In the days since a The New York Times report revealed a resolution meant to encourage breastfeeding was blocked by U.S. delegates at the World Health Assembly, breastfeeding advocates, political pundits, parents, doctors—and just about everyone else—have been talking about breastfeeding, and whether or not America and other countries are doing enough to support it.
The presidents of the American Academy of Pediatrics and the American College of Obstetricians say the controversy at the World Health Assembly reveals that mothers need more support when it comes to breastfeeding, while others, including The Council on Foreign Relations, suggest the national conversation needs more nuance, and less focus on the "breast is best" rhetoric.
The one thing everyone agrees on is that parents need more support when it comes to infant feeding, and in that respect, the controversy over the World Health Assembly resolution may be a good thing.
In their joint letter to the editor published in the New York Times this week, the presidents of the American Academy of Pediatrics and the American College of Obstetricians, Dr. Colleen Kraft and Dr. Lisa Hollier urge "the United States and every country to protect, promote and support breast-feeding for the health of all women, children and families."
The doctors go on to describe how breastfeeding "provides protection against newborn, infant and child infections, allergies, asthma, inflammatory bowel disease and sudden infant death syndrome," and note the health benefits to mothers, including reduced risks for "breast cancer, ovarian cancer, diabetes, hypertension and heart disease.
"Helping mothers to breastfeed takes a multifaceted approach, including advancing public policies like paid family leave, access to quality child care, break time and a location other than a bathroom for expressing milk," say Kraft and Hollier.
Certainly such policies would support breastfeeding mothers (and all mothers) in America, but some critics say framing the discussion around domestic policy is a mistake, because the World Health Assembly resolution is a global matter and women and babies in other parts of the world face very different feeding challenges than we do here at home.
In an op-ed published by CNN, Gayle Tzemach Lemmon, an adjunct senior fellow at the Council on Foreign Relations suggests the laudable goal of breastfeeding promotion can backfire when mothers in conflict-riddled areas can't access formula due to well-meaning policy. Lemmon points to a 2017 statement by Doctors Without Borders calling for fewer barriers to formula distribution in war-torn areas.
"International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding ... and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition," Manuel Lannaud, the head of Doctors Without Borders Iraq mission wrote.
The various viewpoints presented this week prove that infant feeding is not a black and white issue, and policy debates should not be framed as formula versus breast milk—there is more nuance than that.
A recent study in the Journal of Pediatrics found opting to supplement with formula after first breastfeeding improves outcomes for infants and results in higher rates of breastfeeding afterward, and while the benefits of breastfeeding are numerous, they are sometimes overstated. Another recent study published in the journal PLOS Medicine found breastfeeding has no impact on a child's overall neurocognitive function by the time they are 16. Basically, parents should not be shamed for supplementing or choosing to use formula.
This, according to Department of Health and Human Services says national spokesperson Caitlin Oakley is why the HHS opposed the original draft of the breastfeeding resolution at the World Health Assembly (although critics and the initial NYT report suggest the United States delegation were acting in the interests of infant formula manufacturers).
"Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies," Oakley said in a statement.
That's true, but so is everything the presidents of the American Academy of Pediatrics and the American College of Obstetricians presented in their op-ed, and that's why the U.S. should support breastfeeding policy.
Here's another truth: This is an issue with many perspectives and many voices. And we need to hear them all, because all parents need support in feeding their babies, whether it's with a breast, a bottle or both—and we're not getting it yet.