There is no doubt about the huge harm caused by commercial promotion of breastmilk substitutes (BMS) in low and middle income countries (LMIC). Commercial promotion that always violates the International Code or circumvents it. Many of those who have posted messages on this topic have made appeals or proposals; they all go in the direction of strengthening
national legislation and control, with adequate independent monitoring.
I would like to draw some attention also to a problem that so far is causing problems mainly in high income countries (HIC), but will soon show up and grow in LMICs: the inappropriate commercial promotion of breast pumps and so called breastmilk feeding (as opposed to breastfeeding). In the USA, but other HICs are following the same trend, rates of breastmilk
feeding have already outdone those of breastfeeding; it is estimated that every new mother is buying on average three breast pumps. Yet, breastmilk feeding is not without harms. There is literature showing that, compared to breastfeeding, it is associated with a higher incidence of infection (diarrhoea, otitis), worse infant growth and self-regulation of breastmilk
intake, and higher carbon footprint.
The culprit, obviously, is not only the inappropriate promotion of these devices. The lack or inadequacy of legislation for maternity protection plays an important role. But the industry takes advantage of this background to disseminate messages that persuade more mothers that those who would need a breast pump to buy one. There are published studies in support of the previous statement
(https://pubmed.ncbi.nlm.nih.gov/27103601/ ; https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884... ).
All the above indicates that the breast pump industry should also be subject to regulations. In fact, most producers make and sell also feeding bottles and teats and therefore are covered by the International Code like the BMS industry. This is the only way to avoid spreading the use of a tool that is very useful in a limited number of specific cases but should not be widely used, as the industry would like, by most or all mothers, as currently occurring in the USA, UK, Australia and other HICs. Anecdotally, I was recently told by friends and colleagues in some LMICs that breast pump feeding is becoming trendy also out there.
Adriano Cattaneo
CHIFA Profile: Adriano Cattaneo is a retired epidemiologist. Until recently he was the coordinator of the WHO Collaborating Centre for Maternal and Child Health in Trieste, Italy. He is particularly interested in infant and young child feeding and is a member of IBFAN.
Email: adriano.cattaneo AT gmail.com
Moderator inexpert comment: I would love to hear comment from midwives health visitors parents or others about this. I can easily think of circumstances when the use of expressed (or mechanically expressed) breast milk is the step that avoids the use of breast milk substitutes. Maybe a lot depends on the life circumstances of the parents.
Tom Hutchison CHIFA moderator
