At the World Health Assembly meeting in Geneva this past spring, the United States delegation shocked the assembly by opposing breastfeeding regulations that would encourage nations to limit the use of infant formulas and milk substitutes.
When it comes to feeding newborn babies, the science is settled: Breast milk has myriad health benefits that formula simply can’t rival. This became clear in the 1970s, when Nestlé began to aggressively market infant formula in developing countries and running ads implying it was just as good as breast milk.
Unlike formula, however, breast milk provides nursing babies with antibodies to protect from some infectious diseases, such as malaria. As many as 1.5 million babies died across the developing world because they were fed infant formula rather than breast milk.
In 1981, alarm over Nestlé’s advertising campaign led to the International Code of Marketing Breast Milk Substitutes. A resolution to strengthen this code was expected to pass easily at a recent meeting of the World Health Assembly. But the US delegation stunned participants by opposing it.
Elisabeth Starken, director of the Infant Feeding Action Coalition in Canada, explains what happened: “This year, Ecuador had taken the lead on a new resolution, which included the new guidance on ending the inappropriate marketing of foods for infants and young children,” Starken says. “However, when the Trump administration got wind of it, they began to threaten the Ecuador government with economic sanctions, so Ecuador was forced to drop the lead on this proposed resolution. Subsequently, the Russian Federation took up the lead and the other countries continued to support the resolution.”
Companies who sell formula often make nutrition and health claims in their advertising and on their labels which suggest that a certain ingredient, such as DHA or ARA, will lead to better eyesight, brain development or neurological development, Starken says. Instead, she insists, these companies should include warnings that formula can actually lead to increased rates of diarrhea, respiratory disease, obesity and cardiovascular disease, as well as various other long-term consequences.
“Formula feeding has not only short-term consequences of infectious diseases, but also long-term consequences for human health,” Starken says.
Starken has seen these problems up close. She worked in the pediatrics department of a university in Nigeria, where her role was to set up a unit for malnourished children.
“This is where I saw firsthand the devastation of formula feeding in a developing country,” she says. “The water, of course, is just not potable for mixing formula, the cost is prohibitive and it's just very deadly to be formula feeding — and breastfeeding is so normal. To see the sabotaging of breastfeeding in that context really hit home for me. And then to see the high mortality and the high rates of malnutrition and dehydration and other side effects that this would cause. As a matter of fact, we called it Baby Bottle Syndrome.”
A study in the journal The Lancet estimates that roughly 800,000 lives will be saved when breastfeeding becomes optimal, Starken points out. Unfortunately, she adds, infant formula and baby foods are a $70 billion annual market, so there is a huge incentive for these companies to push for weaker regulations.
Shortly after this story emerged, Donald Trump took to Twitter and called it “fake news.” He said: "The US strongly supports breastfeeding, but we don't believe that women should be denied access to formula. Many women need this option because of malnutrition and poverty.”
Access is not a problem, Starken counters.
“The International Code of Marketing of Breast Milk Substitutes does not restrict access; it restricts the marketing and the promotion of the products. If you are living in poverty and you're suffering from malnutrition, it's an incredibly costly way to feed your infants. If the mother is malnourished, you want to support the mother nutritionally so she can feed her baby.
“Formula should be a product that is used when needed, and all the precautions that are needed in order to prepare and feed the products safely should be there, as well as good health monitoring of infants who are formula-fed,” Starken continues. “Those conditions should be in place for mothers who are unable to breastfeed or if a mother has passed away and the baby needs to be fed with formula. There are situations where there is a need for formula.”
Nevertheless, according to the World Health Organization, breastfeeding remains the best option for babies: IQ levels are higher; infants experience fewer neurological problems and fewer deaths related to diarrheal and upper respiratory diseases. Incidences of cancer, diabetes, obesity, cardiovascular disease are much lower in a breastfed population.
“And of course, breastfeeding is part of our normal reproductive system that creates this very special relationship between a mother and her infant and young child,” Starken adds. “These are things that you could never reproduce and put into a tin can.”