The Human Pacifier

I'm sitting in the rocker with my son in the blue light of dawn. We've been at this a few weeks now, getting to know each other after nine months of anticipation. I am searching for feedback; a sign that I'm doing right by him, getting closer to figuring out what ails him when he seems so inconsolable.

I hear voices. Well-meaning voices telling me, advising me, warning me to not let this tiny boy grab the reins and yank me down the race track. I look at the child in my arms, his eyes slightly crossed as he tries to steady his gaze, and I feel somehow, in spite of the fact that I've only been his mother for forty-two days, that he gets it. I mean, he knows what he needs more than I do.

He is my sherpa guide, my compass.

He is barely out of my womb when I am asked how long I plan to nurse. I look at Nicholas suckling at my breast, and I ask him about his long-range plans. He burps.

He cries and I nurse him. They warn me not to do this too much, or I'll become a "human pacifier." They are friends, strangers, sometimes relatives. One neighbor is concerned that my baby will learn to depend on me for comfort.

My baby never took to a pacifier, or his thumb, or knuckle, or any plastic teething ring no matter how fascinating the texture or color. He wants to nurse. He likes to stretch his free arm upward and hook his fingers onto my tank top or bra, like he's riding the train and that's his strap.

In his laid-back mood, he nurses with both hands on his head, kind of massaging what little hair he has, like he's giving himself a shampoo. Sometimes, he thumps his chest then mine, like he Tarzan and me Jane. And sometimes, he's got too much on his mind and he just lays his palm flat on his forehead. My heart melts and breaks when, with his eyes closed, he reaches up to my lips with his outstretched hand so I can kiss his fingertips while we nurse in the shadows.

As the months pass, I learn to let go of my ego, to get out of the way, and, not surprisingly, we find our rhythm. Some days, we are tuning the instrument. Some days, we make music. Some days, I feel out of tune with both of us. But there is one constant amid the rapid changes of new motherhood, one thing I can offer my child regardless of time, place, and circumstance: comfort.

He is lying in the crook of my arm, nursing, after a long morning of cramps and gas. I feel so relieved for both of us. He couldn't be more comfortable if he were lying naked in a cloud. After my cyclone of emotions, from empathy to confusion, anxiety, exasperation, and guilt, I finally feel calm. He is at peace at last. For the moment, anyway. Sitting here nursing my baby, he is pacified, yes, but so am I. Being a human pacifier works both ways.

Nursing for comfort, his, mine, and ours, is so much more than soothing him when he cries.

When we sit here after a difficult morning, after I've questioned my competence as a new mother, wrestled down my nostalgia for a past where everything seemed easier, struggled with tolerance and compassion and reminded myself (sometimes out loud) that all will pass and he will be happy and well-adjusted and remember none of his intestinal fury and my quiet panic, the shallow-breathing, and lilting lullabies sung tentatively over the shrill tones of his cry, I feel that nursing him in this slow and fluid silence is all about emotional replenishment. He and I re-group after the contradictions and ambivalence of that particular hour or day or week. It feels to me, in these moments, like I am refueling myself, bringing myself back to center, to the symbiosis that will dissipate in tiny, imperceptible ways as he grows. And it feels like he is, in these moments, reorienting himself, getting comfortable in his skin, clearer about me and my intentions.

Letting my baby pacify himself at my breast feels right to me because it feels so right to him. He has made it abundantly clear that this is his chosen method of self-soothing. He wants a pacifier that's human.

By Lu Hanessian Englewood
(From NEW BEGINNINGS, Vol. 19 No. 1, January-February 2002, p. 14)

Control on breast milk substitutes urged

An allout war against fake powdered milk has been launched across China following the deaths of 12 babies from malnutrition in Fuyang, in East China's Anhui Province.

Investigations have revealed the infants, aged between four and six months, died after being fed milk powder with little, if any, nutritional value.

As a result of consuming these products, More than 100 other infants in Fuyang are suffering from "big head disease," so-called because their heads grew abnormally large, while their torsos, arms and legs were reduced to skin and bone.

Experts say that some of these babies may suffer from further problems as they grow up.

Worst of all, is the fear that killer milk powders like this could affect tens of thousands of other infants across the country, if their existence is not discovered in time.

The incident shocked the country, where at least 13 million babies are born each year, with over one-third of them mainly being fed breast milk substitutes for the first six months of their lives.

To date, a total of 47 people have been detained in the fake milk powder incident in Fuyang, which was exposed last month. The case involves 40 enterprises spread over 10 provinces.

Breastfeeding imperative

"The deaths of the babies (in Fuyang) might have been avoided if they were breastfed," said Dai Yaohua, a senior researcher with the Beijing-based Capital Institute of Paediatrics (CIP).

An increasing body of scientific evidence, especially in recent years, indicates that breastfeeding and the use of human milk for infant feeding offer diverse and compelling advantages for infants, mother, families and society.

Epidemiologic studies have shown that human milk and breastfeeding have positive effects on growth, development and the general health of children.

For babies in developing nations, experts say that breastfeeding is even more imperative, as babies' very survival largely depends on the immune-boosting properties of mother's milk.

However, a survey found that less than 58 per cent of the infants born in 2000 were breastfed in Anhui Province, where "big head" infants were first reported.

The number of babies in China fed exclusively on breast milk during their first four months of life has declined from around 76 per cent in 1998 to only 64 per cent today.

In urban areas, maternity leave can be as long as seven and a half months for working mothers with stable incomes, meaning that they are in a position to be able to breastfeed their babies for the first few months, but nonetheless, the use of infant formula milk is on the rise.

Mothers in rural areas, however, have to give up breastfeeding within six months because more and more of them are moving to cities to work as migrant workers.

In Fuyang, many mothers were found to have gone to work in urban areas before their babies were six months old.

The babies are usually left in the care of their grandmothers, who frequently are unable to distinguish genuine from fake infant formula.

Investigations have shown that poor families, particularly in rural areas, often dilute costly formula with unclean water and mix it in unclean bottles, adding to the risk of illness among infants.

Behind the tragedy

Experts also attribute the recent tragedy to irresponsible promotion and marketing of breast milk substitutes.

"The real issue is the increasing use of breast milk substitutes in China for infant nutrition, with insufficient attention being paid to the quality of the substandard powdered milk," UNICEF authorities said in their latest report on the issue.

Last summer, Dai and other CIP experts participated in an International Baby-Food Action Network (IBFAN) project, monitoring how the International Code of Marketing of Breast milk Substitutes was observed in six major cities in China, including Beijing and Shanghai.

The code, adopted by the World Health Assembly (WHA) in 1981 and recommended to its member states, bans all advertising and promotion of breast milk substitutes to the general public.

The code applies to all products marketed as partial or total replacements for breast milk, such as infant formula, follow-up formula, special formula, cereals, juices, vegetable mixes and baby teas. It also applies to feeding bottles and nipples.

Entitled "Monitoring Code Compliance in China," the report submitted by Dai and her colleagues is trying to look into what such promotion is doing and how it has undermined breastfeeding for mothers and their infants.

And they found that relentless promotion of breast milk substitutes has affected breastfeeding patterns in China.

Infant health in China is under attack, the IBFAN report cries out, saying that "with the opening of the lucrative market, foreign companies have swarmed to the country like flies to a honey pot."

Advertising promoting breast milk substitutes, including powdered milk, for infants, although banned by the international code, can be easily found in shops, supermarkets and many of the so-called baby-friendly hospitals, which are becoming increasingly financially dependent on baby-food companies to carry out their services and activities.

Baby-friendly hospitals are identified by the Ministry of Health for better mother/baby service.
Media blitzes coupled with some hospitals' activities have given millions of Chinese parents wrong ideas about infant feeding.

"The health of following generations of the Chinese nation might be threatened if breastfeeding is replaced by milk powder," said Cao Bin, an official with the Ministry of Health.

According to Cao, the present breastfeeding rate during the first four months of life in China is much lower than the target breastfeeding rate set by the government in its "Outline Plan for Chinese Children's Development, 2001-10."

The plan specifies that the rate should reach 85 per cent across China by the end of the period.
Although there is a special regulation in China which stipulates rules for the marketing of breast milk substitutes, enforcement remains a problem.

Six governmental ministries and agencies including the Ministry of Health and the State Administration of Industry and Commerce are jointly responsible for the enforcement of the regulation.

With so many parties involved, lack of co-ordination has made it difficult to implement the Rules Governing the Administration of Marketing of Breast milk Substitutes, which embody the principles set out in the international code.

Action needed

Before the monitoring, experts were already aware of the fact that the ever-increasing promotion of breast milk substitutes posed serious problems for breastfeeding in China.

Sponsors of the monitoring programme, including the Ministry of Health and UNICEF, are seeking countermeasures to raise breastfeeding rates in China.

UNICEF says "the recent tragedy (in Fuyang) may be seen as 'a wake-up call' to the medical community, the health systems and the community at large to take action now to restore breastfeeding."

The Chinese Government was urged to take action against random promotion of breast milk substitutes and to intensify administration and supervision of health facilities.

The State Administration of Industry and Commerce, a watchdog for advertising violations, was also asked to participate in the action.

Experts also urged health authorities to re-assess the qualifications of baby-friendly hospitals.
IBFAN hopes to extend surveillance of code compliance to all hospitals that deal with babies, especially paediatric hospitals, where such products are aggressively promoted.

The government, IBFAN suggested, should conduct continuous and systematic monitoring to determine the effectiveness of regulations concerning the promotion of breast-feeding substitutes, which will facilitate the review of the existing law and policies affecting the feeding of infants and young children.

[Taken from www.chinadaily.com.cn]

Follow-on formulas: Why they are Unnecessary

Follow-on milks - milks for older babies which often share the same brand name as infant formulas - were invented by companies following the adoption of the 1981 International Code of Marketing of Breastmilk Substitutes, in a cynical strategy to get round the Code's restrictions. Follow-on milks are not suitable for young babies yet they are aggressively promoted with TV and media advertising, discounts, prizes and health claims. This causes confusion and tempts parents to use them instead of carrying on breastfeeding or using infant formula.

In 1985 there was an outcry from UK health professionals who noticed that very young babies were being fed on these milks. They feared a return to the days when hypernatraemia was common when all baby milks had high solute loads - like these new milks. European parliamentarians questioned the scientific basis for follow-on milks, calling them 'extremely dubious.' In 1986 World Health Assembly Resolution (WHA Res 39.28) described them as ‘not necessary.' Despite these concerns companies succeeded in establishing them, first with a Codex Standard in 1987 and then with the European Directives - with no limits on their promotion.

Companies push follow-on milks with the claim that it provides the extra iron older infants need. Iron is of course important for infants, but it is risky to add too much to milk. Ideally babies should carry on breastfeeding or using infant formula, taking in the extra iron from food. The claims used for follow-on milks have yet to be proven and much of the research (funded by industry) compares the formulas to cow's milk rather than infant formula. Follow-on milks can also legally contain higher amounts of sucrose, glucose and other non-milk sugars, and when bottle-fed can increase the risk of dental caries and other problems in older babies. Aware of the risks, some European scientists are urging caution, recommending that the composition of follow-on milks is brought closer to infant formulas. The nutritional need for follow-on milks remains a mystery. The commercial advantage is clear.

The International Code, adopted by the World Health Assembly in 1981, prohibits the promotion of all breastmilk substitutes and "any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose." Subsequent WHA Resolutions describe follow-on milks as ‘not necessary' and recommend that infants be exclusively breastfed for 6 months with continued breastfeeding for up to 2 years of age or beyond. Follow on milks replace that part of the child’s diet best provided by breastmilk and are, therefore, breastmilk substitutes.

Follow-on milks are not necessary and should not be promoted. Labelling should avoid any risk of confusion between infant formulas and follow-on formulas and follow-on milks should not carry any idealised pictures, symbols or text or imply that the product is suitable for use at an inappropriate age.

[Taken from babymilkaction.org website]

The Cosiness of Co sleeping

By Dr Sarah Buckley

Imagine this. Your baby is two weeks old, and you have finally settled her to sleep for the night in her cot, in the newly painted nursery next to your room. You are awakened from a short, but deep, sleep, by distressed crying, and you stagger out of bed. You turn on the lamp and pick up her up. She is red-faced and too loud for that time of the morning, and her crying has awoken your partner, who you can hear sighing loudly next door.

After a few minutes, you calm her and persuade her to breastfeed. After some time, just as you are about to nod off yourself, she falls off the breast contentedly. Slowly and carefully- you are more awake now, appreciating the delicacy of this manoeuvre- you slide her into the cot. Only two steps away from the door, and she whimpers. As you turn the door handle, she cries softly, and then increasingly loudly. Your partner, angel that he is, comes in bleary eyed and offers to walk the corridor with her, which he does for 15 minutes before putting her gently back in her cot.

“Welcome to parenthood”, your friends say, but you can’t accept that, or the bone-aching tiredness. Then one day, you discover that you can actually feed her lying down. The next day, as you feel her nestling up against you on the sofa, you begin to wonder if you could feed her like this in bed at night. Your partner is sceptical, and you don’t tell anyone else. After a few nights, you realise that, if your baby starts the night with you, you don’t actually need to get out of bed at all. Your partner is pleased to be hardly disturbed, because you attend to her before she cries, and you feel decidedly brighter in the morning too.

Congratulations. You have rediscovered co-sleeping.

For the millions of years of our human evolution, mothers have slept with their babies; it is what we are adapted for, physiologically, hormonally and emotionally. The warmth of our bodies, our vigilance even in deep sleep (actually, a breastfeeding, co-sleeping mother spends less time in deep sleep) the easy access to our breast and the synchronising of sleep cycles all provide an optimal night-time environment for our babies.

These benefits are confirmed by the elegant research done by James McKenna, Professor of Anthropology at University of Notre Dame, Indiana, US and his colleagues, (McKenna, J., Mosko, S 1990) who invited 35 mother-baby pairs into a sleep research laboratory, and monitored overnight their sleep patterns as they slept together or in separate rooms. They found that, not only did co-sleeping pairs get into the same sleep cycles, but that babies who co-slept experienced more frequent “arousals”, triggered by the mother’s movements, and spent less time in deep sleep.

As a researcher in SIDS, Prof McKenna believes that these low-level arousals, which did not actually awaken either partner, give the baby practice in arousing itself, and may lessen a baby’s susceptibility to some forms of SIDS which are thought to be caused when a baby fails to arouse from deep sleep to re-establish breathing patterns. (McKenna, J., Bernshaw, N. 1995)

Professor McKenna speculates our young are not developmentally prepared to “sleep through” in a solitary bed, involving, as this does, long periods of deep sleep. (McKenna, J., Bernshaw, N. 1995)

Videos taken during the study showed that co-sleeping mothers, even in deep sleep, seemed aware of their baby’s position, and moved when necessary to avoid over-laying. At no time in the study did co-sleeping mothers impede the breathing of their babies, who had higher average oxygen levels than solitary sleepers.

Although there is no direct evidence to prove Professor McKenna’s theories, some of the lowest rates of SIDS are found amongst cultures where co-sleeping is predominant. (McKenna, J., Bernshaw, N. 1995)

In fact, on a word-wide basis, co-sleeping is very much the norm. (Small, 1998) Even in western cultures, bed sharing between mother and nursing baby (usually up to two) was standard practice up until around 150 years ago. Older children would co-sleep with siblings, with a member of the extended family or, for the upper classes, with a servant or nursemaid. (Thevenin, 1996)

The 1800s saw the rise of the child-rearing expert- usually male- who emphasised self-reliance from an early age, with strict guidelines for breastfeeding, toilet training and sleep. Newborns were expected to sleep with their mother, but they were to be removed to an unshared room before the age of one. (Thevenin, 1996)

With the industrial revolution in the late 1800s, the extended family began to splinter. Mother became solely responsible for the house and children, and the need for children who required little of her time became paramount. The rise of the germ theory, where the populace was warned not to breathe the air of another, led to a further emphasis on separate sleeping. (Thevenin, 1996)

Later this century, smaller and increasingly affluent families began to build houses with separate sleeping quarters so that each child could sleep alone. The myth arose that “cot-death” was caused by mothers over-laying and smothering their babies, which further frightened mothers away from co-sleeping. (Thevenin, 1996)

Thankfully, there has been a recent turn-around, and many parents feel more comfortable about sleeping with their babies. Books such as Tine Thevenin’s classic, The Family Bed (Avery, 1993), have helped to dispel some of the myths around co-sleeping. The most stubborn concern, that of safety, has also been addressed, with recent western studies showing that co-sleeping does not increase SIDS risk unless co-sleeping parents smoke or use alcohol or drugs (National SIDS Council, 1997).

However, our soft western bedding may offer more hazards than that of other cultures. Co-sleeping parents need to ensure that their baby’s face or head does not become covered by bedding (pillows or quilts can cause problems), that the baby cannot sink into an overly soft mattress -water beds are not recommended- and that the baby does not become entrapped, especially in a face-down position. (AAP 1997, National SIDS Council, 1997))

Co-sleeping is safe, satisfying and pleasurable; and its fun to wake up to a cute smile in the mornings. Co-sleeping does not guarantee a full nights sleep- in fact, in McKenna’s studies, co-sleeping babies fed more often, (although the mothers usually underestimated this)- but, in my experience, waking several times from light sleep is less tiring than the panic and disruption of being woken from deep sleep.

Personally, I have also particularly enjoyed the nighttime intimacy with my second and third babies, for whom day times are shared with siblings. Perhaps I have also relaxed, and stopped counting the night wakings, knowing that it passes in its own time and that satisfying my baby’s needs is an investment, which pays rich dividends.

Milk, Money, and Madness

"An appreciation of breastfeeding leads to an appreciation of the breast itself, a gland composed largely of fatty tissue. Unfortunately, too often it is seen as an object of sexual desire rather than as a fountain of utilitarian magnificence. The lack of appreciation for the breast reflects a lack of appreciation of the female as a person. When the fluid responsible for sustaining human life is seen as essentially identical to a canned powder produced in a factory, it is easy to see how the appreciation of the breast (and with it, the female body) has been lost."

- Baumslag and Michels

Breastfeeding in the Bible

Psalm 8:2 (English-KJV)
Out of the mouth of babes and sucklings hast thou ordained strength because of thine enemies, that thou mightest still the enemy and the avenger.

Genesis 49:25 (English-NIV)
Even by the God of thy father, who shall help thee; and by the Almighty, who shall bless thee with blessings of heaven above, blessings of the deep that lieth under, blessings of the breasts, and of the womb:

I Samuel 1:21-23 (English-NIV)
When the man Elkanah went up with all his family to offer the annual sacrifice to the Lord and to fulfill his vow, Hannah did not go. She said to her husband, "After the boy is weaned, I will take him and present him before the Lord, and he will live there always." "Do what seems best to you," Elkanah her husband told her. "Stay here until you have weaned him; only may the Lord make good his word." So the woman stayed at home and nursed her son until she had weaned him.

Joel 2:15-16 (English-NIV)
Blow the trumpet in Zion, declare a holy fast, call a sacred assembly. Gather the people, consecrate the assembly; bring together the elders, gather the children, those nursing at the breast. Let the bridegroom leave his room and the bride her chamber.

Psalms 22:9 (English-NIV)
Yet you brought me out of the womb; you made me trust in you even at my mother's breast.

1 Thessalonians 2:7 (English-NASB)
But we proved to be gentle among you, as a nursing mother tenderly cares for her own children.

1 Peter 2:1-3 (English-KJV)
Wherefore laying aside all malice, and all guile, and hypocrisies, and envies, all evil speakings, As newborn babes, desire the sincere milk of the word, that ye may grow thereby: If so be ye have tasted that the Lord is gracious.

Isaiah 66:10-13 (English-NIV)
"Rejoice with Jerusalem and be glad for her, all you who love her; rejoice greatly with her, all you who mourn over her. For you will nurse and be satisfied at her comforting breasts; you will drink deeply and delight in her overflowing abundance." For this is what the LORD says: "I will extend peace to her like a river, and the wealth of nations like a flooding stream; you will nurse and be carried on her arm and dandled on her knees. As a mother comforts her child, so will I comfort you; and you will be comforted over Jerusalem."

Isaiah 60:15,16 (English-NIV)
"Although you have been forsaken and hated, with no one traveling through, I will make you the everlasting pride and the joy of all generations. You will drink the milk of nations and be nursed at royal breasts. Then you will know that I, the LORD, am your Savior, your Redeemer, the Mighty One of Jacob.

Isaiah 49:15, 16 (English-KJV)
Can a woman forget her sucking child, that she should not have compassion on the son of her womb? yea, they may forget, yet will I not forget thee. Behold, I have graven thee upon the palms of my hands; thy walls are continually before me.

Exodus 2:1-10 (English-NIV)
(God wonderfully spared Moses' life, and He made a way for Moses' mother to breastfeed him. They were able to share that special time together before Moses had to go live with Pharaoh's daughter.)

Now a man of the house of Levi married a Levite woman, and she became pregnant and gave birth to a son. When she saw that he was a fine child, she hid him for three months. But when she could hide him no longer, she got a papyrus basket for him and coated it with tar and pitch. Then she placed the child in it and put it among the reeds along the bank of the Nile. His sister stood at a distance to see what would happen to him. Then Pharaoh's daughter went down to the Nile to bathe, and her attendants were walking along the river bank. She saw the basket among the reeds and sent her slave girl to get it. She opened it and saw the baby. He was crying, and she felt sorry for him. "This is one of the Hebrew babies," she said. Then his sister asked Pharaoh's daughter, "Shall I go and get one of the Hebrew women to nurse the baby for you?" "Yes, go," she answered. And the girl went and got the baby's mother. Pharaoh's daughter said to her, "Take this baby and nurse him for me, and I will pay you." So the woman took the baby and nursed him. When the child grew older, she took him to Pharaoh's daughter and he became her son. She named him Moses, saying, "I drew him out of the water."

Luke 11:27, 28 (NASB)
(It's kind of interesting to note that apparently breastfeeding was not a topic about which one needed to keep quiet. The lady in this passage raised her voice in the crowd!)

While Jesus was saying these things, one of the women in the crowd raised her voice and said to Him, "Blessed is the womb that bore You and the breasts at which You nursed." But He said, "On the contrary, blessed are those who hear the word of God and observe it."

Support Aamir Raza!

http://www.supportaamirraza.org/Default.htm

This website was created to support Syed Aamir Raza Hussain in his quest to be accepted as a permanent resident in Canada. After denouncing the marketing practices of Nestlé Milkpak Ltd in Pakistan, Aamir received several threats and he is no longer safe in his country. Such marketing practices violate the International Code of Marketing of Breastmilk Substitutes, as they undermine breastfeeding. The Code has been endorsed by Canada as well as by over 160 countries at the World Health Assembly. UNICEF has stated: "Marketing practices that undermine breastfeeding are potentially hazardous wherever they are pursued: in the developing world, WHO estimates that some 1.5 million children die each year because they are not adequately breastfed. These facts are not in dispute."

Aamir came to Canada in 2000 and applied for refugee status soon after his arrival. His application was rejected in 2001. He has now been in Canada for four years and has been trying to obtain permanent resident status for the past three. He has not seen his wife and two children (now 6 and 10) since he left Pakistan.

He was unable to attend the funeral of his mother (Sept 2003) nor of his father (Dec 2003). Since the first year of his arrival in Canada, Aamir has been working nearly 60 hours a week to meet his needs and those of his family. Several prominent groups and experts in infant health across the country have told Minister of Citizenship and Immigration Judy Sgro, and her department, that the case of Aamir clearly deserves our full support. If he is sent back to Pakistan, he and his family will be punished for his courage and honesty in defending the interests of mothers and children, and this in keeping with the Convention on the Rights of the Child. Because he is a Shiite, further persecution could ensue. Increased public support for Aamir could help resolve his case with Citizenship and Immigration Canada. Please sign the petition (letter) to the Honorable Judy Sgro, Minister of Citizenship and Immigration, in support of Aamir. A copy will be sent to Citizenship and Immigration.

Blogger's note: If you want to see a heart-wrenching picture of what bottle feeding does to babies in developing countries, I encourage you to visit this website and click on "Aamir's Story"...

How Breastfeeding is Undermined

1. Promotion using free supplies

2. Inappropriate language

3. Using "humanitarian aid" to create markets

4. Labels which undermine breastfeeding

5. Promotion to mothers and pregnant women

6. Promotion to health professionals

7. Undermining implementation of the International Code

For more information, please see http://www.ibfan.org/english/issue/bfundermined01.html

Nestle makes PR blunder in Ethiopia

Infant formula milk push

The whole Nestle mess has two main roots. The first is its aggressive promotion of infant formula milk in developing countries, like Ethiopia, at the expense of breast milk. This has been in defiance of the World Health Organization (WHO) which advocates exclusive breastfeeding for the first four to six months if possible and which, in 1981, passed an International Code of Marketing of Breastmilk Substitutes to protect against unscrupulous encouragement to bottlefeed.

Milk substitutes need to be made up with water. So, wherever there is water of dubious quality — abundant in third world countries where poor hygiene and poor water supply are common — there are huge risks of introducing virulent water-borne diseases to babies from bottled formula milk.

Dr Raj Anand, trained in medical college in Britain and now one of India's top pediatricians, says babies fed on infant formula are 14 times more likely to die from diarrhoea than those who are breastfed. He has waged a decades-long campaign against Nestle for paying incentives to Indian general practitioners to recommend Nestle baby milk powder to new or expectant mothers rather than breast milk.

Around the world, the case against Nestle since 1979 is that the company has systematically and cynically undermined the WHO's and many other organizations' promotion of breastfeeding. Nestle was sending — and in some countries still does — its salesmen into maternity units in poor countries dressed in white doctors' lab coats to give a false impression of authority. They were handing out gift packs of bottles and milk powder to new mothers, thereby undermining their commitment to breastfeeding.

"When newborn babies are given a bottle, they are less able to suckle well," said James Grant, executive officer of the United Nations Children's Fund (UNICEF). "This makes breastfeeding failure likely, and the baby is then dependent on artificial milk.

"When the mother and baby leave hospital the milk is no longer free. At home parents are forced to buy more Nestle or other formula milk, which can cost 50% of the family income. Because the milk is so expensive the child is not fed enough and malnutrition and associated diseases set in. Contaminated water mixed with the formula leads to diarrhoea, malnutrition and death."

UNICEF estimates 1.5 million babies will die this year from unsafe bottle feeding. "Every day some 3,000 to 4,000 infants die because they are denied access to adequate breast milk," said Grant.

From an article by Fred Brigland in Japan Today (24 Dec 2002)