The Importance of Breastfeeding Then and Now: A Response to U.S. Threats Against Ecuador Over Their Resolution Supporting Breastfeeding

Jacqueline H. Wolf

For every 100 infants born in the United States in 1900, 13 died before their first birthday. More than half of the babies who died, died of diarrhea. Physicians and public health officials recognized, and widely publicized, the cause. In the late 19th– and early-20thcenturies, feeding babies cows’ milk-based infant food, what we now call “formula,” was a deadly practice. Public health posters, circulated nationwide by municipal health departments, advertised that fact. “Mother’s Milk for Mother’s Babe Cow’s Milk for Calves” implored one particularly popular poster. “To Lessen Baby Deaths Let Us Have More Mother-Fed Babies.”

The American dairy industry was largely unregulated before 1930. Milk, shipped in large, open vats, took up to 72 hours to travel in unrefrigerated railroad cars from rural dairy farmer to urban consumer. By the time the milk reached its destination, it was spoiled and greying. To whiten the milk, shippers and merchants often threw handfuls of powdered chalk, and worse, into the vats.

Beginning in the 1890s, urban newspapers heralded what they dubbed “the milk wars,” to urge states to pass legislation regulating the shipping and sale of milk. Headlines about the progress of these “wars” dominated newspapers for the next 30 years. The Chicago Tribune wrote of cows’ milk: “It is worse than fraud…[and] play[s] no small part in this colossal crime of infanticide.”

I recalled this history when news broke that the United States had threatened Ecuador with trade sanctions and the withdrawal of military aid after Ecuador sponsored what they thought was an uncontroversial resolution at the World Health Assembly to “protect, promote, and support breastfeeding.” Breastfeeding is especially important in developing countries where populations still contend with unclean water that can be life-threatening to formula-fed infants. But human milk is more than just a sanitary food – it is a living substance that contains antibodies, beneficial bacteria, oligosaccharides and countless other bioactive factors not found in formula. In all countries, breastfeeding prevents respiratory and gastro-intestinal infections among infants and lowers the incidence among older children of obesity, type 1 and type 2 diabetes, allergic diseases and cancer. In 2016, scientists writing for the Lancet estimated that universal breastfeeding would prevent 800,000 children’s deaths and yield $300 billion in health care savings annually.

We should all be grateful that cows’ milk, and therefore cows’-milk-based formula, is safer than it was a century ago. But because human milk is essential to short- and long-term human health, infant formula should be used only when mothers are unable to breastfeed, for whatever reason. In other words, the formula industry should not be a growth industry. Rather than protect formula companies at the expense of the health and life of the world’s children, the U.S. government should join the rest of the world in a full-throated endorsement of societal supports for breastfeeding, the most effective way to ensure that every child lives a healthy, long life.

Jacqueline H. Wolf is a professor of the history of medicine in the Department of Social Medicine at the Ohio University Heritage College of Osteopathic Medicine and the author of Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19thand 20thCenturies and, most recently, Cesarean Section: An American History of Risk, Technology and ConsequenceThe opinions expressed in this piece are her own.

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