*First author is Sonia Lopezcastro
USA and Mexico, two neighboring countries, one rich, one poor, who blame each other for weapons and drugs, may be surprised to learn that they are not very different after all. Both countries share health crises.
Both governments have implemented some campaigns and actions trying to curb a little bit the existing crisis, but there has not been any plan to prevent these problems from the moment a new citizen is born. Because one thing is to try to solve a problem, when is already there, and another thing is to prevent it so it does not arise. For instance, there has been a lot of promotion of the pink ribbon in relation with the breast cancer early-detection, but there is really not much information about how to avoid the formation of the tumor itself. But, is it really possible to prevent these diseases?
Research demonstrates that there is a common denominator for all these illnesses: the lack of breastfeeding. Only 16% of American women exclusively breastfeed their infants at 6 months of age. In Mexico, only 14% does. In this regard, it is important to mention that the percentage in US has increased in the last years; however, Mexico unfortunately shows a decrement year after year21-22. Breastfeeding is linked to less breast cancer in mothers. Breastmilk protects infants from early death, and protects them as they grow from diabetes, obesity, arthritis, osteoporosis and Alzheimer’s disease.
Because of its beneficial effects on gut bacteria and the immune system, breast milk should be an exclusive diet for at least 6 if not 12 months, with continued breastfeeding along with appropriate complementary foods up to two years or beyond23. Breast milk is beneficial for both the child and the mother:
Why is it then that breastfeeding rates are so low in both countries? The reasons are grave:
1. Breastfeeding-unfriendly medical establishments. In 2011, the US Surgeon General put out a report noting that only 4% of US hospitals were breastfeeding friendly (called “baby-friendly” by the WHO). In Mexico, the friendly breastfeeding program started in June 2012, and just a few hospitals have complied; it’s a common practice to feed the newborn with formula, while it is under “observation” in the nursery room. The pediatrician will most likely recommend a brand of commercial substitute to the mother before leaving the hospital. In the USA, hospitals still provide free formula to new mothers to take home with them and there is poor regulation of breastmilk substitutes48-49.
2. Uneducated health professionals. Obstetricians in both countries often separate the baby from the mother right after birth, which is known to affect breastfeeding success. In Mexico, doctors don’t even ask if she intends to breastfeed. Often the chance is missed to let her provide the baby with colostrum, which is a “bomb” of nutrients (including vitamin K) and defenses to protect the health of the newborn. Medical professionals and health institutions often do not follow the practices recommended by WHO and UNICEF for breastfeeding friendly (“baby-friendly”) neonatal practices, among other authorities and scientific studies which prove the amazing benefits of lactation, starting during the first hours of life. It’s very common to hear doctors in Mexico saying that breast milk becomes water after a few months or that is not good to breastfeed in case the mother gets sick with a simple flu.
See here for a comparison of breast milk and formula.
3. Insufficient maternity leave. By law, women in both countries are entitled to 12 weeks for maternity leave (the shortest period of the largest economies in the world), fully paid in Mexico, fixed as 6 weeks before the birth and another 6 weeks after that (i.e., only 42 days with the newborn!). In US, this period is unpaid, but flexible to distribute as the mother wishes (e.g., one week before and 11 after). Such a short period most likely hinders the success of lactation for the oncoming months, and the early separation affects mother-child bonds. To avoid this, many women choose to quit their jobs (tightening their belts) and postpone their professional careers. Many others, with a bad economy, have no other option than to return to the workforce, and stop breastfeeding or to try expressing their milk (in Mexico, no decent place at work is provided for this). In the latter case, the babies must be left with a relative, since no childcare place accepts the breast milk kit.
In connection with this situation, more than 3,000 Mexicans (total keeps increasing) have joined to petition the House of Representatives for an extension of the current maternity leave up to 6 months postnatal (+ 1 prenatal, 7 months in total, i.e., from 12 weeks to 28 weeks). The supporters are open for negotiation based on a deep analysis. There are other alternatives, for example, starting with at least 18 total weeks as the ILO recommends, and gradually increasing the period depending on budget adjustments. There are also alternatives on how to cover the salaries and strategies to not affect as much female labor force. About this matter, Chile is a clear example of what it can be accomplished, country who a couple years ago extended this period to 6 months postnatal, the second longest in the whole continent, after Canada. Increasing the leave duration to ease lactation and attachment is an investment in health and wellness of new families, and not an expense. In a few years all this will reflect in saving lot of money and effort put into treatments, studies, medicines and palliatives, which will have a lower demand due to the improvement of health.
Maximum Family Leave (in weeks, OECD, 2011)
65 United Kingdom
56 New Zealand
4. Cultural. We are not used to see women breastfeeding in public places. Mexican society considers it as a “rural” practice, that only “indigenous” women does it (absurd, besides racist), that is “indecent” and “obscene”. But it’s so natural that thanks to that, the human race has developed and survived during thousands of years, back when formula didn’t exist and women used to breastfeed between 5 and 9 years, according to anthropological studies. It would be easy to get rid of this cultural stigmatization with massive and continuous informative campaigns, among other actions like update courses to health professionals, creation of new mothers’ support groups, creating places for nursing in public places and enterprises’ facilities. The Affordable Care Act mandates that businesses with 50 or more employees have lactation rooms with refrigerators where moms can pump and store milk for their babies.
Lack of breastfeeding may be the most critical cause of the aforementioned health problems. But it is something that we can change.
What can be done to turn around the health crises?
1. Demand that medical establishments in your area become “baby-friendly.” See the UNICEF/WHO’s list of 10 characteristics that characterize baby-friendly hospitals.
3. Petition for lengthier maternal (and paternal) leaves.
4. Educate everyone about the “white gold” that breastmilk is. See this series of posts on the contents and benefits of breastfeeding versus formula.
5. Change your culture. Support moms who breastfeed. Educate expectant parents about the importance of breastfeeding for the health of their child (and society).
1. CDC. “Breast Cancer”. http://www.cdc.gov/vitalsigns/breastcancer/
2. Breastcancer.org. “U.S. Breast Cancer Statistics”. http://www.breastcancer.org/symptoms/understand_bc/statistics
3. SS. SPPS. "19 de Octubre de 2012 Día internacional de la lucha contra el Cáncer de Mama". http://www.spps.gob.mx/noticias/1183-19-octubre-dia-internacional-lucha-contra-cancer-mama.html
4. OCDE. "CO1.1: Infant mortality", p 1. http://www.oecd.org/els/family/CO1.1%20Infant%20mortality%20-%20updated%20081212.pdf
5. UNICEF. "Estado Mundial de la Infancia 2012", p 87. http://www.unicef.org/spanish/sowc2012/pdfs/SOWC%202012%20Main%20Report%20LoRes%20PDF_SP_03132012.pdf
6. FOX News. ”Mexico surpasses US as world’s most obese nation”. http://www.foxnews.com/health/2013/07/09/mexico-surpasses-us-as-world-most-obese-nation/
7. FAO. "The State of Food and Agriculture", p 77, 79. http://www.fao.org/docrep/018/i3300e/i3300e.pdf
8. CNN. "La historia de cómo kilo a kilo México se volvió líder en obesidad". http://mexico.cnn.com/salud/2013/07/12/la-historia-de-como-kilo-tras-kilo-mexico-se-volvio-lider-en-obesidad
9. IDF. "IDF Diabetes Atlas". Diabetes prevalence comparative 2012 and Deaths attributable to diabetes. http://www.idf.org/atlasmap/atlasmap
10. INEGI. "Mujeres y Hombre en México 2012", p 29. http://cedoc.inmujeres.gob.mx/documentos_download/101215.pdf
11. Ovarian Cancer National Alliance. ”Statistics”. http://www.ovariancancer.org/about-ovarian-cancer/statistics/
12. Instituto Nacional de Cancerología. "Cáncer de Ovario, una visión práctica", p 4
13. CIMAC. "México: Sin recursos contra el cáncer de ovario". http://www.ipsnoticias.net/2012/04/mexico-sin-recursos-contra-el-cancer-de-ovario/
14. CDC. ”Breastfeeding Report Card 2013”, p 4. http://www.cdc.gov/breastfeeding/pdf/2013BreastfeedingReportCard.pdf
15. CDC. ”Arthritis-Related Statistics”. http://www.cdc.gov/arthritis/data_statistics/arthritis_related_stats.htm
16. National Osteoporosis Foundation. “What women need to know”. http://nof.org/articles/235
17. Maternal & Child Health Bureau. “Alzheimer’s disease”. http://www.mchb.hrsa.gov/whusa11/hstat/hshi/pages/223ad.html
18. Salud180. “Artritis afecta más a las mujeres”. http://www.salud180.com/salud-z/artritis-afecta-mas-las-mujeres
19. Televisa. “En México, 5 millones de mujeres con osteoporosis”. http://noticierostelevisa.esmas.com/especiales/592394/mexico-5-millones-mujeres-con-osteoporosis/
20. Asociación Potosina de Alzheimer. “Qué es la enfermedad de Alzheimer”. http://www.apaes.com.mx/documentos/QueEsAz.cfm
21. Milenio. "Mexicanas entre las que amamantan menos a sus bebés". http://www.milenio.com/cdb/doc/noticias2011/e93bbbd7d41412630bd0071b8cec8c42
22.ENSANUT. ”Evidencia para la política pública en salud 2012”, figura 3. http://ensanut.insp.mx/doctos/analiticos/DeterioroPracLactancia.pdf
23. OMS. "10 Datos sobre la lactancia materna". http://www.who.int/features/factfiles/breastfeeding/facts/es/index.html
24. "Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease". http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)09454-0/abstract
25. "Effects of Breastfeeding on the Mother". http://www.pediatric.theclinics.com/article/S0031-3955(05)70290-X/abstract
26. Organización Panamericana de la Salud. "Efecto de la lactancia materna en la salud materna". http://www.google.se/#bav=on.2,or.r_qf.&fp=9eb0132ec3301b47&q=paho+que+significa
27. "Lactancia materna: un método eficaz en la prevención del cáncer de mama". http://scielo.isciii.es/scielo.php?pid=S0212-16112010000600010&script=sci_arttext&tlng=e
28. UNICEF. "Semana de la lactancia materna". http://www.unicef.es/actualidad-documentacion/noticias/la-lactancia-materna-es-la-forma-mas-barata-y-eficaz-de-salvar-vid?utm_source=Facebook&utm_medium=SocialMedia&utm_campaign=SemanaLactanciaMaterna
29. "Breastfeeding and the Risk of Postneonatal Death in the United States". http://pediatrics.aappublications.org/content/113/5/e435.abstract?sid=9e5e914e-b096-457d-8aaf-feb2d5f15d00
30. Organización Panamericana de la Salud. "Efecto de la lactancia materna en la mortalidad infantil". http://www1.paho.org/spanish/ad/fch/BOB2.pdf
31. IMSS. "Lactancia materna previene obesidad". http://www.eluniversal.com.mx/sociedad/2013/lactancia-materna-previene-obesidad-imss-940096.html
32. "Efecto de la lactancia materna en las enfermedades crónicas. Efecto de la lactancia materna en la obesidad". http://www1.paho.org/spanish/ad/fch/BOB4.pdf
33. "Breast feeding and obesity: cross sectional study". http://www.bmj.com/content/319/7203/147.full
34. "Breastfeeding as Obesity Prevention". http://archpedi.jamanetwork.com/article.aspx?articleid=1107563
35. UNICEF. "Breastfeeding & diabetes, Ziegler 2003". http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Diabetes/Exclusive-breastfeeding-reduces-risk-of-diabetes/
36. UNICEF. "Breastfeeding reduces risk of maternal type 2 diabetes". http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Diabetes/Breastfeeding-reduces-risk-of-maternal-type-2-diabetes/
37. American Diabetes Association. "Breastfeeding Lowers the Risk of Diabetes". http://www.diabetes.org/news-research/research/access-diabetes-research/breastfeeding-lowers-the-risk.html
38. UNICEF. "Breastfeeding and rheumatoid arthritis, Pikwer 2008". http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Rheumatoid-arthritis/Breastfeeding-may-reduce-mothers-risk-of-rheumatoid-arthritis/
39. BBC. "Breastfeeding 'may cut arthritis'". http://news.bbc.co.uk/2/hi/health/7395810.stm
40. AZTECA. "Lactancia reduce riesgos de cáncer y osteoporosis". http://www.aztecanoticias.com.mx/notas/salud/133871/lactancia-reduce-riesgos-de-cancer-y-osteoporosis
41. LA LECHE LEAGUE. "La Leche League International Offers Good News about the Link between Breastfeeding and the Prevention of Osteoporosis during National Osteoporosis Prevention Month". http://www.lalecheleague.org/release/osteo.html
42. "Breastfeeding may reduce Alzheimer's risk". http://medicalxpress.com/news/2013-08-breastfeeding-alzheimer.html
43. "La lactancia materna puede reducir el riesgo de Alzheimer". http://www.medicalpress.es/la-lactancia-materna-puede-reducir-el-riesgo-de-alzheimer
44. Organización Panamericana de la Salud. "Efecto de la lactancia materna en la morbilidad infantil". http://www1.paho.org/spanish/ad/fch/BOB1.pdf
45. MedlinePlus. "Breastfeeding tied to kids' intelligence". http://www.nlm.nih.gov/medlineplus/news/fullstory_139154.html
46. Organización Panamericana de la Salud. "Efecto de la lactancia materna en el desarrollo intelectual y motor". http://www1.paho.org/spanish/ad/fch/BOB3.pdf
47. Brown University. "Breastfeeding benefits babie's brains". http://news.brown.edu/pressreleases/2013/06/breastfeeding
48. OMS. "Reglamentación de los sucedáneos de la leche materna". http://www.who.int/features/factfiles/breastfeeding/facts/es/index6.html
49. OMS. ”Regulating breast-milk substitutes”. http://www.who.int/features/factfiles/breastfeeding/facts/en/index6.html