What we don't know about mother's milk

Have you ever heard the one
about how breastfeeding is free?

(Laugther)

Yeah, it's pretty funny

because it's only free if we don't value
women's time and energy.

Any mother can tell you
how much time and energy it takes

to liquify her body --

to literally dissolve herself --

(Laughter)

as she feeds this precious
little cannibal.

(Laughter)

Milk is why mammals suck.

At Arizona State University,

in the comparative lacation lab,

I decode mothers' milk composition

to understand its complexity

and how it influcences infant development.

The most important thing that I've learned

is that we do not do enough
to support mothers and babies.

And when we fail mothers and babies,

we fail everyone who loves
mothers and babies:

the fathers, the partners,
the grandparents, the aunties,

the friends and kin that make
our human social networks.

It's time that we abandon simple solutions
and simple slogans,

and grapple with the nuance.

I was very fortunate

to run smack dab into
that nuance very early,

during my first interview
with a journalist

when she asked me,

"How long should a mother
breastfeed her baby?"

And it was that word "should"
that brought me up short

because I will never tell a woman
what she should do with her body.

Babies survive and thrive

because their mother's milk
is food, medicine and signal.

For young infants,

mother's milk is a complete diet

that provides all the building
blocks for their bodies,

that shapes their brain,

and fuels all of their activity.

Mother's milk also feeds the microbes

that are colonizing the infant's
intenstinal tract.

Mothers aren't just eating for two;

they're eating for two to the trillions.

Milk provides immunofactors
that help fight pathogens,

and mother's milk provides hormones
that signal to the infant's body.

But in recent decades,

we have come to take milk for granted.

We stopped seeing
something in plain sight.

We began to think of milk as standardized,
homogonenized, pasturized,

packaged, powdered, flavored
and formulated.

We abandoned the milk
of human kindness,

and turned our priorities elsewhere.

At the National Institutes of Health
in Washinton D.C.

is the National Library of Medicine,

which contains 25 million articles --

the brain trust of life science
and biomedical research.

And we can use key words
to search that database,

and when we do that,

we discover nearly a million
articles about pregnancy,

but far fewer about
breast milk and lactation.

When we zoom in on the number
of articles just investigating breast milk

we see that we know much more
about coffee, wine and tomatoes.

(Laughter)

We know over twice as much
about erectile dysfunction.

(Laughter)

And I'm not saying we shouldn't
know about those things --

I'm a scientist,

I think we should know about everything.

But that we know so much less --

(Laughter)

about breast milk --

the first fluid a young mammal
is adapted to consume --

should make us angry.

Globally, nine out of 10 women will
have at least once child in her lifetime.

That means that nearly 130 million
babies are born each year.

These mothers and babies
deserve our best science.

Recent research has shown that milk
doesn't just grow the body,

it fuels behavior and shapes
neurodevelopment.

In 2015, researchers discovered
that mixture of breast milk

and baby saliva --

specifically, baby saliva --

causes a chemical reaction
that produces hydrogen peroxide

that can kill Staff and Salmonella.

And from humans
and other mammal species,

we're starting to understand
that the biological recipe of milk

can be different when produced
for sons or daughters.

When we reach for donor milk
in the neonatal intensive care unit,

or formula on the store shelf,

it's nearly one-size-fits-all.

We aren't thinking about how sons
and daughters may grow at different rates

or different ways,

and that milk may be a part of that.

Mothers have gotten the message,

and the vast majority of mothers
intend to breastfeed,

but many do not reach
their breastfeeding goals.

That is not their failure;

it's ours.

Increasingly common medical conditions
like obesity, endocrine disorders,

C-section and pre-term births

all can disrupt the underlying
biology of lactation.

And many women do not have
knowledgable clinical support.

25 years ago,

the World Health Organization
and Unicef established criteria

for hospitals to be
considered baby friendly --

that provide the optimal level
of support for mother-infant bonding

and infant feeding.

Today, only one-in-five babies
in the United States

is born in a baby-friendly hospital.

This is a problem,

because mothers can grapple
with many problems

in the minutes, hours, days
and weeks of lactation.

They can have struggles with
establishing latch,

with pain,

with milk letdown,

and perceptions of milk supply.

These mothers deserve
knowledgable clinical staff

that understand these processes.

Mothers will call me as they're
grappling with these struggles,

crying with wobbly voices.

"It's not working.

This is what I'm supposed to
naturally be able to do,

why is it not working?"

And just because something
is evolutionarliy ancient

doesn't mean that it's easy
or that we're instantly good at it.

You know what else
is evolutionarily ancient?

(Laughter)

Sex.

And nobody expects us
to start out being good at it.

(Laughter)

Clinicians best deliever quality
equitable care

when they have continuing education
about how to best support lactation

and breastfeeding.

In order to have
that continuing education,

we need to anchor it
to cutting-edge research

in both the life sciences
and the social sciences,

because we need to recognize
that too often historical traumas

and implicit biases

sit in the space between a new
mother and her clinician.

The body is political.

If our breastfeeding support
is not intersectional,

it's not good enough.

And for moms who have to return for work,

because countries like the United States
do not provide paid parental leave,

they can have to go back in as short
as just a few days after giving birth.

How do we optimize mother
and infant health

just by messaging about
breast milk to moms

without providing
the institutional support

that facilitates
that mother-infant bonding

to support breastfeeding?

The answer is we can't.

I'm talking to you, legistlators,

and the voters who elect them.

I'm talking to you, job creators,
and collective bargaining units,

and workers,

and shareholders.

We all have a stake in the public
health of our community,

and we all have a role
to play in achieving it.

Breast milk is a part
of improving human health.

In the NICU, when infants are born
early or sick or injured,

milk or bioactive constituents in milk
can be critically important.

Environments or ecologies,

or communities where there's
high risk of infectious disease,

breastmilk can be incredibly protective.

Where there are emergencies
like storms and earthquakes,

when the electricity goes out,

when safe water is not available,

breast milk can keep babies
fed and hydrated.

And in the context of humanitarian crises,

like Syrian mothers fleeing war zones,

the smallest drops can buffer babies
from the biggest global challenges.

But understanding breastmilk is not
just about messaging to mothers

and policy makers.

It's also about understanding what
is important in breastmilk

so that we can deliver better formulas

to moms who cannot or do not
breastfeed for whatever reason.

We can all do a better job

of supporting the diversity
of moms raising their babies

in a diversity of ways.

As women around the world struggle

to achieve political, social
and economic equality,

we must reimagine motherhood

as not the central
core aspect of womanhood,

but one of the many potential facets
of what makes women awesome.

It's time.

(Applause)