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UNICEF to Health Canada: Formula isn't second best

Unicef CanadaHealth Canada is currently in the process of updating its recommendations for infant feeding. As part of that process, Health Canada has solicited comments from stakeholders and the general public on its draft statement on Nutrition for Healthy Term Infants - Recommendations from Birth to Six Months through an online consultation.

The update to their recommendations come just as a number of interesting developments are taking place in infant feeding in Canada. The Canadian Pediatric Society recently called for the creation of more human milk banks in Canada. At the same time, there has been an increase in informal milk sharing in Canada and a renewed debate on the relative risks of informal breastmilk sharing versus formula feeding.

Health Canada has not taken any concrete steps towards the creation of more milk banks in Canada (although apparently one may be being opened in Quebec) and it has warned mothers against informal milk sharing while affirming its recommendation that infants that are not breastfed should be formula fed.

In light of Health Canada's consultations on infant nutrition, UNICEF took the opportunity to submit the following statement (which was shared with me via e-mail) to Health Canada affirming the fact that breast milk is the preferred food for infants and that infant formula is not the most acceptable alternative to breastmilk.

The text of the statement from Lisa Wolff at UNICEF Canada is as follows [emphasis mine]:
INFANT FEEDING AND HEALTH CANADA REVIEW (Nutrition for Healthy Term Infants)

The review by Health Canada of its 2004-2005 infant feeding recommendations, Nutrition for Healthy Term Infants, is a welcome opportunity to strengthen and clarify guidance on breastfeeding in support of the health of Canada’s children.

UNICEF Canada suggests that the process examine Canada’s compliance with the 2003 WHO/UNICEF Global Strategy on Infant Feeding to promote the optimal application of the Strategy and the supplementary Acceptable Medical Reasons for Use of Breastmilk Substitutes 2009, to ensure the most appropriate guidance for health professionals and parents and the optimal health of Canada’s children.

Context: Health Canada, together with consultative partners including the Canadian Paediatric Society and Dietitians of Canada, is undertaking a review to update its 2004-2005 infant feeding recommendations (including breast milk alternatives) for health professionals in Canada, Nutrition for Healthy Term Infants (http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php). The current Health Canada recommendations regarding the use of alternatives to breast milk state “If an infant is not breastfed, or is partially breastfed, commercial formulas are the most acceptable alternative to breast milk until 9 to 12 months of age.” The recommendations include no reference to, nor encourage the possibility of, accessing human milk from wet-nurses or human-milk banks as identified in the Global Strategy.

The Canadian Paediatric Society supports the establishment of human-milk banks but not informal access to human milk in light of medical concerns. Due to the small supply of banked breast milk in Canada, it recommends that regulated human milk be made available to pre-term, sick or hospitalized infants as a priority where mothers are unable to breastfeed (http://www.cps.ca/english/statements/N/N10-01.htm).

UNICEF’s recommendations:
The Global Strategy and the supplementary Acceptable Medical Reasons for Use of Breastmilk Substitutes 2009 promote the use of breast milk from a healthy wet-nurse or a human-milk bank as the best alternative to mother’s breast milk. Inclusion of the choice of human milk should be explicit in Health Canada’s recommendations, in principled support of the expanded banking of breast milk and because many parents are accessing it informally anyway. We suggest that:

(1) encouragement for the establishment of regulated human milk banks, and guidelines for safe wet-nursing, be strongly supported, as donor human milk from a milk bank or wet nurse is the most acceptable alternative for an infant who cannot be fed breast milk from his or her own mother, with formula as the third choice;

(2) the policy on milk banks should include in principle as a target all healthy children who cannot access their mother's own milk at all, or who have been adopted (as per the Human Milk Bank of North America stipulation, see http://www.hmbana.org/index/served), recognizing that the most common reasons for prescribing donor milk will be sick neonates, illness, prematurity, etc, and that these infants should be prioritized. As milk banks are promoted and expanded, so the prioritization criteria can also be expanded;

(3) with reference to the current Canadian recommendations that formula is the "most acceptable alternative to breast milk", this text should be changed, in line with the Global Strategy and with the Acceptable Medical Reasons for Use of Breastmilk Substitutes, which lists the conditions or reasons for recommending alternatives to breast milk. Breast milk is the best food and the preferred choice that should be recommended for all infants who do not have any of the conditions listed in this document. Similarly, the language in the current recommendation "if an infant is not breastfed..." is not appropriate. Even though the choice of feeding method is ultimately the mother's or caregiver's, the guidelines should be clearer on recommending breastfeeding as the best way to feed an infant; (See attached file: Acceptable Medical Reasons for use of BM substitutes 2009.pdf)

(4) regarding the mention of "partially breastfed" children in the current recommendations, the Global Strategy recommends exclusive breastfeeding for the first 6 months and does not support partial breastfeeding or "mixed feeding" (e.g., giving both breast milk and formula) before 6 months. The Canadian Paediatric Society has a similar recommendation of exclusive breastfeeding for 6 months. The Health Canada recommendation should more clearly reflect this. Giving formula as well as breast milk reduces the supply of breast milk the mother produces, while pumping of breast milk can help to maintain an adequate supply of breast milk even when the mother returns to work.

These recommendations from UNICEF have made a lot of breastfeeding advocates very happy. However, the real test will be whether Health Canada actually listens to and acts on the recommendations. Moving in the direction suggested by UNICEF has the potential to ensure that many more babies have access to breast milk. It also has the potential to start closing the guilt gap between "thou shalt breastfeed" and having no option but to use formula.
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Reader Comments (14)

I love this, I am from the US and I hope that we have some sort of major policy reform when it comes to breastfeeding as well. There are NO milk banks within quite a distance from where I live. I would love to see more banks most definitely.

February 7, 2011 | Unregistered CommenterMamaBennie


At the moment, the US is far ahead of Canada when it comes to milk banks. We only have one milk bank in the whole country -- in Vancouver.

February 7, 2011 | Unregistered Commenterphdinparenting

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February 7, 2011 | Unregistered CommenterLeisa Hammett

I'm impressed... Now I hope that their recommendations may come into effect.

And yes, Quebec is "looking into having a milk bank" which essentially means about 10 years of thinking about it and another 10 to maybe implement one...

February 7, 2011 | Unregistered Commenterpaxye

I love those recommendations. I shared milk with my younger sister when she had trouble getting things started with her second baby. It was just a little boost to get things moving and not use formula. It would be nice to see more support for such options so that more parents realize it can be done safely and to the benefit of their babies.

February 7, 2011 | Unregistered CommenterStephanie - Green SAHM

Thanks for saying hi Leisa!

February 7, 2011 | Unregistered Commenterphdinparenting

I live in Vancouver & due to supply issues, my midwife referred me to the BC Women's milk bank. It was great having that available, but because they don't have that many donors, we were only able to get a few bottles each time we went. Due to what I assume is a lack of funding, it was also too expensive for us to continue using. I was never able to get my milk supply up to my son's needs & still supplement with about 25-30% organic formula. I would definitely prefer to be giving him pasteurized human milk as a supplement, but at $5 for a bottle, we'd be spending about $12 a DAY to do so.

February 7, 2011 | Unregistered CommenterLisa

I live in North Van and would have loved to donate to the BC Women's milk bank but....you need to have such a large quantity before they will accept a donation and that is just not something I can pump at this time, with a baby and a 3 year old to take care of. If only they'd say "we'll take half a litre of your milk, thanks!" instead of "thou shalt not even consider bothering until you can give us three litres."

February 7, 2011 | Unregistered Commentereva

I love those recommendations. I just want to reiterate that the public can comment on this document!! And the more of us that do, the more reason they'll have to listen.

February 7, 2011 | Unregistered CommenterKrista

Eva: I understand your frustration, but I bet these types of requirements are the result of the structural and financial difficulties facing milk banks. Each bank must vet every single donor, which includes a psychological/health profile (over the phone), paperwork on mother's and baby's health, and a blood draw. The donors don't pay for their own processing, so that's a pretty significant start up cost for the bank on each new donor. That's why they have minimum first time donation requirements. If they vetted every one who wanted to give a little here and a little there and then maybe only ever donated half a liter, it would be disastrous to them, both in terms of time and money. (I have been a donor to a milk bank in the states - their minimum donation was 200 ounces for each first donation; thereafter the quantity didn't matter. I kept it in my freezer until I built up 200 oz.)

February 8, 2011 | Unregistered CommenterErin

Personally, I do not like UNICEF and am almost always displeased with their position on things. Maybe that is because I usually only come in contact with them in terms of adoption where they always do their best to stop the process. That said I am glad to see this information being put out there by them. Whether I like them or not I know they are respected and hopefully more people hearing this will take to heart what they are saying. I understand the risks of informal milk sharing. I'm not sure I would take milk from someone else for my baby. Especially a stranger. I mean my best friend? Sure. My sister? Absolutely. But a stranger? Probably not. BUT I also know why someone would choose to do that. Having regulated milk banks would be AWESOME. :)

February 9, 2011 | Unregistered CommenterUpstatemamma

I threw out litres and litres of breastmilk. I had an incredible oversupply issue at the beginning (and while preferable to the alternative, still no joke!)

Anyway, looked into donating but because I lived in Europe I'm ineligible (also can't give blood). Seems silly to me since my mom didn't feed us British beef but whatever...

None of my friends or acquaintances needed the milk (and incidentally, what an awkward question to be asking!). And while midwives and lactation consultants clearly know ladies who want milk bank access, I was told repeatedly that regulations are such that they can't exchange info.

February 10, 2011 | Unregistered CommenterMary @ Parenthood

[...] Canada gets it [...]

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