When the US Opposes Evidence-Based Efforts to Promote Breastfeeding, What Comes Next? Three Recommendations for Policymakers to Move Forward

On Sunday, The New York Times reported an unexpected confrontation at the World Health Assembly (WHA). The US delegation tried to thwart the passage of a resolution to promote breastfeeding and reduce misleading marketing of breastmilk substitutes.

The Trump administration’s actions elicited widespread condemnation, with statements from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, United States Breastfeeding Committee, International Society for Social Pediatrics and Child Health, and 1000 Days.

The events that unfolded at the WHA reflect the Trump administration’s deeply troubling disregard for evidence and its impact on an issue that shouldn’t be controversial: promoting what is best for babies. These actions have nonetheless shined a light on a critical global health issue. Here are three key considerations policymakers should keep in mind to advance much-needed progress on the issue.

Stay focused on the evidence

There is robust, comprehensive evidence around the benefits of breastfeeding. According to a 2016 Lancet series, universal breastfeeding could save the lives of 823,000 children and 20,000 mothers as well as $300 billion a year. There is very strong evidence that in places without access to clean water, using formula transmits water-borne disease and leads to higher infant mortality. An NBER study estimates that in 1981, at the peak of the infant formula controversy, the availability of formula increased infant mortality among mothers without access to clean water, resulting in approximately 66,000 infant deaths in low- and middle-income countries that year.

Dedicate more resources and pursue integrated approaches

There are immense benefits that could be realized from increased resources and prioritization of breastfeeding promotion and support. According to a report by 1,000 Days with WHO, the World Bank, and UNICEF, for every $1 invested in breast-feeding, $35 are created in returns. Promoting and supporting breastfeeding is most effective when integrated with other early childhood development interventions. This includes enabling policies—such as paid leave, which enables women to breastfeed for longer periods of time, increases the likelihood that babies receive check-ups and immunizations, and promotes cognitive and social development by increasing the time parents have to nurture and care for their babies. The Nurturing Care For Early Childhood Development framework provides comprehensive solutions to support early childhood development outcomes from pregnancy to age 3. Governments and societies around the world would reap exponential benefits from integrated approaches to promote health, nutrition, responsive caregiving, early learning, and safety and security.

Put principles over profit

An important dimension of the WHA controversy is the role of formula companies in putting profit over the wellbeing of babies. Violations of the World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes, which restricts formula companies from directly advertising to mothers and health workers, are rampant. Many of these companies also have robust lobbying efforts.

These practices are disturbing, and the Trump administration and leaders around the world should call upon companies to follow the WHO code.

Looking ahead

Now is the time for not only the Trump administration, but all those who champion improved wellbeing of babies, to redouble evidence-based efforts to promote and support breastfeeding. A critical part of doing so is putting new energy into approaches to promote nurturing care of the world’s youngest children and invest in the supports their families need to be successful in a modern world.

Joan Lombardi, PhD, advises a number of organizations on child and family policy. Both Joan and Cindy serve on the board of 1000 Days.