Abstract
T
After years of underinvestment, the world is finally starting to recognize the critical role that nutrition plays in global health and development. But we still have more work to do. Malnutrition is linked to about half of all children's deaths. Stunting caused by malnutrition makes it much harder for children to get an education and for communities to escape poverty.
No less important is the recognition that the basis of proper nutrition is exclusive breastfeeding for the first 6 months and continued breastfeeding plus quality complementary food for the next 1–2 years. As such, today it has become axiomatic that a critical measure of the nutritional status of a given country is the 6-month “exclusive breastfeeding” rate. In turn, programs for the support of breastfeeding target a rate of 50% as the goal of all government public health programs. Unfortunately, the 2015 Global Nutrition Report 1 has noted that only 32 of 78 countries that have provided up-to-date statistics were “on course” for reaching this “exclusive breastfeeding” target, whereas six countries (Cuba, Egypt, Turkey, Mongolia, Nepal, and Kyrgystan) actually showed large reversals in their rates!
Failure to reach these desired rates has resulted in populations of infants and children with a “stunting” rate on the order of 40–50%. Such a degree of stunting is associated with irreversible damage to the brain, leading to cognitive deficiencies, learning difficulties, and educational limitations and thus poorer economic potential. The economic consequences for such global undernutrition are a major factor in the inability of conventional international aid programs to impact on the dire macroeconomic situation in many developing countries. Simply put, the help is just too late to aid a generation of stunted children who have an irreversible reduced capacity to contribute to the economic growth, a reality that is recognized even by the economists of the World Bank. 2
Thus the article 3 in this month's issue of Breastfeeding Medicine describing the total commitment of a country (the Emirate of Sharjah, United Arab Emirates) to breastfeeding support is most welcome and illuminating. This program highlights the need for a country to commit itself to breastfeeding advocacy and support at all levels of the society, led and inspired by its supreme political authorities and not limited to medical facilities or by health professionals. The seriousness of the commitment is highlighted by the redecorated trailer home (see Fig. 3 in Al Ghazal et al. 3 ) that functions as a mobile breastfeeding site that can meet the immediate needs of mothers anywhere and anytime throughout the Emirate. This is in addition to the comprehensive educational program, availability of lactation counselors, and physician continuing education. A worthwhile read and a lesson for all worldwide!
Of interest are the reports that “exclusive breastfeeding” rates have decreased in the Northern European countries. These countries have extensive paid maternal/paternal leave programs, publicly supported daycare programs, and supportive and Baby-Friendly work rules. Despite all this ostensible and “ideal” support, the breastfeeding rates are decreasing, suggesting that the modern world's changes in life style and personal preferences, coupled with a distrust of authorities who are seemingly dictating and intruding into private life style decisions, are no less critical variables in the decision-making of mothers in the developed world regarding breastfeeding. Clearly this is a subject that needs more in-depth study and analysis.
A discussion of one small aspect of this change in the pattern of breastfeeding is highlighted by Drs. Felice and Rasmussen 4 in their thoughtful comments in the current issue of Breastfeeding Medicine. They discuss the near-routine practice of incorporating breast pumps and feeding of pumped milk by bottle into the routines of infant feeding. Questions are raised as to what are the implications and concerns of how this procedure might affect the biologic qualities of milk as compared with suckled breastmilk, what are the consequences of the disassociation of breastmilk from the act of breastfeeding, and what is the impact on breastfeeding rates and duration. Most definitely these are to-date unanswered questions, but surely they should serve as a stimulus for more in-depth studies of our modern life style.