Carol is currently the Canterbury Cot Death
Research Fellow. The Canterbury Medical Research Foundation funds
this research position. The following is a summary of the main
points of Carol’s article, the full text and references of
which can be found in LLLNZ’s Breastfeeding Communiqué 2003.
- Artificial formula is an inert product compared to breast
milk, which is a species specific, living fluid containing
many essential growth and immunological factors that are unable
to be reproduced in artificial baby milks.
- Formula manufacturers are not required to constantly justify
their products compared to the protection, promotion and support
of breastfeeding that breastfeeding advocates are continuously
forced to engage in.
- The attempt to make artificial baby milks (ABMs) more like
breast milk by the addition of long chain polyunsaturated fatty
acids (LCPUFAs) needs further, more extensive, ‘non-formula
industry’ research to determine if this is an improvement
for all babies or if problems occur with this practice.
- Some ABMs contain genetically modified (GM) components (soy,
yeast based) but parents are generally unaware of this. Similarly
they are also generally unaware of the availability of organic
formula. Health professionals could be more proactive in providing
information on these products.
- There is a lack of research into the long-term implications
and effects of using GM technology in ABMs and in particular
of the impact on vulnerable developing baby brains.
- GM techniques may give rise to new toxins (possibly from
pesticide residues) and to risks of allergies and antibiotic
resistance.
- No maximum allowable amounts of ingredients are specified
for ABMs. This overlooks an important safety factor in baby
nutrition as babies could be overloaded with some ingredients.
- The Australian College of Midwives submission to the 1999
ANZFA (Australia, New Zealand Food Authority) review of infant
formula stated “any artificial formula sold with ‘novel
ingredients’ should carry large warning messages that
the ingredient is experimental and the appropriate consent
arrangements be put in place for its use, consistent with other
medical clinical trials in humans”. If ABM is treated
as ‘nutrition only’ clinical trials may not be
subjected to as rigorous a review process as trials with recognised
medications.
- Attempts have been made within the current review (not yet
released) of the New Zealand interpretation of the World Health
Organisation’s International Code of Marketing of Breast
Milk Substitutes, to increase the defined age range of an infant,
from birth to six months old, to birth to one year old. This
would increase protection for breastfeeding. Follow on formula
is a most successful marketing initiative for ABM and is not
covered by the New Zealand interpretation as it is designed
for babies over six months old. Free samples can be sent to
mothers of breastfeeding babies over six months old, which
can negatively impact on breastfeeding by promoting the idea
that breast milk becomes inadequate after six months of age.
The New Zealand Infant Formula Marketers’ Association
Code of Practice should provide more protection for breastfeeding.
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- The United Nations Convention on the Rights of the Child (UNCROC)
1989, to which New Zealand is a signatory, calls on state parties
to always act in the “best interests of the child”.
It enshrines the “right of the child to the enjoyment of
the highest attainable standard of health” and the obligation
to “ensure that all segments in society, in particular parents … are
informed, have access to education and are supported in the use
of basic knowledge of child health and nutrition, (and) the advantages
of breastfeeding”. Some of this obligation falls on health
professionals.
- The decline of breast milk banks occurred after slower and supposedly
inadequate growth rates were noted in babies fed on banked breast
milk. This resulted in the production of special preterm formulas.
Human milk fortifiers based on cow’s milk were later developed
to add to expressed breast milk at the expense of research into
the use of lacto-engineering of human milk to produce blends suitable
for very low birth weight babies. There is an absence of evidence
of the long-term benefit or deleterious effects of supplementation
with multicomponent human milk fortifiers.
- Powdered milk products are not sterile and are susceptible to
bacterial contamination, (eg Enterobacter sakazakii which may cause
meningitis, septicaemia and necrotising enterocolitis). These are
very serious infections in neonatal intensive care units where
babies are particularly vulnerable. Research by United States Food
and Drug Administration (FDA) that showed E. sakazakii could be
recovered from 14% of 141 samples of infant formula products. (Update:
In August 2004 a premature baby in Hamilton NZ died as a result
of E. sakazakii infection).
- The establishment of human milk banks to supply screened, pasteurised
donor breast milk would provide a safer more nutritionally suitable
option for babies whose mothers are unable to produce enough of
their own milk.
The use of ABM will still be necessary in some situations but stringent
labelling and monitoring of these products is essential. Companies
should be required to declare the sources of ingredients, including
whether any genetically engineered ingredients are being used. Maximum
allowable levels of ingredients should also be established and regulated.
Carol Bartle, IBCLC, RM, RN, Post Grad Dip – Child
Advocacy (U of O), Masters Student – Health Sciences
AROHA Sep - Oct 2004.
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