Infant feeding in the Third World.

During the last decade a great deal of scientific research has helped to establish the biological value of human breast milk. Starting with the nutrient and anti-infective properties we have now come to realise that breast milk is a live substance carrying at least two different populations of living cells each with a distinct biological property of its own (Ogra & Ogra, 1978). Furthermore, the mother's milk contains substances which influence a number of physiological functions in the infant including the endocrine metabolic responses (Lucas et al., 1980) and the absorptive processes in the gut (Ebrahim, 1982, 1985). As a result many research workers now look upon breast milk not merely as a source of nourishment but also as a biological mediator of a number of functions in the newborn. In this respect the mammary gland in the human continues to provide the same sustenance and support for the newborn as the placenta does for the fetus. The paediatric profession has been quick to grasp the significance of this research and, in Britain certainly, the promotion of breast feeding has come to be an important part of paediatric care. In all the leading neonatal units in Britain early feeding of the newborn with human breast milk is now established as a significant part ofneonatal care. This is particularly so for those babies who need intensive care. Where the mother's milk is not available pooled donor milk is used for the purpose. Over the past several years a great deal of research and technological innovation have gone into the setting up of milk banks for the storage of human milk in conditions which cause the least deterioration of protective substances. Health education of the public and the formation of national bodies like the La Leche League together with changes in hospital routines have led to a marked upsurge in breast feeding. Britain today can be described as essentially a breast feeding nation. By comparison we see a different scenario in the Third World. Breast feeding has been on the decline for the past 20 years or so, and in the case of some countries drastically so (World Health Organization, 1981). 'Modernisation' has been blamed. Education of women and their entry into the labour force in increasing numbers have also been put forth as reasons. However, Sweden, Britain and the United States are all 'modernised' nations. Women play significant roles in the labour force in these countries, and are active in professional and public life. In most Western countries the educated women and those from the professional and upper classes are most likely to breast feed their babies, and also feed them for a longer period, compared to those with less education or from a working class background. How has present scientific knowledge affected the development of breast milk substitutes? It is true that infant formulae have become more safe. Conditions like idiopathic hypercalcaemia and hypernatraemia are now things of the past. Unmodified cow's milk formulae are no longer used in infant feeding, and instead low-electrolyte low-protein formulae are recommended. However safe our present day products may be, it is important to bear in mind that at any given time the quality of a baby food is as good as the science and technology at that time; also that the road to good breast milk substitutes is strewn with the tombstones of products once heralded as scientific advances and later discarded as defective or dangerous.