Opportunity to submit comments on the most recent World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories

The amount of work that needs to be done to improve families’ lives can sometimes feel paralyzing. Over the next few weeks though, individuals and organizations will have the opportunity to engage with an important endeavor: submitting comments on the most recent World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories.

The WBTi report assesses the status of benchmarks on the progress of implementation of the Global Strategy for Infant and Young Child Feeding.

The first national assessment in the U.S. was completed in 2016 with an update made in the spring of 2019.

The U.S. as a nation scores consistently low in most indicators.

In 2017, Healthy Children Project also released a national report based on the WBTi criteria that monitors the progress of infant and young child feeding (IYCF) in each of the 50 U.S. states plus six  territories.

This year, the subject matter expert panel is calling on any individual with an interest in maternal child health to submit their comments on the next update by June 30. In order to include any initiative on the report, the information must be documented on a publicly available source.

Healthy Children Project presented the preliminary reports at the United States Breastfeeding Committee’s National Conference and Convening June 8- 10 to gain feedback from state coalitions.

What we measure as a nation is what we value, thus the report helps guide lactation policy by gauging the success of current practices and determining where improvement is needed.

On a state, organizational or individual level, the reports can help channel opportunities to engage in areas where states are lacking.

Find the preliminary reports and submit comments here: www.wbtiusa.org

You will need to enter your email address to receive a password, which will allow you to suggest changes and additions.

The Details

WHO: Individuals vested in maternal child health in the U.S. and territories

WHAT: 2023 World Breastfeeding Trends Initiative’s (WBTi) report for the United States and territories

WHEN: Now until June 30

HOW: www.wbtiusa.org

WHY: To help guide and improve maternal child health policy

Tips for infusing equity into philanthropy

In April, we reported on a thread that came up during the Black Birth Maternal & Infant Health Symposium: capitalism and how it influences health equity.

This month, the United States Breastfeeding Committee (USBC) hosted Philanthropy with an Equity Lens featuring Dr. Cara V. James of Grantmakers in Health.

Photo by Jon Tyson

For those who couldn’t attend, there will be a recording sent to registrants. And if you missed registration, we’ve distilled the conversation in hopes that you’ll use it as a jumping-off point in your discovery or continued understanding of operationalizing Diversity, Equity, and Inclusion (DEI) or what is sometimes referred to as J.E.D.I. (Justice, Equity, Diversity, Inclusion).

First off, USBC Senior Engagement & Training Manager Denae Schmidt and Dr. James made the distinction between operationalizing DEI and advancing health equity. Simply put, the former is the practice and the latter is the outcome. Dr. James suggested participants think of the distinction as the difference between who is doing the work and who is being served.

So, what practices are philanthropists adopting in order to serve the advancement of health equity?

  • Funders are reevaluating what is truly needed from grantseekers. Many are making the application process less tedious, acknowledging that many small organizations do not have the resources to “jump through hoops.”
  • Some funders are forgoing reporting requirements, adopting the concept of trust-based philanthropy.  Trust-based philanthropy embraces the idea that the community has a lot of expertise, as Dr. James puts it. In this relationship, there is trust in the collaboration, a power share. Dr. James nods to MacKenzie Scott who tends to vet organizations on the front end in order to understand their focus, and then give funding with no strings attached.
  • Over the past five or so years, there has been a shift in the field to recognize that there needs to be more capacity-building for grant seekers. Catchafire is a “network of volunteers, nonprofits, and funders working together to solve urgent problems and lift up communities” offering pro bono services. Find out how that works here: https://vimeo.com/462743914
  • Dr. James reports that more people are starting to recognize that policy is an important piece in health equity. She said that we need to get “upstream” to address health disparities which means that we need to address the structures that lead to poor outcomes in conjunction with providing resources to organizations.

 

What are some tips for grant seekers?

Photo by Tim Mossholder
  • Grantseekers can check funders’ websites for statements on commitments to DEI to make sure it’s a good fit for them. Grantseekers might also research what other projects funders have supported to get a sense of what kind of work they invest in.
  • Grantseekers might consider inviting potential funders to their events in order to engage with the community. Dr. James suggests not approaching the first meeting with funders with an “ask”.
  • Work alongside and across spaces to pool resources like talent and time. Collaboration expands reach, and this is desirable to funders.
  • Don’t be afraid to reach out to funders to get more information about how proposals can align more with their commitment.

Schmidt and Dr. James closed with some thoughts on why good intentions just aren’t good enough. Mainly, good intentions don’t always lead to action, Dr. James pointed out. And sometimes, she added, they can lead to harmful action. She reminded us that we didn’t start talking about health equity in 2020. These discussions had been happening long before, and what has been missing are the resources and the support in leadership.

What leadership talks about in public and in private signals what they care about, Dr. James continued. Individuals leading DEI initiatives need to have the authority and the respect to make decisions.

So, generally speaking, what can we all do to help operationalize DEI?

  • Take the courageous stand to commit to DEI.
  • Facilitate the collection and evaluation of DEI initiatives, so that we can gain an understanding of what is happening in these spaces.
  • Enter spaces with cultural humility. Recognize who is already in the space and what you can learn from them.

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

 

Breastfeeding is food sovereignty. Breastfeeding is health equity. Breastfeeding is healing.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is food sovereignty. Breastfeeding is health equity. Breastfeeding is healing.

Breastfeeding is a “weapon of mass construction”, a phrase coined by Camie Jae Goldhammer, MSW, LICSW, IBCLC, (Sisseton-Wahpeton).

In her Reclaiming the Tradition of Breastfeeding: the Foundation of a Nation webinar, Goldhammer describes how breastfeeding has the power to heal those suffering the effects of generational trauma, specifically through the release of oxytocin, subsequently allowing mothers and their babies to feel empowered and independent.

Photo by Luiza Braun

Kathleen Kendall Tackett’s work also illuminates how breastfeeding can heal trauma. Her videos, How Birth Trauma Affects Breastfeeding and Breastfeeding Can Heal Birth Trauma and Breastfeeding’s Healing Impact on Sexual Assault Trauma discuss the mechanisms behind why and how breastfeeding can be helpful for trauma survivors. Essentially, breastfeeding allows for the down regulation of stress responses, specifically adrenocorticotropic hormone (ACTH) and cortisol, and similar to exercise, improves maternal mood, decreases the risk of depression, decreases hostility, and improves the mother infant bond.

Jennie Toland, BSN, RN, CLC offers commentary on the role lactation care providers play in offering trauma-informed care in this piece.

This Invisibila episode, Therapy Ghostbusters, shares the incredible story of how a Cambodian practitioner worked to help heal an entire community from generational trauma. It took him over a year to simply earn individuals’ trust.

“…That’s pretty unique,” the podcast hosts point out and offers insight into how our nation approaches care for individuals with specific mental health needs and cultural considerations.

Goldhammer quotes Round Rock elder Annie Kahn:  “When a mother nurses her baby, she is giving that child her name, her story and her life’s song. A nursed baby will grow to be strong in body, mind and spirit.”

This connection to the past that Kahn refers to, also offers a form of healing. Breastfeeding is an example of Indigenous food sovereignty, “a part of living culture” and facilitates the revitalization of traditional knowledge. (Cidro, et al 2018)

The revitalization of breastfeeding spans the Black Indigenous People of Color (BIPOC) experience and is a channel to champion equity.

Ifeyinwa V. Asiodu,  Kimarie Bugg,  and Aunchalee E.L. Palmquist write in Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future:

“Breastfeeding is an especially important public health issue in Black communities, particularly given that Black families and communities continue to experience the highest burden related to poor maternal and infant health outcomes, including higher incidence of preterm birth, low birth weight, maternal mortality and morbidity, infant mortality, and lower breastfeeding rates. Owing to lifetime exposure of racism, bias, and stress, Black women experience higher rates of cardiovascular disease, type 2 diabetes, and aggressive breast cancer. Given that cardiovascular disease and postpartum hemorrhage are leading causes of maternal mortality and morbidity, increasing breastfeeding rates among Black women can potentially save lives.”

Photo by Emily Finch

More specifically, studies show that the experience of racial discrimination accelerates the shortening of telomeres (the repetitive sequences of DNA at the ends of chromosomes that protect the cell) and ultimately contributes to an increase in people’s risks of developing diseases.

It has been found that higher anxiety scores and inflammation are associated with shorter telomere length.

Because physical and psychological stressors trigger the inflammatory response system, one way to counter this reaction is by supporting ongoing breastfeeding relationships; when breastfeeding is going well, it protects mothers from stress. (Kendall-Tackett, 2007)

Another study found that early exclusive breastfeeding is associated with longer telomeres in children.

Photo by Luiza Braun

The authors of Achieving Breastfeeding Equity and Justice in Black Communities: Past, Present, and Future continue, “Yet breastfeeding is rarely seen as a women’s health, reproductive health, or a public health strategy to address or reduce maternal mortality and morbidity in the U.S. Inequities in lactation support and breastfeeding education exacerbate health inequities experienced by Black women, specifically maternal mortality and morbidity, and thus a greater investment in perinatal lactation and breastfeeding education and resources is warranted. Breastfeeding is an essential part of women’s reproductive health.”

Journalist and maternal child health advocate Kimberly Seals Allers’ approach is one “For Black people, from Black people.”

“…The call to revive, restore and reclaim Black breastfeeding is an internal call to action,” Kimberly Seals Allers begins in Black Breastfeeding Is a Racial Equity Issue.  “… Breastfeeding is our social justice movement as we declare the health and vitality of our infants as critical to the health and vitality of our communities.”

Specifically through her work with Narrative Nation, Seals Allers and colleagues are promoting health equity “by democratizing how the story of health disparities is told,” centering BIPOC voices. Additionally, through her Birthright podcast, KSA uplifts stories of  joy and healing in Black birth.

Especially after the deaths of George Floyd, Breonna Taylor and Ahmaud Arbery, organizations made statements about their commitments to dismantling structural racism and focusing efforts on equity.

Equity has become a buzzword; in fact, one author brands the sentiment “Fakequity”. This year, United States Breastfeeding Committee (USBC) National Conference and Convening presenters expressed their fatigue with the word.

“We want to see action,” they said.

Nikki & Nikki LIVE offer their Allies, Advocates and Activists Equity in Lactation webinar which covers the meaning of equitable in lactation care, how to show up for the marginalized and how to make a lasting impact.

In other efforts, the CDC has identified breastfeeding as a priority area to address health inequities.

Photo by Luiza Braun

NICHQ’s Achieving Breastfeeding Equity campaign also focuses on closing breastfeeding disparity gaps, viewing their efforts through an equity lens.

Director of policy and partnerships at the National Women’s Health Network Denys Symonette Mitchell offers commentary on a way forward with key policies that will ensure investment in breastfeeding to ultimately advance health equity.

Watch Racism and the Colonial Roots of Gendered Language in Public Health and Biomedicine with Dr. Aunchalee Palmquist, PhD, IBCLC for more on these issues.  

 

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us about how you are contributing to working toward healthy equity.

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

Breastfeeding is collaborative.

–This post is part of our 10-year anniversary series “Breastfeeding is…”

Breastfeeding is collaborative.

A breastfeeding dyad is a beautiful, fascinating, complex organism. Mother and bab(ies) attend and respond to one another facilitating nourishment, the flow of hormones, immunity, learning and bonding, comfort, fun, an all-encompassing sensory experience that has generational impacts on social, emotional and physical health.

Photo by Luiza Braun

In this intimate depiction of a breastfeeding dyad, a world of collaborative intricacies occur: the undulation of baby’s tongue to help with milk removal, the contraction of myoepithelial cells thanks to oxytocin elicited by baby, the removal of milk to signal mother’s body to produce more, to name a few.

It’s clear that breastfeeding is so much more than “the healthiest feeding choice” nutritionally speaking. Take the following anecdotes for example.

Nikki Lee offers her commentary to this case report on infant botulism in an exclusively breastfed baby explaining how interactive feeding can save a baby’s life.

https://unsplash.com/@luizabraun

“One doesn’t have to ingest honey to contract botulism. Exclusively breastfed babies can get botulism. Some parts of the continental US have c.botulinum in the soil; construction stirs up the soil, and the germ floats in the air. The breastfeeding mother is the one to notice that the baby’s suck isn’t as strong. This is a reason that breastfed babies survive botulism, because they get diagnosed and treated sooner than bottle-fed babies.”

In this case, breastfeeding offered early detection of breast cancer in the mother because of her baby’s refusal to nurse from one side. This phenomenon is known as Goldsmith’s Sign.

To demonstrate the importance of  the relationship that breastfeeding affords, we might consider the implications of separation. Lee again offers insight on the implications of mother baby separation in this piece.

Zooming out to view breastfeeding less individualistically and instead as a global food security system, we must recognize the collaboration necessary to support the breastfeeding dyad and abandon the idea that breastfeeding is a solitary act, a “one-woman job”.

https://unsplash.com/@luizabraun

In Breastfeeding as a ‘Resilient’ Food Security System: Celebrating…. And Problematizing Women’s Resilience in the face of chronic deprivation as well as emergencies, Dr. Vandana Prasad, MBBS, MRCP (Ped) UK, MPH describes breastfeeding as “wholly community-based”. Dr. Prasad continues that breastfeeding is potentially universally accessible and sustainable because it  “depends wholly upon the status of time, energy, health, nutrition and general availability of women”. This achievement, breastfeeding as definitely universally accessible and sustainable,  would require collaborative efforts by “governments, decision-makers, development partners, professional bodies, academia, media, advocates, and other stakeholders” working together, as Dr. Tedros Adhanom Ghebreyesus writes.

In the U.S., WIC has created an interactive resource “to help reinforce the important role that family and friends play in supporting breastfeeding moms.” The resource invites WIC staff to “click through the prompts with parents, grandparents, and others discussing when and how to offer helpful support so that mom and baby continue to thrive.”

At an organizational level, the United States Breastfeeding Committee (USBC) uses a collective impact approach to manage multi-sectoral collaborations, working to protect, promote, and support breastfeeding and human milk feeding.

Source: United States Breastfeeding Committee.

Internationally, the Global Breastfeeding Collective calls on donors, policy makers and civil society to increase investment in breastfeeding worldwide.

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: Who is your s/hero in the field of maternal child health?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.