Why the breastfeeding vs formula debate is especially critical in poor countries?

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Abstract

The breast vs. bottle feeding issue has sparked a controversial debate. Mainstream analysis of the problem shows that arguments made by the business community, as represented by the Nestle Corporation, do not withstand examination of the evidence. For example, it cannot be substantiated that women begin formula feeding because they have entered the labor force. Mainstream studies of cost effectiveness further indicate that bottle feeding is a drain on the incomes of impoverished Third World families and nations. Marxist analysis gives a very different perspective. Nestle represents 19th century capitalist development and the Industrial Revolution, and 20th century imperialism, neocolonialism and monopoly capitalism. Its motive has been capital accumulation and expansion. To increase surplus value appropriation, capitalism must devalue the household [subsistence] economy in which women enjoyed considerable status. Women also produce the most fundamental commodity for capitalism-laborers; therefore, the biological connection must be masked and controlled for the benefit of capital. Thus, as the capitalist mode of production has developed, women have been removed from important roles in production and reproduction. Coupled with the ascendancy of science, expertism and public health imperialism, breast feeding in any market economy becomes nearly impossible. As women internalize the values of capitalist ideology, they elevate "man-made" marketed commodities over subsistence goods such as breast milk.

Journal Information

The International Journal of Health Services delivers articles on health and social policy, political economy and sociology, history and philosophy, ethics and law in the areas of health and well-being. JOH provides analysis of developments in the health and social sectors of every area of the world, including relevant scholarly articles, position papers, and stimulating debates about the most controversial issues of the day. The journal is of interest to health professionals and social scientists interested in the many different facets of health, quality of life, and wellbeing of populations.

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Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE is a leading international provider of innovative, high-quality content publishing more than 900 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne. www.sagepublishing.com

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An overzealous push for breastfeeding is affecting availability of baby formula in food banks, worsening problems for the poorest people, writes Clare Wilson

Health | Comment 27 January 2021

Michelle D’urbano

WITH many people enduring extreme hardship because of the covid-19 pandemic, food banks in the UK are providing a more important function than ever. These vital institutions, funded mainly through public donations, act as a safety net so those in financial crisis at least don’t go hungry.

But there is one section of society who cannot always benefit from their support, and they are among the most vulnerable group of all: infants. In the UK, most babies are entirely or mainly dependent on formula milk.

Baby milk takes up a hefty chunk of a low-income family’s food budget. It can cost up to £30 a week and most food banks don’t stock formula milk because it is seen as clashing with breastfeeding promotion.

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Some local authorities and health boards explicitly tell food banks not to supply it, often citing recent UN guidelines on the issue, according to a recent report from Feed, a Scottish-based charity that aims to provide impartial advice on infant feeding.

The resistance to providing formula milk stems from a long-running dispute over infant feeding. In the past, some manufacturers wrongly claimed that their formula milk was the healthiest choice. Today, we know that breast milk contains a range of beneficial substances like antibodies that fight off microbes and there is some evidence that breastfed babies have fewer infections in their first year of life.

But many of the broader claims about the benefits that breastfeeding can lead to in later life, like protecting against obesity and asthma, and raising IQ, may not be true. Studies suggest that these apparent correlations arise because, in high-income countries like the UK, breastfeeding is more common among better-off families.

Child health organisations tend to say that if families have a baby that they can’t feed, they need specialist help, which is best given by referring them to health or social services. This can take time, however, and people are resorting to watering down formula or giving unsuitable milk alternatives, which risks babies’ health, Feed’s investigation has found.

It isn’t as if families can simply switch from formula milk to breastfeeding if financial circumstances change. When someone stops breastfeeding, or doesn’t start, milk production ceases. So saying that someone ought to breastfeed when they are unable to is about as helpful as saying someone ought not to be poor.

Health benefits aside, not everyone can breastfeed. For example, a woman may not make enough milk or be on medication that would be harmful for their baby if they did breastfeed.

Breastfeeding can also be painful and take up a lot of time and effort. It is often said that breastfeeding is free, but that is only the case if you view women’s time and labour as financially worthless.

In other words, breast isn’t always best, and only the people involved can decide if the health benefits outweigh any toll to well-being to make that decision.

In the past decade or so, breastfeeding promotion has been overzealous, making some who use formula milk feel so guilty it threatens their mental health. It has triggered a backlash from groups, such as Fed is Best, that say the health system shouldn’t try to control people’s bodies in this way.

People who have so little money that they need handouts of food may be in no position to argue with health workers over their personal autonomy – but it is a disgrace that the often unscientific debate over breast milk versus baby formula is harming the most vulnerable. It has to stop.

More on these topics:

  • parenthood

Why is breast feeding especially important in poverty stricken countries?

There is a strong evidence that promotion, protection and support of breast feeding is an exceptionally cost effective strategy for improving child survival and reducing burden of childhood diseases specially in developing countries [2,3].

Why is breast feeding crucial in developing countries?

Research has illuminated the longer-term health benefits of exclusive breastfeeding for the mother and child. These benefits include reducing the risk of overweight and obesity in childhood and adolescence and certain noncommunicable diseases later in life and enhancing human capital in adulthood.

What are the arguments against breastfeeding?

Awkwardness, body image issues, stigma, fear, and lack of confidence can all contribute to negative feelings about breastfeeding, says Tamika Auguste, MD, an obstetrician-gynecologist practicing in Washington, D.C. Concerns about exposing the breasts to nurse can also make people feel uncomfortable.

What are the advantages and disadvantages of breastfeeding versus formula feeding?

As a group, breastfed infants have less difficulty with digestion than do formula-fed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer bouts of diarrhea or constipation. Breast milk also naturally contains many of the vitamins and minerals that a newborn requires.

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