Assuring Optimal Access to First Food: A Critical Health and Prevention Strategy

Good afternoon. Although I live in Washington, DC, I work in Battle Creek, MI, which is the site of the W.K. Kellogg Foundation, and it is an interesting challenge to divide my life between two such distant places. One of the things that I don't miss is that if you have been in Washington long enough, you end up talking to the same people and hearing the same thing on a great many occasions. Innovation is rare. I am therefore very pleased with what has been accomplished concerning policy and progress in the past few years in the effort to reduce childhood obesity and to get breastfeeding into the conceptual framework for accomplishing that.

Most of us, including myself, have been working for many years on the issues that are the realm of the Affordable Care Act ¹ (ACA) and its preventive focus, and the present is truly our time in terms of having reached the precipice of opportunity for its realization. What we really have to do now is to mobilize people and create more public will to support policies such as those in the ACA that support a mother's right to breastfeed her baby privately and safely in the workplace.

Yet, as important as workplace policy is, most of the babies being born in this country today, and most of those babies' mothers, are not being affected by such workplace policies. Sixty-seven percent of the infant feeding formula in our country is still being distributed through the U.S. Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (the WIC Program). What does that say about the primary population on which we have to focus?

Yes, we need to care about the women who qualify for the Family and Medical Leave Act. ² Their needs have to be met. But the much broader population that isn't as evident is the population of children and families who rely upon and sometimes fall through the safety net, for health and nutrition, such as WIC and Medicaid recipients.

Millions of children are vulnerable because their parents, particularly their mothers, are working part-time or in low-wage temporary jobs. Reaching these families and children is an important aspect of our work. Assuring access to first food or exclusive breastfeeding for the first 6 months is a critical health and prevention strategy for all infants, but it is even more important for those families that are struggling to navigate through chronic financial insecurity and poverty. We must find creative ways to reach these families, as they make up the largest percentage of births in America today.

The pharmaceutical and infant formula industries have figured out how to reach them. They know very well how to influence infant feeding practices. Because they do, one of our challenges is to engage the pharmaceutical and infant formula industries in significant conversations. We must invite them to make concessions and partner on behalf of vulnerable children.

Someone asked me what I would want if I were bargaining with the formula industry and asking them to help improve breastfeeding levels in the United States. My answer would be, “No mass marketing targeted for infants during the first 6 months of life.”

WIC has made tremendous strides in promoting breastfeeding, but I would like to see, in the foreseeable future, that WIC is no longer distributing most of the infant formula in this country.

There is a book with the title The Revolution Will Not Be Funded. ³ When I was coming of age, the line was, “The revolution will not be televised.” However, the truth is that the revolution is being televised and that the telecommunications industry is creating revolutions around the world. We haven't figured out how to use that industry to create the revolution that we are talking about in breastfeeding, and we have to figure out how to do that. It is about social marketing, about the need for the millennial generation of young people to start texting about breastfeeding and its benefits.

Reaching younger generations is part of our challenge. At this point our work is about galvanizing and mobilizing people, about outreach using social marketing to create new opportunities for collaboration for the sake of our nation's children and our collective future.

Yes, we do need the business community behind us, because when you look at the disproportionate burden of chronic disease on our nation's population, there is no more powerful motive for changing the picture of disparity in health than the billions of dollars—and that is probably a low estimate—that our current obesity and chronic disease epidemic is costing.

That becomes more apparent when we look at those billions of dollars with a life-course perspective and link the disease disparities to obesity and poor birth outcomes. We can make a strong case about the importance of access to mother's milk in the early months of life for the populations that bear the disproportionate burden of disease.

We call it First Food, and by calling it First Food we are helping to frame breastfeeding as part of the life-course continuum of health, thereby moving away from the stigma that is subconsciously associated with the breast as a symbol of sexuality in our society. The concept of First Food is also part of the critical mother–infant bonding relationship supported through breastfeeding.

We now know more about infant brain development as a result of recent breakthroughs in genomics and neuroscience. We can better understand what makes a brain develop optimally, and we can see tremendous implications for the role of breastfeeding in optimizing early brain and child development.

We talk about nurture and social support. Researchers at Harvard University and elsewhere now regularly give us new information about brain development, early life experiences, and health. But I don't think I ever once heard them mention breastfeeding, although it is right at the heart of that critical first relationship. The first food in that relationship should be mother's milk for many reasons, not just nutritional ones.

Another challenge, in addition to using the social media for optimum benefit and focusing on the populations that will be the dominant demographic groups in our society, is to get philanthropy and the nonprofit sector in general to understand the importance of optimizing breastfeeding rates to achieving their priorities for societal benefit. Philanthropies are trying to change society for the better. We have to get them to understand the role of First Food in that process.

Jeff Levi is Chair of the Prevention Council and Executive Director of the Trust for America's Health. It was wonderful that he participated in the Third Annual Summit on Breastfeeding. He suggested that the Prevention Council, which is composed of the heads of 17 federal agencies, could contribute to this work by defining a role for each of their agencies. This is brilliant. What is the role of the U.S. Department of Commerce, the U.S. Department of Agriculture, or the U.S. Department of Labor? How might the Environmental Protection Agency contribute to improving breastfeeding rates in this country? The passage of the ACA legislation was a victory for breastfeeding on many levels. We now have the opportunity to assure that its implementation moves our agenda forward.

To be pragmatic we also have to make sure that there is an administration in Washington that remains committed to the implementation of the ACA and to prevention as a major aspect of health care in this country. This is our work. It is societal. It is global. It is political, but nonpartisan, and it has to be carried forward on behalf of all of the children.

Perhaps the worst form of social injustice is limited access to food. By assuring optimal access to the best possible food for a newborn we are taking on a mission for social justice. I would like everyone to think about that and carry that thought away from the Summit. Most of the newborns and infants in our country today are children of color: Today. This is true now. It is not a future demographic trend. More than half of these children are impoverished or living in low-income families. This means that most of these children face barriers to the conditions that promote healthy living. Exclusive access to mother's milk for the first 6 months of life is a vital condition for healthy living. These newborns deserve no less. Consequently, if we do it correctly, our work is for social justice and equity, and, most importantly, it is work of realizing our potential as a nation, a fulfilled democracy in which all children have the right to life, liberty, and the pursuit of happiness.