Month: August 2017

Nutrition & WASH: A Recipe for Success

In the lead-up to World Water Week, WaterAid, SHARE (Sanitation and Hygiene Applied Research for Equity) and Action Against Hunger launched a new report, “The recipe for success,” in which they discuss a key ingredient for fighting global malnutrition – WASH (water, sanitation and hygiene). The report highlights that 50% of undernutrition in children under five is associated with repeated diarrhea and infections resulting from poor WASH conditions. Additionally, poor sanitation is listed as the second leading cause of stunting worldwide.

Given the report’s findings, it is clear that poor WASH conditions can undermine access to good nutrition. A better understanding of how WASH and nutrition are linked prove critical in the fight against malnutrition.

The findings of this report are playing out around the world, but one acute example is taking place in Yemen right now. More than 60 percent of the Yemeni population faces hunger and starvation, and UNICEF estimates that the country is currently home to the worst outbreak of cholera in the world. The outbreak affects nearly all of Yemen and there have been nearly 500,000 cases of suspected cholera and about 2,000 associated deaths reported to date. Unsurprisingly, the UN Office for Coordination of Humanitarian Affairs reports that, “Malnourished children and pregnant women are at greatest risk of death as they face the “triple threat” of conflict, famine and cholera.”

Poor WASH systems and a lack of access to good nutrition, mixed with conflict, is undermining the resilience of the already vulnerable Yemeni population. This makes it harder for women and children to recover from extreme bouts of diarrhea caused by cholera. The situation is so dire that at this moment, urgent humanitarian assistance and an end to conflict in the region is needed to save lives.

The children that survive these circumstances are still at risk of suffering the long-term consequences of chronic malnutrition and stunted growth. The potential for children to attain optimal growth in life lies within the first 1,000 days between when a woman becomes pregnant and her child’s second birthday. We must ensure that even in the face of crises this period in life is protected.

This World Water Week (Aug 27 – Sept 1) is a time to refocus on the needs around water and sanitation but hopefully also a time to make policymakers aware that WASH and nutrition are connected and in-turn, so are the solutions. Just as malnutrition and poor WASH mutually reinforce bad health outcomes, promotion of good nutrition and WASH policies that work together result in healthier and more nourished communities. This means ensuring that WASH and nutrition are included in each other’s policies and plans, implementation is consistent and institutional structures are strengthened. WASH and nutrition programming that work together to mitigate the malnutrition crisis worldwide must be a priority.

Mwandwe Chileshe is a Global Program Associate at 1,000 Days and a Global Health Corps fellow. In her role at 1,000 Days, Mwandwe supports the organization’s efforts to mobilize greater resources for global nutrition by supporting the management of ICAN and participating in international coalitions. She previously led the Zambia Civil Society Scaling up Nutrition Alliance, a network that works to improve the status of nutrition in Zambia.

Guest Post: Looking to Eradicate Racial Disparities in Breastfeeding? Time to Bet on Black

In recent years, many innovative interventions have been implemented seeking to reduce the four-decades long racial disparity in breastfeeding rates. In 2011, the Surgeon General made a critical Call to Action, the National Institutes of Health and others have supported research on the topic, and many philanthropic organizations have offered generous funding to help alleviate the problem. These efforts have been key contributions to making small, incremental increases in improving African American breastfeeding rates in initiation and duration. I applaud that. But when it comes to the 6-month and 12-month exclusivity milestones, with the latter being the gold standard for infant nutrition, the gap between black and white rates still lingers at an unacceptable rate of 50%.

It’s time to Bet on Black—which is the theme for this year’s National Black Breastfeeding Week, August 25-31, celebrating its 5th anniversary this year. As researchers and other so-called experts seek to grapple with this tenacious issue—it’s time to turn to the black community for answers. Yes, the efforts of scientific research and evidence-based practices are very important, but we can’t discount the fact that these methods have only moved the needle but so far. Furthermore, for far too long, the black community has been defined by deficiencies—words such as disadvantaged are often used to describe low-income communities. But these words completely ignore the resilience, strength and experiential knowledge of communities of color. This language prevents us from turning to those most impacted as a partner in problem solving. This reeks of paternalistic models where one group seeks to “save” another, without ever acknowledging that perhaps that group has solutions to save itself but just needs to be supported to do so.

As one of the co-founders of Black Breastfeeding Week, I have also had first handf experience with betting on the black community. For the past three years, I have been a witness to community power as director of The First Food Friendly Community Initiative (3FCI), a pilot project in Detroit and Philadelphia, funded by the W. K. Kellogg Foundation. While the work was complex, the mantra was simple, “Whatever the question, the answer is in the community.”

In our project, the community is the “expert” and the only source of so-called evidence-based research we seek to use. We believe that the local residents have the experiential knowledge, the historical context and lived experience to be the best change agents for creating breastfeeding supportive communities and we are there to simply leverage that innate potential. To be clear, we do not ask the residents to execute an idea created by a researcher, public health official or other so-called authority. During the three-day training of our proprietary curriculum, residents choose and design the interventions they think will work best and then execute it as part of a paid internship opportunity that also provides job skills training.

This unique model, combining community breastfeeding support with individual job skills training, allows us to also address one of the most stubborn barriers to breastfeeding continuation in marginalized communities —social stressors. Our unique community assessment in Detroit, revealed that mothers were stressed out about jobs and how they would provide for their families. Here’s something we have definitely learned from lactation science: chronically stressed out mothers cannot successfully breastfeed.

Empowered by our trust in their ability to lead the community change, our 3FCI interns in Detroit chose to target local businesses to make commitments, display ‘Breastfeeding is Welcome Here’ signage or sign a letter of support. Of the 57 establishments targeted for their work, including restaurants, churches and child care centers, 25 agreed to sign a letter of support for breastfeeding, 20 agreed to display the 3FCI decal (including one funeral home!) within their business, 5 agreed to designate space within their facilities to allow mothers to breastfeed, and 3 agreed to also display their 3FCI certificate. That’s a powerful community presence for all—while making breastfeeding more visible where moms eat, work, play and worship. Remember, these requests to businesses came from local residents who were consumers and customers of the establishments they visited. The request to support breastfeeding came from their neighbors not strangers.

Yes, we can Bet on Black—we can turn to black communities and those from the black community for solutions for closing the breastfeeding gap. We can trust black communities and their residents to save themselves—our role is to figure out how we can offer the resources they need and get out of the way! We can change our language of lacks to a language of strength and capacity. We can all bet on black. As my co-founder, Kiddada Green, of Black Mother’s Breastfeeding Association says, “When we bet on black, we are all winning.”

Black Breastfeeding Week is a week-long, national celebration to increase awareness of breastfeeding as a key element of improving infant and maternal health outcomes in the black community. The week will feature over 60 community events and daily social media events. Get all the updates on the BBW Facebook page and on BlackBreastfeedingWeek.org.

Kimberly Seals Allers is an award-winning journalist and nationally recognized advocate for infant and maternal health. A former writer at Fortune and senior editor at Essence, she is the author of The Big Letdown—How Medicine, Big Business and Feminism Undermine Breastfeeding(St. Martin’s Press). A former Food & Community Fellow with the Institute for Agriculture and Trade Policy, Kimberly is a divorced mother of two who lives in New York. Learn more at www.KimberlySealsAllers.com and follow her on Twitter at @iamKSealsAllers.

Moving Forward Toward Constructive Dialogue

In the interest of being transparent, 1,000 Days is posting publicly the message our Executive Director, Lucy Sullivan, sent today to the co-founder of the Fed Is Best Foundation. 1,000 Days has joined over 40 other organizations to request a meeting with the co-founders of the Fed Is Best Foundation. Our hope is to engage in a constructive dialogue to discuss the concerns they have raised with respect to our nation’s infant feeding recommendations and associated health care practices.

Dear Dr. del Castillo-Hegyi,

Thank you for your message.

In the spirit of moving forward with a constructive dialogue, you have my apologies for the social media post that caused you offense. There is no benefit to divisive messages. To clarify, the comments I made were in response to this post shared by your organization, the Fed Is Best Foundation, on Facebook on February 15th, promoting the use of infant formula in Africa:

Fed Is Best Facebook Post

As I mentioned in my response to your organization’s post (captured in the screenshots that you sent me in your email and pasted here again), promoting the use of infant formula in developing countries where clean water, good sanitation and hygiene practices are often absent is deeply irresponsible.

Facebook Comment

In fact, the aggressive promotion of infant formula in sub-Saharan Africa and other impoverished parts of the world in the 1970’s led to a rise in infant deaths and horrific cases of malnutrition. This became an international scandal when the UK charity War on Want published their ground-breaking report “The Baby Killer in 1974 which detailed how “more and more Third World mothers are turning to artificial foods during the first few months of their babies’ lives. In the squalor and poverty of the new cities of Africa, Asia and Latin America the decision is often fatal.”

War On Want

The Baby Killer goes on to note that a significant part of companies’ efforts to promote the use of infant formula is the “confidence trick” which emphasizes “when a mother’s milk is not enough, our product will help to make up the difference”. The report asks: “In a Third World context, is that approach really ethical?

It is the same question I would ask today.

While opposing the aggressive and unethical promotion of breastmilk substitutes, 1,000 Days supports the safe and appropriate use of infant formula when necessary in accordance with the World Health Organization’s infant feeding recommendation. Moreover, 1,000 Days believes that women have the right to decide how to feed their children, to full and accurate information and to the conditions that will enable them to carry out their decisions—rights that are not yet fully realized in many places throughout the world.

I understand if you do not wish to meet with me or 1,000 Days because of what I wrote in response to the aforementioned post. But please do not let that be the reason you decline the invitation to meet with the 43 other organizations that represent parents, physicians, health professionals and volunteers working tirelessly to help families give kids the strongest start to life and that signed the letter sent to you seeking a constructive dialogue with the Fed Is Best Foundation. In no way does 1,000 Days speak for these organizations. 1,000 Days does however stand together with these groups in genuinely wanting to explore if there is common ground with the Fed Is Best Foundation when it comes to providing families with accurate and unbiased information on infant feeding.

Since the letter was sent to you last week, there have been several new requests from other organizations wanting to sign-on to the letter inviting you to discuss your concerns. An updated letter reflecting the additional signatories will be sent to you in the coming week.

Finally, in the interest of transparency, I plan to make my apology to you public by sharing the content of this message on our website. I trust that you will not object to this as you indicated that you wanted a public apology.

Sincerely yours,


40+ Organizations Call For A Constructive Dialogue On Infant Feeding Recommendations

Today, over 40 organizations signed-on to a joint letter to request a meeting with the co-founders of the Fed Is Best Foundation. Our hope is to engage in a constructive dialogue to discuss the concerns they have raised with respect to our nation’s infant feeding recommendations and associated health care practices.

You can read the full letter and see the list of organizations signed-on below.


August 15, 2017

Dear Dr. Castillo-Hegyi and Ms. Segrave-Daly:

We write to you as fellow advocates for the health and well-being of infants and their families. We believe that we share a common goal—to ensure that every baby gets the strongest start to life. It is in that spirit that we extend an invitation to you to discuss the concerns that you and your organization, the Fed Is Best Foundation, have raised with respect to our nation’s infant feeding recommendations and associated health care practices.

We believe the ground we have in common is far greater than the areas where we may have disagreement. For the sake of all children, mothers and families, we therefore seek ways to unite in a shared vision rather than engaging in divisive messaging. For example, we all agree that the health of the baby is the ultimate goal, that infant feeding is a highly personal decision, that the mother should be fully informed of her options in making this decision, that nobody has the right to impose their beliefs or values on another, and that no infant, mother, or family should suffer as a result of ineffective support or care practices. We also agree that many physicians and other health care providers need improved training and education to ensure the competency to properly diagnose and address infant feeding issues, and that improved continuity of care is needed to enable new mothers to access timely, integrated, and continuous care throughout the prenatal and postpartum periods.

That’s a lot of common ground to build on.

Where we seem to disagree is on the root cause behind the tragic stories that Fed Is Best has recently highlighted. That is where we would hope to engage in some honest and constructive dialogue to find shared messaging focused on providing the accurate and unbiased information families need to make their personal infant feeding decisions, along with the appropriate care and support they need to implement those decisions.

We believe that we can be most effective in serving moms and babies when we attack the root causes of problems, rather than each other. For this reason, we invite you to meet with us to talk about your concerns and discuss ways we can work together to ensure that no family has to endure the pain and heartbreak of a baby who doesn’t get the nutrition they need to thrive. We hope that you will take us up on our offer and look forward to receiving your response.


1,000 Days
Academy of Breastfeeding Medicine
Alabama Breastfeeding Committee
American Association of Birth Centers
American Breastfeeding Institute
American Samoa Breast Feeding Coalition
Arkansas Breastfeeding Coalition, Inc.
Baby Cafe USA
Baby-Friendly USA, Inc.
Best for Babes Foundation
Breastfeeding Task Force of Nevada
California Breastfeeding Coalition
California WIC Association
Childbirth and Postpartum Professional Association
Eastern Kentucky Breastfeeding Coalition
Georgia Breastfeeding Coalition
Healthy Children Project, Inc.
Indiana Breastfeeding Coalition
International Board of Lactation Consultant Examiners
International Childbirth Education Association
Kansas Breastfeeding Coalition, Inc.
La Leche League USA
Louisiana Breastfeeding Coalition
Macomb County Breastfeeding Coalition
Massachusetts Breastfeeding Coalition
Michigan Breastfeeding Network
The Milk Mob
Mom2Mom Global
Mothers’ Milk Bank
Mothers’ Milk Bank Northeast
National Alliance for Breastfeeding Advocacy
National WIC Association
Nebraska Breastfeeding Coalition
New Hampshire Breastfeeding Task Force
New Mexico Breastfeeding Task Force
New York Statewide Breastfeeding Coalition, Inc.
NYC Breastfeeding Leadership Council, Inc.
Ohio Breastfeeding Alliance
Reaching Our Sisters Everywhere, Inc.
Rhode Island Breastfeeding Coalition
Texas Breastfeeding Coalition
United States Lactation Consultant Association
Vermont Breastfeeding Network

Guest Post: Playing Football with Infant Health: U.S. Breastfeeding as a Game of Inches

This week the U.S. Centers for Disease Control and Prevention released new data on breastfeeding rates from 2004 to 2014. The encouraging news is that more babies start breastfeeding and breastfeed for longer. The percentage of babies who start out breastfeeding increased to more than 82% surpassing the U.S. Government’s Healthy People 2020 goal of 81.9% initiation rate.

Yet while greater numbers of babies start out breastfeeding, there is still a sharp drop-off in the numbers of babies being exclusively breastfed (i.e. no other food or drink other than breastmilk) at 3 months and 6 months. The analysis of the CDC’s National Immunization Survey (NIS) data found that in 2014, children who were being exclusively breastfed for three months now stands at 46.6%— a big increase from the 36% rate in 2009—but still almost half the number that start out breastfeeding.

In addition, when it comes to six months exclusive breastfeeding —the gold standard of infant nutrition and the recommendation from the American Academy of Pediatrics and other health organizations—the number of infants being fed at this standard drops to 20%.

In America only 1 in 5 babies is being fed in accordance with the health recommendations.

Breastfeeding does not occur in a vacuum-it is impacted by cultural views, structural barriers, supportive and non-supportive policies and the impact of commercial interests. In fact, the CDC release also showed that 1/3 of all babies were supplemented with formula before 6 months and 15% were supplemented with artificial milk before 2 days.

But perhaps the most sobering detail in the CDC release is the continuation of the racial disparities in breastfeeding rates. Among infants born during 2010–2013, 64.3% of non-Hispanic black infants started breastfeeding, compared to 81.5% of white infants, a gap of 17.2 percentage points.

In 14 states, primarily in the Midwest and South, the difference in breastfeeding initiation between white and black infants was greater than 15 percentage points and the disparity exceeded 25 percentage points in seven of these states. The percentage point differences between white and black infants in exclusive breastfeeding through 6 months ranged from −4.2 in Rhode Island to 17.8 in Wisconsin, and at 12 months duration, the difference ranged from −4.4 in Minnesota to 31.6 in DC, the report detailed.

These gaps show that even with increased support and awareness, black families are not receiving the multi-dimensional support needed to successfully breastfeed.

Given that the mortality rate for black infants is more than twice that of white infants, more needs to be done to ensure that all women can give their babies the powerful life-saving, brain-boosting and health-giving benefits of breastfeeding.

And what we are learning overall, is that women want and are willing to try breastfeeding but something gets in the way—no maternity leave? An unsupportive employer? Fear of being shamed while breastfeeding in public? Limited child care options that easily facilitate human milk feeding? The possibilities are varied. What we don’t have in place are structural solutions that don’t fully rest the weight and responsibility of breastfeeding squarely on the shoulders of mothers.

Until breastfeeding is properly supported systemically and structurally, breastfeeding will remain akin to football—a game of inches, with some women eking out small gains while pushing through and past monumental obstacles but rarely making it to end zone or scoring the collective touchdown.

We are pleased to see the inches, but mothers and babies deserve the whole nine yards.

Kimberly Seals Allers is an award-winning journalist and nationally recognized infant health advocate. Her fifth book, The Big Letdown—How Medicine, Big Business and Feminism Undermine Breastfeeding was released in January by St. Martin’s Press. Learn more at www.KimberlySealsAllers.com and follow her on Twitter @iamKSealsAllers.

Unleashing A Woman’s Power to Breastfeed

As World Breastfeeding Week kicks off today, 1,000 Days Executive Director Lucy Sullivan published a new piece on Huffington Post to bring attention to the consequences of our collective failure to support women to breastfeed.

Women have the ability to improve the health and well-being of their children, their communities and the world because they have the ability to make milk, nature’s perfect nutrition for babies. Yet women in every corner of the world face too many barriers to start breastfeeding and continue breastfeeding successfully. This is our collective responsibility, for when we fail to support women to breastfeed, we all feel the consequences.

With targeted investments in the right policies and programs, we can save lives, improve health and build prosperity. For just $5 per baby, we could save 520,000 lives by simply ensuring that half of the world’s children are breastfed for the first 6 months of life.

This is a global call to action – for all of us. Together we can help unleash a woman’s power to breastfeed and her power to transform the world.

Read the “Breaking Breastfeeding Barriers” on Huffington Post.

Breastfeeding: A Collective Responsibility

Over 820,000 children die each year and millions more suffer from avoidable diseases and learning difficulties as a result of suboptimal breastfeeding practices. If even half of all babies under 6 months of age were exclusively breastfed, we would save hundreds of thousands of lives and help protect against breast cancer, ovarian cancer and diabetes in mothers across the globe.

Breastfeeding benefits all of us – and is up to all of us to give support to the millions of mothers who want to breastfeed but do not have the support they need.

This World Breastfeeding Week (August 1-7), 1,000 Days joins the World Health Organization and UNICEF to launch the Global Breastfeeding Collective – a partnership of 20 prominent international agencies and non-governmental organizations committed to increasing investment in breastfeeding worldwide. Smart investments are needed in programs and policies that enable more mothers to reach their personal breastfeeding goals.

We want children to thrive, and that means giving the millions of mothers who want to breastfeed the support they need. The Global Breastfeeding Collective will fight for a world in which mothers and families across the globe are empowered to breastfeed.

To elevate the importance of needing better policies and greater investments in programs that support breastfeeding, the Global Breastfeeding Collective also launched two new reports:

The Global Scorecard for Breastfeeding 

This new scorecard presents a daunting reality: No country in the world meets recommended standards for supporting breastfeeding. The scorecard evaluated 194 low-, middle-, and high-income countries on seven factors including financial investment, workplace protections, health care services, and community supports for breastfeeding and found most countries aren’t doing enough to protect the health and well-being of mothers and babies.

Click here to view the scorecard.

The Investment Case for Breastfeeding

A new investment case shows how investing in breastfeeding now will save lives, money, and lead to health and economic well-being worldwide for generations to come. The report reveals that in order to meet the World Health Assembly target of increasing the percentage of children under 6 months of age who are exclusively breastfed to at least 50% by 2025, an additional $5.7 billion is required. This investment translates to just $4.70 per newborn.

Click here to read the full report.

Greater progress in breastfeeding is possible. With the right level of ambition and the right policies and investment, countries can fully realize the potential gains from breastfeeding.

This World Breastfeeding Week, let’s remember: No one breastfeeds alone. Together, we can support women with better policies and investments, implementing solutions to get real results for children, families and entire nations.

If you are interested in receiving communications materials to help share these new reports and to celebrate World Breastfeeding Week please contact Amanda at amanda@thousanddays.org.