In February, nutrition advocates around the world welcomed the publication of the 2023 Lancet Breastfeeding Series. In addition to contributions to the research articles, Alive & Thrive staff participated in launch events for the series and have supported its dissemination around the world. Alive & Thrive’s East Asia Pacific Regional Director Roger Mathisen’s remarks during the recent Australasia and Pacific launch are adapted here.

By Roger Mathisen

Around the world and for generations, the contributions of women have too often gone unrecognized and unvalued. During the launch of the 2023 Lancet Breastfeeding Series in the Australasia and Pacific region, two co-authors, Phil Baker and Julie P. Smith, explored further how mothers and breastfeeding are still undervalued and underinvested in by governments and public health.

Join the USA Launch of the 2023 Lancet Series on Breastfeeding, including the influence of commercial milk formula marketing, on Tuesday, April 18 at 11 a.m. EDT. Register here.

They raised two important points: “What’s measured matters,” and, to echo Julie, “Money is the language of policymakers.”

For years, countries have used GDP to measure economic output – using the economic values of various activities as guides to policymaking. But for every country except one, the value of breastmilk has never been so considered. There is hope, however, as some countries progress towards a wellbeing economy. With the release of the new Mothers' Milk Tool, we’re also finally taking an important step toward addressing some of these serious omissions.

A key message to policymakers from the Lancet Series, and the Mothers’ Milk Tool: the global monetary value of breastfeeding was an estimated USD 3.6 trillion in 2020. This figure simply cannot be ignored. And it compels advocates to call on policymakers to count breastfeeding and mothers’ milk production in national food balance sheets, food statistics, and food surveillance systems. And advocates should, similarly, focus on food systems and collaborate with the systems for national accounts.

One of the biggest investments to enable recommended breastfeeding practices is enacting adequate maternity protection. And what is felt as adequate by mothers might be very different from the current minimum recommendations from the International Labor Organization, which is the only tripartite UN agency with government, employer, and worker representatives. There is a growing consensus that working women – in both the formal and informal sectors – need at least six to eight months paid maternity leave. Further, this period of paid maternity leave should be aligned with the recommended exclusive breastfeeding duration as it requires mothers and babies being close together.

Other maternity protection provisions, including workplace policies, need to be in place to support continued breastfeeding for two years – or as long as mothers want – when they return to work. And policymakers need to know about the tremendous human and financial costs of not breastfeeding, which make the investments needed in maternity protection small by comparison.

I have used the terms maternity protection and maternity leave deliberately. Breastfeeding needs to be better recognized as reproductive work that should not be reduced and cannot be directly redistributed as part of policy solutions to get mothers back to work and as taxpayers before they are ready, or other gender equity agendas not considering protection of motherhood clearly stated in the Universal Declaration of Human Rights. Rather, the agenda involving the 3Rs of reducing, redistributing and recognizing time for care work needs to be reconceptualized to isolate breastfeeding as “sexed” care work.

"Breastfeeding needs to be better recognized as reproductive work that should not be reduced and cannot be directly redistributed as part of policy solutions to get mothers back to work and as taxpayers before they are ready."

With this reconceptualization, economic adjustments are needed to appropriately recognise and reimburse for the value of this work. I’m happy to announce that there is more to come on this, as a team of experts is working on this for publication.

The Lancet Series also highlights that vulnerabilities of women and families are exploited by the commercial milk formula industry. This multi-billion-dollar industry has considerable economic power and uses a marketing playbook that includes political lobbying and interference with international regulatory processes.

The Lancet Series cites some really concerning research findings. For example, between 1995 and 2019, there were 245 interventions made in the World Trade Organization by commercial milk formula and dairy-producing member states concerning the regulation of formula milk marketing, labelling or safety in another member state.

It has been over 40 years since the World Health Assembly ratified the International Code of Marketing of Breast-milk Substitutes. But, incredibly, most countries in the world have not meaningfully adopted the Code. Indeed, the sales of commercial milk formula has only grown in that time to astounding heights. And this during a time where we now clearly understand – more than ever before – that manufacture of these products contributes significantly to global climate change.

It is time for the world to correct this historical inaction. To make this a reality, past and present policymakers need to be held accountable. The media also needs to recognize what is at stake and provide more in-depth reportage of the many nefarious impacts of the commercial milk formula industry.

We conducted a global scoping review of Code violations over the last four decades referenced by The Lancet Series and published a commentary with additional analysis and recommendations in BMJ Global Health focusing on protecting the integrity of health professional from institutional conflict of interest. National regulatory measures to implement and ensure monitoring of compliance with the International Code of Marketing of Breast-milk Substitutes also protect health workers in addition to children and their families.

The massive digital transformation we are currently experiencing has made marketing so personalized, tailored as it is through powerful big data-driven algorithms. Digitalization is a megatrend identified both as a threat and an opportunity. In Viet Nam, an innovation called VIVID shows that two can play this game. VIVID is a virtual violations detector or virtual assistant that has been trained to scan and flag Code violations online. It is now replicated to many languages and integrated into the Corporate Accountability Tool & Communication Hub (CATCH).

In the East Asia Pacific region, as in many regions of the world, the main concern today is climate change and, specifically, the need for mitigation efforts, literally, to keep heads above water. The negative environmental impacts associated with the commercial food industry, including the commercial milk formula industry, are substantial. As mentioned in the Lancet Series, these include water use, pollution and packaging waste, but also greenhouse gas emissions.

In 2018, two million tons of commercial milk formula were sold globally – equating to between 14 and 28 million tons of GHG emissions and 10 million cubic meters of water. But through innovation, such as the Green Feeding Climate Action Tool, we have the potential to positively influence the design of policies and programs across food and health systems to reduce GHG emissions and climate-related impacts.

This quantification tool will soon put the power of data in the hands of policymakers, advocates, environmentalists and climate change scientists, enabling them to evaluate the reduction in GHG emissions and water use by increased breastfeeding and reduced reliance on commercial milk formula.

While providing a tool to aid governments and stakeholders to mitigate climate impacts, the Green Feeding Tool also supports advances in global breastfeeding rates in line with the World Health Organization targets. The aim is for this tool to be available by International Environment Day in June this year.

"We have the power of the evidence supporting efforts to increase support for mothers and breastfeeding."

So, despite that the commercial milk formula industry is as powerful as ever, I am optimistic. Research continues to show how important, how vital breastfeeding is – not only for mothers and children, but for all of society. Whether we are talking about the very survival of mothers and infants, the productivity of workers or the costs to society of not breastfeeding, or whether we’re talking about the profound economic value of breastmilk itself, we have the power of the evidence supporting efforts to increase support for mothers and breastfeeding.