Equal Opportunity for Babies:Breastfeeding as a Strategic Priority
In March 2005 in Canberra, three MPs decided to breastfeed their babies while in Parliament House. This could have stimulated wider understanding of the far-reaching importance of breastfeeding for human health and well-being. Yet despite some stir in the media, the underlying issue of equal opportunity for babies was not recognized. These infants (officially "strangers in the House") could have reminded legislators of all those who are disadvantaged at their most vulnerable ages by social policies that effectively prevent their mothers from breastfeeding them. For long-term national and individual well-being, we should support mothers who wish to follow this natural practice, removing any barriers that stand in their way.
Breastfeeding improves children's intellectual, mental and physical health prospects in childhood and throughout life. It promotes bonding between mother and baby - a foundation for lifetime emotional well-being; it reduces risks of a wide range of infectious diseases, asthma, overweight, obesity, diabetes, heart disease, arthritis, and some malignancies. For mothers it promotes recovery from childbirth, and reduces some cancer risks and later osteoporosis. A more honest and valid way of expressing all this is to say that formula feeding of infants, without breastfeeding, raises the risks of all these disorders. The promotion of such feeding has been illegal in India since 1992, following the WHO and UNICEF 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. They urged that "for optimal maternal and child health and nutrition, all women should be enabled to practise exclusive breastfeeding and all infants should be fed exclusively on breastmilk from birth to 4-6 months of age. Thereafter, children should continue to be breastfed, while receiving appropriate and adequate complementary foods, for up to two years of age or beyond. This child-feeding ideal is to be achieved by creating an appropriate environment of awareness and support so that women can breastfeed in this manner." They further urged that "All governments should develop national breastfeeding policies and set appropriate national targets ... ."
The American Academy of Pediatrics, in their 2005 Statement Breastfeeding and the Use of Human Milk, documents "diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and use of human milk for infant feeding." They say: "These advantages include health, nutritional, immunological, developmental, psychological, social, economic and environmental benefits". They urge exclusive breastfeeding for 6 months and then, while adding suitable complementary foods, continuing for "at least the first year and beyond for as long as mutually desired by mother and child".
Likewise, the Australian National Health and Medical Research Council, in their 2003 Dietary Guidelines say: "The total value of breastfeeding to the community makes it one of the most effective prevention measures available and well worth the support of the entire community ... it will contribute to the health of all Australians from birth." As a "best-buy" to reduce the obesity epidemic, the National Obesity Task Force (2004) advised increasing breastfeeding. A program to achieve this is outlined in the Australian Breastfeeding Association's Leadership Plan.
But breastfeeding is not just a matter of supplying better milk. In Reversing the Real Brain Drain: the Early Years Study, McCain and Mustard describe the importance of the experience of breastfeeding, with its opportunities for skin-to-skin touch and smell stimulation. When a baby is being breastfed, cuddled and rocked in his mother's arms as she smiles and coos at him, his brain is busily receiving signals through the sensations of warmth, touch, taste, sight, sound and smell. In the first three years, when the brain's pathways are being "wired", these experiences help to develop structures and functions of the brain in ways that will set the base for lifelong effects on learning, behavior, and emotions, influencing his sense of security and social relationships throughout life. They also affect the endocrine and immune systems, and hence responses to stress and risks of disease throughout life; so the quality of the early sensory stimulation and nurture can have far-reaching effects. When breastfeeding is not possible for some reason, then holding and cuddling the baby while feeding, with skin-to skin contact where convenient can still provide valuable loving sensory experiences for the nursing couple.
Norway used to have extensive infant bottle-feeding, but following an active government program to mobilize community awareness and practical support for mothers, breastfeeding is now initiated by up to 99% of mothers, and at 6 months around 80% of mothers continue to breastfeed. Norway provides generous maternity leave and other work-related consideration for lactating mothers, as part of the system of social supports that have enabled this national benefit to be achieved. Over a span of 35 years it has become a role model for how to swap bottles for breasts.
Breastfeeding can influence a nation's way of life in many ways, even possibly improving its average national IQ by up to six points! In the Journal of the American Medical Association, Mortensen in 2002 reported on two large groups born in Copenhagen, whose breastfeeding histories were known. Independent of a wide range of confounding factors, a significant positive association between duration of breastfeeding and intelligence was observed. For example, those who had been breastfed for nine months averaged six points higher IQ than those breastfed less than a month. The first group were 2280 18-year old males, called before the Danish draft board, and the findings were confirmed in another group of 973 men and women aged around 28 years.
Reducing a nation's overall average IQ by six points right across the normal distribution curve has far-reaching costs and implications for the whole of society. For example, at the upper end, there is the loss of the brightest, who are all 6% points less intelligent; at the lower end, there are the remedial education and social costs associated with the six-point IQ reduction. In emergency or war situations, infants who are breastfed survive much better than those who are not.
It is a serious shortcoming of social policies when many women in some of the world's most affluent societies can no longer afford to breastfeed and mother their own babies, however much they may wish to do so. The "economy" is said to require their labor, but who has a greater claim on a mother's presence than her own baby?
We were all babies once. The fruits of good mothering and early nurture are among the greatest blessings a person can have in life. In offering these to their babies, mothers and fathers are setting patterns of relationships which can be creative, mutually rewarding and last for the rest of their lives.
We now have good evidence that, as well as being sound economics, following the above infant feeding recommendations can significantly benefit a nation's health and overall well-being. Is there any more cost-effective way of spending and investing the health dollar than in promoting this equal opportunity for babies?
- American Academy of Pediatrics. Policy Statement. Breastfeeding and the use of human milk. Pediatrics 2005:115:496-506. (216 references).
- Alvarez L. Norway leads industrial nations back to breastfeeding. New York Times. October 2, 2003.
- Australian Breastfeeding Association. Australian Breastfeeding Leadership Plan, 2004.
- Galtry, J. The impact on breastfeeding of labour market policy and practice in Ireland, Sweden, and the United States. Social Science & Medicine, 2003; 57:167-177.
- Greve, T. Norway: the breastfeeding top of the world. Midwifery Today, Int. Midwife, 2003; 67:57-9.
- McCain, M. & Mustard, J. Fraser. Reversing the Real Brain Drain: The Early Years Study - Report to the Government of Ontario, 1999.
- Mortensen EL et al. The association between duration of breastfeeding and adult intelligence. Journal of the American Medical Association, 2002; 287:2365-2371, May 8.
- National Health and Medical Research Council. Dietary Guidelines for Children and Adolescents in Australia; incorporating the Infant Feeding Guidelines for Health Workers. The National Health and Medical Research Council. 2003. Canberra.
- Smith, Julie. Mothers' milk and markets. Australian Feminist Studies, 2004;19 (No.45):369-379.
- WHO/UNICEF. On the protection, promotion and support of breastfeeding. Innocenti Declaration. Florence, Italy, 1990, 1 August.
This article was published in the September 2005 edition of Byronchild (now Kindred). Reprinted with permission.
Peter S. Cook is a retired consultant child psychiatrist who writes on child and family mental health
Copyright © Peter S. Cook, Sydney, 2005. This article may be freely reproduced in whole or in part, with acknowledgement to Kindred and the author.