Hernández-Aguilar Comments on: “Breastfeeding Goals: Are We Fighting the Right War?” by Eidelman

Dear Editor:

As the coordinator of the Baby-Friendly Hospital Initiative (BFHI) Network, I agree with Dr. Eidelman that it certainly is disheartening that only 47% of U.S. infants at 3 months and 26% at 6 months are exclusively breastfed. ¹ This deprives one out of four future U.S. citizens of realizing their full potential and puts them and their mothers at risk of future health problems. However, a 84% breastfeeding initiation rate does not ensure that adequate hospital support is happening when 19.2% of breastfed infants receive formula supplementation before 2 days of age. ²

Moreover, Dr. Eidelman is surprised that the Healthy People 2030 Goals are set at 54% for breastfeeding at 12 months, below the global recommendations. ¹ This is, however, an issue of concern more than surprise. Lowering standards enables policy makers to reduce efforts to support breastfeeding. The aforementioned figures should alert U.S. policymakers, and citizens of the need to improve breastfeeding support countrywide through programs such as the BFHI, together with additional measures, to help their citizens achieve global infant feeding goals.

The World Health Organization's (WHO) infant feeding recommendations are evidence based and apply to all women and infants regardless of their citizenship. When a country makes different recommendations, it is not a matter of having different needs or being developed. There are mostly other factors at play, too frequently related to concessions made to the infant food industry. An industry with a long history of undermining breastfeeding through unethical marketing practices. ³ Follow-up formulas are advertised as the option for feeding infants after 6 months and as such, are products directed to substitute breast milk.

These formulas contain excess sugar, saturated fats and advanced glycation end-products, and WHO experts have deemed them unnecessary and lacking any health advantage. ⁴ It is puzzling thus, that Dr. Eidelman suggestions imply that Code definitions of breast milk substitutes should be based on current practice instead of recommendations. Would it be acceptable then that infant formula is advertised as the best option, without restrictions or coverage under the Code, wherever exclusive breastfeeding rates do not reach 3 months? I do not think so. The baby food industry invests important amounts of money to train and influence health care professionals and policymakers globally. ⁵ This creates significant conflicts of interest and could be the reason why professionals and policymakers are not convinced enough of the importance of breastfeeding nor concerned about infant formula abuse.

Unethical marketing of breast milk substitutes and other unhealthy food products directed to infants and children is pervasive. It is a worldwide practice that affects all high, middle, and low-income countries. Public Health policymakers, scientists, health care professionals, and journal editors must take WHO recommendations seriously. Unethical marketing may make good editors incorrectly change their focus and defend a product that should not be needed if mothers in the United States, and worldwide, were adequately protected in their right to breastfeed. It is not a matter of “development” Dr. Eidelman, it is a matter of being on the right side of this war.