tag:theconversation.com,2011:/es/topics/breast-milk-6184/articlesBreast milk – The Conversation2024-03-14T12:43:02Ztag:theconversation.com,2011:article/2229442024-03-14T12:43:02Z2024-03-14T12:43:02ZProteins in milk and blood could one day let doctors detect breast cancer earlier – and save lives<figure><img src="https://images.theconversation.com/files/581419/original/file-20240312-28-8qcsls.jpg?ixlib=rb-1.1.0&rect=18%2C91%2C5398%2C3982&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What if a simple blood test could diagnose otherwise undetected breast cancer?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vascular-testing-in-research-laboratories-royalty-free-image/1443155227">Srinophan69/Moment via Getty Images</a></span></figcaption></figure><p>Doctors may someday be able to use bodily fluids to noninvasively detect breast cancer in patients earlier than is possible now.</p>
<p>Breast cancer is the <a href="https://doi.org/10.3322/caac.21763">most commonly diagnosed cancer among women</a> in the U.S. and is currently one of the leading <a href="https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/cancer-facts/cancer-facts-for-women.html">causes of cancer deaths</a>. Earlier diagnosis and treatment <a href="https://doi.org/10.1002/cncr.32887">lead to better prognoses</a> for breast cancer patients. But mammograms have proved to be <a href="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/limitations-of-mammograms.html">less effective for those under age 40</a>, as their breast tissue is denser and screening and biopsies can be unpleasant to endure.</p>
<p><iframe id="Nf0up" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Nf0up/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>In breast milk and blood serum, researchers, including <a href="https://people.clarkson.edu/%7Ecdarie/">those in my lab group</a>, have identified proteins that are involved in tumor development. Eventually, biochemists like my colleagues <a href="https://scholar.google.com/citations?user=GH2M7ZEAAAAJ&hl=en">and I</a> hope we can use these cancer-related proteins to create a <a href="https://doi.org/10.3390/proteomes10040036">biomarker panel</a> that physicians can use to detect breast cancer earlier, therefore aiding in diagnosis and treatment.</p>
<h2>Proteins as biomarkers for what’s happening</h2>
<p>Researchers can analyze the proteins present in a variety of tissues, from biopsies of tumors to biological fluids including blood, saliva, urine, tears or breast milk. This technique is an example of studying a sample’s proteome – all the proteins in a particular cell, organism or species. The field is called <a href="https://doi.org/10.4331/wjbc.v12.i5.57">proteomics</a>. </p>
<p><a href="https://doi.org/10.1016/S1672-0229(07)60018-7">Proteomics can be a powerful tool</a> when researchers compare the proteomes of individuals from different groups, such as in blood from healthy people versus those with breast cancer. This kind of case-control comparison can identify a single protein or a group of proteins and their variants that are specific to one condition.</p>
<p>That’s what my colleagues and I are looking for: proteins that are present only in the samples from people who have breast cancer. Scientists call them <a href="https://www.britannica.com/science/biomarker">biomarkers</a> because they signal that a patient has a particular condition. Once our candidates are verified by large-scale clinical trials that include many patients, we hope that particular proteins can then be used to assess someone’s future risk of developing the disease.</p>
<p>Doctors can currently use <a href="https://doi.org/10.5493/wjem.v2.i5.86">biomarkers for breast cancer</a> to gauge a patient’s response to treatment. For instance, the molecules cancer antigen 15-3 (CA 15-3) and carcinoemybronic antigen (CEA) are elevated in breast cancer patients, so monitoring their levels can let physicians know whether treatment is working. </p>
<p>Inherited variants of the BRCA1/2 genes can increase the likelihood of developing cancer; they can act as biomarkers in screening for cancer risk. </p>
<p>None of these biomarkers aid in diagnosis of breast cancer, though.</p>
<p>Researchers prefer proteins as cancer biomarkers over the genetic materials DNA and RNA because proteins provide a snapshot of what is happening in a patient’s body at the time a sample is collected. DNA and RNA can tell you whether a certain gene is turned on or off, but not the active form of the protein it codes for or the relative abundance of <a href="https://doi.org/10.1016/j.heliyon.2023.e13323">proteins</a>. Protein analysis can also reveal changes the protein has undergone and <a href="https://doi.org/10.1016/S1672-0229(07)60018-7">protein-protein interactions</a> that can alter the way a protein functions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="diagram showing nursing mother and breast milk bag, and a blood draw and test tube" src="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581402/original/file-20240312-18-og1u88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Looking for biomarker proteins in breast milk or blood serum could detect the presence or absence of cancer.</span>
<span class="attribution"><span class="source">Danielle Whitham</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Benefits of milk and serum biomarkers</h2>
<p>Breast milk and blood serum are two bodily fluids that can be collected noninvasively and that give information about what is happening in the body when collected.</p>
<p><a href="https://doi.org/10.1002/elps.201700123">Breast milk contains</a> secreted proteins, immune cells and sloughed cells of the milk ducts. During lactation, the breast is actively working to create milk to feed an infant. Any abnormalities in the breast milk reflect the current situation in the body. Some proteins in breast milk also circulate throughout the body and can be found in blood serum as well.</p>
<p>Serum is the <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/serum">liquid part of the blood</a> after red blood cells have been removed. It contains all the same proteins found in the blood, minus the clotting factors, therefore allowing circulating protein levels to be monitored. Narrowing in on a serum-based biomarker would mean it could be used to screen every woman, not just one who is currently lactating.</p>
<p><a href="https://doi.org/10.3390/proteomes10040036">The proteins we’ve found</a> <a href="https://doi.org/10.3390/proteomes10040036">in breast milk and identified as being</a> <a href="https://doi.org/10.1002/elps.202300040">out of whack in breast cancer</a> are involved in the cancer cells’ ability to divide, multiply and spread throughout the body. They all promote disease progression.</p>
<p>My colleagues and I currently consider these breast milk proteins to be <a href="https://doi.org/10.1080/14789450.2024.2320158">a draft biomarker for breast cancer</a>. Our group is currently working on using blood serum to identify proteins that could be involved with breast cancer. Moving from breast milk to blood serum would allow people of any age and reproductive status to be screened for the disease, rather than just those who are lactating.</p><img src="https://counter.theconversation.com/content/222944/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Biochemistry and Proteomics Laboratories at Clarkson University receives funding from National Cancer Institute of the National Institutes of Health under Award Number R15CA260126.</span></em></p>Identifying proteins that are only present in bodily fluids when a patient has breast cancer could provide a way to screen healthy people for the disease.Danielle Whitham, Ph.D. Candidate in Chemistry and Biochemistry, Clarkson UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2248582024-03-06T03:32:43Z2024-03-06T03:32:43ZSome women’s breasts can’t make enough milk, and the effects can be devastating<figure><img src="https://images.theconversation.com/files/580034/original/file-20240305-22-gta22i.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C1000%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-looking-camera-depression-dark-circles-2364312147">Alberto_Rodriguez/Shutterstock</a></span></figcaption></figure><p>Many new mothers worry about their milk supply. For some, support from a <a href="https://www.breastfeeding.asn.au/breastfeeding-helpline">breastfeeding counsellor</a> or <a href="https://www.lcanz.org/resources/clients/what-is-a-lactation-consultant/">lactation consultant</a> helps.</p>
<p>Others cannot make enough milk no matter how hard they try. These are women whose breasts are not physically capable of producing enough milk. </p>
<p>Our recently published <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">research</a> gives us clues about breast features that might make it difficult for some women to produce enough milk. Another of our studies shows the devastating <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">consequences</a> for women who dream of breastfeeding but find they cannot.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-feel-guilty-for-feeling-like-that-one-fifth-of-breastfeeding-women-report-an-aversion-response-208938">'I feel guilty for feeling like that.’ One fifth of breastfeeding women report an aversion response</a>
</strong>
</em>
</p>
<hr>
<h2>Some breasts just don’t develop</h2>
<p>Unlike other organs, breasts are not fully developed at birth. There are key <a href="https://pubmed.ncbi.nlm.nih.gov/33711581/">developmental stages</a> as an embryo, then again during puberty and pregnancy.</p>
<p>At birth, the breast consists of a simple network of ducts. Usually during puberty, the glandular (milk-making) tissue part of the breast begins to develop and the ductal network expands. Then typically, further growth of the ductal network and glandular tissue during pregnancy prepares the breast for lactation.</p>
<p>But our online <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">survey</a> of women who report low milk supply gives us clues to anomalies in how some women’s breasts develop.</p>
<p>We’re not talking about women with small breasts, but women whose glandular tissue (shown in this diagram as “lobules”) is underdeveloped and have a condition called breast hypoplasia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Anatomical diagram of the breast" src="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580068/original/file-20240306-20-onsg4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes not enough glandular tissue, shown here as lobules, develop.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/mammary-gland-vector-illustration-showing-cross-1550556230">Tsuyna/Shutterstock</a></span>
</figcaption>
</figure>
<p>We don’t know <a href="https://doi.org/10.1111/jmwh.12070">how common</a> this is. But it has been <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2021.0032?journalCode=bfm">linked</a> with lower rates of exclusive breastfeeding. </p>
<p>We also don’t know what causes it, with much of the research conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33711581/">in animals</a> and not humans. </p>
<p>However, certain health conditions have been associated with it, including <a href="https://connect.springerpub.com/highwire_display/entity_view/node/154992/full">polycystic ovary syndrome</a> and other endocrine (hormonal) conditions. A high body-mass index around the time of puberty may be another <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">indicator</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-men-have-nipples-120893">Why do men have nipples?</a>
</strong>
</em>
</p>
<hr>
<h2>Could I have breast hypoplasia?</h2>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">survey</a> and other research give clues about who may have breast hypoplasia. </p>
<p>But it’s important to note these characteristics are indicators and do not mean women exhibiting them will definitely be unable to exclusively breastfeed.</p>
<p>Indicators include:</p>
<ul>
<li><p>a <a href="https://pubmed.ncbi.nlm.nih.gov/33586493/">wider than usual gap</a> between the breasts</p></li>
<li><p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">tubular-shaped</a> (rather than round) breasts </p></li>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057589/">asymmetric</a> breasts (where the breasts are different sizes or shapes)</p></li>
<li><p>lack of breast growth in pregnancy</p></li>
<li><p>a <a href="https://www.tandfonline.com/doi/full/10.1080/14767058.2023.2214833">delay</a> in or absence of breast fullness in the days after giving birth </p></li>
</ul>
<p>In our survey, 72% of women with low milk supply had breasts that did not change appearance during pregnancy, and about 70% reported at least one <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299642">irregular-shaped</a> breast.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-expert-tips-on-how-to-look-after-your-baby-in-a-heatwave-216906">5 expert tips on how to look after your baby in a heatwave</a>
</strong>
</em>
</p>
<hr>
<h2>The effects</h2>
<p>Mothers with low milk supply – whether or not they have breast hyoplasia or some other condition that limits their ability to produce enough milk – report a range of emotions.</p>
<p>Research, <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">including our own</a>, shows this ranges from frustration, confusion and surprise to intense or profound feelings of failure, guilt, grief and despair. </p>
<p>Some mothers describe “<a href="https://bmjopen.bmj.com/content/9/5/e026234">breastfeeding grief</a>” – a prolonged sense of loss or failure, due to being unable to connect with and nourish their baby through breastfeeding in the way they had hoped. </p>
<p>These feelings of failure, guilt, grief and despair can trigger symptoms of <a href="https://www.sciencedirect.com/science/article/pii/S1877575624000089">anxiety and depression</a> for some women.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired, stress woman with hand over face" src="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=397&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=397&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580048/original/file-20240306-24-lhznqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=397&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Feelings of failure, guilt, grief and despair were common.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-mother-rubbing-face-while-breastfeeding-2371946203">Bricolage/Shutterstock</a></span>
</figcaption>
</figure>
<p>One woman told us:</p>
<blockquote>
<p>[I became] so angry and upset with my body for not being able to produce enough milk.</p>
</blockquote>
<p>Many women’s emotions intensified when they discovered that despite all their hard work, they were still unable to breastfeed their babies as planned. A few women described reaching their “breaking point”, and their experience felt “like death”, “the worst day of [my] life” or “hell”. </p>
<p>One participant told us:</p>
<blockquote>
<p>I finally learned that ‘all women make enough milk’ was a lie. No amount of education or determination would make my breasts work. I felt deceived and let down by all my medical providers. How dare they have no answers for me when I desperately just wanted to feed my child naturally.</p>
</blockquote>
<p>Others told us how they learned to accept their situation. Some women said they were relieved their infant was “finally satisfied” when they began supplementing with formula. One resolved to:</p>
<blockquote>
<p>prioritise time with [my] baby over pumping for such little amounts.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-youre-feeding-with-formula-heres-what-you-can-do-to-promote-your-babys-healthy-growth-106165">If you're feeding with formula, here's what you can do to promote your baby's healthy growth</a>
</strong>
</em>
</p>
<hr>
<h2>Where to go for help</h2>
<p>If you are struggling with low milk supply, it can help to see a <a href="https://www.lcanz.org/resources/clients/how-do-i-access-a-lactation-consultant/">lactation consultant</a> for support and to determine the possible cause. </p>
<p>This will involve helping you try different strategies, such as optimising <a href="https://www.breastfeeding.asn.au/resources/attachment">positioning and attachment</a> during breastfeeding, or <a href="https://www.breastfeeding.asn.au/resources/increasing-supply">breastfeeding/expressing more frequently</a>. You may need to consider taking a medication, such as <a href="https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648">domperidone</a>, to see if your supply increases. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/domperidone-can-boost-breast-milk-supply-heres-what-you-need-know-88648">Domperidone can boost breast milk supply – here's what you need know</a>
</strong>
</em>
</p>
<hr>
<p>If these strategies do not help, there may be an underlying reason why you can’t make enough milk, such as insufficient glandular tissue (a confirmed inability to make a full supply due to breast hypoplasia).</p>
<p>Even if you have breast hypoplasia, you can still breastfeed by giving your baby extra milk (donor milk or formula) via a bottle or using a <a href="https://www.breastfeeding.asn.au/resources/supply-line">supplementer</a> (which involves delivering milk at the breast via a tube linked to a bottle). </p>
<h2>More resources</h2>
<p>The following websites offer further information and support:</p>
<ul>
<li><a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a></li>
<li><a href="https://www.lcanz.org">Lactation Consultants of Australia and New Zealand</a></li>
<li><a href="https://www.thewomens.org.au/health-information/breastfeeding">Royal Women’s Hospital</a>, Melbourne</li>
<li><a href="https://www.facebook.com/groups/SupplyLineBreastfeedersSupportGroupAustralia/">Supply Line Breastfeeders Support Group of Australia</a> Facebook support group</li>
<li><a href="https://www.facebook.com/groups/IGTmamas/">IGT And Low Milk Supply Support Group</a> Facebook support group</li>
<li><a href="https://www.breastfeedingmed.com.au/">Breastfeeding Medicine Network Australia/New Zealand</a></li>
<li><a href="https://professoramybrown.co.uk/articles/f/supporting-breastfeeding-grief---a-collection-of-resources">Supporting breastfeeding grief</a> (a collection of resources).</li>
</ul>
<hr>
<p><em>Shannon Bennetts, a research fellow at La Trobe University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/224858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Feelings of failure, guilt, grief and despair are common, our study shows. But there is support.Renee Kam, PhD candidate and research officer, La Trobe UniversityLisa Amir, Professor in Breastfeeding Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083402024-03-01T13:43:16Z2024-03-01T13:43:16ZGut microbiome: meet Bifidobacterium breve, keeping babies healthy<figure><img src="https://images.theconversation.com/files/539057/original/file-20230724-21-ezb4di.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C4500%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-bifidobacterium-grampositive-anaerobic-rodshaped-which-1036394278">Kateryna Kon/Shutterstock</a></span></figcaption></figure><p><em>Bifidobacterium breve</em>, or <em>B breve</em> for short, is a bacterial species that’s found in the human intestine. It’s especially relevant <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.01204/full">in early life</a>, being one of the most abundant bacteria in the newborn gut.</p>
<p><em>B breve</em> is a species of the genus <em>Bifidobacterium</em> and is considered key in the development of a healthy gut. It has been studied extensively over the years to uncover how it benefits us from our first days of life.</p>
<p>Some of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908950/">benefits</a> associated with this species include protection against pathogens, modulation of the immune system, and provision of nutrients through the breakdown of non-digestible carbohydrates from the diet.</p>
<p>We’re still learning about the origin of <em>B breve</em>. But <a href="https://journals.asm.org/doi/10.1128/AEM.02037-15">vertical transmission</a>, where the origin is the mother and the transfer to the baby occurs either during or after birth, is understood to be the main source of microbes at an early age.</p>
<p>A <a href="https://www.nature.com/articles/s41467-023-38694-0">study</a> carried out by MicrobeMom (a project I was part of during my PhD) has shown that <em>Bifidobacterium</em> strains including <em>B breve</em> are indeed transferred from mother to infant. We didn’t investigate the precise mode of transfer, but one of the key factors influencing the outcome was vaginal birth, so it’s likely these bacteria are passed on during childbirth.</p>
<p>Our research also showed that <em>B breve</em> was the most frequently isolated of the <em>Bifidobacterium</em> species. It was present in vaginal samples from the mother, stool samples from the infant and the mother, as well as breast milk. In fact, <em>B breve</em> represented 80% of the total <em>Bifidobacterium</em> isolated from breast milk.</p>
<p>This highlights the pivotal role that the mother’s gut microbiome has in fostering a baby’s gut health.</p>
<h2><em>Bifidobacterium</em> and the infant gut</h2>
<p><em>Bifidobacterium</em> in general are known for being one of the first <a href="https://journals.asm.org/doi/full/10.1128/mmbr.00036-17">colonisers</a> of the infant gut. This is because of their important role degrading carbohydrates from the diet that the infant gut cannot digest. </p>
<p>This has a positive effect not only on the development of the gut but also the baby’s <a href="https://www.cell.com/cell/pdf/S0092-8674(21)00660-7.pdf">immune system</a>. The mechanism for this is quite complex, but in general terms <em>Bifidobacterium</em> have been shown to interact with human immune cells and to modify <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722804/">immune responses</a>.</p>
<p>The human microbiome changes constantly, and <em>Bifidobacterium</em> is a good example of this. The amount of <em>Bifidobacterium</em> in our gut changes during our lifespan, as does the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990546/">composition</a> of specific <em>Bifidobacterium</em> species, in response to our diet.</p>
<p><em>Bifidobacterium</em> is the most abundant bacteria in the first months of life, when a baby is breastfed, and when microbial diversity (the variety of bacteria, viruses and other microbes we carry) is still very low. The <a href="https://www.bmj.com/content/361/bmj.k2179">microbiota</a> begins to change when solid food is introduced, and we have less <em>Bifidobacterium</em> as we get older when the <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.01204/full">microbial diversity</a> in our gut increases.</p>
<p>Species such as <em>Bifidobacterium adolescentis</em> and <em>Bifidobacterium longum</em> are typically associated with adulthood, due to their ability to degrade plant-derived carbohydrates found in fruit and vegetables. But <em>B breve</em> and certain other species are generally associated with infancy. </p>
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<strong>
Read more:
<a href="https://theconversation.com/why-breastfed-babies-have-improved-immune-development-new-findings-156008">Why breastfed babies have improved immune development – new findings</a>
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<h2>Breast milk</h2>
<p>Human milk is a complex fluid capable of satisfying all the nutritional requirements of a newborn. It also provides extensive <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/benefits/">health benefits</a>, such as reduced risk of various infections. Its composition changes over the period of lactation, adapting to the requirements of the infant. </p>
<p>Breast milk is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/32552141/">main factors</a> that influences the infant microbiota, as breastfeeding <a href="https://www.nature.com/articles/s41564-021-00970-4">increases the number</a> of <em>Bifidobacterium</em> in the infant gut.</p>
<p>One specific component of breast milk that affects the composition of the microbiome is <a href="https://academic.oup.com/glycob/article/22/9/1147/1988076?login=true">human milk oligosaccharides</a>, which are the most abundant carbohydrates present in breast milk after lactose.</p>
<p>These carbohydrates cannot be digested by the human gut, which is where <em>B breve</em> plays an important role. It’s among the microbes that can degrade <a href="https://www.nature.com/articles/srep38560">human milk oligosaccharides</a>, and in this way, they promote its persistence in the gut.</p>
<figure class="align-center ">
<img alt="A woman sitting on a couch breastfeeding her baby." src="https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"><em>B breve</em> helps to break down certain carbohydrates present in breast milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1968728029">Nastyaofly/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Prebiotics and probiotics</h2>
<p>Human milk oligosaccharides are considered prebiotics – carbohydrates, indigestible by the human gut, that promote the growth of beneficial bacteria in the gut, such as <em>B breve</em>.</p>
<p><em>B breve</em> is regarded as a <a href="https://isappscience.org/for-scientists/resources/probiotics/">probiotic</a> – a bacterial species whose intake has a benefit for the host.</p>
<p>Nowadays, human milk oligosaccharides can be found in formula milk, aiming to facilitate the same changes in the microbiota through their prebiotic effects.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
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</p>
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<p><em>B breve</em> is used as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265827/">a supplement</a> to treat and prevent gastrointestinal problems such as diarrhoea, often administered in combination with other probiotic bacteria such <em>Lactobacillus</em> or other <em>Bifidobacterium</em> species. It’s also commercially available in combination with prebiotics.</p>
<hr>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/208340/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rocío Sánchez Gallardo receives funding from a peer reviewed research grant from Science Foundation Ireland (SFI).</span></em></p>B breve has benefits for a baby from their first days of life.Rocío Sánchez Gallardo, PhD candidate, School of Microbiology & APC Microbiome Institute, University College CorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047162023-08-14T19:37:44Z2023-08-14T19:37:44ZCanada’s welfare system is failing mothers with infants<figure><img src="https://images.theconversation.com/files/541320/original/file-20230805-15-xi8j4t.jpg?ixlib=rb-1.1.0&rect=0%2C82%2C3670%2C2351&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food insecurity can impact both a mother’s ability or decision to breastfeed, and also the ability to purchase baby formula.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canadas-welfare-system-is-failing-mothers-with-infants" width="100%" height="400"></iframe>
<p>The Canadian government issued a <a href="https://theconversation.com/federal-budget-2023-grocery-rebate-is-the-right-direction-on-food-insecurity-but-theres-a-long-road-ahead-201926">one-time grocery rebate</a> in July, targeted at low-income Canadians. While the rebate provided some relief to people struggling with soaring inflation, <a href="https://theconversation.com/federal-budget-2023-grocery-rebate-is-the-right-direction-on-food-insecurity-but-theres-a-long-road-ahead-201926">it is far from enough</a> to address the depth of poverty and intensity of food insecurity faced by the lowest income Canadians. </p>
<p>During the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981537/">most vulnerable time of life</a>, mothers and infants living on welfare are experiencing food insecurity, which can have <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645">lifelong impacts</a>. Governments need to make policy changes to better serve mothers and their children. </p>
<h2>Infant food insecurity</h2>
<p>Food insecurity is defined as having “<a href="https://proof.utoronto.ca/food-insecurity/">inadequate or insecure access to food due to financial constraints</a>.” Maternal food insecurity can result in many health-damaging effects, ranging from <a href="https://bmjopen.bmj.com/content/10/1/e033296">adverse birth outcomes</a> to <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645">mental health issues</a>. Infant food insecurity can result in long-term developmental impacts, including effects on <a href="https://doi.org/10.1016/j.pcl.2019.12.004">cognition and brain development</a>. </p>
<p>Experts have outlined how <a href="https://theconversation.com/why-are-babies-going-hungry-in-a-food-rich-nation-like-canada-165789">food insecurity can impact a mother’s ability or decision to breastfeed</a>. Food-insecure mothers might cease breastfeeding much sooner because they feel they have inadequate breastmilk supply. In addition, they might struggle to afford infant formula.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman feeding a baby from a bottle." src="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Mothers and infants living on welfare are experiencing food insecurity, which can have lifelong impacts.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>While food-insecure mothers initiate breastfeeding at the same rate as food-secure mothers, <a href="https://www.ctvnews.ca/health/study-finds-moms-living-in-poverty-struggle-to-breastfeed-their-babies-longer-1.3853616?cache=yes">rates drop steeply within the first two months</a>. Mothers who are undernourished themselves might perceive they have less than adequate milk supply and often stop breastfeeding for this reason, <a href="https://www.ubcpress.ca/out-of-milk">believing the baby will suffer because they have an inadequate diet</a>. </p>
<p>For low-income mothers, breastfeeding might seem to be the most cost-effective way of feeding their infants. However, other research shows that <a href="https://pubmed.ncbi.nlm.nih.gov/32162282/">both formula and breastfeeding are unaffordable to mothers who receive welfare</a>. </p>
<h2>Problems with the welfare system</h2>
<p>Approximately <a href="https://maytree.com/wp-content/uploads/Social_Assistance_Summaries_All_Canada.pdf">four to six per cent of people</a> in most provinces and territories receive welfare benefits. The number is slightly lower in the Yukon and Alberta and significantly higher in Nunavut where it is just under 28 per cent. </p>
<p>While some provinces and territories provide more financial resources to pregnant women and mothers than others, incomes remain low and inadequate to achieve food security. </p>
<p>For example, Nova Scotia welfare recipients receive a total of <a href="https://novascotia.ca/coms/employment/documents/ESIA_Program_Policy_Manual.pdf">$51 per month in maternal nutrition allowance</a> during pregnancy and up to 12 months after birth. However, this is often not enough support for low-income mothers to adequately feed their infants.</p>
<p><a href="https://proof.utoronto.ca/2023/new-data-on-household-food-insecurity-in-2022/">COVID-19 increased household food insecurity rates for households with children in both Canada</a> and the <a href="https://www.ers.usda.gov/amber-waves/2022/february/food-insecurity-for-households-with-children-rose-in-2020-disrupting-decade-long-decline/">United States</a></p>
<p>Allowances for pregnant women and mothers of infants receiving welfare are similarly low across Canada. These low rates create food insecurity for these vulnerable families and must be rectified via provincial, territorial and federal government policies. </p>
<h2>Charity alone is not enough</h2>
<p>Some might assume that charities and food banks will provide vital support for low-income families. A recent study found that during the peak of the COVID-19 pandemic, many community organizations <a href="https://doi.org/10.1080/14927713.2022.2054460">answered the increased call for food</a>. </p>
<p>While community organizations were critical in filling pandemic gaps, they alone cannot address the root cause of food insecurity: inadequate incomes. That problem continues, and the number of people relying on food banks has <a href="https://www.cbc.ca/news/canada/toronto/60-rise-use-of-food-banks-programs-canada-2023-1.6711094">increased exponentially in the past couple of years</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/as-governments-shirk-their-responsibilities-non-profits-are-more-important-than-ever-205169">As governments shirk their responsibilities, non-profits are more important than ever</a>
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<p>Additionally, many food banks are <a href="https://ca.style.yahoo.com/at-breaking-point-canadian-food-banks-struggling-insecurity-inflation-214221464.html">struggling to provide enough food</a>. The demand for food now far outstrips the donations most food banks receive. A sustainable solution to food insecurity is needed, particularly for pregnant women and mothers of infants. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in a grey t-shirt placing food items on a shelf" src="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A volunteer places products on shelves at a food bank in Ottawa. Food banks alone cannot address the root cause of food insecurity: inadequate incomes.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
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</figure>
<h2>Child welfare laws</h2>
<p>In addition, child welfare laws need to be changed to stop them from unfairly penalizing poorer parents. In Nova Scotia, the <a href="https://policyalternatives.ca/sites/default/files/uploads/publications/Nova%20Scotia%20Office/2023/03/CCPAChildPovertyReportCardFINAL.pdf"><em>Children and Family Services Act</em> stipulates</a> that parents’ failure to provide adequate nutrition is grounds for child apprehension.</p>
<p><a href="https://policyalternatives.ca/sites/default/files/uploads/publications/Nova%20Scotia%20Office/2023/03/CCPAChildPovertyReportCardFINAL.pdf">The 2022 Report Card on Child and Family Poverty in Nova Scotia</a> recommended removing this stipulation. <a href="https://fernwoodpublishing.ca/book/ineligible">Experts have highlighted</a> the punitive nature of such requirements. These kinds of regulations punish mothers for their poverty and food insecurity, rather than increasing the financial support they receive.</p>
<h2>Impact of inflation</h2>
<p>There are also reforms that need to take place around welfare rates that would create a more liveable income source for mothers and infants in particular. </p>
<p>As the 2022 report card on poverty in Nova Scotia shows, welfare rates are not indexed to inflation in the province. This has resulted in <a href="https://www.cbc.ca/news/canada/nova-scotia/ns-income-assistance-rates-unchanged-1.6788662">benefits stagnating</a> despite a few modest increases in the past several years. Only three provinces and territories <a href="https://maytree.com/wp-content/uploads/Welfare_in_Canada_2021.pdf">index welfare rates to inflation:</a> New Brunswick, Québec and the Yukon. In Québec, <a href="https://inroadsjournal.ca/quebecs-distinct-welfare-state-on-poverty-among-families-with-children-quebec-%E2%80%A8and-the-rest-of-canada-have-taken-different-paths/">this has resulted in lower income inequality</a>. </p>
<p>The province has also recently launched a <a href="https://www.cbc.ca/news/canada/montreal/quebec-basic-income-program-begins-advocates-say-many-low-income-people-excluded-1.6730003">basic income program</a> and although the eligibility requirements exclude many, it does increase income recipients would otherwise receive from welfare benefits.</p>
<p>With inflation affecting the price of food, the depth of food insecurity for mothers receiving welfare payments will only grow. Welfare rates must reflect the income necessary to feed pregnant and new mothers and provide them the support they need to care for their children.</p><img src="https://counter.theconversation.com/content/204716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Fisher receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p>Low-income mothers with infants are struggling with food insecurity, which can lead to long-term health impacts for both mothers and children.Laura Fisher, PhD student, Sociology, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1844082022-06-06T12:50:45Z2022-06-06T12:50:45ZThe US is importing baby formula to help end supply shortage – what parents need to know<figure><img src="https://images.theconversation.com/files/467053/original/file-20220605-58806-z06n5u.jpg?ixlib=rb-1.1.0&rect=0%2C53%2C4500%2C2937&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hopefully not staying empty for much longer.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/shelves-normally-meant-for-baby-formula-sit-nearly-empty-at-news-photo/1240839231?adppopup=true">Samuel Corum/AFP via Getty Images)</a></span></figcaption></figure><p><em>Industry and federal efforts to <a href="https://www.cnn.com/2022/06/03/politics/baby-formula-crisis-timeline/index.html">alleviate a baby formula shortage</a> in the U.S. are ramping up, with the <a href="https://www.npr.org/2022/05/28/1101931160/baby-formula-shortage-overseas-shipments">import of foreign brands</a> supplementing increased domestic production.</em></p>
<p><em>It follows a crisis in which mothers, fathers and caregivers across the U.S. have had to <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scramble to find scarce supplies</a> or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">drive long distances</a> to buy formula.</em></p>
<p><em>But are the efforts enough to overcome the supply problem – and protect against it happening again in the future? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, what parents should know about the imported formula.</em> </p>
<h2>Remind me, what caused the shortage?</h2>
<p>First, we had a <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a> that affected all manner of goods since the onset of the pandemic. Then in February 2022 a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in the U.S. went down</a>. </p>
<p>The U.S. Food and Drug Association <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a> amid concerns over <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">bacterial infections</a>.</p>
<p>The Michigan plant is the largest producer in the country, so when it went down, it put added strain on the entire U.S. formula distribution system.</p>
<h2>Are there still shortages?</h2>
<p>The situation is beginning to improve in some parts of the country. People are reporting fewer incidents of going to stores and finding no formula on the shelves. But it is patchy – urban areas seem to be doing better than rural places with one store serving an area.</p>
<p>I can see the supply issue easing further in the coming weeks. This is down to three factors: First, the <a href="https://www.reuters.com/world/us/baby-formula-makers-ramp-up-us-supplies-tackle-shortage-2022-05-17/">domestic production of baby formula has improved</a>. Secondly, <a href="https://www.cnn.com/2022/05/16/politics/baby-formula-biden-administration-steps/index.html">imported formulas</a> – part of the Biden Administration’s <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/01/president-biden-announces-third-operation-fly-formula-mission/#:%7E:text=Under%20Operation%20Fly%20Formula%2C%20the,can%20get%20to%20store%20shelves">Operation Fly Formula</a> mission – have helped supplement the domestic brands. Lastly, there seems to be anecdotal evidence of less hoarding by panicked parents as time goes on. This will all help alleviate the shortage.</p>
<figure class="align-center ">
<img alt="A FedEx pane is seen with a cargo shipment of baby formula being unloaded." src="https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467054/original/file-20220605-58478-uu76zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A shipment of baby formula being delivered as part of Operation Fly Formula.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/fedex-workers-unload-a-shipment-of-baby-formula-as-part-of-news-photo/1240902959?adppopup=true">Nathan Posner/Anadolu Agency via Getty Images</a></span>
</figcaption>
</figure>
<p>The good news is, more relief is on the way. The factory that closed had already been allowed to release its stock of specialized formula for babies with severe allergies. And as of June 4, it <a href="https://www.cnbc.com/2022/06/04/abbott-nutrition-restarts-baby-formula-production-in-reopened-michigan-plant.html">also restarted production</a> of specialty formulas after being given the green light from the FDA. However, it is expected to take 6-8 weeks for more routine formulas to be produced from this factory and make it to store shelves.</p>
<p>On top of that, more shipments <a href="https://www.businessinsider.com/baby-formula-shortage-us-operation-fly-formula-royal-family-2022-5">on the way from the U.K.</a> <a href="https://www.upi.com/Top_News/World-News/2022/05/28/australia-goats-milk-operation-fly-formula/6091653750809/">and Australia</a> will add to the shipments of specialty formula from Europe we <a href="https://www.axios.com/2022/05/17/nestle-baby-formula-netherlands-switzerland">have already seen from Nestle</a>. Additional <a href="https://www.foxnews.com/health/baby-formula-imports-mexico-july-october-fda">shipments from Mexico</a> from Nestle of routine formula are also expected within the next few weeks. We are expecting two shipments in the coming days. It will take a few days to get to stores, but parents should start seeing them on the shelves soon.</p>
<h2>What do American parents need to know about imported formula?</h2>
<p>Formula from Europe, Australia and Mexico are labeled differently: as “stage 1” formula for newborns and up to 12 months and “stage 2” for babies over six months.</p>
<p>And their mixing instructions are different. For a start, EU and Australia formula uses milliliters rather than ounces. Some, but not all, will have substantially different powder to water ratios. Parents will need to pay attention to this. Anyone preparing imported formula will need to take careful note of the mixing instructions – too much powder and you will over-concentrate the formula, risking too much salt. Over-diluting will mean too little salt and nutrients.</p>
<p>In addition, two of the brands being imported will include formula made from goats milk protein – the Australian firm Bubs and the U.K. company Kendamil. This isn’t uncommon in the rest of the world, but in the U.S., all animal-based infant formula is based on cow’s milk.</p>
<p>This isn’t a bad thing. Some scientific evidence suggests goat’s milk is more digestible for babies than cow’s milk.</p>
<p>The other thing to note is that we are still waiting on the FDA to find out which of the imported formulas will get approved for distribution through the federal food program <a href="https://www.fns.usda.gov/wic">called WIC</a>. WIC provides formula for a majority of babies in low-income families.</p>
<h2>How has the shortage affected low-income families?</h2>
<p>A majority of all parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of six months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of 1-year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures – mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage has affected some parents more than others. And not surprisingly, the most affected parents are those on the lowest income.</p>
<p>During the shortage, some families drove long distances to find stores selling formula. Obviously that is harder to do for poorer families, as there are costs involved. Likewise, more affluent parents have been able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage affected both regular infant formula and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type.</p>
<p>Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs.</p>
<h2>Why is getting sufficient supplies of formula so important?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">nutritionally incomplete</a>, they may not be entirely sterile. Indeed, we have seen <a href="https://www.newsweek.com/baby-fed-homemade-formula-hospitalized-shortage-1708626">reports of babies</a> <a href="https://www.insider.com/er-doc-says-watered-down-homemade-formulas-putting-infants-danger-2022-5">being hospitalized</a> as a result of being fed homemade formula.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow’s milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow’s milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow’s milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>What can be done to prevent this situation from happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas – the worst thing would be that those who have moved to homemade formulas continue to do so after stocks are supplied.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. Competition could potentially drive down prices. One positive to come from the shortage is that it is introducing new entrants into the U.S. market. Meanwhile, there is now a recognition that the U.S. needs to diversify its production of formula.</p>
<p>I believe America also needs to look at the country’s breastfeeding support system. Don’t get me wrong: Some parents will always need formula. But those who want to breastfeed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p>
<p><em>Editor’s note: This is an updated version of an article <a href="https://theconversation.com/whats-causing-the-us-baby-formula-shortage-and-how-to-make-sure-it-doesnt-happen-again-182929">originally published</a> on May 12, 2022.</em></p><img src="https://counter.theconversation.com/content/184408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains the efforts to ensure there is enough baby formula for US consumption and the differences between domestic and imported produce.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1829292022-05-12T13:09:02Z2022-05-12T13:09:02ZWhat’s causing the US baby formula shortage – and how to make sure it doesn’t happen again<figure><img src="https://images.theconversation.com/files/462578/original/file-20220511-18-x6ls08.jpg?ixlib=rb-1.1.0&rect=53%2C341%2C6000%2C3646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No easy formula.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/grocery-store-shelves-where-baby-formula-is-typically-news-photo/1240603860?adppopup=true">Stefani Reynolds/AFP via Getty Images</a></span></figcaption></figure><p><em>A <a href="https://www.nytimes.com/2022/05/10/us/baby-formula-shortage.html">baby formula shortage</a> has added to the woes of American parents already confronted with the pressures of <a href="https://www.theatlantic.com/culture/archive/2021/03/isolation-becoming-new-parent-during-pandemic/618244/">raising an infant during a pandemic</a> in a country <a href="https://www.forbes.com/sites/marybethferrante/2019/06/21/unicef-study-confirms-the-u-s-ranks-last-for-family-friendly-policies/?sh=176ff24133ba">ranked low for family-friendly policies</a>.</em></p>
<p><em>Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scrambled to find scarce supplies</a>, or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">driven long distances</a> to buy formula.</em></p>
<p><em>But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.</em> </p>
<h2>1. Why there is a shortage of formula now?</h2>
<p>There are really two factors that have driven the current shortage. First, we have the <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a>, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it <a href="https://www.wired.com/story/supply-chain-crisis-data/">became worse</a>.</p>
<p>Then in February a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in U.S. went down</a>. The FDA <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan. The closure came after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a>, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.</p>
<p>Closing the factory had to be done amid an <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">investigation into bacterial infections</a> in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.</p>
<p>Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.</p>
<p>On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.</p>
<h2>2. Who is the shortage affecting?</h2>
<p>A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of 6 months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, <a href="https://www.fns.usda.gov/wic">called WIC</a>, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.</p>
<p>I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage is affecting both regular infant formula, and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.</p>
<h2>3. What are the potential consequences of the shortage?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">not nutritionally complete</a>, they may not be entirely sterile.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>4. Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>5. So what guidance is there for low-income parents?</h2>
<p>It is challenging and I can’t provide a magic answer. But food banks and the WIC program have been a crucial lifeline. The WIC program in particular has proved itself to be very flexible during this shortage. When Abbott had to recall products and then couldn’t provide enough non-recalled formulas in states in which they were the WIC provider, WIC was able to change providers and reprogram EBT cards to allow low-income parents to buy different brands.</p>
<h2>6. What can be done to prevent this situation happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. This doesn’t necessarily mean increased costs – competition could potentially drive down prices.</p>
<p>I believe America also needs to look at the country’s breast feeding support system. Don’t get me wrong, some parents will always need formula. But those who want to breast feed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p><img src="https://counter.theconversation.com/content/182929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1807932022-04-08T12:35:39Z2022-04-08T12:35:39ZKenya puts in place tougher labelling for baby foods, bottles, teats and pacifiers<figure><img src="https://images.theconversation.com/files/456599/original/file-20220406-24-llhu1n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman breastfeeds her baby. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>The Kenyan government has provided <a href="http://www.parliament.go.ke/sites/default/files/2020-12/The%20proposed%20Breast%20Milk%20Substitute%20%28General%29%20Regulations%2C%202020.pdf">more stringent measures</a> for the labelling of feeding bottle, teat and pacifier packages. It wants the labels of these products to include a warning that their use can have negative effects on breastfeeding.</p>
<p>The new regulations show the government’s commitment to revisiting a <a href="http://kenyalaw.org:8181/exist/kenyalex/actview.xql?actid=No.%2034%20of%202012">law</a> passed in Kenya in 2012 that laid the ground work for key regulations around the marketing of breast milk substitutes. These substitutes include infant formulas, follow-on formulas and any other food or drink, alongside feeding bottles and teats, intended for babies and young children.</p>
<p>The act was passed to regulate the promotion of the substitutes, which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967752/">interfere</a> with breastfeeding. The law is aligned to the World Health Organization’s <a href="https://apps.who.int/iris/bitstream/handle/10665/40382/9241541601.pdf?sequence=1&isAllowed=y">International Code</a> of Marketing of Breast-milk Substitutes.</p>
<p>The act outlines the prohibitions on advertising of substitutes. It also covers the rules on education and informational materials, as well as the labelling of packages. For instance, it requires that any educational materials on substitutes be approved by the cabinet secretary in charge of the health ministry. Health workers and proprietors of health centres are additionally not allowed to accept breast milk substitutes as gifts or donations without the approval of the health ministry.</p>
<p>The act doesn’t prohibit the sale of breast milk substitutes or the distribution of factual information. Rather, it aims to ensure parents make informed choices on infant feeding based on evidence, not biased, misleading claims.</p>
<p>The new regulations target bottles, teats and pacifiers. All can interfere with breastfeeding. The regulations introduce fresh labelling requirements for baby feeding bottles, teats and pacifiers. These products will include a warning in both Swahili and English <a href="http://www.parliament.go.ke/sites/default/files/2020-12/The%20proposed%20Breast%20Milk%20Substitute%20%28General%29%20Regulations%2C%202020.pdf">stating that</a> the use of bottles, teats and pacifiers can interfere with breastfeeding.</p>
<p>The updated act also includes prohibitions around labelling, marketing and donation of pre-packaged complementary baby foods, which are increasingly being consumed.</p>
<p>The implementation of infant and young child feeding strategies, such as legislation around breast milk substitutes as well as labelling of key products, has been associated with an increase in breastfeeding rates. In Kenya, implementation of the 2012 act was associated with an increase in exclusive breastfeeding in the country. A report released in 2014 found that there had been an <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf">increase</a> in exclusive breastfeeding rates from 32% to 61% over a five-year period. Although the act only came into effect in 2012, it was deemed to have contributed to this rise.</p>
<p>The stringent measures included in the updated regulations are likely to further improve the exclusive breastfeeding rate in Kenya – at 61%, it is already higher than the global average of <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding#:%7E:text=About%2044%25%20of%20infants%200,are%20appropriate%20for%20their%20age.">44%</a>. This will lead to further improvements in child health, growth and development.</p>
<h2>The history</h2>
<p>Since it was passed in 2012 the health ministry has updated the Breast Milk Substitutes act to improve its clarity and enforcement. The updated version was published as a legal notice in August 2021. It will be enforced on 30 May 2022. The amendments followed an increase in aggressive, inappropriate marketing by manufacturers of breast milk substitutes in Kenya.</p>
<p>As part of the process, the ministry conducted an <a href="https://www.health.go.ke/wp-content/uploads/2021/07/Draft-Regulatory-Impact-statement-on-the-Proposed-Breast-Milk-Substitutes-Regulations-1.7.21-1.pdf">impact assessment</a>on the legislation with the aim of examining and measuring the likely benefits, costs and effects of the proposed regulations. <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/906260/RPC_Impact_Assessments_Room_for_Improvement.pdf">This is done to</a> support legislative change, regulation of markets, policy development and parliamentary decision making.</p>
<p><strong><em>Read more: <a href="https://theconversation.com/whats-missing-in-south-africas-strategy-to-get-breastfeeding-levels-up-165548">What’s missing in South Africa’s strategy to get breastfeeding levels up</a></em></strong></p>
<p>The impact assessment focused on the following sections of the Breast Milk Substitutes act:</p>
<ul>
<li><p>donations, labelling, and the interaction between health workers and manufacturers or distributors</p></li>
<li><p>advertising and promotion</p></li>
<li><p>demonstrations of the use of designated products</p></li>
<li><p>publication of information, education and communication materials on substitutes</p></li>
<li><p>penalties for failure to adhere to the Breast Milk Substitutes act and its regulations.</p></li>
</ul>
<h2>The science behind it</h2>
<p>The World Health Organization <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommends</a> exclusive breastfeeding for the first six months of a child’s life. It also recommends continued breastfeeding up to and beyond two years.</p>
<p>Breast milk has been found to have significant <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding">health and nutrition benefits</a> for both the child and mother. These include protection against infant death and common childhood illnesses, such as diarrhoea and pneumonia. Breastfeeding also lowers the risk of breast and ovarian cancers, and diabetes. It additionally improves birth spacing.</p>
<p><strong><em>Read more:<a href="https://theconversation.com/breastfeeding-trends-show-most-developing-countries-may-miss-global-nutrition-targets-166853">Breastfeeding trends show most developing countries may miss global nutrition targets</a></em></strong></p>
<p>For mothers to exclusively breastfeed, they need accurate information on the benefits of breast milk, the importance of breastfeeding and a supportive environment. However, there has been an increase in the <a href="https://journals.sagepub.com/doi/full/10.1177/0379572115602174">marketing</a> and <a href="https://www.thelancet.com/action/showPdf?pii=S0140-6736%2815%2901044-2">availability</a> of breast milk substitutes. This could <a href="https://journals.sagepub.com/doi/pdf/10.1177/0379572115602174">influence</a>some mothers to stop breastfeeding.</p>
<p>Promotion tactics, such as the use of health workers to endorse baby formulas, aggressive media advertising and point-of-sale marketing, have been widely used to advance the use of breast milk substitutes. This has created a <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/international-code-of-marketing-of-breastmilk-substitutes-lessons-learned-and-implications-for-the-regulation-of-marketing-of-foods-and-beverages-to-children/4F94026E6F983C45DB0423530FC314AE">false sense of superiority</a> of substitutes over breast milk, hence the need for heightened regulations around the marketing of these products.</p>
<h2>The impact</h2>
<p>The importance of protecting and promoting breastfeeding is recognised across most of Africa. A recent report by the <a href="https://www.who.int/publications/i/item/9789240006010">World Health Organization</a> found that 32 of the 47 countries that fall under the WHO African Regional Office have implemented the International Code on Marketing of Breast-milk Substitutes. However, researchers found that adoption has happened at varying levels. For instance, Kenya is moderately aligned with the code, while South Africa is substantially aligned with it.</p>
<p><strong><em>Read more: <a href="https://theconversation.com/kenya-is-a-breastfeeding-success-story-but-still-has-its-challenges-45378">Kenya is a breastfeeding success story but still has its challenges</a></em></strong></p>
<p>To complement the enactment of the code, countries must regularly monitor barriers and bottlenecks to exclusive breastfeeding. These can then be addressed and resolved through research, regulatory impact assessments and more effective legislation.</p><img src="https://counter.theconversation.com/content/180793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Antonina Mutoro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kenya wants parents to be able to make more informed choices about feeding their babies.Antonina Mutoro, Postdoctoral Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1657892021-11-10T15:16:33Z2021-11-10T15:16:33ZWhy are babies going hungry in a food-rich nation like Canada?<figure><img src="https://images.theconversation.com/files/431095/original/file-20211109-17-1nj4al0.jpg?ixlib=rb-1.1.0&rect=22%2C8%2C1894%2C1218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Whether they breastfeed or use formula, food insecure mothers are struggling to feed their babies. </span> <span class="attribution"><span class="source">(Hessam Nabavi/Unsplash)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/why-are-babies-going-hungry-in-a-food-rich-nation-like-canada" width="100%" height="400"></iframe>
<p>Jean, a 24-year-old mother of two, said: “People don’t think there’s hungry kids out there [in Canada].” She would like us to know “there definitely is.” </p>
<p>More than <a href="https://proof.utoronto.ca/food-insecurity/">1.2 million children in Canada live in food-insecure households</a>, including babies of the families as well. In Nunavut, that number is higher than any other part of Canada. Many of the children in food insecure families go hungry: parents often need to cut the size of meals, or skips meals altogether. </p>
<p>The first 1,000 days of a baby’s life is the <a href="https://doi.org/10.1002/ajhb.22952">most important time for growth and development</a>. There are special and <a href="https://www.canada.ca/en/health-canada/services/publications/food-nutrition/prenatal-nutrition-guidelines-health-professionals-iron-contributes-healthy-pregnancy-2009.html">costly nutritional needs for both mother and baby such as increased iron and folic acid for mothers</a>, <a href="https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html">vitamin D for breastfed babies, and commercial formula for those not breastfed</a>. But for many, this is also a time of diminished incomes. </p>
<p>People have often said to me that even the most undernourished women can successfully breastfeed and that the real cause of infant food insecurity too much access to infant formula. This misses the point I’m making.</p>
<p>At the heart of infant <a href="https://doi.org/10.2752/175174415X14101814953927">food insecurity in Canada is poverty and food access, which disrupts maternal eating and infant feeding habits</a> regardless of how and what babies are fed. </p>
<p>To really understand infant food insecurity, one needs to listen to mothers. While researching my book, <a href="https://www.ubcpress.ca/out-of-milk"><em>Out of Milk: Infant Food Insecurity in a Rich Nation</em></a>, I spoke to many mothers, those who were breastfeeding and those who had opted to use formula. Their stories reveal how poverty and food insecurity are disrupting their eating and infant feeding habits. I recount some of their stories here; all of the following names are pseudonyms.</p>
<h2>The breastfeeding paradox</h2>
<p>When breastfeeding works, it is praised by the mothers we spoke with as the ideal healthy and secure food system. Some mothers said they were drawn to breastfeeding because of health benefits and the high cost of food. Lorraine explained: “There is no risk of cross-contamination, it’s there, it’s ready, it’s the right amount, it’s the perfect food.” </p>
<p>Erica said: “You know your baby is never going to go hungry. You don’t have to worry about where you’re going to get food and where the money is going to come from.” </p>
<p>Yet the most food-insecure mothers stop breastfeeding after one or two months. Some never start. For them, breastfeeding is a non-sustainable food system. This is referred to as the “<a href="https://doi.org/10.2752/175174415X14101814953927">breastfeeding paradox</a>.” It means that those that can least afford to stop breastfeeding <a href="https://doi.org/10.1503/cmaj.170880">are actually more likely to do so</a>. </p>
<p>The reasons include the struggles of daily living: lack of practical support, insufficient public services and poverty brought on by inadequate income supports. A mother’s own lack of food is at the root — and like any food system, the system breaks down when producers are not supported.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&rect=75%2C117%2C5543%2C3622&q=45&auto=format&w=1000&fit=clip"><img alt="A woman browses infant formula at a grocery store." src="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&rect=75%2C117%2C5543%2C3622&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417866/original/file-20210825-13-1r24eqa.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mothers least able to afford infant formula are more likely to rely on it to feed their babies.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Mary said: “I don’t know if what I was producing was really enough, nutrient-wise, if it was … healthy enough for him, giving him what he needed. Plus, in order to be able to produce milk, the mother needs to be food secure, and you don’t have that all the time. You still have to buy food for yourself to keep yourself healthy and the price of fruits and vegetables and proper meat is really high.”</p>
<p>Another mother, Sally, challenged the idea that breastfeeding is free, saying: “It might be cheaper than formula feeding but it still costs.” </p>
<h2>Inadequate access to formula</h2>
<p>When breastfeeding fails and infant formula is not affordable, the outcomes are tragic. </p>
<p>Unlike <a href="https://www.fns.usda.gov/wic/about-wic">other developed countries</a>, Canada has no government-provided infant formula for low-income mothers. The reasons are, at a minimum, twofold: One, there are concerns that <a href="https://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/pdf/ppsb-ppsam-eng.pdf">supplying free formula will affect infant feeding choices</a>; and two, Canada doesn’t use food as a form of welfare benefits for anyone.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman feeds a baby with a milk bottle." src="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417684/original/file-20210824-16536-1v68mcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Without income supports, struggling mothers resort to using watered-down formula and buying it second-hand online.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This, on top of a failed social safety net, leaves families struggling to feed their babies with limited options. Parents can look to food banks, <a href="https://doi.org/10.15353/cfs-rcea.v5i1.230">but infant formula may not be consistently available, if at all</a>. Reasons for its scarcity are embedded in the nature of food charity, which is marked by inconsistent donations, and more specifically, beliefs in Canada and elsewhere that <a href="https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/05/Provision-of-formula-milk-at-food-banks-Unicef-UK-Baby-Friendly-Initiative.pdf">formula provision in food banks may put breastfeeding and babies at risk</a>. </p>
<p>When we allow food insecurity to disrupt breastfeeding, or make formula inaccessible with the intent to protect breastfeeding, it punishes already struggling mothers.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381818/original/file-20210201-13-1g0n3ld.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/podcasts">Click here to listen to Don’t Call Me Resilient</a></span>
</figcaption>
</figure>
<p>Unsurprisingly, <a href="https://globalnews.ca/news/4864964/baby-formula-under-lock-and-key-as-thefts-rise-say-winnipeg-retailers/">infant formula is now one of the most shoplifted items</a>, leading some retailers to keep it locked-up. </p>
<p>Desperate mothers are <a href="https://www.ubcpress.ca/out-of-milk">turning to online platforms</a> like Facebook Marketplace and Kijiji to get second-hand formula, which is sometimes already opened.</p>
<p>Heather said: “You take what you can get. It is a matter of being able to feed the baby at all.… We sold stuff. Stole stuff. Stole it to sell it and stole formula from the store. Whatever we had to do to feed them we did it — I am not proud of it but my kids are still alive.” </p>
<p>Mothers sometimes resort to watering-down formula to make it last longer and introduce solids and other liquids early when there is no formula to be found. These survival tactics show the lengths families must go to find food.</p>
<h2>A nutritious diet is expensive</h2>
<p>Most low-income families with babies who receive federal maternity benefits or income assistance cannot afford a basic nutritious diet. If they tried, according to <a href="https://doi.org/10.17269/s41997-020-00306-5">our research</a>, they would likely be short hundreds of dollars each month, whether they breastfeed or use formula. </p>
<p>According to many mothers, no matter where you live in the world, poverty and food insecurity is a threat to maternal and infant health. The consensus among mothers we spoke with say the solutions lie in their economic security. </p>
<p>Yes, breastfeeding is a robust physiological system and malnourished mothers can breastfeed. But we need real upstream policy solutions that ensure mothers and their babies don’t go hungry in the first place. Canada needs adequate social welfare that protects sustainable breastfeeding and ensures that non-breastfed babies have access to food. </p>
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<p><iframe id="tc-infographic-572" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/572/661898416fdc21fc4fdef6a5379efd7cac19d9d5/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p><img src="https://counter.theconversation.com/content/165789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lesley Frank receives funding from the Social Science and Humanities Research Council, Research Nova Scotia, and Acadia University. She is affiliated with the Canadian Centre for Policy Alternatives - Nova Scotia as a Research Associate and Steering Committee member of Campaign 2000. </span></em></p>With the high cost of infant formula, food-insecure mothers who cannot breastfeed are struggling to feed their babies.Lesley Frank, Tier II Canada Research Chair in Food, Health, and Social Justice, Acadia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699952021-10-21T11:03:01Z2021-10-21T11:03:01ZBreast milk companies are popping up around the globe – why haven’t governments stepped in?<figure><img src="https://images.theconversation.com/files/426947/original/file-20211018-32522-1w9fi21.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4256%2C2816&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/breast-pump-blank-baby-bottle-on-599414015">Nor Gal/Shutterstock</a></span></figcaption></figure><p>Over the last few decades, the demand for breast milk has grown. The message “breast is best” has driven parents and caregivers to buy breast milk. Even the <a href="https://www.newsweek.com/adults-really-shouldnt-drink-human-breast-milk-345288">unwell, bodybuilders and “clean eaters”</a> are known to use it. Once limited to milk banks and peer-to-peer sharing, a new for-profit milk market has emerged. </p>
<p>Companies producing a range of breast milk products are popping up around the globe, including in <a href="https://neolacta.com/">India</a>, <a href="https://www.theguardian.com/world/2017/mar/28/cambodia-breast-milk-us-export-ambrosia-labs">Cambodia</a>, the <a href="https://www.prolacta.com/en/products/">US</a> and <a href="https://neokare.co.uk/about-us/">England</a>. These products include formula replacements – designed to be the sole source of nutrition – and other dietary supplements that complement or are added to formula. </p>
<p>Breast milk products are often marketed as safer, vegan, better for the immune system and infant development. Sometimes, in the case of replacements, products are marketed as more ethical than formula. And they are not just sold to individuals and caregivers, but also to healthcare providers and hospitals.</p>
<p>In England, one breast-milk processing company produces and sells, <a href="https://www.bbc.co.uk/news/uk-england-hereford-worcester-58343016">according to</a> its own sources, six 50ml bottles for £45. Breast milk sale is now a <a href="https://www.tandfonline.com/doi/full/10.1080/09692290.2020.1864757">profitable endeavour</a>. </p>
<p>Notably, a company in England cites <a href="https://www.bmj.com/content/350/bmj.h1485">my past research</a> with colleagues on its <a href="https://neokare.co.uk/about-us/">website</a> to support mothers donating breast milk to it rather than selling or sharing peer-to-peer or to other online sites like onlythebreast.com. The research of mine that is being cited found selling milk informally poses risks to the consumer, whether an <a href="https://www.bmj.com/content/350/bmj.h1485">infant</a> or an <a href="https://journals.sagepub.com/doi/pdf/10.1177/0141076815588539">adult</a>, because the milk can transmit viruses and bacteria, and can be contaminated. Using safety concerns as marketing, these companies promote themselves as a better alternative to the informal market because they test and process the milk to reduce the risk of food-borne illness.</p>
<p>But as companies seek to grow their business, they are likely to increasingly look to more stable longer-term contracts with larger entities, such as the NHS, and this poses other issues to us all. Companies courting healthcare providers to become their suppliers, may increase costs to the healthcare system while creating ethical dilemmas. If mothers move from donating to national health services and milk banks to donating to companies, the natural effect is to drive healthcare providers to turn to such contracts to provide milk in their services and communities.</p>
<p>Rationing access to milk banks – which limits who can get milk on fixed medical criteria, excluding, for example, those adults looking for fitness supplementation – directs milk to those who need it most. This has sought to keep demand in closer alignment with supply, but this is not the same in the for-profit sector. For-profit companies are beholden to their shareholders who wish to see growth and profit. The imperative to growth will probably see the privatisation of a previously public service.</p>
<p>Milk too will be needed to meet the growing demands and mass contracts. To avert concerns about exploitation, by their own accounts, many of these companies state that those women providing the milk do so as “donors”, meaning these women expressing milk are not paid a salary or per ounce payments, nor are they employed by the company. Many company websites convey a distinctively middle-class woman as the typical “donor”, but <a href="https://www.tandfonline.com/doi/full/10.1080/09692290.2020.1864757">research suggests</a> it is not always made clear that milk could instead be coming from those in poverty, often in developing countries or marginalised communities, who are paid to provide it.</p>
<p>While donation regimes were designed to avoid the commercialisation of women’s bodies, there are real concerns we are now engaging in <a href="https://www.emerald.com/insight/content/doi/10.1108/IJHRH-07-2019-0058/full/html">the commodification of</a> a woman-produced substance. But also, to meet healthcare-provider contracts, donations to companies are not stable enough. Companies can’t rely on the same public and community sentiments that drive NHS and other public system donations. </p>
<h2>Pumping for profit</h2>
<p>While marketing their products and donation programmes may increase milk donations to companies, employing women to pump on contracts is probably needed in the longer term to create a more stable supply. The result, though, could be women pumping for profit. </p>
<p>This has happened around the world, leading to issues like women pumping more than they would to meet company demands, or diverting nutrition from their own children. Indeed, such concerns about payment and employment practices led to community activism <a href="https://www.thecut.com/2015/03/what-happens-when-breast-milk-goes-big-business.html">in the US</a> and <a href="https://time.com/4716190/cambodia-human-breast-milk-ban/#:%7E:text=Cambodia's%20Cabinet%20has%20ordered,milk%20to%20supplement%20their%20incomes">led Cambodia</a> to a total ban on sales to the US. </p>
<p>Few governments, however, are revisiting their frameworks to address what some commentators have labelled “<a href="https://theconversation.com/behind-moves-to-regulate-breastmilk-trade-lies-the-threat-of-a-corporate-takeover-152446">a corporate takeover</a>”. Most responses to date <a href="https://www.emerald.com/insight/content/doi/10.1108/IJHRH-07-2019-0058/full/html">have focused</a> on the public health or food safety risks of milk-sharing and mother-to-consumer sales. Indeed, many countries regulate breast milk as a food and so have failed to explore the substantial issues about the new global marketplace.</p>
<p>Such a discussion must respect breastfeeding and long-held customary practices concerning infant feeding in diverse cultures, but we must address the fact that multinational corporations are moving into the space. Policymakers must consider what this means for women and their infants and place these voices at the centre of responses.</p>
<p>Blood, cells, tissues and organs are highly regulated in most countries to stop people from being exploited. We must urgently consider an international agreement on breast milk, which would help to guide governments in drafting regulation. </p>
<p>This will involve confronting difficult ethical questions. Is employing women to pump for profit really where we wish to head in the future? Are we comfortable paying women to produce milk, much like we do dairy cows? Should milk continue to flow from areas of poverty to areas of affluence?</p>
<p>Regulators must look at milk as more than a food. The global market means we must look instead to the women, and their children, who ultimately could be the greatest losers if for-profit companies put profit before people.</p><img src="https://counter.theconversation.com/content/169995/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Steele receives funding from the Wellcome Trust via Bocconi University and the University of Cambridge. She consults for Australian National University's College of Law. She has worked on research funded by the John and Laura Arnold Foundation, but received no funds or grants directly from that organisation herself.</span></em></p>Companies are popping up selling expressed breast milk for profit.Sarah Steele, Senior Research Associate, Cambridge Public Health; Associate Research Fellow, Cambridge Centre for Applied Research into Human Trafficking; Deputy Director, Intellectual Forum, Jesus College, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1692312021-10-15T12:36:50Z2021-10-15T12:36:50ZBreast milk can contain COVID antibodies – good news for babies<figure><img src="https://images.theconversation.com/files/426282/original/file-20211013-25-1uvwce5.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-woman-breastfeeding-little-baby-1029287806">Irina Polonina/Shutterstock</a></span></figcaption></figure><p>Although babies and young children are at lower risk of getting very sick with COVID-19 compared to older adults, a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943393/pdf/main.pdf">small proportion of babies</a> will require hospital care. </p>
<p>There has been immense interest among scientists, health-care workers and new mothers especially in understanding whether potentially protective antibodies against SARS-CoV-2 (the virus that causes COVID-19) can be provided to babies via breast milk.</p>
<p>But what does the evidence tell us? Does a natural COVID infection lead to SARS-CoV-2 antibodies in a woman’s breast milk, and how long do these last? What about after vaccination? If natural COVID infections and vaccination do produce antibodies in a woman’s breast milk, does this mean babies of these mothers will be protected against COVID-19? And could antibody-filled milk be used as a treatment somehow?</p>
<p>There are now several studies looking at breast milk antibody responses in women <a href="https://reader.elsevier.com/reader/sd/pii/S1386653221001839?token=619A77777AFD7491AA07678CBA5B90D9BC1E6BEE66CCF36D6CDF311E6223950881760DA7AE59C5EA4F30819A70DEC67C&originRegion=eu-west-1&originCreation=20211013101911">who have had COVID-19</a>, while research is increasingly exploring breast milk antibody responses in mothers following vaccination <a href="https://pubmed.ncbi.nlm.nih.gov/34547533/">with an mRNA vaccine</a>.</p>
<p>After COVID infection, antibodies have been found to persist in breast milk for at least <a href="https://reader.elsevier.com/reader/sd/pii/S1386653221001839?token=619A77777AFD7491AA07678CBA5B90D9BC1E6BEE66CCF36D6CDF311E6223950881760DA7AE59C5EA4F30819A70DEC67C&originRegion=eu-west-1&originCreation=20211013101911">six months</a>, with emerging data suggesting they are still abundant <a href="https://www.medela.com/dam/medela-com/breastfeeding-professional/documents/general/symposium-2021/null.pdf?uuid=jcr:8dfc00c0-66f6-4fd7-812d-1a9133a0a657">ten months later</a>. Antibodies are found in breast milk even after mild SARS-CoV-2 infections, and in women who have no symptoms at all.</p>
<p>Meanwhile, the breast milk of women who are vaccinated while lactating (who haven’t had COVID-19) has been found to contain <a href="https://www.liebertpub.com/doi/10.1089/bfm.2021.0122?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed">significant levels of SARS-CoV-2 antibodies</a> after vaccination. Determining how long SARS-CoV-2 antibodies in breast milk last after vaccination will take time, but <a href="https://jamanetwork.com/journals/jama/fullarticle/2778766">reports suggest</a> they persist for at least six weeks.</p>
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<img alt="A woman breastfeeding a baby on a bed." src="https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426283/original/file-20211013-19-x7gwbv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Antibodies from the mother protect the baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/peaceful-loving-young-african-mother-sitting-1440379625">SeventyFour/Shutterstock</a></span>
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<p>It’s not surprising that if the mother is infected with or vaccinated against COVID-19 we see SARS-CoV-2 antibodies produced in her breast milk. Pregnant women are often advised to be vaccinated against other diseases, such as <a href="https://www.nhs.uk/pregnancy/keeping-well/whooping-cough-vaccination/">whooping cough</a>. </p>
<p>In these cases, we know the resulting antibodies that the mother produces can pass on to the baby through the placenta and in breast milk. This is known as “<a href="https://www.nhs.uk/common-health-questions/childrens-health/how-long-do-babies-carry-their-mothers-immunity/">passive immunity</a>”, meaning the baby gets immune protection while its own immune system matures to the point where it can make antibodies for itself.</p>
<p>It’s a continuation of a process that starts while the baby is developing in the womb, and receiving maternal antibodies that are passing across the placenta. This is very important to protect the baby against infectious diseases circulating in the community into which it’s born. </p>
<h2>Breast milk antibodies are unique</h2>
<p>Antibodies are made by specialist antibody-producing immune cells called B cells, which are found in our gastrointestinal tract and other tissues. Antibodies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823845/pdf/zjw2165.pdf">can be found</a> in blood, saliva and other parts of the body. </p>
<p>When a mother’s body is preparing for the birth of a baby, some of these antibody-producing cells travel to the breasts where they produce antibodies locally into the breast milk.</p>
<p>All antibodies can have sugars bound to them. The types and amounts of these sugars vary depending on the part of the body the antibodies are in. We don’t yet fully understand the significance of this, but the pattern of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823845/pdf/zjw2165.pdf">sugars associated with antibodies in breast milk</a> probably supports them in promoting the baby’s wellbeing. For example, these factors might help the antibodies avoid being digested too quickly in the baby’s gastrointestinal tract.</p>
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Read more:
<a href="https://theconversation.com/covid-19-and-pregnancy-what-we-know-about-what-happens-to-your-immune-system-144256">COVID-19 and pregnancy: what we know about what happens to your immune system</a>
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<p>After natural infection or vaccination, breast milk contains both types of key antibodies – immunoglobulin A and immunoglobulin G. These SARS-CoV-2 antibodies in breast milk have been found to neutralise the virus in <a href="https://journals.asm.org/doi/epub/10.1128/mBio.03192-20">laboratory models</a>. This confirms they’re likely to protect a baby from infection.</p>
<p>Interestingly, breast milk collected <a href="https://reader.elsevier.com/reader/sd/pii/S1201971221007475?token=F28EEF8DC50A2DFB6A993D4C4CF1F5D1DFDDC8B8FCD29C1AD193A0E59885902C97DE972D86FAA6F61ECCD69A34A7633E&originRegion=eu-west-1&originCreation=20211013104851">before the pandemic</a> has also been shown to contain antibodies that respond to SARS-CoV-2. This suggests some women have developed antibodies to other human coronaviruses that might protect newborns against COVID-19 – though we don’t know for sure.</p>
<h2>Breast milk is safe</h2>
<p>While a COVID infection and vaccination confer protective antibodies, there’s no danger the virus itself can be transmitted through breast milk from mother to baby.</p>
<p>In a study which tested breast milk from women while they were COVID-positive, the researchers <a href="https://journals.asm.org/doi/epub/10.1128/mBio.03192-20">could not detect viral RNA</a> (the genetic material of SARS-CoV-2) in the samples. Meanwhile, where <a href="https://pediatrics.aappublications.org/content/147/5/e2020010918">unpasteurised expressed breast milk</a> was fed to babies separated from their mothers who had COVID-19, none of these babies showed evidence of infection.</p>
<p>Similarly, the mRNA from COVID-19 vaccines <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2781679">is not detectable</a> in the breast milk of women vaccinated while breastfeeding.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1447085885292531715"}"></div></p>
<h2>Could we use breast milk therapeutically?</h2>
<p>The presence of SARS-CoV-2 antibodies in the breast milk of women who have had COVID-19 or been vaccinated is incredibly important, as these antibodies will help to protect babies from infection.</p>
<p>This knowledge also paves the way for questions as to whether we could use breast milk <a href="https://www.theguardian.com/lifeandstyle/2021/sep/27/antibodies-in-breast-milk-remain-for-10-months-after-covid-infection-study">to treat</a> or prevent COVID-19. </p>
<p>Some of the health benefits of breast milk are already harnessed in various ways. Through <a href="https://ukamb.org">human breast milk banks</a>, for example, donated breast milk is used to save the lives of premature and sick babies.</p>
<p>The ability of SARS-CoV-2 breast milk antibodies to neutralise the virus is retained after <a href="https://www.mdpi.com/2072-6643/13/5/1645">high pressure pasteurization</a>, which is a good sign.</p>
<p>If we were to consider using SARS-CoV-2 antibodies in breast milk to treat COVID-19, such an approach would be similar to that of convalescent plasma therapy. This is where antibodies from the blood of people who have had COVID-19 are administered to <a href="https://www.nature.com/articles/s41591-021-01488-2.pdf">hospital patients with the virus</a> to limit disease severity – although these trials have not been very successful.</p>
<p>We’re still a long way off any kind of treatment like this. But the ongoing research to understand SARS-CoV-2 antibodies in breast milk is a good start.</p>
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Read more:
<a href="https://theconversation.com/do-covid-19-antibodies-fade-more-quickly-in-men-than-women-150573">Do COVID-19 antibodies fade more quickly in men than women?</a>
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<img src="https://counter.theconversation.com/content/169231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Thornton receives funding from MRC and Welsh Goverenment. </span></em></p><p class="fine-print"><em><span>April Rees does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is immense interest in understanding whether potentially protective SARS-CoV-2 antibodies are provided to the baby via breast milk. This is what we know so far.Catherine Thornton, Professor of Human Immunology, Swansea UniversityApril Rees, PhD Researcher in Immunology, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1668532021-09-16T14:33:43Z2021-09-16T14:33:43ZBreastfeeding trends show most developing countries may miss global nutrition targets<figure><img src="https://images.theconversation.com/files/419959/original/file-20210908-22-8w3xm0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exclusive breastfeeding in the first six months makes more difference to a baby's health and survival than any other intervention.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Exclusive breastfeeding, the practice of giving only breast milk (no other food or water), is the ideal for an infant’s first six months. Breast milk <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_1">contains all the essential nutrients</a> an infant needs at this stage.</p>
<p>Research has illuminated the longer-term health benefits of exclusive breastfeeding for the mother and child. These benefits include <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_1">reducing the risk of overweight and obesity</a> in childhood and adolescence and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929058/">certain noncommunicable diseases later in life</a> and enhancing human capital in adulthood. Additionally, breastfeeding <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930884/">reduces the risk</a> of breast and ovarian cancers, type 2 diabetes and high blood pressure among mothers. </p>
<p>These are just a few of the benefits of exclusive breastfeeding. Overall, it makes <a href="https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding">more difference to a baby’s health and survival than any other intervention</a>. That’s the reason why the World Health Organisation (WHO) includes it as a <a href="https://globalhandwashing.org/resources/whounicef-global-action-plan-for-pneumonia-and-diarrhoea-gappd">proven protective intervention</a> in the Global Action Plan for Pneumonia and Diarrhoea.</p>
<p>The WHO initially set a global target of 50% prevalence of exclusive breastfeeding <a href="https://apps.who.int/nutrition/publications/globaltargets2025_policybrief_breastfeeding/en/index.html">by 2025</a>. Recently it was updated to at least <a href="https://www.who.int/nutrition/global-target-2025/discussion-paper-extension-targets-2030.pdf?ua=1">70% prevalence by 2030</a>. It means that every member country is expected to achieve an exclusive breastfeeding prevalence of at least 70% by the end of 2030. </p>
<p>Previous research has shown that the proportion of exclusively breastfed children <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30752-2/fulltext">remains low</a> in many lower and middle-income countries, however. </p>
<p>As part of the <a href="http://www.healthdata.org/gbd/2019">Global Burden of Disease study</a>, my colleagues and I recently <a href="https://www.nature.com/articles/s41562-021-01108-6">published</a> our analysis of data covering two decades (2000-2018) from 94 low- and middle-income countries. We examined the trends and prevalence of exclusive breastfeeding and projected the performance of countries in relation to WHO targets. This type of analysis can help countries formulate the necessary policies and interventions to promote breastfeeding practices.</p>
<h2>Findings from our study</h2>
<p>Total prevalence of exclusive breastfeeding increased (27% to 39%) across all countries during the study period (2000-2018). But we found significant variations between countries and within regions. This suggests intra-regional inequalities that need attention from leaders.</p>
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Read more:
<a href="https://theconversation.com/malnutrition-among-children-is-rife-in-nigeria-what-must-be-done-164496">Malnutrition among children is rife in Nigeria. What must be done</a>
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<p>Countries included in the study made substantial progress. For example, 57 of the 94 countries had an aggregate exclusive breastfeeding practice level of less than 30% in half of their basic administrative units (referred to in this study as provinces) in 2000. But by 2018, exclusive breastfeeding prevalence in some of these countries (8) rose closer to 50%, with at least 45% exclusive breastfeeding levels in most provinces. Similarly, 34 countries had at least one province recording more than a 45% increase in exclusive breastfeeding prevalence by the end of 2018.</p>
<p>Of the African countries, Chad and Somalia had the highest rates of annualised decline in exclusive breastfeeding practices during the study period. </p>
<h2>Progress towards the 70% target</h2>
<p>To estimate future prevalence, we assumed that current trends would continue. We first projected based on the initial target of 25% by 2025, followed by the updated target of at least 70% by 2030. In general, exclusive breastfeeding practices across the countries are expected to increase from 39% in 2018 to 43% by 2025. The practice level will increase to 45% by the end of the new targeted period of 2030. Although this is positive progress, it falls short of the 70% goal. </p>
<p>Our analysis projected six countries – Burundi, Cambodia, Lesotho, Peru, Rwanda and Sierra Leone – to meet 70% of exclusive breastfeeding prevalence by 2030. Eighty-eight of 94 countries are unlikely to meet the global nutrition target on exclusive breastfeeding by 2030. Only three countries (Burundi, Lesotho and Rwanda) are predicted to meet this target in all their sub-national level units (provinces and districts). </p>
<h2>Reasons for low rates of exclusive breastfeeding</h2>
<p>Several reasons may account for the poor performance of countries towards the goal. They include but are not limited to:</p>
<ul>
<li><p>manipulative <a href="https://journals.sagepub.com/doi/10.1177/0379572115602174">marketing or promotion</a> of breast-milk substitutes</p></li>
<li><p>lack of <a href="https://gh.bmj.com/content/3/5/e001032.abstract">workplace support</a> for optimal breastfeeding practices </p></li>
<li><p>lack of attendance at <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/addressing-barriers-to-exclusive-breastfeeding-in-low-and-middleincome-countries-a-systematic-review-and-programmatic-implications/53EBA65F5D58D16E3E4D32E0FCFA938B">antenatal care</a></p></li>
<li><p>lack of skilled <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/addressing-barriers-to-exclusive-breastfeeding-in-low-and-middleincome-countries-a-systematic-review-and-programmatic-implications/53EBA65F5D58D16E3E4D32E0FCFA938B">lactation support or breastfeeding counselling</a> in health facilities </p></li>
<li><p>societal or cultural <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/addressing-barriers-to-exclusive-breastfeeding-in-low-and-middleincome-countries-a-systematic-review-and-programmatic-implications/53EBA65F5D58D16E3E4D32E0FCFA938B">beliefs</a> favouring mixed feeding.</p></li>
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Read more:
<a href="https://theconversation.com/whats-missing-in-south-africas-strategy-to-get-breastfeeding-levels-up-165548">What's missing in South Africa's strategy to get breastfeeding levels up</a>
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<h2>Way forward</h2>
<p>Breastfeeding requires a lot of effort from mothers and support from wider networks, including their families, communities, workplaces, health systems and government leadership. </p>
<p>Advocacy at global, national and sub-national levels is critical and must be pursued by national and sub-national governments. For example, the global breastfeeding <a href="https://www.k4health.org/toolkits/breastfeeding-advocacy-toolkit">advocacy toolkit</a> outlines seven key policy actions to increase breastfeeding practices. These include:</p>
<ul>
<li><p>increasing funding to support exclusive breastfeeding and continued breastfeeding up to 2 years</p></li>
<li><p>fully adopting and monitoring the International Code of Marketing of Breast-Milk Substitutes</p></li>
<li><p>enacting workplace breastfeeding policies and paid family leave</p></li>
<li><p>implementing the baby-friendly hospitals’ ten steps to successful breastfeeding</p></li>
<li><p>improving access to skilled breastfeeding counselling in health facilities </p></li>
<li><p>strengthening links between health facilities and communities to support breastfeeding</p></li>
<li><p>strengthening monitoring systems to track progress. </p></li>
</ul>
<p>These documented strategies can aid policy-makers in monitoring the success of breastfeeding policy and programme investments.</p>
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Read more:
<a href="https://theconversation.com/community-initiative-keeps-kenyan-women-breastfeeding-exclusively-for-longer-165177">Community initiative keeps Kenyan women breastfeeding exclusively for longer</a>
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<p>In conclusion, our study found that only six of the 94 low and middle income countries are on course to meet the WHO target of at least 70% exclusive breastfeeding prevalence by 2030. That means that 94% of the countries included in our study are unlikely to meet the target. This projected poor performance calls for deliberate efforts to promote exclusive breastfeeding for better child health and well-being. Robust policy interventions may still make it possible for some of these low and middle income states to achieve the target by 2030.</p><img src="https://counter.theconversation.com/content/166853/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The original research of this paper was supported by Bill & Melinda Gates Foundation grant (OPP1132415) to the Institute of Health Metrics and Evaluation, University of Washington, USA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Bill & Melinda Gates Foundation.
The author of the present paper, Dr Dickson Amugsi, who works with the African Population and Health Research Center has no conflict of interest to declare.
</span></em></p>Prevalence of exclusive breastfeeding has increased across all countries but few are likely to meet the 2030 goal of 70%.Dr Dickson Amugsi, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1597712021-06-14T12:24:51Z2021-06-14T12:24:51ZNew technologies claiming to copy human milk reuse old marketing tactics to sell baby formula and undermine breastfeeding<figure><img src="https://images.theconversation.com/files/401396/original/file-20210518-23-ss0njf.jpg?ixlib=rb-1.1.0&rect=15%2C15%2C5099%2C3397&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite claims to the contrary, the real thing cannot be replicated.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-mother-nursing-newborn-baby-royalty-free-image/601801509">Jose Luis Pelaez Inc/DigitalVision via Getty Images</a></span></figcaption></figure><p>New products that <a href="https://www.foodnavigator-usa.com/Article/2020/12/17/TurtleTree-Labs-raises-6.2m-to-support-cell-cultured-milk-platform">claim to replicate mother’s milk</a> have entered the lucrative market for infant formula. </p>
<p>To an <a href="https://scholar.google.com/citations?user=0VycH7AAAAAJ&hl=en">anthropologist and public health scholar</a> who studies breastfeeding, these claims appear to be built on old patterns of misleading scientific statements – and reveal the power of marketing to exploit gaps created by inadequate societal support for breastfeeding. </p>
<p>The costs of undermining breastfeeding are enormous. <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">Globally, over 823,000 child deaths</a> could be prevented annually with appropriate breastfeeding. Additionally, <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">20,000 maternal deaths</a> could be averted each year worldwide from breast cancer. Poor communities of color around the world disproportionately shoulder this harm.</p>
<h2>The rise of commercial formula</h2>
<p><a href="https://www.routledge.com/Breastfeeding-New-Anthropological-Approaches/Tomori-Palmquist-Quinn/p/book/9781138502871">Throughout most of history and across cultures</a>, communities understood that breastfeeding ensured the best chance for infants to survive and thrive. Breastfeeding continued, on average, <a href="https://www.doi.org/10.4324/9781315145129-10">from two to four years</a>, with caregivers introducing new foods while continuing to breastfeed.</p>
<p>Attempts to fully replace human milk, <a href="https://www.springer.com/gp/book/9783030273927">usually with animal milk and gruels</a>, were relatively rare. Such attempts were most common when mothers were ill or dead, and caregivers couldn’t locate a lactating woman. <a href="https://www.springer.com/gp/book/9783030273927">Compared with breastfeeding, replacement feeding reduced babies’ chances of survival</a>.</p>
<p>Efforts to mimic breast milk <a href="https://uwpress.wisc.edu/books/0655.htm">escalated with the rise of scientific thinking and industrial capitalism</a> in Europe and the U.S. in the late 18th and early 19th centuries. Mass migration to urban centers eroded community support – and poor labor conditions made breastfeeding challenging. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Old advertisement for Nestlé formula with lead text that reads 'Don't Wait Too Long Before You Wean the Baby.'" src="https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=875&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=875&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=875&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1100&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1100&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405394/original/file-20210609-14833-1th1a61.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1100&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nestlé advertisement, 1911.</span>
<span class="attribution"><a class="source" href="https://www.aims.org.uk/journal/item/nestle">Nestlé</a></span>
</figcaption>
</figure>
<p>From the first commercial milk formula <a href="https://yalebooks.yale.edu/book/9780300188127/milk">patented in 1865 by Justus von Liebig</a>, formula-makers drew on science to gain the trust of medical providers and <a href="https://uwpress.wisc.edu/books/0655.htm">argue their products were as good as</a> – or even superior to – human milk. A study prepared for and published by Nestlé in 1878 <a href="https://yalebooks.yale.edu/book/9780300188127/milk">asserted that mother’s milk was deficient in key nutrients</a> and infants aged 6 to 8 weeks already required supplementation – with Nestlé’s food.</p>
<p>Physicians often claimed to support breastfeeding while undermining it in practice with poor advice and an increasing focus on formula feeding. Pioneering American pediatrician Emmett Holt advocated <a href="https://uwpress.wisc.edu/books/0655.htm">his own method of making formula</a>. <a href="https://archive.org/details/carefeedingof00holt/page/20/mode/2up">In his bestselling book, first published in 1894</a>, Holt claimed infants could be harmed by mother’s milk that was corrupted by emotion. Holt also advised mothers to schedule brief breastfeeding sessions and limit physical contact. Such advice <a href="https://dro.dur.ac.uk/26620/1/26620.pdf">impeded the physiology of breastfeeding</a>, which relies on frequent, responsive feedings and close contact – and contributed to growing reliance on supplementation with formula. </p>
<p>Physicians ultimately <a href="https://uwpress.wisc.edu/books/0655.htm">incorporated formula into their routine medical practices</a> and institutionalized them in <a href="https://history.wisc.edu/publications/brought-to-bed-childbearing-in-america-1750-1950/">hospital childbirth protocols</a>. </p>
<h2>Global spread</h2>
<p>In the first half of the 20th century, colonial administrations spread these new “scientific” infant care norms and products around the globe. They saw bottle-feeding as a <a href="https://doi.org/10.1093/ahr/121.4.1196">solution to infant mortality, disease and malnutrition</a> – and ultimately as an answer to labor shortages in the colonies. </p>
<p>In the 1950s, Nestlé used marketing techniques perfected in Europe to <a href="https://doi.org/10.1080/03086534.2020.1816624">dramatically expand its market in Africa</a>, <a href="https://doi.org/10.1093/ahr/121.4.1196">Asia and other parts of the world</a>. The growing number of infant deaths associated with the use of these products drew international attention and ultimately led to the <a href="https://doi.org/10.1093/ahr/121.4.1196">Nestlé boycott in 1977</a>. </p>
<p>Nestlé’s practices were not unique among formula-makers. Growing concerns about the <a href="https://doi.org/10.1111/j.1753-4887.1972.tb04042.x">role of inappropriate marketing practices</a> in declining breastfeeding rates and infant illness and death led to the development of the <a href="https://www.who.int/nutrition/publications/code_english.pdf">International Code of Marketing of Breast-milk Substitutes</a>, which was adopted by the World Health Assembly 40 years ago, in 1981. The U.S. was the <a href="https://doi.org/10.1136/archdischild-2011-301299">only nation that voted against it</a>, driven by formula lobbying efforts.</p>
<h2>Milking profits</h2>
<p>In the 1950s through the 1970s, multiple social movements fueled <a href="https://doi.org/10.2307/2080604">increased interest in breastfeeding in the U.S.</a>. Medical experts supported these movements with a growing body of <a href="https://doi.org/10.1093/ahr/121.4.1196">scientific research demonstrating the importance of breastfeeding for infant, child and maternal health</a>. But despite <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">significant gains in breastfeeding</a> in some settings, like the U.S., the formula industry <a href="https://doi.org/10.1016/S0140-6736(15)01044-2">continues to expand</a>. </p>
<p>Between 2005 and 2019, global <a href="https://doi.org/10.1111/mcn.13097">formula sales increased 121%</a>, led by middle-income countries. The global industry is <a href="https://doi.org/10.1111/mcn.13097">currently valued at US$50.6 billion</a> and <a href="https://www.globenewswire.com/news-release/2021/01/29/2166545/0/en/Global-Infant-Formula-Market-Size-Will-Reach-USD-110-26-Billion-by-2026-Facts-Factors.html">projected to double by 2026</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman stands in front of a massive grocery store display of infant formula." src="https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/401411/original/file-20210518-15-emjp6x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Infant formula is big business.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-young-asian-mother-groceries-shopping-royalty-free-image/1255253039">d3sign/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Formula-makers devote <a href="https://doi.org/10.1111/mcn.13097">billions of dollars each year to marketing</a> that co-opts scientific and medical authority and <a href="https://www.who.int/publications/i/item/9789240006010">undermines breastfeeding globally</a>. These marketing practices have <a href="https://www.who.int/publications/i/item/9789240006010">continued to defy the International Code of Marketing of Breast-milk Substitutes</a>. </p>
<p>As in the 19th century, <a href="https://www.savethechildren.org.uk/what-we-do/policy-and-practice/our-featured-reports/dont-push-it">formula marketing</a> still <a href="https://doi.org/10.1186/s12992-020-00597-w">presents breastfeeding as an inherently problematic</a>, unreliable process to which formula provides the solution. </p>
<p>Yet most breastfeeding challenges, like the perception of insufficient milk and the difficulties faced by lactating workers, are the product of <a href="https://doi.org/10.1016/S0140-6736(15)01044-2">structural and social conditions</a> that can be addressed by <a href="https://doi.org/10.1016/S0140-6736(15)01044-2">investing in policies</a> that provide quality perinatal care, skilled breastfeeding support, parental leave and workplace accommodations for lactating parents. </p>
<h2>More than a food</h2>
<p>Formula companies focus on human milk as the only important element of breastfeeding – and claim near equivalence between their product and human milk. Yet human milk is a living, life-sustaining substance with a <a href="https://www.routledge.com/Breastfeeding-New-Anthropological-Approaches/Tomori-Palmquist-Quinn/p/book/9781138502871">long evolutionary history and cultural meaning</a>. </p>
<p>Human milk is <a href="https://jhupbooks.press.jhu.edu/title/milk">specific to our species</a>. It is <a href="https://doi.org/10.1002/ajhb.23564">dynamic and adaptive</a> – ever-changing in response to local environments. Human milk contains <a href="https://doi.org/10.1002/ajhb.23564">bioactive compounds</a> and has <a href="https://doi.org/10.1002/ajp.22994">a unique microbiome that varies by setting and over time</a>. New technology, including <a href="https://www.foodnavigator-usa.com/Article/2020/12/17/TurtleTree-Labs-raises-6.2m-to-support-cell-cultured-milk-platform">the culturing of human cells</a>, cannot replicate any of this. </p>
<p>Through complex interactions among mothers, infants and their communities, breastfeeding provides infants with <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">optimal nutrition and protection from infectious disease</a>. Across cultures, lactation and human milk create <a href="https://www.routledge.com/Breastfeeding-New-Anthropological-Approaches/Tomori-Palmquist-Quinn/p/book/9781138502871">relationships that bind families</a> and communities together. </p>
<p>Families need accurate information free of commercial influence to make informed decisions about breastfeeding. I believe when lactation is not possible or desired, <a href="https://doi.org/10.1016/S2214-109X(19)30402-4">families could benefit</a> from <a href="https://doi.org/10.1177/0890334419850820">donor human milk</a>. <a href="https://doi.org/10.1016/S0140-6736(15)01044-2">Government investment in policies</a> that protect, promote and support breastfeeding remains key to creating an environment in which breastfeeding can thrive.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/159771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cecília Tomori has received funding from the National Institutes of Health, US Health Resources & Services Administration, Johns Hopkins University, and the University of Michigan.</span></em></p>Around the globe, 823,000 child deaths could be prevented annually with appropriate breastfeeding. Formula makers continue to defy a 40-year-old international code on marketing their product.Cecília Tomori, Associate Professor and Director of Global Public Health and Community Health, Johns Hopkins University School of NursingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1524462021-05-27T01:22:31Z2021-05-27T01:22:31ZBehind moves to regulate breastmilk trade lies the threat of a corporate takeover<figure><img src="https://images.theconversation.com/files/402795/original/file-20210526-13-c441xs.jpg?ixlib=rb-1.1.0&rect=283%2C60%2C2629%2C1440&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Romanova Anna/Shutterstock</span></span></figcaption></figure><p>The European Union is preparing to harmonise regulations governing the trade in <a href="https://ec.europa.eu/health/sites/default/files/blood_tissues_organs/docs/swd_2019_376_en.pdf">human milk</a>, which sounds like a good thing. But it won’t be if it sidelines breastfeeding or makes informal human-to-human milk exchanges more difficult.</p>
<p>Women and their families have exchanged human milk <a href="https://dl.uswr.ac.ir/bitstream/Hannan/140507/1/9781472569257.pdf">informally</a> (including for money) throughout history, and still do. </p>
<p>Until a century ago human milk was mainly delivered <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0034-9">in person</a>, breast-to-child, by friends, relatives or wet nurses if mothers couldn’t provide it.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=969&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=969&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=969&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1218&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1218&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402762/original/file-20210526-19-fop25i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1218&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Woman buying milk from nurse at counter, 1939.</span>
<span class="attribution"><span class="source">AP-HP Archives, 3Fi3_25_MATERNITE _092</span></span>
</figcaption>
</figure>
<p>As the paediatric profession developed, hospitals in Europe and the United States took over the process and began administering human milk by bottles, at first filled by volunteers, and later, in the lead-up to the second world war, by <a href="https://academic.oup.com/ajcl/article-abstract/65/3/469/4157869">paid donors</a>. </p>
<p>Higher women’s wages after the war made paying donors financially prohibitive, and most countries moved closer to a “<a href="https://www.tandfonline.com/doi/abs/10.1111/j.1540-6563.1996.tb00985.x">gift economy</a>” in which payment for products such as human milk and blood was seen as <a href="https://www.routledge.com/Banking-on-Milk-An-Ethnography-of-Donor-Human-Milk-Relations/Cassidy-Dykes/p/book/9781138559073">inappropriate</a>, alongside a growing commercial market for formula and powder derived from cows milk. </p>
<p>Donor milk collected by charities and non-profit organisations from screened donors is mostly <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-1-26">pasteurised</a> and tested to minimise risks of disease.</p>
<h2>Biotech discovers breast milk</h2>
<p>Things changed in 1999 when an American company, <a href="https://www.prolacta.com/en/products/preterm-nutrition-products/#human-donor-milk">Prolacta</a>, developed human milk-based products for fortifying breast milk fed to premature infants.</p>
<p>At first Prolacta <a href="https://www.thecut.com/2015/03/what-happens-when-breast-milk-goes-big-business.html">didn’t pay</a> donors, but it now pays about <a href="https://www.prolacta.com/en/donors/donate-breastmilk-help-babies/">US$4</a> per 100ml for milk it uses to make products that sell for up to <a href="https://www.nature.com/articles/jp2015168">US$250</a> per 100 ml.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=92&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=92&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=92&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=115&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=115&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402767/original/file-20210526-21-1y235q7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=115&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.prolacta.com/en/products/">Prolacta human milk products</a></span>
</figcaption>
</figure>
<p>In 2015 a not-for-profit Utah-based company, <a href="https://www.bodyandsoul.com.au/health/womens-health/big-business-breast-milk-for-sale/news-story/cad3a38aec71aee6f817994bf15b9809">Ambrosia Labs</a> established clinics in Cambodia to collect milk for exporting to the United States.</p>
<p>After the United Nations Children’s Fund condemned the practice saying breast milk could be considered “human tissue” the Cambodian government <a href="https://www.smh.com.au/world/cambodias-ban-on-breast-milk-sales-throws-spotlight-on-growing-international-trade-20170329-gv8z5u.html">banned</a> it. Some mothers despaired at losing <a href="https://www.phnompenhpost.com/national/breast-milk-mothers-mourn-trade">crucial income</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/without-better-regulation-the-market-for-breast-milk-will-exploit-mothers-79846">Without better regulation, the market for breast milk will exploit mothers</a>
</strong>
</em>
</p>
<hr>
<p>A few years later in 2017 an Australian-Indian company <a href="https://neolacta.com/testimonials-donor/">Neolacta</a>, was granted permission to sell milk collected from <a href="https://www.abc.net.au/news/2017-06-15/indian-company-neolacta-looking-to-sell-breast-milk-to-australia/8619020">Indian mothers</a> in Australia.</p>
<p>In 2019 a related company, <a href="https://neokare.co.uk/home-donors.php">NeoKare</a>, established a “state-of-the-art” plant in Europe making freeze-dried fortifier sourced from UK donors. </p>
<p>These human milk product manufacturers are competing with cow-sourced product manufacturers such as Nestle and might soon be competing with start-ups growing new products that <a href="https://www.theatlantic.com/science/archive/2020/02/lab-grown-breast-milk/606955/">mimic human milk</a>.</p>
<h2>Industry backs new regulation</h2>
<p>The harmonisation being considered by the European Union would extend to human milk the rules that already govern trade in blood, tissues and cells. </p>
<p>Some member states in the European Union already apply tissue and cell rules to human milk, others apply food legislation, and at least 11 <a href="https://ec.europa.eu/health/sites/default/files/blood_tissues_organs/docs/swd_2019_376_en.pdf">don’t regulate it at all</a>.</p>
<p>Australian regulators will be watching closely, because Australian states and territories have similarly diverse rules. </p>
<p>That <a href="https://www.efcni.org/human-milk-regulation/">formula companies</a> are backing the idea provides cause for concern.</p>
<h2>But it’s women who matter</h2>
<p>Health authorities have already expressed <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-6-8">disquiet</a> about commerce-free internet-based milk sharing. The proposal would give them greater powers to act against it.</p>
<p>If these powers were applied heavily they could shut down the generally <a href="https://pubmed.ncbi.nlm.nih.gov/31206310/">safe</a> and self-regulated human-to-human trade. </p>
<p>And advancing the medical market for human milk products might delay the advances in social and employment protection policies needed to support breastfeeding at work, at home and in public.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=970&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=970&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=970&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1218&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1218&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402773/original/file-20210526-21-11n6z0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1218&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a></span>
</figcaption>
</figure>
<p>Human milk is not simply a homogenised “commodity crop in a bottle”. </p>
<p>Breastfeeding creates connections that are important for women’s <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.13102">health and wellbeing</a> and for their <a href="https://onlinelibrary.wiley.com/doi/10.1111/apa.13136">babies</a>.</p>
<p>Ironically, <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0034-9">where governments fail</a> to adequately protect, promote and support breastfeeding, mothers are often forced to turn to commercial formula for a quick fix.</p>
<p>The proposals <a href="https://ec.europa.eu/health/sites/default/files/blood_tissues_organs/docs/swd_2019_376_en.pdf">as drafted</a> pay scant regard to the United Nations <a href="https://www.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=20871">human rights commissioner’s</a> view that “states should do more to support and protect breastfeeding, and end inappropriate marketing of breast-milk substitutes”.</p>
<p>A truly comprehensive set of laws would include protection from marketing and <a href="https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1065442&dswid=-9951">biomedical experiments</a> and allow suitable recompense for donors. Serological testing would be easily available to donors along with guidance to support milk sharing outside of medical facilities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-rise-of-commercial-milk-formulas-matters-for-women-and-children-149681">The rise of commercial milk formulas matters for women and children</a>
</strong>
</em>
</p>
<hr>
<p>Such comprehensive laws would impose levies on commercial substitutes in order to fund better <a href="https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation-2018.pdf">breastfeeding support</a> in maternity and newborn facilities.</p>
<p>They would have at their centre the needs and rights of women, who are both the main providers of human milk and (on their children’s behalf) its biggest users.</p><img src="https://counter.theconversation.com/content/152446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie P. Smith receives funding from the Australian Research Council under an ARC Future Fellowship, for her research on measurement, understanding, and policy regulatory approaches to emerging markets and trade in mothers' milk (FT140101260). She has previously received funding from the World Health Organization and the Australian Department of Health for research consultancies on marketing of baby foods and breastfeeding policy. She is also a volunteer breastfeeding counsellor, community educator, and honorary member of the Australian Breastfeeding Association, and an associate member of the Lactation Consultants Association of Australia and New Zealand.</span></em></p><p class="fine-print"><em><span>Dr. Tanya M. Cassidy receives funding from the Irish Research Council for her research entitled "Parenting in the Pandemic." She also received funding from the Irish Health Research Board, the Fulbright Commission in Ireland, and the European Commission. She volunteers as an ethics advisor to the UK Association of Milk Banking (UKAMB) Scientific Advisory Board. Also, she volunteers her expertise to parent groups across Europe.</span></em></p><p class="fine-print"><em><span>Mathilde Cohen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New European laws aimed at regulating trade in human milk products could be used to target person-to-person sharing of milk for babies.Julie P. Smith, Honorary Associate Professor, Australian National UniversityMathilde Cohen, George Williamson Crawford Professor of Law, University of ConnecticutTanya M. Cassidy, International Convenor, School of Nursing, Psychotherapy and Community Health, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1518202021-02-08T20:51:20Z2021-02-08T20:51:20ZBreastfeeding research improves lives and advances health, but faces conflicts<figure><img src="https://images.theconversation.com/files/380821/original/file-20210127-19-1a4si88.jpg?ixlib=rb-1.1.0&rect=207%2C0%2C5591%2C4012&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows the breast milk of women who have recovered from COVID-19 offers a source of COVID-19 antibodies.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Breastfeeding and breast milk provide <a href="https://doi.org/10.1016/S0140-6736(16)00012-X">big opportunities to support maternal, infant and population health</a>. This is especially true during the current pandemic because breastfeeding can help alleviate food insecurity, and research shows the breast milk of women who have recovered from COVID-19 offers a source of <a href="https://doi.org/10.1016/j.isci.2020.101735">COVID-19 antibodies</a>. </p>
<p>Breastfeeding <a href="https://doi.org/10.1016/S0140-6736(15)01024-7">saves lives</a> and prevents illness. It is <a href="https://doi.org/10.1136/bmj.l5646">environmentally friendly</a> and profoundly important to children’s long-term development. After all, breast milk is the <em>only</em> food that has evolved specifically to feed humans. </p>
<h2>Breastfeeding matters</h2>
<p>Beyond supplying nutrition, breast milk provides personalized <a href="https://doi.org/10.1093/nutrit/nuz019">immune protection and shapes the developing microbiome</a>. Scientists have discovered enzymes, hormones, antibodies and live cells in <a href="https://doi.org/10.3345/cep.2020.00059">breast milk</a>, and these bioactive components could hold the key to <a href="https://doi.org/10.1007/s13577-019-00251-7">developing new therapies</a> — not only for COVID-19, but also autoimmune diseases, diabetes and cancer.</p>
<p>Yet, remarkably, we still don’t fully understand the composition of breast milk, or the biological basis for its many health effects. In fact, more scientific papers have been published on <a href="https://pubmed.ncbi.nlm.nih.gov/?term=headache&sort=pubdate">headaches</a> than <a href="https://pubmed.ncbi.nlm.nih.gov/?term=breastfeeding&sort=pubdate">breastfeeding</a>, and more federal research dollars from <a href="https://cihr-irsc.gc.ca/e/37788.html">Canadian Institutes of Health Research</a> and the <a href="https://www.nserc-crsng.gc.ca/db-tb/index-eng.asp">Natural Sciences and Engineering Research Council of Canada</a> have been invested to <a href="https://webapps.cihr-irsc.gc.ca/funding/Search?p_language=E&p_version=CIHR">study corn</a> than <a href="https://www.nserc-crsng.gc.ca/ase-oro/index_eng.asp">breast milk</a>. </p>
<p>The act of breastfeeding also <a href="https://doi.org/10.1089/bfm.2019.0106">supports mother-infant bonding</a> and helps to prevent <a href="https://doi.org/10.1111/apa.13102">breast and ovarian cancer in mothers</a>. Unfortunately, most mothers <a href="https://doi.org/10.1542/peds.2012-1295">do not even meet their own breastfeeding goals</a>, let alone <a href="https://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2017.pdf">achieve recommendations</a> of exclusive breastfeeding for six months, followed by 18 months of breastfeeding along with other foods.</p>
<p>This is particularly concerning during this pandemic, when mothers infected with COVID-19 may be <a href="https://theconversation.com/separating-mothers-with-covid-19-from-their-newborns-does-more-harm-than-good-141291">separated from their newborns</a> (despite <a href="https://www.who.int/news-room/commentaries/detail/breastfeeding-and-covid-19">World Health Organization guidance</a> to the contrary) and <a href="https://doi.org/10.1111/mcn.13088">breastfeeding support is often unavailable</a> because public health visits are being cancelled and lactation services have been suspended in many places.</p>
<h2>Tensions abound</h2>
<p>Every parent knows that infant feeding is a complex issue, often evoking strong emotions based on personal experience. Difficult or negative breastfeeding experiences can fuel a defensive “<a href="https://raisingwonder.wordpress.com/2019/08/08/its-time-to-talk-about-the-breastfeeding-science-backlash-movement/">breastfeeding denialism</a>” attitude.</p>
<figure class="align-right ">
<img alt="A woman with tattoos breastfeeding her infant" src="https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380822/original/file-20210127-19-1345mev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding support such as public health visits may not be available during the pandemic.</span>
<span class="attribution"><span class="source">(Pexels/Anna Shvets)</span></span>
</figcaption>
</figure>
<p>Conversely, some breastfeeding advocates refuse to acknowledge that for some families, formula is necessary for medical, personal, societal or socioeconomic reasons. These extreme attitudes cause a tense and unproductive environment for researchers working to generate inclusive evidence-based guidance for infant feeding.</p>
<p>Industry partnerships also cause tension in this field because the infant feeding industry frequently violates the <a href="https://www.unicef.org/nutrition/index_24805.html">World Health Organization code for marketing of breastmilk substitutes</a>, and transgressions have <a href="https://doi.org/10.1016/S0140-6736(20)32119-X">worsened during the pandemic</a>. However, due to lack of funding for breastfeeding research, scientists are often faced with choosing between industry funding or no funding at all.</p>
<p>Unfortunately, these tensions often detract from the energy and resources that breastfeeding advocates, researchers, health professionals and policy-makers could be using to advance their shared goal of supporting maternal and child health.</p>
<h2>What can be done</h2>
<p>Of course, members of the diverse breastfeeding advocacy and research communities will not always agree — but we should aim to find common ground and work together. There are many stakeholders involved, each with a role to play:</p>
<p><strong>Governments and non-profit funding organizations</strong> should acknowledge the importance of breastfeeding and breast milk and invest more resources into this field.</p>
<p><strong>Researchers</strong> should build interdisciplinary teams to study breast milk as a biological system and think broadly about “breastfeeding challenges” in the context of complex social systems - including social inequities, parental leave policies, lactation difficulties and donor breast milk.</p>
<p><strong>Companies, researchers and advocacy groups</strong> should co-develop a conflict of interest framework for research on breastfeeding and breast milk and reporting of results.</p>
<p>Messaging is key to achieving these goals. All groups need to communicate effectively with each other, and with the health-care, research and public sectors. This means <a href="http://www.azadlab.ca/resources">providing or sharing clear resources</a> to convey scientific evidence free of conflict of interest, targeted to each audience, such as fact sheets for policy-makers, engaging videos for the public and infographics for health-care providers. </p>
<p>Stakeholders also need to actively discredit unfounded claims and misinformation, such as <a href="https://doi.org/10.1136/bmj.m875">unsubstantiated health claims made by infant nutrition companies</a>, or rumours about the transmission of COVID-19 via breastfeeding, when <a href="https://doi.org/10.1111/nyas.14477">there is no evidence of this occurring</a>.</p>
<h2>Looking forward</h2>
<figure class="align-center ">
<img alt="A woman breastfeeding a baby" src="https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/380826/original/file-20210127-17-54o1ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 has highlighted both the importance and fragility of breastfeeding support systems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Progress in breastfeeding, breast milk and lactation research is being hampered by tensions among researchers, advocates and industry.</p>
<p>As breast milk scientists, breastfeeding researchers and lactation specialists, we are concerned about these tensions and their potential to impede or delay discoveries in our field. Last year, we <a href="https://www.chrim.ca/2020/breastfeeding-and-the-origins-of-health-interdisciplinary-perspectives-and-priorities/">held a workshop</a> to discuss these concerns and develop solutions.</p>
<p>Our <a href="https://doi.org/10.1111/mcn.13109">workshop paper</a> was written before the pandemic, but its recent publication is timely. The pandemic has brought researchers together in ways that seemed impossible before.</p>
<p><a href="http://doi.org/10.1001/jama.2020.15580">Breast milk research</a> that would normally take years has been completed in months with unprecedented efficiency. A <a href="https://doi.org/10.1016/S2352-4642(20)30134-6">global network of human milk banks</a> was established in a matter of days to share information about safe operations during the pandemic. Milk scientists and breastfeeding researchers are <a href="https://www.who.int/docs/default-source/mca-documents/research/working-group-document-22june2020.pdf?sfvrsn=fbb43e6c_2">meeting monthly with the WHO</a> to speed up the transition from discovery to policy. </p>
<p>We hope these trends will continue beyond the pandemic and become the new standard for doing and sharing research.</p>
<p>COVID-19 has also emphasized both the importance and fragility of breastfeeding support systems, which <a href="https://doi.org/10.1111/mcn.13088">have suffered considerably due to current restrictions</a>. The pandemic has also highlighted the potential of breast milk to inform new avenues of biomedical research, such as <a href="https://doi.org/10.1016/j.isci.2020.101735">milk antibodies</a> as potential therapeutics. </p>
<p>We hope this added urgency will encourage researchers, advocates, funders and policy-makers to work together to accelerate progress in supporting breastfeeding and breast milk research.</p><img src="https://counter.theconversation.com/content/151820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meghan Azad co-Directs the Manitoba Interdisciplinary Lactation Centre. She holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease at the University of Manitoba and is a Fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She receives research funding from the Canadian Institutes of Health Research, Research Manitoba, the Canada Foundation for Innovation, the Bill and Melinda Gates Foundation, the Manitoba Children’s Hospital Foundation, Prolacta Biosciences, Mitacs, CIFAR, and the Garfield G. Weston Foundation. She regularly speaks at conferences and workshops on infant nutrition, some sponsored by Medela, the Institute for the Advancement of Breastfeeding & Lactation Education, and Prolacta Biosciences. She has contributed to online courses on breast milk and the infant microbiome produced by Microbiome Courses. She serves in a volunteer capacity as Secretary to the International Society for Research on Human Milk and Lactation and as a member of the National Academy of Sciences, Engineering and Medicine Committee on Scanning New Evidence on the Nutrient Content of Human Milk. </span></em></p><p class="fine-print"><em><span>Katie Hinde's research has been supported by grant funding from the National Science Foundation and the National Institutes of Health. </span></em></p><p class="fine-print"><em><span><a href="mailto:lbode@health.ucsd.edu">lbode@health.ucsd.edu</a> works for University of California San Diego. He receives funding from the National Institutes of Health and the Family Larsson-Rosenquist Foundation. </span></em></p><p class="fine-print"><em><span>Luisa Zuccolo receives funding from the UK Medical Research Council and the Jean Golding Institute at the University of Bristol. She consults for the Human Milk Foundation and sits on the Advisory Board of the UK National Institute of Health Research's Cochrane review on breastfeeding support strategies. She is a trained volunteer in breastfeeding peer support and co-chairs a breastfeeding peer supporter group, which is audited by the UK Baby Friendly Initiative. </span></em></p><p class="fine-print"><em><span>Merilee Brockway receives funding from The Molly Towell Perinatal Research Foundation and the Garfield Weston Foundation.</span></em></p><p class="fine-print"><em><span>Nathan Nickel, PhD is an Associate Professor of Community Health Sciences, Associate Director at the Manitoba Centre for Health Policy, and Co-Director of the Manitoba Interdisciplinary Lactation Centre. Dr. Nickel is the Scientific Chair for Breastfeeding at the American Public Health Association and he works with the Breastfeeding Committee of Canada and the Centre for Health Equity Education and Research. He receives funding for breastfeeding and population health research from the Public Health Agency of Canada, Health Canada, the Canadian Institutes for Health Research, Research Manitoba, and the Canadian Foundation for Innovation. </span></em></p><p class="fine-print"><em><span>Rafael Pérez-Escamilla, PhD is professor of public health and director of the Office of Public Health Practice, the Global, the Global Health Concentration, the Yale-Griffin CDC Prevention Research Center, and the Maternal Child Health Promotion Program at the Yale School of Public Health. He receives funding from The National Institutes of Health (NIH), the US Centers for Disease Control and Prevention (CDC), The World Health Organization, The Bill and Melinda Gates Foundation, The Robert Wood Johnson Foundation, The Kellogg Foundation, and The Family Larsson-Rosenquist Foundation </span></em></p>Researchers don’t fully understand the composition of breast milk and its benefits. Beyond nutrition, it contains enzymes, hormones and the mother’s antibodies — including antibodies for COVID-19.Meghan Azad, Associate Professor of Pediatrics and Child Health; Canada Research Chair in the Developmental Origins of Chronic Disease, University of ManitobaKatie Hinde, Associate Professor, School of Human Evolution and Social Change, Arizona State UniversityLars Bode, Professor of Pediatrics and Director of Mother-Milk-Infant Center of Research Excellence, University of California, San DiegoLuisa Zuccolo, Senior Research Fellow, Health Sciences, University of BristolMerilee Brockway, Post-doctoral Fellow, Department of Pediatrics and Child Health, University of ManitobaNathan C. Nickel, Associate Professor of Community Health Sciences; Co-Director MILC; Associate Director, Manitoba Centre for Health Policy, University of ManitobaRafael Perez-Escamilla, Professor of Public Health, Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1368062020-05-07T19:03:20Z2020-05-07T19:03:20ZBreastfeeding is recommended during pandemic, but coronavirus has changed support systems<figure><img src="https://images.theconversation.com/files/332468/original/file-20200504-83769-18y6b39.jpg?ixlib=rb-1.1.0&rect=10%2C905%2C6699%2C3561&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Community support programs for breastfeeding have changed under COVID-19 restrictions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Breastfeeding sets babies up for good health <a href="https://my.clevelandclinic.org/health/articles/15274-the-benefits-of-breastfeeding-for-baby--for-mom">across the lifespan</a>. However, the COVID-19 pandemic is causing health-care providers to change the way they support breastfeeding mothers. While many supports have been reduced or eliminated, others have transitioned online where it may be easier for families to access them. </p>
<p>As researchers in the field of breastfeeding and human lactation, we are asking <a href="https://www.pregnancyduringthepandemic.com/">many questions</a> about the safety of breast milk from mothers who are sick with COVID-19, the impact of COVID-19 on quality of care and breastfeeding support, and how the pandemic will affect breastfeeding rates. </p>
<h2>Is it safe to breastfeed my baby during COVID-19?</h2>
<p>The <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/pregnancy-advise-mothers.html">Public Health Agency of Canada</a> and the <a href="https://www.cps.ca/en/documents/position/breastfeeding-when-mothers-have-suspected-or-proven-covid-19">Canadian Pediatric Society</a> recommend that mothers suspected of or confirmed positive for COVID-19 continue to breastfeed. Currently, there is <a href="https://www.isrhml.com/files/ISRHML%20Coronavirus%20and%20Breastfeeding%2004_09_2020%20-%20English.pdf">no evidence</a> of the presence of the SARS-CoV-2 virus in breast milk. This means that breast milk itself is likely not a potential route for transmission of COVID-19. </p>
<p>COVID-19 is primarily spread through droplets, which could be a path for transmission from a sick mother to her baby. However, there are many benefits of breastfeeding including providing <a href="https://jaoa.org/article.aspx?articleid=2093315">antibodies</a> that contribute to strong immune system development. </p>
<p><a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/pregnancy-advise-mothers.html">Current recommendations</a> state that sick mothers can remain with their infant and continue to breastfeed while taking extra precautions. These include wearing a mask, washing hands frequently and disinfecting surfaces that may be in contact with the infant. Pumping breast milk and feeding the infant from a cleaned bottle is recommended for mothers who are too sick to feed at the breast. </p>
<p>If a mother is not sick, they can continue to breastfeed the way they normally would. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&rect=296%2C13%2C4304%2C3421&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330382/original/file-20200424-163058-wbz60a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is no evidence that SARS-CoV-2 — the virus that causes COVID-19 — is present in the breast milk of sick mothers.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>Establishing breastfeeding requires significant professional and social supports. In the midst of the COVID-19 pandemic, practitioners are grappling with how to best support breastfeeding mothers in safe and healthy ways. </p>
<p>The current evidence on the extent to which COVID-19 affects moms and babies is preliminary and still ongoing. That means families and practitioners may have to deal with changing recommendations and information about COVID-19, which may bring about disruptions in care. Health-care agencies are choosing to use the <a href="https://www.sciencedirect.com/topics/earth-and-planetary-sciences/precautionary-principle">precautionary principle</a>, which favours stricter regulations than may be necessary. </p>
<h2>How have breastfeeding supports changed?</h2>
<p><a href="https://doi.org/10.1002/14651858.CD001141.pub5">Breastfeeding support</a> is critically important in helping moms continue to breastfeed and meet their own breastfeeding goals. There are approximately <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310041501">1,000 babies born each day</a> in Canada, <a href="https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11879-eng.htm">89 per cent of whom begin breastfeeding</a> in hospital. </p>
<p>However, many maternity care centres are now discharging families with uncomplicated deliveries <a href="https://www.qpbriefing.com/2020/04/02/delivering-during-the-covid-19-pandemic-expectant-mothers-facing-stricter-policies-share-fears-changed-plans-and-tough-choices/">six hours after birth</a>. This means that there is currently very little breastfeeding support available in hospital and the responsibility has shifted to care in the community. </p>
<p>Community breastfeeding supports have also changed in light of COVID-19 restrictions. Practitioners who work in <a href="http://wpgbreastfeedingcentre.com/">clinics</a> helping mothers with breastfeeding issues have seen a decrease in in-person assessments due to families wanting to stay at home. In-person breastfeeding assessments are important because practitioners can assess latch and <a href="https://ibconline.ca/information-sheets/tongue-tie-lip-tie-and-releases/">tongue tie</a>, and help with positioning. Further, many health regions have discontinued their prenatal and breastfeeding classes.</p>
<p>On the other hand, there has been a surge in virtual and phone-based assessments, which were not available to families prior to COVID-19. Virtual formats for breastfeeding support can reach more families in the safety of their own homes. </p>
<p>Professional breastfeeding support is important, but so is social support. Due to social distancing measures, in-person breastfeeding support groups have been cancelled and visits from friends and family members are off limits. Social support can improve mothers’ <a href="https://doi.org/10.1177/0890334417707957">confidence and success (what researchers call self-efficacy) in breastfeeding</a> and provide the emotional stamina to continue on. The importance of professional and social supports on the initiation and duration of breastfeeding are <a href="https://dx.doi.org/10.1002%2F14651858.CD001141.pub5">well supported</a> and the impact of COVID-19 on breastfeeding outcomes could be significant. </p>
<h2>What are the new opportunities for breastfeeding mothers?</h2>
<p>Among the new barriers present for breastfeeding mothers, there are also breakthroughs. These breakthroughs may provide better support to previously unreached populations. COVID-19 has forced providers to transition to online care, which can offer services to women and families in remote locations. </p>
<p>Through online platforms, providers can also see women in their own homes and offer tailored recommendations based on their current set-up. In many areas, there are now online parenting support groups and online videos are being created to <a href="https://www.cbc.ca/news/health/coronavirus-covid-19-pandemic-pregnancy-1.5505198">provide pre- and post-natal care to families</a>. </p>
<p>Additionally, while tangible social supports from friends and family are reduced, there are benefits to mothers having uninterrupted time with their infants, which can help to enhance the breastfeeding relationship. </p>
<p>Our current circumstances are shifting the way breastfeeding support is provided. Looking ahead, we see great opportunities to merge new online support systems with in-person supports to provide more options and better care to new babies and families. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=927&fit=crop&dpr=1 600w, https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=927&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=927&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1165&fit=crop&dpr=1 754w, https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1165&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/330390/original/file-20200424-163088-uv6bev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1165&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you can, keep breastfeeding during COVID-19.</span>
<span class="attribution"><a class="source" href="https://stores.praeclaruspress.com/free-infographic-breastfeeding-and-covid-19/">(Praeclarus Press)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/136806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merilee Brockway receives funding from the Garfield Weston Foundation and the Molly Towell Perinatal Research Foundation and is also a member of the New Democratic Party (NDP) of Alberta.</span></em></p><p class="fine-print"><em><span>Sarah Turner is a Vanier Scholar and receives funding from Canadian Institutes of Health Research. </span></em></p>There is no evidence that the coronavirus is transmitted through breast milk, and breastfeeding is encouraged during COVID-19. However, the support available to new mothers has changed dramatically.Merilee Brockway, Post-doctoral Fellow, Department of Pediatrics and Child Health, University of ManitobaSarah Turner, PhD Candidate, Community Health Sciences, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1296552020-02-20T13:27:02Z2020-02-20T13:27:02ZSome infant formula milks contain more sugar than soda drinks – new research<figure><img src="https://images.theconversation.com/files/315015/original/file-20200212-61952-1cvrhiz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhealty-baby-food-concept-problem-hidden-1365243554">Shutterstock/Lithiumphoto</a></span></figcaption></figure><p>Some formula milks have double the sugar per serving than a <a href="https://www.bbc.co.uk/news/magazine-35831125">glass of soda</a>. That was the key finding of our <a href="https://www.nature.com/articles/s41415-020-1252-0">global investigation</a> into the sugar content of infant formula and follow-on milks. But perhaps more shocking is the fact that there are so few regulations in place to control sugar content and to make sure consumers are well informed. </p>
<p>We all love sugar. But too much of the sweet stuff can lead to obesity, type 2 diabetes and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133084/">dental disease</a>. Our preference for sugary foods stems from our primitive ancestors, who were scavengers and sought out sweet foods for energy. But if we are hardwired to like sweet foods, being fed lots of sugar as babies can increase our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3738223/">desire for sweet things</a> and increase the risk of developing disease in later life. </p>
<p>Breast milk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882692/">the recommended</a> source of nutrition for infants, especially during the first six months of life. Although it is sweet and high in energy, the sugar is mainly lactose and the content is specific to the needs of the growing infant. Conversely, infant formula milks have a standardised make-up and contain added sugars such as corn syrup which are added during production and are not found in breast milk. This is bad for babies because high consumption of added sugars <a href="https://www.sciencedirect.com/science/article/pii/S2212267219313401?via%3Dihub">may contribute</a> to tooth decay, poor diet and lead to obesity in children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315054/original/file-20200212-61981-zzlu4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A baby being fed formula milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-feeding-her-little-cute-1300509853">Shutterstock/OlenaChukhil</a></span>
</figcaption>
</figure>
<p>We investigated the sugar content of 212 commercially available infant formula milk products targeted at infants under three. The products were being sold in supermarkets in 11 countries. We collected data on sugar content from nutrition labels and compared it to average breast milk compositions and sugar content guidelines. We also noted the clarity of the labels and the marketing strategies used on the packaging. </p>
<p><a href="https://www.nature.com/articles/s41415-020-1252-0">Our findings</a> revealed that over half of the products contained more than 5g of sugar per 100ml. In many cases, the sugar content was over 7.5g per 100ml, which exceeds <a href="http://www.babymilkaction.org/archives/8274">European parliament</a> recommended levels for infants. For example, we found that a powdered product for infants under six months sold in France contained 8.2g of sugar per 100ml, or nearly two teaspoons, while a ready-to-drink milk formula for infants under 12 months sold in the UK contained 8.1g of sugar per 100ml. </p>
<p>This comes at a time when sugar-sweetened beverages have been subject to widespread taxation to reduce their sugar content due to <a href="https://www.wcrf.org/sites/default/files/PPA-Building-Momentum-Report-WEB.pdf">negative impacts on health</a>. As a result, many formula products included in our study contained almost double the sugar of well known drinks such as <a href="https://www.coca-cola.co.uk/drinks/fanta/fanta-orange">Fanta Orange</a>. </p>
<h2>Nutritional information</h2>
<p>Obtaining information from the labels of these formula products was difficult as the fonts used were small and the facts provided varied between countries. For example, some products listed sugar content per 100g while others listed it per 100kcal. This is despite <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/18/made">guidelines</a>, such as those in the UK, which state that values should be expressed as kJ/kcal per 100ml.</p>
<p>There are also <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">codes</a> in place to limit the marketing of infant formula products because they are not the best way to feed a growing baby. But most of these are voluntary codes of practice which manufacturers do not have to abide by. </p>
<p>Even guidelines which are enforced by law can be side-stepped by manufacturers, since they are <a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">not strictly monitored</a> and have loopholes. In some cases, manufacturers themselves have even influenced their development. </p>
<p><a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">For example</a> it was revealed that the industry has funded research into infant health and has given doctors free formula products. This almost certainly helps ensure that their sale is affected as little as possible by such guidelines. It is possible that the sale of infant formula products has increased worldwide as a result. </p>
<p>The World Health Organization’s <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">International Code of Marketing of Breastmilk Substitutes</a> stipulates that infant formula products should not be promoted over breastfeeding. <a href="http://www.legislation.gov.uk/uksi/2007/3521/regulation/17/made">In the UK</a> the guidelines state that the labels on products targeted at infants under six months should not include images of infants or any other pictures that idealise their use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315055/original/file-20200212-61941-8x3ri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-woman-choosing-milk-powder-632850146">Shutterstock/VirojtChangyencham</a></span>
</figcaption>
</figure>
<p>But we found that many of the formulas had labels that included images of infants or cute toys of animals, presumably designed to entice caregivers into buying. Such findings are not unsurprising as there is evidence that <a href="http://www.babymilkaction.org/monitoring-global">harmful marketing strategies</a> have been used extensively by infant formula and follow-on milk manufacturers. </p>
<h2>Recommendations</h2>
<p>Our findings are alarming, as is the potential negative impact of the high sugar content on the health of babies. We urge parents and caregivers to opt for breast milk whenever possible. However, to help those families unable to breastfeed their babies, we also have two key recommendations for policymakers:</p>
<p>1) Regulate the amount and type of sugar in infant formula products as a matter of urgency. Encourage manufacturers to aim for formulations as close to breast milk as possible. Such regulations could be conducted in a similar way to the taxes on sugar-sweetened beverages which have been <a href="https://www.worldobesity.org/resources/policy-dossiers/pd-1/case-studies">implemented across the world</a>. </p>
<p>2) We are also calling for the mandatory disclosure of added sugar by manufacturers and suggest that this could be implemented alongside the introduction of a clear front-of-pack labelling system. Such disclosures and clear labelling could aid consumers to make informed choices about what products they purchase.</p><img src="https://counter.theconversation.com/content/129655/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Bridge is affiliated with the World Federation of Public Health Associations. She thanks the members of the organisation for helping to collect the data included in the study. This article was published with the support of co-researchers Raman Bedi, an emeritus professor at Kings College London, and Marta Lomazzi, a Medical Biotechnologist, from the University of Geneva.</span></em></p>Researchers investigated 212 commercially available infant formula milk products on sale in 11 countries.Gemma Bridge, Research Evidence Impact Officer, Leeds Business School, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1215872020-01-23T17:33:13Z2020-01-23T17:33:13ZProbiotics: What they are and how you might benefit from them<figure><img src="https://images.theconversation.com/files/304349/original/file-20191128-178121-1xivflu.jpg?ixlib=rb-1.1.0&rect=269%2C22%2C4580%2C2971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Increased scientific understanding of the role microbes play in humans and other animals has led to the development of probiotics to improve heath. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Probiotics are <a href="http://www.fao.org/3/a-a0512e.pdf">live microorganisms, usually bacteria, that can be consumed to offer health benefits</a>. </p>
<p>The ability of certain microbes to confer health benefits on their host was recognized more than 100 years ago. In 1904, Elie Metchnikoff, a scientist at the Pasteur Institute, claimed that <a href="https://www.smithsonianmag.com/science-nature/science-lecture-accidentally-sparked-global-craze-yogurt-180958700/">Bulgarian peasants lived longer by eating yogurt made from bacteria that served to ferment the milk</a>. Parisians rushed out to buy yogurt in response.</p>
<p>However, the huge variety of bacteria living on the planet was not appreciated back then. More recently, the development of technology that identifies organisms from their DNA has allowed scientists to show that <a href="https://doi.org/10.1093/femsle/fnz117">plants, animals, insects and humans can be hosts for many different types of microorganisms</a>.</p>
<p>This has fostered <a href="https://www.newscientist.com/round-up/microbiome/">the term “microbiome”</a> as studies have uncovered the <a href="https://doi.org/10.1038/nature06244">range of organisms present throughout the human body and their association with many diseases</a> — from cardiovascular and digestive diseases to anxiety, allergies and infection.</p>
<p>Recognition of the roles that microbes play has led to the purposeful development of <a href="https://www.healthlinkbc.ca/health-topics/tw2302spec">microbes (probiotics)</a> that aim to restore and maintain health in humans and other life forms. </p>
<h2>From babies to honey bees</h2>
<p>One research group discovered that some strains of probiotic lactobacilli can be used instead of antibiotics to <a href="https://doi.org/10.1086/652763">treat women with infectious mastitis</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304351/original/file-20191128-178066-jgyuhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One research study shows probiotics to be an efficient alternative to antibiotics for the treatment of infectious mastitis during lactation.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The use of probiotics can also be used in other life forms. They can counter the <a href="http://www.dx.doi.org/10.1128/AEM.02820-17">damage pesticides cause to the immune system of insects such as the honey bee</a>. </p>
<p>Research has also shown that gut microbes can affect the drugs we take, <a href="https://doi.org/10.1038/nrmicro.2016.17">processing them to become more active, less active and even toxic</a>. </p>
<h2>Probiotics for urogenital health</h2>
<p>In 1982, Dr. Andrew Bruce, then the chair of urology at Toronto General Hospital, and I decided to try to use lactobacilli to reduce the incidence of urinary and vaginal infections among women. </p>
<p>The idea was based on the finding that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941341">lactobacilli are dominant in the vagina and urethra of healthy women, but <em>E. coli</em> and other pathogens displace them in disease</a>. We theorized that by boosting the lactobacilli in the vagina and perineum (the space between the anus and the vulva), we could reduce the ascent of infective bacteria into the bladder.</p>
<p>The laboratory and clinical research took over 20 years to identify the lactobacilli that could best inhibit and disrupt the harmful bacteria. The end result was a product containing <em>Lactobacillus rhamnosus</em> GR-1 and <em>Lactobacillus reuteri</em> RC-14 that is now sold in more than 30 countries as <a href="https://doi.org/10.1139/cjm-2016-0733">a probiotic to alleviate the suffering associated with these conditions</a>.</p>
<p>With no alternative to antibiotics in almost 50 years, the contribution of probiotics to managing urogenital health is tangible and worthy of further exploration.</p>
<p>Other substances called prebiotics (essentially food for beneficial microbes) can also provide health benefits. For example, inulin from the chicory root, or human oligosaccharides in breast milk, <a href="https://doi.org/10.1038/nrgastro.2017.75">stimulate bacteria in the gut</a>. Compounds like lactulose may <a href="https://doi.org/10.1128/AEM.02200-17">help prevent urogenital infection</a>. </p>
<h2>The success of poop transplants</h2>
<p>If someone has a really disrupted intestinal microbiome, such as when antibiotic use leads to infection by <em>Clostridium difficile</em>, then the solution may be a fecal transplant — transferring a healthy person’s poop into their gastrointestinal tract. </p>
<p>As yucky as it sounds, it has a cure rate of <a href="https://dx.doi.org/10.1155%2F2018%2F1394379">80 to 90 per cent for this infection</a>. It is is done by <a href="https://doi.org/10.1038/ismej.2014.13">inserting a healthy stool (which is mostly microorganisms) into the intestine via the rectum</a> or via a tube from mouth to stomach. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304354/original/file-20191128-178094-oongbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">3D illustration of intestinal bacteria.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The success, and the now recognized link between the gut microbiome and health at other body sites, has led to fecal microbiota transplant being considered to treat other diseases. Examples include multiple sclerosis, digestive and <a href="http://www.dx.doi.org/10.1053/j.gastro.2019.01.033">liver diseases</a>. The rationale is that the transplanted bacteria can produce molecules that affect metabolism and other organ functions. </p>
<h2>Regulation of probiotics</h2>
<p>Probiotics tend to be sold as dietary supplements and foods, which keeps manufacturers from claiming they treat disease, even though some studies have shown efficacy. This dates back to regulators stating that only drugs can cure, treat, prevent and mitigate disease. </p>
<p>While this is an outdated view, it has formed the system within which all health and disease-related products are adjudicated. One result has been to curtail research and development and clinical studies by researchers and companies in the United States and Europe. </p>
<p>Many commercial products have been labelled as probiotic, but only those with clinical evidence to support their benefits should be considered. Experts have summarized the <a href="http://www.probioticchart.ca">tested products available in Canada</a> and the <a href="http://www.usprobioticguide.com">United States</a>, as well as the level of evidence, to help inform consumers and health-care providers.</p>
<p>These lists do not document every product, as many have not undergone the necessary testing in humans. More research is needed, so that probiotic use can be widened to have impacts across society and the ecosystem. </p>
<h2>A multi-billion dollar market</h2>
<p>The global market for probiotics is <a href="https://www.statista.com/statistics/821259/global-probioticsl-market-value/">forecast to reach to about US$69.3 billion by 2023</a>. This illustrates the interest of consumers and health-care providers in this area. In future, more products will be developed for specific health applications. </p>
<p>Because probiotic organisms produce molecules that pass from the intestine into the bloodstream, we may see treatments that could help <a href="https://www.ncbi.nlm.nih.gov/pubmed/27801892">the brain</a>, <a href="https://www.doi.org/10.1097/MPG.0000000000000187">lungs</a>, liver, <a href="http://www.dx.doi.org/10.1016/j.jmii.2015.10.003">skin</a> and <a href="http://www.dx.doi.org/10.1371/journal.pone.0187964">other organs</a>. Hopefully, researchers will compare probiotic strains to drugs to provide a perspective on where probiotics might fit in the spectrum of patient management. </p>
<p>Probiotics are not magic bullets or cures for all ills. For example, products tested so far have not proven valuable in the treatment of Crohn’s disease. Nevertheless, the use of beneficial microbes does represent an important field of science, with specific probiotic strains having the capacity to contribute to the well-being of humans and other life forms. </p>
<p>It is through scientific endeavour that such progress will be made to the betterment of humanity and the planet.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/121587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregor Reid helped to develop and commercialize probiotic strains GR-1 and RC-14 but has had no financial interest in them for over 10 years.
He is Chief Scientific Officer for Seed, a company producing probiotic products.
He has provided advice on probiotics in the past three years to Seed, KGK Science, Acerus Pharma, Danone, Chr Hansen, Altmann, Kimberly Clark Corp., and Metagenics.
He is funded by NSERC, OMAFRA and Kimberly Clark. </span></em></p>From dietary supplements to poop transplants, probiotics are now a multi-billion dollar market.Gregor Reid, Professor at Schulich Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1258192020-01-02T21:55:52Z2020-01-02T21:55:52ZExpressing breast milk this summer? Storing it safely will protect your baby’s health<figure><img src="https://images.theconversation.com/files/304874/original/file-20191203-66982-utcyx1.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5973%2C3376&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food safety guidelines for expressed breast milk can be confusing.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>The summer months are upon us and with them we’re getting the usual food safety reminders. Be careful handling raw meat when preparing for your backyard barbecue, refrigerate the potato salad, and so on. These tips are designed to protect us from food poisoning, an unwanted addition to anyone’s summer holiday.</p>
<p>But few people are likely to consider the issue of food handling for babies: in particular, of expressed breast milk. Parents who use expressed breast milk are routinely transferring it between containers, defrosting it, and reheating it.</p>
<p>Breast milk is a raw animal food product. It contains live cells, proteins, carbohydrates, fatty acids, micronutrients, probiotics, and more. But the health-giving properties of breast milk decrease over time. And while breast milk has properties which inhibit the growth of some harmful bacteria, factors such as heat and time can enable these harmful bacteria <a href="https://www.jove.com/science-education/10100/bacterial-growth-curve-analysis-and-its-environmental-applications">to grow</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/want-to-breastfeed-these-five-things-will-make-it-easier-109507">Want to breastfeed? These five things will make it easier</a>
</strong>
</em>
</p>
<hr>
<h2>From breast, to bottle, to bub</h2>
<p>The World Health Organisation recommends feeding babies breast milk exclusively for the first <a href="https://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/">six months</a> of life. So for many babies, this is their only source of food.</p>
<p><a href="https://www.nhmrc.gov.au/sites/default/files/images/literature-review-infant-feeding-guidelines.pdf">Up to 98%</a> of breastfeeding women will express milk at some stage. Mothers may express milk if they are leaving their babies with partners, relatives, or babysitters. Planning to <a href="https://www.breastfeeding.asn.au/system/files/ABA_Alchohol_BF%2520for%2520website.pdf">drink alcohol</a> is another common reason women express milk ahead of time.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304880/original/file-20191203-67023-1holvf7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mothers may choose to express milk if they’re going to be away from their baby for an extended period.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Some mothers only express and never directly feed: around <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-212#Tab1">4%</a> of breastfeeding women in Australia and up to <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-212#Tab1">18%</a> elsewhere. Mothers may exclusively express if their baby is not able to feed (because of a mouth malformation, poor latching, or breast refusal), if returning to work, or for other reasons.</p>
<p>If you’re using expressed breast milk to feed your baby – whether you do it all the time or it’s just a once off – here’s what to keep in mind.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-national-breastfeeding-strategy-is-a-start-but-if-we-really-valued-breast-milk-wed-put-it-in-the-gdp-121302">The National Breastfeeding Strategy is a start, but if we really valued breast milk we'd put it in the GDP</a>
</strong>
</em>
</p>
<hr>
<p><strong>Preparation for expressing</strong></p>
<ul>
<li><p>Wash hands with soap and water (or hand sanitiser) every time, and dry on a clean cloth (or paper towel)</p></li>
<li><p>equipment and storage containers should be washed with warm soapy water and air dried (or dried with a paper towel).</p></li>
</ul>
<p><strong>Storage</strong></p>
<p>Like other food products, the length of time for which you can safely store breast milk will depend on where you store it – whether at room temperature, in the fridge, or in the freezer. </p>
<p>Storage guidelines based on the most up-to-date evidence are published by the <a href="https://www.nhmrc.gov.au/sites/default/files/images/literature-review-infant-feeding-guidelines.pdf">National Health and Medical Research Council</a>.</p>
<p>We’ve summarised this information in the table below, where the “ideal limit” will ensure the milk keeps its nutritional value, and the “maximum limit” is the time period which should not be exceeded for safety reasons.</p>
<p>The advice for room temperature does not apply for environmental conditions over 26°C. It’s important to immediately refrigerate or freeze any expressed milk in temperatures above 26°C.</p>
<iframe title="Storage of expressed breast milk" aria-label="Table" src="https://datawrapper.dwcdn.net/T1ddG/1/" scrolling="no" frameborder="0" style="border: none;" width="100%" height="360"></iframe>
<p>One study looked at storing breast milk in <a href="https://pediatrics.aappublications.org/content/97/4/492">ice-packed coolers</a>, for example a small styrofoam box packed with “blue ice” (the ice packs designed to keep food cold). This study found breast milk could be safely stored in this way for a maximum limit of 24 hours. This may be useful when parents need to store breast milk on the go, but this method of storage requires further research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
</strong>
</em>
</p>
<hr>
<p><strong>Feeding</strong></p>
<ul>
<li><p>Ideally, thaw breast milk in the fridge and use it within 24 hours (you can also thaw it in a container of warm water for immediate use)</p></li>
<li><p>nutrients are best maintained under 37°C. Warm the breast milk by putting the bottle in lukewarm water (less than 40°C) for up to 20 minutes. Avoid the microwave for heating because it has the risk of <a href="https://www.quirkyscience.com/microwave-cooking/">hot spots</a> (overheated sections of the liquid, like when you microwave a meal and some bits are hotter than others) </p></li>
<li><p>you can offer cool, room temperature, or warmed milk to the baby</p></li>
<li><p>discard any unused remains after a feed.</p></li>
</ul>
<h2>The guidelines aren’t always clear</h2>
<p>In our <a href="https://www.sciencedirect.com/science/article/pii/S1871519219308595?via%3Dihub">recently published research</a>, we reviewed the online guidelines around handling and storage of expressed breast milk accessible to Australian women. We found a lot of conflicting advice, which can be confusing for mothers.</p>
<p>Considering breast milk is the only source of food for many young babies, the number of mothers who express, and the future trend toward milk banking, more research needs to be done into the physical properties of breast milk, and its safe handling and storage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/breast-milk-banking-continues-an-ancient-human-tradition-and-can-save-lives-69351">Breast milk banking continues an ancient human tradition and can save lives</a>
</strong>
</em>
</p>
<hr>
<p><em>The authors would like to acknowledge the contributions of fellow team members Hayley Scott and Leah Strauch.</em></p><img src="https://counter.theconversation.com/content/125819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re expressing breast milk for your baby, it’s important to understand how to store it safely – particularly when we’re experiencing warmer weather.Linda Sweet, Professor, Chair in Midwifery, School of Nursing and Midwifery Deakin University and Western Health Partnership, Deakin UniversityAmanda Muller, Senior Lecturer, College of Nursing and Health Sciences, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1276592019-12-04T13:30:39Z2019-12-04T13:30:39ZInequity takes a toll on your gut microbes, too<figure><img src="https://images.theconversation.com/files/304799/original/file-20191202-66998-29wvlu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Affluent neighborhoods have very different microbes from those in poor ones.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/luxury-house-slum-gap-between-poverty-1106629235">Zentangle/Shutterstock.com</a></span></figcaption></figure><p>People worry about having access to clean water, power, health care and healthy foods because they are essential for survival. But do they ever think about their access to microbes? </p>
<p>Every day, humans encounter microbes - in air, water, soil, food and buildings - and pick them up and leave them behind everywhere they go. Although you might be reaching for the hand sanitizer as you read this, many of these microbial exposures are beneficial to human health. But not everyone has equal access to good microbes.</p>
<p>Social equity is the practice of applying justice and fairness to our social policies. Society often measures it in terms of access. Do people have equal access to healthy food and clean water? Medical care? Safe housing? Parks and forests? My idea of “microbes and social equity” is rooted in the fact that we rely on the microbes that live in our bodies or in the environment around us. We need public policies that promote access to microbes. </p>
<p><a href="https://sueishaqlab.org/team/sue-ishaq/">I’m a gut microbiologist</a>, and I want to understand the microbes that pass through our digestive tract and how they impact us. For example, human beings can’t digest plant fiber; <a href="https://doi.org/10.1016/j.cmet.2014.07.003">we actually rely on several species of microbes</a> in our gut to do this, which provides us with the nutrients we need. <a href="https://doi.org/10.1371/journal.ppat.1004506">Microbes also help “train” our immune cells</a> not to attack those trillions of microorganisms living in or on the body, thereby maintaining a delicate truce.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303199/original/file-20191122-74588-o05qjn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all microbiomes are created equally.</span>
<span class="attribution"><span class="source">Sue Ishaq</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Connecting with good microbes</h2>
<p>I wanted to create a space to learn about and discuss the idea of “Microbes and Social Equity,” so I developed and taught a course at the University of Oregon during the summer of 2019. I focused on how access to basic necessities like nutritious foods (and especially fiber), pre- and postnatal health care, and green space and city parks could influence microbial exposures and individual experiences throughout a lifetime. These findings and discussions have now been published as a <a href="https://doi.org/10.1371/journal.pbio.3000536">peer-reviewed essay in the journal PLoS Biology</a>. </p>
<p>Fibrous foods recruit microbes in the gut, especially ones that break down and ferment complex plant carbohydrates in order to create energy for themselves. In doing so, they produce several molecules (like butyrate) that we use for energy, and they yield a number of health benefits. </p>
<p>The paper in PloS Biology provides examples of research on microbes and health, such as the benefit of a fiber-rich diet in recruiting beneficial <a href="https://doi.org/10.1126/science.aao5774">gut microbes and reducing the symptoms of diabetes</a>. There are specific examples of social policies that might promote access to microbes, such as launching more school nutrition programs that require fruits and vegetables. There are also examples of policies with negative microbial impacts, such as inadequate food-service infrastructure in prisons, which can allow for the spread of foodborne illness.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/303209/original/file-20191122-74584-1qk9sen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Providing a safe, supportive environment where women can nurse at work avoids situations like this.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-mother-give-breastfeeding-while-talking-1421859695">Phoderstock/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>My students were especially interested in policies that support maternal health care and enable breastfeeding. Breast milk contains important components to boost the infant immune system, as well as a diverse community of bacteria, some of which <a href="https://doi.org/10.1016/j.chembiol.2017.03.012">support digestion of milk in the infant gut</a> and confer health benefits. </p>
<p>Infants who only receive formula recruit different gut microbes and are missing the ones derived from <a href="https://doi.org/10.1067/mai.2001.111237">breast milk that protect against allergies</a> and other health problems. Policies that provide pre- and postnatal care are known to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193436/">improve health outcomes for mothers and infants</a>. These policies also happen to support mother-infant microbial exposure, which can have huge health benefits. The lack of good policies may have the opposite effect: Many women identify a lack of social and infrastructural support as <a href="https://www.ncbi.nlm.nih.gov/books/NBK52688/">preventing them from breastfeeding their infants</a>, which also deprives the babies of the microbes they need.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304800/original/file-20191202-66998-gb2c5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Urban gardens are one way to encourage exposure to healthy microbes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-african-american-woman-inspecting-beets-1054297805">Joshua Resnick</a></span>
</figcaption>
</figure>
<h2>Poor-quality city infrastructure leads to poor-quality health</h2>
<p>The quality of the environment greatly impacts health. Plants are known to produce chemical compounds that benefit human health, and exposure to the diverse microbes found in the natural environment can keep our immune systems fit. Living near industrial areas exposes <a href="https://doi.org/10.1089/env.2011.0037">residents to lower air quality, contamination of water sources</a> with hazardous materials, noise pollution, and more. Worse, studies suggest that <a href="https://doi.org/10.1089/env.2008.0506">pollution-heavy industry is often intentionally placed in disadvantaged</a>, low-income, or predominantly minority-resident neighborhoods because they lack the social capital to negotiate better zoning. And, heavily urbanized or <a href="https://doi.org/10.1016/j.scitotenv.2016.07.037">industrial zones disperse different microbes</a> than a forest or park would, changing outdoor microbial exposure for residents of poorly planned neighborhoods. </p>
<p>Inequalities in access - such as only putting parks in wealthier neighborhoods - creates social inequity in resource distribution. But it also creates inequity in microbial exposure and may affect your health. However, zoning could be used to aid in the equitable distribution of resources. </p>
<p>Access is the basis for creating social equity. Globally, many governments have a legal obligation to provide access to a safe and healthy natural environment. If we consider that microbes are integral to maintaining public health, it follows that there is also a legal obligation to provide policy and infrastructure to enable equitable access to microbes. </p>
<p>This can be done by providing affordable maternal health care and parental leave to facilitate breastfeeding and train the immune system with good microbes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/304806/original/file-20191202-67007-40uzy5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Industrial zones are particularly lacking in good microbes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/railroad-tracks-detroit-michigan-94905997">Judy Marie Stepanian</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It can be done with access to an affordable, high-quality diet with lots of fiber, especially by making healthy food available in public schools, prisons and “food deserts” with inadequate shopping options. </p>
<p>It can also be done by equitably distributing natural environments and green space in urban settings. Encouraging urban farms, local farmers’ markets, bike lanes and walking paths, and giving stores incentives to stock and sell healthy food items, can make urban and rural areas healthier by promoting physical activity, good food, clean air and water and diverse microbial exposures.</p>
<p>[ <em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/127659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sue Ishaq has received funding from the United States Department of Agriculture, The Alfred P. Sloan Foundation, and the University of Oregon for her research in microbiology. She received salary for teaching this class at the University of Oregon but no additional funding for the work.</span></em></p>You probably know about the collection of microorganisms that live in, on and around us. But did you know that not everyone in society has equal access to them? That needs to change.Sue Ishaq, Assistant Professor of Animal and Veterinary Sciences, University of MaineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1262382019-11-06T13:37:24Z2019-11-06T13:37:24ZUK has one of the lowest breastfeeding rates in the world – here’s how to change this<figure><img src="https://images.theconversation.com/files/300133/original/file-20191104-88409-an2a8g.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6639%2C3631&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-breastfeeding-her-baby-home-1446976127">shutterstock/Pixel-Shot</a></span></figcaption></figure><p>It’s been four years since <a href="http://www.legislation.gov.uk/uksi/2014/3050/contents/made">shared parental leave</a> was introduced in the UK. The policy that would see more dads taking an active role in parenting – with new parents sharing time off following the birth of a baby or an adoption. </p>
<p>Under shared parental leave, mothers must still take the initial two weeks after birth, but they can then cut their maternity leave short and exchange it for shared leave time for their partner. Parents can take leave in their child’s first year at different times or double up by taking it at the same time. </p>
<p>While the introduction of shared parental leave aimed to get both parents involved in the early days of bringing up a baby, the number of families benefiting from <a href="https://www.birmingham.ac.uk/Documents/college-social-sciences/business/research/wirc/spl-policy-brief.pdf">the change in policy</a> remains <a href="https://www.birmingham.ac.uk/Documents/college-social-sciences/business/research/wirc/spl-policy-brief.pdf">low</a>. </p>
<p>Maybe this isn’t so surprising though, as the <a href="http://www.legislation.gov.uk/uksi/2014/3050/contents/made">legislation</a> makes mothers the gatekeeper – they must forfeit some of their maternity leave to share with their partner. And my research investigating the reasons why mothers may or may not want to share leave with their partners also suggests that <a href="https://theconversation.com/no-wonder-dads-arent-taking-shared-parental-leave-most-employers-have-failed-to-embrace-it-104290">many employers have failed</a> to embrace and normalise shared parental leave in the workplace.</p>
<p>Another reason thought to be contributing to this is the fact that most workplaces aren’t set up <a href="https://theconversation.com/breastfeed-for-longer-or-share-parental-leave-this-shouldnt-be-a-choice-couples-have-to-make-80431">for women to breastfeed</a>. And this lack of employer support not only impacts breastfeeding rates, but also directly affects the take up rate of shared parental leave – as it’s easier for new mothers to stay home with their baby where they can <a href="https://theconversation.com/men-have-an-influential-role-to-play-in-breastfeeding-but-are-sidelined-instead-36449">breastfeed with ease</a>.</p>
<h2>The barriers to breastfeeding</h2>
<p>The UK remains one of the countries with the <a href="https://www.independent.co.uk/life-style/breastfeeding-rates-britain-lowest-world-channel-4-dispatches-kate-quilton-a8468416.html">lowest breastfeeding rate</a> in the world. And as well as, negative attitudes towards breastfeeding in <a href="http://shura.shu.ac.uk/12131/1/Morris%20et%20al.%20Journal%20of%20Human%20Lactation.pdf">public</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2577622/">workplace</a>, limited awareness about the benefits of breastfeeding, as well as <a href="https://www.theguardian.com/lifeandstyle/2013/jun/22/breastfeeding-figures-fall-nhs-cuts">cuts in public health funding</a> have all been <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">highlighted as contributing factors</a>.</p>
<p>In my <a href="http://www.breastfeedingnetwork.org.uk/MakingItWork/">latest research</a> in collaboration with <a href="https://www.nationalbreastfeedinghelpline.org.uk/">The National Breastfeeding Helpline</a> – which provides independent breastfeeding support and information – I analysed over 450 responses from mothers collected through an online survey. </p>
<p>The findings reveal that 95% of the mothers agreed that breastfeeding is their preferred choice for young babies – 73% breastfed or planned to breastfeed for 49 weeks or more. But that almost half felt they would have had to stop breastfeeding if they took shared parental leave – as explained by one mother in the survey: </p>
<blockquote>
<p>It would make it impossible for me to continue breastfeeding. I’ve just gone back to work – my daughter is nine months – and my milk supply has plummeted … [it] would have been a disaster to go back even earlier.</p>
</blockquote>
<p>Many of the mothers also said they were not comfortable <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/">expressing breast milk</a>. One of the mothers explained how this had influenced her decision around shared parental leave: </p>
<blockquote>
<p>Breastfeeding was one of the reasons we chose not to do shared parental leave. I feed on demand and wanted to do so for at least the first year. I think this would have been hard if I’d gone back to work at six or nine months. I hate expressing.</p>
</blockquote>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300135/original/file-20191104-88409-uwij5z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Expressing breast milk for your baby after you’ve gone back to work can be done, but it’s not always easy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/above-view-breast-milk-frozen-storage-633914645?src=de645589-718e-4c95-bf03-337255edcc52-1-66">Shutterstock/Mut Hardman</a></span>
</figcaption>
</figure>
<p>That said, 57% of the mothers stated that they would be happy to express breast milk at work. But this would only be possible if women were supported in the workplace to continue breastfeeding. Indeed, only 3% of the respondents said they were provided with adequate facilities to enable them to express milk. Many of the women also said that although they were provided with a private room with plug sockets (so a breast pump could be plugged in), there wasn’t access to a fridge – which made the whole process useless, as they were unable to store the expressed milk. </p>
<h2>Clear laws needed</h2>
<p>These findings demonstrate that most workplaces aren’t set up for women to breastfeed and highlight the need for action to improve breastfeeding rates in the UK. Women must have more choice about how to feed their baby upon their return to work – and must be provided with suitable facilities. As a bare minimum, this should include a private room with plug sockets and a fridge. Mothers must also be able to work flexibly – and take breaks when needed. And breastfeeding friendly policies within the workplace also need to be made the norm. </p>
<p>In larger companies or organisations, having an on-site nursery can make it much easier for mothers who don’t like to express milk to breastfeed their babies while at work. </p>
<p>Maybe the UK would also benefit from looking to its Nordic neighbours for advice. In Sweden, for example, which has some of the highest breastfeeding rates in the world, <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-019-0230-0">advertising and marketing of infant formula</a> is restricted. Sweden also provides generous maternity and paternity pay – which maybe explains why more than 80% of mothers breastfeed, as they aren’t having to rush back to work. Ultimately, the Swedish government recognises women as both caregivers and contributors to the labour market – something that still seems quite a way off in the UK.</p><img src="https://counter.theconversation.com/content/126238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ernestine Gheyoh Ndzi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most UK workplaces aren’t set up for women to breastfeed, so is it any wonder rates are so low.Ernestine Gheyoh Ndzi, Senior Lecturer, Law Department, York St John UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1246762019-10-07T16:25:06Z2019-10-07T16:25:06ZBreastfeeding can help tackle climate crisis but it’s on governments, not mums to save the world<figure><img src="https://images.theconversation.com/files/295613/original/file-20191004-118228-2va2vn.jpg?ixlib=rb-1.1.0&rect=301%2C50%2C6408%2C4416&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/peaceful-loving-young-african-mother-sitting-1440379625?src=xJYXH3-ZmUGFbKT3J0uPDA-1-2">shutterstock/SeventyFour</a></span></figcaption></figure><p>In the midst of debates about how to best tackle the climate crisis, <a href="https://www.bmj.com/content/367/bmj.l5646">breastfeeding</a> was recently highlighted as a significant way women can help to make a difference. But while there is no doubt of the important role breastfeeding can play, there must be caution in the way such messages are communicated. </p>
<p>This is because telling women that breastfeeding will help save the planet just further fuels feelings of <a href="https://connect.springerpub.com/content/sgrcl/9/4/200">anger, grief and loss</a> women can experience when they are unable to breastfeed. The UK, for example, has some of the <a href="https://www.breastfeedingnetwork.org.uk/crisis-in-bf/">lowest breastfeeding rates in the world</a>, but that is not through lack of desire. Most women who want to breastfeed – but are unable to do so – have been <a href="https://www.pinterandmartin.com/breastfeeding-uncovered">affected by factors outside their control</a> and are deeply frustrated at any message that implies <a href="https://theconversation.com/breastfeeding-is-not-easy-stop-telling-new-mothers-that-it-is-98026">they should just try harder</a>. </p>
<p>Given these barriers, simply telling women that breastfeeding is important is <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">unlikely to make any difference</a>. Yet, there is a stark similarity in the way the climate and infant feeding crises are ineffectively communicated in the press – with emotive headlines about the need for individuals to take action. </p>
<p>Of course, as individuals we can all play our part, but real change is only possible with investment at a societal level. This is why government investment in breastfeeding is needed to make changes in policy, industry and the workplace to enable both a healthier planet and a healthier population. </p>
<h2>Environmental cost</h2>
<p>The science surrounding <a href="http://www.babymilkaction.org/wp-content/uploads/2014/10/Carbon-Footprints-Due-to-Milk-Formula.pdf">breastfeeding and climate change</a> is only just being revealed. <a href="https://www.sciencedirect.com/science/article/pii/S0959652619307322">Breastfeeding uses</a> few water or land resources, produces no carbon emissions and minimal or zero waste. It <a href="https://link.springer.com/chapter/10.1007/978-1-4757-4242-8_7">suppresses ovulation</a>, helping to reduce family sizes and keep <a href="https://www.sciencedirect.com/science/article/pii/S0140673615010247">families healthy</a>, which can further protects the impact of humanity on the Earth’s resources. </p>
<p>Indeed, <a href="https://www.sciencedirect.com/science/article/pii/S0959652619307322">a recent study</a> showed breastfeeding for six months saved 95-153kg CO₂e (carbon dioxide equivalents) per baby compared to formula feeding. If all babies were breastfed for just six months in the UK, the <a href="https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator">carbon emission savings</a> would equate to removing between 50,000 and 77,500 cars from the road for a year. This <a href="https://www.sciencedirect.com/science/article/pii/S0959652619307322">data holds true</a>, even when you take into consideration the small additional dietary demands of breastfeeding for the woman. </p>
<p><a href="https://www.pnas.org/content/109/9/3232.short">The water footprint of milk powder</a> alone has been estimated at about 4,700 litres of water per kilo of milk powder. Formula is supplemented with multiple ingredients such as palm oil to approximate the minerals and vitamins required by babies for growth and development. Despite industry proclamations for greening of their supply chains, Nestlé’s accent recent <a href="https://www.abc.net.au/news/science/2018-06-29/nestle-suspended-sustainable-palm-oil/9923238">temporary suspension</a> from the Roundtable on Sustainable Palm Oil highlights potential deficiencies in sustainability in global food production. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/palm-oil-boycott-could-actually-increase-deforestation-sustainable-products-are-the-solution-106733">Palm oil boycott could actually increase deforestation – sustainable products are the solution</a>
</strong>
</em>
</p>
<hr>
<p>There are only <a href="https://wayback.archive-it.org/7993/20170405150238/https://www.fda.gov/ohrms/dockets/ac/03/briefing/3939b1_tab4b.htm">40-50 formula milk processing plants worldwide</a>. The food miles consumed in transporting raw ingredients to these plants, and transporting them to consumers worldwide is as yet unknown but obviously considerable. </p>
<p>Formula preparation also consumes resources. Powdered infant formula is not sterile, and can <a href="https://www.firststepsnutrition.org/making-infant-milk-safely">only be made safely</a> with water heated to 70°C. In the UK, the estimated energy cost of boiling this water over the first year of a baby’s life equates to <a href="https://fn.bmj.com/content/100/2/F173.short">over 1.5m kilograms of carbon dioxide</a>. And in terms of waste, research shows 550m infant formula cans, 86,000 tons of metal and 364,000 tons of paper <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140673609606619/fulltext">are added to landfills every year</a> – and the formula industry has more than doubled since that research was published in 2009. </p>
<p>Not breastfeeding also usually <a href="https://digital.hbs.edu/platform-rctom/submission/the-ecological-impact-of-feminine-hygiene-products/">means a quicker return of women’s periods</a>. Considering that in the UK, on average, <a href="https://www.huffingtonpost.co.uk/entry/period-cost-lifetime_n_7258780?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAAMFUc2GGJ0uXPVUr8JMO9KfkFtMt24sxoa5lAUMDb7eFJrQ4GqQsk7YqihIOTGcvvLFX63RS038IkQZ3xRv6DWkSXijGB6CDUBx71eJ6g8BiZyNKQ387XMvizhAq62-tm-hE4OQNXU3Zl42AOIjZ3zdAWHX-ZmiUjp27S7S_k6N">each woman uses 264 pads</a> and tampons each year, breastfeeding also reduces the number of cotton fibres, polyethylene plastics and <a href="https://www.researchgate.net/publication/265149999_Comparative_Life_Cycle_Assessment_of_Sanitary_Pads_and_Tampons_GROUP_6">contaminants being used</a> for their production.</p>
<h2>More support</h2>
<p>There are of course obvious gaps in our knowledge across the whole sector that scientists must urgently address. But it’s clear that <a href="https://www.bmj.com/content/367/bmj.l5816">reducing our reliance on formula where possible</a> is an important step in helping mitigate the climate crisis. But what use is that message <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">in a system that fails to support breastfeeding mothers</a>? Women need the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12496">right environment and support</a> for breastfeeding to flourish. But despite continued messaging that this is how you raise breastfeeding rates, the government fails to sufficiently invest. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295616/original/file-20191004-118213-ccysf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It is illegal for anyone to ask a breastfeeding woman to leave a public place, but despite this, many women still find breastfeeding out of the house challenging.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-woman-breastfeeding-little-baby-1029287806?src=y3YDVRuiHydKAhGA631m0Q-2-23">Shutterstock/Irina Polonina</a></span>
</figcaption>
</figure>
<p>Ultimately, highlighting the role breastfeeding can play in protecting our planet is not a message that should be aimed at individual women. It should be aimed at those with the power to make a change. And for breastfeeding rates to increase, governments must invest in <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00446.x?casa_token=P5_x0OetRhYAAAAA:nIHWjNpm8Cc_B8TxxpDP_3mCoRvZBlDUMoZiv7QvnKitjnkepNK3hwDa3yBWOrqXkr91XcD3gRjrDCQ">greater health professional support</a>, cut down on the <a href="https://www.bmj.com/content/362/bmj.k3577/rapid-responses?int_source=trendmd&int_medium=trendmd&int_campaign=trendmd">reach of the breast-milk substitute industry</a>, ensure <a href="https://www.unicef.org.uk/babyfriendly/still-talking-about-a-womans-right-to-breastfeed-in-public/">public spaces</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/30335485">workplaces</a> have policies in place to enable women to breastfeed, and increase the <a href="http://theconversation.com/six-ways-the-world-has-empowered-and-enabled-breastfeeding-121333">maternity protections</a> women need to meet the needs of their baby. </p>
<p>It also means ensuring that when formula milk is needed, it leaves the <a href="https://www.sciencedirect.com/science/article/pii/S0959652619307322">lowest possible environmental footprint</a>. Strategies such as reducing reliance on ready-made formula and disposable bottles, stepping up to prevent so many resources being used on formula milk promotion – especially that of <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/types-of-infant-formula/">unnecessary follow on and toddler milks</a> – and requiring the industry to be responsible for reducing its own impact such as making products recyclable would be critical steps that protect us all, no matter how people choose to feed their babies.</p><img src="https://counter.theconversation.com/content/124676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Shenker receives funding from UKRI through a Future Leaders Fellowship. She is a Trustee and cofounder of the Human Milk Foundation, a charity that aims to ensure more babies can be fed with human milk.</span></em></p><p class="fine-print"><em><span>Amy Brown has previously received research funding from the ESRC, NIHR, Public Health Wales, the Breastfeeding Network and First Steps Nutrition Trust. She is author of four books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' , 'The Positive Breastfeeding Book' and "Informed is best'
</span></em></p>Proper support for breastfeeding is an environmental imperative.Natalie Shenker, Research Associate in the Faculty of Medicine, Imperial College LondonAmy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213332019-08-06T15:11:34Z2019-08-06T15:11:34ZSix ways the world has empowered and enabled breastfeeding<figure><img src="https://images.theconversation.com/files/286765/original/file-20190802-117881-hd0b65.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-breastfeeding-her-newborn-baby-beside-628630097?src=y3YDVRuiHydKAhGA631m0Q-1-22&studio=1">mrvirgin/Shutterstock</a></span></figcaption></figure><p>In an ideal world, the value of breastfeeding would go uncontested, and mothers would be supported to do it in all places and spaces. But unfortunately this is not the case. Even in the UK, a country which is so progressive in other health areas, breastfeeding mothers do not receive <a href="https://theconversation.com/breastfeeding-five-ways-it-can-be-encouraged-responsibly-82666">the support they need</a> to naturally feed their babies and <a href="https://www.stokesentinel.co.uk/news/stoke-on-trent-news/leave-breasts-alone-mums-turn-3166499">cuts to support services</a> are still being made. </p>
<p>Elsewhere in the world, things are very different, however. As this year’s <a href="https://worldbreastfeedingweek.org">World Breastfeeding Week</a> focuses on empowering and enabling breastfeeding, here are some of the ways that countries have <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12496">invested in public health</a>, changed the culture of their society and increased breastfeeding rates.</p>
<h2>1. Sweden’s maternity leave policies</h2>
<p>Want more women to breastfeed? Protect their time to do so. Women in Sweden can take <a href="https://www.yourlivingcity.com/stockholm/work-money/maternity-paternity-leave-sweden/">up to 15 months maternity leave at 80% pay</a>. This means that they can breastfeed and take care of their babies well beyond the period exclusive breastfeeding is recommended for (six months) without having to worry to about how to pay their bills and keep a roof over their family’s heads. By comparison, women in the UK are entitled to just six weeks’ leave at 90% pay before <a href="https://www.gov.uk/employers-maternity-pay-leave">it falls to £148 a week</a> – unless they have additional occupational pay. This has led to one in six mothers with a baby over four months old giving returning to work as a <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">reason for stopping breastfeeding</a>, and is reflected by the fact that just 34% of babies receive any breastmilk at six months old in the UK, compared to 62% in Sweden. Of course, things are <a href="https://www.washingtonpost.com/gdpr-consent/?destination=%2fnews%2fwonk%2fwp%2f2018%2f02%2f05%2fthe-worlds-richest-countries-guarantee-mothers-more-than-a-year-of-paid-maternity-leave-the-u-s-guarantees-them-nothing%2f%3f">even worse in the US</a> where statutory maternity pay is non-existent. </p>
<h2>2. Kenya’s workplace support</h2>
<p>Kenya identified that exclusive breastfeeding rates were falling partly because women were returning to work. So it created the <a href="http://kenyalaw.org/kl/fileadmin/pdfdownloads/bills/2017/BreastfeedingMothersBill_2017.pdf">breastfeeding mothers bill</a> that supported breastfeeding in the workplace. This bill requires all workplaces to offer paid breaks and a private comfortable place with a lockable door. They must also provide a fridge to store milk, a power socket, a sink, and a table and chair. If employers don’t do this they can be fined or even imprisoned. </p>
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<em>
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Read more:
<a href="https://theconversation.com/lessons-from-kenya-on-how-to-boost-breastfeeding-rates-121059">Lessons from Kenya on how to boost breastfeeding rates</a>
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<h2>3. Bangladesh’s ban on formula marketing</h2>
<p>The <a href="https://www.who.int/nutrition/publications/code_english.pdf">international code of marketing of breast milk substitutes</a> was developed in the 1980s to protect families from unscrupulous marketing of formula milk. It does not limit formula milk – which can be vital for those mothers who are unable to breastfeed – but <a href="https://www.savethechildren.org.uk/content/dam/gb/reports/health/dont-push-it.pdf">prevents the industry from trying to push their products</a>. Research has shown <a href="https://www.ncbi.nlm.nih.gov/pubmed/10796281">that promotion of formula milk reduces breastfeeding rates</a> so while the products are still available, in those countries following the code they are not allowed to be promoted in any form. </p>
<p>In 2017, Bangladesh became one of only 35 out of 194 countries who have <a href="https://apps.who.int/iris/bitstream/handle/10665/272649/9789241565592-eng.pdf?ua=1&fbclid=IwAR21hMnKeK5E9MttXgCxF7zzqoT71vIOFZOpFU-Zwt-KwQiZF2-5rhxCv5o">fully adopted the code</a> meaning that no formula milk, foods for babies under six months, teats or bottles can now be promoted in the country.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/26-years-ago-the-uk-signed-up-to-formula-milk-advertising-rules-so-why-isnt-it-law-yet-74794">26 years ago the UK signed up to formula milk advertising rules – so why isn't it law yet?</a>
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<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286766/original/file-20190802-117898-ao84ry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Several countries have implemented simple solutions that have effectively improved breastfeeding rates.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/peaceful-loving-young-african-mother-sitting-1440379625?src=zCk5DaxMdhGUHBAHETZdTQ-1-38&studio=1">SeventyFour/Shutterstock</a></span>
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</figure>
<h2>4. Croatia’s 100% adoption of baby-friendly hospitals</h2>
<p>Research has shown that babies born in <a href="https://www.who.int/nutrition/topics/bfhi/en/">baby-friendly hospitals</a> – an initiative set up by UNICEF and the World Health Organization in 1991 – <a href="https://www.ncbi.nlm.nih.gov/pubmed/26924775">are more likely to be breastfed</a>. To help protect breastfeeding, hospitals that have gained this accreditation <a href="https://www.unicef.org/newsline/tenstps.htm">follow ten steps</a> such as staff training, support after birth, keeping mum and baby together, and continued support in the community after discharge. </p>
<p>In Croatia, things weren’t always perfect – manufacturers had managed to get formula promotion into hospital bags meaning that no hospital met the criteria. But <a href="https://journals.sagepub.com/doi/full/10.1177/0890334417703367">things have been turned around</a>, and now all facilities in the country are accredited as baby friendly, and the steps are integrated into national policies, strategies and plans. </p>
<h2>5. Brazil’s human milk banks</h2>
<p>Donor human milk banks are lifesaving for premature babies who cannot receive their own mother’s milk, particularly just after birth. <a href="https://www.huffpost.com/entry/delaying-breastfeeding-increases-risk-of-newborn-death-by-80-un_n_579b65ebe4b0e2e15eb57fab?utm_hp_ref=impact">According to UNICEF</a>, delaying breastfeeding by between two and 23 hours after birth increases a baby’s risk of dying in its first month by 40%. If breastfeeding is delayed by 24 hours or more, this risk increases to 80%.</p>
<p>Brazil has invested heavily in donor milk provision as part of its strategy to improve breastfeeding rates. They now have <a href="https://brightthemag.com/the-surprisingly-simple-way-to-save-babies-lives-65c1806f4f60">around 230 of the 550 milk banks worldwide)</a> and more than 170,000 babies received donor milk in 2015. Not only has this investment meant more babies get donor milk, but this strategy helps improve the perception of the importance of breastmilk too. </p>
<h2>6. Scotland’s integrated feeding teams</h2>
<p>Recognising the importance of supporting breastfeeding, Scotland has recently achieved <a href="https://www.unicef.org.uk/babyfriendly/scotland-celebrates-full-maternity-community-baby-friendly-accreditation">100% baby-friendly accreditation</a> for its maternity and community services as Baby Friendly. The country has also invested <a href="https://www.bbc.co.uk/news/uk-scotland-46035569">£2 million</a> (on top of the existing £2.3 million funding) into breastfeeding support, and £300,000 into <a href="https://www.snp.org/policies/pb-what-is-the-snp-scottish-government-doing-to-promote-breastfeeding/">donor human milk banks</a>. <a href="https://www.gov.scot/news/breastfeeding-support-strong/">Integrated infant feeding teams</a> have also been created which bring together maternity and health visiting, infant feeding teams and peer supporters, to provide consistent, joined up care so that mothers can access one visible team for a variety of different needs. </p>
<p>With so many countries seeing the value in breastfeeding support, it’s about time all women were genuinely empowered and enabled to breastfeed too.</p><img src="https://counter.theconversation.com/content/121333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.</span></em></p>So many other countries see the value in breastfeeding support but the UK is lagging behind.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1184922019-08-05T12:56:03Z2019-08-05T12:56:03ZHuman breast milk may help babies tell time via circadian signals from mom<figure><img src="https://images.theconversation.com/files/286780/original/file-20190802-117898-1hrwqt6.jpg?ixlib=rb-1.1.0&rect=24%2C0%2C4939%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is a bottle of morning milk at night the equivalent of turning on all the lights at bedtime?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frozen-breast-milk-leg-baby-lying-742203790?studio=1">comzeal images/Shutterstock.com</a></span></figcaption></figure><p>Human breast milk is more than a meal – it’s also a clock, providing time-of-day information to infants. The composition of breast milk changes across the day, giving energizing morning milk a different cocktail of ingredients than soothing evening milk. Researchers believe this “chrononutrition” may help program infants’ emerging circadian biology, the internal timekeeper that allows babies to distinguish day from night. </p>
<p>What happens, though, when babies drink milk that does not come directly from the breast, but is pumped at different times of day and stored in advance of feeding? Scientists have rarely considered the potential effects of “mistimed” milk on infants’ development, but the implications are potentially far-reaching.</p>
<p><a href="https://scholar.google.com/citations?user=q676bXMAAAAJ&hl=en&oi=ao">As psychologists</a> <a href="https://scholar.google.com/citations?user=hI28SJIAAAAJ&hl=en&oi=ao">who study</a> the <a href="http://jhahnholbrook.wixsite.com/latchlab">biology of parenting</a>, we teamed up with <a href="https://scholar.google.com/citations?user=LKbQRd4AAAAJ&hl=en&oi=ao">Laura Glynn</a>, <a href="https://www.choc.org/video/nutrition-caroline-steele/">Caroline Steele</a> and <a href="https://www.choc.org/providers/neonatology/christine-bixby-md/">Caroline Bixby</a> to <a href="https://doi.org/10.1038/s41390-019-0368-x">investigate the evidence</a> for breast milk as a timekeeper.</p>
<h2>Body clocks over the course of the day</h2>
<p><a href="https://www.sleepfoundation.org/articles/what-circadian-rhythm">Sleep</a>, <a href="https://www.sciencedaily.com/releases/2019/04/190425143607.htm">eating</a> and <a href="https://hbr.org/2015/01/the-ideal-work-schedule-as-determined-by-circadian-rhythms">energy levels</a> all show circadian rhythms, which means they follow a daily cycle. As any parent who has sleepwalked through a 3 a.m. feeding knows, infants are not born with these rhythms fully set. Instead, their sense of day and night <a href="https://doi.org/10.1542/neo.4-11-e298">develops over the first weeks</a> and months of life, thanks to cues like sunlight and darkness.</p>
<p>Babies vary: Some show predictable circadian fluctuations in hormones linked with alertness, sleep and appetite, and can sleep for long stretches shortly after birth, whereas others seem to have their daily rhythms upside-down for months. Delays in the development of circadian biology can increase the <a href="https://doi.org/10.1016/0306-9877(92)90180-K">risk of colic</a> and lead to <a href="https://doi.org/10.2147/NSS.S125992">growth and feeding problems</a>.</p>
<p>But scientists know very little about why circadian biology comes online on such different schedules for different infants. Breast milk may help program infant circadian rhythms, helping to explain why some parents of newborns enjoy long full nights of sleep, whereas others struggle to get their infants on a schedule.</p>
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<a href="https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286781/original/file-20190802-117871-6ljvhl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An evening feeding might be sharing ‘time for bed’ signals from mom’s body with baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-mother-breastfeeding-her-newborn-707981059?studio=1">Tomsickova Tatyana/Shutterstock.com</a></span>
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<h2>Milk in flux</h2>
<p>Breast milk changes dramatically over the course of the day. For example, levels of cortisol – a hormone that promotes alertness – are <a href="https://doi.org/10.1007/s10911-017-9375-x">three times higher in morning milk</a> than in evening milk. Melatonin, which promotes sleep and digestion, can <a href="https://doi.org/10.1007/s00431-011-1659-3">barely be detected in daytime milk</a>, but <a href="https://doi.org/10.1210/jcem.77.3.8370707">rises in the evening</a> and peaks around midnight.</p>
<p>Night milk also contains <a href="https://doi.org/10.1179/147683009X388922">higher levels of certain DNA building blocks</a> which help promote healthy sleep. Day milk, by contrast, has <a href="https://doi.org/10.2478/v10136-012-0020-0">more activity-promoting amino acids</a> than night milk. <a href="https://doi.org/10.1007/s10517-005-0500-2">Iron in milk peaks at around noon</a>; vitamin E peaks in the evening. Minerals like magnesium, zinc, potassium and sodium are <a href="https://www.ncbi.nlm.nih.gov/pubmed/3335969">all highest in the morning</a>.</p>
<p><a href="https://doi.org/10.1080/09291010903407441">Daytime milk may pack a special immune punch</a>. Among mothers who provided researchers with milk samples across the first month postpartum, immune components – including key antibodies and white blood cells – looked higher in day milk compared to night milk. Another study found higher levels of a component important for <a href="https://doi.org/10.1080/09291016.2015.1056434">immune system communication in day milk</a> compared to night milk.</p>
<p>While it’s clear that milk changes over the course of the day, scientists know little about what this means for infant health.</p>
<p>Researchers do know that the hormones and immune components in breast milk are passed along to infants, and that infants are starting to develop and refine their own circadian rhythms during the first months of life. It’s plausible that the chronosignals in breast milk would help to shape infants’ own circadian biology. Differences in infant feeding patterns might help explain why there’s such variability in the development of these daily rhythms from one infant to another.</p>
<h2>Mistimed messages in milk?</h2>
<p>For most of human history, breast milk could only be consumed directly from the breast, meaning that milk was always ingested right when it was produced. Now, with the advent of breast pumps and refrigeration, that’s no longer the case. According to a 2005-2007 survey, <a href="https://doi.org/10.1542/peds.2008-1315c">over 85% of breastfeeding mothers in the U.S.</a> have pumped their milk.</p>
<p>What happens when babies drink night milk in the morning, or morning milk in the late afternoon? We don’t know for sure, because this question has been woefully understudied. Offering an infant a bottle of morning milk in the evening, with its high cortisol and low melatonin, might be the nutritional equivalent of flipping the lights on right before bedtime.</p>
<p>If chronosignals in milk do indeed help to calibrate infant circadian biology, then infants who drink “mistimed” milk may struggle more with sleep, digestion and development.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286782/original/file-20190802-117887-e7z8ep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Keeping track of the time of day breast milk was pumped could help sort out any circadian clock issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/breast-milk-pumps-bottles-on-bed-1376184122?studio=1">Kiwis/Shutterstock.com</a></span>
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</figure>
<p>There’s a fairly easy fix, of course. Mothers can label their milk with the time it was pumped and coordinate infant feedings to offer morning milk in the morning, afternoon milk in the afternoon and night milk at night.</p>
<p>If this became standard practice in neonatal intensive care units, we think that thousands of infants could benefit from milk served right on time, potentially helping them better regulate their circadian rhythms. Many NICUs have already adopted practices designed to better regulate infant circadian biology, such as dimming the lights at night, so time-matched milk would be a logical next step. Similarly, milk banks that accept donor milk could sort milk into batches by time of day.</p>
<p>There’s a simpler alternative to time-matching pumped milk: boosting women’s ability to breastfeed their infants right on the spot by offering reasonable paid parental leave policies. Mothers who can feed their infants directly don’t need to worry about organizing their milk by time of day, and milk that is offered straight from the breast <a href="https://www.nytimes.com/2019/06/12/health/breastmilk-microbiome-parenting.html">may confer other health benefits</a> as well.</p>
<p>Research continues to explore the role of breast milk in timekeeping and its impact on infant health and development. If time-matched milk does turn out to be a key way to help set babies’ internal clocks, the <a href="https://theconversation.com/paid-family-leave-is-an-investment-in-public-health-not-a-handout-108323">public health case grows stronger</a> for policies that support mothers’ ability to stay home with their infants during the first year of life.</p>
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<figcaption><span class="caption">Consider a timestamp for breast-pumped milk.</span></figcaption>
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<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/118492/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darby Saxbe receives funding from the National Science Foundation.</span></em></p><p class="fine-print"><em><span>Jennifer Hahn-Holbrook does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Breast milk contains ingredients in concentrations that change over the course of the day. Researchers think milk is chrononutrition, carrying molecular messages to help set a baby’s internal clock.Darby Saxbe, Assistant Professor of Psychology, USC Dornsife College of Letters, Arts and SciencesJennifer Hahn-Holbrook, Assistant Professor of Psychology, University of California, MercedLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213022019-08-04T20:05:02Z2019-08-04T20:05:02ZThe National Breastfeeding Strategy is a start, but if we really valued breast milk we’d put it in the GDP<figure><img src="https://images.theconversation.com/files/286889/original/file-20190805-36367-171yn64.jpg?ixlib=rb-1.1.0&rect=8%2C117%2C2514%2C984&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breast milk is far more valuable than the competitors we include in the GDP.</span> <span class="attribution"><span class="source">Catherine Constable</span></span></figcaption></figure><figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=848&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=848&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=848&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286819/original/file-20190804-117861-1sa29lg.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://t.ly/vyjp">COAG Health Council. August 2, 2019</a></span>
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<p>Australia’s new <a href="https://t.ly/vyjp">National Breastfeeding Strategy</a> sets ambitious goals. By 2022 it wants 40% of Australian babies to exclusively breastfeed until they are six months old. At present it’s 25%. </p>
<p>By 2025 it wants 50%.</p>
<p>Beyond that it wants non-exclusive breastfeeding up until at least 12 months of age, and beyond that for as long as both mother and child want. </p>
<p>It notes that what’s important is the first 1000 days (from conception to the end of the child’s second year).</p>
<p>It quotes with approval a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">finding</a> that human breast milk is</p>
<blockquote>
<p>not only a perfectly adapted nutritional supply for the infant, but probably the most specific personalised medicine that he or she is likely to receive, given at a time when gene expression is being fine-tuned for life</p>
</blockquote>
<p>The goals are welcome. But one of the reasons we need them is because we don’t properly value what is just about our most valuable nutritional resource. Statistically, breast milk is almost invisible.</p>
<h2>If it’s not counted…</h2>
<p>That’s partly because a lot of what women produce <a href="https://link.springer.com/article/10.1023/A:1007524722792">isn’t counted</a>. </p>
<p>My estimates, based on the price of the human milk that is traded, suggest that the 44 million litres produced per year in Australia is worth <a href="https://journals.sagepub.com/doi/abs/10.1177/0890334413494827">A$3 billion</a>.</p>
<p>By comparison, the commercial formula sold in stores is <a href="http://www.iariw.org/papers/2012/SmithPaper.pdf">a few hundred million dollars per year</a>.</p>
<p>The number of diseases breast milk prevents <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">in both mothers and children</a> and its personalised nature (delivering what’s needed when it is needed) means it is probably worth more than A$3 billion.</p>
<h2>…we act as if it doesn’t count</h2>
<p>Ever since the global financial crisis, we’ve been trying to boost GDP (gross domestic product) in order to ensure we don’t have a recession. </p>
<p>But because GDP excludes some of what’s most valuable (breast milk and the home production of services such as childcare) and includes alternatives that are at best unimportant and at worst damaging (such as formula milk) boosting GDP can hit the wrong targets.</p>
<p>An <a href="https://www.oecd-ilibrary.org/economics/including-unpaid-household-activities_bc9d30dc-en">OECD study</a> finds that as we have switched away from using services that are not measured towards using those that are our estimates of true economic growth have become inflated.</p>
<p>That’s why two Nobel Prize winners, economists Joseph Stiglitz and Amartya Sen, agree on including <a href="http://www.stiglitz-sen-fitoussi.fr/documents/overview-eng.pdf">human milk in conventionally-defined GDP</a>. They say its exclusion distorts priorities.</p>
<h2>What if the uncounted shrinks?</h2>
<p>The latest data from <a href="https://www.bettersafercare.vic.gov.au/reports-and-publications/victorian-perinatal-services-performance-indicators-reports">Victoria </a>and <a href="https://www.health.nsw.gov.au/hsnsw/Pages/mothers-and-babies-reports.aspx">NSW</a> suggests rates of full breastfeeding are shrinking. While more mothers are deciding to give breastfeeding a go, more infants are leaving hospital <a href="https://www.ncbi.nlm.nih.gov/pubmed/27211798">having consumed formula</a>. </p>
<p>Time is probably a factor. Breastfeeding takes time, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/24106021">women bear the cost of that time</a> unless compensated by paid maternity leave and lactation breaks. Longer leave makes for more milk.</p>
<p>Lack of skilled and knowledgeable support from health workers is a probably another factor, especially when combined with <a href="https://www.who.int/nutrition/topics/guidance-inappropriate-food-promotion-iyc/en/">inappropriate promotion of commercial formula</a> to health workers. Although more professional bodies are <a href="https://www.bmj.com/content/bmj/364/bmj.l743.full.pdf">refusing industry sponsorship</a>, health workers remain an important channel for formula marketing. </p>
<h2>Future GDP suffers</h2>
<p>A new study by World Bank economist Dylan Walters and colleagues finds that the economic costs of not breastfeeding globally amounts to <a href="https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz050/5522499">US$1 billion a day</a>. </p>
<p>They are not only the treatment costs for infectious illness, but also the costs of higher rates of maternal diabetes and breast cancer as well as the costs of higher childhood obesity and chronic disease, and the lifelong economic consequences of cognitive losses in children who were not sufficiently breastfed. </p>
<p>A 2016 study in <a href="https://www.thelancet.com/series/breastfeeding">The Lancet</a> estimates the global cost of the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.13139?mod=article_inline">cognitive loss</a> associated with not breastfeeding at <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext">US$302 billion</a> per year in lost labour productivity; about 0·49% of world gross national income. For Australia, it is around A$6 billion per year.</p>
<p><a href="https://www.abc.net.au/radionational/programs/healthreport/breastfeeding-reduces-cancer-risk/8630730">Later life maternal breast-cancer</a> is also a major economic cost, mostly concentrated in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">high income countries</a> with low breastfeeding rates such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12457">Australia</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/breastfeeding-isnt-just-about-the-baby-womens-bodies-matter-too-112901">Breastfeeding isn't just about the baby – women's bodies matter too</a>
</strong>
</em>
</p>
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<p>Importantly, these estimates are likely to understate the costs of low breastfeeding by ignoring the cost of the unpaid time women spend <a href="https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz064/5531187">caring for sick children</a>.</p>
<p>The <a href="https://www.liebertpub.com/doi/10.1089/bfm.2016.0128">World Bank</a> as well as the <a href="https://www.who.int/nutrition/publications/infantfeeding/global-bf-collective-investmentcase/en/">World Health Organization</a> are leading a call for increased investments in all countries to raise the proportion of children exclusively breastfed in the first six months of life from 37% to at least 50%.</p>
<h2>We shouldn’t blame mothers</h2>
<p>Australia’s <a href="https://t.ly/vyjp">new strategy</a> reflects an <a href="https://consultations.health.gov.au/population-health-and-sport-division/breastfeeding/">important shift</a>.</p>
<p>It responds to evidence suggesting that that breastfeeding practices are strongly influenced by <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/fulltext">commercial factors</a> such as marketing, as well as by the employment and financial and healthcare environment mothers find themselves in. An international review has found that these findings are <a href="https://www.saxinstitute.org.au/publications/review-effective-strategies-promote-breastfeeding/">relevant to Australia</a>. </p>
<p>It makes a strong case for funding for breastfeeding information and education, especially in communities where breastfeeding is at risk. </p>
<p>It could have also made a strong case for more wide ranging financial support of breast milk production, along the lines of Australia’s historical support of dairy farmers. </p>
<p>Or for including breast milk in GDP. The home production of other food products is included in GDP, including the <a href="https://www.abs.gov.au/Ausstats/abs@.nsf/glossary/5204.0">cows milk produced and consumed on farms</a>. Leaving out breast milk distorts goals and helps distort incentives. </p>
<p>It’s time making mothers’ milk counted, and governments invested. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/breast-milk-banking-continues-an-ancient-human-tradition-and-can-save-lives-69351">Breast milk banking continues an ancient human tradition and can save lives</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/121302/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie P. Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If breast milk was made in factories, we’d count it in the GDP.Julie P. Smith, Honorary Associate Professor, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1205592019-07-18T22:54:12Z2019-07-18T22:54:12ZIs it safe to drink alcohol while breastfeeding?<figure><img src="https://images.theconversation.com/files/284811/original/file-20190718-116539-17fj4n4.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C3000%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ultimately, just as in pregnancy, there is no known safe level of alcohol consumption while breastfeeding.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Is it safe to drink alcohol and breastfeed? As physicians, we have always cautioned patients not to. As mothers, we look forward to the occasional glass of wine. </p>
<p>We also know that drinking while breastfeeding remains a controversial and very personal choice, one for which many mothers find themselves judged by friends and family.</p>
<h2>Does beer increase milk supply?</h2>
<p>Historically, beer was made very differently than it is today. Beer companies <a href="https://doi.org/10.1007/0-306-46830-1_2">marketed low alcohol beers to women to stimulate appetite, increase their strength and enhance milk production</a>. Barley used in beer production contains a <a href="https://doi.org/10.1007/0-306-46830-1_2">polysaccharide that can enhance breast milk production by increasing prolactin secretion in nursing mothers</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284808/original/file-20190718-116557-15s1gh8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Stephanie Liu with her first child.</span>
<span class="attribution"><span class="source">(Stephanie Liu)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>On the other hand, alcohol may also <a href="https://doi.org/10.1542/peds.2011-3552">inhibit breast milk letdown</a> and slow the flow of milk to the baby due to a blunted prolactin response required for breast milk production. An older study published in <em>Developmental Psychobiology</em> also found that <a href="https://doi.org/10.1002/dev.420260804">infants consumed less milk during the four-hour testing sessions in which nursing mothers drank alcoholic beer</a> compared to mothers who drank nonalcoholic beer. </p>
<p>Alcohol consumption may cause a woman’s breasts to feel fuller, giving the illusion of enhanced milk production when in fact there is less milk transferring to the baby.</p>
<h2>How much alcohol will reach your baby?</h2>
<p>The amount of alcohol present in your breast milk is <a href="https://doi.org/10.1111/bcpt.12149">closely related to the amount of alcohol present in your bloodstream</a>. The highest amount of alcohol level in your breast milk occurs <a href="https://www.ncbi.nlm.nih.gov/books/NBK501469/">30 to 60 minutes after an alcoholic drink</a>.</p>
<p>Many studies have been performed that <a href="https://www.ncbi.nlm.nih.gov/pubmed/3862407">measure the amount of alcohol that gets into breast milk and thus into baby</a>. One study found that <a href="https://www.ncbi.nlm.nih.gov/books/NBK501469/">consuming 250 ml of wine had a very small impact on the baby’s blood alcohol level</a>. </p>
<p>The legal driving limit for blood alcohol concentration in many cities is 0.05 per cent. This correlates to 50 mg of alcohol in 100 ml of blood. Because the amount of alcohol present in your breast milk is closely related to the amount of alcohol in your bloodstream, the amount transferred to your baby depends upon your blood alcohol level at the time of nursing. </p>
<p>For example: If your baby drinks 100 ml of breast milk while you have a blood alcohol level of 0.05 per cent, your baby will consume 50 mg of alcohol. For a 5 kg baby, this is 0.001 per cent of their body weight in alcohol.</p>
<p>Put another way: a standard drink (defined as one 355 ml can of beer, one 150 ml glass of wine or 45 ml of hard liquor) contains approximately 14,000 mg of alcohol. If your baby drinks 100 ml of breast milk while you have a blood alcohol concentration of 0.05 per cent, this is nearly equivalent to your baby drinking 1.5 ml of beer, or 0.5 ml of wine or 0.2 ml of hard liquor.</p>
<h2>Wait at least two hours before nursing</h2>
<p>Ultimately, just as in pregnancy, <a href="https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/alcohol.html">there is no known safe level of alcohol consumption while breastfeeding</a>. We cannot know for certain the safety of even small amounts of alcohol for young babies. </p>
<p>Research does suggest that alcohol exposure above moderate levels through feeding an infant immediately after drinking alcohol may be harmful. One study published in the <em>New England Journal of Medicine</em> suggested that <a href="https://www.ncbi.nlm.nih.gov/pubmed/2761576">exposure to alcohol above one drink per day through breast milk may be detrimental to infant motor development</a>. Another study published in <em>Pediatrics</em> found that <a href="https://www.ncbi.nlm.nih.gov/pubmed/9565435">infants who were given breast milk approximately one hour after their mothers consumed alcohol may have impaired sleep-wake patterns</a>.</p>
<p>However, studies do show that occasional alcohol consumption (defined as less than one drink per day) is <a href="https://doi.org/10.1111/bcpt.12149">unlikely to be harmful</a>.</p>
<p>Timing infant feeds is one possible way to minimize how much alcohol your baby is exposed to. Guidelines published in <em>Canadian Family Physician</em>, in conjunction with <em>Motherisk</em>, provide recommendations surrounding the timing of nursing and maternal alcohol consumption. These guidelines suggest <a href="https://www.cfp.ca/content/cfp/48/1/39.full.pdf">waiting at least two hours after alcohol consumption before nursing your infant</a>.</p>
<h2>‘Pumping and dumping’ doesn’t work</h2>
<p>Pumping your breast milk then throwing it away (“pumping and dumping”) after you consume alcohol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213923/">does not decrease the amount of alcohol in your breast milk</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284626/original/file-20190717-147288-1l6ub0e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Better to wait at least two hours before breastfeeding, after consuming alcohol.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>The alcohol content of your breast milk will remain closely correlated to the alcohol content in your bloodstream. As long as you have alcohol in your bloodstream, you will likely have alcohol in your breast milk. </p>
<p>Pumping and dumping may be beneficial for the mother only to relieve the discomfort of full breasts and to help maintain breast milk supply.</p>
<h2>The bottom line of personal choice</h2>
<p>If you have alcohol in your bloodstream, you will likely have alcohol in your breast milk. Most studies indicate that breastfeeding when your blood alcohol concentration is below the legal driving limit <a href="https://www.ncbi.nlm.nih.gov/pubmed/24118767">likely does not cause harm to the baby</a></p>
<p>It remains a personal choice whether or not you decide to have alcohol in moderation while breastfeeding.</p>
<p>After reviewing the medical evidence, some of us have chosen to enjoy the occasional alcoholic drink while breastfeeding. But we have carefully timed any alcohol consumption to reduce the amount of alcohol present in the breast milk.</p>
<p><em>Stephanie Liu offers evidence-based parenting and health advice at her blog <a href="https://lifeofdrmom.com">Life of Dr. Mom</a>.</em></p><img src="https://counter.theconversation.com/content/120559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Liu is co-founder of Lifeofdrmom.com an evidence based parenting blog. </span></em></p><p class="fine-print"><em><span>Erin Manchuk is contributing editor for Lifeofdrmom.com; an evidence based parenting blog.</span></em></p><p class="fine-print"><em><span>Shannon Ruzycki receives funding from Alberta Health Services CMO funding.</span></em></p>Does beer help a new mother’s milk come in? Does ‘pumping and dumping’ allow you to drink and breast-feed? A doctor sorts the evidence from the myth.Stephanie Liu, Clinical Lecturer, Department of Family Medicine, University of AlbertaErin Manchuk, Clinical Academic Colleague, Faculty of Pharmacy and Pharmaceutical Sciences, University of AlbertaShannon Ruzycki, Clinical Lecturer, Department of Internal Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.