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LeDrew M, Benoit B, O'Grady K, Ustianov J, Edwards C, Gallant C, Loring S, Clément L, Aziz K, Green M, O'Sullivan P, Nickel NC. Promoting maternal-child health by increasing breastfeeding rates: a National Canadian Baby-Friendly Initiative Quality Improvement Collaborative Project. BMJ Open Qual 2024; 13:e002537. [PMID: 38232983 PMCID: PMC10806552 DOI: 10.1136/bmjoq-2023-002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024] Open
Abstract
While breastfeeding has long been an important, globally recognized aspect of population health, disparities exist across Canada. The Baby-Friendly Initiative (BFI) is a WHO/UNICEF best-practice program that helps ensure families receive evidence-based perinatal care and is associated with improved breastfeeding rates. However, <10% of hospitals in Canada are designated as 'Baby-Friendly'.The Breastfeeding Committee for Canada (BCC) aimed to increase the number of hospitals that moved towards BFI designation by implementing a National BFI Quality Improvement Collaborative Project. Key activities included (1) implementing and evaluating the BFI Project with 25 hospital teams across Canada and (2) making recommendations for scaling up BFI in Canada.As of December 2023, three hospitals in the BFI Project have attained designation and six have started the official process towards designation with the BCC. Breastfeeding initiation rates remained high and stable (>80%); however, breastfeeding exclusivity rates did not meet targets. All BFI care indicators improved across participating facilities. All skin-to-skin indicators improved, with rates of immediate and sustained skin-to-skin meeting targets of >80% for vaginal births. BFI care indicators of documented assistance and support with breastfeeding within 6 hours of birth, rooming-in and education about community supports also met target levels. Leadership buy-in, parent partner engagement and collaborative activities of workshops, webinars and mentoring with BFI Project leadership were viewed as valuable.This BFI Project demonstrated that hospitals could successfully implement Baby-Friendly practices in various Canadian settings despite challenges introduced by the COVID-19 pandemic. Indicators collected as part of this work demonstrate that delivery of Baby-Friendly care improved in participating facilities. Sustainability and scaling up BFI implementation in both hospitals and community health services across Canada through implementation of a BFI Coach Mentor Program is ongoing to enable continued progress and impact on breastfeeding and maternal-child health.
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Affiliation(s)
- Michelle LeDrew
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | - Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Kathleen O'Grady
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | | | - Candi Edwards
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | - Claire Gallant
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | - Sally Loring
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | | | - Khalid Aziz
- Office of Lifelong Learning, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Marina Green
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
| | - Pam O'Sullivan
- Breastfeeding Committee for Canada, Glen Margaret, Nova Scotia, Canada
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Yanni AE, Iakovidi S, Vasilikopoulou E, Karathanos VT. Legumes: A Vehicle for Transition to Sustainability. Nutrients 2023; 16:98. [PMID: 38201928 PMCID: PMC10780344 DOI: 10.3390/nu16010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Legumes are an excellent source of protein and have been used in the human diet for centuries. Consumption of legumes has been linked to several health benefits, including a lower risk of cardiovascular diseases, type 2 diabetes mellitus, and certain types of cancer, while legumes' high fiber content promotes digestive health. Aside from the positive health benefits, one of the most significant advantages of legumes is the low environmental footprint of their cultivation. They can be grown in a variety of climates and soil types, and they require less water and fertilizer than other crops, making them a sustainable option for farmers. Thanks to their nutritional and physicochemical properties, they are widely used by the food industry since the growing popularity of plant-based diets and the increasing demand for alternatives to meat offers the opportunity to develop legume-based meat substitutes. As the use of legumes as a source of protein becomes widespread, new market opportunities could be created for farmers and food industries, while the reduction in healthcare costs could have a potential economic impact. Achieving widespread adoption of legumes as a sustainable source of protein requires coordinated efforts by individuals, governments, and the private sector. The objective of this narrative review is to present the benefits coming from legume consumption in terms of health and environmental sustainability, and underline the importance of promoting their inclusion in the daily dietary pattern as well as their use as functional ingredients and plant-based alternatives to animal products.
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Affiliation(s)
- Amalia E. Yanni
- Laboratory of Chemistry-Biochemistry-Physical Chemistry of Foods, Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou Ave, 176-71 Athens, Greece; (S.I.); (E.V.); (V.T.K.)
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Wright KN, Melnyk AI, Emont J, Van Dis J. Sustainability in Obstetrics and Gynecology. Obstet Gynecol 2023; 142:1341-1346. [PMID: 37944151 DOI: 10.1097/aog.0000000000005435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/14/2023] [Indexed: 11/12/2023]
Abstract
Current practices in the U.S. health care industry drive climate change. This review summarizes the vast research on the negative health effects of the climate crisis on patients as relevant to obstetrics and gynecology. We further propose solutions to decarbonize operating rooms, labor and delivery units, and nurseries and neonatal intensive care units through evidence-based reduction in our single-use supply, energy, and water, as well as anesthetic gases and appropriate waste sorting.
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Affiliation(s)
- Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh, Pennsylvania; and the Department of Obstetrics and Gynecology, Columbia University Medical Center, and NewYork-Presbyterian Hospital, New York, and the Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
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O’Sullivan EJ, Kennedy A. Parents' experiences of infant and young child feeding during the COVID-19 pandemic in Ireland. Public Health Nutr 2023; 26:2652-2662. [PMID: 37905581 PMCID: PMC10755413 DOI: 10.1017/s1368980023002343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/25/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE The WHO has urged member states to develop preparedness plans for infant and young child feeding (IYCF) during emergencies. Ireland has no such plan. We aimed to identify the needs of caregivers in Ireland with regards IYCF during the COVID-19 pandemic. DESIGN Online survey conducted in May-June 2020. SETTING Ireland, during the first period of severely restricted movement due to COVID-19 (lockdown). PARTICIPANTS Respondents (n 745) were primary caregivers of a child under 2 years; they were primarily well educated and likely of higher socio-economic status. RESULTS Among those who breastfed, being unable to access breast-feeding support groups and being unable to access in-person, one-to-one breast-feeding assistance were the biggest challenges reported. Nearly three quarters of those who had their babies during lockdown reported these challenges: 72·8 % and 68·8 %, respectively. For those using formula, the main challenges were structural in nature; approximately two-thirds of those who had their baby prior to lockdown feared there would be formula shortages and a third were unable to purchase formula due to shortages. CONCLUSIONS Regardless of how their babies were fed, parents in Ireland experienced multiple challenges with infant feeding during the COVID-19 crisis. Breast-feeding should be protected, supported and promoted, particularly during an infectious disease pandemic. Additionally, assurances around supply of infant formula could reduce parental stress during a pandemic or emergency. An IYCF in emergencies plan would clearly set out how we could best support and protect the nutrition of the most vulnerable members of our population.
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Affiliation(s)
- Elizabeth J O’Sullivan
- School of Biological, Health and Sports Sciences, City Campus, Technological University Dublin, CQ312 Central Quad, Grangegorman, Dublin, Ireland
| | - Aileen Kennedy
- School of Biological, Health and Sports Sciences, City Campus, Technological University Dublin, CQ312 Central Quad, Grangegorman, Dublin, Ireland
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Ching C, Sethi V, Nguyen TT, Murira Z, Shats K, Rowel D, Ahmed K, Dorji K, Chakma I, Haag KC, Singh PP, Khatoon S, Bukhari UK, Aminee A, Ghosh S, Forissier T, Kappos K, Zambrano P, Khan GM. Law matters - assessment of country-level code implementation and sales of breastmilk substitutes in South Asia. Front Public Health 2023; 11:1176478. [PMID: 37937076 PMCID: PMC10626485 DOI: 10.3389/fpubh.2023.1176478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka). Design A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country's barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data. Findings There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries. Recommended actions include (1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women's rights jurist networks.
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Affiliation(s)
| | - Vani Sethi
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | - Zivai Murira
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | | | | | | | | | | | | | - Salma Khatoon
- UNICEF Field Office for Khyber-Pakhtunkhwa, Peshawar, Pakistan
| | | | | | - Sebanti Ghosh
- Alive & Thrive, Global Nutrition, FHI360, New Delhi, India
| | | | - Kristen Kappos
- Alive & Thrive, Global Nutrition, FHI 360, Washington, DC, United States
| | - Paul Zambrano
- Alive & Thrive, Global Nutrition, FHI 360, Manila, Philippines
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Tomori C. Protecting, promoting and supporting breastfeeding in all policies: reframing the narrative. Front Public Health 2023; 11:1149384. [PMID: 37397783 PMCID: PMC10313398 DOI: 10.3389/fpubh.2023.1149384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Recent research highlights the importance of breastfeeding to health across the lifecourse, yet inadequate investment to facilitate breastfeeding according to World Health Organization recommendations threatens to undermine breastfeeding's protective effects. Western media narratives often fail to convey the significance of breastfeeding, and such narratives can hinder efforts to direct sufficient resources to scaling up effective systems and generating policy change. Delayed action disproportionately harms poor and marginalized communities. The urgency of making these investments in an era of rapidly intensifying climate change and other crises is clear. Reframing the narrative is needed to better appreciate the significance of breastfeeding as well as to recognize and address extensive efforts of undermine it. Evidence-based scientific, health professional and media discussions are necessary to recognize breastfeeding as foundational to food and health security and to enact change so that protecting, promoting and supporting breastfeeding is integrated across all policies.
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7
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Baker P, Smith JP, Garde A, Grummer-Strawn LM, Wood B, Sen G, Hastings G, Pérez-Escamilla R, Ling CY, Rollins N, McCoy D. The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress. Lancet 2023; 401:503-524. [PMID: 36764315 DOI: 10.1016/s0140-6736(22)01933-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
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.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Julie P Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Amandine Garde
- Law & Non-Communicable Diseases Unit, School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | | | - Benjamin Wood
- Global Centre for Preventive Health and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | | | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, Geneva, Switzerland
| | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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9
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Aros-Vera F, Chertok IRA, Melnikov S. Emergency and disaster response strategies to support mother-infant dyads during COVID-19. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2021; 65:102532. [PMID: 34458086 PMCID: PMC8386097 DOI: 10.1016/j.ijdrr.2021.102532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 08/21/2021] [Indexed: 06/06/2023]
Abstract
The COVID-19 pandemic has produced an unprecedented global health crisis. Vulnerable populations, such as breastfeeding mother-infant dyads, are in a particularly delicate situation. Before, during, and after birth mothers and their infants could be exposed to the virus. Due to fear of infection transmission, there has been an increase in separation of COVID-positive mothers and their infants and a decline in breastfeeding, despite research supporting the provision of mother's milk for her infant. During this crisis, evidence-based education counseling and resources can support healthful infant feeding which is necessary for short- and long-term infant growth and development. Using a framework of disaster preparedness and response, we delineate operational guidelines and policy recommendations to support maternal-infant dyads during the COVID pandemic outbreak. Key recommendations include promotion of breastfeeding and milk expression, avoiding the use of formula, engaging healthcare providers in supporting lactation, and incorporating evidence-based breastfeeding and lactation protocols and practices in disaster preparedness and disaster response plans.
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Affiliation(s)
- Felipe Aros-Vera
- Department of Industrial and Systems Engineering, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Ilana R Azulay Chertok
- Associate Director of Nursing Research and Scholarship, Ohio University, 1 Ohio University, Athens, OH, 45701, USA
| | - Semyon Melnikov
- Department of Nursing, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Kim HS, Ashrafudoulla M, Kim BR, Mizan MFR, Jung SJ, Sadekuzzaman M, Park SH, Ha SD. The application of bacteriophage to control Cronobacter sakazakii planktonic and biofilm growth in infant formula milk. BIOFOULING 2021; 37:606-614. [PMID: 34190008 DOI: 10.1080/08927014.2021.1943741] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/26/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
The goal was to identify the biofilm-forming ability of Cronobacter sakazakii on surfaces of stainless steel (SS) and silicone rubber (SR) in contact with infant formula milk. Two representative bacteriophages (PBES04 and PBES19) were used to control the growth of C. sakazakii as well as its biofilm forming ability on either SS or SR surfaces. Bacterial growth was confirmed at 20 °C when PBES04 and PBES19 were used, whereas C. sakazakii was not normally detected in infant formula milk treated with both bacteriophages for 6 h. In an additional biofilm reduction experiment, the biofilm on SS or SR surfaces were reduced by 3.07 and 1.92 log CFU cm-2, respectively after PBES04 treatment, and 3.06 and 2.14 log CFU cm-2, respectively, after PBES19 treatment. These results demonstrate that bacteriophages can be effective in inactivating C. sakazakii in biofilms which could potentially increase food safety in commercial facilities.
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Affiliation(s)
- Hyung Suk Kim
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
| | - Md Ashrafudoulla
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
| | - Bo-Ram Kim
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
| | - Md Furkanur Rahaman Mizan
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
| | - Soo-Jin Jung
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
| | | | - Si Hong Park
- Food Science and Technology Department, Oregon State University, Corvallis, OR, USA
| | - Sang-Do Ha
- Department of Food Science and Technology, Advanced Food Safety Research Group, BrainKorea21 Plus, Chung-Ang University, South Korea
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11
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Bridge G. Consider the Whole Picture When Discussing Infant Formula and Breast Milk. J Nutr 2021; 151:1375-1377. [PMID: 34036339 DOI: 10.1093/jn/nxab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/10/2021] [Accepted: 04/16/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gemma Bridge
- Centre for Clinical Trials & Methodology, Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom
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12
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Dadhich JP, Smith JP, Iellamo A, Suleiman A. Climate Change and Infant Nutrition: Estimates of Greenhouse Gas Emissions From Milk Formula Sold in Selected Asia Pacific Countries. J Hum Lact 2021; 37:314-322. [PMID: 33586512 DOI: 10.1177/0890334421994769] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations. RESEARCH AIMS To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region. METHOD We used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012-2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines. RESULTS Annual emissions for milk formula products ranged from 3.95-4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq. CONCLUSIONS Policies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are "Triple Duty Actions" that help improve dietary quality and population health and improve the sustainability of the global food system.
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Affiliation(s)
- J P Dadhich
- 2219 Breastfeeding Promotion Network of India (BPNI), Pitampura, New Delhi, India
| | - Julie P Smith
- Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Adlina Suleiman
- 248241 Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia/ National Defence University of Malaysia
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13
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Binns CW, Lee MK, Maycock B, Torheim LE, Nanishi K, Duong DTT. Climate Change, Food Supply, and Dietary Guidelines. Annu Rev Public Health 2021; 42:233-255. [PMID: 33497266 DOI: 10.1146/annurev-publhealth-012420-105044] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Food production is affected by climate change, and, in turn, food production is responsible for 20-30% of greenhouse gases. The food system must increase output as the population increases and must meet nutrition and health needs while simultaneously assisting in achieving the Sustainable Development Goals. Good nutrition is important for combatting infection, reducing child mortality, and controlling obesity and chronic disease throughout the life course. Dietary guidelines provide advice for a healthy diet, and the main principles are now well established and compatible with sustainable development. Climate change will have a significant effect on food supply; however, with political commitment and substantial investment, projected improvements will be sufficient to provide food for the healthy diets needed to achieve the Sustainable Development Goals. Some changes will need to be made to food production, nutrient content will need monitoring, and more equitable distribution is required to meet the dietary guidelines. Increased breastfeeding rates will improve infant and adult health while helping to reduce greenhouse gases.
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Affiliation(s)
- Colin W Binns
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;
| | - Mi Kyung Lee
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia 6150, Australia;
| | - Bruce Maycock
- College of Medicine and Health, University of Exeter, Exeter EX1 2LU, United Kingdom.,Asia-Pacific Academic Consortium of Public Health (APACPH), APACPH KL Secretariat Office, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;
| | - Liv Elin Torheim
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, NO-0130 Oslo, Norway,
| | - Keiko Nanishi
- Office of International Academic Affairs, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo 113-0033, Japan;
| | - Doan Thi Thuy Duong
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Bac Tu Liem District, Hanoi 100000, Vietnam;
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Gribble K, Marinelli KA, Tomori C, Gross MS. Implications of the COVID-19 Pandemic Response for Breastfeeding, Maternal Caregiving Capacity and Infant Mental Health. J Hum Lact 2020; 36:591-603. [PMID: 32757878 DOI: 10.1177/0890334420949514] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Karleen Gribble
- 89381 School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Kathleen A Marinelli
- 12227 University of Connecticut School of Medicine, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Cecília Tomori
- 15851 Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Marielle S Gross
- 223121 Johns Hopkins Berman Institute of Bioethics, Bloomberg School of Public Health, Baltimore, MD, USA
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Hastings G, Angus K, Eadie D, Hunt K. Selling second best: how infant formula marketing works. Global Health 2020; 16:77. [PMID: 32859218 PMCID: PMC7455895 DOI: 10.1186/s12992-020-00597-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/10/2020] [Indexed: 11/12/2022] Open
Abstract
Background Despite the clear policy intent to contain it, the marketing of formula milk remains widespread, powerful and successful. This paper examines how it works. Methods The study comprised a mix of secondary analysis of business databases and qualitative interviews with marketing practitioners, some of whom had previously worked in formula marketing. Results The World Health Assembly Code aims to shield parents from unfair commercial pressures by stopping the inappropriate promotion of infant formula. In reality marketing remains widespread because some countries (e.g. the USA) have not adopted the Code, and elsewhere industry has developed follow-on and specialist milks with which they promote formula by proxy. The World Health Assembly has tried to close these loopholes by extending its Code to these products; but the marketing continues. The campaigns use emotional appeals to reach out to and build relationships with parents and especially mothers. Evocative brands give these approaches a human face. The advent of social media has made it easier to pose as the friend and supporter of parents; it is also providing companies with a rich stream of personal data with which they hone and target their campaigns. The formula industry is dominated by a small number of extremely powerful multinational corporations with the resources to buy the best global marketing expertise. Like all corporations they are governed by the fiduciary imperative which puts the pursuit of profits ahead of all other concerns. This mix of fiscal power, sophisticated marketing, and single-mindedness is causing great harm to public health. Conclusions Formula marketing is widespread and using powerful emotional techniques to sell parents a product that is vastly inferior to breast milk. There is an urgent need to update and strengthen regulation.
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Affiliation(s)
- Gerard Hastings
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK. .,L'École des Hautes Études en Santé Publique, Rennes, France.
| | - Kathryn Angus
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Douglas Eadie
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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Smith JP. A commentary on the carbon footprint of milk formula: harms to planetary health and policy implications. Int Breastfeed J 2019; 14:49. [PMID: 31798668 PMCID: PMC6882342 DOI: 10.1186/s13006-019-0243-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Infant formula requires mass production by the dairy industry, with plastic and other waste and degradation of land and waterways. Millions of babies, two thirds globally, now have milk formula, with breastfeeding in dramatic decline in Asia. Economic cost externalities and commercial incentives Economic thinking clarifies that markets are not perfect - price incentives can lead to excessive and inefficient environmental damage. Market prices paid to produce or use a commodity may not reflect its true resource costs. The ongoing global transition in infant and young child feeding (IYCF) toward milk formula use makes urgent the investigation of its environmental costs, including greenhouse gas (GHG) implications. Socially vulnerable populations are also particularly exposed to climate change risks, but have the least voice and agency. The important role of public health advocacy Few question the scale of the baby food industry, especially in major food exporting countries. Breastfeeding advocacy non-government organisations have led the investigations, and exposed the inequitable vulnerabilities. A ground-breaking study in 2016 showed emissions from just six Asia Pacific countries were equivalent to 6 billion miles of car travel. Each kilogram (kg) of milk formula generated 4 kg of (carbon dioxide (CO2) equivalent) greenhouse gas during production. Much of this was from unnecessary toddler formula. Recent research reveals that if looking at the full product lifecycle, including consumer use, GHG emissions per kg are actually three times higher than these pioneering estimates. Environment and health harms combined with economic evidence highlight the place for a strong public health response on this issue. Conclusion Formula feeding is a maladaptive practice in the face of contemporary global environmental and population health challenges. Breastfeeding protection, support and promotion helps to safeguard planetary and human health by minimising environmental harm. It is a beneficial response to concerns about disease burdens and climate change. Breastfeeding populations are more resilient in emergencies. Effective and cost-effective policies and interventions exist for increasing breastfeeding and reducing unnecessary use of formula. Implementing such measures presents a rare opportunity to both reduce the greenhouse gas problem and improve human nutrition, health, and health equity.
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Affiliation(s)
- Julie P Smith
- Research School of Population Health, Australian National University, Canberra, Australia
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Wong PD, Parkin PC, Moodie RG, Dai DWH, Maguire JL, Birken CS, Borkhoff CM. Total Breastfeeding Duration and Household Food Insecurity in Healthy Urban Children. Acad Pediatr 2019; 19:884-890. [PMID: 30831248 DOI: 10.1016/j.acap.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/24/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Health care policy positions breastfeeding as an important part of the solution to household food insecurity; however, there are critical gaps in our knowledge of the relationship between breastfeeding duration (exposure variable) and household food insecurity (outcome variable). Our objective was to examine this relationship. METHODS A cross-sectional study was conducted from 2008 to 2016 of healthy urban children (N = 3838) who were 0 to 3 years old and recruited from The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Total breastfeeding duration was collected from parent-reported questionnaires. Household food insecurity was measured using 1-item and 2-item food insecurity screens. Multivariable regression analysis was performed adjusting for prespecified covariates. RESULTS The median total breastfeeding duration was 10.5 months (interquartile range, 6.0-14.0), and 14.7% of households were food insecure. After adjusting for child characteristics (age, sex), maternal characteristics (age, ethnicity, education, employment), and family characteristics (number of children, single parent family, neighborhood equity score), there was no significant association between total breastfeeding duration and household food insecurity (odds ratio, 0.99; 95% confidence interval, 0.98-1.01). Although low-income families had an increased odds of being household food insecure (P ≤ .001), we found no significant association between total breastfeeding duration and household food insecurity at varying income levels. CONCLUSIONS We found no association between breastfeeding duration and household food insecurity, regardless of family income. Although breastfeeding is associated with improved child health outcomes and considered to be part of the solution to household food insecurity, interventions focused on social determinants may provide more promising targets for the prevention of household food insecurity.
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Affiliation(s)
- Peter D Wong
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children.
| | - Patricia C Parkin
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Rosemary G Moodie
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Division of Neonatology (RG Moodie)
| | - David W H Dai
- Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Department of Paediatrics (JL Maguire); Li Ka Shing Knowledge Institute (DWH Dai and JL Maguire), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, Faculty of Medicine (PD Wong, PC Parkin, RG Moodie, JL Maguire, and CS Birken); Joannah & Brian Lawson Centre for Child Nutrition (PC Parkin, JL Maguire, and CS Birken); Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation (PC Parkin, JL Maguire, CS Birken, and CM Borkhoff), University of Toronto; Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PD Wong, PC Parkin, JL Maguire, CS Birken, and CM Borkhoff); Sick Kids Research Institute (PD Wong, PC Parkin, CS Birken, and CM Borkhoff), Hospital for Sick Children
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Bradshaw CJA, Otto SP, Mehrabi Z, Annamalay AA, Heft-Neal S, Wagner Z, Le Souëf PN. Testing the socioeconomic and environmental determinants of better child-health outcomes in Africa: a cross-sectional study among nations. BMJ Open 2019; 9:e029968. [PMID: 31570408 PMCID: PMC6773304 DOI: 10.1136/bmjopen-2019-029968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We sought to test hypotheses regarding the principal correlates of child-health performance among African nations based on previous evidence collected at finer spatial scales. DESIGN Retrospective, cross-sectional study. SETTING All countries in Africa, excluding small-island nations. PRIMARY AND SECONDARY OUTCOME MEASURES We defined a composite child-health indicator for each country comprising the incidence of stunting, deaths from respiratory disease, deaths from diarrhoeal disease, deaths from other infectious disease and deaths from injuries for children aged under 5 years. We also compiled national-level data for Africa to test the effects of country-level water quality, air pollution, food supply, breast feeding, environmental performance, per capita wealth, healthcare investment, population density and governance quality on the child-health indicator. RESULTS Across nations, child health was lowest when water quality, improved sanitation, air quality and environmental performance were lowest. There was also an important decline in child health as household size (a proxy for population density) increased. The remaining variables had only weak effects, but in the directions we hypothesised. CONCLUSIONS These results emphasise the importance of continued investment in clean water and sanitation services, measures to improve air quality and efforts to restrict further environmental degradation, to promote the UN's Sustainable Development Goal 3 target to '… end preventable deaths of newborns and children under 5' and Goal 6 to '… ensure access to water and sanitation for all' by 2030.
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Affiliation(s)
- Corey J A Bradshaw
- Global Ecology, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Sarah P Otto
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zia Mehrabi
- Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alicia A Annamalay
- Discipline of Paediatrics, University of Western Australia, Crawley, Western Australia, Australia
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, Stanford, California, USA
| | | | - Peter N Le Souëf
- Discipline of Paediatrics, University of Western Australia, Crawley, Western Australia, Australia
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Orr SK, Dachner N, Frank L, Tarasuk V. Relation between household food insecurity and breastfeeding in Canada. CMAJ 2018; 190:E312-E319. [PMID: 29555861 PMCID: PMC5860892 DOI: 10.1503/cmaj.170880] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada. METHODS We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional hazards models and logistic regression to examine the relation between food insecurity and infant feeding practices, adjusting for sociodemographic characteristics, maternal mood disorders and diabetes mellitus. RESULTS Overall, 17% of the women reported household food insecurity, of whom 8.6% had moderate food insecurity and 2.9% had severe food insecurity (weighted percentages). After adjustment for sociodemographic factors, women with food insecurity were no less likely than others to initiate breastfeeding or provide vitamin D supplementation to their infants. Half of the women with food insecurity ceased exclusive breastfeeding by 2 months, whereas most of those with food security persisted with breastfeeding for 4 months or more. Relative to women with food security, those with marginal, moderate and severe food insecurity had significantly lower odds of exclusive breastfeeding to 4 months, but only women with moderate food insecurity had lower odds of exclusive breastfeeding to 6 months, independent of sociodemographic characteristics (odds ratio 0.60, 95% confidence interval 0.39-0.92). Adjustment for maternal mood disorder or diabetes slightly attenuated these relationships. INTERPRETATION Mothers caring for infants in food-insecure households attempted to follow infant feeding recommendations, but were less able than women with food security to sustain exclusive breastfeeding. Our findings highlight the need for more effective interventions to support food-insecure families with newborns.
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Affiliation(s)
- Sarah K Orr
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Naomi Dachner
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Lesley Frank
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Valerie Tarasuk
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
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Hurlimann T, Peña-Rosas JP, Saxena A, Zamora G, Godard B. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. PLoS One 2017; 12:e0186897. [PMID: 29073186 PMCID: PMC5658098 DOI: 10.1371/journal.pone.0186897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022] Open
Abstract
Background The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. Aim The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. Methods A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. Results The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. Discussion The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. Conclusion General ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.
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Affiliation(s)
- Thierry Hurlimann
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Abha Saxena
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Gerardo Zamora
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Béatrice Godard
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
- * E-mail:
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Ryan-Fogarty Y, Becker G, Moles R, O'Regan B. Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services. WASTE MANAGEMENT (NEW YORK, N.Y.) 2017; 61:405-414. [PMID: 28089082 DOI: 10.1016/j.wasman.2016.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/25/2016] [Accepted: 12/17/2016] [Indexed: 06/06/2023]
Abstract
Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding.
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Affiliation(s)
| | | | - Richard Moles
- Department of Chemical Sciences, University of Limerick, V94 T9PX, Ireland.
| | - Bernadette O'Regan
- Department of Chemical Sciences, University of Limerick, V94 T9PX, Ireland.
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Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway? Public Health Nutr 2016; 19:2540-50. [DOI: 10.1017/s1368980016001117] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractObjectiveThe 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.DesignDescriptive 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.SettingEighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations.SubjectsMF 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).ResultsIn 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.ConclusionsA 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.
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Abstract
This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women. Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the world's poorest women might profit. How can we improve on the present situation where everyone except the woman who donates her milk benefits? Breastfeeding is a global food production system with unsurpassed capacity to promote children's food security and maternal and child health, but it is side-lined by trade negotiators who seek instead to expand world markets for cow's milk-based formula. Regulators focus on potential risks of feeding donated human milk, rather than on health risks of exposing infants and young children to highly processed bovine milk. Similarly, policymakers aspire to provide universal health care access that may be unaffordable when two thirds of the world's children are not optimally nourished in infancy, resulting in a global double burden of infectious and chronic disease. Universal breastfeeding requires greater commitment of resources, but such investment remains lacking despite the cost effectiveness of breastfeeding protection, support and promotion in and beyond health services. Women invest substantially in breastfeeding but current policy - epitomised by the G20 approach to the 'gender gap' - fails to acknowledge the economic value of this unpaid care work. Economic incentives for mothers to optimally breastfeed are dwarfed by health system and commercial incentives promoting formula feeding and by government fiscal policies which ignore the resulting economic costs. 'The market' fails to protect breastfeeding, because market prices give the wrong signals. An economic approach to the problem of premature weaning from optimal breastfeeding may help prioritise global maternity protection as the foundation for sustainable development of human capital and labour productivity. It would remove fiscal subsidies for breast milk substitutes, tax their sale to recoup health system costs, and penalise their free supply, promotion and distribution. By removing widespread incentives for premature weaning, the resources would be available for the world to invest more in breastfeeding.
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