Breastfeeding and breast milk provide big opportunities to support maternal, infant and population health. This is especially true during the current pandemic because breastfeeding can help alleviate food insecurity, and research shows the breast milk of women who have recovered from COVID-19 offers a source of COVID-19 antibodies.
Breastfeeding saves lives and prevents illness. It is environmentally friendly and profoundly important to children’s long-term development. After all, breast milk is the only food that has evolved specifically to feed humans.
Beyond supplying nutrition, breast milk provides personalized immune protection and shapes the developing microbiome. Scientists have discovered enzymes, hormones, antibodies and live cells in breast milk, and these bioactive components could hold the key to developing new therapies — not only for COVID-19, but also autoimmune diseases, diabetes and cancer.
Yet, remarkably, we still don’t fully understand the composition of breast milk, or the biological basis for its many health effects. In fact, more scientific papers have been published on headaches than breastfeeding, and more federal research dollars from Canadian Institutes of Health Research and the Natural Sciences and Engineering Research Council of Canada have been invested to study corn than breast milk.
The act of breastfeeding also supports mother-infant bonding and helps to prevent breast and ovarian cancer in mothers. Unfortunately, most mothers do not even meet their own breastfeeding goals, let alone achieve recommendations of exclusive breastfeeding for six months, followed by 18 months of breastfeeding along with other foods.
This is particularly concerning during this pandemic, when mothers infected with COVID-19 may be separated from their newborns (despite World Health Organization guidance to the contrary) and breastfeeding support is often unavailable because public health visits are being cancelled and lactation services have been suspended in many places.
Every parent knows that infant feeding is a complex issue, often evoking strong emotions based on personal experience. Difficult or negative breastfeeding experiences can fuel a defensive “breastfeeding denialism” attitude.
Conversely, some breastfeeding advocates refuse to acknowledge that for some families, formula is necessary for medical, personal, societal or socioeconomic reasons. These extreme attitudes cause a tense and unproductive environment for researchers working to generate inclusive evidence-based guidance for infant feeding.
Industry partnerships also cause tension in this field because the infant feeding industry frequently violates the World Health Organization code for marketing of breastmilk substitutes, and transgressions have worsened during the pandemic. However, due to lack of funding for breastfeeding research, scientists are often faced with choosing between industry funding or no funding at all.
Unfortunately, these tensions often detract from the energy and resources that breastfeeding advocates, researchers, health professionals and policy-makers could be using to advance their shared goal of supporting maternal and child health.
What can be done
Of course, members of the diverse breastfeeding advocacy and research communities will not always agree — but we should aim to find common ground and work together. There are many stakeholders involved, each with a role to play:
Governments and non-profit funding organizations should acknowledge the importance of breastfeeding and breast milk and invest more resources into this field.
Researchers should build interdisciplinary teams to study breast milk as a biological system and think broadly about “breastfeeding challenges” in the context of complex social systems - including social inequities, parental leave policies, lactation difficulties and donor breast milk.
Companies, researchers and advocacy groups should co-develop a conflict of interest framework for research on breastfeeding and breast milk and reporting of results.
Messaging is key to achieving these goals. All groups need to communicate effectively with each other, and with the health-care, research and public sectors. This means providing or sharing clear resources to convey scientific evidence free of conflict of interest, targeted to each audience, such as fact sheets for policy-makers, engaging videos for the public and infographics for health-care providers.
Stakeholders also need to actively discredit unfounded claims and misinformation, such as unsubstantiated health claims made by infant nutrition companies, or rumours about the transmission of COVID-19 via breastfeeding, when there is no evidence of this occurring.
Progress in breastfeeding, breast milk and lactation research is being hampered by tensions among researchers, advocates and industry.
As breast milk scientists, breastfeeding researchers and lactation specialists, we are concerned about these tensions and their potential to impede or delay discoveries in our field. Last year, we held a workshop to discuss these concerns and develop solutions.
Our workshop paper was written before the pandemic, but its recent publication is timely. The pandemic has brought researchers together in ways that seemed impossible before.
Breast milk research that would normally take years has been completed in months with unprecedented efficiency. A global network of human milk banks was established in a matter of days to share information about safe operations during the pandemic. Milk scientists and breastfeeding researchers are meeting monthly with the WHO to speed up the transition from discovery to policy.
We hope these trends will continue beyond the pandemic and become the new standard for doing and sharing research.
COVID-19 has also emphasized both the importance and fragility of breastfeeding support systems, which have suffered considerably due to current restrictions. The pandemic has also highlighted the potential of breast milk to inform new avenues of biomedical research, such as milk antibodies as potential therapeutics.
We hope this added urgency will encourage researchers, advocates, funders and policy-makers to work together to accelerate progress in supporting breastfeeding and breast milk research.
Meghan Azad co-Directs the Manitoba Interdisciplinary Lactation Centre. She holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease at the University of Manitoba and is a Fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She receives research funding from the Canadian Institutes of Health Research, Research Manitoba, the Canada Foundation for Innovation, the Bill and Melinda Gates Foundation, the Manitoba Children’s Hospital Foundation, Prolacta Biosciences, Mitacs, CIFAR, and the Garfield G. Weston Foundation. She regularly speaks at conferences and workshops on infant nutrition, some sponsored by Medela, the Institute for the Advancement of Breastfeeding & Lactation Education, and Prolacta Biosciences. She has contributed to online courses on breast milk and the infant microbiome produced by Microbiome Courses. She serves in a volunteer capacity as Secretary to the International Society for Research on Human Milk and Lactation and as a member of the National Academy of Sciences, Engineering and Medicine Committee on Scanning New Evidence on the Nutrient Content of Human Milk.
Katie Hinde's research has been supported by grant funding from the National Science Foundation and the National Institutes of Health.
email@example.com works for University of California San Diego. He receives funding from the National Institutes of Health and the Family Larsson-Rosenquist Foundation.
Luisa Zuccolo receives funding from the UK Medical Research Council and the Jean Golding Institute at the University of Bristol. She consults for the Human Milk Foundation and sits on the Advisory Board of the UK National Institute of Health Research's Cochrane review on breastfeeding support strategies. She is a trained volunteer in breastfeeding peer support and co-chairs a breastfeeding peer supporter group, which is audited by the UK Baby Friendly Initiative.
Merilee Brockway receives funding from The Molly Towell Perinatal Research Foundation and the Garfield Weston Foundation.
Nathan Nickel, PhD is an Associate Professor of Community Health Sciences, Associate Director at the Manitoba Centre for Health Policy, and Co-Director of the Manitoba Interdisciplinary Lactation Centre. Dr. Nickel is the Scientific Chair for Breastfeeding at the American Public Health Association and he works with the Breastfeeding Committee of Canada and the Centre for Health Equity Education and Research. He receives funding for breastfeeding and population health research from the Public Health Agency of Canada, Health Canada, the Canadian Institutes for Health Research, Research Manitoba, and the Canadian Foundation for Innovation.
Rafael Pérez-Escamilla, PhD is professor of public health and director of the Office of Public Health Practice, the Global, the Global Health Concentration, the Yale-Griffin CDC Prevention Research Center, and the Maternal Child Health Promotion Program at the Yale School of Public Health. He receives funding from The National Institutes of Health (NIH), the US Centers for Disease Control and Prevention (CDC), The World Health Organization, The Bill and Melinda Gates Foundation, The Robert Wood Johnson Foundation, The Kellogg Foundation, and The Family Larsson-Rosenquist Foundation
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