WIC's promotion of infant formula in the United States

Breastfeeding Initiation Trends by Special Supplemental Nutrition Program for Women, Infants, and Children Participation and Race/Ethnicity Among Medicaid Births

OBJECTIVE

Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity.

DESIGN

Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009.

PARTICIPANTS

Term births with hospital costs covered by Medicaid (N = 6,402,704).

MAIN OUTCOME MEASURES

Breastfeeding initiation.

ANALYSIS

The descriptive characteristics of WIC participants and WIC-eligible nonparticipants were compared by year and race/ethnicity using the chi-square test of independence or t tests. Adjusted breastfeeding initiation prevalence was estimated using linear regression models with county fixed effects, controlling for sociodemographic and obstetric/health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Differences and P values were assessed using interaction terms between WIC and year.

RESULTS

Breastfeeding initiation increased for WIC participants and nonparticipants. Special Supplemental Nutrition Program for Women, Infants, and Children participants had lower adjusted breastfeeding initiation (2009: 69.0%; 2017: 78.5%) than nonparticipants (2009: 70.8%; 2017: 80.1%) (P < 0.001 per year). Breastfeeding initiation increased more rapidly in WIC participants than in nonparticipants for non-Hispanic Asian/Pacific Islander (21.4% and 8.6%, respectively; P < 0.001) and American Indian/Alaskan Native (13.6% and 8.1%, respectively; P = 0.02)-narrowing the gap between WIC participants and nonparticipants over time.

CONCLUSIONS AND IMPLICATIONS

Annual birth certificate data provide detailed information for monitoring trends and disparities in breastfeeding initiation by prenatal WIC status. These findings can inform WIC and maternal child health program efforts to improve breastfeeding promotion for populations with low-income and racial/ethnic groups.

The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress

Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0-36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) industry to commodify the feeding of infants and young children; influence policy at both national and international levels in ways that grow and sustain CMF markets; and externalise the social, environmental, and economic costs of CMF. Second, this paper examines how breastfeeding is undermined by economic policies and systems that ignore the value of care work by women, including breastfeeding, and by the inadequacy of maternity rights protection across the world, especially for poorer women. Third, this paper presents three reasons why health systems often do not provide adequate breastfeeding protection, promotion, and support. These reasons are the gendered and biomedical power systems that deny women-centred and culturally appropriate care; the economic and ideological factors that accept, and even encourage, commercial influence and conflicts of interest; and the fiscal and economic policies that leave governments with insufficient funds to adequately protect, promote, and support breastfeeding. We outline six sets of wide-ranging social, political, and economic reforms required to overcome these deeply embedded commercial and structural barriers to breastfeeding.

A Quasi-Experimental Assessment of the Effect of the 2009 WIC Food Package Revisions on Breastfeeding Outcomes

Breastfeeding rates among infants participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are consistently lower than those of WIC nonparticipants. The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias. We used novel data from the Feeding Infants and Toddlers Survey from 2008 and 2016. We defined our treatment group as infants eligible for WIC based on household income and our control group as infants in households with incomes just above the WIC eligibility threshold. The breastfeeding outcomes we analyzed were whether the infants were ever breastfed, breastfed through 6 months, and breastfed exclusively through 6 months. We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.

Racial capitalism and the US formula shortage: A policy analysis of the formula industry as a neocolonial system

The U.S. is currently experiencing a formula shortage and an infant feeding crisis that began with a formula recall and the hospitalization of 4 infants, 2 of whom died. Since 1981, governments around the world have been calling for an end to blatant human rights violations made by the commercial milk formula (CMF) industry. These practices not only involve targeting nutritionally vulnerable populations of mothers and newborns to turn a profit, but also actively undermining the implementation of policies, legislation, and regulatory oversight that might compromise their accumulation of wealth. In this paper we analyze the 2022 formula-shortage-as-infant-feeding-crisis through the lens of the history of colonialism and critical theory in the anthropology of reproduction. First, we provide an overview of the colonial roots of the formula industry from a global perspective. We then focus on how the mechanisms of racial exploitation remain entrenched in the U.S. approach to infant feeding policies, regulation and investment, setting the stage for the current infant feeding crisis. Through our analysis of the 2022 infant feeding crisis we demonstrate how the multinational CMF industry perpetuates racial capitalism and racialized health inequities and disparities through its operations as a neocolonial enterprise. Finally, we offer policy interventions and potential solutions that are grounded in structural interventions for more equitable, anticolonial, antiracist infant feeding systems.

Globalization, first-foods systems transformations and corporate power: a synthesis of literature and data on the market and political practices of the transnational baby food industry

BACKGROUND

The global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources.

RESULTS

Global milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments.

CONCLUSION

The baby food industry uses integrated market and political strategies to shape first-foods systems in ways that drive and sustain milk formula market expansion, on a global scale. Such practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. New modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.

The role of prenatal food insecurity on breastfeeding behaviors: findings from the United States pregnancy risk assessment monitoring system

BACKGROUND

In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity and breastfeeding has been explored previously, with varying results. The purpose of this study was to determine the relationship between prenatal food insecurity and breastfeeding initiation and early cessation (< 10 weeks) among U.S. mothers.

METHODS

Data were pooled from 2012 to 2013 (Phase 7) of the Pregnancy Risk Assessment Monitoring System, a population-based cross-sectional survey of postpartum women administered 2-4 months after delivery. The analytic sample was drawn from Colorado, Maine, New Mexico, Oregon, Pennsylvania, and Vermont, and limited to mothers aged 20 years and older whose infants were alive and living with them at the time of the survey (n = 10,159). We used binomial and multinomial logistic models to assess the predictive association between food insecurity and breastfeeding initiation and early cessation, respectively, while controlling for confounders.

RESULTS

Most women reported prenatal food security (90.5%) and breastfeeding initiation (91.0%). Of those who initiated breastfeeding, 72.7% breastfed for > 10 weeks. A larger proportion of food secure women compared to food insecure women, initiated breastfeeding (91.4% vs. 87.6%, P < 0.01), and patterns of early breastfeeding cessation differed significantly between the two groups (P < 0.01). In the final models, prenatal food insecurity was not associated with breastfeeding initiation or early cessation, with one exception. Compared to food secure mothers, mothers reporting food insecurity had a lower risk of breastfeeding for 4-6 weeks than for > 10 weeks, independent of covariates (relative risk ratio 0.65; 95% CI 0.50, 0.85; P < 0.01). Women who were married, had a college degree, and did not smoke were more likely to initiate breastfeeding and breastfeed for a longer time, regardless of food security status (P < 0.01).

CONCLUSIONS

Socioeconomic, psychosocial, and physiological factors explain the association between prenatal food insecurity and breastfeeding outcomes among this U.S.

SAMPLE

More targeted and effective interventions and policies are needed to encourage the initiation and duration of breastfeeding, regardless of food security status.

Advances in Infant Formula Science

Human milk contains a plethora of nutrients and bioactive components to help nourish the developing neonate and is considered the “gold standard” for early life nutrition—as befits the only food “designed” by evolution to feed human infants. Over the past decade, there is considerable evidence that highlights the “intelligence” contained in milk components that contribute to infant health beyond basic nutrition—in areas such as programming the developing microbiome and immune system and protecting against infection. Such discoveries have led to new opportunities for infant milk formula (IMF) manufacturers to refine nutritional content in order to simulate the functionality of breast milk. These include the addition of specialized protein fractions as well as fatty acid and complex carbohydrate components—all of which have mechanistic supporting evidence in terms of improving the health and nutrition of the infant. Moreover, IMF is the single most important dietary intervention whereby the human microbiome can be influenced at a crucial early stage of development. In this respect, it is expected that the complexity of IMF will continue to increase as we get a greater understanding of how it can modulate microbiota development (including the development of probiotics, prebiotics, and synbiotics) and influence long-term health. This review provides a scientific evaluation of key features of importance to infant nutrition, including differences in milk composition and emerging “humanized” ingredients.

Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme

OBJECTIVE

To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme.

DESIGN

Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ 2 tests and logistic regression were used describe the sample and explore relationships between variables.

SETTING

Loudoun County, VA, USA.

SUBJECTS

A sample of 190 predominantly Hispanic women attending local WIC clinics.

RESULTS

Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P&lt;0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months.

CONCLUSIONS

A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.

Neighborhood Disadvantage and Neighborhood Affluence: Associations with Breastfeeding Practices in Urban Areas

Objective To estimate the associations between neighborhood disadvantage and neighborhood affluence with breastfeeding practices at the time of hospital discharge, by race-ethnicity. Methods We geocoded and linked birth certificate data for 111,596 live births in New Jersey in 2006 to census tracts. We constructed indices of neighborhood disadvantage and neighborhood affluence and examined their associations with exclusive (EBF) and any breastfeeding in multilevel models, controlling for individual-level confounders. Results The associations of neighborhood disadvantage and affluence with breastfeeding practices differed by race-ethnicity. The odds of EBF decreased as neighborhood disadvantage increased for all but White women [Asian: Adjusted odds ratio (AOR) 0.82 (95% confidence interval (CI) 0.69-0.97); Black: AOR 0.77 (95% CI 0.70-0.86); Hispanic: AOR 0.78 (95% CI 0.70-0.86); White: AOR 0.99 (95% CI 0.91-1.08)]. The odds of EBF increased as neighborhood affluence increased for Hispanic [AOR 1.19 (95% CI 1.08-1.31)] and White [AOR 1.12 (95% CI 1.06-1.18)] women only. The odds of any breastfeeding decreased with increasing neighborhood disadvantage only for Hispanic women [AOR 0.85 (95% CI 0.79-0.92)], and increased for White women [AOR 1.16 (95% CI 1.07-1.26)]. The odds of any breastfeeding increased as neighborhood affluence increased for all except Hispanic women [Asian: AOR 1.31 (95% CI 1.13-1.51); Black: AOR 1.19 (95% CI 1.07-1.32); Hispanic: AOR 1.08 (95% CI 0.99-1.18); White: AOR 1.30 (95% CI 1.24-1.38)]. Conclusions Race-ethnic differences in associations between neighborhood disadvantage and affluence and breastfeeding practices at the time of hospital discharge indicate the need for specialized support to improve access to services.

Infant food applications of complex carbohydrates: Structure, synthesis, and function

Professional health bodies such as the World Health Organization (WHO), the American Academy of Pediatrics (AAP), and the U.S. Department of Health and Human Services (HHS) recommend breast milk as the sole source of food during the first year of life. This position recognizes human milk as being uniquely suited for infant nutrition. Nonetheless, most neonates in the West are fed alternatives by 6 months of age. Although inferior to human milk in most aspects, infant formulas are able to promote effective growth and development. However, while breast-fed infants feature a microbiota dominated by bifidobacteria, the bacterial flora of formula-fed infants is usually heterogeneous with comparatively lower levels of bifidobacteria. Thus, the objective of any infant food manufacturer is to prepare a product that results in a formula-fed infant developing a breast-fed infant-like microbiota. The goal of this focused review is to discuss the structure, synthesis, and function of carbohydrate additives that play a role in governing the composition of the infant microbiome and have other health benefits.

Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?

Objective

The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels.

Design

Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008–2013 and projections to 2018, using industry-sourced data.

Setting

Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.

Subjects

MF categories included total (for ages 0–36 months), infant (0–6 months), follow-up (7–12 months), toddler (13–36 months) and special (0–6 months).

Results

In 2008–2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries.

Conclusions

A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems.

Increasing breastfeeding in WIC participants: cost of formula as a motivator

OBJECTIVE

To assess the cost of infant formula, explore mothers' perceptions of formula cost, and assess whether cost influences the decision to breastfeed.

METHODS

A mixed-methodological descriptive study with survey (phase 1) and interviews (phase 2) was completed in Rhode Island Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices. Thirty non-breastfeeding mothers participated in phase 1 and 14 pregnant women participated in phase 2. Means and frequencies were calculated for phase 1. For phase 2, data were organized into matrices and thematic analysis identified key themes.

RESULTS

Non-breastfeeding mothers were spending an extra $46 a month on average in their child's fourth month on formula beyond the formula supplied by WIC. This was perceived as high, but formula cost did not influence their decision to breastfeed. For mothers intending to breastfeed, cost information was perceived as an additional motivation.

CONCLUSIONS AND IMPLICATIONS

Information on supplemental formula cost could be provided as a motivator for women intending to breastfeed. Future research should investigate how cost information could be used to support breastfeeding initiation and duration among WIC mothers.

Breastfeeding patterns in the rural community of Hilo, Hawai'i: an exploration of existing data sets

Before any breastfeeding promotion effort, an understanding of the existing breastfeeding patterns is essential. Hawai'i County is a rural, ethnically diverse, medically underserved community. The purpose of this study was to describe the breastfeeding patterns of women living in Hilo, Hawai'i. Data from several existing national, state, and local data sets were accessed to identify and describe the breastfeeding patterns of women in this community. Available breastfeeding data about women in Hilo was obtained from the Hawai'i WIC program and includes initiation, duration, exclusivity of breastfeeding, and reasons for not breastfeeding. These data were compared to data from published reports available at the county, state, and national level. The State of Hawai'i and Hilo exceed national targets for breastfeeding initiation; however, rates soon drop following delivery, and mixed feedings of infants is common. The highest percentage of mothers weaned their infants within the first four weeks postpartum. The reasons the majority of the mothers gave for weaning were tied to breastfeeding situations that are amenable to skilled lactation support (eg, milk supply issues and latch or sucking problems). While available data sets offer valuable information on the breastfeeding patterns in this rural community, there are limitations to their usefulness, primarily due to the inconsistent operational definitions of infant feeding variables used in the surveys, and the lack of availability of community level data.

The association between early childhood overweight and maternal factors

BACKGROUND

Early childhood obesity, like other health disparities, disproportionately affects low-income populations. The purpose of this study is to determine the association between maternal sociodemographic factors and child overweight and obesity in a sample of low-income Mexican Americans.

METHODS

The current study is a secondary analysis of baseline data that were collected as part of a longitudinal study of 374 children aged 12-24 months receiving Women, Infants, and Children (WIC) services in a large metropolitan area in central/south Texas.Measures used in this secondary analysis were: Measured weight and height of the child and mother to calculate weight-for-stature and BMI, respectively; maternal sociodemographic variables (age, education, marital status, employment status, and nativity); maternal acculturation level; and child breastfed status. Descriptive statistics are reported as frequencies, percentages, means, and standard deviations (SD). Chi-squared Fisher exact tests assessed differences in maternal factors by child weight (healthy weight and overweight). Odds ratios (OR), 95% confidence intervals (CI), and levels of significance are reported.

RESULTS

Of the 372 mothers, most were young (mean age 26.1 years, SD = 6.1), 47.3% had graduated high school, 33.6% were employed at the time of the study, and 72.1% were U.S. born. No significant differences were observed for the maternal factors by child weight-for-stature z-score. However, maternal BMI statistically differed by child weight. Healthy weight mothers were more likely to have healthy weight children than overweight mothers. Maternal nativity and maternal acculturation were not statistically associated with child weight in this sample of low-income Mexican Americans.

CONCLUSIONS

The findings of the current study reinforce the importance of addressing the influence of maternal sociodemographic factors on child weight, in particular, maternal weight. A more comprehensive investigation of ecological factors' influence on obesity onset and control in young Mexican-American children is needed.

Factors associated with breastfeeding duration among Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants

This retrospective study aimed to identify factors associated with breastfeeding duration among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) of Hartford, Connecticut. The authors included mothers whose children were younger than 5 years and had stopped breastfeeding (N = 155). Women who had planned their pregnancies were twice as likely as those who did not plan them to breastfeed for more than 6 months (odds ratio, 2.15; 95% confidence interval, 1.00-4.64). One additional year of maternal age was associated with a 9% increase on the likelihood of breastfeeding for more than 6 months (odds ratio, 1.09; 95% confidence interval, 1.02-1.17). Time in the United States was inversely associated with the likelihood of breastfeeding for more than 6 months (odds ratio, 0.96; 95% confidence interval, 0.92-0.99). Return to work, sore nipples, lack of access to breast pumps, and free formula provided by WIC were identified as breastfeeding barriers. Findings can help WIC improve its breastfeeding promotion efforts.

Breastfeeding and WIC enrollment in the Nurse Family Partnership Program

OBJECTIVE

Recent studies have raised the issue of lower breastfeeding rates for mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). We wanted to explore this association of WIC and lower breastfeeding in Nurse Family Partnership Program (NFP), a national representative group of mother-baby pairs on which extensive background data are available. Our aim was to compare breastfeeding rates at 6 and 12 months in NFP high-risk mothers who were enrolled in WIC to those who were not enrolled in WIC.

METHODS

We conducted a retrospective secondary analysis in mothers and infants from this cohort for 2000-2005 (n = 3,570).

RESULTS

We found that at 6 months of age, 87.8% of mothers who were not breastfeeding were enrolled in WIC as compared to 82.6% of mothers who were breastfeeding (p < 0.001). However, in the multivariate analysis, WIC was no longer a significant predictor of breastfeeding.

CONCLUSIONS

Prospective evaluation of this issue is warranted particularly with the implementation of changes in the WIC Food Package and Breastfeeding Promotion.

Marketing breastfeeding--reversing corporate influence on infant feeding practices

Breast milk is the gold standard for infant nutrition and the only necessary food for the first 6 months of an infant's life. Infant formula is deficient and inferior to breast milk in meeting infants' nutritional needs. The infant formula industry has contributed to low rates of breastfeeding through various methods of marketing and advertising infant formula. Today, in New York City, although the majority of mothers initiate breastfeeding (approximately 85%), a minority of infants is breastfed exclusively at 8 weeks postpartum (approximately 25%). The article reviews the practices of the formula industry and the impact of these practices. It then presents the strategic approach taken by the NYC Department of Health and Mental Hygiene and its partners to change hospital practices and educate health care providers and the public on the benefits of breast milk, and provides lessons learned from these efforts to make breastfeeding the normative and usual method of infant feeding in New York City.

Breastfeeding patterns in a community of Native Hawaiian mothers participating in WIC

Although Hawaii has high breastfeeding initiation rates (89%), Native Hawaiian WIC participants have much lower initiation (64%) rates. Little is known about why these disparities occur. The study's aim was to describe the breastfeeding patterns of Hawaiian/part-Hawaiian women enrolled in the WIC who had initiated breastfeeding. Retrospective descriptive data (N=200) were gathered from WIC records. Descriptive and parametric statistics with univariate and multivariate analysis of breastfeeding patterns were completed. Mothers exclusively breastfeeding at initiation weaned significantly later and were significantly more likely to breastfeed for 6 months than were mothers who partially breastfed. Practice and policy implications of these findings are discussed.

Child feeding and human rights

Background

The human right to adequate food needs to be interpreted for the special case of young children because they are vulnerable, others make the choices for them, and their diets are not diverse. There are many public policy issues relating to child feeding.

Discussion

The core of the debate lies in differences in views on the merits of infant formula. In contexts in which there is strong evidence and a clear consensus that the use of formula would be seriously dangerous, it might be sensible to adopt rules limiting its use. However, until there is broad consensus on this point, the best universal rule would be to rely on informed choice by mothers, with their having a clearly recognized right to objective and consistent information on the risks of using different feeding methods in their particular local circumstances.

Summary

The obligation of the state to assure that mothers are well informed should be viewed as part of its broader obligation to establish social conditions that facilitate sound child feeding practices. This means that mothers should not be compelled to feed in particular ways by the state, but rather the state should assure that mothers are supported and enabled to make good feeding choices.

Thus, children should be viewed as having the right to be breastfed, not in the sense that the mother is obligated to breastfeed the child, but in the sense that no one may interfere with the mother's right to breastfeed the child. Breastfeeding should be viewed as the right of the mother and child together.