According to a series of recent articles on breastfeeding in The Lancet, the deaths of 823,000 children and 20,000 mothers each year could be prevented through universal breastfeeding, along with economic savings of US$300 billion.^1,2 The authors highlight the benefits of breastfeeding, which include fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers. 

In 2013, a similar series on Maternal and Child Nutrition found that 800,000 child deaths could be prevented through breastfeeding, and called for further support.³ Despite the overwhelming evidence of the benefits of breastfeeding in recent years, and in particular the economic gains to be made, little progress has been made.

As we know, rates of breastfeeding vary greatly and it is one of the few health-positive behaviours more commonly found in poor countries than rich ones. In low-income countries, most infants are still breastfed at one year, compared with less than 20% in many high-income countries and less than 1% in the UK.¹ The reasons why women avoid or stop breastfeeding are many and can involve medical, cultural and psychological factors, with many turning to infant formula. 

The active and aggressive promotion of breast milk substitute (BMS) by manufacturers and distributors continues to be a substantial global barrier to breastfeeding, according to Rollins NC et al, who point out that the reach and influence of the BMS industry is growing fast.² The authors highlight the huge retail value of the industry, which is projected to reach US$70.6 billion by 2019. In many low-income and middle-income countries, growth in sales of BMS exceeds 10% annually.²

Global sales of milk formula (including infant formula and follow-on milks) have increased from a value of about $2 billion in 1987 to about $40 billion in 2013, and account for two-thirds of all baby food sales internationally.² Sales of BMS in China, worth more than $12 billion in 2012, are projected to increase annually by 14%.² This growth is not difficult to understand, given that investment in promoting BMS exceeds the spending by many governments on efforts to promote, protect and support breastfeeding.²

The authors conclude that the promotion and marketing of BMS have turned infant formula, which should be seen as a specialised food and one that is vitally important for babies who cannot be breastfed, into a normal food for any infant.²

All of this has particular significance for Ireland and for the agri-food sector. Ireland is a major producer and exporter of food products and there has been significant expansion of the dairy sector since EU milk quotas were removed. Irish food products are marketed using a healthy, green image emphasising natural farming methods. Unfortunately, one of the major export products of the Irish dairy industry is breast milk substitute and sales in Asia have been boosted by incidents of contamination of competitor products from New Zealand. Reliance on this aspect of food processing could threaten the image of Irish food exports and is perhaps not something we should be too proud of.

References

1. Victora CG, Bahl R, Barros AJD et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet 2016; 387 (10017): 475
2. Rollins NC, Bhandari N, Nemat Hajeebhoy N et al. Why invest, and what it will take to improve breastfeeding practices? The Lancet 2016; 387 (10017): 491
3. Maternal and Child Undernutrition. The Lancet, June 2013