Monthly Archives: January 2019

Issue 1, January 2019

Ancient cultures and the most current research provide an abundance of conclusive scientific evidence that mothers’ milk is the best source of nutrition for infants, and breastfeeding is the best feeding choice for both the mother and the baby.  In many cultures, to this day, if for any reason a mother cannot breastfeed her baby, the first and natural choice for the parents is to find another breast-feeding mother to breastfeed their baby (Fildes, 1988 & 1995). However, since the recent advent of artificial feeding, infant feeding has changed dramatically along racial and social dimensions, generating a conflictual situation for mothers who wish to breastfeed their babies (Hausman, 2003).  This statement argues for why we must acknowledge, inform, recommend, assist, endorse, support, encourage, advocate, and promote breastfeeding.

Human milk is the “optimal nutrition” for full term infants, as well as for promoting the health and survival of preterm babies (Wight 2001).   The Promotion Of  Breastfeeding Intervention Trial (PROBIT) randomized study demonstrates that breastfeeding supports both short and long-term health outcomes for child and mother, (Kramer, Chalmers & Hodnett, et  al., 2001).

Morbidity and mortality:

Infant feeding practices have been,  and continue to be, major determinants of infant morbidity and mortality around most of the world (World Health Organization, 2003).  Overwhelming research has shown that there is a far lower risk for mortality and morbidity among breastfed children in comparison to those children who were not.  

Health benefits of breastfeeding:

Physical-biological health and development: Mother’s milk is proven to promote physical health and growth, immune ontogeny, and prevent diseases for both the mother and the growing baby in both short and long term.

Mother’s milk is effective and useful forallergy prevention and digestive health, including compensating for and protecting the immune system, (Goldman, 2012; Kramer & Kakuma, 2004; &  Quigley, Kelly & Sacker, 2007), prevention of multiple illnesses such as diarrhea, and other digestive problems and infectious diseases (Chien & Howie, 2001; Quigley, Kelly, & Sacker, 2007).  For example, in their meta-analysis, Bachrach and colleagues (2003) found evidence of a positive impact of breastfeeding on lowering risk for hospitalization (72%)

for respiratory infections.

Breastfed babies’ have more stable and predicatable growth than formula fed babies. Mother’s milk is qualitatively superior to the artificial milk. Analyses show it is a stabilizing factor for weight gain (Beyerlein, Toschke, & von Kries, 2008; & Grummer-Strawn & Mei, 2004), as well as a preventive factor for obesity in childhood and later in life (Gillman, Rifas-Shiman, Camargo, et al., 2001; Rolland-Cachera, Deheeger, Akrout, et al., 1995; & Lucas, Sarson, Blackburn, et al., 1980), and type 2 diabetes (Savino, Bebetti, Lignori, et. al. (2013).  

Mother’s milk is also associated with better gastrointestinal health (Brandtzaeg, 2003; Chirico, Marzollo, Cortinovis, et al., 2008; and Newburg, & Walker, 2007).  Formula feeding has been shown to result in a higher incidence of feeding intolerance and gastrointestinal diseases such as necrotising enterocolitis, which, if  the infant survives, may adversely affect the baby’s growth and development. By contrast, mother’s milk is shown to prevent this devastating condition  (Lucas & Cole, 1990; McGuire & Anthony, 2003).

Nutrition: The lactose in mother’s milk helps with absorption of minerals and calcium. Lactose deficiency results in malabsorption and intolerance syndrome. Such diseases are rare among exclusively breastfed infants (Martin, Ling & Blackburn, 2016).

In regions where clean water is not available, making a safe formula is not possible.  It is also common practice in poor communities that formula is diluted to extend the supply, leaving babies malnourished, hungry and underdeveloped, and resulting in subsequent negative health outcomes with long-term consequences. Inadequate and inappropriate nutrition can lead to the diarrhea, and dehydration which is a primary cause of infant mortality worldwide. Even developed countries are affected: illness and death due to unsafe and non-sterile formula was reported by the U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition in 2002.

Whole brain development:  Breastfeeding has direct beneficial impact onself-regulation, socio-emotional, and cognitive domains for infants, with corresponding benefits for breastfeeding mothers including mood stabilizing, affect regulation, stress reduction, and more responsive and effective parenting (Krol and Grossman 2018).  

Social and relational health: Physical perception of the mother’s heart beat (hearing, feeling) while breastfeeding has a calming effect that a bottle does not provide. While breastfeeding, mother and child are connected physically, emotionally, and intellectually.  

Eye contact between the mother and the baby while in the position of breastfeeding provides a right brain to right brain conduit of communication that is critical to brain development. The experience of shared joy during these face to face close interactions, feeling each others’ body temperature, heart-beats, holding and touch, and the mother’s tone of voice are factors in regulating the baby neurologically and emotionally, supporting bonding and connections that set a template for his further growth and development for all other relationships over the lifetime of the child. Additionally, mother’s verbal expressions and reciprocal interactions with the baby’s responses  – movements and sound utterances  – provide critical mental stimulations known to facilitate language skills and learning in the infant. 

Cognitive development and learning: Findings of the PROBIT study were controlled for potential confounding factors such as parent’s education, social status, and the environmental variances. At 6 ½ year follow up breastfed children had higher IQ scores and teacher ratings than those in the alternative feeding group (Kramer, Aboud, Mironova, et al., 2008). In another study, Amin, et. al. (2000), reported that breastfed infants have faster brainstem maturation, which the researchers attributed to the constituent composition of breast milk compared with formula-fed infants. In another study, Lucas, et al. (2002) report lower IQ (8-15 points) for premature babies who were not breastfed.  In the largest ever randomized study of human lataction, Kramer, et al. (2008), concluded that “prolonged and exclusive breastfeeding improves children’s cognitive development.”

Maternal health outcomes for breastfeeding mothers:

Breastfeeding is a protective factor for mothers. They are likely to enjoy improved health, as well as reduced risk of developing diseases in the future (Godfrey & Lawrence, 2010).

Dieterich, Felice, O’Sullivan & Rasmussen, (2013), list immediate, short, and long-lasting positive outcomes for breastfeeding mothers, including:

Bonding is facilitated through breastfeeding between mother and the baby and is the primary reason for breastfeeding reported by breastfeeding mothers (Leung & Sauve, 2005). Breastfeeding mothers become more attuned to the cues of the baby, and consequently, more reciprocal and responsive to the needs of the baby. These linkages are less observed among formula-fed infants (Kim, Feldman, Mayes, et al., 2011).

Weight loss: Breastfeeding mothers arebetter able to lose weight gained during pregnancy.  This effect is associated with the duration of breastfeeding (Baker, Gamborg, Heitmann, et al., 2008; Dewey, Heinig, & Nommsen, 1993).

Lactational amenorrhea (Godfrey & Lawrence, 2010), is a natural effect of breastfeeding, typically lasting 6 months or more, reducing the likelihood of another pregnancy in the infant’s first formative months of life. This phenomenon is absent in formula feeding mothers.  

Diabetes, metabolic, reproductive cancer, and cardiovascular risk:

Breastfeeding is associated with positive metabolic changes resulting in reduced risk for chronic diseases which may persist after weaning. (Stuebe, & Rich-Edwards, 2009).  For example, during lactation insulin sensitivity increases, an enduring effect that reduces the risk that the mother will develop type 2 diabetes.

The medical community has long recognized that breastfeeding is associated with a reduced risk of both breast cancer and ovarian cancer (Collaborative Group on Hormonal Factors in Breast Cancer, 2002; Ip, Chung, Raman, et al., 2009).

Lactation is associated with better cardiovascular health (Natland, Nilsen, Midthjell, et al., 2012; Schwarz, Ray, Stuebe, et al., 2009).  Research findings show decreased risk for the breastfeeding mother for cardiovascular disease, hypertension, diabetes, and hyperlipidemia.

Cost: A cost benefits analysis (Kelly Bonyata Feb. 2, 2018) reports an average savings of $3000.0 per year for families that breastfeed vs. purchasing and using formula.    

Bartick & Reinhold (2010), estimate that if 80% of mothers breastfeed for six months, this would result in a savings of over $13 billion per year in healthcare costs and save more than 900 lives.

An earlier analysis of the costs of formula feeding vs. benefits of breastfeeding, (Ball & Wright, 1999), analyzed cost of three diseases for which infants were most frequently referred to the medical facilities in the first year of life: lower respiratory tract illnesses, otitis media, and gastrointestinal illness. They found that for every 1,000 infants exclusively breastfed for 3 months,1,000 infants never breastfed required 2,033 more office visits, 212 more days in the hospital, and 609 more prescriptions in the first year of life.


While breastfeeding rates are rising in the United States, 81% of mothers in 2016, up from 75% in 2011 (CDC), there are still many barriers to breastfeeding in the US including maternal education, beliefs about breastfeeding, her physical and emotional health, community support, and the health of the infant.

It is is not always possible for a mother to breastfeed her baby, and women should not be made to feel shame when they are unable to do so or choose not to breastfeed for their own personal reasons,  professionals and policy makers, however, have a clear and compelling duty to acknowledge, inform, recommend, assist, endorse, support, encourage, advocate, and promote breastfeeding for every mother who is able to feed her baby during the first year of life. The failure to do sobrings harm to infants, mothers, and society.


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