Abstract
BackgroundIncreased global demand for imported breast milk substitutes (infant formula, follow-on formula and toddler milks) in Asia, particularly China, and food safety recalls have led to shortages of these products in high income countries. At the same time, commodification and trade of expressed breast milk have fuelled debate about its regulation, cost and distribution. In many economies suboptimal rates of breastfeeding continue to be perpetuated, at least partially, because of a failure to recognise the time, labour and opportunity costs of breast milk production. To date, these issues have not figured prominently in discussions of food security. Policy responses have been piecemeal and reveal conflicts between promotion and protection of breastfeeding and a deregulated trade environment that facilitates the marketing and consumption of breast milk substitutes.DiscussionThe elements of food security are the availability, accessibility, utilization and stability of supply of nutritionally appropriate and acceptable quantities of food. These concepts have been applied to food sources for infants and young children: breastfeeding, shared breast milk and breast milk substitutes, in accordance with World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) guidelines on infant feeding. A preliminary analysis indicates that a food security framework may be used to respond appropriately to the human rights, ethical, economic and environmental sustainability issues that affect the supply and affordability of different infant foods.SummaryFood security for infants and young children is not possible without high rates of breastfeeding. Existing international and national instruments to protect, promote and support breastfeeding have not been implemented on a wide scale globally. These instruments need review to take into account the emerging trade environment that includes use of the internet, breast milk markets and globalised supply chains for breast milk substitutes. New approaches are required to handle the long-standing policy conflicts that surround infant and young child feeding. Placing breastfeeding in a food security framework may achieve the political attention and policy co-ordination required to accelerate breastfeeding rates in a range of economies.
Highlights
Increased global demand for imported breast milk substitutes in Asia, China, and food safety recalls have led to shortages of these products in high income countries
Studies of the short- and long-term health risks of inadequate breastfeeding indicate that breast milk substitutes fail to meet the objectives of the Rome Declaration on World Food Security as ‘sufficient, safe and nutritious food that meets ...dietary needs and food preferences for an active and healthy life’ ([50] p. 3)
A high rate of breastfeeding is a marker of the cultural appropriateness and utilisation of food for infants and young children, as well as its supply
Summary
Definition of food security Concepts of food security have developed from a focus on the supply of food to its current definition, established in 1996 and confirmed in the 2009 Declaration of the World Summit on Food Security convened by the Food and Agriculture Organization of the United Nations: ‘Food security exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food, which meets their dietary needs and food preferences for an active and healthy life.’ ([49] p. 1). 26) or trade opportunities, for example the export of dairy-based breast milk substitutes [132,156] These policy conflicts may entrench poor infant health outcomes worldwide and inhibit the policy development required to improve breastfeeding rates and long-term food security in both exporting and importing countries [54,157]. Concerns over the safety of shared milk obtained from unregulated sources have prompted calls for quality standards and regulation of this trade [34] For those infants whose mothers are unable to fully breastfeed them and are not eligible for banked donor milk, the challenges for health authorities and consumers are to assess and manage the risks of shared milk relative to breast milk substitutes, in terms of food safety and short- and longterm infant and maternal health [28]. The Chinese government responded to price increases for imported breast milk substitutes by tightening food regulations but it is less clear what measures were taken to improve breastfeeding rates
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