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Chapter 1 36 Chapter 3 Breastfeeding, especially exclusive breastfeeding, has been shown to be the most important infant and child survival intervention in terms of its potential impact on mortality. Increased exclusive breastfeeding could prevent about 13 percent of all preventable child deaths worldwide, including at least nine hundred infant deaths annually in the United States, and reduce the rate of many infectious and chronic diseases in both industrialized and developing country settings.1 However, active support for breastfeeding is rarely a central component in public health programming. Concerns about alternative feeding filled the health literature in the nineteenth century, and the response was to try to improve human milk substitutes .2 The concept that increasing breastfeeding might be the best response, rather than fine-tuning the substitutes, has been considered worthy of public health research support only recently. This new support for breastfeeding may have resulted from the increase in mainstream medical recognition of the negative health possibilities with commercial formula use, consumer interest in breastfeeding in the 1970s and thereafter, the global women’s and children’s rights agenda in the 1980s and 1990s, in concert with the recognition and evolution of “child survival” as a major global health and development measure. However, no one sector has stepped to the fore; contributions from multiple sectors have been necessary to create this interest. Concurrently, another sector—the evolving commercial market and the marketing of supplements and complementary foods—is expanding and offers a reliable ongoing source of resources to use against the perceived competition of increasing support for breastfeeding. Breastfeeding in Public Health What Is Needed for Policy and Program Action? Miriam Labbok Breastfeeding in Public Health 37 The global public health sector, represented by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), records its support for breastfeeding as a vitally important practice for health and survival.3 In addition, the European Union, the U.S. Department of Health and Human Services (DHHS), and virtually all health professional organizations now agree that the data support the need for improved breastfeeding for public health. Nonetheless, given ongoing discourses in the media, encouraged by the commercial sector, it would seem that the importance of breastfeeding for maternal, child, and intergenerational health remains controversial. Media headlines, at least one corporate blog, and recent feminist popular and academic literature bombard us with the argument that there is no defensible science supporting the health impacts of breastfeeding—arguments often rendered by persons with little breastfeeding research expertise—and that the practice of breastfeeding is a barrier to women’s rights.4 Other media emphasize that breastfeeding is simply a replacement for formula, one that places a heavy burden on the mother. In fact, global rights documents support breastfeeding as both a woman’s and child’s right. The challenge to the evidence published over the last few decades is a result of the fact that we cannot ethically randomize women to feed exactly as we dictate. The randomized controlled trial, the “gold standard” of evidence-based medical research, is not possible with this population. The study of breastfeeding demands large groups, or cohorts, and careful control for factors such as social class or education that might influence both the decision to breastfeed, success in breastfeeding, and the health outcomes of both mothers and infants. Despite increasing medical evidence, programming to support or promote breastfeeding is poorly funded compared to the other global child health programs, such as HIV/AIDS, clean water, vitamin A, and immunization. Further, where intervention programs exist, they often include only breastfeeding promotion—that is, mention of its importance—but do not provide active or skilled support or protection for breastfeeding in light of the onslaught of polished commercial messages for formula. Such promotion-only programs can, indeed, place the entire burden on the mother, without offering any social or clinical support. For women to consider breastfeeding positively, to decide to exclusively breastfeed, and to succeed in optimal breastfeeding, appropriate social, educational , health care, and economic support must be readily and freely available and accessible, and the messages must be clear and complementary. This chapter explores how we might create momentum and increase support for breastfeeding policy and programming in public health. While 38 Miriam Labbok breastfeeding could be supported by a variety of sectors and disciplines, it is becoming increasingly clear that change has been catalyzed only when there is interdisciplinary and cross-sectoral support, partnerships across the socialecological spectrum, and active collaboration in...


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