When the U.S. pushed to weaken language supporting breastfeeding in a WHO resolution at the World Health Assembly recently, the Trump administration prioritized the U.S. dairy industry and the $70 billion baby food industry over babies’ health, according to Alison Stuebe, M.D., M.Sc.f, a maternal-fetal medicine physician and president-elect of the Academy of Breastfeeding Medicine.
“What the WHO is trying to do is help women achieve their own breastfeeding goals, and unfortunately those goals conflict with goals of the dairy industry,” Stuebe said. “The U.S. decided that the dairy industry is more important than moms and babies.”
The resolution Stuebe is referring to should have been noncontroversial, as journalist Amruta Byatnal first reported in News Deeply last month. It updated the evidence on supporting breastfeeding, which is particularly useful for low-income nations without the resources to conduct their own research on breastfeeding support. The resolution included guidance on the WHO’s International Code of Marketing of Breast-milk Substitutes, which outlines what kind of marketing is and is not acceptable from formula companies.
And that’s what the U.S.—home to most of those companies—had a problem with. The U.S. first tried to block the resolution and then pushed hard for an alternative that removed language related to restricting aggressive marketing by formula companies. In fact, as Vox reported, the U.S. threatened Ecuador, one of the resolution’s sponsors, with trade retaliation and withdrawal of military aid if Ecuador didn’t backtrack.
The resolution eventually passed, but only after substantial changes diluting the language about formula marketing (and after Russia supported it). (Here’s the original draft, the U.S. proposed alternative wording, and the final resolution that passed.)
The reason for U.S. opposition, according to the Department of Health and Human Services in the New York Times, was that “The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children.”*
When I reached out to the department, HHS spokesperson Caitlin Oakley told me the following:
Recent reporting attempts to portray the U.S. position at the recent World Health Assembly as ‘anti-breastfeeding’ are patently false. The United States has a long history of supporting mothers and breastfeeding around the world and is the largest bilateral donor of such foreign assistance programs. The issues being debated were not about whether one supports breastfeeding. The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies. Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies.
But the issue being debated was about support of breastfeeding — that, and allowing women “to make the best choices for the nutrition of their babies” is what the entire resolution focused on. The resolution also in no way stigmatized women who might choose–or need–to use formula. In reality, it’s the U.S. placing unnecessary hurdles for mothers who want to choose how to feed their babies, including in this country with policies that make it more difficult for women to establish and maintain breastfeeding.
The benefits of breastfeeding are well established, and while formula is a lifesaver for women who do not breastfeed or children who cannot take breast milk, it cannot offer the benefits for an overall population of children that breast milk does. At the population level, Stuebe said, evidence shows that higher breastfeeding rates translate to better health of moms and babies.
“This isn’t about forcing women to do things—this is about letting women who wish to breastfeed having the support and resources to do so,” Stuebe said. Research shows that globally, most women want to breastfeed, but many face structural barriers, said Stuebe, who wrote the updated opinion on breastfeeding for the American College of Obstetricians and Gynecologists, emphasizing the need to support all women in their feeding choices.
“If breast milk is unavailable because mom is separated from her baby, cannot make milk, is experiencing excruciating pain, or doesn’t want to do it and hates it, which is a legitimate concern, then formula is a better choice than cow’s milk because an infant cannot digest regular cow’s milk and will become ill,” Stuebe said. “It’s incumbent on health professionals to support women in making decisions that are right for their lives.”
But that also means supporting women who want to breastfeed, and “aggressive marketing of formulas in developing countries contributed to a global decline in breastfeeding,” according to a 2009 article in The Journal of Perinatal Education.
Formula companies heavily pushed formula to mothers who lived in poverty across the world, undermining their confidence in breastfeeding. Formula similarly overtook breastfeeding in the U.S., to the detriment of infants’ health, the New York Times reported in 1981.
While most women in developing countries continued to breastfeed, many also supplemented with formula—which must be mixed with water. Since local water was often contaminated, babies frequently developed and even died of diarrhea, Stuebe said.
“It became clear that aggressive marketing of formula globally was killing babies,” she said. That led the WHO to develop the Code on marketing formula, restricting companies from marketing directly to families. When it was voted on in 1981, the U.S. was the only country to vote against the Code.
“We have a lengthy history of getting in the way of maternal and child health and putting the interest of the dairy industry and formula companies ahead of the interests of health and well-being of moms and babies,” Stuebe said. That has continued with Trump administration’s bullying over the WHO resolution, almost certainly driven by support for the dairy industry, whose latest attempt to unload their surplus of milk is the rapidly growing “toddler milk” market, she wrote in a blog post. “Protecting toddler milk as a dumping ground for excess milk was likely a primary motivation for the U.S. take-no-prisoners attack on global breastfeeding,” she wrote.
This latest move from the Trump administration is part of a pattern in attacking the rights of children, women and families, said Kristen Rowe-Finkbeiner, author and executive director of the large nonprofit organization Moms Rising.
“We are seeing an attack on women’s rights to simply have information about breastfeeding as well as to have what little rights we have in the workplace be protected,” she said. “There are so many barriers in our workplaces to have the time and place to pump and to have the chance to establish breastfeeding in the first place with paid family leave.”
In his tweet attempting to defend U.S. actions, Trump claims the U.S. “strongly supports breastfeeding” but does not believe “women should be denied access to formula”—except the WHO resolution did not restrict access to formula in any way. Trump goes on to say, “Many women need this option because of malnutrition and poverty.”
But as Stuebe points out, this statement doesn’t make any sense. “Poverty and malnutrition don’t prevent breastfeeding. Women make adequate milk except in cases of extreme starvation,” she said. “What prevents breastfeeding is inadequate support, such as total absence of paid parental leave, absence of lactation support, and policies that have work requirements for Medicaid,” which can prevent women from establishing a breastfeeding relationship if they need to work.
Plus, when those structural barriers are removed, breastfeeding is free, points out Rowe-Finkbeiner.
“That isn’t to say that everyone should breastfeed,” she said. “It’s to say that everyone should have the choice and not be forced to support the $70 billion infant formula industry when breastfeeding is free.”
She said actions speak louder than Trump’s words on Twitter, and U.S. actions have shown where the administration’s priorities lay.
“People need to be able to choose what’s right for them and their baby, and right now the barriers to being able to decide whether or not to breastfeed are ridiculously high. It’s time to break down the barriers, not put more up,” Rowe-Finkbeiner said. “To have the Trump admin to push against that is shameful, it’s an insult to parents and to our country and the rest of the world.”
*This post has been updated with the response from HHS.