Monday, 26 August 2013

Deconstructing infant formula

What follows is not intended as a convince-you text where breastfeeding as such is concerned. If, in the light of the compelling evidence that’s readily available elsewhere, you don’t already fully subscribe to breastfeeding’s universal significance, it’s unlikely that you will be won over by delving here.

On the other hand, if you already accept this fundamental truth, I hope that my reflection will contribute by suggesting what we might do, individually and collectively, to move things forward.

From a commercial standpoint, one of infant formula’s most important comparative advantages is that in most markets – for that is what we’re dealing with here, marketing – it is firmly lodged in the public consciousness as No. 2 in the child-feeding hierarchy, and a very close second to breast milk at that. I compare this strategic result to what the global rental-car company Avis has accomplished since 1962 by making a lemons-into-lemonade virtue out of being second behind the reputed market leader Hertz.

What I would really like more people to know about are the life-long health and developmental implications for millions of babies the world over of the routine corruption of the cellular matrix, including their guts and brains; their eyes and ears; their renal, respiratory and cardiovascular systems; and the very essence of their tissues, organs and organ systems by the everyday non-emergency use of infant formula that’s supposedly flawless in every way – nutritionally “adequate”, “perfectly” clean, correctly mixed, and lovingly fed.

And what I would also really like more people to know about are the short- and longer-term implications of routine artificial feeding for the health of many millions of women, including increased risk of pregnancy, postpartum hemorrhaging, iron-deficiency anemia, hip fractures and osteoporosis, breast, uterine and ovarian cancer, and quite possibly diabetes.

The truly extraordinary thing is this: All this information and considerably more is already out there and readily available in the public domain, some of it for decades; and it is being confirmed and reinforced almost daily by new studies, new evidence and new understanding about this integral part of the reproductive process on which the healthy growth and development of the infants and young children of our species depend. Indeed, you could look it up. But as English philosopher John Locke observed, it is one thing to show people that they are in error. It is quite another to put them in possession of the truth.

I’m reminded here of one of sociology's elementary principles: A situation defined as real, is real in its consequences; and of the hypothesis of delusion, which is applied to psychopathology in some schizophrenic patients. The ordinary dictionary meaning of “delusion” is a false belief that’s maintained despite compelling evidence to the contrary. Given the mass of compelling scientific and epidemiological evidence about the harm caused by routine artificial feeding, it’s hardly farfetched to qualify as collective delusion the unquestioned faith that the general public and health professionals alike in many settings continue to place in infant formula.

Reframing risk

In fact, the perceived relative risk of routine artificial feeding in industrialized countries is extremely low to non-existent despite an avalanche of contrary evidence regularly reported in the popular media. If scientific inquiry demonstrates that "breastfeeding is protective against SIDS", it’s not unreasonable to conclude that artificial feeding increases SIDS risk. If it’s true that "breastfed babies are less likely to die", it’s not unrealistic to assume that artificially fed babies are more likely to die. If we can believe that "breastfeeding decreases infant mortality", it’s hardly outlandish to accept that artificial feeding increases infant mortality. If "Breast-feeding cuts risk of myopia", shouldn’t we be trumpeting the news that "Infant formula raises risk of myopia"? And doesn’t "Breast milk halves gluten intolerance risk" translate into "Artificial feeding doubles gluten intolerance risk"? The backward way these headlines are currently cast accurately mirrors the majority perception. It suggests that even when reporting hopeful news, many journalists, too, can’t quite come to grips with – or even identify – the cultural chasm between normal breastfeeding as the original default child-feeding mode and normalized artificial feeding. They are writing, wittingly or not, in ways that continue to mask artificial feeding’s serious life-long consequences for the health of children (for example higher blood pressure in adolescents and increased risk of obesity in adulthood) and mothers (the link between artificial feeding and increased risk of some cancers surely ranks as one of popular health knowledge’s best kept secrets).

Consider what happens when the national public health authorities in the world’s largest infant formula market get behind a year-long multi-media campaign with the truly inspired title Babies Were Born to Be Breastfed (click here to view some of the TV ads). Well, several things if you bear in mind that the launching of an ad campaign with a commercial-market value of $40 million was delayed for seven months because of intense pressure not only from infant formula manufacturers (which is at least understandable) but also from the American Academy of Pediatrics (which is hardly intuitive to the uninitiated). As a result, and despite convincing research pointing to the importance of focusing on risk, the campaign’s approach was changed from pointing out the risks of formula feeding to highlighting the benefits of breastfeeding. This certainly isn’t the tack taken in most major public health campaigns over the past, say, half-century to promote awareness about reducing health risks through public service advertisements, for example on seat-belt use, not smoking, and preventing underage drinking, drunk-driving and obesity. Why have we made an exception for breastfeeding?

We continue to devote considerable time and other resources to singing the praises of breast milk and breastfeeding. Isn’t it time we also focused on illustrating why normalized artificial feeding is next to the nadir of nutritional mediocrity and what the true – that is complete and permanent – costs are, both to individuals across the entire life course and thus to society as a whole? Completion of the counterrevolution already under way will be deferred for as long as there is lack of a critical mass – an adequate proportion of the general public, health professionals and politicians that has finally grasped what routine infant formula feeding is really all about and what its true implications are in both the short and longer term.

Infant formula will sustain life in a pinch, and thank goodness this is so. But as I describe elsewhere [see here], from a nutritional and developmental standpoint, most people do not understand just how hugely inferior it is to breast milk, with negative implications for both children and their mothers – and thus the whole population – across the entire life course. The idealized view of normalized infant formula feeding that manufacturers are so adept at portraying – and, regrettably, so many consumers, health professionals and politicians are inclined to accept – doesn’t allow for even a hint of this disenchanting reality. Finally, routine non-emergency formula feeding ends up being perceived across society and culture as a perfectly legitimate, albeit second-best, source of nourishment for children instead of the vastly inferior ersatz pretender that it is.

Sending formula back to the medicine cabinet

If we wish to move infant formula, once and for all, from the kitchen pantry and permanently relegate it to where it got its start – in the medicine cabinet, for emergency use only – there needs to be a major shift in popular, health-professional and political thinking. In the second decade of the third millennium, deconstructing infant formula may well be our single most important priority in this connection, starting in well-to-do environments in any part of the world. It most assuredly is a pre-condition to moving to breastfeeding’s next plateau – improved awareness followed by the significant behavioral change throughout society that will lead to greater prevalence and duration.  As with seat-belt and tobacco use, based on what we already know about the direct and indirect costs, to individuals and to society as a whole, of more or less breastfeeding, there should be no let up in promoting this health-enhancing behavior as an overall societal good. Breastfeeding is an idea whose time has returned. We quite literally can’t afford to do otherwise.

Clinching the counterrevolution

But let me not appear to be waxing too lyrical too long. I am also keenly conscious of the challenge of change and its differential rate – slower or faster in one part of a culture or in one society compared with another. Public-health revolutions are anything but linear; despite real progress it’s clear that in 2013 too many people still fail to buckle up and too many people still use tobacco in one form or another. But a key difference today is that virtually no one any longer dares to suggest that either approach is somehow beneficial or risk-free. Moreover, consensus about what is desirable, indeed normal, behavior in this regard could not be clearer.

Formula: a pediatric fast-food.
Where breastfeeding is concerned, even if “everyone” supposedly now knows that breast is best, not nearly enough people know just how damaging routine artificial feeding is both for today’s children and tomorrow’s adults and the soaring price that society continues to pay for its collective ignorance. Postpartum child development, for better or for worse, is nutritionally programmed at the base level of still-maturing tissues and organs. It is clear that achieving our genetic potential – including in terms of brain development, visual acuity, even longevity – is just not going to happen by ingesting a pediatric fast-food prepared from the milk of an alien species.

We need to emphasize the steadily expanding evidence about the short- and longer-term risks associated with routine artificial feeding; they should surprise no one given so fundamental a deviation from the biological norm for the young of our species. I propose this be done initially by undertaking major multi-center research projects, in representative low-, medium- and high-income settings, followed by international expert consultations to present results and forge global consensus on two interrelated topics:

Topic one: “Beyond breast is best” – to focus on the multiple risks of artificial feeding and their impact on the health of children and mothers alike, and thus society as a whole, throughout the life course.

Topic two: “We can’t afford not to breastfeed” – to get a firm fix on the multiple, complex and lifelong economic implications of observing or disregarding the hominid blueprint for nourishing the young of our species.

What about formula makers?

So what about the infant-food industry – does it have a place at the table? Yes, I think it does, albeit a narrowly defined ad hoc one [see here], in the same way that manufacturers of emergency equipment – for example air bags, oxygen masks, life vests and inflatable rafts – have places at consortium tables around which also sit hospitals, airlines, aircraft and automobile manufacturers, accident prevention bureaus and consumer organizations. I’m not naively suggesting that the infant-food industry, as presently self-perceived, will voluntarily assume such a narrowly defined and spartan straight-back chair in favor of its currently coveted cushy one; just that, if this is indeed the seat we want the industry to occupy, it’s up to us to effect the downward product-demand shift – through significantly more and longer breastfeeding – that will make industry only too glad to grab it out of sheer enlightened self-interest. But as with gradually shifting society-wide attitudes toward tobacco and seat-belt use in recent decades, we’re not going to see this downward shift in product demand happen overnight, or at all, except by altering the way society as a whole views artificial feeding and its life-long negative consequences.

James Akre prepared this post for The Alpha Parent. It is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).


Andrea Karim said...

Isn't it enough, really, to have formula "firmly" lodged as "second best" in the public mind? As someone who had no choice but to feed her baby formula, there's nothing quite so tiresome as being constantly reminded of my failure as a parent, the damage that I am doing to my child, and the horrors that will be wrought upon society by my breasts' refusal to produce milk.

I understand the benefits of breast milk. Too well. In fact, I wish I had never learned of it to begin with, because perhaps I could enjoy watching my happy, healthy, developmentally advanced daughter grow without feeling like I am depriving her of something important.

Jennifer Fletcher said...

Andrea, no one is having a go at you. The article states that there is a place for formula. When it is needed for a baby to survive then it is a godsend.
You shouldn't feel bad for formula feeding your daughter if that's what you had to do.
There is no question that formula is inferior to breast milk though. The purpose of bringing this up is to ensure that babies and mums who are able to breastfeed naturally should do just that. Formula should be a last resort, not a convenient option. It's for the good of mums and babies out there.
If it could be given on doctors prescription, then maybe mums like you in future, who have to feed formula, can get it for free!

Jane Graves said...

I have four children and experienced different challenges with each one in breastfeeding them. Only the youngest never had any formula. I now work supporting mums to breastfeed as long as they want to.
I was upset when I read this article. I wish I had been able to fully breastfeed all my children. It is difficult to accept that I may have made choices that increased their long term health risks. I wish I had been given better information and support.
I think that some of the resistance to viewing formula as an emergency baby food, is that many people - including health professionals, grandparents and others who influence the decisions of new mums about feeding - would have to face up to the understanding of the risks they have taken in routinely feeding their own children formula. Having experienced this myself, I can report it is difficult to handle. For some people it may seem easier to ignore the risks and go on seeing formula as the 'second best'.
After some years I have come to a place of peace about what happened - I am thankful for my wonderful healthy children - but I would like my daughter's experience to be different if ever she has a baby.

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