The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) are continuing to push for legal restrictions on how infant formula and breast-milk substitutes are marketed, after they found that an estimated 78 million newborns are not being breastfed within their first hour of life. That’s three out of five babies globally, according to a new report, and the lag is putting their health – and even lives – at risk.

The report is being released less than a month after the United States shocked delegates at the World Health Assembly, when it reportedly tried to kill a resolution that encourages breastfeeding. In dramatic fashion, according to news reports, U.S. representatives pushed against regulations on misleading or false marketing of breast-milk substitutes – some say to uphold the interests of a $70 billion infant formula industry. In the end, the resolution was passed (when initiated by the Russians), but without any measures to monitor or enforce “inappropriate” marketing.

Prior studies have found that newborns who begin breastfeeding two to 23 hours after birth are at a 33 percent higher risk of dying than those who are breastfed within the first hour. If a baby isn’t breastfed until 24 hours after birth or later, their risk of dying becomes twice as high.

Even if babies aren’t exclusively breastfed, doing so within the first hour of life (“early initiation”) positively impacts their survival rate. That’s because breast milk in the initial days after birth is exceptionally rich in nutrients and antibodies that serve as a baby’s first “vaccine.” Delaying, therefore, also puts them at a higher risk of infection.

According to the new report, Eastern and Southern Africa has the highest rate of early initiation of breastfeeding (65 percent). East Asia and the Pacific has the lowest at 32 percent.

Most of the newborns who are not being breastfed within their first hour of life are in low- and middle-income countries; but most of the babies that are being breastfed within the first hour are also in low- and middle-income countries. That’s because the report found a gaping hole in data on high-income countries. Of the 76 countries examined, only three – Oman, Barbados and Uruguay – were high-income.

Unlike many low- and middle-income countries that conduct household surveys every four or five years, most high-income countries are not collecting breastfeeding data according to standard global indicators, like initiation within the first hour of life. Therefore, the report says, it’s not possible to report the early initiation rate of newborns in high-income countries.

However, it does say that 21 percent of children in high-income countries – or 2.6 million children – are never breastfed, compared to 4 percent of children in low- and middle-income countries.

“…Each year, millions of newborns miss out on the benefits of early breastfeeding and the reasons – all too often – are things we can change,” UNICEF Executive Director Henrietta Fore said in a press release.

Those things, according to the new report, include inadequate quality of care to mothers and newborns, an increase in elective caesarean sections (“C-sections”), and feeding newborns food or drinks.

Despite more births taking place in health facilities than ever before, the report says that many babies are still being separated from their mothers immediately after birth, because health workers are not receiving sufficient guidance. But, for example, when Serbia made a concerted effort to improve the quality of care mothers receive at birth, early initiation rates increased by 43 percentage points from 2010 to 2014.

C-sections have also increased globally from an average of 13 percent in 2005 to more than 20 percent in 2017, according to the report. But studies have found that babies are far less likely to receive immediate skin-to-skin contact or early initiation of breastfeeding if they are delivered by C-section. In Egypt, for example, only 19 percent of infants born by C-section were breastfed in their first hour of life, compared to 39 percent of naturally-delivered babies.

It is also common practice in many places to discard breast milk from the first few days after birth or to feed newborns other substances, like honey, sugar water or infant formula. But babies who are fed breast milk exclusively are twice as likely to be breastfed in the first hour after birth, according to the report. By feeding newborns substitutes, their initial contact with their mothers is often delayed, depriving them of breast milk when it is most beneficial – even critical – to their health.

That’s why the WHO, UNICEF and many others are pushing for stronger restrictions on how infant formula and other breast-milk substitutes are being marketed. It’s impacting 78 million newborn babies – including in the U.S.

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