see also new Policy Blog: http://info.babymilkaction.org/node/326
WHO breastfeeding recommendations under attack from industry-funded scientists
Press release 14 January 2011
The BBC, the Guardian, The Times, The Sun and other media are carrying stories - about a comment piece from four authors published in the British Medical Journal today challenging World Health Organisation (WHO) recommendation that breastfeeding is exclusive for 6 months (no other foods or drinks introduced). The media coverage implies that the challenge is based on new evidence. In fact this is not a new scientific study nor a systematic review, but the authors review of selected past research, published in the 'Analysis' section of the BMJ.
Three of the four authors of the piece, Mary Fewtrell, Alan Lucas and David Wilson, receive funding from the baby food industry. The baby food industry marketing strategy is to encourage parents to move onto processed foods, rather than family foods, and promoting their introduction before 6 months generally requires feeding purees and paps, which parents are less likely to home prepare. The risks of early introduction of complementary foods have been known for many years, with the World Health Assembly adopting a Resolution in 1994 saying that complementary feeding should be fostered from 6 months (rather than 4-6 months).
Prof Lucas in particular plays a key role in advising the UK baby food industry, and has opposed the WHO recommendation for many years. In 2003 he went so far as to appear for the defence when one of the largest baby food companies, SMA Wyeth was successfully prosecuted for illegal advertising by Trading Standards. (for links to previous articles about Prof Lucas see below.
Professor Mary Renfrew, Director of the Mother and Infant Research Unit, University of York says: "this is not a report of a systematic review, but a critique of literature the authors have chosen to examine. No methodological details are given either of how they decided to include studies, or how they critiqued them in terms of appropriateness and quality."
Baby Milk Action expects this comment piece and the media coverage it is generating (see below) to be used by companies in their attempt to weaken national policies and legislation requiring complementary foods to be labelled for use from 6 months. In the UK, baby food companies are already labelling complementary foods for use from 4 months of age despite Government policy recommending 6 months exclusive breastfeeding or formula feeding.
There are more general concerns over processed foods as the industry has for years resisted moves to market them responsibly, improve labelling and reduce sugar levels (see below).
Some media reports incorrectly imply that it is the 'breast is best' message that is being challenged, but the authors have not suggested that breastfeeding should stop when complementary foods are introduced.
When looking at the authors' comment piece, the following points should be borne in mind:
- The four authors are not attacking the recommendation that breastfeeding continue alongside complementary foods or the WHO recommendation of breastfeeding into the second year of life and beyond. Baby Milk Action is concerned about misreporting of the paper, with headlines such as, "Breastfeeding 'not always best'" or "Recommendation to breastfeed for 6 months challenged". Please post examples as comments to this articles, with links if possible.
- This is not a new scientific study - it is a review of existing research selected by the authors and has been published in the 'Comment' section of the BMJ.
- WHO’s policy arose from a systematic review of 3,000 studies on infant feeding. See The optimal duration of exclusive breastfeeding and Guiding principles for complementary feeding of the breastfed child. WHO has issued a statement today (14 January 2011 - see below) pointing out that the evidence had been reviewed in 2009.
- Keeping recommendations under review is good practice and randomised controlled trials are also in progress; the four authors are pre-empting the results of these and do not refer to the 2009 review published by the Cochrane Library.
- In 1994, the World Health Assembly adopted Resolution 47.5 calling for: "fostering appropriate complementary feeding practices from the age of about six months, emphasizing continued breast-feeding and frequent feeding with safe and adequate amounts of local foods". It took nine years of campaigning by Baby Milk Action and its partners to persuade Nestlé, the global leader of the baby food market, to change its policies on the labelling of baby foods, which it agreed to do during national demonstrations in 2003 (click here). Since the 1994 Resolution many countries introduced policies promoting 6 months for introduction of complementary foods/exclusive breastfeeding (see list below).
- The four authors imply that delayed introduction of solid foods may be linked to increased obesity - this is total conflict with the studies which show that early introduction - particularly of sugary foods is an important factor behind the obesity epidemic. Breastfeeding may actually help in the development of taste receptors.
- The argument to introduce solids at 4 months to prevent coeliac disease and allergies was summarised by ESPGHAN in late 2009 and was considered by many to be flawed. see our press release: http://www.babymilkaction.org/press/press23dec09.html
- The UK Scientific Committee on Nutrition (SACN) and the Committee on Toxicity (COT) are reviewing the evidence on solid foods and coeliac disease. The draft opinion is NOT FINAL BUT Is on the SACN website with the Agenda papers for next week's SACN meeting. See paper SMCN/11/01 downloadable from http://www.sacn.gov.uk/meetings/sub_groups/maternal_child_nutrition/19012011.html
- SACN use international growth charts to describe the optimal pattern of infant growth in the UK (UK-WHO charts). These are based on studies of babies in 7 countries around the world and no significant difference was found between their growth profiles. The proposal from the four scientists that babies are treated differently depending on where they live conflicts with this research evidence. The mean age at introduction of solids to this cohort of breastfed infants in the WHO studies was 5.4 months (or "..about 6-months").
- The UK policy is to introduce complementary foods at around 6-months and progress responsively, in line with individual babies' progress and acceptance. Not all babies need solids at the same time: in every aspect of infant development there is a wide range of normal. Very importantly the introduction of the new policy in 2003 has been associated with a marked reduction in the numbers of mothers giving solids very early (i.e. before 4-months). Since it is widely accepted that very early introduction carries greater risk (particularly of coeliac disease), the UK policy could be considered from this perspective a success.
- The practice of ‘baby-led weaning’ is becoming more widespread, where babies are allowed to play with appropriately prepared solid foods and decide for themselves when to eat. Experience in this area suggests that babies naturally start to ingest complementary foods at around 6 months of age, when various developmental factors (hand-eye coordination, mastication ability etc) come together. This may be an evolved natural behaviour that has been lost through the practice of spoon feeding prepared paps. Further research is required in this area.
- Marianne Monie, Chair of the nationwide Breastfeeding Network, made an important point about the risk of swine flu: “The evidence supports introducing food when a baby is developmentally ready at around 6 months. Introducing food or infant formula before that time increases the risk of infections. Questioning the wisdom of the six-month guideline at a time when babies are at risk of catching swine flu is unfortunate, because exclusive breastfeeding reduces the risk of secondary infections that can be serious enough to need hospital admission. Parents should not feel pressured into rushing their baby onto solid food. Waiting until around six months gives another two valuable months of additional protection against chest and stomach infection."
Previous concerns about Alan Lucas’s links with industry
Response from UNICEF UK:
Response from Joanna Moorhead, The Guardian:
WHO statement 15 January 2011
Exclusive breastfeeding for six months best for babies everywhere
Global support for the 6-month exclusive breastfeeding policy
The following list was prepared when the UK Government was considering its position in 2003. At that time over 70 Countries had already introduced Government policies recommending 6 months exclusive breastfeeding (expressed either as legislation, Presidential Decree, official statement, letter or as guidance to health workers):
Africa: Cameroon, Cape Verde, Central African Republic, Cote d'Ivoire, Djibouti, Egypt, Eritrea, Gambia, Ghana, Guinea, Kenya, Liberia, Malawi, Morocco, Mozambique, Niger, Nigeria, Rwanda, Sao Tome Principe, South Africa, Uganda, Zambia and Zimbabwe.
Americas: Argentina, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, Panama, Paraguay, Peru, Uruguay and Venezuela. Oceania - Australia, Kiribati, Micronesia and Palau.
Asia: Cambodia, Pakistan, India, Iran, Hong Kong, Jordan, Kazakhstan, Kyrgyzstan, Maldives, Mongolia, Philippines, Singapore, Tajikistan, Turkmenistan, Uzbekistan and Yemen.
Europe: Bosnia, France, Belarus, Bulgaria, Czech Republic, Georgia, Germany, Luxembourg, Netherlands, Slovakia and the UK
Some of the media headlines and comments (14 January 2011):
The Guardian: Six months of breastmilk alone is too long and could harm babies, scientists now say
The Sun: Breast is not Best -milk can put babies off food & cause allergy, says study
Daily Telegraph: Risks to babies in NHS breastfeeding Code
The Times: Babies 'need solid food - not just breastmilk' Official guidelines will be reviewed
Blog from Professor Miriam Labbock, Department of Maternal and Child Health, Director, Carolina Global Breastfeeding Institute (CGBI) http://www.breastfeeding4health.com/
Blog from Chief Scientist at the Food Standards Agency: http://blogs.food.gov.uk/science/entry/what_s_behind_the_development
Blog from the analytical armadillo