Breastfeeding a 'Major Public Health Issue,' Israel's Pediatricians Say, Urging Breast Milk Over Formula

Breastfeeding should be top priority for doctors, says Israel Pediatrics Association, citing its clear advantages over baby formula

A baby breastfeeding.
Lihi Amitsur Lubel

Doctors should do their utmost to encourage breastfeeding and avoid either suggesting that parents stop it or promoting the use of baby formula, according to a new position paper issued by the Israel Pediatrics Association that calls breastfeeding a “major public health issue.”

In the paper, which is expected to be presented at the association’s annual conference on Wednesday, the group calls on doctors to provide an environment that supports breastfeeding in hospitals and clinics, and to actively promote nursing during pregnancy and after birth.

The document is rather strident and uncompromising with regard to the necessity of breastfeeding and its contribution to infant health, although there is already a clear preference in Israel for breastfeeding in the early months. Guidelines issued in recent years by the Health Ministry restrict the distribution of formula samples to new mothers in hospitals.

According to the document, 88 percent of the babies born in Israel are breastfed exclusively right after birth. By the time the babies are two months old, however, only 50 percent are still nursed exclusively and by six months the rate drops to 20 percent. The paper notes that the sharpest drop in nursing comes during the first month. “Active support for nursing by medical staff has proven to contribute to a significant rise in breastfeeding rates,” the paper says.

Declarations about the importance of nursing aren’t enough, the association says; there must be active encouragement, and difficulties with nursing must be addressed immediately. “Breastfeeding is a major public health issue, and must be defined as one of the objectives of the medical staff treating the child,” the paper says.

The paper states that there are almost no situations that contraindicate breastfeeding. The few such instances include if the mother is an HIV or AIDs carrier; if she is undergoing chemotherapy or being treated with radioactive iodine. Nursing might need to be stopped temporarily if the mother has active tuberculosis, brucellosis or breast lesions originating from herpes.

But breast infections or pain, being a carrier of hepatitis B or C, or even smoking or drug use are not necessarily reasons to stop nursing, because the benefits to the baby generally outweigh the risks, the doctors say. The paper does, however, recommend timing the smoking to minimize its impact on the mother’s milk, and leaves it to physicians to determine whether the drugs the mother is using could be harmful. The doctors also recommend that mothers who go back to work continue to feed their babies mother’s milk exclusively by pumping and storing their milk.

Regarding baby formula, the doctors write that formulas “do not contain the antibodies and other active immune components that are present in breast milk,” and that “the fats from which brain cells are built are different in formula than in breast milk, and there is reduced cognitive development in formula-fed babies.” Giving formula periodically even while nursing “reduces the amount of milk produced by the mother and harms the baby’s microbiome and his immune defenses,” the paper states.