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© 2004 American Public Health Association
LETTER |
Correspondence: Requests for reprints should be sent to Jacqueline H. Wolf, PhD, Department of Social Medicine, Ohio University, Athens, OH 45710 (e-mail: wolfj1{at}ohio.edu).
I agree with Grandjean and Jensen that supporters of breastfeeding must address the environmental pollutants contaminating human milk. Feeding babies should be a risk-free venture, which is why the American propensity to formula-feed is so troubling. We need to solve this international public health problem. However, limiting infants’ exposure to human milk is no solution.
Formula—which increases children’s rates of respiratory, gastrointestinal, and middle ear infections, as well as meningitis, allergies, asthma, obesity, diabetes, leukemia, lowered IQ, and sudden infant death syndrome (SIDS)1—is not contamination-free either. Lead levels in milk-based formula are higher than those in breast milk.2 Although some colostrum samples have higher levels of mercury than formula, mature breast milk has levels of mercury equal to or lower than those of formula.3 And while heavy metal–contaminated formula may be relatively chemical-free, the water it is mixed with is not.4
Recently, the Technical Workshop on Human Milk Surveillance and Research for Environmental Chemicals in the United States concluded that research overwhelmingly supports the value of breastfeeding and that there has been no clinical or epidemiological demonstration of adverse effects of consumption of human milk containing background levels of environmental chemicals. If there is risk, its nature and magnitude are unclear. Thus the workshop’s expert panel took care to emphasize that current research should not have a negative impact on breastfeeding.5 Besides, few mothers know what contaminants are in their breastmilk and at what levels. If women make the decision to formula-feed when there are so many unknowns, there will be increased infant morbidity and mortality rather than improved infant health.
An obvious solution to the problem of contaminated human milk does exist. Surveys taken by the Mothers’ Milk Centre in Stockholm, Sweden, which has monitored human milk for more than 30 years, show that when persistent organic pollutants are banned, their levels in breastmilk fall quickly.6 Studies in other countries corroborate this.7,8 Similarly, restricting dioxin emissions in Europe has produced cleaner breastmilk there.9
Weighing the risks of feeding babies formula versus the risks of feeding babies contaminated human milk poses an intolerable dilemma. As ecologist Sandra Steingraber argues, the contamination of human milk violates a basic human right: the right of children to attain maximum health.10 Indeed, the contamination of mothers’ milk should make environmental activists of us all.
References
1. Wolf JH. Low breastfeeding rates and public health in the United States. Am J Public Health. 2003;93:2000–2010.
2. Gundacker C, Pietschnig B, Wittman KJ, et al. Lead and mercury in breast milk. Pediatrics. 2002;110:873–878.
3. Drasch G, Aigner S, Roider G, Staiger F, Lipowsky G. Mercury in human colostrum and early breast milk: its dependence on dental amalgam and other factors. J Trace Elem Med Biol. 1998;12:23–27.[Web of Science][Medline]
4. Houlihan J, Wiles R. Into the Mouths of Babes: Bottle-Fed Infants at Risk from Atrazine in Tap Water. Washington, DC: Environmental Working Group; 1999. Also available at: http://www.ewg.org/issues/risk_assessment/20030303/index.php. Accessed April 19, 2004.
5. Berlin CM jr, LaKind JS, Sonawane BR, et al. Conclusions, research needs, and recommendations of the expert panel: technical workshop on human milk surveillance and research for environmental chemicals in the United States. J Toxicol Environ Health A. 2002;65:1929–1935.[Web of Science][Medline]
6. Noren K, Meironyte D. Certain organochlorine and organobromine contaminants in Swedish human milk in perspective of past 20–30 years. Chemosphere. 2000; 40: 1111–1123.[Medline]
7. Craan AG, Haines DA. Twenty-five years of surveillance for contaminants in human breast milk. Arch Environ Contam Toxicol. 1998;35:702–710.[Web of Science][Medline]
8. Solomon GM, Weiss PM. Chemical contaminants in breast milk: time trends and regional variability. Environ Health Perspect. 2002;110:A339–A347.[Web of Science][Medline]
9. Buckley-Golder D et al. Compilation of EU Dioxin Exposure and Health Data: Summary Report. Abingdon, Oxfordshire, United Kingdom: AEA Technology; 1999. Available at: http://europe.eu.int/comm/environment/dioxin/summary.pdf (PDF file). Accessed March 13, 2004.
10. Steingraber S. To breastfeed or not to breastfeed is not the question: why risk-benefit analysis is the wrong way to look at the problem of breast milk contamination. The Ribbon. 2003;8:4–5.
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