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Baby food matters

22 Jun 11    The Breast Milk Cure, NYT, NICHOLAS D. KRISTOF
May 1981    WHO baby food code, WSJ, Anton Keller

June 22, 2011

The Breast Milk Cure

Gayshita Abdullah, the mother of a Tuareg family in Niger, does nurse her baby. But, like many others, she says it's important to give even the smallest babies water on a hot day, a potentially dangerous belief.

What if nutritionists came up with a miracle cure for childhood malnutrition? A protein-rich substance that doesnít require refrigeration? One that is free and is available even in remote towns like this one in Niger where babies routinely die of hunger-related causes? Impossible, you say? Actually, this miracle cure already exists. Itís breast milk.

When we think of global poverty, we sometimes assume that the challenges are so vast that any solutions must be extraordinarily complex and expensive. Well, some are. But almost nothing would do as much to fight starvation around the world as the ultimate low-tech solution: exclusive breast-feeding for the first six months of life. Thatís the strong recommendation of the World Health Organization.

The paradox is that while this seems so cheap and obvious ó virtually instinctive ó itís also rare. Here in Niger, only 9 percent of babies get nothing but breast milk for the first six months of life, according to a 2007 national nutrition survey. At least thatís up from just 1 percent in 1998. (In the United States, about 13 percent of babies are exclusively breast-fed for six months, according to the federal Centers for Disease Control and Prevention. Then again, most of the rest get formula, which is pretty safe in America.)

Next door to Niger in Burkina Faso, fewer than 7 percent of children get breast milk exclusively for six months. In Senegal itís 14 percent; in Mauritania, 3 percent.

These are some of the countries weíre passing through on my annual win-a-trip journey, this year with a medical student from Atlanta, Saumya Dave, and a teacher from Newark, Noreen Connolly. Itís heartbreaking to see severely malnourished children and to meet mother after mother who has buried children when such a simple life-saving solution is not applied.

The biggest problem is that many mothers believe that breast milk isnít enough, and that, on a hot day, a child needs water as well. On a rural road near the remote town of Dogon Doutchi, in southern Niger, we ran into a family of Tuareg nomads traveling north. ďOn a hot day, babies need water,Ē Gayshita Abdullah, the mother, told me. She said she tries to get water from a well, but if there is no well nearby she gets it from a mud puddle.

In fact, most nutritionists are adamant that babies are best off with nothing but breast milk for the first six months of life (they used to recommend four months, but now say six months). And water in poor countries is often contaminated and dangerous for a baby. Even when the mother is herself malnourished, her body will normally provide enough milk for a baby, nutritionists say.

A 2008 report in The Lancet, the British medical journal, found that a baby that is partially breast-fed is 2.8 times as likely to die as a baby that is exclusively breast-fed for at least five months. A child that is not breast-fed at all is 14.4 times as likely to die.

Over all, The Lancet said, 1.4 million child deaths could be averted each year if babies were breast-fed properly. Thatís one child dying unnecessarily every 22 seconds. ďAs far as nutritional interventions that have been studied, we have crushing evidence of breast-feedingís efficacy in reducing child mortality,Ē said Shawn Baker, a nutrition specialist with Helen Keller International, an aid organization that works on these issues. ďItís the oldest nutritional intervention known to our species, and itís available to everybody,Ē Baker added. ďBut for a development community too focused on technological fixes, it hasnít gained the traction it should.Ē

The challenges with breast-feeding in poor countries are not the kinds that Western women face, and many women in the developing world continue nursing their babies for two years. The biggest problem is giving water or animal milk to babies, especially on hot days. Another is that mothers often doubt the value of colostrum, the first milk after childbirth (which is thick and yellowish and doesnít look much like milk), and delay nursing for a day or two.

One mother near the town of Dosso, Fati Halidou, who has lost four of her seven children, told me that after childbirth, it is best to give a baby sugar water or Koranic water. This is water made by writing a verse of the Koran on a board and then washing it off; the inky water is thought to protect the child.

Itís not clear why a human instinct to nurse went awry. Does it have something to do with the sexualization of breasts? Or with infant formula manufacturers, who irresponsibly peddled their products in the past but are more restrained now? Or is it just that moms worry that their babies need water on hot days? Nobody really knows.

But what is clear is that thereís a marvelous low-tech solution to infant malnutrition all around us.