Nursing a grudge: going to war over World Health Assembly breastfeeding recommendations

At the UN’s World Health Assembly, which took place in May, health experts attempted to reach consensus on ways to improve health worldwide. As in any international gathering, there was conflict. But this year’s conference featured strong-arm tactics on the unlikely issue of breastfeeding.

If you’ve never had a baby, you probably wonder what all the fuss is about. If you have, you’ve almost certainly experienced recommendations from doctors and pressure from peers to breastfeed your child.

There are reasons for this. In the US, the American Academy of Pediatrics recommends that mothers feed their children breastmilk exclusively for the first six months. Health benefits include fewer infections and a lower chance of childhood obesity. Putting it simply, breast milk is adapted to the needs of a baby and naturally self-limiting; formula lacks the natural immunities that come from breast milk and is more likely to lead to overfeeding.

Culturally, there has been a complete shift in attitudes towards breastfeeding and formula in the US in the last few decades. In the 1950s, when I was a baby, the culture treated breastfeeding as a low-class thing to do. Affluent moms bought formula. As the health research emerged, a very slow inversion happened. Even as breastfeeding rates for educated and affluent mothers increased, rates for lower-income parents decreased, as they emulated what they believed were attitudes of those with higher incomes. But now, breastfeeding rates are on the rise for all social classes, with rates for babies at 6 months above 50%.

One important element of the shift is marketing. The days after parents have a new baby are confusing and difficult. While there are lactation experts to help with nursing advice in hospitals, new moms now tend to leave the hospital soon after giving birth. This makes the window for the decision very short — and once a mom starts with formula, it’s a challenge to start breastfeeding later. It used to be an important element of marketing for formula companies to put free samples in the bags of goodies moms take home from the hospital. As of May, 2018, 25% of US births now occur in “baby-friendly” hospitals where such formula samples are banned.

International breastfeeding battle

Breastfeeding is, of course, the default in less developed countries — it’s free and instantly available, and comes with advice passed down from mother and grandmother to daughters. But for formula companies, these countries are potential markets that may expand as the market in developed companies dries up. The question of how formula companies market is central to the fight that just happened at the World Health Assembly. In past years, the Obama administration’s Health and Human Services Department has supported international efforts to position breastfeeding as the best alternative for new babies throughout the world. You might think, given the broad consensus among health professional internationally, that this would be a no-brainer. And it was, until the Trump administration took over.

According to the New York Times, here’s what happened at the World Health Assembly:

• The Assembly was poised to agree on a resolution that “mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes.”
• American officials “sought to water down the resolution by removing language that called on governments to ‘protect, promote and support breast-feeding’ and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.”
• They threatened the nation of Ecuador, which was planning to introduce the resolution. The threats included punishing trade sanctions and withdrawal of military aid Ecuador was using to fend off violence from neighboring Colombia.
• Russians re-introduced the resolution, after which the US relented.
• The resolution passed with changes, but with removal of some elements and the addition of the words “evidence-based” regarding breastfeeding recommendations. (A study in The Lancet found that universal breastfeeding would prevent 800,000 child deaths and save $300 billion in health care costs.)

The statement from our government’s department of Health and Human Services in this article was fascinating. Here’s how that person was quoted in the Times:

“The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children,” an H.H.S. spokesman said in an email. “We recognize not all women are able to breast-feed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.” The spokesman asked to remain anonymous in order to speak more freely.

While I can’t find the final edited World Health Assembly statement online, if it is consistent with previous statements of consensus, and based on the article, it concerns the health benefits of breastfeeding and limits the marketing of formula. I’m not sure how a statement from an international health body would “stigmatize” women or create hurdles. Formula is still available to women who can’t breastfeed for one reason or another. What I’m sure the statement does do is to encourage countries to place limits on the marketing of baby formula, especially at hospitals.

I have a few questions for my government

I find this whole affair troubling. So here are a few questions I have for my elected and appointed government representatives:

• Why is the U.S. the only country to dissent from an international health consensus?
• Is there any situation at all in which you feel that businesses should face restrictions, or is a business always right and a regulator, international or not, always wrong?
• Are there any multilateral international agreements of which you’d like to be a part (or a leader), or are such agreements always, always evil? If you want to dismantle international agreements, what will you do when other countries violate them?
• Would you agree that children’s lives are sacred, even children who live in countries other than the US? When, exactly, is it necessary to place corporate America’s desires above the needs of children? What is the “Trump Doctrine” on such choices?
• If you disagree with activities by another country (like Ecuador), is it always legitimate to threaten trade sanctions or changes in foreign policy, regardless of the magnitude of the “transgression” that the other country commits? Is there such a thing as a proportional response, or is the most heavy-handed, bullying response always the best?
• Why are your official spokespeople insisting on anonymity in response to legitimate questions by reporters?

I am not a polemicist. Honestly, I can understand some of the reasons that Donald Trump and his subordinates make the choices they make and do the things they do. But my questions remain.

Bullying international health bodies and tiny countries for the benefit of a small number of American and European corporations is reprehensible. Withdrawing from international consensus on the health of children is bizarre.

Is it absolutely necessary to make the most provocative, evil-seeming decision in every single case? Is this in America’s interest?

Do the right thing, please.