The food industry generates roughly 30% of the emissions of greenhouse gases (GHG) – and the manufacture of breastmilk substitutes contributes to that amount. As world leaders recently met in Glasgow, Scotland, at COP26, to discuss global climate change, Dr. Julie Smith, a leading researcher on the BMS industry’s carbon footprint, discussed the industry’s impact on global climate change: Not only does the manufacture of the products pump millions of tons of greenhouse gases into the atmosphere – it also discourages breastfeeding, which, by comparison, bestows myriad benefits on infants, mothers, families, and societies. And, when natural disasters do occur, dependence on BMS products can lead to even worse outcomes because access to clean water and the energy to sterilize bottles and teats, necessary to prepare and feed formula, are often very limited.

Alive & Thrive: Dr. Smith, before we get into the substance of the matter, can you tell us about how you came to conduct research on the BMS industry’s carbon footprint?

Julie Smith: My specific interest in this issue, I suppose, was kindled in the early 1990s by work done by Andrew Radford at the Baby Milk Action, and by the World Alliance for Breastfeeding Action's 1997 World Breastfeeding Week theme.

Fast forward to 2013-16 when I was doing some work with colleagues in India and in Australia using industry data on baby food sales to highlight the huge changes in infant nutrition that were underway in middle income counties especially. My colleagues in India said let’s use this data to also estimate the greenhouse gas impact. So, we prepared a report published by IBFAN in 2016 for selected countries in the Asia Pacific region.

IBFAN - the International Baby Foods Action Network - was developing a package of green feeding advocacy materials to calculate the impact of milk formula on greenhouse gas emissions in countries, and they were relating it to how much policy effort there was to implement the WHO-UNICEF Global Strategy on Infant and Young Child feeding. So, we published that report in 2015 – on the carbon footprint of milk formula. And since then, I've published a commentary on the carbon footprint of milk formula because what I learned during that exercise is that there are some really wide implications of the infant nutrition transition, across all three "pillars" of governments’ response to climate change: "mitigation," "adaptation," and "resilience." These can be usefully analyzed using economic thinking because they epitomize market failures and cost externalities.

And we've also recently published our findings in the Journal of Human Lactation, which correlate pretty well with the even more concerning findings of the full infant formula product "life cycle analysis" by the World Health Organization team, which was published in 2019. We found that producing a kilogram of milk formula creates an environmental cost of at least 4 kilograms of greenhouse gases, while the study led by Karlsson found infant formula generates between 7 and 14 kilograms of emissions, measured from the beginning to the end of the product’s life. Exclusive formula use for the first six months used around 21 kg of formula and around 150 kg of greenhouse gas emissions to feed a baby. Even allowing for extra food for breastfeeding mothers, there were always much higher emissions from formula feeding, especially because of the need to properly prepare and sterilize the product, and accounting for waste, transport and packaging. Breastfeeding has the world’s lowest "food miles" and food waste. Women are super-efficient producers of food for babies from an environmental point of view.

Alive & Thrive: Put the problem in perspective for us.

Dr. Julie Smith: In terms of scale, (our research showed) about 2,000,000 tons (of GHG) emitted from just six countries in the Asia Pacific region in 2012 – with emissions equivalent to about 6.8 billion car miles driven. This was based on production of 720,000 tons sold in the six countries. By now, it will be much higher than that. China alone accounts for that much emissions now, and our estimates of 4 kg of emissions per kg of milk formula were too low because they excluded the consumption end of the product life cycle, which later research did count. You could more than double that estimate based on the Karlsson study; with over 2 million tons of milk formula sold globally in 2018, we could be looking at over 21 million tons of greenhouse gas emissions in 2018. About half of this is from invented products like "toddler" milk or "follow up" formula products, which are entirely unnecessary for good nutrition or health, and may even be harmful.

Our research showed "about 2,000,000 tons (of GHG) emitted from just six countries in the Asia Pacific region in 2012 – with emissions equivalent to about 6.8 billion car miles driven."

Our calculations showed that trends were very much driven by what's happening in China, of course, because there are so many people in China, and so when the country turns to formula feeding, it has major, major impact globally.

At the same time, high and rising sales of infant formula globally means lower levels of breastfeeding in many countries, and that is concerning. Sales trends for formula has multiple relevance for breastfeeding because when countries are not supporting women to breastfeed, they use a lot more formula – commercial milk formula – and that's going to generate a lot more greenhouse gas impacts.

We know from previous IBFAN research, which looked at broader environmental impacts, that this also has huge water impacts. The water use is immense – nearly 5,000 liters of water are used to produce a kilogram of milk powder. This matters a lot as fresh water is the world’s most foundational resource and, as an Australian living on the world’s driest continent, I am aware of how precious it is.

But it's not only at the "mitigation" or preventative part of the climate change response – it’s also important to other pillars of the climate change response framework: as climate change increases and we get, as expected, a greater number of extreme weather events, mothers and babies are more exposed than others (to harm) if they're not part of a breastfeeding population. That’s because in an emergency often you don't have access to clean water or electricity or all the things that, at least in high-income countries, people have come to expect. We saw this problem during Australia’s recent devastating bushfires, but it is an ongoing worldwide issue. In poorer countries, it is more customary to wet-nurse or share milk for babies who are deprived of their own mother’s milk, which can be beneficial in emergencies and disasters, but on the other hand, a very high proportion of the population is potentially exposed both to contaminated water and to lack of access to nutritional food if there's a temporary, or even a quite long period interruption to the supply of commercial food products. So, the sort of struggles that countries like the Philippines and other parts of monsoonal Asia, have long had in dealing with natural disasters and emergencies are going to become the norm in many countries with climate change. Companies jump in with donations so they seem like good citizens, but mothers are particularly vulnerable to the mistaken idea that they need formula at that time, and, after that, local communities’ confidence in breastfeeding is lowered. Breastfeeding is important "insurance" for mothers and babies food and health in our uncertain future, and governments must protect it.

In high-income countries, the ongoing "infant nutrition transition" in the Asia Pacific region should be a wake-up call to what's happening already with climate change around the world.

As I said in my 2019 article, the nutrition transition towards a diet of milk formula for infants and young children is a "maladaptive response" to climate change, and governments need to do far better in policies that support women to breastfeed.

Alive & Thrive: Can you connect the findings to the broader implications of the manufacture of these products?

Julie Smith: What we show, quite shockingly, in these six countries in the Asia Pacific region, was that approximately half of the emissions are coming from unnecessary and potentially harmful products. They're addressing a consumer demand to feed the baby when the mother hasn't got enough time, leaving busy, time-pressed parents feeling they need to buy these products. But nutritionally, and from the viewpoint of the planet, these milk products are not necessary. Around half of the milk formula product greenhouse gases emitted in the Asia Pacific region countries we looked at was coming from these toddler formulas and follow-up formulas, which is very distressing for a lot of reasons.

Governments need to be asking, "Why are parents so time pressed that they can’t nourish babies and toddlers safely and adequately?"

But it does point to the links to public policy – because if mothers are feeding these products, without knowing that it might make the baby fat or displace breastfeeding and healthy home prepared foods – then governments need to be regulating the misleading messages that families get from baby food marketing. And similarly, if mothers and parents are giving their babies or young children these products because caregivers have to work and don't have enough time to prepare safe and adequate indigenous weaning foods at home, then governments need to be asking, "Why are parents so time pressed that they can’t nourish babies and toddlers safely and adequately?" They need to be giving families enough time to raise children properly. They need to be ensuring sufficient paid leave. Society needs children to be well cared for and parents need enough time to do it.

There are wider social implications of this environmental issue in terms of the structural supports for breastfeeding. You can't castigate mothers for using time-saving commercial baby foods if it is because they can't get paid maternity leave or help with the housework – they need to earn a living and to have time off. You also can’t castigate parents for using infant formula when the hospital system is not functioning to support breastfeeding – governments must take responsibility for ensuring health services make breastfeeding easy. And you can't treat parents or health workers as being foolish for valuing unnecessary and harmful products if the baby food industry is being allowed to spin a whole heap of rubbish to convince them that such products are essential!

Alive & Thrive: Has the issue of the production of BMS been raised at COP26?

Julie Smith: It’s been hot on social media – the people are certainly talking about it and related research even if governments are not. There are efforts to raise this infant feeding aspect to the policy level. But clearly (manufacturing BMS products) is only one part of the food industry, and much of the attention tends to be on the mining sector and on coal and oil and gas, which is 70% of the world's emissions. It's only been recently that there's been a focus on the food industry and its impact on emissions; it is hard to make this issue visible.  Addressing issues and developing policies around infant formula, milk formula, and milk products targeting older babies are important ‘Triple Duty Actions’ for a healthy and sustainable food system.

The companies are starting to use people’s concern with climate change to “greenwash,” saying things like, “we use renewable energy to produce our formulas.” However, that renewable energy could be used to run essential industries because we should be helping mothers to breastfeed. The useful thing to do is not to focus on making a small part of the production process of formula less damaging to the environment – it’s to make sure women do not need to use it. There’s a fantastic recent study on decarbonizing breastmilk substitutes that compared the impact of reducing the greenhouse gas impact of the production process of formula with the emission impacts of helping mothers to breastfeed as per WHO recommendations – the global targets for breastfeeding. And it's far more effective, far more efficient to target policies that increase women's capacity to breastfeed than it is to use renewable sources of energy in producing milk formulas. That’s just looking at the emissions aspect of the problem. As I said, the other part is if you have more infants using formula, you have more dependent on formula and, come an emergency, they are vulnerable and will get sick when they get exposed to contaminated water and do not have access to fuel supplies, etc.

The message has to be that we must support breastfeeding through paid maternity leave, restrained marketing, and better maternity care to support breastfeeding. By investing in breastfeeding at a policy level, we improve the environment and reach the global targets for breastfeeding. This leads to less illness, fewer deaths and lower health costs, which is good for women and children, families, governments, and the planet.