By Christine Gross-Loh
Issue 122, January/February 2004
How should breastfeeding advocates respond to media coverage that undermines breastfeeding? In our bottle-feeding culture, any negative news about breastmilk leads many women away from breastfeeding, comments Marsha Walker, RN, IBCLC. "Each time something happens that hits the newspaper, we start getting these mothers calling in with these questions, and they're concerned about feeding their babies breastmilk. It is very difficult for them to sort through this information. We have to work through it until I know [the mother] understands what I'm talking about. I walk her through why [she should breastfeed]. This takes time, this is a clinician's time, and what happens is not all clinicians have the time or understand. Other women don't even call in, they just feed their babies formula and don't make changes in their own lifestyles to reduce their own body burden." The way in which the issue of breastmilk and chemical contaminants is portrayed is particularly crucial; many believe that it could have a huge impact on a woman's decision to breastfeed.
Environmentalists and breastfeeding advocates are passionately opinionated about chemical contaminants in breastmilk. While breastfeeding advocates fear that media misrepresentation leads many mothers to stop breastfeeding, environmentalists have wondered if breastfeeding advocates are not concerned enough about the very real problem of toxic body burden. Efforts have been made to reach common ground via meetings involving representatives of both interests. Some of these meetings have resulted in accord and renewed resolve to work together. A joint statement in January 2002 by the World Alliance for Breastfeeding Action (WABA) and the International POPs Elimination Network (IPEN) declared that both groups "share a common concern: Toxic chemicals are contaminating our children. . . . We recognize the need to promote breastfeeding while we work towards ending the contamination of our communities"1
How exactly can this be achieved? Can the concerns of these two organizations coexist? New challenges will arise in the near future, making it especially vital that advocates be armed with information and avenues of action. Biomonitoring technology has improved in the last few years, making it easier and less costly to do, and there will be much more new research focusing attention on the purity of breastmilk. Centers for Disease Control and Prevention (CDC) grants are providing five laboratories across the US with the funding for lab enhancements to carry out biomonitoring, which would likely include the biomonitoring of breastmilk. In addition, the CDC's own ongoing biomonitoring program is raising interest among communities and states that want to do their own biomonitoring, and the United Nations will be setting up a global monitoring program to assess the progress of bans once the Stockholm Convention is implemented, says Sharyle Patton, director of the Health and Environmental Program at Commonweal, an environmental group based in northern California.
Several recent studies have specifically focused on flame retardants (PBDEs) in breastmilk. One of them, a study by the Environmental Working Group (EWG), shows that American women have 10 to 100 times more PBDEs in their bodies than European women do. Sonya Lunder of the EWG says, "The alarming levels of fire retardants in American women's breastmilk make us realize that the US and Europe have two vastly different policies toward chemical safety. The EU chooses to monitor for pollution in people and takes precautionary action when they detect a problem. In the US, we are just starting to monitor for chemicals that accumulate in our bodies, and we are not yet using this information to protect our children's health." All of the women in this study received the results of their PBDE levels through individual counseling, and all chose to continue to breastfeed.
A bill in California sponsored by Senator Deborah Ortiz, the Breast Cancer Fund, and Commonweal proposes a multifold way for the biomonitoring of breastmilk to take place within a community support network. Subjects of the study would have immediate contact with educated health professionals, who could help them assess the information about their body burdens.
In other words, these groups are working to "develop some pilot project that does [biomonitoring] the right way so that it's fully integrated into the community, with the idea that they want to support and encourage breastfeeding," according to Sharyle Patton of Commonweal. If breastmilk monitoring is inevitable, this might provide one template for a way to do it "right."
But how inevitable is it to test breastmilk? Is it necessary to include breastmilk in biomonitoring efforts? Urine, semen, blood, and other bodily fluids can be tested. But the main reason breastmilk is used is because the persistent organic pollutants that researchers are concerned with are fat-soluble. Detecting them requires high volumes of easily obtained body tissue that is high in fat, and breastmilk fits that description. Otherwise, says Dr. Ruth Lawrence, author of Breastfeeding: A Guide for the Medical Profession, "you would have to do a fat biopsy. This is not an issue of contaminants in breastmilk, but an issue of the fact that the easiest way to measure contaminants is through the use of breastmilk." Dr. Lawrence says that breastmilk sampling has been standardized to account for variabilities in breastmilk fat levels. Sharyle Patton notes, "There's a protocol for monitoring breastmilk. It's easier to monitor than blood, and some chemicals show up more in breastmilk than in blood."
Others agree. Sonya Lunder of the Environmental Working Group notes that for advocacy groups such as hers, breastmilk is easier to test. Dr. Gina Solomon of the Natural Resources Defense Council also believes a breastmilk monitoring program would be beneficial: "A good breastmilk monitoring program would be a way to decrease the chances that serious contamination problems creep up on us. Bans on many of the persistent, bioaccumulative chemicals have resulted in clear decreases in levels of these chemicals in countries where we have time-trend data. That shows that bans, phase-outs, and other regulatory strategies do work." Solomon believes that a good breastmilk monitoring program would give us the information we need to identify the chemicals showing up in our bodies and to devise strategies to eliminate or reduce their use.
But Marsha Walker is skeptical that breastfeeding rates will not be adversely affected by the biomonitoring of breastmilk, no matter what preventive measures are put in place. "Why insist on using breastmilk? It is just one more unnecessary barrier to breastfeeding." Walker is concerned about the California legislation's specific focus on breastmilk as the target of biomonitoring. Marian Tompson, one of the founders of La Leche League, shares Walker's concerns. "Environmentalists use breastmilk as a red flag to gain attention, but the fact of the matter is that in doing so they are making a lot of women decide not to breastfeed their babies. . . . Sometimes breastmilk is easier to use [for testing] and is not as invasive, but it is also used to create attention about this pure food being contaminated." Dr. Lawrence also comments, "the Environmental Protection Agency has chosen human milk as the marker of environmental contaminants in the general population. We are concerned because it will be viewed that human milk is contaminated." These concerns are valid, for newspapers have so often headlined toxins in breastmilk rather than chemical contamination.
Clearly, biomonitoring is a touchy subject, and there are no easy answers. However, given that it is rapidly becoming a key element in many current and planned research projects, breastfeeding and environmental advocates might now consider turning their attention to strategizing how to maximize the benefits of this information and prevent damage. "The message needs to be," says Sandra Steingraber, author of Having Faith: An Ecologist's Journey to Motherhood, "that we need to move immediately to divorce our economy from any toxic chemical known to accumulate in mothers' milk."
The Importance of Language
Much of the friction between breastfeeding and environmental activists could be ameliorated if particular attention were paid to the way in which the issue is framed. This is not about contaminated breastmilk; it is about contaminated bodies, about the body burden each of us carries. The key issue, states Kristin Schafer, program coordinator at Pesticide Action Network, "is how you talk about chemicals in breastmilk. . . .It is important that people understand the issue is not chemicals in breastmilk but the chemicals in our bodies, men and women, that reflect poor public health choices." Even recommendations for ways in which women can make lifestyle choices to reduce their body burdens can sound offensive, somehow implying that a woman is responsible for how this problem affects her family, when "it shouldn't have to be the woman's responsibility to avoid these chemicals. The release of those chemicals should be banned," says Schafer. Some experts, such as Dr. Cheston Berlin, University Professor of Pediatrics at Penn State University College of Medicine, find even the word contaminant to be problematic and misleading. "Contaminant implies an adverse reaction would occur if you come into contact with it. We have a paucity of data" that this happens, he states.
The important point is that pollution, not breastfeeding, must be stopped at its source. But breastfeeding is vulnerable. Formula companies experiment with new ingredients such as tropical oils or DHA, implying that breastmilk can be imitated. Advisories that breastmilk be supplemented by iron or vitamin D imply that it is somehow deficient. Mothers who nurse their children past infancy are the object of media scrutiny and sometimes even ridicule. Recently, a major national magazine included breastfeeding in a list of "time-wasting rules to break." Until there is a shift in this societal attitude, breastfeeding will be under fire. Rather than discussing the benefits of breastfeeding, perhaps a more frank discussion of the risks of not breastfeeding-the risks associated with using formula-should be the focus of future advocacy.
Breastfeeding should not have to prove itself-not breastfeeding is the choice that needs explaining. Similarly, the chemical burdens our bodies bear are not our responsibility; this polluting of our bodies was not done with our consent. When she participated in a biomonitoring study led by the Mt. Sinai School of Medicine, Sharyle Patton of Commonweal discovered that her body contained high levels of dioxin, PCBs, and other contaminants. She states, "If someone threw paint on my car, I would have legal recourse. No one asked me if they could use my body as a toxic waste dump."
Dr. Lawrence finds it ironic that the media highlights stories about contaminants in breastmilk, even though it is prenatal exposure to these chemicals that has been found to be damaging. She notes that a study released earlier in 2003, showing 20- to 106-fold increases for flame retardants in maternal and fetal cord blood-essentially, prenatal exposures-was not picked up by the media.2
Marian Tompson reminds us that women should keep in mind that all the studies that demonstrate the benefits of breastfeeding-the myriad ways it protects mother and baby-were done on contaminated breastmilk. There are many safeguards built into mothers' milk that are yet unknown. Tompson says, "You really can't compare the contaminant level in human milk to the contaminant level in formula. Breastmilk is a live fluid. Formula is a dead food." The benefits a baby receives from the food his body was made to grow on are immeasurable, and Tompson believes "it is breastmilk and the process of breastfeeding that might best help a baby deal with the impact of envi-ronmental contaminants." Breastfeeding helps our babies be resilient.
No one is more certain of that than a mother who has received information about her own body burden and still has chosen to breastfeed. Angela Strother-Akhtar, mom to eight-month-old Graceanna, was one of 20 mothers whose breastmilk was tested in the Environmental Working Group study. Her level of flame retardants was the fifth highest of the women tested. Still, she is "dead convinced" that she is doing the right thing by continuing to breastfeed her daughter. As a mother, though, she finds the results upsetting. "It makes me angry that there are other things we can use as fire retardants. Europe has banned PBDEs and we haven't. If we can make people hear what's going on, we can simply switch over to things that are less detrimental to our bodies."
Of course, Strother-Akhtar has complicated feelings about the findings. "It's mostly an emotional issue because you want your baby's health to be perfect, do anything you can to give this new innocent baby the best in life." She has experienced anger that she leads a health-conscious lifestyle and yet has no control over the chemicals found in her body. She has channeled her anger into action, staying aware of and informed about environmental health issues.
The most important action Strother-Akhtar takes-a powerful message for us all to heed-is to continue to breastfeed her daughter, buffering her against environmental toxins. "As a mother, it makes you feel empowered, because you have this great tool that you can use," she says. "The one thing about being a mother that has made me feel most successful is being able to breastfeed."
All quotations in this sidebar are from interviews held between July and September 2003.
1. World Alliance for Breastfeeding Action Call for Endorsement, www.waba.org.br/ipen.htm.
2. Anita Mazdai et al., "Polybrominated Diphenyl Ethers in Maternal and Fetal Blood Sample," Environmental Health Perspectives 111 (2003): 1249-1252.