Protecting Lactation in a Time of Climate Change and Accelerating Emergencies 

A perspective by Cecília Tomori

A third of Pakistan is under water after historic floods have hit the country. Puerto Rico, which is still recovering from the terrible effects of Hurricane Maria, lost electricity and safe drinking water from Hurricane Fiona. While electricity has been restored in some parts of the island, many still face outages and shortages of diesel fuel used to run generators. After years of disinvestment and neglect, a few weeks ago in August the main water treatment plant failed following heavy rains in the predominantly Black city of Jackson, Mississippi, leaving 180,000 people without safe drinking water.  

People around the globe are increasingly aware that global warming, driven by human use of fossil fuels, is driving an acceleration of these disasters. Drought, wildfires, extreme storms and new infectious disease threats are some of the hallmarks of climate change that endanger human life and threaten ecosystem collapse on Earth. However, few are aware that lactation is foundational to protecting vulnerable infants in these situations.  

Breastfeeding is a key element of emergency preparedness. Lactation entails a set of evolutionary adaptations that date back to the ancestors of mammals. Breastfeeding provides optimal nutrition and hydration, protection from disease, and is deeply interconnected with other physiological mechanisms that support physiological co-regulation between the mother and infant.  Each year, over 800,000 infants die globally because they are not appropriately breastfed – initiating breastfeeding within the first hour, exclusive breastfeeding for 6 months, and continued breastfeeding with complementary foods to 2 years and beyond as desired. Maternal health also suffers with close to 100,000 dying annually from breast and ovarian cancers and Type II diabetes. 

These crucial physiological foundations provide the foundations of health for infants and young children each day. But during emergencies, their protective effects are even more pronounced. When electricity is out and backup systems may be damaged, water treatment plants can fail. In many emergencies there is simply no safe water. And that means parents cannot prepare commercial milk formula (CMF) safely, nor can they keep bottles and nipples clean. This opens up new pathways for dangerous infections for the infant or young child who are fed CMF. Supply chains are also affected in emergencies, which may lead to insufficient CMF or dilution of the product, once again leading to malnutrition, disease and death. Therefore, keeping lactating mothers and infants together, and protecting breastfeeding during emergencies saves lives. Additionally, resources for skilled lactation support and safe infant and young child feeding practices must be allocated to ensure the safety of all infants.  

To address the acceleration of emergencies, however, it is not enough to protect breastfeeding in a moment of acute crisis. A resilient infant feeding system requires prioritizing lactation each day. Unfortunately, lactation is threatened by inadequate governmental support for breastfeeding,  unethical marketing practices and corporate political activity of the CMF industry, which has led to policies that favor industry interests and has established it as a normative standard for health professionals. Without adequate understanding of the value of lactation or training in how to support it, health professionals are vulnerable to misleading marketing that often arrives under the guise of science and via affiliations with health professional associations. And without policies that eliminate predatory marketing practices, parents around the world continue to receive misleading information from targeted advertisements – increasingly in the digital space – that undermines breastfeeding.  

Worse, the roots of CMF industry practices are deep and inequitable from the start. They are entangled in colonial practices of exploitation. Despite considerable public attention in the 1970s and 1980s to predatory marketing by Nestlé in the Global South that led to the development and adoption of the WHO International Code of Marketing of Breast-Milk Substitutes by the World Health Assembly in 1981, the CMF industry continued these practices and grew even more powerful.  

Indeed, the consequences of this system are on display today in the recent and still ongoing US CMF crisis. The crisis was triggered after multiple deaths and severe illness of infants from CMF contaminated with Cronobacter forced Abbott Nutrition to shut down its Sturgis, Michigan plant, which produces approximately a fifth of the US CMF supply. Investigations have uncovered a long history of prioritizing profits over safety and industry efforts to weaken regulation that could have prevented these harms.  

Importantly, each of these emergencies disproportionately affects marginalized communities globally – who are disproportionately Black and Brown. This is hardly a coincidence. This mirrors the pathways of colonial power relationships. Even though Pakistan consumes a fraction of fossil fuels compared to the US, its people bear the burden of the floods, including the risks of disease to their infants. Indeed, Pakistan’s Ministry of Health already had to issue a statement to discourage donations of CMF during the floods. These donations aim to cast CMF companies in a positive, humanitarian light, but put infants in emergency situations at grave risk. Similarly, Black, Indigenous, and Latinx families in the US who have experienced systemic, structural racism, targeted CMF marketing, and inadequate lactation support in health systems, have primarily bore the intersecting burdens of the CMF and unsafe water crises this summer.   

It is crucial that we position lactation at the center of plans to address climate change and climate justice. We must invite communities who have been directly impacted by historical, racial oppression and exploitation that have disrupted intergenerational knowledge and traditions of lactation. Policies must address both resources and acute crisis situations, as well as the fundamental inequities of a system that continually fails to provide sufficient investment in supporting lactation globally. Scaling up equitable, comprehensive support in health systems and workplaces – including paid leave – and across all sectors of society is needed to achieve this transformation.