Communicating about environmental risks and infant feeding.

Breastfeeding as a media subject is both sexy and emotional. Sometimes the news media extol the many well-documented benefits of breastfeeding. But on the subject of environmental toxins in mother's milk, newspapers and television frequently sensationalize the degree of threat. "Babies in Poison Peril from Breastfeeding" or "Scientists Find Deadly Toxins in Mothers' Milk" are typical headlines on the subject. (1) Media reports seldom stress that it is not mothers who are poisoning their babies but chemical companies and identifiable industrial processes. Rarely cited are studies that indicate the levels of toxins found in breastmilk are falling. (2)

Media reports can have a direct impact on policy and on breastfeeding women. An article in the Bangladesh Observer stated, "With new information on the hazards of breastfeeding and the link between dioxins and cancer, it may be necessary to review our position on advocating breastmilk." (3) Bangladesh has an infant mortality rate of 69.68 per 1000 live births; (4) any decline in breastfeeding would significantly increase that rate. Reports about toxins in the breastmilk of Inuit women in Canada left some women frightened and desperate. One mother decided to stop nursing in an effort to protect her new baby; after several weeks of being bottle-fed a mixture of water and Coffee-mate, the baby was hospitalized. (5)

Hazards in infant formula, which is marketed as the best alternative to breastmilk, are rarely publicized by the media. Just to give one example, clinical evidence provided by medical research shows cause for concern about the dangers of nitrates in water used to reconstitute infant formula. (6) In the face of commercial interests that benefit from casting doubts on breastfeeding, accurate reporting about the risks and benefits of all forms of infant feeding is essential.

To understand the accumulating and often contradictory evidence on breastfeeding and environmental toxins and to consider what messages should be communicated to women about this evidence, I reviewed the medical, social science and advocacy literature on the topic. The scientific research indicates that everyone, not only breastfeeding women, carries a body burden of toxic chemicals. All babies, not just breastfed ones, are exposed pre-and post-natally. Breastmilk is often used by medical researchers as a gauge of human exposure to environmental toxins not because it is "more toxic" than other substances such as urine or blood, but because breastmilk fat is more easily and cheaply obtained for testing (7) and because the "fat soluble pollutants are likely to be found in higher concentrations in milk than in blood or urine." (8)

Some of the most exhaustive studies of toxic contaminants in breastmilk have been done in the Netherlands where the population has been exposed to the heaviest industrial pollution in Europe. (9) The work of Rogan and colleagues in North Carolina represents a second cluster of thorough studies. (10) PCBs, dioxins, pesticides, phthalates, and heavy metals have been found in samples of breastmilk from some women. The long-term effects of contamination are not yet known, but the evidence suggests that no adverse effects on growth or occurrences of illnesses in the first year of life are attributable to the presence of these chemicals in human milk, except in the case of extreme levels of contamination as in accidental industrial spills. One of the most authoritative reference texts on this subject, Chemical Compounds in Human Milk, concludes: "Virtually all national and international expert committees have hitherto concluded--on the basis of available information--that the benefits of breastfeeding outweigh the possible risks from contaminants present in human milk at normal levels." (11)

How can accurate information about risks and infant feeding be communicated to the media and to breastfeeding women? By placing the issue in a broader environmental health context. The following principles might serve as guidelines for coalitions of breastfeeding advocates, health advocates and environmentalists who want to work together to send clear and accurate messages to the public:

* Acknowledge what is known about contaminants in breastmilk.

* Stress prenatal exposure as contributing to the body burden of all babies, not just breastfed babies.

* Identify the source of the pollution (chemical industries), not the source of evidence (breastmilk).

* Stress the risks associated with artificial breastmilk substitutes and the risks of not breastfeeding.

* Draw attention to alternatives to toxic products, not alternatives to breastmilk.

Women have the right to know the milk they produce is as pure as it can be. Only by reducing environmental pollution can this right become a reality.

Notes

(1.) The Geneva Infant Feeding Association collected headlines from North American and European newspapers between 1980-2000.

(2.) Levels of toxins in breastmilk in European women fell by about 35% between 1988 and 1994. From World Alliance for Breastfeeding Action, Breastfeeding: Nature's Way (brochure, Penang, Malaysia, 1997).

(3.) Bangladesh Observer, Sept 13, 1989.

(4.) M.R. Dowling, "The Interactive Table of World Nations and Infant Mortality, 2000." On-line at http://www.mrdowling.com/800infantmortality.html

(5.) T. Colborn, D. Dumanoski and J. Myers, Our Stolen Future (New York: Plume, 1996) p. 108.

(6.) Lietuvos rytas (Lithuania) Nov 14, 2001.

(7.) A. Jensen and S. Slorach, Chemical Contaminants in Human Milk (Boca Raton: CRC Press, 1991) p. 22.

(8.) E. Pellizzari, et al., "Purgeable organic compounds in mother's milk." Bulletin of Environmental Contamination and Toxicology 28 (1982): 322-328.

(9.) For example, C. Koopman-Esseboom, et al., "Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants' mental and psychomotor development." Pediatrics 97(1996): 700-706; M. Huisman, et al., "Neurological condition in 18-month-old children perinatally exposed to polychlorinated biphenyls and dioxins." Early Human Development 43 (1995): 165-176; Weisglas-Kuperus, et al., "Immunologic effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children." Environmental Health Perspectives 108 (2000): 1203-7; Women in Europe for a Common Future (WECF), Women and POPs: Women's View and Role Regarding the Elimination of POPs. Report on the Activities of the IPEN's Women's Group (Utrecht, Netherlands, 1999) pp. 11-12.

(10.) W. Rogan, "Pollutants in breast milk." Archives of Pediatric and Adolescent Medicine 150 (1996): 981-990.

(11.) Jensen and Slorach, op cit., p. 246.

Penny Van Esterik's book, Risks, Rights and Regulation: Communicating about Risks and Infant Feeding (2002) is available from the World Alliance for Breastfeeding Action (e- mail: [e-mail]) and on-line as a discussion paper from:

National Network on Environments

and Women's Health York

University, 4700 Keele Street,

Suite 214 York Lanes

Toronto, ON, Canada M3J 1P3

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The author is a Professor of Anthropology at York University (Toronto, Canada) and a member of the World Alliance for Breastfeeding Action (WABA) and the National Network on Environments and Women's Health. Reprinted from The Centres of Excellence for Women's Health, Research Bulletin, Spring 2003 (Volume 3, Number 2). For more information, visit the website http://www.cewhcesf.ca/