Green Feeding

Guest blog post collaboration with Donna Walls,  RN, BSN, IBCLC, CLC, ANLC

At its core, Green Feeding means taking action from birth to safeguard the health of humans and the environment.

Photo by Akil Mazumder

Green Feeding encompasses the promotion, protection and support of breastfeeding as the most valuable natural resource from 0 to 36 months of age.

In May 2019, the International Baby Foods Action Network (IBFAN) in partnership with the World Breastfeeding Trends Initiative (WBTi), published Green Feeding–climate action from birth, issuing a plea for awareness on the impact of infant feeding practices on the environment and to promote breastfeeding which nurtures a healthy population and planet.

Green Feeding practices should continue beyond exclusive breastfeeding. When complementary foods are introduced at six months of age, guidelines include:

  • foods which are naturally occurring foods (such as plants and animals),
  • minimizing processed (foods prepared with salt, sugar, oils such as canned fruits or vegetables or simple cheeses),
  • culturally appropriate, family foods which rarely contain concerning levels of sugar, salt, fats, and toxic additives,
  • and the avoidance of ultra processed foods (foods altered by processing and additives not normally found in foods like dyes, preservatives, stabilizers). Infant formulas fall into the category of ultra processed foods.

 

Human and planetary health interplay 

Breastfeeding is a frequently ignored topic by global climate action leaders despite it being an almost cost-neutral intervention with a huge impact on human and planetary health.

Photo by willsantt

“Recent studies have highlighted the environmental cost of decades of disinvestment in services to support breastfeeding,”  the authors of Support for breastfeeding is an environmental imperative write. “When breastfeeding is encouraged and supported the associated infant and maternal health outcomes produce healthier populations that use fewer healthcare resources.”

Authors of Why invest, and what it will take to improve breastfeeding practices? note that breastmilk is a “natural, renewable food” that is environmentally safe and produced and delivered to the consumer without pollution, unnecessary packaging, or waste.

By contrast, breastmilk substitutes leave an ecological footprint and require energy to manufacture, materials for packaging, fuel for transport distribution, and water, fuel, and cleaning agents for daily preparation and use, and numerous pollutants are generated across this pathway.

Human health is often sacrificed for business interests and profits; the “bottom line” is about dollars and not  families’ precious health.

The Green Feeding advocacy document continues to spell out the interplay between human and planetary health through the lens of healthy infant and young child feeding (IYCF).

As a renewable natural food resource, mother’s milk contributes to local food and water security and biodiversity.

Differently, the run-off of waste from dairy farming used in artificial milk development, threatens our water supply with contamination by toxic chemicals, pesticides and harmful microorganisms.

The global food system, from production through all stages of processing, distribution, food preparation and consumption, accounts for an estimated 19 to 29 percent of global anthropogenic greenhouse gas emissions. Animal-based food products generally have a higher climate impact than plant-based foods, due to emissions from feed production, manure management and, in the case of ruminant animals, enteric fermentation, as noted in The carbon footprint of breastmilk substitutes in comparison with breastfeeding.

Not breastfeeding poses the risk of multiple avenues for exposure to toxic heavy metals like contaminated foods and artificial baby milks and contaminated water.   Municipal tap water, groundwater or well water is used to reconstitute powdered formulas and cereal foods and can contain high levels of toxic chemicals. This same water is used for cleaning feeding equipment and for drinking. The risk is increased because powdered formulas and foods prepared with water are the sole or the major source of food and drink at the most vulnerable stage of infant and young child development.

“Exposure to toxic heavy metals causes permanent decreases in IQ, diminished future economic productivity. Toxic heavy metals endanger infant neurological development and long-term brain function,” according to a 2021 IBFAN report.

Plastic pollution is a huge environmental concern made worse by the need for bottle feeding supplies and consumption of single-use articles.

Green Feeding contributes to the work of social justice and poverty reduction, offering protection to the most vulnerable infants and their families, creating a “level playing field” for family budgets. It challenges inequalities in marginalized households and communities that are most negatively impacted by climate change. The high cost of infant formula and ultra-processed baby foods can overwhelm low and middle income households.

 

Green Feeding begins prenatally

There’s a growing body of research connecting prenatal and early life toxic exposures to poor health outcomes.

Photo by Thiago Borges

For example, high urinary metabolite concentrations for several prevalent phthalates were associated with greater odds of delivering preterm, and hypothetical interventions to reduce phthalate exposure levels were associated with fewer preterm births. The most consistent findings were for exposure to a phthalate that is used commonly in personal care products like nail polish and cosmetics, noted by the authors of Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth: A Pooled Study of 16 US Cohorts

Things like air pollution, heavy metals, phthalates, plasticizers (PCB) and per- and poly-fluoroalkyl acids (PFASs) which are produced during industrial manufacturing and are widely used in consumer items such as food packaging and non-stick cookware have been known to lead to childhood liver disease, development of diabetes and developmental delays in children.

Endocrine disruptor exposure prenatally and early in life also present a major concern to children. Dozens of these endocrine disrupting chemicals are found in pesticides, personal care products, flame retardants and are found in the air, water and foods. They mimic the female hormone estrogen and thus interfere with the action of the body’s natural hormones which influence reproduction, immunity, metabolism and behavior. More on endocrine disruptors can be found in Endocrine disrupting chemicals and the battle to ban them.

In studies from the University of Rochester Medical School, it was found that wistar rats exposed prenatally to environmental estrogens resulted in damage to the alveolar cells of the breast to the extent that the mother rats were unable to nourish their offspring, as documented in Dioxins In Food Chain Linked To Breastfeeding Ills. 

Authors LaPlante and Vandenberg note reduced milk production in mice exposed to 17α-ethinyl estradiol, and less “mothering behaviors” in rats exposed to environmental estrogens, including reduced nesting behaviors and pup retrieval have also been documented.  These, and other studies, show a concerning trend in the future care of offspring.

 

Eliciting change from the top down 

UNICEF’s 2022 report Places and Spaces: Environments and Children’s Well-Being calls on national, regional, and local governments to make protection of children’s environmental health a priority. Clean air, water and food make up an essential foundation for infant and childhood health. Creating a cleaner, healthier environment begins with the cleanest first food, breastfeeding, and continues with toxic-free foods throughout childhood and adolescence. Taking these steps now reduces the risk of food-induced illnesses including childhood obesity, diabetes, hypertension, asthma, neurodevelopmental delays and immune dysfunction. While we continue to see the predatory marketing of altered foods claiming to offer health benefits, there is no evidence that any of these are superior in any way to clean, naturally occurring foods.

 

Eliciting change from the bottom up 

Anthropologist Margaret Mead said, “Never doubt that a small thoughtful, committed group of citizens can change the world: indeed it is the only thing that ever has.”

Photo by Nandhu Kumar

Advocate for breastfeeding. Join local breastfeeding support groups and talk about the risks of not breastfeeding for mother, infant, and the environment. Connect with “breastfeeding adjacent” groups such as breast cancer advocates or prenatal and infant information groups or toddler play groups.

Talk with local stores selling maternity or infant care products about the opportunity to present this information to customers. Use social media to help spread the word.

Stay politically aware of legislation and contact your local, state or federal representatives and let them know why and how you support breastfeeding and climate-friendly actions. The United States Breastfeeding Committee (USBC) is a great launching pad for this type of activism.

If you, your family or friends need to use infant feeding bottles, teats and other products, find safer alternatives like non-plastic infant feeding bottles and plant-based food storage containers.

Connect with local health food or natural food stores, local organic farms or community assisted agriculture groups to brainstorm ways to distribute recipes and meal ideas for cleaner, healthier foods. Local food pantries can also be a great starting point to connect with community resources to encourage healthier family foods.

Local childbirth education and doula groups can also be a great resource for connecting with pregnant or new families to discuss feeding choices.

Many local gardening groups may have information on growing and preparing natural, organic foods.

Join food cooperatives wherever possible and offer education to families on breastfeeding, clean foods and safer food storage/preparing/serving utensils.

Join civic groups in starting community gardens in public spaces, schools, churches and housing complexes.

 

Additional resources to explore 

Safely Fed Canada

Assessing the environmental impact of powdered baby formula sold in North America

The Unseen Dangers of Ultra Processed Foods

Breastfeeding for the Health and Future of our Nation 

Carbon Footprints Due to Milk Formula. A study from selected countries of the Asia Pacific region

Ultra-Processed Foods and Health Outcomes: A Narrative Review

Food safety, climate change, and the role of WHO

Food safety considerations for commercial complementary foods from global operational guidance on infant and young child feeding in emergencies

Plastic-free parenting 

Ensuring Safe and Toxic-Free Foods Act of 2022

Protecting Brain Development in Children: Neurotoxic Effects of Phthalates and Need for Critical Policy Reform webinar

 

Understanding value and accessing capital in Black maternal health

In Kimberly Jones’s 2020 viral video, How can we win, which comments on looting during the protests sparked by the death of George Floyd, she asks us to consider the why behind peoples’ actions. To explain, she delves into an economic history of Black people in America and the ways in which capitalism and racism are messily entangled.

Capitalism was one of the first ideas acknowledged during opening remarks at the Black Birth Maternal & Infant Health Symposium at Saint Kate- The Arts Hotel in Milwaukee, Wis. last month.

Photo by Anna Shvets

Geraud Blanks, Chief Innovation Officer for Milwaukee Film and one of the organizers of the event, thanked all of the sponsors who showed up.

“Accessibility is the key to inclusion,” Blanks said. The Black Birth Symposium was completely free to participants including parking, lunch and the space.

Blanks went on to share feedback from a 2022 Black Birth Symposium participant, driving home the importance of investment. It read: “I really hope all the medical facilities get on board with this event. They say that this is the most important issue impacting Black women but I didn’t see everyone at the event. Our community watches to see who puts their money where their mouth is. This also helps build trust in our communities. We don’t need another billboard ad, we need your dollars to go to events like this that really make an impact in our communities. We are watching.”

The thread of capitalism held through the keynote conversation with Tiffany Green, PhD, Assistant Professor Population Health Sciences and Obstetrics & Gynecology at UW-Madison and Jeanette Kowalik, PhD, MPH, MCHES, president and owner of Jael Solutions Consulting Services, LLC.

Dr. Green urged Black and Brown individuals to understand their value.

Photo by nappy on Pexels

The Center for American Progress’s piece Women of Color and the Wage Gap points out that, “When looking at women’s wages across broad racial and ethnic categories among full-time, year-round workers, Hispanic women experience the largest pay gap, having earned just 57 cents for every $1 earned by white, non-Hispanic men in 2020.  Black women also experience wide pay gaps, with data on Black women alone revealing that—despite consistently having some of the highest labor force participation rates—they earned just 64 cents for every $1 earned by white, non-Hispanic men in 2020. This number dips slightly to 63 cents, reflecting a slightly larger wage gap, when data on multiracial Black women—meaning Black women who also identify with another racial category—are included in the analysis.”

With these inequities in mind, Dr. Green and Dr. Kowalik acknowledged the difficulty in accessing capital, for both individuals and grassroots organizations.

Dr. Green asked participants to consider not giving away their knowledge. You are a part of the community; how can you take care of the community if you’re not taking care of yourself, she posed. Ask for what you are worth, she further advised.

In the arena of maternal child health research, Dr. Green explained that it is well within reason to ask hard questions to funders and leaders like: What is the budget for this grant? What problems are you addressing? Are you stigmatizing the community? May I co-author or co-create?

Photo by Christina Morillo

An audience participant brought up the phenomena of large funding institutions being insular and wondered who holds them accountable. What is the metric? she wondered.

“Folks like us… with our boots on the ground… doing this work every day, have to fight and jockey to keep ourselves alive,” she pointed out.

The authors of First, Do No Harm: Why Philanthropy Needs to Re-Examine Its Role in Reproductive Equity and Racial Justice address ways in which funders can “embody the equity they aspire to see and build through the operationalization of cultural rigor to advance structural equity and racial justice and to sustain community engagement in research.”

Building upon her previous comment, the participant added that spirituality and emotional intelligence are not valued in science. She called on us to “restore ancient knowledge”, to “transform and decolonize what we consider competence”, and to “honor the people who brought their lived experiences.”

Dr. Kowalik applauded the work of The Birth Justice Fund – Rapid Response Fund (BJF-RRF), an organization addressing the challenges in accessing capital in under-resourced communities. BJF-RRF is a three- year opportunity to advance community power efforts led by Black, Indigenous, and People of Color (BIPOC) birth justice (BJ) organizations to address implicit bias and structural racism and their impact on maternal and infant morbidity and mortality. The second wave of funding opens this month. Apply here.

Dr. Greene said, “Black scholars need a seat at the table. When you have the lived experience, you ask the right questions. That’s what makes the science better.”

Source: United States Breastfeeding Committee.

The authors of Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future echo Greene’s call and write that “public health and policy priorities need to center on listening to Black women, and funding Black, Indigenous, and People of Color (BIPOC) organizations and researchers conducting innovative projects and research.”

More to explore on the intersection between racism, capitalism and research in maternal child health 

Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.

Colorado pediatric office becomes breastfeeding friendly employer

Castle Rock Pediatrics (CRP) made a splash this summer at the Douglas County Fair Parade where they displayed their incredible Under the Sea themed float. Patients and families created a colorful array of paper plate fish that “swam” through pool noodle crafted seaweed.

CRP also attended the  Renaissance Expeditionary Magnet School Back to School Carnival and the Downtown Castle Rock Concert Under the Lights where they set up a lactation station.

After breastfeeding her own young children and later completing the Lactation Counselor Training Course (LCTC), Laura Westover PA-C, CLC, one of the providers at CRP, dove into helping transform her office into a Breastfeeding-Friendly Employer and soon-to-be Breastfeeding- Friendly Medical Office.

Their work is supported by a grant through the Tri-County Health Department. Westover has been working alongside Susan Howk, a breastfeeding policy specialist, to create their policies and lactation spaces through a six-point plan which includes policy, staff and provider training, patient education, environment, evaluation and sustainability, and continuity of care.

The grant has funded things like a chair, end tables, a hospital-grade multi user breast pump and kits, a stuffed animal nursing dog with her puppies for siblings to play with, and a lactation scale for weighted feeds.

Westover displays the breastfeeding friendly employer certificate in March 2022 standing in their first lactation space.

Their lactation space started in one of their smallest exam rooms, but has recently graduated to one of their larger exam rooms, which is now near the end of its renovation. Westover notes that the space also functions for newborn and young baby visits.

Westover reports that CRP owners since November 2021 Drs. Anderson and Bouchillon have been highly supportive of the breastfeeding-friendly changes.

Prior to the implementation of their lactation policies, Westover says their office “was not lactation friendly at all.” She describes stacks of formula in plain view.

“It gave the impression that we were promoting formula,” she comments.

Gift bags for patients were also riddled with formula-promotions, so the team phased out the branded materials and replaced them for non-branded, breastfeeding-friendly items.

Now, Westover and her colleague Sydney Gruenhaupt RN-BSN, CLC  see breastfeeding dyads weekly for office visits; whereas they once had to refer out. Of mothers’ main concerns are poor weight gain and uncomfortable or painful latch.

Westover points out that Colorado has very high breastfeeding initiation rates, but like the national trend, tapers dramatically at 6 months and beyond. While Westover and her colleagues are not currently tracking their office’s breastfeeding rates, it’s part of the plan in hopes that their numbers will hold steady beyond initiation rates. Westover explains since they’ve switched over to a larger electronic medical records system, there should be potential for a simple, infant feeding tracking system. A 2016 project by the County of San Diego Healthy Works program, implemented by UC San Diego Center for Community Health with funding from First 5 San Diego extensively explores current practices and future possibilities of  breastfeeding measurement in the outpatient electronic health record.

Westover and her colleagues will be out and about again this fall where they’ll craft their  lactation tent at events like Oktoberfest and the town of Castle Rock Spooktacular Halloween celebration.

“[It’s] really wonderful because we are able to promote [to] the whole community,” Westover shares.

For more about CRP’s lactation services visit https://castlerockpediatrics.com/Services/Additional-Services .

New Mexico Breastfeeding Task Force (NMBTF) at the forefront of harnessing the power of art

Art is multifunctional. It can be used to enhance or furnish a space, to document history, to simply fill a wall,  to convey a message or emotion or expression, to entertain. Art can do some or all of these things and more. While “art and health have been at the center of human interest from the beginning of recorded history,” the healing properties of art have only begun to be acknowledged in Western medicine in the past few decades, with art therapy first recognized as a profession in 1991. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/ ] 

Photo by Luiza Braun on Unsplash

The New Mexico Breastfeeding Task Force (NMBTF) is at the forefront of harnessing the power of art. Recognizing that art is medicine, the task force includes supporting lactation and breastfeeding/chestfeeding through art as a priority initiative, providing scholarships to chapters that take on the initiative.  

“We are  leaders in acknowledging how much art means to our communities,” says NMBTF Core Team Leader Siboney A. Rodriguez-Gallegos, LMSW, CLC. “When we can put those skills to paper or canvas or wall or bench or city bus, I think that we’re just barely starting to explore what can be done with that. I am really proud of our chapters.” 

In Valencia County, April Vasquez and Rosa Sisneros and other team members are working with artist Ana June to create the outline of a mural which will be painted collectively by community members on August 6. The unveiling of the mural will be held August 13. 

“We want to include the community as much as we can with this project,” Vasquez shares. 

She goes on to give a shoutout to University of New Mexico Valencia Assistant Professor of Fine Arts Sarah Heyward who has donated paint and other supplies for this project as well as thanking the property owners who have donated space for the mural to be displayed.  

The imagery is being created on a large canvas making the art moveable and less likely to be destroyed when building ownership changes or buildings are razed, like a past mural project by Betsy Casanos which was painted over when building ownership changed. Putting the art on canvas also allows for reprinting so that the art can be shared on other products and disseminated more widely, Rodriguez-Gallegos explains. 

Former mural that was painted over when building ownership changed. https://www.facebook.com/NMBFING/photos/gm.278067862815360/1881191575312766/

“It’s so exciting,” Vasquez begins. “There were a bunch of emotions getting it together… It’s happening!”  

Further south, Las Cruces County Chapter co-chairs Dr. Martha Morales and Melissa Marie Lopez and members are working with artist Kate Pults. This mural too is being created on canvas to avoid its potential demise on a fixed structure.  

Pults holds families, mothers and babies in many ways and we are thrilled to have her put those gifts in art form,” Rodriguez-Gallegos  shares. 

NMBTF has sponsored past mural projects here, here and here. An extension of the projects, you can find corresponding coloring pages of the murals here

The coloring pages are often distributed at community outreach events and in hospital settings like the antepartum unit and for parents who have babies in the NICU.

There is ample research that demonstrates the influential nature of imagery and how representation matters. (Explore some of those pieces here and here.) This is especially true as the baby milk substitute (BMS) industry advances their marketing tactics, and as we continue to navigate the COVID pandemic. 

Rodriguez says she sees these projects as a way to “reinvigorate the normalization of breastfeeding.”  

On August 31,  NMBTF will present the Lactation Art Gallery and Auction. Artists should submit their work by August 1. Find more information here.  

You can support NMBTF’s work by becoming a member or joining a chapter. Those interested can also donate monetarily to a variety of efforts. Find NMBTF across various social media platforms to help spread the word about the work they’re doing. 

Rodriguez shares her gratitude and pride in some closing thoughts: “All of our chapters put so much heart into the work that they do. It feels really good to be able to support [them]. The task force is really heading in a new direction to ensure we’re coming from an equitable lens, supporting our families, communities and wellness.”