Weird Findings

 In the era of the International Breastfeeding Conference, Cindy Turner-Maffei and Karin Cadwell would present their beloved Weird Findings segment on the last day of the conference. I always found it delightful and now wistfully reminisce about the session sometimes.

One year, we learned about pink yak milk, spider milk, goat wet nurses and donkeys with “good moral reputations” with the alleged ability to cure distemper and poisoning. That year, I was also introduced to the jaunty tune “I’m a Mammal”.  It was all great fun; entertaining and educational.  

So, this week’s post is my attempt at a Weird Findings collection, a nod to all that is quirky. I landed on quirky as the best word applicable to most of the items below, but quirky and weird are really just umbrella terms for those things that might also be totally awesome, maddening, perplexing and all of the things in between and just outside of these descriptors. 

 

The artificial womb 

My high school biology teacher once asked our class to contemplate a riddle about the Nacirema people. Part of it contained a description of their reproduction which read like an excerpt from a science-fiction novel. Really, it described Americans. 

Reading about the development of an artificial womb to support premature birth had me thinking back to this exercise. 

Like any technology,  great promise and great unknown surround “advancements”. Because this womb is not available to humans yet and because of my overall skepticism, I thought it necessary to point out that we have a means to help very premature babies right this very moment…our bodies.

 

Be inspired, maddened, saddened, weirded out by the remainder of the comments here

 

Exercise and breastfeeding 

This study found that adiponectin concentrations increased in breast milk after high intensity interval training (HIIT). “It has been postulated that higher breast milk adiponectin concentrations may prevent rapid weight gain in infancy,” the authors write. The real-life implications of this discovery?  South China Morning Post’s coverage on the study points out how exercise has physical and mental benefits for mom and baby. 

 

Tomatoes and erectile dysfunction 

Around three minutes into this amazing video, Katie Hinde points out: “When we zoom in on the number of articles just investigating breast milk, we see that we know much more about coffee, wine and tomatoes… We know over twice as much about erectile dysfunction.

I’m not saying we shouldn’t know about those things — I’m a scientist, I think we should know about everything. But that we know so much less about breast milk — the first fluid a young mammal is adapted to consume — should make us angry.” 

 

The disgraceful CMF industry 

As sophisticated as the commercial milk formula industry’s insidious marketing tactics are, they are truly a disgrace in the event of pregnancy loss or stillbirth. The authors of an ABM blog post share the perspectives of mothers who endured pregnancy loss and stillbirth and subsequently received infant formula samples. 

 “‘It feels like a slap in the face, a punch to the gut,’ Caitlin C. says, after discovering formula samples at her door following two second-trimester losses. ‘If [the formula company] somehow knew I was pregnant, couldn’t they also know I’m not anymore?’”

 

Amphibian milk 

It wouldn’t be a proper Weird Findings collection without the inclusion of a creature that challenges our Linnaean classification system. NPR reported that “a species of worm-like amphibian has been caught on camera feeding milk to its young…The creature, known as a caecilian, lives underground. Researchers believe that the animal developed the ability to produce a milk-like substance independently of mammals…” Weird. 

 

Milk composition 

There’s weird and then there’s WEIRD: Western, educated, industrialized, rich, and democratic.   

Klein’s, et al work found variations in milk composition across populations classified by four subsistence patterns: urban-industrialism, rural-shop, horticulturalist-forager or agro-pastoralism. The authors synthesize: “Populations living in closer geographic proximity or having similar subsistence strategies (e.g. agro-pastoralists from Nepal and Namibia) had more similar milk immune protein compositions. Agro-pastoralists had different milk innate immune protein composition from horticulturalist-foragers and urban-industrialists. Acquired immune protein composition differed among all subsistence strategies except horticulturist-foragers and rural-shop.” 

It was found that “When compared with western populations, some of these groups have genetic profiles that favor… immune responses and elevated levels of immune molecules throughout life…” 

 

Microbiome and breast cancer 

Other examples of the microbiome and immune connection come from Nikki Lee’s ponderings.  “This new world of research is astounding!” she shares. 

In Microbiome and Breast Cancer: New Role for an Ancient Population, the authors show “a significant difference in the microbiome composition of nipple aspirate fluid between healthy individuals and patients with BC suggested the potential role of the ductal microbiome in BC incidence.”

In L-asparaginase from human breast milk Lactobacillus reuteri induces apoptosis using therapeutic targets Caspase-8 and Caspase-9 in breast cancer cell line the authors conclude that “Breast milk L. reuteri L-asparaginase induces apoptosis via Cas8 and Cas9 upregulation in the breast cancer cell line. L. reuteri L-asparaginase treatment may be the hopeful approach for the management of breast cancer. Furthermore, the results may highlight the fact that the presence of L-asparaginase-producing L. reuteri isolates in human breast milk may aid in breast cancer improvement or even prevention.”

“Could the microbiome be a reason that breastfeeding reduces the chances of breast cancer?” Lee asks.  

 

Choose and embrace breast milk

The Nigerian Federal Ministry of Health created a mass communication campaign to increase awareness of the importance of exclusive breastfeeding for infants in their first 6 months. This video features a Nigerian celebrity and family. Watch it here

The final element of a Weird Findings segment is song and dance! 

This video is a public health announcement rolled into song by Rodah Amakal, a gospel musician from West Pokot County for the Pokot community in Kenya. Enjoy! 

 

 



Balancing family health and economic well-being in Kenya

Josephine (Josie) W. Munene is the Director of Community Engagement at Maziwa Breastfeeding, an organization that helps mothers balance their babies’ health and their families’ economic well-being in Kenya. Munene leads the lactation education training programs and the Community Breastfeeding Ambassador peer support initiatives.

Munene completed her graduate work in the UK with a focus on international development, and while she imagined she would spend her life working globally, and after spending some time working in the corporate world, she determined a need for helping moms in her home country. 

After her first son (now 14 years old) was born, she struggled to find breastfeeding support. Munene noticed that many of the resources and programs were established in the Global North and lacking for women in her community. So Munene switched gears and launched a business that sold breastfeeding supplies like breast pumps and nursing bras and nursing pads different from the “lumps” handed out by the hospital. She was looking to infuse dignity in the experience, she explains.  But Munene quickly realized that it wasn’t enough to sell products to women, so she pursued the Infant and Young Child Feeding Counselor Training in order to meld her lived experience with technical knowledge and offer evidence-based care to breastfeeding dyads.   

Kenya ranks quite well in the World Breastfeeding Trends Initiative (WBTi) coming in at number 10 worldwide. Still, Munene shares that in Kenya, lactation professionals are not widely accepted as competent nor essential care providers. Instead, they are often considered “quacks” or the profession is regarded as a “hobby”. Munene has therefore made it a priority to engage in policy change with a goal to establish a national accreditation curriculum in her country that will recognize lactation care as an essential part of the continuum of care. Munene sees engagement of social enterprises in public private partnerships as an important piece to this work; reliance on governments alone or donor partners alone has proven to be ineffective, she comments. Further, Munene emphasizes the importance of engaging the people who the policies are intended to benefit. 

She sees an opportunity to adapt well-established accreditation programs in the Global North to Sub-Saharan countries’ needs. Growing the membership of the Kenya Association of Breastfeeding would signal to the Kenyan government the need for a local accreditation, she proposes. 

Recently, Munene and her colleagues helped facilitate a  Kenya Association for Breastfeeding workshop during the Amref International University (AMIU) Public Health Care Congress. A range of participants including gynecologists, pediatricians, students were invited to learn about the fundamental principles of lactation and breastfeeding. They then participated in reflecting on case studies using Healthy Children Project’s (HCP) 8-Level Problem Solving Process by Karin Cadwell and Cindy Turner-Maffei as a framework. 

Munune reports that the most interesting finding from the interactions was the participants’ identification of the need for breastfeeding support early on to alleviate or to eliminate challenges. 

Another takeaway illuminated  the specialized care that breastfeeding can require. Munene explains that in Kenya, breastfeeding generally falls under the nutrition category which overgeneralizes the “benefits” of breastfeeding and ignores the need for practical support that is tailored and effective. 

Munene mentions that Kenya employs Community Health Promoters which are important players in preventive health care, but the program does not address the need for more targeted support for breastfeeding dyads. 

Overall, Munene sees a need for a more comprehensive approach to lactation and breastfeeding care in her country. She calls for policies that go beyond “paperwork and guidelines”. 

For instance, Kenya has established lactation laws for working mothers, but she finds implementation and enforcement is lacking. [Check out this qualitative study for interesting  perspectives from women, families and employers in Kenya.] 

In Breastfeeding challenges for working mothers and their families in different workplace settings, around 18 minutes into the webinar, Munene presents on maintaining exclusive breastfeeding for working mothers.

Munene also reflects on maternity cash benefits for those working in the informal sector. These interventions can only be effective if they come with proper education, she reports. Cash benefits have the potential to influence personal nutritional wellness, and if individuals use the money to purchase indigenous foods from their neighbors, they have the added potential to boost income for the community as a whole. 

You can learn more about these endeavors and connect with Munune here

You might also be interested in learning about The Cost of Not Breastfeeding in Kenya. Check it out here.

LCTC participant fueled by daughter’s poor experiences

Shipley pictured with her grandchild.

As Tanya Shipley, a recent Accessing the Milky Way scholarship awardee, shares her experience working through the Lactation Counselor Training Course (LCTC) thus far, I sense both enthusiasm and relief.

“I love it!” Shipley exclaims. “I am learning so much stuff, oh my gosh, I love it. I  am just in awe.”

She goes on to explain that while she has always been interested in women’s health and wellness, she only became interested in maternal child health after her 35-year-old daughter’s pregnancy and birth this year.

Not unlike many women, and especially BIPOC women, Shipley’s daughter did not receive competent lactation care in the hospital.

“She was really bummed about it,” Shipley begins. “When she got home, she was having issues because she thought that she wasn’t producing enough milk. She felt like she let the baby down.”

Shipley blames some of what was lacking on her “own ignorance” as the grandmother.

At one point Shipley recalls suggesting: “Why don’t you just [give the baby] a little formula right now because she’s hungry.”

“It bothers me today because everything I am learning now,” Shipley reflects.  “It didn’t have to be that way.”

Shipley circles back to how much she is learning through the LCTC. This is where I hear a sense of relief in her tone; she is now well-equipped to share the knowledge she gains with not only new families but women her age, so that they can help their children, as she explains. It’s well-known that grandmothers have the capacity to influence exclusive breastfeeding. [More here and here.]

“After I finish a module,  I will call my daughter and I will share with her some of the things I am learning,” Shipley says.

Shipley recently left the entertainment industry and started volunteering for the Happy Mama Health Baby Alliance and Joy in Birthing Foundation. She also completed a birth doula workshop and finds herself exploring where she can make the biggest impact. She’s considering starting her own non-profit and providing lactation care in the hospital setting, fueled by the lack of care that her daughter received.

You can read more about grandmothers’ influence on infant feeding in For many, grandmothers are the village.

Centers for Disease Control and Prevention (CDC) changes their breastfeeding policy for HIV-infected mothers

Without major announcement, in February 2023,  the Centers for Disease Control and Prevention (CDC) changed their breastfeeding policy for HIV-infected mothers and no longer recommend advising against breastfeeding.

Photo by Paul Hanaoka

The new recommendation gets closer to the updated 2010 World Health Organization (WHO) guideline on HIV and infant feeding. Before 2010, “WHO guidance on HIV and infant feeding (UNICEF et al., 2003; WHO et al., 2006) recommended an individualized approach in which women living with HIV would be counselled on feeding options according to their household circumstances.”

The new CDC guideline acknowledges that, “For mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero,” as determined in the PROMISE Study.

The guideline goes on to recommend “patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making.” Read the full document here.

Organizations like the National Institute of Health Office of AIDS Research, the Infectious Disease Society of America and National Association of County and City Health Officials announced the new guidance, but it has gone largely unacknowledged in the field of lactation.

“This change in HIV policy serves as a reminder to always check sources. New research findings and policy reconsiderations make it imperative that the most up-to-date information is available to the families we serve,” Healthy Children Project’s Karin Cadwell PhD, RN, FAAN, IBCLC, ANLC comments.

Photo by Wren Meinberg

In the U.S., HIV diagnoses among women have declined in recent years; still, nearly 7,000 women received an HIV diagnosis in 2019. (The CDC has commented on the effect of the COVID-19 pandemic: “Data for 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state and local jurisdictions. While 2020 data on HIV diagnoses and prevention and care outcomes are available, we are not updating this web content with data from these reports.”)

How does the U.S. compare in their recommendations to other high-income countries?

The British HIV Assocation’s 2018 guidelines for the management of HIV in pregnancy and postpartum states that “Women who are virologically suppressed on cART with good adherence and who choose to breastfeed should be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation and the requirement for extra maternal and infant clinical monitoring” among other recommendations for helping manage lactation in HIV-positive mothers.

Photo by Laura Garcia

A National Health Service (NHS) Greater Glasgow and Clyde document Management of infants born to HIV positive mothers reads: “There is now evidence from developing countries that breast feeding while mum’s viral load is fully suppressed is safe, and BHIVA/CHIVA no longer regard a decision to breast feed as grounds for referral to child protection services. For HIV positive women who choose to breast feed, maternal HAART should be carefully monitored and continued until one week after all breastfeeding has ceased. The mother’s viral load should be tested monthly to ensure that HIV virus remains undetectable; this testing will be undertaken by the obstetric/ID team. It is recommended that breastfeeding be exclusive, and completed by the end of 6 months.”

You can learn more about Canada’s approach here and Switzerland’s here.

For more, check out  Lacted’s Clinical Question and the CDC’s Preventing Perinatal HIV Transmission.

From Africa to Appalachia, improved relationships and communication through nutrition research

 From Africa to Appalachia, Stephanie L. Martin’s, PhD, CLC research on nutrition during pregnancy, lactation, and childhood, has gone beyond nutrition alone.

In a world where infant feeding is commonly reduced to input and output, “perfect” latches and weighted feeds, Martin’s work illuminates the added benefit of improved relationships and communication. 

In Zambia for instance, Martin and her colleagues have looked at how to engage family members to support nutrition in women living with HIV and their children. 

Twenty years ago, when antiretroviral therapy (ART) was less accessible, the risk of transmitting HIV through breastfeeding was high. Today though, with an increase in availability and access to ART, the World Health Organization (WHO) recommends the use of antiretroviral drugs as a safe way to prevent postnatal transmission of HIV through breastfeeding. 

Still, Martin has found that mothers talk about their fears of transmitting HIV to their infants the same way they did two decades ago. Mothers often use unfounded strategies like breastfeeding for shorter durations, breastfeeding less often or offering other liquids in an effort to limit the risk of transmission. So, Martin and her team have counseled mothers not to cut feedings short. Martin shares that her most recent Lactation Counselor Training has offered new insight.

“I’m going to change things in our counseling materials based on what we learned in the CLC training [in regard to] how we phrase things about breastfeeding for longer periods of time; if there is efficient milk transfer, we don’t need to focus on this longer length of time,” she explains.   

Additionally, in an effort to reduce caregivers offering infants under six months food or drink other than breastmilk, alternative soothing recommendations were offered. Martin remembers one mother who tried the suggestions to calm her crying baby. The mother reported that propping her infant onto a specific shoulder alleviated the baby’s discontent. “I don’t know what it was about that shoulder, but she stopped crying,” Martin quotes the mother, noting the importance of empowering mothers and caregivers through counseling. 

In Tanzania, Martin and partners at Kilimanjaro Christian Medical University College sought to identify  facilitators and barriers to exclusive breastfeeding among women working in the informal sector. And in Kenya, Martin and colleagues have worked to improve adolescent nutrition in informal settlements.

Martin pictured with colleagues from Kilimanjaro Christian Medical University College and Better Health for the African Mother and Child organization

Throughout all of her work in East and Southern Africa, Martin says they are reliant on community health workers to roll out their programs. 

“It’s so important to understand their experiences,” Martin says of hearing out the helpers. 

Through her research , Martin has explored the experiences of peer educators, community health workers, WIC breastfeeding peer counselors, health care providers, and program implementers.

Surveying global health professionals provides an opportunity to learn from their experiences and fill gaps in the peer-reviewed literature to strengthen intervention design and implementation as concluded in Martin, et al’s Experiences Engaging Family Members in Maternal, Child, and Adolescent Nutrition: A Survey of Global Health Professionals

Through Facilitators and Barriers to Providing Breastfeeding and Lactation Support to Families in Appalachia: A Mixed-Methods Study With Lactation Professionals and Supporters, Martin draws parallels in the challenges lactation care providers in Africa and Appalachia face, including compensation and availability of services. 

Specifically in Appalachia, the authors heard lactation care providers expressing the desire for additional training for providing support around mental health, chest feeding, drug use, etc. 

Martin says that she found the Lactation Counselor Training Course (LCTC) covered many of these topics. 

“[The course] seemed very intentional in all of the right ways,” she says. 

The Appalachian Breastfeeding Network (ABN) also offers an Advanced Current Concepts in Lactation Course which covers these desired topics with scholarship opportunities. 

When asked if she’s optimistic about the future of maternal child health, Martin answers with a slightly tense laugh: “I feel like I have to say yes.” Martin goes on to explain the inspiring work of ABN and all of the lactation care providers she’s interacted with.

“If they were in charge of the world, it would be such a better place,” she begins. 

“When I think about them, I feel optimistic. I’d like to see different laws that are supportive of women’s health and families. We have all the right people to make positive changes.”