What does the Chinese formula crisis say about breastfeeding?
I've been thinking and thinking about what to write about the Chinese formula crisis.
My first instinct, I'll admit, was to say nothing, since I sometimes worry about offending those of you who, by necessity or by choice, use formula in addition to breastfeeding. But as the scope of the crisis has become more clear, I felt that I should say something, and more importantly open up the topic to your comments.
It goes without saying that it is a tragic situation. 53,000 children are thought to have become ill as a result of the melamine-tainted formula, and four have died. To make matters worse, it also appears that the same formula is contaminated with enterobacter sakazakii.
While the size of the crisis in China is remarkable, problems with formula are not uncommon. In fact, according to the International Baby Food Action Network, there were more than 15 formula recalls around the world in 2007-08 (pdf). Even under better (though some would argue inadequate) quality control in this country, there are formula calls in the U.S. about once a year (pdf).
The crisis clearly illustrates the safest (let alone healthiest) way to feed your baby is with your own milk. Apart from its obvious nutritional and immunological superiority, you know what's in it because you control the contents.
But the thing that troubles me more are the similarities between the Chinese story and with our own history:
In the U.S., the Industrial Revolution shifted women's work from farms, where they were near their babies and could sustain breastfeeding, to factory labor which meant long separations and an end to breastfeeding. The alternative to breastmilk then was cow's milk - unpasteurized, often spoiled, adulterated, and obviously extremely dangerous - and infant mortality rose as a result. In 1897, the Chicago Department of Health estimated that 15 cow's milk fed babies died for every one breastfed baby. The increase in infant mortality resulted in some powerful public health campaigns promoting breastfeeding. Sadly, these campaigns ended with the shift to pasteurization of cow's milk. It has taken generations for the effects of this shift to begin to reverse.
China's economic boom has produced a similar change in womens' work, and this threatens to undermine China's historically high breastfeeding rates. A recent Washington Post column suggested as much (though was poorly subtitled "Chinese women don't like breastfeeding.") Obviously, current formulas are not 19th century cow's milk, and for that we can be grateful. But I worry about a more modern problem - pervasive and persuasive formula company advertising, such as we've seen in the Philippines, Bangladesh, and around the world. China has long had regulations which limit formula company marketing, but lax enforcement has resulted in many violations (pdf).
By the way, it doesn't have to be this way.
So we can only hope that this crisis results in a renewed focus on breastfeeding, and perhaps even donor milk banking, as the Wall Street Journal has reported. The news coverage so far has focused almost exclusively on this story as a Chinese quality control problem, but with some time I think the spotlight will shift to the true issue: the promotion and protection of breastfeeding.
I would love to hear your thoughts.
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