WHO Code training in Toronto

IBFAN's International Code Document Centre
experts talk about historical efforts to
curb deadly infant formula marketing,
and how it lead to the WHO/UNICEF
move to create the
International Code of Marketing
of Breastmilk Subsittudes

I have just completed a three day training workshop on how to monitor for violations of the International Code of Marketing of Breastmilk Substitutes. I plan to blog in more detail shortly. For now, please take a look at the daily summaries of the live-tweets from the workshop (and follow #WHOCode and #nonestle on Twitter for ongoing updates on Code issues and actions.) If you are interested in a little more of history of how the Code was created, see this YouTube excerpt of the 1984 BBC film, "When Breasts are Bad for Business."

Health Canada still warns against milksharing, families still share milk through HM4HB

CBC's Windsor, Ontario outlet has a feature interview and web article today on families who donate or receive milk through the Human Milk 4 Human Babies Southwest Ontario Facebook page. 

CBC Windsor website, March 15, 2013

CBC reports Health Canada has reiterated its years-old alert which was originally issued to warn Canadians about the dangers of purchasing human milk from strangers on Craigslist. 

Families are increasingly ignoring Health Canada's warning, and similar warnings from the US, France, and other authorities about the possible risks of milksharing. HM4HB networks across Canada are facilitating thousands of what they call "milky matches" between families in need and mothers with excess. When breastfeeding advocates started to move away from simply echoing infant formula company's "breast is best" messaging, and started to talk instead about the risks of infant formula, they provided the fuel for families to think hard about to donor milk as a possibly less risky option when breastfeeding fails.

Offers and asks, HM4HB Vancouver

Milksharing advocates responded to the warning in 2010: 

If Health Canada is to recommend anything to Canadian women about the practice of sharing milk, which is a food, please recommend evidence-based procedures for them to follow for the safe sharing of human milk. 

A growing number of people talking about the need for guidance for milksharing families, not warnings. Australia's Dr. Karleen Gribble wants health authorities to move away from proscription. Gribble says it's unethical for health authorities to provide warnings instead of guidance, and I agree (see my blog post of January 2012.) During World Milksharing Week 2012 several lactation consultants and peer counsellors also wrote about the need for guidance and advice.

In addition to the explosion in milksharing, more of Canada's sick, hospitalized babies are also finally receiving donor human through milk banks in Calgary and Toronto. And the availability of milk for the sickest premature babies in hospital is causing families to ask why this need isn't also being met in the community. At the same time, milk banks are concerned the practice of milksharing may be eroding their donor supply.

From the CBC interview:

“Women are just trying to help each other out,” said Margaret Deneau, who owns Sweetheart Baby Boutique in Windsor. “I think it’s wonderful that there is a place for you to get milk for your baby if you can’t produce it yourself.

“It makes me sad it has to be done privately. It would be nice if the region provided it and the moms didn’t have to go underground to do it.”

Over the last few years Canada's paediatricians and Health Canada have begun work on a loose policy framework that acknowledges donor human milk's value both in the NICU and in the community.

Health Canada's new Nutrition for Healthy Term Infants guidelines, produced jointly with the Canadian Paediatric Society, Dieticians of Canada, and the Breastfeeding Committee for Canada, says (and note this is for healthy infants from zero to six months):

For infants who cannot or should not be fed their mother's breastmilk, pasteurised human milk from appropriately screened donors and commercial infant formula are suitable alternatives. These options depend on individual circumstances.

The Canadian Pediatric Society 's position paper on donor human milk says:

When the mother’s own milk is unavailable for the sick, hospitalized newborn, pasteurized human donor breast milk should be made available as an alternative feeding choice followed by commercial formula. 

Health Canada goes on to say: 

Breastmilk from appropriately screened donors must be properly collected, pasteurized, and stored. The only way to ensure this is to obtain the breastmilk from a milk bank that is operated under the Human Milk Bank Association of North America Guidelines.  

And Health Canada echoes the Canadian Paediatric Society's concern that if there isn't enough human milk for the human babies who need it, priority must be given to the most fragile babies in the system.

Hospitalised infants who will get the most benefit have highest priority for this milk.

Instead of warning families away something they're clearly going to do anyway, Canada can take a leadership role by strenghening both this policy framework and our support systems for the use of donor human milk. We must respond to growing demand from families for donor human milk instead of infant formula when mother's own milk isn't available. What can be done?:

• We can step up our efforts to ensure mothers who want to breastfeed are properly supported in hospital and in the community, reducing the need for supplementing and increasing our supply of potential donors.

• We can formally endorse milk banks and give them access to funding and resources to both better attract donors and to offset the financial costs of milk donation. (Breast pumps and collection bottles are expensive, and so is shipping and maintaining drop-off depots.) 

• We can review milk bank screening and processing guidelines to ensure we are not being overly restrictive (for example due to lingering BSE concerns we still don't allow donors who have spent time in the UK - yet those moms could donate to UK milk banks.)

• Processing and pasteurizing donor human milk is expensive but cost-effective for premature babies who can become ill or die, racking up tens of thousands in treatment costs along the way. But healthy babies may not need highly processed milk. Canada can explore the use of unpastuerized milk from screened mothers when healthy babies have a medical need to be supplemented, both in hospital and in the community. 

• We can create evidence-based guidelines for the safer peer-to-peer sharing of milk in the community.

Does human milk protect against allergies?

CTV News Edmonton is one of many outlets
covering this important story - Google News

Really important research into the health of a baby's gut is being done in Canada - indeed, right here in my home town of Edmonton!

Faculty of Medicine researcher Anita Kozyrskyj and her colleagues have published a study in the Canadian Medical Association Journal, the first of its kind in North America, showing common interventions at birth like c-section or the feeding of breast milk substitutes changes the nature of the bacteria in an infant's gut.

Confirming this is the first step to unlocking the puzzle of children's allergies.

The U of A's write-up on the article includes these comments from Kozyrskyj and post-doctoral student Meghan Azad:

“We want parents to realize that the decisions they make regarding C-sections and breastfeeding can affect the infants’ gut bacteria—and that can have potentially lifelong effects on their children.”  - Azad

"The initial step for us was to report on the changes to the gut bacteria based on interventiosn like C-section delivery or formula feeding. Our next step is to answer the question, 'Does this bacteria footprint make a difference in terms of child health?’ We will look for conditions like kids’ wheeze, allergies, and whether they were affected by gut bacteria changes associated with breastfeeding and C-section.” - Kozyrskyj 

Of note is the declaration of funding found in the full research paper:  "This research was funded by the Canadian Institutes of Health Research (grant nos. 85761 and 227312), and was supported by AllerGen NCE, the Killam Trusts and Alberta Innovates — Health Solutions."

Of course, many women do not choose c-section, and they do not choose to have their babies supplemented with infant formula - these are interventions some women feel are forced on them with little regard and often no discussion of possible negative health impacts. The c-section rate in Canada has risen to above 25 per cent in the last two decades - more than one in four babies are born by c-section now! And although upwards of 90 per cent of new mothers say they want to breastfeed, a recent McMaster study found only two-thirds of babies were still exclusively breastfed at discharge. Exclusive breastfeeding is being sabotaged before mom even leaves the hospital! It's no wonder fewer than one in four are still exclusively breastfeeding at six months.

We need more research like this, and we especially need more research that isn't tainted by corporate interests.

-- Jodine Chase
February, 2012

Link to full PDF in CMAJ

Kudos to the Mothers' Milk Bank at Austin for the launch of their new YouTube Channel!

 "Live Saving Milk, Mom and Baby Give Back, Together"