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.



Celebrating Semana de La Lactancia Latina and the efforts of Lactancia Latina en el Suroeste de Kansas

It’s almost Semana de La Lactancia Latina (September 5- 11)! New this year to National Breastfeeding Month, we celebrate Latina/x families and raise awareness about infant feeding barriers specific to Latin communities.

Residents and visitors of Southwest Kansas have the delight of enjoying the efforts of the Lactancia Latina en el Suroeste de Kansas, an organization formed in late 2018 with the nurturing of the Kansas Breastfeeding Coalition and Ford County Breastfeeding Coalition.

Photo by Rosalba Ruiz, used with permission from Latina/x Breastfeeding Week/ https://www.facebook.com/Latinxbreastfeedingweek

This week, with the help of Carmen Valverde, CLC, Local Coordinator at the Lactancia Latina en el Suroeste de Kansas and 2022 USBC Cultural Changemaker Awardee, we highlight the organization’s projects in honor of Semana de La Lactancia Latina.

At the age of seven, Valverde was an immigrant to the United States. Her passion to help the Latin community comes from not having the support she needed while raising her young children.

“I totally relate to the struggles the families in Southwestern Kansas face,” Valverde comments.

In partnership with Vigness Welding, NACCHO, UnitedHealthCare, Western Kansas Community Foundation, the Kansas Breastfeeding Coalition,  and the City of Dodge City,  Lactancia Latina en el Suroeste de Kansas coordinated the placement of several lactation benches throughout the Southwest communities.

The first bench was placed in Garden City because they have the largest zoo in the rural region. Each bench has a QR code with the Kansas Breastfeeding Coalition directory so that families can find the support they need based on their zip code, Valverde explains.

Photo source Lactancia Latina en el Suroeste de Kansas

Additionally, billboards were installed in high traffic areas. The billboards have information about where to find infant feeding support on social media and information about lactation in the workplace.

Alongside breastfeeding, soccer is Valverde’s other passion; Lactancia Latina en el Suroeste de Kansas is a proud sponsor of the Dodge City Toros and Atletico Liberal. Sponsorship was made possible by HealthConnect One.

Valverde has made it a point not to “reinvent the wheel” in the coalition’s efforts to support breastfeeding and become more visible.

“… I like to work and partner with other organizations and events so that we can both have the best outcome,” Valverde begins. “It just works out better that way… So far the public has received it very well. We’ve had more moms… get involved with our local coalitions as a result of it and the [local] newspaper has done a piece on [the sponsorship].”

During one of the most trying times during the pandemic, the coalition was able to accomplish the recording of a PSA with a local meat packing plant in Dodge City. Valverde says the plant, Cargill, does a marvelous job investing in their employees. Watch the video here.

Lactancia Latina en el Suroeste de Kansas provided scholarships to an all-Spanish breastfeeding training made possible through a NACCHO grant and partnership with Lactation Education Resources’s certified breastfeeding specialist training. Valverde reports that the coalition is currently planning an  in-person skills day training so that the online training material can be reinforced.

Source: United States Breastfeeding Committee

You can learn more about these projects and Lactancia Latina en el Suroeste de Kansas’s future endeavors on Facebook.

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

Asian American Native Hawaiian Pacific Islander (AANHPI) Breastfeeding WeekTelling 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

The enemy of knowledge is not ignorance; it is the illusion of knowledge

I’ve been following this conversation started by the Grammar Girl:

“I was a guest on a podcast where kids asked two people questions to decide who was the fake and who was the real expert.

The host said that early on, the kids thought the fake was the expert every time because the actors answered every question confidently, and the experts would hedge or even sometimes say, ‘I don’t know.’

They eventually told the fakes to be less confident so the kids would have a chance of picking the expert sometimes.”

The Grammar Girl’s post was making a point specifically about ChatGPT, but the sentiment can be applied more generally, and in our case to the field of lactation and other perinatal care providers.

Some of my favorite comments on the Grammar Girl’s post include:

Never trust an expert who isn’t willing to admit that they don’t know.

Experts know that there are sometimes variables or gray areas, thus they don’t answer in terms of absolutes.

That makes me think of how an intelligent person (possibly an expert in something) is still curious and open minded enough to not always be sure of everything. 

Those who are experts, look before they leap, stop before they comment, ask for help and do their research. Saying ‘I do not know’ is a strength.

It reminds me of the quote: ‘The enemy of knowledge is not ignorance, it is the illusion of knowledge.’ 

Individuals on the perinatal care team can get stuck in a rut where humility is absent, and this can become dangerous for their patients. 

Debra Bingham of PQI, in a recent newsletter, reminds us of physiologic humility.

Bingham writes:

“Perinatal health professionals work tirelessly to provide the best care they can. Unfortunately, sometimes we get stuck performing “strong but wrong” routines. For example, we have centuries of evidence to tell us that physiologic birth practices are key to having the best outcomes. Yet, too often we do not practice what I like to call physiologic humility. Humility that the physiology of a woman’s body before, during, and after giving birth is complex and typically works well on its own. Thus, we should proceed with physiologic humility because there are so many limitations in our knowledge of the complex physiologic processes related to birth …

As perinatal health professionals it is our responsibility to do everything possible to ensure that women in our care get to experience Mother’s Day. Especially this month, may we all continue to keep that in mind and as a top priority.”

In all fields of care, cultural humility must also be maintained. As defined by the National Association of County & City Health Officials (NACCHO), cultural humility (CH) is “a lifelong process of self-reflection, used to better understand the multi-dimensional identities of clients in order to establish and maintain respectful, healthy, and productive relationships.” NACCHO’s Shifting the Care Paradigm Fact Sheet describes how lactation care providers can partner with families and their community to understand individual patients’ cultural background, experience and personal challenges, and specific goals. 

In the U.S., perinatal care is often siloed; however, this trend seems to be evolving as care becomes more collaborative. Collaboration requires all care providers to exercise a level of humility, offering their expertise while respecting and hearing out other members of the care team. Most importantly though, care team members must work together to respect their patient’s wishes and facilitate informed decision making.

“Absolute certainty leaves little room for shared decision-making,” the author of  Humility and the practice of medicine: tasting humble pie points out.

The author later concludes that “the cultivation of humility is often painful and requires a high level of self-awareness and reflective practice.”

A challenge indeed, but worth the effort. Consider “taking a bite” of “humble pie.” [Chochinov, 2010]

Centering and celebrating cultures in health: Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities

During the first week of April each year, the American Public Health Association (APHA) brings together communities to observe National Public Health Week. This year’s theme  is Centering and Celebrating Cultures in Health and highlights the importance of fostering cultural connections to health and quality of life. 

Last month, we celebrated National Nutrition Month, an annual campaign by the Academy of Nutrition and Dietetics which highlights the importance of making informed food choices across the lifespan.

Photo by Angela Roma

A beautiful example of the convergence of these two themes is work being done by the Asian Pacific Islander Breastfeeding Task Force (APIBTF) a part of  Breastfeed LA, tailoring the Dietary Guidelines for infants and toddlers for Chinese and Vietnamese communities. This project 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. The prenatal toolkit was adapted from an existing toolkit in Alameda County, and is available in English, traditional Chinese, and Vietnamese.

The initiative is supported by the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity (CDC/DNPAO). NACCHO selected seven communities to strengthen community lactation support through the implementation of the Continuity of Care in Breastfeeding Support: A Blueprint for Communities from November 2022 to July 2023. The purpose of this project is to support the implementation of CoC strategies by local-level organizations among oppressed communities with historically low rates of chest/breastfeeding. [https://www.naccho.org/programs/community-health/maternal-child-adolescent-health/breastfeeding-support#early-childhood-nutrition]

Photo by Roderick Salatan

 

The dietary resources which include an Educational Handout from Dietary Guidelines, Nutrition Resource Directory, and social media posts can be found here, available in English, Chinese and Vietnamese. The materials include a dietary guidelines hand out with two toddler-friendly recipes (with a fun suggestion to use green onion to decorate steamed eggs), three social media messages with a timeline for infant feeding, human milk recommendations, and complementary food recommendations, all commonly eaten in Asian communities. The deliverables are full of color and easy to navigate. 

Judy Li and Cindy Young presented their work during NACCHO’s The First 1,000 Days Nutrition: Improving Nutrition Security for Infants and Toddlers in Communities of Color where the Improving Infant and Young Child Nutrition during the first 1,000 days in Communities of Color summary report was introduced. 

Li, Young and their team’s work was community-informed, standing by the sentiment, “Nothing about us, without us.” The team spoke with community members about eating habits and learned that families do not eat according to the MyPlate graphic. Instead, they enjoy their meals in family-style servings from bowls. Recipes developed were tested by community members with children and tailored according to their suggestions; for example, the addition of different dipping sauces.

Participants also offered feedback stating that they appreciated the accessibility of the ingredients. 

 

Helpful links

ASAP!’s Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Social Media Toolkit 

National Public Health Week’s shareables and toolkit (available in Spanish)  

USDA’s Dietary Guidelines for Americans (2020-2025)

The Association of State Public Health Nutritionists (ASPHN) brief on Transition Feeding 

Public Health Nutrition Deserves More Attention

Undernourished and Overlooked