The WHO has recommended at least 2 years of breastfeeding. The American College of Obstetricians and Gynecologists, The American Academy of Family Physicians and The American Academy of Pediatrics have recommended exclusively breastfeeding for at least six months and to extend this as much as possible through the first year and thereafter. Currently only 31.5% of infants are being exclusively breastfed at 3 months and only 11.9% are exclusively breastfed at six months in the US.

The public perception of formula feeding as the norm and a misconception as to the nutritional values of formula vs breastfeeding contribute to these low rates. What needs to be emphasized is that not breastfeeding poses several health risks to both the mother and the baby. There are serious risks involved in not breastfeeding and the public should be informed. The following is a summary of these:

1) Infection Risk Babies who are formula fed are more at risk to the flu, pneumonia, intestinal viruses and bacteria, ear infections and necrotizing enterocolitis.

Breast milk contains several immune factors that help protect the baby. IgA antibodies in mother’s milk help protect the baby against respiratory and intestinal pathogens. additionally, oligosaccharides in breast milk help protect the baby against H. influenzae and Strep pneumoniae. Glycoproteins in breast milk help protect against E. coli, rotavirus and vibrio cholerae, while lipids in breast milk help protect against H. influenzae, Group B strep, G. lamblia, Strep epidermidis, HSV 1 and RSV. Glycosaminoglycans in breast milk help protect against HIV.

Babies who are not breastfed have twice the risk of ear infection. Breast milk provides protection against otitis media due to the oligosaccharides and antibodies it contains. Lipids in breast milk help protect the baby against RSV (respiratory syncytial virus). Babies who are exclusively breastfed fro 4 months are protected, while those who are not breastfed have 3.6 times the risk of being hospitalized during the first year of life with a lower respiratory infection. Babies who are not breastfed also have 1.7 times to 2.8 times higher risk for gastroenteritis.

Preterm babies who are not fed with mother’s milk have a 2.4 times risk of necrotizing enterocolitis which is 15% fatal.

2) Metabolic Risk Babies who are not breastfed are at higher risk for type 2 diabetes and obesity.

The risk is 1.6 fold. Metabolic risk also relates to increased incidence of hypertension and abnormal cholesterol and triglyceride levels. Breast milk contains adipokines that help regulate energy intake.

3) Neurological Babies that are not breastfed have been observed to crawl and walk later.

Also at age 6.5 years they have verbal IQ scores 7.5 points lower according to one study.

4) SIDS (sudden infant death syndrome) Risk of SIDS is shown to be 1.6 to 2.1 fold for babies that are not breastfed.

This increased risk is found to be attributable to factors associated with breastfeeding rather than breastfeeding itself.

5) Other issues Babies that are not breastfed have higher incidence of alkaline stools and colonization of bowel with potentially harmful bacteria such as C. dificile and B. fragilis.

They also have immune systems that are not as prepared for defense. Therefore they seem to have a higher chance of allergic problems and infectious diseases, asthma, allergic skin rashes especially atopic dermatitis. The risk of type 1 diabetes , childhood leukemia is also increased in babies who are not breastfed.

Impact on Mother’s Health

Mothers who have not breastfed or only breastfed briefly have higher incidence of breast and ovarian cancers, Each year of breastfeeding seems to confer 4.3% reduction of risk for invasive breast cancer. Mothers who don’t breastfeed have a tougher time losing weight postpartum , have higher risk of metabolic syndrome and diabetes.

The following is a useful resource on this topic: http://www.womenshealth.gov/breastfeeding/ programs/business-case/outreach-marketing- resources.pdf