How to save 14 billion litres of breastmilk

Recent research published in the journal Frontiers in Public Health shows that annually, 14 billion litres of breast milk that could be produced to feed babies is not, due to cultural barriers and structural impediments to breastfeeding. This is unfortunate since there are many benefits to breastmilk. For instance, the World Health Organization says that “breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers”.

The researchers’ survey covered 15 countries across Europe, Asia, America, Africa, and Australasia. The research used the Mothers’ Milk Tool to arrive at its estimation. They used the number of infants and young children aged 3 years and below; country survey data on continued breastfeeding rates; estimates of human milk intake by child age; and a price per litre of human milk of $100 (based on the official price for fresh human milk within Norway’s human milk banking system).

The researchers also found that more breast milk is lost in high-income countries compared to low- and middle-income countries. For instance, an average of two-thirds of breast milk that could be produced never is in the U.S., Norway and Australia, and more than 80 per cent in Ireland. In contrast, Kenya, Nigeria, and Vietnam currently lose around a third or less of the breast milk that could be made.

What is preventing so many women from breastfeeding, for those who have no physical reason stopping them? While there are barriers such as workplaces or public spaces that are not supportive of lactating women, there also are global cultural barriers that vary across countries. In the US, some believe that infant formula is equivalent to breast milk in terms of its health benefits; in Lebanon, a harmful cultural belief says abdominal cramps are transmitted to infants through breast milk; in Nigeria, some communities are fearful that infants may get addicted to breast milk; and in Ireland, there is negative social perception of breastfeeding within Irish culture.

I have seen firsthand the impact of negative cultural practices on breastfeeding. In 2017, I led a photo and video documentation of a nutrition project implemented by an international NGO across several states in northern Nigeria. Interviewing women in a community in Plateau State, north-central Nigeria, revealed that culturally, colostrum (the first highly nutritious thick yellowish breast milk) is considered dirty milk, and babies are not allowed to consume it. Shockingly, elderly female community members – usually grandmothers, suck the colostrum and spit it out.

These harmful cultural practices deprive babies of critical nutrients, which could lead to stunting and wasting. Therefore, a reminder of the benefits of breast milk is pertinent. According to the Cleveland Clinic, colostrum is high in protein, vitamins, minerals and antibodies that help build your baby’s immune system. It is often called “liquid gold” because of its rich, golden colour and valuable benefits.

The benefits of breastfeeding cannot be overemphasized. Therefore, it is imperative to help women succeed with breastfeeding, if they want to do it. These are four ways to change cultural norms and help more babies receive breast milk.

First, all countries should enforce the International Code of Marketing of Breastmilk Substitutes. Published by the World Health Organization in 1981, it is an internationally agreed voluntary code of practice, which regulates the marketing of breastmilk substitutes in order to protect breastfeeding. Recently, Tedros Ghebreyesus, the director-general of the World Health Organization, tweeted that years of aggressive marketing of breast milk substitutes have led to significant reductions in rates of exclusive breastfeeding. He added that rates of exclusive breastfeeding are 20 per cent higher in countries that have legislation substantially aligned with the International Code of Marketing of Breastmilk Substitutes than in countries without it.

Second, promote the establishment of breast milk banks. Mothers who produce more than enough milk for their babies can donate to breast milk banks. The donated breast milk undergoes a health screening, is pasteurized and stored in refrigerators. Breast milk banks work with local hospitals to provide milk for premature babies who are unable to suckle on their own. Consequently, mothers who are unable to lactate can also buy breast milk from the banks. Breast milk banks can also support donors with breast pumps to enable donors to increase their breast milk production. It is important to make the breast milk donation process less intensive while observing all safety procedures, to encourage more women to donate.

Third, train more lactation consultants to help dispel harmful myths and increase breastfeeding. A lactation consultant is a certified professional who works with mothers to understand their breastfeeding goals and helps them develop a plan. Babymigo (Nigeria’s largest parenting community) has a list of more than 50 lactation consultants spread across several states in the country.

Finally, social services should provide monetary and in-kind compensation to women who breastfeed. Such payments could be by providing adequate nutrition for pregnant women so they can breastfeed better after childbirth. It’s an important social service that ensures a healthy and prosperous future because the first 1000 days of life are crucial for the health and well-being of any child. A study in the United Kingdom showed that “vouchers might significantly improve rates in areas where they are below the national average. It will also help inform discussions around this issue at a global level.”

Helping more breastmilk be produced and used in these ways could help millions of babies.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool)
Senior New Voices Fellow at the Aspen Institute
Senior Atlantic Fellow for Health Equity at George Washington University
2006 Ford Foundation International Fellow