Doubts raised over WHO’s ‘exclusive breastfeeding’ advice

A breastfeeding mother

The world health organisation, WHO in 2001 setout a recommendation on infant feeding, describing breastfeeding as an unequalled way of providing ideal food for the healthy growth and development of infants, and an integral part of the reproductive process with important implications for the health of mothers.

“As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health,” the world health body said.

It added: “Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.”

However, the WHO had some reservations on exclusive breastfeeding in instances where a few medical conditions exist, but added that unrestricted exclusive breastfeeding results in ample milk production as well.

Contradictions

Nonetheless, nearly 10 years after the recommendation was laid down by the WHO, a Report said to be “controversial” argued that “exclusive breastfeeding for six months may put babies off some foods and increase their risk of allergies, obesity and iron deficiency.”

The study, published in the British Medical Journal in January 2011, raises serious questions about the Government’s advice to hold off giving babies any solid food until they are six months old.

Mamadou Edrisa Njie - News & Report

Concerns

Leaving ordinary people around the world wondering if exclusive breastfeeding is the best for their new born babies or whether the reverse is the case.

“You cannot understand which is which,” Mamadou Edrisa Njie, a Gambian journalist who has paid heed to the worldwide acceptable recommendation of the WHO said in reaction to the new study.

“After six months of exclusive breastfeeding, it took my son almost one month before he accepts the introduction of other solid foods, I was a bit discouraged and to some extent regretted why I adopted the six-month goal.”

Njie, who is a Senior Staff Writer for The Gambia News and Report Weekly Magazine, added: “Now things are ok, my son seems to be enjoying the introduction of other foods along with the breast-milk.”

Little scrutiny

The new study, whose authors include Professor Alan Lukas, director of the largest child and nutrition research centre in Europe, and Professor Ian Booth, an expert in pediatrics and child health at Edinburgh University, was conducted in the United Kingdom.

According to them, the decision to adopt the six months goal, after a WHO recommendation in 2001, underwent “surprisingly little scrutiny” in the UK. And that 65 percent of European countries and the United States did not fully adopt the advice, if at all; hence, they are now calling for a review of the guidance.

UNICEF’s stance

The United Nations Children Fund, UNICEF is a strong advocate of prolonged breastfeeding around the world. In fact, it has partnered with the WHO, governments and other organisations to promote the cause of prolonged breastfeeding.

In August 2010 during a press conference on (World Breastfeeding Week August 1-7), its Deputy Representative in The Gambia and Officer-in-Charge Dr. Meritxell Relaòo, said: “Exclusive breastfeeding for at least six months is one of the most powerful and cheap instrument to fight child diseases.”

The campaign to get parents to practice exclusive breastfeeding has been going on in The Gambia over the years, an advice rural mothers are paying more heed to than their urban contemporaries, or at least, that was what we were told.

Dr. Relaòo added: “exclusive breastfeeding plays an integral part in providing the necessary nutritional requirements for babies and infants for the first 6 months and when coupled with appropriate complementary foods after six months, it continues to make a significant contribution to the child’s healthy growth, physical and mental health development while lowering the incidence and degree of child diseases.”

A month earlier, precisely in July 2010, a new study conducted in the United States of America gave strong backing to the WHO recommendation on exclusive breastfeeding.

But the authors’ of the “controversial report” maintain that they are not disputing the benefits of breastfeeding, but wholeheartedly support it alongside the timely introduction of other food.

Mixed evidence

As per their research, they said the WHO recommendation “rested largely” on a review of 16 studies, including seven from developing countries, where infants are at much higher risk of infection.

While this concluded that babies just given breast milk for six months had fewer illnesses and experienced no growth problems, the experts said a review of another 33 studies found “no compelling evidence” against starting solids from four months onwards.

In fact, they argued that some research has shown purely breastfeeding for so long does not give infants all the nutrition they need. One US study found it leaves children at greater risk of anemia, which can permanently damage their development.

“There is also mixed evidence on whether children who live on breast milk for six months are at greater risk of allergies. Researchers in Sweden found the incidence of early onset celiac disease increased after a recommendation to delay introduction of gluten until six months, “and it fell to previous levels after the recommendation reverted to four months,” the authors said.

They later added: “There are also relatively unexplored concerns about the potential for prolonged exclusive breastfeeding to reduce the window for introducing new tastes. Bitter tastes, in particular, may be important in the later acceptance of green leafy vegetables, which may potentially affect the later food preferences with influence on health outcomes such as obesity.”

They noted that most parents already make a judgment on the right time to wean their children based on their behaviour, with a UK survey in 2005 showing just 1% limit their diet to breastmilk for six months. Scotland has poor breastfeeding rates overall, with almost three-quarters of babies drinking infant formula by eight weeks.

The Author - Modou S. Joof

Feeling of failure

Dr. Mary Fewtrell is a consultant paediatrician at University College London’s Institute of Child Health and the lead author on the report. She was quoted to have said: “To make mothers feel they have failed because they have not reached this six-month target, particularly when it is not solidly evidence-based, is simply wrong.”

“I think we should be more honest with parents as to what evidence we have. At any other development stage of a baby’s life we do not expect them to achieve it at the same time. Why this should be seen in a different way, I do not know.”