Tag: commercial milk formula

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Baby Safety Month

Photo by George Pak

The United States Consumer Product Safety Commission recognizes September as Baby Safety Month. The observance focuses on educating parents and caregivers on creating safe environments for babies and young children. So, this week, we’re exploring a variety of products and practices and getting curious about how the responsibility for creating safe environments for infants and young children extends beyond parents and caregivers. 

 

Generating profit over baby safety  

The first concept to explore, which has been well-explored, is manufacturers’ and the industry’s commitment to profit over safety and health. Read Marketing of commercial milk formula: a system to capture parents, communities, science, and policy for a recent, comprehensive publication on marketing tactics. Another important document to consult is Countering Industry Arguments Against Code Implementation: Evidence and Rights-Based Responses which was just published this summer. 

If you visit the The Juvenile Products Manufacturers Association website, you’ll find a section on “How to promote Baby Safety Month.” Does this snippet surprise you?:  “It’s hard to keep parents away if you create a contest. Consider a Best Baby Photo Contest showing products being used properly according to instructions!” Proper use of products is important, no doubt, and consumers should have an awareness that they’re being used to generate profit first and foremost. 

Head over to saferproducts.gov, search infant formula and you’ll find thousands of submissions of incidents and responses from businesses which almost always pin fault on the parent/user.  

Poke around resources from the US Stakeholders Codex Committee on Contaminants in Foods (CCCF). In doing so, I was alarmed by “Maximum level for melamine in liquid infant formula”, so I consulted some colleagues to gain a better understanding. 

Nikki Lee replied: “Remember the melamine crisis in Chinese formula in 2009? ‘A major food safety incident in China was made public in September 2008. Kidney and urinary tract effects, including kidney stones, affected about 300,000 Chinese infants and young children, with six reported deaths. Melamine had been deliberately added at milk-collecting stations to diluted raw milk ostensibly to boost its protein content. Subsequently, melamine has been detected in many milk and milk-containing products, as well as other food and feed products, which were also exported to many countries worldwide.’

Melamine has no nutritional value. The best that can be said is that in ‘small amounts’, it is not harmful. It can be an accidental contaminant. Are the formula manufacturers trying to get away with a certain level that will be deemed acceptable, because the manufacturing process can’t keep all melamine out of formula?” 

And Karin Cadwell suggested: “My understanding is that melamine could trick the tests of how much protein there is in the product and the manufacturers could sell the removed protein for a profit elsewhere.  I am struck with the similarities with the cinnamon in the applesauce. My spidey sense gotten from reading between the lines, is that lead and chromium were added to increase the weight of the cinnamon when being sold by weight.” 

Author Valerie McClain explores how policy affects infant health and safety on her Substack. Check out her June 2024 commentary on formula recalls.  

Multinational corporations work to influence infants’ and young children’s diets in so many ways in order to increase their profits. Check out How Nestlé gets children hooked on sugar in lower-income countries for instance.   

Diets aren’t the only things targeted and marketed. In 2023, a report was released covering nursing pillows and infant deaths. The report elicited a response on behalf of a bunch of manufacturers and retailers trying to sell their product, shrouded in a feminist tone. 

[More on profit over health and safety: The big issue with ‘Big Formula:’ Americans want paid parental leave, the formula industry says it’s bad for business, Conflicts of interest everywhere one turns, Breastfeeding advocate battles formula companies, protects mothers and babies, Industry lies and the Code, Food before one is NOT just for fun] 

 

Our planet and baby safety 

The manufacturing, use, and movement of products tolls our planet and therefore the health and safety of babies and children. Commercial milk formula leaves an ecological footprint while direct breastfeeding doesn’t. We’ve covered this extensively on Our Milky Way, how infant and young child health and planetary health go hand in hand. 

Now consider this headline: Breast milk can expose babies to toxic ‘forever chemicals’. 

“For decades, physicians and scientists have touted breast milk as liquid gold for its immunological benefits.

But nursing parents with considerable exposure to cancer-linked ‘forever chemicals,’ or PFAS, may unwittingly be exposing their babies to these compounds as well…” the author begins. 

The article acknowledges contaminated water could be a potential source of PFAS which infant formula is often mixed with. The author also includes that “the benefits of nursing likely outweigh the potential risk of PFAS exposure through breast milk.” [Note the language used here. There are generally no benefits to breastfeeding. Instead, there are risks associated with not breastfeeding.] 

Nikki Lee asks some important questions: “Why doesn’t formula get tested for these chemicals?  Do folks believe that somehow cows are protected against pollution?”

There will be risks associated with any variation of infant feeding. 

Healthy Children Project’s Karin Cadwell points out that if toxins are being detected in human milk, it means we need to reconsider the products being used in industry.

The author of Study Finds High Levels of Toxic Chemicals in Mothers’ Breast Milk quotes Erika Schreder, science director at Toxic-Free Future who shares a similar sentiment: “’If we want to make pregnancy and breastfeeding safe and free from PFAS, we really need to eliminate the use of these chemicals and products, so that we can have clean food, clean air, and clean water… We really don’t believe that responsibility should be placed on individuals when we need regulations to end the use of these chemicals.’”

[More on One Health: Glints of hope and control in a burning world, The tide is turning, Breastfeeding is eco-friendly] 

 

Detachment parenting and baby safety 

On a Wait Wait Don’t Tell Me: The Oddly Informative News Quiz, a comedian jokes about our nation’s detachment parenting style: “You can actually go weeks without touching your child.”

We’ve reflected on this phenomena in Absurd and awesome products, Implications of mother baby separation, Breastfeeding is collaborative, and Proximity and Profit. 

Regardless of infant feeding method, feedings provide the opportunity for a loving, intimate interaction. Not only do products like the one pictured to the right promote solitary, disconnected feeding, they also induce the risk of choking and aspiration. It’s important to consider why parents might be drawn to products that promote separation. Are they overwhelmed? Do they lack support from other humans? Have they been manipulated by marketing? 

 

 

More to explore on baby safety, products, profit, and health 

September is also National Preparedness Month. Check out our pieces on infant and young child feeding in emergencies  (IYCF-E) here.

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Opportunity to join research project documenting Code violations

Surveying the Landscape of Breastmilk Substitute (BMS) Marketing Practices in Four Countries is well underway!

Launched this summer, the purpose of the research project is to document violations of the World Health Organization’s International Code on Marketing of Breast-milk Substitutes and subsequent WHA resolutions (the Code) in the U.S., Canada, the UK and Australia. 

On behalf of those conducting the study, Ellie Mulpeter, MPH, CLC Director, Academy of Lactation Policy and Practice (ALPP) says that they are excited about the level of engagement.

“It seems that participants are seeing and monitoring code violations across all four countries, perhaps even more than they expected!” she exclaims. “This is such a fun and engaging project – both active and practical – and is telling us so much already about what is happening throughout these four countries.” 

So far, the most prevalent violations have been reported on online social media platforms, influencers and online advertising and sales platforms. Read Scope and impact of digital marketing strategies for promoting breastmilk substitutes to understand why this finding is unsurprising. 

Mulpeter says of the research that “raising awareness is the first goal, particularly in countries that do not currently monitor or enforce the Code.” 

According to this 2022 WHO status report, “as of March 2022, a total of 144 (74%) of the 194 WHO Members States (countries) have adopted legal measures to implement at least some of the provisions in the Code. Of these, 32 countries have measures in place that are substantially aligned with the Code. This is seven more countries than reported in the 2020 report.” The U.S. and Canada have no legal measures. 

Mulpeter comments, “Policy makers in the U.S. are behind the ball when it comes to protecting breastfeeding individuals and their babies. That is nothing new. For many, I believe that seeing the sheer number of violations that the average individual can identify when walking along the aisles of their grocery store(s) will be eye-opening. Additionally, it’s great to have a study where those who care about maternal and child health can get out there and help with this project. If we are fortunate to find one or more advocates in the legislature that are passionate about this legislation, I think we can find a way to bring the U.S., Australia, the UK and Canada up to speed with other countries that effectively monitor and enforce The Code and its subsequent WHA resolutions.” 

Examples of countries with legal measures include Brazil, India and Bangladesh though compliance and enforcement is not always substantial. 

“It is inspiring to see the successes that other countries have had in protecting breastfeeding parents and their babies from the harmful practices of the infant formula and other breastmilk substitute industry,” Mulpeter continues. 

In the U.S., the Federal Trade Commission (FTC) provides an avenue to monitor false advertising and hold companies accountable for making claims that are not evidence-based. Mulpeter reports that INFACT USA has submitted several different reports of false advertising on infant formula cans and other commercial milk formulas in the U.S.

“Unfortunately, the FTC does not actively investigate those submissions, but does keep a database of those submitted,” she explains. “After submitting those cases, a message is relayed to the submitter notifying them that they will not receive a response from the FTC, but that the report will be logged in their database.” 

Though the U.S. has not adopted the Code, this research may eventually feed into the NetCode Protocol which supports the development of a monitoring framework, protocols and training materials for monitoring of the International Code and relevant WHA resolutions, and the formulation, monitoring and enforcement of national Code legislation. 

The study will be capped at 1,000 participants. Once enrollment closes, new submissions of violations will be accepted for approximately six months. You can join here. 

Further exploration on the topic

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Infant feeding and planetary health go hand in hand

I recently woke up to a headline with the words “climate” and “hope” strung together. As author Jeff Brady points out, it’s “…something you don’t hear much when it comes to climate change: hope.” 

Brady goes on to illuminate a recent International Energy Agency (IEA) report that shows “countries are setting records in deploying climate-friendly technologies…” 

There’s more: “While greenhouse gas emissions keep rising, the IEA finds that there’s still a path to reaching net-zero emissions by 2050 and limit global warming to 1.5 degrees Celsius, or 2.7 degrees Fahrenheit. That’s what’s needed to avoid the worst effects of climate change, such as catastrophic flooding and deadly heatwaves,” he writes.

Photo by Mika Baumeister on Unsplash

It’s hard to imagine that we’re in a place where there’s still the potential for “the worst effects.” Are we not already there? 

Not long ago, when extreme weather occurred, we were told it wasn’t possible to link specific events to the climate crisis. Now though, scientists have figured out a model to represent how the climate crisis produces specific weather events like hurricanes and extreme heat.

Extreme weather events and other disasters and emergencies will continue to occur, so it’s imperative that we develop infant and young child feeding in emergencies (IYCF-E) preparedness in the U.S., something we are seriously bad at.  

Jennifer Russell’s, MSN, RN, IBCLC, NHDP-BC, Ph.D. Candidate in Nursing Science from the University of Tennessee Health Science Center co-authored Domestic Preparedness Journal article “Challenges with pediatric mass care feeding,”(p 27-31) details the importance of and how state, local, tribal, and territorial organizations’ (SLTTs) can “safely, effectively, equitably, and quickly provide pediatric feeding support” in emergencies. 

Namely, the authors state: “SLTTs must estimate and plan for the logistical distribution and cost of breastfeeding and re-lactation supplies along with safe alternatives to mothers’ breastmilk and other pediatric feeding items.” The authors bust some common misconceptions about emergency response and offer ways in which we can improve existing guidance. 

Photo by Dave Clubb on Unsplash

In her most recent guest post on Our Milky Way, “Nourishing Children and the Planet”,  Healthy Children Project’s Donna Walls considers the critical weather events of late and highlights the urgency of education, legislation and action.

Walls points out that lactation care providers (LCPs) and health advocates can and should take a leading role in the fight for the health of our planet.  LCPs are important actors within the greater need for national-level policy development, and LCPs’ work helps to mitigate the more grandiose challenges of the climate crisis.  

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The first best food for infants is mother’s own milk. We all know about the benefits for mothers and babies, but we don’t often discuss the benefits for the health of the planet.

https://www.gifa.org/en/international-2/green-feeding/

This is a win-win situation. By providing our infants and children with cleaner, “greener” foods, we also create a cleaner, safer environment for our families, our communities and the world. 

By contrast, commercial milk formulas (CMFs) are harmful to the planet because they require procurement of ingredients and manufacturing and transport of the product. All of these processes use resources and contribute to the increasing burden of greenhouse emissions. Read Powdered Baby Formula Sold in North America: Assessing the Environmental Impact for a detailed look at the environmental and Greenhouse Gas impact of powdered baby formula, which as the authors note, “should be considered when developing and funding infant and young child feeding policies and supportive programs.”

Water resources are scarce in many countries around the world, and yet “about 5000 litres of water are used for every kilogram of milk powder, including producing the milk, then processing the powdered milk, preparing the feeds, and sterilising feeding equipment.” (Linnecar, van Esterik, 2023).  Unnecessary use of precious water resources threatens the very survival of children across the globe.

It’s true that “the few extra litres of water required by a breastfeeding mother are negligible compared to the amounts of water for formula production and preparation.” (Linnecar, van Esterik, 2023) 

Destruction of natural resources, such as the rainforest for harvesting ingredients as well as ever-mounting pollution from plastics is creating a negative impact on the environment ultimately contributing to rapid climate change. 

By supporting breastfeeding families,  LCPs can be the first line of defense by reducing pollution and minimizing the powerful effects of the climate crisis. Breastfeeding  is, without doubt, the cleanest, “greenest” form of infant nutrition. 

Ultra processed foods (UPFs) impact on  health

What’s more, we have evidence that breastfed infants consume less ultra processed foods (UPFs) as they get older (Paharia, 2023). 

UPFs not only strain our resources but have been shown to increase rates of type 2 diabetes, obesity, hypertension, cardiovascular disease and dementia further straining resources as communities struggle to care for sick individuals. Shockingly, research shows “67% of children’s calories come from empty ultra processed foods” in the U.S. (Berg, 2022).

Food additives– “any substance not normally consumed as the food itself and not normally used as a typical ingredient of the food, whether or not it has nutritive value” (FAO, Codex Alimentarius, 2021)– frequently found in UPFs, present a myriad of concerns including central nervous system disruptions, hyperactivity or other behavioral or neurological issues in children. (Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children, 2021) 

Predatory marketing lulls families into believing that these convenient food sources are not harmful. Information and research about the toxicities and harm is usually assigned to the small print or not disclosed at all. 

The Environmental Working Group (EWG) has published information on several food additives that are especially troubling. These include:

  • Nitrates and nitrites- meat preservatives  linked to stomach cancer, esophageal cancer, and possibly brain and thyroid cancers
  • Propyl paraben- a preservative in pastries shown to cause developmental and reproductive harm.
  • Food dyes (especially red and yellow dyes) linked to cancers
  • Potassium bromate- carcinogen found in baked goods
  • BHT and BHA- preservatives in foods are possible carcinogens
  • Titanium dioxide- color additive implicated in DNA damage
  • PFAS- known as forever chemicals used in food packaging which has been shown to leach into foods. These are known to increase the risk of cancer, damage to the immune system and hormone disruption. 
Food additives’ impact on environmental health 

According to Lempart-Rapacewicz, et al, the latest literature classifies food additives as one of the groups of so-called Contaminants of Emerging Concern (CECs), defined by the United States Environmental Protection Agency (USEPA) and United States Geological Survey (USGS).

These chemicals are not naturally occurring, and so require manufacturing resources ie; water, energy, systems for disposal of by-products and waste and packaging materials, to either develop or alter the final product.  Pollution of our air and water are well documented consequences of this type of manufacturing. 

These  substances are also found in sewage where current processes are unable to remove them from the systems, leading to concerns of the micropollutants in the ground and water tables. 

Additives such as ascorbic acid might sound harmless, but when found in large quantities,  alters the pH of water and soil, affecting the basic growing medium for plants and crops. Ongoing research investigates the long-term consequences on plant and crop properties and the effects on biodiversity. Some studies have found mutagenic and teratogenic effects on fish and aquatic vegetation after exposure to food additives. ( Lempart-Rapacewicz, et al, 2023)

Plastic ingestion

Infants and children can be especially susceptible to  exposure to micro or nano plastics–plastics so small they are measured in micrometers or nanometers (microplastics are plastic particles under 5 millimeters in size, and nanoplastics are under 0.001 millimeters in size). They’ve been detected in many of the foods we eat,  in the air we breathe and the water we drink. Micro and nanoplastics are absorbed into our bodies through food packaging or in infants and children through feeding bottles and teats, baby food containers and pouches. Significantly more particles are released when the food containers are heated in the microwave (Hussain, et al, 2023).

Photo by Zeesy Grossbaum on Unsplash

The health effects of ingesting plastics are not completely understood yet, but early research implicates micro and nano plastics in imbalances in the microbiome, altered lipid metabolism, reproductive system, brain and lung dysfunctions. 

More on environmental degradation

In 1962,  Rachel Carson wrote the groundbreaking book Silent Spring, sounding the alarm about the use of pesticides and herbicides. Concerningly, as a nation, we have yet to heed her warnings. 

Use of these powerful chemicals is negatively impacting plants by causing them to produce less phytonutrients– the vitamins and minerals we need to stay healthy. 

Scientists are finding “dead zones” in bodies of water, areas that are so polluted they can no longer sustain aquatic animals and plants on account of run off of these toxins. Disruptions in the ecosystems have led to the rapidly changing climate and instability of our weather patterns.

Since the publishing of Carson’s book, micro and nano plastics have been found to inhibit the growth of healthy microbiota in aquatic animals and have also been shown to obstruct the digestive system of marine organisms such as mussels and oysters. 

Scientists note increasing contamination of agricultural soils with these particles, reducing plant growth and overall productivity (Amboyne, et al, 2021). Soil contamination negatively affects inhabitants such as earthworms and nematodes resulting in changes in the soil microbiome.

Learning to live in balance
Photo by Derek Owens on Unsplash

On an individual level, tackling the catastrophic challenges spurred by the way we produce and consume food, is insurmountable and requires system-level action;  however, there are resources for families to consult when working to make the healthiest choices for their families. Beyond breastfeeding,  families can check out theEWG’s  “Dirty Dozen” and “Clean 15” listing of foods to find the most budget-friendly way to provide cleaner, organic foods. There is no question that organic foods are the healthiest. 

When we learn to live in balance with the natural world, the health of both flourishes.  It can sometimes seem an uphill battle to create a cleaner, greener world but as individuals, and collectively, it is our privilege and responsibility to do whatever we can. One person at a time, one family at a time, one community at a time. One of my life-long favorite quotes is from Margaret Mead, and it is as important now as when she wrote it in 1978: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has”. This seems to be the time for those committed to caring for mothers and babies to also commit to caring for Mother Earth as well.

More resources to consult

Global Nutrition Report 

Green Feeding Tool

IBFAN’s Health and Environmental Impacts

Report on CARBON FOOTPRINT DUE TO MILK FORMULA: A study from selected countries of the Asia-Pacific region

Register to attend  Infant and Young Child Feeding in Emergencies: Preparedness Systems for Communities to Keep Our Babies Safe webinar hosted by U.S. Breastfeeding Committee (USBC) and the National Association of County and City Health Officials (NACCHO) on November 1 from 2:00 – 3:30 pm ET. The session will provide an overview of the Centers for Disease Control and Prevention’s (CDC) infant and young child feeding in emergencies (IYCF-E) toolkit, share current research exploring personal experiences and disaster-related factors that influence breastfeeding, describe how NACCHO has supported communities in emergency preparedness for maternal and child population.



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A collection of stories by and about those in the AANHPI community

Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding Week— Telling our own stories. Elevating our voices— is coming to a close.

On Friday, the U.S. Breastfeeding Committee AANHPI Caucus presented the AANHPI Lactation Community Forum, an open panel discussion where AANHPI community members shared about their journeys to becoming lactation support professionals as well as provided guidance on how we can further build community capacity to support AANHPI families.

Photo by Samrat Khadka on Unsplash

Other opportunities as part of the celebration included visiting the Asian American, Pacific Islander, and Native Hawaiian Breastfeeding Week Facebook page and engaging with activities like the AANHPI Coloring Pages Contest. The Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce AANHPI Social Media Toolkit produced shareable social media content including messages and captions in the toolkit which have been translated into 11 different AANHPI languages: Chinese (both traditional and simplified), Farsi, Hindi, Hmong, Japanese, Korean, Native Hawaiian, Samoan, Tagalog, and Vietnamese.

In an engaging discussion from last summer, Tonya Lang, MPH, CHES, IBCLC and Grace Yee, described the diversity that exists under the AANHPI umbrella, shaking away the stereotypical idea that Asian culture is monolithic.

The Asian Pacific Institute on Gender-Based Violence begins to describe the complexity of AAPNHPI groupings and the forces that shape identity in Census Date & API Identities. AAPI DATA, which provides demographic data and policy research on Asian Americans and Pacific Islanders, compiled some wonderful visuals to help shape the numbers.

The overgeneralization of the API community has led to some misleading data about breastfeeding rates. On an aggregate level, initiation and duration rates are relatively high, but the statistics don’t account for stark disparities within these population groups. This piece covers this phenomenon in more depth and offers strategies for tailoring infant feeding support in the Chinese American population.

As Dr. Magda Peck has pointed out, numbers and data are important because they drive decisions and policies, but they also have the potential to sanitize humanity. That’s where stories come in. Not only do they humanize the numbers, they can also help us make sense of the data.

In celebration of AANHPI Week and in hopes of demonstrating the complexity and diversity of this population, we have collected several stories by and about those in the AANHPI community.

Photo by Dragon Pan on Unsplash

First up, is To-wen Tseng and her contributions to the San Diego County Breastfeeding Coalition’s blog. Tseng wrote most recently about her ‘why’ reflecting on National Breastfeeding Month. Read that piece here.

Joanne Datangel-Gallardo, MD, DPPS of the National Children’s Hospital, Philippines has worked extensively with relactation efforts. Read about Dr. Datangel-Gallardo’s work here.

Also out of the Philippines is a piece by Micaela Papa detailing how breastfeeding saved one baby’s  life and helped her mother recover from the stress of Typhoon Odette.

Not far south from this archipelago, is the island nation of Timor Leste. Here, emergency response efforts to protect breastfeeding have saved the lives of many. Community members manage and intercept artificial baby milk and other ultra-processed food product donations among other components of the nurturing care model. Read about these efforts here.

In Indonesia, efforts are also underway to combat commercial milk formula companies. Find a simple model for reporting Code violations here.

Jenny Lei Ravelo writes about the tangle of infant feeding complexities on Indonesia’s remote islands complete with stunning photos in partnership with the 1000 Days Fund.

In India, the Foundation for Mother & Child Health (FMCH) works to empower families from vulnerable communities with actionable information and services, resulting in health seeking behavior and nutritious food choices in order to tackle maternal child malnutrition, ultimately breaking the cycle of poverty. Read about the organization’s impact here.

In the spring, the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of Breastfeed LA, tailored the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities, a project that augments APIBTF’s sister organization Alameda County’s Asian, Southeast Asian, Pacific Islander (ASAP!) Breastfeeding Taskforce’s Continuity of Care (CoC) Blueprint Project Prenatal Toolkit for AANHPI families. You can find out more about the efforts to center culture in health here.

Elisabeth Millay/BreastfeedLA and API Breastfeeding Task Force

Also exemplifying culture centered in health is the Hmong Breastfeeding Initiative (HBI). With funding from Reducing Disparities in Breastfeeding through Continuity of Care Identifying Care Gaps grant from National Association of County and City Health Officials (NACCHO), the Hmong Breastfeeding Coalition (HBC) conducted an environmental scan of the Twin Cities (Minneapolis and Saint Paul, Minn.) on breastfeeding promotion and support for child-bearing age Hmong women and families. Read more here.

Tiffany Pao Yang has played a crucial role in this work. The daughter of Hmong refugees, she is especially invested in helping change the narrative around infant feeding in the Hmong population. Read part of her story here.

 

More to explore

 

Breastfeeding in Emergencies: The Struggles of New Mothers in the World’s Largest Refugee Camp

A Journal of Aboriginal and Indigenous Community Health: Community Influences on Breastfeeding Described by Native Hawaiian Mothers

Breastfeed LA’s Current APIBTF Projects

API Breastfeeding Task Force Video Library

AANHPI Lactation Collab 

The Cost of Not Breastfeeding from Alive & Thrive Downloadable PDFs for several Asian countries

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USBC Deputy Director Amelia Psmythe Seger’s ‘The Four Pillars of Infant Nutrition Security in the United States’

Our headlines are overloaded with tragedy, perversion, inequities, the unthinkable yet preventable.

Journalist Mary Pilon says in Throughline’s Do Not Pass Go episode “It’s a shame to waste a crisis. A crisis can also be a moment when you look at things and make changes and improvements.”   

And so, from that vantage point, we are honored to be republishing United States Breastfeeding Committee Amelia Psmythe Seger’s piece The Four Pillars of Infant Nutrition Security in the United States originally published here last month. 

“We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust,” she writes. 

In celebration of World Breastfeeding Week and National Breastfeeding Month on the horizon, there’s no better time than now to take action.  #TogetherWeDoGreatThings

 

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The Four Pillars of Infant Nutrition Security in the United States by Amelia Psmythe Seger, Deputy Director USBC

Throughout its 22-year history, the U.S. Breastfeeding Committee has been working towards the policy, systems, and environmental changes that build a landscape of breastfeeding support.
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The catastrophic infant formula shortage demonstrates the value of this work and the need to build a robust infrastructure for infant nutrition security in the U.S. that holds all families in care.

This infrastructure includes four pillars: Parents, Programs, Policies, and a Plan for emergencies.

Parents:

Parents are critical stakeholders in infant nutrition security. The Parents pillar includes people of all races, genders, caregiving roles, routes to parenthood, immigration status, religious or political views, and infant feeding methods. Everyone who loves and cares for a young child belongs. Welcome.

Parents deserve the full support of a robust national infant nutrition security infrastructure. Without it, many are forced onto painful and difficult paths of infant feeding and care. The U.S. needs equitable programs, policies, and a plan for emergencies that centers on the most impacted.Parents and caregivers whose infants rely on formula are the highest priority right now. They need help finding formula, advice on switching between formulas, reassurance that reliable supplies are on the way, and an answer to the question: what should I feed my baby if I cannot find formula?  With appropriate caution, the American Academy of Pediatrics (AAP) published an article on what to feed babies of different ages and situations in an extreme emergency (such as this). Babies under six months should truly only consume human milk or infant formula. In considering very short-term alternatives, the stakes are so high that a physician should monitor the baby.

Parents who are breastfeeding or feeding human milk are in anguish right now, too. Many are feeling pressure to share their milk without acknowledgment of how hard this society has made it to establish and maintain milk supply. Few families have access to lactation support providers, paid family leave, and workplace accommodations to pump breast milk during the workday. In this context, many turn to formula as their backup plan, and it is very scary for them to see that their safety net is in tatters. To answer questions related to human milk, the Academy of Breastfeeding Medicine (ABM) published a guide. This ABM guide addresses pregnancy, low milk supply, re-lactation, options for donation or safe milk sharing, and healthcare guidance and training.
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Additional burdens or blame should never be placed on the families and caregivers whose hands are literally full of babies and toddlers. When capacity allows, however, the collective potential power of parents is significant. Consider if parents insisted on being at the table with the commercial milk formula industry, playing a role in ensuring industry quality, safety, and ethics. They are key stakeholders, after all, so this should be encouraged. Parents could also insist the U.S. enhance our nonprofit milk banking system to ensure an affordable, plentiful donor milk supply for medically fragile infants and those whose parents cannot or do not wish to breastfeed. This would diversify the infant food supply and provide parents with more options.

Programs:

Federal programmatic funding needs to be expanded considering setbacks caused by the pandemic, including the current infant formula shortage.

Federal funding supports quality improvement investments to implement maternity care best practices in hospitals, especially while recovering from pandemic-induced breakdowns in those settings.

Expansion of this funding supports state and community efforts to advance care coordination and strengthen lactation support through policy, systems, and environmental change interventions to reduce or eliminate breastfeeding disparities along the fault lines of income and race.

Federal investments enhance and deepen partnerships to integrate infant feeding and lactation support services into emergency response systems and food security programs during acute disasters and prolonged public health crises.
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This funding supports critical national monitoring and public reporting activities, including annual analysis of the National Immunization Survey (NIS), administration of the bi-annual Maternity Practices in Infant Nutrition and Care (mPINC) Survey, bi-annual production of the National Breastfeeding Report Card, and administration of the longitudinal Infant Feeding Practices Study. All of which is especially needed in light of recent updates to the Dietary Guidelines for Americans, which, for the first time, provides nutritional guidance for infants and toddlers.

Policies:

Due to major policy gaps, families face obstacles that make it difficult or impossible to start or continue breastfeeding. Policymakers must choose to prioritize the policies and investments for infant food security so that we never find ourselves in this situation again.

Critically needed policy solutions are waiting for Congressional action:

  • Establish a national paid family and medical leave program. The FAMILY Act (S. 248/H.R. 804) would ensure that families have time to recover from childbirth and establish a strong breastfeeding relationship before returning to work.
  • Ensure all breastfeeding workers have time and space to pump during the workday. The Providing Urgent Maternal Protections (PUMP) Act (S. 1658/H.R. 3110) would close gaps in the Break Time for Nursing Mothers Law, giving 9 million more workers time and space to pump. Contact your legislators about the PUMP Act!
  • Invest in the CDC Hospitals Promoting Breastfeeding program by increasing funding to $20M in FY2023. This funding helps families start and continue breastfeeding through maternity care practice improvements and community and workplace support programs.
  • Create a formal plan for infant and young child feeding in emergencies. The DEMAND Act (S. 3601/H.R. 6555) would ensure the Federal Emergency Management Agency can better support access to lactation support and supplies during disasters. Contact your legislators about the DEMAND Act!

Additional areas for policy development

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.
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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.Enhance the national network of nonprofit donor milk banks. 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.

Plan:

All nations should have a robust plan for infant and young child feeding in emergencies that includes three phases: preparedness, response, and resiliency. The USBC-Affiliated Infant & Young Child Feeding Constellation has published a Joint Statement on Infant & Young Child Feeding in Emergencies (IYCF-E) in the U.S. context.
Emergency preparedness includes building a lactation support provider directory and a system to track the inventory of national resources such as infant formula.Emergency response for infants, young children, and their families must include priority shelter, trauma-informed care, lactation support providers in every community; access to breast pumps, and milk storage and cleaning supplies; non-branded infant formula, clean water, bottles, and cleaning supplies.
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Emergency resilience includes trauma-informed care that centers on the needs of communities that have been historically undersupported, and disproportionately impacted in emergencies.

Every system is perfectly designed to get the results it gets. The insufficient system we’ve had, led to this crisis. It was predictable, and thus it was preventable.
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Now that there’s a mass mobilization of activity – from neighbors driving many miles to find spare formula tins, to the President invoking the defense production act – we must collectively build the resiliency to support a community during a flood, a region during a power outage, or a nation during a pandemic and supply chain crisis. We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust.
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