The benefits of breastfeeding and dangers of bottle-feeding as two sides of a complex set of issues are constantly becoming better understood. Breastfeeding is well known to reduce exposure to pathogens in the environment, to give protection by immunization, to provide anti-bacterial and anti-viral substances, and to supply the correct mix and density of nutrients; it also has very little direct cost. Bottle feeding, in contrast, tends to be contaminated, non-ideal in terms of nutrients, and not affordable to many families in poor societies.
New knowledge expands our realization of the sophisticated meshing of the newborn infant's needs and the mother's ability to provide for them - not only to nourish but to protect1. A continuity has evolved to bridge the gap between the safety of the womb and the shock of post-natal life, when the gut suddenly replaces the placenta as an interface with the world. The immature infant gut is adapted to the nutrition and protection of breast milk. Antibodies from colostrum and then breastmilk protect the gut and provide some immunity against other infections. Antibiotic activity in breast milk proteins is being shown to be selective against precisely certain of the harmful bacteria that cause infantile diarrhoea. The protein of breast milk is tailor-made to the infant's needs, and is quite innocuous unlike many non-human proteins. The hazards of sudden exposure of the fragile gut to foreign materials is now being realized. The gut matures in the first few months - the recommendation for 4-6 months' exclusive breastfeeding is no accident.
1. For a recent review see: "Infant Feeding: the Physiological Basis" Suppl. to Bull. WHO 67, 1989, edited by J. Akre; reviewed in SCN News No. 6 p.56-7.But before this time, researchers are beginning to realize just how vulnerable the infant gut is, and protection by excluding everything but breast milk is of crucial importance - for preventing contamination with pathogens and exclusion of foreign materials.
The story goes on. The natural effect of suckling itself in delaying the resumption of fertility is better understood - protecting the infant from displacement by a new pregnancy, and the mother's health from excessive reproductive stress.
This process needs to be fostered throughout the world. "It is still true to say that the artificial feeding of our infants has been the largest uncontrolled clinical experiment in human history2." Here we highlight a number of recent summaries from the UN system on these issues, mainly compiled from material in SCN News. The first is known as the "Innocenti Declaration". This is followed by the recommended steps for maternity services, from WHO and UNICEF. Messages from "Facts for Life" (information was distributed with SCN News No. 4) are then extracted, giving succinct guidance on breastfeeding, and clear warnings on bottle feeding. The next item emphasizes relations between population and nutrition issues (from the SCN's recent symposium, article forthcoming in next SCN News), in particular the congruence of interests centred on breastfeeding. This extract, printed with support from UNICEF, aims to bring together some pertinent material to help promote and protect breastfeeding practices.
2. Minchin, M. Birth 14, 25-34 (1987).