By :Stephanie Herseth Sandlin and Marshall Matz
The Obama Administration has established a strong commitment to sound science as the basis for regulatory action and public policy. Nowhere is this needed more than when it comes to the subject of infant nutrition, which is often quite simply equated with breastfeeding. When the subject of breastfeeding comes up, too many times it gets either an uncomfortable smile or some ideological response based on a personal bias. What mothers and expectant mothers need is support and science-based practical advice on infant feeding for a wide range of personal situations. It is important that the information and message regarding infant nutrition disseminated by federal agencies be comprehensive, balanced, consistent and aligned.
The Secretary of the Department of Health and Human Services (HHS) and the Surgeon General recommend breastfeeding as the best form of infant nutrition, a recommendation that is widely accepted and supported. They also make clear that a mother who can’t breastfeed, or shouldn’t breastfeed for health reasons, or chooses not to for personal reasons, should not feel guilty or inadequate. In issuing a “Call to Action to Support Breastfeeding” earlier this year, the Surgeon General stated that, “the decision to breastfeed is a personal one . . . . [N]o mother should be made to feel guilty if she cannot or chooses not to breastfeed.” It’s very reassuring to hear the Surgeon General express sensitivity to the needs and circumstances of individual mothers.
Traditionally, the most succinct, balanced and practical advice on infant nutrition has come from the United States Department of Agriculture (USDA), which administers the Special Nutrition Program for Women, Infants and Children (WIC). USDA recently issued a one-page tip sheet for moms on infant nutrition, including breastfeeding. It’s excellent, and says in part:
A recent comment by Dr. Thomas Frieden, on the other hand, was both disappointing and inappropriate. Dr. Frieden is the Director of the Centers for Disease Control and Prevention, an agency within HHS. Dr. Frieden said glibly (we hope) that he believes “a prescription should be written to give formula.” What? Formula is no more a “medication” than pregnancy is a “disability.” Let’s be careful not to lose the ground that women have worked so hard to gain. Such a comment or suggestion is a prescription for absurdity and not what is expected from the CDC, a prestigious agency dedicated to sound science. We fear that Dr. Frieden’s statement reflects a personal ideology that is attempting to drive public policy on the issue of infant nutrition, thereby turning a blind eye to the realities faced by most mothers and families in America today.
It’s helpful to note that seventy-five percent (75%) of all mothers in the United States now initiate breastfeeding in the hospital. That is just excellent and shows that encouragement, guidance and support for expectant mothers who want to breastfeed has improved. What we need now are better support systems so that mothers who want to breastfeed can do so in a work setting and in public with accommodation and understanding. If you are a mother who chooses to breastfeed and you happen to serve in Congress, there is support. But if you are a WIC mom working for an hourly wage in a retail service business you will more likely face a difficult challenge. That is where the focus needs to be in the years ahead.
Yet, we also know that many mothers cannot breastfeed, should not breastfeed for health reasons, supplement breast milk with formula, or simply choose not to breastfeed. So it is highly important that recommended practices for encouraging breastfeeding and supporting mothers who choose to breastfeed do not also actively discourage the safest alternative, withhold balanced information on infant nutrition, and fail to support mothers who formula feed. As the USDA tip sheet points out, iron-fortified infant formula is the safe and recommended option . . . and in no circumstance should the baby be fed soda in a bottle as is too frequently the case.
For many infants obesity starts at six months of age, with very poor nutrition choices a likely contributing factor, such as parents or caregivers putting soda or juice in the bottle, often before the infant even has teeth. HHS needs to address this issue, too. If federal agencies and other experts on infant nutrition focus only on the importance of breastfeeding—as important as it is—then they aren’t providing sufficient guidance to mothers on other critical nutrition issues, such as the appropriate alternatives to breast milk and the totally inappropriate alternatives, in a changing world with many cultural, health and practical challenges. The manner in which USDA has handled this important and sensitive issue and in which it has distributed balanced information is a good place to start.
Marshall Matz was General Counsel to the Senate Select Committee on Nutrition. Both are partners at OFW Law in Washington, D.C.
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