Unlocking the value of breastfeeding with a revolutionary approach to global health and climate action

28 Oct 2024

Feeding babies commercial formula doesn’t add up. It’s costly for caregivers, not as healthy as breastfeeding and it’s also bad for the environment.

In total, only 44% of women worldwide exclusively breastfeed their babies for the first six months of their lives, which is what the World Health Organization recommends. Data from 2016 shows that in South Africa that number drops to 32%.

Researchers say the $55-billion (R968-billion) baby formula industry’s powerful marketing has a lot to do with the low breastfeeding rates. Public health advocates have been trying to fix this for decades, ever since an exposé about the industry’s deceptive marketing in developing countries in the seventies led to a boycott of Nestlé, a major formula producer, and the creation of international guidelines to police industry advertising.

But there is a solution that could help. It’s designed to increase the number of women who breastfeed, cut back the greenhouse gas emissions that lead to global warming and get countries that produce the bulk of emissions to foot the bill.

Here’s how it would work.

Banking on carbon

The proposal, which is based on a United Nations programme, was published in the May edition of the World Health Organization Bulletin. It suggests that high-income countries — which are by far the greatest emitters of climate-changing greenhouse gas emissions — pay for clean energy projects like wind farms in lower- and middle-income countries.

In exchange, these countries would receive “credits” that help them meet their promised targets to lower their emissions and slow global warming. This type of programme is also known as “carbon offsetting”. That’s because the largest portion of emissions are carbon-based, mainly from the gas released into the air when we burn fossil fuels for energy or manufacture goods.

A third of the world’s greenhouse gases come from our food system. Baby formula is part of that. Mostly made from cow’s milk — which often is the biggest contributor of emissions from baby formula production — it is turned into powder and packaged in a factory, transported to the shop and then to the mother’s home where she uses a plastic bottle to feed the baby.

Adding breast milk to the economy

Enter Julie Smith, an economist, is based in Australia and is the lead author of the proposal. For the past 30 years, Smith has been thinking about how to get breast milk factored into gross domestic product, or GDP, which is how the international community measures the economic worth of a country.

It was in 2022, during an online meeting with the Unicef team in Nepal that she was gobsmacked by a single statistic. The number of women breastfeeding in Nepal is so high that — if you were to put a value on it — it would equal half of the country’s GDP.

One of the Unicef representatives who worked on environmental issues joked about using carbon offsetting as a way to get breast milk on to the world’s balance sheets. So she went to work.

But Smith says the proposal isn’t really about carbon pricing breast milk.

“My purpose is to get governments thinking of it as something of value,” she says. “Women invest their time, energy and skills, but governments are not investing in the necessary support systems for breastfeeding.”

As an economist, she knew that to get governments to buy into the idea, she would have to give it a monetary value.

By the numbers

Women produce 35.6-billion litres of breast milk worldwide per year, according to the Mother’s Milk Tool, which Smith helped to develop. If you put an economic value on it — which Norway does, at $100 (R1,800) a litre — it’s a resource worth more than $3.5-trillion (R61.6-trillion).

Breast milk also adds up to major health benefits. It acts as a kind of natural immunisation for babies, protecting them against illnesses like asthma, diarrhoea and diabetes. It also improves thinking skills. Healthier babies mean fewer doctor visits and a healthier future workforce, which is more productive and less of a drain on clinics and hospitals.

But because governments don’t invest in programmes that encourage breastfeeding, the world loses out on $341.3-billion (R6-trillion) worth of better health and development outcomes each year, one study found.

Companies behaving badly

Smith argues that the GDP is a flawed system that leaves out the economic contributions of unpaid work like breastfeeding, while less healthy, carbon-emitting baby formula sales make GDP numbers go up. She’s in good company. Scholars, including Nobel Prize-winning economists Joseph Stiglitz and Amartya Sen, began advocating for this 15 years ago.

Even the World Bank agrees. It estimates that every $1 (about R18) invested in boosting breastfeeding could generate $35 (R630), injecting billions into the economy.

Smith says that money could go into programmes that support breastfeeding, such as paid maternity leave and hospitals with trained staff and facilities for breastfeeding — and even to help police baby formula companies.

Researchers say that how baby formula is advertised is a big part of the reason for low breastfeeding rates. South Africa has strict laws around the advertising of formula. They prohibit marketing formula for children under 36 months and ban free samples or promotions in stores or clinics. But researchers found companies regularly ignore this and face no consequences when they violate the law.

Still, carbon offset schemes aren’t without dissenters.

Environmentalists say it encourages polluters to keep polluting, and there have been plenty of stories of carbon offset schemes gone bad. Meanwhile, getting developing countries to pay up for their climate damage hasn’t been easy. International climate finance plans like this one could be taken up by the World Bank, though it’s not clear yet how these might work.

But investing in breastfeeding, as you would in a clean energy project, seems to have major pay-offs for everyone. That is, apart from the baby formula companies. DM

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

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South Africa

Banking on carbon

Adding breast milk to the economy

By the numbers

Companies behaving badly