Breastfeeding and the environment: Guest post for World Breastfeeding Week 2020

By Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

Each year the World Alliance for Breastfeeding Advocacy (WABA) chooses a theme for World Breastfeeding Week (WBW) celebrations around the world. WBW is celebrated every year during the first week in August. This year’s theme is “Support Breastfeeding for a Healthier Planet”. 

The 2020 objectives are:

  • Inform people about the links between breastfeeding and the environment/climate change
  • Anchor breastfeeding as a climate-smart decision
  • Engage people and organizations for greater impact
  • Galvanize action on improving the health of the planet and people through breastfeeding

Can breastfeeding really affect climate change and create a cleaner, healthier environment? 

Our planet’s health is closely tied to human health, and so there is a growing interest in learning how to protect the health of the environment. 

Among the many things humans can do to protect the environment, breastfeeding is one of the most important. Breastfeeding is the best example of a clean, eco-friendly action to protect and improve the health of planet Earth. 

Breastfeeding is the ultimate natural, sustainable resource. It requires no raw materials needed for processing and no energy consumption in production or transportation. It does not produce any material waste or by-products, does not require any packaging materials, water resources or electricity, and creates no pollution of the air or water. Lactation is a perfect partner for environmental health and the ultimate example of “eating local”.

Parents who express their milk and feed from bottles or other methods also provide a more planet-friendly feeding method than artificial feeding. Formula manufacturing requires energy, material and transportation. 

The carbon footprint of breastfeeding gives us another glimpse into the environmental impact of breastfeeding. Wikipedia defines carbon footprint as “the total greenhouse gas emissions caused by an individual, event, organization, service, or product, expressed as carbon dioxide equivalent.” In simple terms, it’s a measurement that shows us something’s impact  on the health of the environment. 

The carbon footprint of breastfeeding is based on the production and transportation of food for the mother based on the RDA of an additional 500 kcal/day recommended during breastfeeding. According to research from the United Kingdom, the carbon footprint of breastfeeding is estimated at 5.9 (this varies between countries). 

In comparison, the carbon footprint of formula feeding— which is based on the use of resources, animal and factory production emissions and transportation of the formula as well as supplies, preparation and storage of formula at home— is estimated at 11.0 (again varying between countries). On average, feeding breast milk substitutes had a higher impact on the climate than breastfeeding in all countries studied. This certainly demonstrates the positive impact on the environment when the infant feeding choice is breastfeeding.(Bodkin, 2019 Meade, 2008)

The International Baby Food Action Network (IBFAN) supports optimal infant feeding practices and  advocates for universal implementation of the International Code of Marketing of Breastmilk Substitutes, an international health strategy recommending restrictions on the marketing of all formulas and supplies intended to discourage breastfeeding. In 2015 IBFAN developed their statement on breastfeeding and the environment:

“Breastfeeding protects our health and our planet – right from the start, breastfeeding is the first step towards protecting human health, short- and long-term. It is also the first step towards protecting the health of our environment and conserving our planet’s scarce natural resources. We need to start at the beginning, with infants and young children. Our babies and children are in no way responsible for climate change and environmental degradation, but instead they suffer the disastrous consequences.” (IBFAN, 2015)

 It’s clear that breastfeeding is the most climate-friendly option for infant feeding, but does the environment have an impact on breastfeeding? The answer is yes. 

For decades scientists around the world have studied the impact of environmental contaminants on the mammary gland, and on mothering behaviors. For instance, a study from the Journal of Health Science demonstrated that rats exposed to dietary bisphenol A (BPA) in early pregnancy showed cellular injury to the mammary glands as well as lower prolactin levels. (Miyaura, 2004). 

What’s more, Rochester Medical Center studies reported in Science Daily demonstrated damage to rat mammary glands to the extent that some mother rats were unable to nourish their pups after exposure to dioxins. Researchers noted that some rats were able to recover mammary function by late pregnancy. (Lawrence, 2009). 

In 2013, a study in the Journal of Neurotoxicology and Teratology showed a decrease in maternal behaviors in Wistar rats (less grooming, protection and nuzzling), a concerning finding but not yet demonstrated in humans. (Boudalia, 2013}.

Studies like these are the basis for ongoing research looking into possible negative impacts on human lactation. The studies are also the basis of much education related to how to create a safer environment while protecting lactation.  

An unpublished study from Wright State University looked at mothers with self-described low milk supply and the relationship between environmental contaminants. The 78 mothers in the study were four  weeks to eight  months postpartum and were all given education on reducing exposures to environmental estrogens (personal care products, food hormones and plasticizers). 

Results were seen in one to five weeks and ranged from the mothers stating her “breasts were fuller,” the “babies seemed more satisfied,” and fewer needed supplementation. Some found a doubling of supply (noted with pumping during work hours). Seven had no noticeable increase in milk supply, and of those only two weaned from breastfeeding. The rest continued supplementation. (Walls, presented 2009). 

In a Mexican study of young Yaqui tribe women, those who moved from native land  to new chemical based agriculture, had less alveolar tissue compared to the young women who remained with the tribe and practiced  traditional, non-chemical farming techniques. 

Many of the agri-chemical exposed young women were found to have larger than normal breasts, but less glandular tissue (referred to as “empty breast” syndrome) and many were unable to breastfeed their infants which is viewed as an integral part of mothering in their culture. (Hansen, 2010).

On the surface, these studies can seem discouraging until we really weigh the risks and benefits of breastfeeding in a polluted world. 

First, human milk contains properties that have been shown to mitigate some negative, environmental effects. (Williams, Florence, NYT) 

For instance, human milk contains bio-active components which specifically control and resolve inflammation, promote a thick, healthy gut lining to support an optimum functioning immune system and provide the most nutritious food for optimum general health for infants and children.  

Emeritus Director of the Carolina Global Breastfeeding Institute Miriam Labbok, MD, MPH, IBCLC stated “The fact that studies of child [health] outcomes in highly polluted areas are still better for the breastfed infant . . . would seem to indicate that certain factors in the production of human milk and in the milk itself, immunological and other, may mediate the potential harm of the ambient pollution.”

She went on to say, “… No environmental contaminant, except in situations of acute poisoning, has been found to cause more harm to infants than does lack of breast-feeding. I have seen no data that would argue against breastfeeding, even in the presence of today’s levels of environmental toxicants.”

Sandra Steingraber, biologist and author of Living Downstream and Having Faith: An Ecologist’s Journey to Motherhood agrees: ”We haven’t yet compromised breast milk to such an extent that it’s a worse food than infant formula…..”

The American Academy of Family Physicians (AAFP) has also published that certain components of human milk act to increase the infant’s elimination of some toxins and to protect the infant’s developing brain, central nervous system, and body as a whole.

WABA’s statement  on breastfeeding and environmental contaminants echoes this sentiment and  encourages breastfeeding as the safest feeding choice despite maternal exposure to contaminants. 

Their statement reads: “Is the presence of these chemical residues in breastmilk a reason not to breastfeed? No. Exposure before and during pregnancy is a greater risk to the fetus. The existence of chemical residues in breastmilk is not a reason for limiting breastfeeding. In fact, it is a reason to breastfeed because breastmilk contains substances that help the child develop a stronger immune system and gives protection against environmental pollutants and pathogens. Breastfeeding can help limit the damage caused by fetal exposure.” (WABA, 2005.)

The World Health Organization’s (WHO) review on contaminants and human milk states definitively, “The benefits of breastfeeding far outweigh the toxicological disadvantages that are associated with certain POPs” (persistent organic pollutants). 

To reiterate, considering the safety of human milk even when contaminants have been detected, neonatal intensive care researcher Fani Anatolitou (2012) states, “the detection of any environmental chemical in breast milk does not necessarily mean that there is a serious health risk for breastfed infants. No adverse effect has been clinically or epidemiologically demonstrated as being associated solely with consumption of human milk containing background levels of environmental chemicals”. 

It is important to understand that many of the measurements of POPs in human milk are not clinically meaningful, hence are not a cause for alarm. Even more importantly, as mentioned earlier, a number of components of human milk act to counter potential risks of contaminant exposure (Anitolitou, 2012). The Centers for Disease Control and Prevention (CDC) points out that effects of exposure have only been detected in a breastfeeding infant when the mother was extremely ill.

As lactation care providers we are in a unique position to not only support the optimum health of infants and children, but also be a part of creating a healthier environment for the children to grow and thrive.

For more on WBW check out this action folder by BPNI

Resources/References

American Academy of Family Physicians (AAFP). (2018). Breastfeeding, Family Physicians Supporting (Position Paper). Downloaded 17. Jan. 2018 from https://www.aafp.org/about/policies/all/breastfeeding-support.html

American Academy of Pediatrics (AAP), Section on Breastfeeding. (2012). Breastfeeding and the use of human milk (Policy Statement). Pediatrics 129(3), e827-e841. DOI: 10.1542/peds.2011-3552.

AMERICAN ACADEMY OF PEDIATRICS The Transfer of Drugs and Other Chemicals Into Human Milk Committee on Drugs  https://pediatrics.aappublications.org/content/108/3/776/T7

Anadón, A., Martínez-Larrañaga, M. R., Ares, I., Castellano, V., Martínez, M. A. (2017). Drugs and chemical contaminants in human breast milk. In R. C. Gupta (Ed.), Reproductive and Developmental Toxicology (2nd Ed., pp. 67-98). London, UK: Academic Press.

Anatolitou, F. (2012). Human milk benefits and breastfeeding. Journal of Pediatric and Neonatal Individualized Medicine 1(1), 11-18. DOI: 10.7363/010113.

Arnardottir,H. et al. Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology, October 2015 DOI: 10.1038/mi.2015.99

Bodkin, H. Breastfeed to save the planet, scientists say as study exposes infant formula damage to environment https://www.telegraph.co.uk/science/2019/10/02/breastfeed-save-planet-scientists-say-study-exposes-infant-formula/

Boudalia, S. et al.  A multi-generational study on low-dose BPA exposure in Wistar rats: Effects on maternal behavior, flavor intake and development. Neurotoxicol Teratol 2013                      Nov 20. pii: S08920362(13)00217-1. doi:10.1016/j.ntt.2013

Climate Change and Health June 2015 https://ibfan.org/docs/climate-change-2015-English.pdf

Dadhich, J,  Lellamo, A. Report on Carbon Footprints Due to Milk Formula: a Study from Selected Countries of the Asia-Pacific Region

BPNI/IBFAN Asia, New Delhi (2015). http://ibfan.org/docs/Carbon-Footprints-Due-to-Milk-Formula.pdf, Accessed 24th Jan 20

Eidelman AI. Environmental Impact on Maternal Breastfeeding Behavior. Breastfeed Med. 2018 Jul/Aug;13(6):397. doi: 10.1089/bfm.2018.29096.aie. Epub 2018 Jul 5.PMID: 29975551 

Goldman, A. Anti‐inflammatory Properties of Human Milk. September 1986.  https://doi.org/10.1111/j.1651-2227.1986.tb10275.x 

Hoffman K, et al. Lactational exposure to polybrominated diphenyl ethers and its relation to social and emotional development among toddlers..Environ Health Perspect. 2012 Oct;120(10):1438-42. doi: 10.1289/ehp.1205100. Epub 2012 Jul 19.PMID: 22814209 

Joffe, N. Support for breastfeeding is an environmental imperative. Oct 2, 2019. www.bmj.com › content › bmj

Karlsson, J.O. The carbon footprint of breastmilk substitutes in comparison with breastfeeding. Feb 2019. Journal of Cleaner Production. https://doi.org/10.1016/j.jclepro.2019.03.043

Kowalewska-Kantecka B. Breastfeeding – an important element of health promotion. Dev Period Med. 2016;20(5):354-357.PMID: 2839125

Mead, N. Contaminants in Human Milk: Weighing the Risks against the Benefits of Breastfeeding Environ Health Perspect. 2008 Oct; 116(10): A426–A434PMCID: PMC2569122 PMID: 18941560

Murínová, P et al. Partitioning of hexachlorobenzene between human milk and blood lipid..Environ Pollut. 2017 Oct;229:994-999. doi: 10.1016/j.envpol.2017.07.087. Epub 2017 Aug 1.PMID: 28778790

Natural Resources Defense Council. 2005. Healthy Milk, Healthy Baby. Chemical Pollution and Mother’s Milk. New York, NY: National Resources Defense Council. http://www.nrdc.org/breastmilk/chems.asp

Pan IJ, Paediatr Perinat Epidemiol. 2010 May;24(3):262-71Lactational exposure to polychlorinated biphenyls, dichlorodiphenyltrichloroethane, and dichlorodiphenyldichloroethylene and infant growth: an analysis of the Pregnancy, Infection, and Nutrition Babies Study. doi: 10.1111/j.1365-3016.2010.01114.x.PMID: 20415756

 Poore and Nemecek, 2018.  Reducing food’s environmental impacts through producers and consumers. Science, 360 (6392) (2018), pp. 987-992. https://doi.org/10.1126/science.aaq0216

Stigum H, et al. A novel model to characterize postnatal exposure to lipophilic environmental toxicants and application in the study of hexachlorobenzene and infant growth..Environ Int. 2015 Dec;85:156-62. doi: 10.1016/j.envint.2015.08.011. Epub 2015 Sep 19.PMID: 2639804339

Terri Hansen, Today correspondent. Pesticide exposure deprives Yaqui girls of breastfeeding – ever,  Feb 28, 2010. https://www.sej.org/headlines/pesticide-exposure-                              deprives-yaqui-girls-breastfeeding-ever

Toxic Release Inventory http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?TRI

Tran CD, Dodder NG, Quintana PJE, Watanabe K, Kim JH, Hovell MF, Chambers CD, Hoh E  Organic contaminants in human breast milk identified by non-targeted analysis.Chemosphere. 2020 Jan;238:124677. doi: 10.1016/j.chemosphere.2019.124677. Epub 2019 Aug 26.PMID: 31524616

United Nations Sustainable Development Goals and Breastfeeding https://www.un.org/sustainabledevelopment/blog/tag/breastfeeding/

Vermeulen, B.M. Campbell, J.S.I. Ingram. Climate change and food systems. Annu. Rev. Environ. Resour., 37 (1) (2012), pp. 195-222

WABA Towards Healthy Environments for Children Q. Frequently asked questions (FAQ) about breastfeeding in a contaminated environment https://www.waba.org.my/whatwedo/environment/pdf/faq2005_eng.pdf

Breastfeeding in shelters

Among the many effects of the novel coronavirus, the pandemic has exposed our nation’s deficiencies: emergency unpreparedness, racial health disparities, our “highly polarized, fragmented, and individualistic society…” (I would add arrogant), and the failure of capitalism.  In marginalized populations, poverty, health inequities, and other burdens are amplified during an outbreak or other emergency. 

Long before the pandemic hit, individuals and advocacy organizations have been ringing the alarm, calling for better access to education, better healthcare, and equity and justice for all.

Of these trailblazers is Powerhouse Nikki Lee RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, CKC, RYT whose recent endeavor includes creating and implementing the 10 Steps to a Breastfeeding Friendly Shelter

In her role at the City of Philadelphia Department of Public Health, Lee noticed the challenges breastfeeding people face in shelters. 

The barriers are a result of our cultural attitude toward lactating people and misunderstandings about their bodies and needs. 

Lee talks about issues of privacy and ‘fairness’ in a shelter. Organizational dress codes often require residents to dress modestly, so when a person exposes their breasts to feed a baby, other residents can wonder why they’re not allowed to wear short shorts. Parents can express concern about the teenage boys in their families seeing breasts while a baby is being fed.

There’s the concern over safe milk storage and the mythology around reimbursement through the Child and Adult Care Food Program. Shelter staff may believe that if a mother breastfeeds, the facility will lose money to buy food because the allotted amount for infant formula isn’t getting used. Lee clarifies that if a mother breastfeeds, the institution will have more money to spend on food.  

Just like in the rest of the US, there tends to be a push for formula feeding because the baby’s intake is easily measured, and staff are more comfortable with what is familiar, i.e. bottle-feeding

Lee continues, “There is a genuine honesty from people who don’t understand anything about breastfeeding, ‘Why are we breastfeeding?’ ‘Why are we bothering?’”  Staff in hospitals have been educated about breastfeeding over the past few decades; staff in shelters have not.

So when she conducts trainings, she starts at the rudimentary level of ‘what are mammals?’ 

“All the worst mythology that you can imagine is in the shelter,” Lee says. “All the worst in how society treats mothers and babies gets magnified in shelters.” 

With the problem identified, Lee says she started “from scratch in a way,” looking for a written policy to support breastfeeding people.  Early on in her search, she followed up on a news story featuring a homeless mother in Hawaii. She posted inquiries on Lactnet, CDC listserv, international online forums, Facebook groups, and reached out to shelters at random wondering if they had breastfeeding policies . 

“Nothing,” Lee reports. “There is probably a shelter somewhere that has a policy, but after two years of a global search, I wasn’t able to find it.” 

In all her search,  Lee found one published document— a Canadian study looking at the factors that influence breastfeeding practices of mothers living in a maternity shelter– that could be helpful. 

Lee wrote the first draft of the 10 Steps to a Breastfeeding Friendly Shelter with policies like the Ten Steps to Successful Breastfeeding and Ten Steps to Breastfeeding-Friendly Child Care in mind. 

She sent it out to colleagues at CHOP’s Homeless Health Initiative for feedback, and for quite a while, there was none. Lee’s colleague Melissa Berrios Johnson, MSW,  a social work trainer with HHI, and the convenor of its breastfeeding workgroup subcommittee, helped to make the policy reality. 

Partner agency Philadelphia Health Management Corporation (PHMC) received a grant that funded research which took the policy to four different shelters for staff and resident feedback. 

“Everyone, residents and staff alike, felt this policy was important and feasible,” Lee says. 

PHMC’s next step was to identify a shelter staff member to become a breastfeeding champion. This champion would be provided with free breastfeeding training, and receive an honorarium.

As program oversight changed though, “breastfeeding champion” became a job, with a list of responsibilities. So far, Lee says they’ve only found four people out of 10 shelters who are willing to take on the task.

“There are some folks in shelters working hard to make things better,” Lee says. “They are those champions, most of whom have breastfed themselves.”

Currently, Lee and colleagues are in the process of developing training for staff members and ironing out how to help staff implement the policy.  

Lee’s and co-authors Alexandra Ernst MPH, and Vanesa Karamanian MD, MPH landmark paper about the 10 Steps to a Breastfeeding Friendly Shelter has been submitted to the  Journal of Human Lactation (JHL)

At present, COVID has put all of this work on hold.

A time for renewal

On one of my favorite walking routes, there is a beautiful oak tree that shades the street corner. Its sprawling roots heave through the sidewalk. One day, a dreamy song played through my earbuds, and as I walked toward the tree I felt the urge– almost like a spiritual calling– to touch its sturdy bark. Making contact with its trunk, a tickling, buzzing static traveled through my arm and zapped my ears like some energy had traveled through the cord on my earbuds. Stunned, I stepped back and gazed up at the oak’s gangly branches overhead, for a second believing that I’d connected with some otherworldly force. The sun shone down on the scene, casting a stark outline between the tree’s branches when I realized they were intertwined with telephone wires overhead.

Human innovation and nature entangled. 

April 22, 2020 marked the 50th anniversary of Earth Day and as this video points out, while we breathe through masks, our planet breathes a sigh of relief.

Healthy Children Project faculty, Master Herbalist, Certified Aromatherapist and author of  Growing Green Families: A Guide for Natural Families and Healthy Homes Donna Walls, RN, BSN, IBCLC, ICCE, ANLC agrees that Earth Day this year has a “different look.” 

“Around the world we are seeing the rebound of the earth when there is reduced human impact,” she says. “We see fish returning to the waters of Venice, kangaroos jumping in the streets of Sydney and comparison pictures of Los Angeles two months ago and now with clear, blue skies.” 

For the first time in decades, air pollution has cleared enough to reveal mountaintops from over 100 miles away. (Find pictures here and here.)  

Walls wonders if these spectacular phenomena will motivate humans to better care for our planet moving forward. 

She explains: “Being a maternity nurse for many years I usually go directly to ‘how does this impact new families?’ Maybe this is the opportunity to educate families on a cleaner life for our children, grandchildren and the planet.”

In 2013, Walls pioneered Miami Valley Hospital’s Green Team in an effort to provide safer, toxin-free products for families. 

“Anyone who says healthcare is not about cleaning up the environment is not well,” she laughs.

The Green Team worked to eliminate disposable diapers, formaldehyde-layden mattresses and unsafe, employee hand soaps, Walls reports. They found a clean, safe line of products and ultimately saved money.

Looking ahead, Walls poses: “At this time of renewal for the earth, can we make it the beginning of a new way of thinking, starting with the care and feeding of the newest members of the human race?” 

The environmental cost of infant formula milk is well documented in some countries. 

For instance, “For the UK alone, carbon emission savings gained by supporting mothers to breastfeed would equate to taking between 50,000 and 77,500 cars off the road each year,” recorded in research by UKRI Future Leaders Fellow at Imperial College London

IBFAN and BPNI published Formula for Disaster , a document that details infant formula’s detrimental impact on the environment and by contrast, breastfeeding’s sustainability. 

WABA also includes information on “the most ecologically sound food available to humans”– breastmilk. 

Bethany Kotlar, MPH, Program Manager, Center of Excellence in Maternal and Child Health at Harvard Chan School Center of Excellence writes in Amidst the COVID-19 Pandemic, We Must Remember Maternal Health, “The pandemic gives us the unique opportunity to reassess the cracks in our society…” 

We’ve been granted the opportunity to reevaluate our responsibility to our planet and pledge to protect it so that we may continue to receive its bounty and find solace in its beauty. 

“Treat the earth well. It was not given to you by your parents—it was loaned to you by your children.” —Native American proverb