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On Breastfeeding and Staying Away From Baby Formula

I am the soil, the filaments of the roots, the cradle of the shade.

It’s my power to nurture, pouring love

Into the beauty I held inside me.

Anyone that claims, my nurturing a burden,

Masquerading their fear of my power,

Their reluctance to redefine their ideas about shame

Shame not me, as I breastfeed.

Shame you, you failed your soil.

Breastfeeding is beautiful. The mother holds her child so close to her bosom, pouring strength and resilience, exhibiting love as the child smells home. It is empowering.

There is unequivocal global consensus about the importance of breastfeeding infants, both for infant and maternal health. A policy statement from the American Academy of Pediatrics highlights that ‘breastfeeding and human milk are the normative standards for infant feeding and nutrition.’

The following image outlines the benefits of breast milk and breastfeeding:

Source

According to the World Health Organization, if breastfeeding was adopted globally, it has the potential of saving the lives of about 8,20,000 children annually. Breast milk contains antibodies that provide resistance against the most common childhood illnesses such as diarrhoea and pneumonia, two major causes of child mortality worldwide. Further, research shows that adolescents who were breastfed as children are less likely to be obese and suffer from Type 2 diabetes.

As highlighted by the image, breastfeeding is beneficial for mothers too. Exclusive breastfeeding is a natural protection against pregnancy  for six months, with a pregnancy prevention rate of 98%. Further, it also mitigates the risk of infliction of breast and ovarian cancer, Type 2 diabetes and postpartum depression, on mothers.

The American Academy of Pediatrics recommends that infants should be exclusively breastfed for the first six months of their life.

The following table highlights the differences in the composition of breast milk, animal milk and infant formula, in turn explaining why breast milk is healthier for infants compared to the available alternatives:

Composition Breast Milk Animal Milk Formula
Anti-infective factors Present Absent Absent
Growth factors Present Absent Absent
Protein Adequate amount, easily digested by infants. Excessive proteins, difficult for infants to digest. Present in almost adequate amount but not as readily digested as proteins in breast milk.
Fat Essential fatty acids present and accompanied by lipase to digest it. Lacks essential fatty acids; lipase absent. Lacks essential fatty acids; lipase absent.
Iron Adequate, well absorbed. Adequate, but not well absorbed. Excess and not well absorbed.
Vitamins Adequate Lack of vitamin A and C. Present
Water Adequate Inadequate Inadequate.

(Additionally, there is no risk of bacterial contamination of breast milk, which may infest animal milk and formula)

Source: World Health Organization

In spite of the remarkable advantages of breastfeeding and breastmilk over available alternatives, globally only 40% of infants are exclusively breastfed in the first six months of their lives. This statistic stands at less than 55% in India, where breastfeeding has been glorified by various ancient scriptures including the Vedas and Sushruta’s Samhita.

Seems preposterous, right?

A web of reasons centered around the idea of shame associated with women’s breasts provides an explanation. Breastfeeding is beautiful. It is empowering. Unfortunately, the veneer of shame that it is shrouded in, crumbles beauty into burden, power into vulnerability.

The idea of sexual appeal associated with breasts together with the assumption that it is incumbent upon a woman to ‘cover up’ and not ‘reveal’ her breasts in public, is so ingrained in the fabric of our society that breastfeeding in public is a taboo, partially because women feel shamed and partially because there wouldn’t be any paucity of demeaning criticisms and stares from people around.

Consequently, breastfeeding which is supposed to be so sacred both for the mother and the infant, ends up being an inconvenient, stressful part of a mother’s life. With the constant fear of being ‘seen’ and the shame accompanying the same, how is a mother supposed to feed a child while travelling or at her place of work or anywhere outside her house? More often than not, while travelling in long distance trains, I’ve seen families struggling to conceal the mother while she feeds her child. This is disempowering. It constricts the mobility of new mothers because public places like bus stops, railway stations and malls may not have private nursing rooms. Further, this also makes it difficult for them to return to work after pregnancy if offices don’t have safe, private spaces for mothers to breastfeed their children (which sadly is the case for most offices). Additionally, it compels mothers to remain silent and not seek help when they experience difficulties while breastfeeding, which can have dire consequences for the health of the infants and the mothers alike. Lack of open, fearless conversations around breastfeeding also breeds the spread of rumours and incomplete or misconstrued understanding about the process of breastfeeding, the appropriate posture and the benefits of the same. For instance, colostrum is rumoured in some rural areas to be ‘witch’s milk’ while the truth is that colostrum, which is the first secretion from the mammary glands after a mother gives birth, is rich in antibodies and is essential for the infant’s health. The rumour may have arisen from the fact that colostrum often doesn’t look like milk, it is thicker and may even be yellowish in colour.

As a result, formula becomes an attractive alternative to breastfeeding. The infant formula industry is worth $70 billion. At the World Health Assembly held earlier this year, a proposition to promote breastfeeding globally was stalled owing to dissent by representatives from the United States of America, who wanted to promote and protect the profits of the infant formula industry. The New York Times reported that the American representatives even resorted to threatening representatives of underdeveloped and developing countries with trade sanctions and withdrawal of military support when they resisted.

The popularity of infant formula has been dwindling in the developed world owing to greater awareness about the benefits of breastmilk and breastfeeding. However, it is the developing world that is falling prey to the infant formula business. According to research conducted by the National Bureau of Economic Research, the availability of infant formula led to the death of 66,000 infants in low and middle income countries in 1981, when protests against Nestle Corporation’s infant formula were at their peak.

By employing unethical marketing practices and coercing unsuspecting mothers in low and middle income countries into adopting formula for their infants, the formula industry is targeting the very segments of the society who are at the greatest risk of health hazards from using formula as well as the ones who can least afford it. An investigation by The Guardian and Save the Children unearthed some of the illegal marketing practices adopted by leading infant formula companies in Philippines. These included luring hospital staff including doctors with tickets to opulent dinners and shows, handing out ‘infant nutrition’ pamphlets, which actually promote specific brands of infant formula, to mothers in hospitals where the rate of exclusive breastfeeding is about 34%. Lack of awareness about the benefits of breastfeeding over formula, imply that women in these countries are easily lured into wrongly believing that formula is superior to breast milk through advertisements that claim that formula results in children having a higher IQ (when the converse is true). Since formula is expensive, mothers often starve themselves and mix excess water with formula to satiate the hunger of the child which implies that the nutrition of both the infant and the mother are compromised.

“I didn’t eat just so I could feed the baby. There were some days when I didn’t eat anything. And Nestogen is expensive so I could not always give it to my baby when she was hungry, I only gave her half bottles, four times a day.” – A mother from the Philippines

Additionally, the lack of clean water in developing/underdeveloped countries implies that there is greater chance of contamination when mixing formula with milk.

That’s the reason, Mr Donald Trump’s tweet which claimed that many women need access to formula due to ‘poverty and malnutrition’ is ignominious.

Breastfeeding and breastmilk are not merely lifestyle choices but important public health concerns which need to be addressed promptly especially in low and middle income countries. Breast milk is not only the best alternative for infants but is also the most effective one and thus, communities in collaboration with governments should provide an open, safe environment for new mothers to voice their concerns regarding breastfeeding, learn how to breastfeed and safely do so in public and work places. Under a policy announced by the Government of Rajasthan, where the rate of infants receiving colostrum through breastfeeding in the first hour is merely 28%, special breastfeeding clinics will be set-up. Post delivery, the mother and infant will be shifted to these clinics with designated nurses helping new mothers to breastfeed their infants before shifting them to the post-partum wards. In a first, a special nursing room was installed on the Bandra railway station in Mumbai in 2017, exclusively for mothers to breastfeed their infants. We need similar initiatives on a larger scale, together with a clamp down on unethical and misleading marketing by infant formula companies. Greater social support and appreciation for breastfeeding are fundamental steps not only to protect the health of entire generations of infants but also to empower mothers.

NOTE: Sometimes, lactation is a problem for new mothers due to various medical conditions and often formula or artificial feeding is recommended by doctors when the mother can’t feed the baby. This article by no means, tries to demean this. Formula and artificial feeding in circumstances where breast milk and breastfeeding is not an option, is a boon. However, it is the deliberate shift away from breastfeeding, that this article tries to warn against.

Sara Sethia is a Research Associate (Gender Justice) at One Future Collective.

Featured image: NBC News

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