Peter E. Hartmann, E/Prof, PhD, BRurSc
Historically, there were only two options for infant nutrition that were compatible with infant survival: a mother’s milk or a wet nurse’s milk. Agricultural developments and the resulting domestication of animals led to an alternative – animal milk. However, most babies fed animal milk did not survive. This was largely due to its inappropriate composition for humans (e.g. cow’s milk has too much sodium and casein) and poor hygiene. Today, the World Health Organization (WHO) recommends infants be exclusively breastfed beginning one-to-two hours after birth and continuing up to six months of age, when they can be gradually weaned over the next 2 years and beyond.
The first section of this book sets the scene with background information that will help readers learn why breastfeeding is so vital. It explains how the human body works to produce such a complex bioliquid for nurturing infants. It also offers a glimpse into the world of data collection on breastfeeding and human milk.
Part I (see chapter 2) begins with a chapter from Leith Greenslade, CEO, JustActions LLC, New York. She provides insight into the importance of breastfeeding, and how producing breastmilk – an extraordinary protective and nutritional substance – for the health and development of their babies empowers mothers. She explores how breastfeeding is important for global health and sustainable development. Finally, Greenslade outlines the many issues surrounding breastfeeding, such as the lack of acceptance of breastfeeding’s importance, the collective failures by society and science to respond to poor breastfeeding outcomes, and the dearth of investment in breastfeeding innovations to help women balance the needs of breastfeeding and returning to paid employment, all of which are yet to be resolved.
Information – data – is the key to understanding the myriad issues linked to breastfeeding and to developing the policies and interventions that will resolve them. Maria Quigley, Professor of Statistical Epidemiology at the National Perinatal Epidemiology Unit, University of Oxford, provides an overview on collecting breastfeeding-related data and how it is processed (see chapter 3). Such data is used to compare infant feeding patterns in different countries and settings, and also to track progress towards achieving longer-term global health targets. Without consistent and comparable statistical data, it would be impossible to formulate and assess interventions aimed at overcoming the barriers to breastfeeding. Precise data definitions are required to ensure this consistency for both surveys and epidemiological studies. Professor Quigley addresses questions about the type of data needed to evaluate the long-term effects of breastfeeding in both mothers and infants, the quality of reporting on exclusive breastfeeding, what data should be collected for matters of economics, policy formation, education and implementation, who collects the data and how is it collected. Finally, she indicates where appropriate, randomized controlled trials are required to confirm observational studies and provide consistent and comparable statistical data.
In chapter 4, Ms Melinda Boss, the team leader of a multidisciplinary group developing evidence-based protocols, and I discuss the issues associated with creating a common understanding of human lactation in relation to how breastfeeding actually works from an anatomical and physiological perspective. The authors also discuss the development of related research – until the beginning of this century, the only definitive research into the anatomy of the lactating human breast was conducted in 1840. They show how this absence of research has greatly impaired advancing understanding of the anatomy and physiology of human lactation, such as the fact that the lactating breast is a complex metabolic organ that accounts for approximately one third of a mother’s daily resting energy output. Next, the authors outline the initial phase of the lactation cycle – an extended process beginning with conception, followed by distinct stages during pregnancy and the first three days after birth. This overview is followed by a summary of the established lactation phase, where milk synthesis is regulated by an autocrine, or local, control that responds to an infant’s appetite. The cycle ends with weaning and the involution of the gland once milk removal has ceased.
Part I (see chapter 5) concludes with Professor Berthold Koletzko, Dr. of Haunerschen Children’s Hospital and Kinderpoliklinik of the Ludwig-Maximilians-University, Munich, answering the question, “Why breastfeed?” He helps readers understand the evolution of lactation and the delicate balance between limiting energy costs to mothers while maximising infant survival. In this context, he touches on the considerable data supporting the health effects and benefits of breastfeeding for both mothers and infants. For example, women who breastfeed may benefit from enhanced regression of fat that accumulates during pregnancy and reduced risk of mammary and ovarian carcinomas. He explains how infants who are breastfed have reduced risk of infections such as acute otitis media and acute gastroenteritis, as well as disorders later in life, such as mammary and ovarian carcinomas. Furthermore, he discusses initial evidence of the small but important benefit breastfeeding can have on a child’s later cognitive ability, which is associated with significant advantages connected to educational achievement and income generation. He also touches on breastfeeding’s role in strengthening mother-infant bonding. Professor Koletzko concludes by explaining how such findings should prompt health care professionals around the world to support women’s health before pregnancy, during pregnancy and throughout lactation as each phase has a direct impact on lactation outcomes.