Dear all:

Many of us have different views on other health care issues and this forum is 
predominantly about breastfeeding.  Therefore, I was surprised to see a post that did not 
reference breastfeeding at all, but an issue that will always be controversial.  

For those of us who live in developed areas of the world --- the actual consequences of 
some diseases are unfamliar.  For those of us who have worked in developing areas of 
the world these are not abstract.  I have spent far too much time in hospitals and clinics 
and watched polio victims scratching out a living to be cavalier about diseases that I 
rarely see in Manhattan.  My favorite polio survivor really was.  He lived on the trains in 
Northeast Congo.  His knees had so many callouses, they looked like elephant feet. He 
could throw down his sack of goods to be sold at markets along the train line and hang 
from the edge of the platform and drop his body down with the skill of a gymnast.  The 
guys in Niger were another story.  They had been given seated bicycles, but they did not 
have the gumption of my friend in the Congo.  Personally, I think those that gave the 
bicycles should have put some thought into a rehabilitation program for these guys.  They 
would sit outside the hotels and beg.  That was not what I would consider a productive 
life.

I have to make this very clear.  NOT ALL COMMUNICABLE DISEASES ARE SPREAD BY 
WATER AND FECES.  Water and sanitation will NEVER SOLVE ALL OF THE PROBLEMS. I did 
a thorough review of water and sanitation projects for a chapter in a book.  These have a 
long term impact on many aspects of health, but they will not reduce HIV, hepatitis, 
malaria, measles, and other diseases that are not water-bourne or transmitted through 
fecal contamination.  Measles in particular is pretty much uncontainable because the 
spread is so rapid.  Polio is not as rapid -- which is why most people in developing 
countries live in oblivion to its serious consequencs.  Small pox is an even slower spread 
which is why it only exists in laboratories now.  

Lactnet is not the forum for debating the merits and harm of immunization, unless it 
pertains to breatfeeding.  And certainly not blanket statements that show considerable 
ignorance of the variability of disease transmission.  It takes to set up a sustainable 
water and sanitation program that is EFFECTIVE AND SUSTAINABLE. I've visited too many 
clinics where I've watched infants dying of measles --- and it is not pretty.  If they are 
the least bit deficient in vitamin A, their eyeballs melt and collapse before the end.  
These infants and children deserve everything we can give them to avoid such a demise.

What I do think is fair game is to point out the discrepancies between programs that 
receive far less funding that the one preventive measure that is TOP OF THE LIST OF THE 
LANCET articles on preventive interventions.  Exclusive breastfeeding until six months 
would reduce the risk of infant death by 13%.  The next item down the less had an 
impact that was half the impact of breastfeeding --- lower than 6%.  The latest UNICEF 
report shows that the percent of infants younger than six months who are exclusively 
breastfed is ONLY 38%.  Furthermore, in the areas of West Africa where infant mortality 
rates are the highest, the exclusive breastfeeding rates are the lowest at 21%.  Water 
and sanitation did not even get on the list. Nevertheless, I would still argue for such 
programs because they have other benefits that were not evaluated --- mainly to the 
work load of women and girls.

Rather than arguing against an intervention --- I would argue towards more funding for 
the most important intervention --- Breastfeeding. Is is the imbalance in funding that is 
important.  If you go to the UNICEF website and read the annual report -- you will find 
that breastfeeding is barely a footnote.  You have to read the entire report VERY 
CAREFULLY to find mention of breastfeeding. As breastfeeding advocates you will realize 
that just about every problem that is discussed could either benefit from breastfeeding 
promotion OR is a problem that hinders breastfeeding.  Read the report and then write a 
letter to Ann Veneman with concrete positive ideas --- suggesting how the focus on 
breastfeeding could be improved and strengthened.

Ditto for the stars.  Educate them to refocus their activities on the FIRST AND MOST 
ENDURING lifelong immunization --- breastfeeding.

Susan E. Burger, MHS, PhD, IBCLC

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