Global Perspectives in Breast Milk Contamination: Infectious and Toxic Hazards. (Chemical Contaminants in Breast Milk: Mini-Monograph)

Article excerpt

Breast milk is the natural and optimal food for infants. In addition to meeting nutritional needs, breast milk provides numerous immunologic, developmental, psychologic, economic, and practical advantages. It is postulated that breast-feeding may also be related to the prevention of some adult health problems such as diabetes and coronary heart disease. Malnutrition among infants and young child-n, which remains one of the most severe global public health problems, is among the main reasons that the World Health Organization (WHO) so strongly supports breast-feeding. However, WHO recognizes the wowing concern expressed by scientists, health professionals, environmentalists, and mothers about the potential risks posed by the presence of toxicants and infectious agents in breast milk. In this paper we review the main infectious hazards (tuberculosis, hepatitis B, and human immunodeficiency virus) and selected chemical hazards (tobacco, persistent contaminants) and the activities undertaken by WHO. We conclude that in cases where there is a high degree of pollution from chemical sources occurring simultaneously in a bacterially contaminated environment, the choice is not simply between polluted breast milk and risk-free substitutes. Rather, informed choice is based on assessing the known and unknown risks of artificial feeding versus the unknown, but Potential, risks of chemical contamination of breast milk. Clearly, the Possible toxicity air compounds requires further investigation. Of much greater importance, however, are effective measures to protect the environment for the entire population by controlling the use of these toxic products. Current scientific evidence does not support altering WHO's global public health recommendation of exclusive breast-feeding for 6 months followed by safe and appropriate complementary floods, with continued breast-feeding, up to 2 years of age or beyond. Key words: breast milk, chemicals, dioxins, infectious agents, hepatitis B, HIV, human immunodeficiency virus, pollutants, tuberculosis.

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Breast milk is the natural and optimal food for infants. In addition to meeting nutritional needs, breast milk provides numerous immunologic, developmental, psychologic, economic, and practical advantages (1). Appropriate feeding practices are essential for the growth, development, health, nutrition, and survival of infants and children everywhere (2). It has been postulated that breastfeeding may also be related to the prevention of some chronic diseases (e.g., diabetes, obesity) (3,4). Malnutrition among infants and young children, which remains one of the most severe global public health problems, is among the main reasons that the World Health Organization (WHO) so strongly supports breast-feeding. Malnutrition is responsible, directly or indirectly, for fully 60% of the 10.9 million deaths annually among children under 5 years of age (5).

To protect breast-feeding from commercial influences, in 1981 WHO adopted the International Code of Marketing of Breast-milk Substitutes, which is now being implemented worldwide. Together with the United Nations Children's Fund (UNICEF), in 1991 it launched the Baby-friendly Hospital Initiative so that maternity services can effectively protect, promote, and support breast-feeding. In a recent recommendation, WHO urged its member states to strengthen activities "to protect, promote and support exclusive breast-feeding for 6 months as a global public health recommendation, and to provide safe and appropriate complementary foods, with continued breast-feeding for up to 2 years of age or beyond" (6).

WHO recognizes the growing concern expressed by scientists, health professionals, environmentalists, and mothers about the potential risks posed by the presence of toxicants and infectious agents in breast milk. WHO programs dealing with chemical safety, food safety, reproductive health and research, human immunodeficiency virus (HIV)/AIDS, nutrition, vaccines and immunization, communicable diseases, and child and adolescent health and development currently address these issues. …