Two months ago, the United States threatened to withdraw critical military aid to Ecuador and impose harsh trade measures if it didn’t get in line — actions that could destabilize the South American country’s security and economy.
What had Ecuador done to attract American ire?
It was hoping to support breastfeeding.
At the 71st World Health Assembly in late May, Ecuador planned to introduce a resolution supporting breast milk as the healthiest choice for feeding babies, and to limit the ways in which formula companies could market their goods.
Ecuador quickly withdrew the resolution in the face of the U.S. threats, which included cutting significant funding to the World Health Organization (WHO). More than a dozen countries — primarily in Latin America and Africa — also rescinded their support, the New York Times reported on Sunday. In the end, Russia stepped in to introduce the resolution, and the U.S. did not issue similar threats to its delegation. The resolution passed — albeit with language that softened its stance on formula marketing.
While the U.S. shocked the world in its staunch opposition to the bill, this move is part of a long history of corporations — and, it seems, the U.S. government — supporting profits over the health of babies in the global south.
In 1974, journalist Mike Muller wrote “The Baby Killer,” a report that rocked the public health world. He outlined how formula companies, primarily based in the U.S. and Europe and comprising a multimillion dollar industry, had aggressively pushed for caregivers in developing countries to feed babies infant formula instead of breast milk. At times, the companies’ actions verged on the unethical; Muller reported that they encouraged sales reps to dress up as nurses when they marketed the product. In particular, he highlighted the role of Nestlé, the Swiss multinational formula company, in changing the way many babies were fed.
As a result, Muller wrote, babies were dying. Rates of chronic diseases like obesity and diabetes skyrocketed across the global south, while malnutrition and infections like diarrhea and pneumonia became more common — and resulted in a rising death toll. Stephen Joseph, once an official with the United States Agency for International Development (USAID), told the New York Times in 1981 that formula was the cause of one million infant deaths every year in the developing world because of malnutrition and diarrhea.
Many parents who switched from breastfeeding to formula lacked access to clean water or refrigeration, leading to a precipitous rise in infections. And many who couldn’t afford enough formula watered it down to make each tin last longer, reducing its nutritional value.
The benefits of breast milk, on the other hand, have been confirmed by research over the past several decades. Breastfed babies are less vulnerable than formula-fed babies to illnesses such as diarrhea, ear infections, and pneumonia, and they are less likely to develop asthma, diabetes, or obesity. Furthermore, breastfeeding can provide children with an immunological boost, which is especially important when families face barriers to medical support and a lack of immunizations. In fact, a Lancet study recently found that supporting breastfeeding could save the lives of more than 800,000 children every year.
In response to the baby formula scandal, the WHO introduced a code in 1981 on limiting the marketing of formula. The U.S. was the only country to vote against the measure. U.S. officials said that outlawing or limiting formula marketing would impinge on free speech; two high-level USAID employees — including Joseph — subsequently resigned in protest. Breastfeeding advocates argued that the opposition stemmed from a cozy relationship with formula companies.
In a tweet on Monday afternoon, President Donald J. Trump did not deny that the U.S. sought to undermine the resolution. Rather, Trump — who previously called a breastfeeding mother “disgusting” — implied that offering support to parents who want to breastfeed is akin to limiting access to formula.
His statement runs counter to decades of research — from the negative health effects of formula outlined above to the steep costs of formula. Shaming a parent’s choice not to breastfeed is a real and important issue to address, advocates say — but that’s not what this is about. Supporting breastfeeding is not the same as denying access to formula.
The Trump administration has positioned itself as particularly friendly to corporations, but the U.S. has a long history of siding with industry over public health, especially internationally. In 1999, Guatemala was considering a ban on infant formula because Gerber flouted its laws on advertising. The Clinton administration responded with trade threats, and Guatemala dropped the idea. The Obama administration fought to expand protections for pharmaceutical companies in the developing world — including negotiating for peace and for Novartis simultaneously in Colombia. More recently, the Trump administration attempted to use NAFTA negotiations to cut back on warning labels about the health dangers of junk food.
This conversation about breastfeeding signals, yet again, that the U.S. is willing to depart from multinational agreements and scientific consensus around the world — from trade agreements to the Paris Agreement on Climate Change.
Although the resolution was, in the end, supported, the U.S. sent a powerful message that could set back decades of progress on child health. Countries dependent on U.S. aid are likely to proceed with caution now when it comes to providing breastfeeding support. And formula companies will likely renew their international marketing efforts with the backing of one of the most powerful countries in the world.
