The nuances of Breast is Best

Growing up under the watchful eyes of a woman whose entire job it is to bear healthy children into this world, I know perhaps an inordinate amount about breastfeeding. It is, in fact, one of my more favorite 3rd World topics.

So I bring it to the fore for a very specific reason, namely China’s Baby Formula Recall. If you weren’t keeping up, a dangerous chemical was discovered in some Chinese-manufactured baby formula after it had left about 1300 infants, some with acute renal failure. Which led hundreds of reporters and pundits around the world to shrug and say, well, that’s China.

To me, though, it says that as the politics of breastfeeding/bottle-feeding become ever more complex in our 21st century world, a little history might be in order.

Since the beginning of time, women have known instinctively how to feed their newborns. Well, not quite instinctively, but close enough. Breastfeeding has as many evolutionary triggers as it has evolutionary benefits. For example, putting a baby to breast causes a release of hormones that simultaneously induce lactation and the kind of uterine contraction that staunches post-birth bleeding. And as the saying goes, what’s good for the goose is good for the gosling (i am modifying). Mother’s milk contains many of our most important early immunities. Even if the mother is undernourished, breastmilk generally contains a perfect nutritive balance for a growing baby.

There are some legitimate concerns as to whether starving mothers can effectively breastfeed a baby, when breastfeeding requires an additional 200-500 calories per day. In the 1970’s, Nestle Corp. exploited those fears, sending their ad agents to promote formula feeding in poor 3rd World countries dressed as doctors. They targeted the poorest of the poor, telling them they could not afford to breastfeed their babies.
The results were horrifying.

While, in theory, formula can be a safe alternative to breastmilk anywhere, it has major drawbacks in the developing world. First, formula is expensive. Families trying to stretch a buck (or a rupie) often water down the mix, leaving their babies dangerously undernourished. But their affects are still felt all over the world, including in places like Brazil, where families in the favelas will spend half their earnings just to buy baby formula, because it confers status. Those who can afford not to breastfeed don’t, and those who do breastfeed are stigmatized.

Perhaps more significantly, formula must be mixed with water–which sounds obvious, but when you consider the condition of the water where the world’s poorest people live formula feeding becomes either prohibitively more expensive, or deadly. In order to purify water for drinking, it must be boiled for more than ten minutes. Both fuel and water are expensive and/or time-consuming and difficult to come by. Even then, studies have shown that in many poor communities, boiled and stored water is dirtier than what comes from the tap or the river. Which is one part of the reason why diarrheal disease is the leading killer of children under five.

But like I said, it’s complicated. Just as Unicef had finally made some breastfeeding headway in places like India and Africa, AIDS happened. And AIDS, as you may know, is transmitted from mother to child. IN places like Sub-Saharan Africa, where AIDS is endemic, the problem is the opposite: New drugs and dumb luck can often prevent the transmission of HIV from mother to child in-utero. But transmission by breastmilk is almost assured. For the health of hundreds of thousands of newborns, it is imperative that mothers not breastfeed.

Ultra-ironically, not breastfeeding in the countries hardest hit by HIV/AIDS has become a stigma in its own right. I’m kicking myself because I can’t find the article I loved about this issue. Here’s one I like less.

And that’s just the nib. We live in a world where evolution’s oldest rules are changing. Like I said, it’s complex.

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