The first week of October marks Canadian Breastfeeding Week. Some may wonder why we need a breastfeeding week; a week for society to reflect and learn about the importance of breastfeeding. While the breastfeeding initiation rate in Canada is quite high at 87%, only 1 in 4 Canadian babies are exclusively breastfed for the recommended duration of 6 months.

Research in the US has found that most women (60%) do not meet their own breastfeeding duration goals. This is a societal problem because when women are not supported to meet their breastfeeding goals, society does not get to reap the many benefits of optimal breastfeeding. Therefore, it is fitting that the theme this year for breastfeeding week is to Empower Parents, Enable Breastfeeding. To better appreciate the importance of breastmilk and breastfeeding, it is important to understand the impact of breastfeeding - not only on the individual mother-child dyad, but also on the bacteria inhabiting the infant’s body (their microbiome), and our greater environment.

Breastfeeding, important for the infant...

Clinicians, scientists, and health care agencies all agree breastmilk is the best nutrition for a baby. The World Health Organization and the Canadian Pediatric Society recommend that infants are exclusively breastfed for 6 months and that breastfeeding is maintained until 2 years and beyond. But is breastmilk truly better than formula milk for supporting infant health outcomes?

The answer is yes, but the magnitude of difference depends on a multitude of factors including genetics, the environment, socio-economic factors, medications, length of gestation (prematurity), and method of birth. Simply put, a healthy full-term infant born vaginally with no genetic risk factors may not benefit to the same extent from breastfeeding as a premature infant requiring multiple medications and interventions, or an infant born by Cesarean section, or an infant with a genetic predisposition to chronic conditions like asthma. However, providing formula to any of these infants is not without risk. Numerous observational studies(because we cannot ethically randomize people to breastfeed or not) routinely indicate that breastfeeding protects from gastrointestinal viruses, upper respiratory tract infections and acute otitis media (ear infections) compared to formula feeding. It has been estimated that optimizing breastfeeding could prevent 823 000 child deaths per year worldwide – primarily in developing countries, although the importance of breast milk in reducing infant mortality is evident even in developed countries like Canada and the USA. Further, providing breastmilk to preterm infants can reduce the risk and severity of several complications of prematurity, which can help to decrease the length of hospitalization in the NICU and prevent long-term negative health effects.

Breastmilk, important for the microbiome...

Breastfeeding and breastmilk provide much more than calories and nutrients. Breastmilk also contains many factors that directly enhance the infant’s immune system, regulate appetite and support their gut bacteria. For example, there are special sugars in breastmilk called human milk oligosaccharides (HMOs). HMOs are the third most abundant solid component in breastmilk, yet they are completely indigestible to the infant. The primary role of HMOs is to act as a prebiotic, or food source, for beneficial bacteria in the infant’s gut, such as Bifidobacterium longum subspecies infantis (B. infantis). This bacterium is specifically adapted to proliferate in the presence of HMOs, allowing it to prevent the growth of other potentially pathogenic bacteria by crowding them out.

B. infantis and other gut bacteria (collectively known as the ‘gut microbiome’) also help train the infant immune system and produce essential vitamins, having a long-term impact on infant health and development. While there is still much to learn about what constitutes a healthy or unhealthy microbiome, we know that breastfeeding is among the most influential factors shaping this important community of ‘good bacteria’. In the Canadian CHILD Cohort Study, we are studying how different components of breastmilk shape the infant microbiome and help prevent conditions like obesity and asthma.

Breastfeeding, important for the mom...

Mothers also benefit from breastfeeding their infants. Although not a perfect method of birth control, lactational amenorrhea (lack of ovulation) occurs with exclusive and predominant breastfeeding and can be up to 98% effective in preventing pregnancy, allowing for increased birth spacing. This is important because mothers with short pregnancy intervals (less than 6 months) are more likely to have a preterm delivery and deliver a low birthweight infant.

Breastfeeding is also protective against breast cancer, offering a 4.3% reduction in risk for every 12 months that a mother breastfeeds over the course of her lifetime, and a 30%reduced risk for ovarian cancer. Protection from diabetes and cardiovascular disease has also been reported. Improvement in long-term maternal health outcomes is an important, yet often overlooked outcome of improved breastfeeding duration.

Breastfeeding, important for the environment...

Many governmental agencies have stated that breastfeeding is environmentally friendly. It is important to consider the environmental savings of breastfeeding as opposed to the environmental footprint created by formula feeding. It is estimated that more than 4000 L of water are required to produce 1 kg of powdered formula and that 86 000 tonnes of metal and 364 000 tonnes of paper end up in USA landfills annually as a result of formula packaging. Considering that the average formula-fed infant consumes about 250 litres of formula in the first year of life, this translates to about 36 cans of powdered formula per infant, per year requiring 144,000 litres of water to produce and generating many tonnes of waste. In contrast, a breastfeeding mother consumes about 3 litres of water per day, which amounts to just 1,095 litres of water to feed one breastfed infant per year. Breastfeeding is an environmentally friendly feeding method that does not require transport, packaging or intensive resources to produce.

Read more in this editorial: Support for breastfeeding is an environmental imperative

Breastfeeding, important for society...

For individual families, the cost of formula feeding is approximately $1700 per year, but there are much greater costs to society when the health impacts are considered. A cost analysis of common childhood infectious diseases that can be prevented through breastfeeding (gastroenteritis, respiratory tract infections, and acute otitis media) found that a 10% increase in exclusive breastfeeding until 6 months and sustained breastfeeding until 1 year could save the US healthcare system $312 million per year.

Guest writers: Dr. Meghan Azad & Dr. Merilee (Meredith) Brockway

Edited by: Shreyas Kumbhare & Sharvari Narendra