The issue has become a hot topic after it was revealed that 18 of New Zealand's district health boards require mothers to sign consent forms to formula-feed their babies in hospitals.
Now, the US-based Fed is Best Foundation has voiced its objections, saying mothers should not be pressured to breastfeed, and that those who cannot produce sufficient milk but give in to such pressure could unintentionally cause their babies developmental problems or even death.
The non-profit foundation — which has a presence in the US, Canada, the UK, Australia, NZ, Ghana, Nigeria, the Philippines, Brazil, Spain, India and Pakistan — was founded by physician Dr Christie del Castillo-Hegyi, who specialises in research on newborn brain injury and breastfeeding complications.
In New Zealand, the push for all mothers to breastfeed their infants has been spurred largely by the Baby-Friendly Hospital Initiative (BFHI), launched by UNICEF and the WHO in 1991.
All maternity services in the country are required to have BFHI accreditation at all times, to “protect, promote and support exclusive breastfeeding from birth”.
BFHI-accredited hospitals must refuse free or low-cost breast milk substitutes in order to discourage infrequent breastfeeding, which may in turn cause a woman to produce less milk.
The New Zealand Breastfeeding Alliance (NZBA) voiced its support for the consent forms. According to learning and development facilitator Dianne Powley, they are necessary in light of potential risks to help mothers make an informed decision when requesting formula.
She justified her stance by citing past incidents, whereby babies had been fed formula milk without their parents’ knowledge.
Fed is Best, however, has harshly criticised the practice of making mothers sign consent forms to formula-feed their own infants.
Del Castillo-Hegyi told NutraIngredients-Asia: “These consent forms leave out major information about the risks of exclusive breastfeeding in the first days of life, namely high dehydration risk, excessive weight loss, hyperbilirubinemia and hypoglycaemia, all of which are starvation-related complications that cause brain injury and long-term disability.
“These have been known risks of exclusive breastfeeding that have hospitalised millions of babies since the publication of the BFHI. In fact, pre-BFHI breastfeeding data shows that breastfeeding mothers all around the world supplemented in the first days of life to prevent these complications.”
Breast is not always best
Fed is Best has been accused of ‘fear-mongering’ and oversimplification; Isis McKay, maternal and child health manager at NZ charity Woman’s Health Action, said their “oversimplifying the message isn’t helping anyone”.
But del Castillo-Hegyi, who founded Fed is Best after her son fell gravely ill in his first week of life, is convinced otherwise.
She said she “read all the books and took all the classes” she could on breastfeeding in preparation for her first child’s arrival.
While she initially managed to breastfeed her newborn son without any issue, he soon became jaundiced and would cry incessantly after being fed. He then lost 15% of his body weight in three days and was hospitalised with hypernatremia, a severe form of dehydration.
It turned out that del Castillo-Hegyi had not expressed any milk during her son’s sudden weight loss, and at four, he was diagnosed with multiple developmental and neurological disabilities.
She attributed her son’s condition to starvation caused by her insufficient milk production, and when she gave birth to twin daughters later on, she chose to feed them formula to avoid a repeat of his plight.
Discuss and destigmatize
Del Castillo-Hegyi said Fed is Best wants to encourage mothers to openly discuss the issues they face when it comes to breastfeeding, in order to remove the stigma surrounding mixed and formula-feeding.
Several NZ mothers recently revealed to local media the problems they’d faced trying to breastfeed their newborns, including insufficient milk production and postnatal depression stemming from it.
Furthermore, many mothers said their decision to mix- or formula-feed their children invited “judgment and stigma”.
“They’re told it’s their fault, they did it incorrectly, they didn’t try hard enough or weren’t given enough support — when it’s a matter of biology,” said del Castillo-Hegyi.
She revealed that Fed is Best volunteers to screen potential members before deciding if they should be admitted to the foundation’s parent support group.
“We have had problems with people who wanted to share private information from the group with others for the purpose of shaming them. We forbid shaming and support every kind of feeding. We respect and believe a mother’s ability to feed, her intelligence and her choice.”
And it’s not just mothers who have been criticised for formula-feeding their babies.
In 2012, pro-breastfeeding campaigners complained about a two-second cutaway in an anti-smoking commercial featuring former All Black Piri Weepu bottle-feeding his daughter; the shot was subsequently cut from the ad.
Only one option?
International organisations like UNICEF and the WHO maintain strongly that babies should be fed only breast milk for the first six months of their lives.
In fact, UNICEF Pakistan’s nutrition chief recently went as far as to liken formula manufacturers to tobacco companies, in favour of promoting breastfeeding.
Fed is Best hopes to change that. Del Castillo-Hegyi told us: “We hope to pass legislation that protects the patient’s right to full disclosure of the risks and benefits of every feeding choice.
“We hope to protect the human right of a newborn to supplemental milk, the same way they are currently protected by the United Nations Declaration of Human Rights.”
She added that the foundation wants to extend its campaign to hospitals, insurance firms, major health organisations and governments, in order to push for legislation that protects parent and infant rights “to know about the risks of insufficient feeding”, as well as to “protect health professionals who offer supplementation to relieve hunger and prevent feeding complications”.