by Dr David Bratt
Two weeks ago, the Breastfeeding Association of Trinidad & Tobago (TBATT) and the Ministry of Health launched World Breastfeeding Week with an online international symposium on the theme, “Step Up for Breastfeeding—Educate and Support.” In addition to T&T there were 20 countries represented by doctors, nurses, nutritionists etc, from places as diverse as Barbados, Italy, the USA, Moldavia, Israel and Greece. The audience included one doctor from T&T. Does this mean that our doctors are so up to date with breastfeeding that they are not interested in breastfeeding? That’s doubtful.
At the start of the Symposium, Dr Erica Wheeler, the PAHO/WHO Representative, Trinidad and Tobago, recalled some of the challenges that women who want to breastfeed face, but do not have the assistance of the medical profession.
Her words are invaluable: “’Breast is Best’: a mantra we all know well. I won’t go into the benefits of breast feeding given the audience today, but I will say that despite all that we know and do, breastfeeding rates for at least 6 months are below 44 per cent globally. The result: the continued undermining of health outcomes for mothers and babies. WHO estimates that 800,000 deaths annually could be averted if breast feeding rates were achieved in both high and low income countries.
Today’s theme is a directive to guide our collective action to educate and support mothers to breastfeed, so that they and their babies can reap the benefits. But how do we clear the hurdles to breastfeeding that women face? Their preference to use formula; lack of knowledge of the enormous benefits; work constraints; inadequate maternity protection; mothers thinking that they do not produce enough milk to satisfy their babies; societal norms or pressures, unfortunately, in some instances inadequate support from the health sector to improve breastfeeding rates; the aggressive marketing of formula milk; and misleading scientific claims that advocate formula as being superior to breastmilk.
So the answer to the question on how do we clear the hurdles to breastfeeding that women face? We do this by “Stepping up for Breastfeeding—Educating and Supporting.”
The WHO/UNICEF 2022 report: “How the marketing of formula milk influences our decision on infant feeding” is a recommended read for everyone whose interest is the health of women and children. It shares the experiences of more than 8,500 women and 300 health professionals across eight countries in each of the WHO regions, including Mexico in our region of the Americas.
The report revealed that 51 per cent of pregnant and postnatal women were exposed to aggressive formula milk marketing through multiple channels and approaches, including via social media, events, free-samples, promotions and gifts. It noted that mis-information and misleading scientific claims were the hallmarks of its aggression with ads, for example, focusing on how formula helped with brain development and growth.
During the COVDI-19 pandemic, it asserted the outlandish claim that formula helped with immunity against SARS-CoV-2. Formula was positioned as modern and breastfeeding antiquated. However a prospective longitudinal cohort study in The Netherlands published in the Lancet in April this year showed that vaccination of lactating women against COVID-19 may protect not only themselves but also their breastfed infant through human milk. Another piece of research from “the Scientist of December 21 worth noting is that of Young and Jarvinen-Seppo, who incubated milk from the vaccinated and infected cohorts with live SARS-CoV-2 virus. Antibodies from both groups neutralized the virus.
Ladies and gentlemen, the goal for 2025 is to reach 50 per cent exclusive breastfeeding for at least 6 months and supportive health care practices are crucial to get us there. PAHO/WHO stands with you in your efforts to strengthen the health system and the efforts of health care professionals in this regard. The Baby-friendly Hospital initiative is a key initiative that focuses on the policies and training needed to support mothers and healthcare providers to improve breastfeeding, and by extension the health of citizens. Honourable Minister, PAHO stands ready to further support your efforts to legislate, regulate and enforce the International Code of Marketing of Breast-milk Substitutes.
Ladies and gentlemen, collectively we need to boldly counter misinformation and the manipulation of science used in formula milk marketing strategies. Clearly this will be an uphill battle judging from past experiences and the recent experience of the COVID-19 pandemic. The US$55 billion formula milk industry will not sleep on this issue and neither must we. Our nation depends on our fortitude and staying power in this fight.
I would like to thank TBATT for its tireless work on this front and for gathering and uniting us here today around this call to action.”
On behalf of TBATT, this column thanks Dr. Wheeler for her powerful words of wisdom.