Fewer than half of mothers of newborns breastfeed until six months. To put it more precisely: today, in the world, only 41% of children under six months receive exclusive breastfeeding. Faced with this meager figure, the World Health Organization (WHO) has urged member countries to commit to the humble goal of increasing this percentage to at least 50%, by 2025. However, the will to improve nutrition The majority of infants continue to collide with the lack of scruples in promoting and marketing breastmilk substitutes, something that has aggravated the covid-19 crisis. Because every small slit that the health system leaves open is used by the manufacturers of substitute foods to insert messages of intended safety and well-being, despite the fact that the WHO and UNICEF recommend that babies be fed exclusively with breast milk in the first six months to live and continue breastfeeding - supplemented with other nutritious and safe foods - until two years or more.
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The latest alert was heard last week with the appearance of the status report on the application of the International Code of Marketing of Breast-milk Substitutes, adopted by the United Nations in 1981 to protect lactation from commercial interference. The 2020 situation report, promoted by the WHO, Unicef and the International Network of Groups for Infant Feeding (Ibfan - International Baby Food Action Network) analyzes the adoption of legal safeguard measures by the different States against the practices of the industry. These are harmful to the health of infants and their mothers, since breastfeeding provides antibodies that protect babies against numerous diseases and contributes to the health of mothers themselves. The report concludes that, although many countries have adopted the Code, very few have legal measures that fully reflect it and, what is worse: in-hospital marketing continues to be at ease in much of the world.
"Aggressive marketing of breast milk substitutes, especially through health professionals who are trusted by mothers and fathers for advice on nutrition and health, is a major obstacle to improving neonatal and infant health across the world. world. Health care systems must act to build mothers 'and fathers' confidence in breast milk without industry influence, ”said Francesco Branca, Director of the WHO Department of Nutrition and Food Safety, at the launch of the report.
Milk substitutes include, but are not limited to, so-called infant formula (for babies between the ages of zero and six months) and continuation. They are, in fact, food products that contain extracts of cow's milk proteins mixed with dextrinomaltose, corn syrup, vitamins and other components for their preservation and digestibility. That is to say that the formulas are not limited to cow's milk with added vitamins, and in no way can they be compared to enzymatic milk , which passes from one human to another and is not obtained industrially.
Hospital donations and brand positioning
The 1981 Regulatory Code aims to eliminate any type of promotion of breast milk substitutes, including gifts to doctors, and establishes a label that should not include messages or images that idealize infant formula. However, in this review of compliance, which covers the 2018-2020 period, it is found that the legal restrictions of most countries are clearly insufficient to curb the onslaught of the industry.
Aggressive marketing of breast milk substitutes is a major obstacle to improving neonatal and infant health
Of the 194 countries analyzed in the review report, about 40 have tightened their regulations regarding the marketing of breast milk substitutes in the past two years, although fewer than 80 countries prohibit their promotion in healthcare facilities; Only in about fifty are there provisions to disallow the distribution of free products within the health system. In addition, fewer than 20 countries have banned manufacturers from sponsoring scientific association meetings, and only five prevent the industry from getting involved in donating equipment.
There are a total of 136 countries that have some type of legal measure related to the Code. Among those that best comply with its recommendations are Brazil, several African countries (South Africa, Zimbabwe, Ghana, Nigeria and The Gambia) and some Asians (such as Lebanon, the Philippines, Kuwait and the United Arab Emirates), but no European country (since in Europe only some measures are applied "moderately"). Meanwhile, those who do not adhere to any marketing restrictions on milk substitutes include the United States, Japan, Israel, Australia, Canada, New Zealand, Argentina or Morocco.
The paradox is that, while many public hospitals in the world —including Latin American and Spanish— are part of the Iham network (Initiative for the humanization of birth and lactation assistance, launched by WHO and Unicef), these same centers are the who receive uninterrupted commercial visits from the manufacturers of breast milk substitutes and even accept monetary contributions to their pediatric services, guaranteeing that certain brands are present in the first days of babies' lives, or to pay for trips to conferences.
Infants not exclusively breastfed are 14 times more likely to die
In practice, commercial interference continues, without control, as neonatology societies and milk banks adhering to the Global Network of Human Milk Banks disclose the benefits of breastfeeding and warn that not breastfeeding increases the incidence of disease. in mothers (various types of cancer and diabetes) and infant mortality: infants not exclusively breastfed are 14 times more likely to die. Breast milk improves the baby's intellectual capacity, in addition to reducing childhood obesity, the risk of type II diabetes and leukemia.
"Artificial feeding is expensive and carries risks of additional illness and death, especially when levels of infectious diseases are high and access to clean water is poor. Formula feeding poses many practical problems for mothers in countries under development, including ensuring that the formula is mixed with clean water, that the dilution is correct, that sufficient amounts of formula can be purchased and that food utensils, especially if bottles are used, can be properly cleaned, "says UNICEF. , in relation to the added dangers represented by the promotion of breast milk substitutes among the poorest, although experts point out that the penetration of this type of product is greater among the middle classes and especially in Europe.
The window that opens the coronavirus
This revision of the Code was released during the covid-19 pandemic, that is, just at a time when the marketing containment measures of breast milk substitutes may suffer a setback due to the fear caused by the contagion and the Less support for families from overburdened hospital services. Expressed explicitly: this health emergency has opened another fissure by which manufacturers of industrial preparations are sneaking around the world, to undertake charity actions or campaigns with advice for mothers and infants on the epidemic (including frightening promotions of the type "en uncertain times, protect your baby from the coronavirus ”). Hence WHO and Unicef insist that the benefits of breastfeeding "far outweigh the possible risks associated with the virus" and stress that "it is not safer to feed infants with substitutes."
Against the separation of babies and mothers by covid-19
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Although breastfeeding continues to be prescribed even to sick women or those with a positive covid-19 test, some hospitals do not have adequate spaces to accommodate them and allow them to breastfeed with a mask, as recommended by pediatric societies. In fact, in certain hospitals mothers carrying this coronavirus are being separated from their newborn babies and, in some cases, without even offering them a breast pump kit. "In the meantime, the infant food industry is taking advantage of the fear of infection, promoting and distributing free infant formula and providing misleading advice, while attributing a humanitarian character to donations and presenting itself as a trusted interlocutor. ”Patti Rundall, from the Ibfan World Council, warned on the occasion of the recent launch of the report on the implementation of the International Code of Marketing of Breast Milk Substitutes.
For his part, Víctor Aguayo, Head of Nutrition at Unicef, added: “We must intensify our efforts, more than ever, to ensure that all mothers and families, everywhere, receive the guidance and support they receive from a trained health professional. They need to feed their creatures with breast milk from the moment of birth. "
Both international health organizations, milk banks and pediatricians themselves recall that the research available to date denies that mothers with covid-19 can transmit the coronavirus simply by breastfeeding. According to studies published in The Lancet magazine, no evidence of any vertical transmission has been found: in the tests carried out so far in women infected with the coronavirus, samples of amniotic fluid, blood from the umbilical cord were taken, swabs were performed on the babies' throats and milk samples were taken to be analyzed for SARS-CoV-2, and all the samples analyzed were negative for the virus. Therefore, it is advisable to continue breastfeeding, attending to the use of masks and other general hygiene and prevention measures.
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