Some truths are laced with tension. Commercial milk formula food, part of the multibillion-dollar baby food industry, are seen as economic growth planks, worthy of resource and recognition. It is another matter that the formula feeding frenzy is also linked to poor child and maternal health; it generates around 11-14 kilograms of greenhouse gas emissions (more than that of eggs, poultry, and vegetables combined); and uses more than 5,000 litres of water during its life cycle. In contrast, breastmilk is economically valuable, leaves a low carbon footprint, and is essential for well-being. Breastfeeding women nourish half the world’s infants and young children. No country, however, accounts for this care work in their GDP figures or national budgets.
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A new challenge mounts against this exclusion. Global health researchers propose to recognise the simple fact that women contribute to sustainable food production, and breastfeeding infrastructures deserve to be invested in as ‘carbon offsets’. This radical reframing benefits not only “the populations in developing countries most burdened by the harms of the commercial milk formula industry”, but also acknowledges “the value of women’s breastfeeding efforts for mitigating greenhouse gas emissions”.
The proposal
The report is part of a special issue of the Bulletin of the WHO. The research was led by Julie Smith from the Australian National University, and published in collaboration with Alive & Thrive at FHI 360 Global Nutrition, the University of Sydney, Munster Technological University, Auckland University of Technology, and the WHO.
The contention is two-fold. One, commercial milk formulas are a maladaptive practice in the context of emerging population and environmental crises. In contrast, breastfeeding is a renewable, economical and an B environmentally friendly natural resource, often neglected in sustainable food production and climate change. The current GDP-growth-based paradigm and food security statistics fail to account for the economic value of breastfeeding women in producing “vast quantities of highly valuable breastmilk”. Globally, 21.9 billion litres of human milk is annually lost because governments fail to invest in supporting breastfeeding. Breastfeeding is valued resourced but still under-valued, a dissonance the authors note in their proposal. “Caring for and nourishing children, including breastfeeding, is highly gendered work that is often ignored and under-valued economically,” co-author hPhillip Baker said..
Two, adequate recognition and resources through international climate change financing “can support new public investments in breastfeeding as a carbon offset, with significant gains and co-benefits for women’s, children’s and planetary health”.
The United Nations Clean Development Mechanism (CDM) allows lower-middle-income countries to avail financing by high-income countries for new policies and programmes to generate offsets to carbon emissions. The authors argue that the CDM could be a “potential platform” for recognising breastfeeding as a carbon offset. Policies such as funding skilled birth attendance, maternity care, and social protections like paid maternity leave would support higher breastfeeding rates, while also redirecting financial resources away from carbon-emitting activities.
Breastfeeding, they note, is a timely illustration of how “current thinking and systems undervalue what matters, inequitably distort investment priorities and strengthen commercial drivers of health...”
The beef with breastfeeding substitutes
Research over the years hint at the conservative ecological costs of breastfeeding substitutes. Producing a commercial milk formula requires industry dairy farming for milk production, milk processing, formula manufacturing, transport, packaging, and electricity to heat the milk at a particular temperature. One estimate showed the average water footprint of milk powder is roughly 4700 L/kg6 (the equivalent of almost 140 showers). A 2016 study found emissions from this industry were equivalent to six billion miles of car travel. Water, waste and methane have shaped the prosperous commercial milk formula industry.
The social and health implications were flagged earlier. A boom in milk formula sales in emerging middle-income countries like India was associated with a decline in breastfeeding, a lack of maternity protection for breastfeeding, unregulated company marketing of baby foods and inadequate support of breastfeeding by health services. The WHO recommends newborns are breastfed within the first hour of birth; exclusively breastfed for the first four to six months, and continue to receive breastmilk for up to two years of age. However, less than half of newborns worldwide are breastfed within an hour of birth, and only 44% are exclusively breastfed from birth to six months, according to a working paper by the National Bureau of Economic Research. The same analysis found that increased marketing of formulas such as Nestle’s in LMICs “was correlated with a substantial reduction in breastfeeding”. This, in turn, has had a negative impact on infants’ health, studies show.
Commercial milk formulas have a rich history going back to the 19th century; they rose as an alternative to meet the nutrition requirements of infants who could not be breastfed. Today, more than half of the world’s children receive heavily marketed breastmilk substitutes in their first six months of life. Others receive follow-up formulas and “growing up” milk -- products considered unnecessary by the WHO.
In India, popular breastmilk substitutes include Lactogen, Cerelac, Nestle, Farex, Dexolac and Similac. The milk substitutes market in India is projected to grow by 18.19% between 2024 and 2028, according to the latest CAGR report.
Breastfeeding and the link to sustainable food infrastructures
Breastfeeding is a natural, renewable resource, and also the “most economical and environmentally friendly way to feed an infant and young child, producing zero garbage, minimal greenhouse gases, and tiny water footprint”, according to the advocacy group Geneva Infant Feeding Association. It is better for the environment even if breastfeeding mothers eat and drink more. A BMJ study showed that exclusive breastfeeding for six months saves an estimated 95-153 kg CO2 equivalent per baby compared with formula feeding. Other economic benefits are derived from the associated infant and maternal health outcomes; nutrition in the early stages of life produces healthier outcomes that use fewer health course resources. Exclusive breastfeeding is a “child’s first immunisation”, the WHO notes, against respiratory infections, obesity, diarrhoeal disease, and other potentially life-threatening ailments.
Conversely, a lack of breastfeeding support is linked to increased disease prevalence in women and children, adding to the healthcare cost and deepening the caregiver burden, according to Roger Mathisen, Alive & Thrive East Asia Pacific Director. In the long run, it also betrays the need for a gender-just transition to sustainable development.
The authors propose a gender lens to build sustainable food infrastructures -- scaffoldings critical in reducing disease burdens and greenhouse gas emissions and increasing nutrition and health. The first step? To consider breastfeeding as the “highest quality, local, sustainable first-food system for generations to come”.
“Governments need to better recognise women’s contributions to sustainable food production, including breastmilk, in international and national food balance sheets,” they wrote, batting to alleviate the economic burden and making seen an “invisible form of investment”.
This consideration must seep within the systems of value and measurement adhered to in the international order. New metrics, such as Mothers’ Milk Tool, are being developed to measure the economic contribution of breastfeeding mothers. In India, the annual production of breast milk amounts to $873,755; 14% of milk volume is lost in all three years due to lack of investment.
Considering breastfeeding as a carbon offset could also divert funds from commercial milk formula markets to environments where women operate. Research by urban studies scholar Divya Ravindranath showed the challenges daily wage labourers faced at construction sites in Ahmedabad: women negotiated with surveillance at workplaces, nature of work, quality of alternative care and domestic work, sapping their time and energy to provide exclusive breastfeeding. Investments in this sector could put in place creche services closer to the workplace and “support new public investments” yielding “significant gains and co-benefits for women’s, children’s and planetary health”.
“Considering breastfeeding as a carbon offset isn’t about coercion or shifting climate change responsibility,” said co-author Aoife Long from Munster Technological University. “It’s about directing funds to governments recognising the environmental impact of commercial milk formula markets, facilitating a gender-just transition to sustainable development, and creating an enabling environment for women who wish to breastfeed.”
