC’s series of Unpacking Commercial Milk Formula Marketing Webinar Recordings]

A history of breastmilk substitutes laid out by Jackson-Dyer reminds us that before the advent of commercial infant formulas,  wet nursing was the original supplemental feeding.

Considering the infant feeding landscape today, Jackson-Dyer quotes Michigan Breastfeeding Network Executive Director Shannon McKenney Shubert, MPH, CLC: “In my 12-year career in the field of human milk feeding, I have never once met a birthing parent who ‘chose not to breastfeed.’ In this country, whether to breastfeed is not a choice. In this country, whether to breastfeed is a question of ‘Within all the systems of oppression that I navigate, what is the best combination of things I can do to ensure the survival of my baby, myself and the rest of my family?’”

With this context in mind, Jackson-Dyer confronts the idea that yes, babies must be fed, but fed is not best; instead, it is required, she says in her webinar.

“It is the absolute minimum to sustain life,” she reminds us. “We can’t just feed the baby anything.”

Again in The Four Pillars of Infant Nutrition Security in the United States, Psmythe Seger shines light on nonprofit donor milk banks which provide pasteurized donor human milk for human babies, “the next best thing to mom.” 

“Enhance the national network of nonprofit donor milk banks,”  Psmythe Seger writes. “Support innovative partnerships across existing structures, taking a cue from a national model such as what exists in Brazil. Consider: Red Cross has the infrastructure to support donor screening; WIC offices or community health clinics could be donor drop-off sites; more hospitals could provide space and equipment for donor milk processing and distribution, as some have done. Models exist to create an affordable and plentiful alternative to commercial milk formula when a parent’s own milk is not available.”

Photo by: Sara D. Davis/
Source: United States Breastfeeding Committee (USBC)

This fall, the Access to Donor Milk Act (ADMA) was introduced in the House. ADMA would increase federal support for nonprofit milk banks and access to donor milk for medically-vulnerable infants.

What’s more, the legislation would allow state agencies to use WIC funding to promote the need for donor milk, provide emergency capacity funding when there is a demand for donor milk,  create a donor milk awareness program, and require the secretary of HHS through the FDA to issue a rule clarifying the regulatory status of donor milk provided by nonprofit milk banks.

Stay tuned for how you can help support this legislation. For other legislative and policies opportunities that support healthy infant feeding, visit USBC’s Take Action page here.

Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond

September is National Preparedness Month. We’ve spent a lot of bandwidth covering our country’s deficiencies in handling healthy infant feeding in emergency situations. There was National Preparedness Month: the U.S.’s deficit in Infant and Young Child Feeding preparedness during emergencies, Guiding resources for infant and young child feeding during emergencies, Spotlight on Infant and Young Child Feeding in Emergencies during National Breastfeeding Month, Toxic Stress, Resilience Building, COVID-19 and Breastfeeding, and Underdeveloped plans for infant and young child feeding during emergencies.

In preparation for Hurricane Katrina– which the Federal Emergency Management Agency (FEMA) called “the single most catastrophic natural disaster in US history”– the government organized an alternate site for the Super Bowl but failed to employ an infant feeding in emergencies (IFE) plan. 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. If you haven’t the time to sift through our coverage on emergency preparedness and response, those accounts pretty much sum up where our priorities lie.

Photo by João Henrique do Carmo: https://www.pexels.com/photo/child-breastfeeds-from-her-mother-5839104/

With the deficit clearly illuminated, we’re glad to report solutions and resources for infant and young child feeding in emergencies (IYCF-E) that have begun to emerge as emergent situations increase in frequency and severity.

During World Breastfeeding Week, we shared work being done in Timor Leste as reported by Dr. Magdalena Whoolery in Strategies for Infant and Young Child Feeding in Climate-Related Emergencies.

We covered Doula and Program Coordinator at Birthmark Doula Collective & New Orleans Breastfeeding Center Malaika Ludman’s, MPH, CLC work in Infant and Young Child Feeding in Emergencies in Louisiana: Lessons Learned from a Post-Hurricane Laura Response During the COVID-19 Pandemic.

Julia-Lorraine Mercedez Moore, a WIC peer counselor in Pickens County, S.C., talks about supporting breastfeeding through the pandemic in South Carolina WIC peer counselors help families through COVID and beyond.  

In New Mexico Breastfeeding Task Force’s efforts to support human milk feeding in alternative housing environments, task force members describe how to best support families in crisis.

Beyond Our Milky Way coverage, there’s fantastic work and opportunities for action to amplify.

CHEERing is an ISO certified, Greek-registered NGO dedicated to improving maternal child health and promoting preventive health in refugee populations. They provide direct support in refugee camps and shelters; training for agencies, including medical professionals and volunteers who work daily with refugee populations, and evaluation and monitoring.

The Global Breastfeeding Collective created an advocacy brief, Breastfeeding in Emergency Situations, which details a call to action that focuses on establishing proactive versus reactive feeding systems.

Photo by Mehmet Turgut Kirkgoz : https://www.pexels.com/photo/a-woman-breastfeeding-her-child-11779231/

The IFE Core Group by the Johns Hopkins Center for Humanitarian Health at Johns Hopkins Bloomberg School of Public Health, the Friedman School of Nutrition Science and Policy at Tufts University and the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill has compiled a repository that provides peer-reviewed journal articles that cover emerging evidence in emergency settings such as natural disasters, conflicts, displacement including refugee settings. Access the repository here.

This summer, the CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) released a toolkit with information and resources for emergency preparedness and response personnel, families, and the public to ensure that children are fed safely when disaster strikes. You can access the toolkit here.

Image credit: United States Breastfeeding Committee

The United States Breastfeeding Committee (USBC) is a leader in helping pass legislation that would better protect young families in emergencies. USBC’s Take Action Center offers an easy way to engage in formalizing legislation. You can contact your legislators about the DEMAND Act (S. 3601/H.R. 6555) here.

Read other USBC coverage on IYCF-E in Disasters Don’t Wait: We Must Make Babies a Priority in Emergencies and The Four Pillars of Infant Nutrition Security in the United States.