First Food: Progress Is Not Enough

Good afternoon and congratulations. There has been significant progress since our gathering last year at the First Annual Summit. The inclusion of breastfeeding in major policy change initiatives is evidence of this progress. From healthcare reform to the First Lady's “Let's Move” initiative to end childhood obesity, it is now very clear that the role of breastfeeding is vital. The presence of the Surgeon General, Dr. Regina Benjamin, to keynote this year's summit is further evidence of progress. But, as is the case in any movement that changes the course of a society for the greater good of humanity, ours is not a fleeting or swift charge. No, we must be in this for the long haul, and our vision of victory—true victory—a time when almost all newborns are exclusively breastfed for the first 6 months of life, requires forging a new social norm. While we should congratulate ourselves for achieving significant momentum, we must now accelerate our efforts in new strategic ways.

Let me offer a few ideas, areas in which our work must accelerate if we are to truly make exclusive breastfeeding for the first 6 months of life the norm. Make no mistake about it, marketing continues to influence the decisions that new mothers make about breastfeeding. These influences are both direct and indirect. New mothers rely heavily upon the advice and perceived wisdom of their caretakers. They turn to doctors and, perhaps, more often today to nurses and physician's assistants. If these providers do not understand the nuances of weight loss and gain in the breastfed infant, and if they have been “educated” or sold the perception that formula is best for the infant's well-being, a new mother's behavior will be clinched in those early interactions. Hormonal influences designed to compel her to breastfeed and assure bonding with her newborn will actually be overridden by the fear of not meeting her child's needs. Perhaps a more accurate statement is that her natural bodily instinct to nurse her baby will be overcome by the (perhaps unintended) exploitation of her vulnerability and fear at that critical moment. I watched this happen recently in the life of a dear colleague. Each return visit to the hospital with her newborn resulted in more uncertainty in her mind about the decision to continue breastfeeding. There is simply no excuse for allowing hospitals in this country to not practice the Ten Steps. All maternal centers must meet this standard.

There is a global movement, led by the World Health Organization, to view health and related behaviors within a broader context of social determinants such as education, income, and environmental factors. It is time for us to bring a social determinants of health frame to this work. By emphasizing the social context in promoting breastfeeding, we may, in fact, be able to accelerate the pace of change. But we must apply this frame carefully. Education means more than convincing mothers about the benefits of breastfeeding. We must mobilize a major communications campaign that engages all forms of media positively, including the rapidly emerging world of social media. This will require new partnerships, new collaborations. We must also recognize and anticipate how the formula industry will resist and respond to the economic impact of our success. If most women breastfeed exclusively for the newborn's first 6 months of life, they will purchase less infant formula. What are the financial implications for that industry? We should include economic analysis and infant formula market projections in our planning.

Education as a social determinant of breastfeeding means educating and changing the cultures of influence that have the most impact upon mothers and infants and upon their families. We will have to mobilize new stakeholders in this effort. Men and fathers must become engaged, too. They can and do have significant influence on a mother's comfort level with breastfeeding. Our next summit can have an even more diverse set of participants. We will need to engage unlikely collaborators. Young people today are adept at social media. This form of communication is driving successful campaigns of all types, from political races to movie premiers. We will need to find creative ways to engage youth and leverage this new tool as a positive, social determinant of breastfeeding, too. The social determinants of health framework will help us to reach more and different key influencers. But success for us, in a timely manner, also requires that the terms of the debate change.

It is not just about a mother's decision. This issue of assuring that every newborn has access to the first food that nature intended is really about the future of our nation and our collective social purpose. While billions of dollars in healthcare costs will be saved and immeasurable levels of suffering on the part of the mothers and infants will be avoided when breastfeeding rates are optimized, we will also become a better nation. Our vision at the W.K. Kellogg Foundation is straightforward: We envision a nation that marshals its resources to assure that all children thrive.

One resource yet to be adequately tapped and directed is the power of love and nurturance embodied in the life-altering experience of exclusive breastfeeding for the first 6 months of life.

The belongingness hypothesis asserts that human beings have a fundamental and extremely powerful need for frequent, nonaversive interaction within an ongoing relational bond. ¹ And, according to Dr. Jack P. Shonkoff and his colleagues at the Center on the Developing Child at Harvard University, Cambridge, MA, beginning as early as the first weeks after conception and continuing into infancy, the developing immature organism “reads” key characteristics of its environment and prepares to adapt to a comparable external world according to early programming. ² When early experiences prepare a developing child for conditions involving a high level of stress or instability, the child's body systems retain that initial programming and put the stress response system on a short-fuse and high alert status. There is an emerging consensus that these early experiences have lasting effects on both brain development and learning capacity, as well as on susceptibility to chronic disease syndromes such as diabetes, obesity, and heart disease later in life.

The optimal breastfeeding experience may inoculate on so many levels. It provides a first modeling of meeting the fundamental human need for connection and a sense of belonging, while contributing to programming for a nonaversive relationship bonding that creates a neurobiological context for healthier physical, emotional, and cognitive development. Benefits are not just for the mother and child; they are for our society as a whole. Sterling Speirn, President of the W.K. Kellogg Foundation, reminds us that “our future is born every day.” Optimizing breastfeeding levels will prove to be a critical determinant of the quality of our nation's future.