>> the money should be spent to supplement the diets of nursing mothers.

I agree - supplement the mother. But I am unabashedly biased from my
studies.  I remember a lecture in late 80s, right after the first Somalian
famine, that Dr. Jelliffe pointed out the greater benefit - not to mention
greater ease at maintaining food storage (where there was no refrigeration),
safety  (clean water availability), & decreasing cost overall - gained by
feeding mom a "2-ounce protein-energy bar" rather than starting
supplementation with formula. Definitely the Somalian woman's milk would not
resemble in content that of a mom in Beverly Hills, but consider instead
that each mother's milk had the specificity to her (and baby's) environment
for immunological protection. When the Somalian baby weaned (as inevitably
happened), the baby lost that critical source of protection and died, and
the mother was in no better nutritional state herself than before
supplementing. What a waste of relief funds!

There *are* studies on this topic of malnourished mothers, but it is
clustered in the nutritional and tropical medicine journals. (See
bibliography at end)  Because Dr. Jelliffe's book is out of print, and he
devotes considerable space to this topic, I will quote the paragraphs on
supplementation for consideration (there are graphs and charts as well which
are worthy ).

From Jelliffe and Jellife "Human Milk in the Modern Word" (Oxford Press.
1978. Out of print)

From Chapter 4: Maternal Nutrition, page 62: "Environmental Psychosocial
Stress

"It has not been sufficiently appreciated in the past that environmental
psychosocial stress can have an effect on lactation performance.  Such
stress is occasioned by poverty and unemployment, by poor housing and crime,
by illegitimacy and family instability, and by cultural confusion and
uncertainty, and is probably manifested through the effect of anxiety on the
letdown reflex -- and possibly on the secretion of various hormones, such as
cortisol (Geissler et al.  1975).  This is mainly of concern in urban slums
and shanty towns.

"Despite these differences, certain general findings seem to be usual and
they enable principles to be suggested on which practical action can be
based.  These can be considered under three headings: volume, composition,
and adequacy of breast-milk in poorly nourished communities."

From page 65: Supplementation

"Limited studies have been carried out on the effect on output of
supplementation of the mother's diet.  Gopalan (1958) showed an increase in
volume secreted from 420 to 540 ml, in poorly nourished Indian women
following protein supplementation (from 61 grams per day to 99 grams per
day) .  Similar results were obtained in western Nigeria by Bassir (1975)
using a vegetable-protein supplement (30 grams of soya flour daily).
Another study in India, where inadequately nourished mothers were fed with
milk biscuits, showed a rise in the serum albumen paralleled by increase in
albumen in the breast-milk, presumably by " spill-over" (Deb and Cama 1962).
An early investigation in 1931 showed that an increase in output of
breast-milk could be achieved in New Zealand women by increasing the calorie
and/or the protein intake.  Recently, a study in England seemed to suggest
that poor lactation could be related to inadequate energy reserves, in the
form of subcutaneous fat laid down late in pregnancy, and calorie intakes in
lactation.  In the U.K.., slimming diets in lactating mothers lead to "an
immediate reduction in milk supply" (Whichelow 1975, 1976).

"The recent detailed investigation by Edozian et al. (1976) from Nigeria
showed that protein supplementation of the lactating mother's diet increased
the milk produced and the weight-gain in the baby, but not the protein
content of the milk.  Similarly, Sosa et al. (1976) demonstrated a rapid
increase in milk production in a malnourished Guatemalan woman following a
diet, improved particularly in calories and protein.

"As usual, those concerned with the production of cow's milk as a business,
the dairy farmers, have infinitely more practical knowledge than those
concerned with human milk and breast-feeding.  Thus, Lindblad and colleagues
(1975) quoted the following aphorism from Morrison's 1948 Handbook of
Stockman, which may not be completely correct for the human, but is
certainly generally so: "Any inadequacy of a ration or fault in the methods
of care or management will generally manifest itself in the yield of milk,
rather than by a change in its chemical composition."

"However, the effect of increasing the maternal diet on human milk output
may be less than in dairy cows, since it should be remembered that such farm
animals have been bred to produce much greater yields that are required by
the offspring (Thomson and Black 1973)."

Bassir (1975) West Afr. J. Biol Chem.(1), 15. Nutritional studies on breast
milk of Nigerian women.  Determination of the output of breast milk.
Deb and Cama (1962) Brit. J. Nutr. (16), 65.  Studies in human lactation.
Dietary nitrogen utilization during lactation, and distribution of nitrogen
in mother's milk.
Edozian et al. (1976) J. Nutr.(106) 312.  Protein deficiency in man: results
of a Nigerian village study.
Geissler et al.  (1975) Fed. Proc.(4) 896. Lactation adequacy, pre- and
post-natal nutritional status and serum hormonal levels in Iranian women of
low and middle socioeconomic status.
Gopalan (1958) J. Trop. Pediatr. (4) 87. Studies on lactation in poor Indian
communities.
Lindblad and colleagues (1975) The composition and yield of human milk in
developing countries.  In: Food and Immunology, p. 125.  Almquist and
Wiksell, Stockholm.
Sosa et al. (1976) J. Pediatr. (88), 688. Feed the mother, thereby the
infant.
Thomson and Black (1976) Bull. World Hlth. Org. (52), 168. Nutritional
aspects of human lactation.
Whichelow (1975) Arch. Dis. Childh. (50), 669. Calorie requirements for
successful breastfeeding.
Whichelow (1976) Proc. Nutr. Soc. (35), 62A. Success and failure in
breast-feeding in relation to energy intake.

Katharine West, RN, BSN, MPH
Sherman Oaks, CA
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