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From:
Helen Armstrong <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 29 Jul 2002 12:14:51 -0400
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As Andrea Eastman pointed out, on the UNICEF website you can now find the very latest, 3rd edition of Facts for Life 2002. at www.unicef.org where it has a special button on the website introductory page.  The breastfeeding chapter is very substantially rewritten. It has been endorsed by a whole alphabet soup of other UN agencies: WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the World Bank.  The entire thing is free for reproduction, and can be downloaded in English, French or Spanish from the web. Alternatively one can buy hard copy in those languages (and it will be translated into many others at country level) for $7.50 a copy plus $5. handling from [log in to unmask] if you are in the Americas, Asia  or Pacific, and from [log in to unmask] if you are in Europe, Africa or the Middle East. 

LactNetters will notice that messages about breastfeeding are scattered throughout the book, including the statement that "Infants who are not breastfed may not learn as easily as breastfed infants." This kind of statement may be useful in developing handouts for families. The whole book is in simple language intended for public communication. 

In the Breastfeeding chapter under key message 4, "Bottle feeding can lead to illness and death," if an infant cannot breastfeed, then next best is milk expressed from the mother's own breast, fed by cup. If that is not possible, then next best is breastmilk of another healthy mother, from a cup.  If breastmilk is not available at all, then a nutritionally adequate breastmilk substitute from a cup. 

Note that Facts for Life does NOT say infant formula. The breastmilk substitute options of course include home-prepared formula, and after 6 months, straight animal milks. Only the US, so far as I know, recommends a whole year of feeding with commercial infant formula.  (LactNetters are well able to consider what non-scientific influences might have nudged that recommendation.)  The UN agencies also recommend cup feeding of any fluids for any infant, including prematures and the infants of employed mothers.

If I may put the heirarchy in my own blunt and positive terms:
Breastfeeding is first rate.
Expressed mother's breastmilk or another woman's breastmilk is second rate (because it does not give the baby all the sweet responsiveness of breastfeeding, of course.) 
Breastmilk substitutes, whether commercial formula or another nutritionally adequate preparation, are third rate.  

It may happen from time to time that our colleagues are ready to hear the message that infant formula is third rate. This is a stunning way to phrase it, and needs judicious use -- but it can stay in the mind of someone who for too long has assumed that breast is best but formula is OK too, "second best" as some advertisements used to say.  No, breastmilk without the mother is second rate, and formula is third rate. 

We may need to just whisper this subversive message when we are working in settings like that hospital recently described on LactNet where "Breast is Best" is considered inflammatory language!   But where we wish gently to set a little contained, warming fire to cook with, the first/second/third rate language could be a bit of useful fuel.  Used with caution, it just might provide a home-cooked meal for a few infants who would otherwise be reliant on store-bought food. 

Helen 




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