The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers’ infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital.

Funding received from breastmilk substitute manufacturers and policy positions of national maternity care provider associations: an online cross-sectional review

ObjectivesMaternity care providers play an essential role in supporting women to breast feed. It is critical that their professional associations limit influence from breastmilk substitute (BMS) manufacturers. Aims of this study were (i) to examine whether maternity care provider associations had policy or positions statements addressing BMS marketing and (ii) to explore the type of funding received by these associations.DesignAn online cross-sectional review.SettingNational or regional maternity provider professional associations in Australia, New Zealand, the USA, Canada and the UK.ParticipantsTwenty-eight maternity care provider (obstetricians, midwives, nurses and others involved in perinatal care) professional association websites.InterventionsWebsites were examined from November 2019 to October 2020.Primary and secondary outcome measuresEvidence of BMS industry funding and policy or position statements addressing acceptance of funding from industries such as BMS.ResultsPolicies addressing the BMS industry were found for 14 associations (50%). UK-based associations (5/5, 100%) and perinatal associations (4/6, 67%) were most likely to have a policy. Six associations (6/28, 21%) received some form of BMS financial support. The highest rates of BMS support were seen in the form of event advertising (5/28, 18%); closely followed by event sponsorship (4/28, 14%). At a provider level, obstetric associations had the highest rates of BMS support (2/4, 50%). At a country level, US-based associations were most likely to receive BMS support (3/7, 43%).ConclusionsBMS industry financial support was received by one-fifth of maternity care provider associations. Half of these associations had policies addressing BMS marketing. BMS industry support can create conflicts of interest that can threaten efforts to support, protect and promote breast feeding. Healthcare provider associations should avoid BMS funding and at a minimum have policy or position statements addressing BMS marketing.

Breastmilk or infant formula? Content analysis of infant feeding advice on breastmilk substitute manufacturer websites

Objective: To evaluate messages about infant feeding on breastmilk substitute (BMS) manufacturer websites directed at US caregivers and compare information and portrayals of breast-feeding/breastmilk with that of infant formula (IF) feeding. Design: We conducted a content analysis of US BMS companies’ websites. A codebook was created through an iterative process to identify messages and images about breast-feeding/breastmilk and IF feeding, including benefits or issues associated with each, and direct-to-consumer marketing practices that could discourage breast-feeding. Setting: Data were collected in 2019–2020 and analysed in 2020–2021 for US websites of five IF manufacturers. Participants: The websites of Similac, Enfamil and Gerber, which collectively represent approximately 98 % of the US IF market, and two US organic brands, Earth’s Best and Happy Baby. Results: Websites contained more messages about breast-feeding/breastmilk than IF but were significantly more likely to mention benefits to baby of IF (44 %) than breast-feeding/breastmilk (<26 %), including significantly more statements that IF provides brain, neural and gastrointestinal benefits; 40 % of breast-feeding/breastmilk content was dedicated to breast-feeding problems (e.g. sore nipples). Twice as many screenshots compared IF brands favourably to breastmilk than as superior to other brands. Certain companies displayed images indicating ease of IF feeding and difficulty of breast-feeding. Conclusions: Substantial messaging on BMS manufacturer websites encouraged IF feeding and discouraged breast-feeding. Health professionals should discourage their patients from visiting these websites and the US government should regulate misleading claims. Companies should refrain from providing breast-feeding advice and align their US marketing with the International Code of Marketing of Breast-milk Substitutes.

Why make fake breastmilk?

There are efforts underway to make “breastmilk” called Biomilq through cell culture, “to produce cultured human breastmilk using patent-pending technology in order to offer families a more nutritious and more sustainable option for feeding babies.” However, Biomilq advocates have not explained their claims that the product would be better for infants’ health or for the environment. Their claim that the product would be breastmilk and not a breastmilk substitute is not convincing. They argue that until now women who cannot or choose not to breastfeed have no alternative but to feed with infant formula, but they ignore options such as mothers expressing their own milk or using wet-nurses. They do not mention the possibility of feeding with pasteurized human milk from other women, obtained through a human milk bank. The prospects for Biomilq do not look promising.

Perspective of Soy Formula and Fiber intake among Non-Cow’s Milk Drinker Pediatric Patients; A Survey among Indonesian Health Care Practitioners

Indonesia is one of the highest countries for soy-based product consumption, which the usage also started from early age as breastmilk substitute product, although local regulation and guideline stated that soy-based formula recommended for cow’s milk protein allergy. However, evidences showed that soy-based formula supplemented with fiber in non-cow’s milk drinker could also have health effect to gastrointestinal system. This online survey aimed to explore the perspective of health care practitioners (HCPs) in recommending soy-based formula for non-cow’s milk drinker pediatric patients, as well as identify the required additional ingredient or supplementation, specifically on fiber, in soy-based formula. Majority of respondents (97% of paediatricians (P < 0.001)), (96% of nurses (P = 0.003)), (99% of midwives (P < 0.001)) recommended soy-based formula as nutritional product toward non-cow’s milk drinker patients. On the added ingredients required, 43% of respondents mentioned that AA and DHA and 31% mentioned that fibre is the ingredient that need to be added to complete the benefits of soy formula. This study concluded that the overall perspective of HCPs showed that soy-based formula is a nutritional product recommended for non-cow’s milk pediatric patients. However, fiber is required to be added to achieve the potential benefits of soy-based formula.

Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study

ABSTRACT Background In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs). Objective This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs. Methods We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0–5 mo, and for continued breastfeeding at ages 12–15 mo through graphical presentation of coverage wealth quintiles. Results Between-country analyses showed that log GDP was inversely correlated with exclusive (r = −0.37, P &lt; 0.001) and continued breastfeeding (r = −0.74, P &lt; 0.0001), and was positively correlated with formula intake (r = 0.70, P &lt; 0.0001). Continued breastfeeding was inversely correlated with formula (r = −0.79, P &lt; 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = −0.40, P &lt; 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries. Conclusions BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.