The World Health Organization recently proposed a new set of guidelines related to infant and young child nutrition. The proposed guidelines support and extend the rules from 1981 that limit the marketing of breast milk substitutes, or infant formulas.
In 1981, the United States was the only country that opposed these rules, and today it remains largely noncompliant with them. I strongly supported the original rules — it would be great to see the United States join virtually every other country in limiting unneeded and often unethical advertising of breast milk substitutes and related products.
But unlike in 1981, the U.S now has indicated that it may support the WHO proposed rules. By adopting these rules, the United States would send a powerful statement that the health benefits of breastfeeding are supported through national policy, as acknowledged by the surgeon general of the United States and groups such as the American Academy of Pediatrics.
There’s just one catch. The new guidelines go too far.
First, some background. The prior set of rules prohibited widespread advertising of questionable health benefits of infant formula. The rules also forbid the promotion of infant formula in hospitals via “discharge bags” and the use of cute symbols on bottles or cans of formula that might mislead consumers.
They were written to prevent for-profit marketing end-runs around efforts to support breastfeeding, without limiting access to infant formulas or leaving formula-feeding mothers feeling inferior.
And they’ve proved to work well, which isn’t surprising. Guidance on the use of these products should come from qualified health care providers, not via cute packaging and often misleading advertisements.
But the new guidelines take a big additional step. As written, they would block the marketing of whole milk for toddlers who are 1 to 3 years old. They also would strongly support the feeding of solid (weaning) foods that are homemade, as opposed to those that can be purchased at stores.
To be clear, these ideas are not unreasonable in many countries. Breastfeeding into the second and third years of life is not uncommon in some parts of the world and can have important health benefits.
But in the United States, relatively few — less than 5 percent — of mothers breastfeed after their children reach 12 months of age, and the use of whole milk or similar products for toddlers 12 months old and older is nearly universal.
The Women, Infants and Children (WIC) program and many others provide milk for toddlers, and the recent Dietary Guidelines for America support the use of milk in the population covered by these guidelines, 24 months and above. It’s reasonable to allow the marketing of these products for small children, if only to provide alternatives to soda and other inappropriate beverages.
And although homemade solid foods are great — and for many families are less expensive and healthy for their infants — they simply aren’t realistic for many U.S. parents, especially single parents and those who rely on day care.
There is no reason to automatically assume that homemade food — no matter its source or preparation — is superior to commercial products, no matter where they come from or how they’re prepared. There simply is not a reason to forbid reasonable marketing of these foods.
The U.S. government should support the new guidelines, but officials also should insist that their focus be on infant nutrition during the first year of life and on limiting unethical and harmful marketing practices related to infant nutrition, especially breast milk substitutes.
There is no need to have the guidelines extend to routinely accepted feeding practices in the United States, especially those that are not necessarily unhealthy or inappropriate. This is an important step forward, but it should not come at the expense of good nutrition.
Steven Abrams is the inaugural chair of the department of pediatrics in the Dell Medical School at The University of Texas at Austin. He is a member of a scientific advisory board for the Milk Processor Education Program and a consultant related to feeding preterm infants for Nestlé, USA.
A version of this op-ed appeared in the Austin American Statesman.
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