Breast milk is commonly understood to provide sustenance to babies, but fewer people know about the importance of breastfeeding immunity. Breastfeeding has been shown to provide vital protection from infectious diseases to infants whilst in the womb and shortly after. But, is that the whole story, or are there effects that reach beyond infancy?
“No, we will not cover up”
Words spoken by anti-vax mother, Taylor Winterstein as she spoke out defending and promoting the importance of breastfeeding. Where the promotion of anti-vaccination may be significantly detrimental, the promotion of breastfeeding is not an inherently bad one. Breastfeeding and vaccinations go hand-in-hand as they both provide passive immunity. Whilst one does not obviate the other, some arguments have been made that if you breastfeed you’re child for two years, they won’t need vaccinations to avoid illness in later life.
Breastfeeding has been proven to provide infants with natural immunity during the time in their lives they most need it, in what is called the perinatal period. This natural immunity is also referred to as passive immunity. The counterbalance to passive immunity is known as active immunity and they both play a big part in Covid-19.
This word is pertaining to the period immediately before and after birth, yet the word immediately is slightly ambiguous.
Depending on the definition, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.
But, is that the whole story, or are there effects that reach beyond the perinatal period, infancy, childhood and even adulthood?
“The word ‘immunity’ conjures up thoughts of complete protection from an illness, but it’s much more complicated than that“
— Leah Groph
The UK has one of the lowest breastfeeding rates in the world, lagging far behind similarly developed countries: at six months old, 34% of babies are receiving any breastmilk, compared with 62.5% in Sweden. Perhaps more concerning is that, as you can see in the table below, only 1% of babies under six months are fed exclusively with breast milk, compared with 34% in Portugal.
A small proportion of women cannot breastfeed for a variety of reasons, often as a result of their own health. However, this cannot explain the UK’s relative position in this data.
Reduced breastfeeding support, cuts in public health funding, negative attitude towards breastfeeding in public and a lack of knowledge of the benefits of breast milk all contribute to Britain having some of the worst breastfeeding rates in the world.
According to research by Swansea University and revealed in an episode of Dispatches: Breastfeeding Uncovered 40% of women who stop breastfeeding by six weeks cite being judged, discouraged and shamed in public as their main reason for doing so.
“Firstly, there’s a grave lack of support for breastfeeding in this country. There were government cuts in 2015 which meant that a lot of breastfeeding support services were cut across the country – now one mum that I spoke to who is based near Blackpool had to travel two and a half hours to her closest breastfeeding support group, and when her baby was five days old, that’s just impossible.”
There is overwhelming evidence that breastfeeding provides substantial health benefits for mothers and babies which extend well beyond the period of breastfeeding itself. Not breastfeeding can increase the risk of death from gut infections in sick and premature babies (necrotising enterocolitis); chest infections (lower respiratory infections); ear infections (otitis media); diarrhoea and vomiting (gastroenteritis); and tooth decay and dental
malocclusion.
“This isn’t about making mums breastfeed who don’t want to breastfeed, it’s about helping the mums that want to for longer”
There is also growing evidence that breastfeeding protects against the risk of a child becoming overweight or obese later down the line. There is some evidence of an association between not being breastfed and risk of Sudden Infant Death Syndrome (SIDS). Feeding with formula instead of breast milk has also been found to increase the risk of Crohn’s disease or ulcerative colitis. Breastfeeding also benefits the mother in many ways, including lowering the risk of breast cancer and potentially the risk of ovarian cancer.
There is evidence that breastfeeding – despite granting passive immunity – positively affects active immunity, reflected in its demonstrated effect on allergen avoidance.
Active and passive immunity both function to ensure our immune systems are in tip-top shape and can protect us from bacteria, viruses and other infectious microbes – but what is the difference between active and passive immunity?
A person can develop passive immunity artificially through immunisations (i.e vaccinations) and naturally from breastfeeding or from the mother’s placenta. This is why passive immunity can be referred to often as ‘natural immunity’.
Active immunity, on the other hand, develops once we come into contact with a certain disease-causing bacteria or virus. Experiencing the infection first-hand usually allows our immune system to learn how to effectively manage the threat in the future, by developing antibodies that can fight it off. The problem is, in the case of Covid-19, this may not be the case.
“We know from many other infections, the vaccine response can be much more durable than the natural infection response“
— Adrian Hill, Principal Investigator of the University of Oxford Vaccine Study
In the aftermath of Covid-19’s first wave, the team behind the University of Oxford’s vaccine study evince the reality of active immunity. They state,
“Immunity to four milder coronaviruses…doesn’t persist for years on end. So, the duration of an antibody response may depend at least in part on whether an infection led to a significant illness – and a significant immune reaction.”
In light of this, ensuring passive immunity and active immunity are equally valued could be crucial for enduring this crisis.
An infant or newborn baby (a neonate) is innately born with a significantly higher risk of contracting an infectious disease. It is also in this state that the decision to provide formula or breast milk is made; a decision worthy of deliberation for reasons outlined below.
Maternal breast milk contains immunoglobulin A’s (IgAs) which are antibodies vital for the immune function of mucous membranes. These mucous membranes line internal organs and capture pathogens they come into contact with. When the infant is fed on breast milk, these IgA’s are transferred; essentially providing protection from passive immunotherapy. By contrast, though formulas provide the nutrition required, they do not contain these crucial IgAs.
It is evolutionarily advantageous for an organism to develop a better and faster secondary immune response to a pathogen, which is harmful and which it is likely to be exposed again. Breast milk has also been shown to create immune ‘priming’ as the infant receives protective antigens from the mother. Immune priming is a memory-like phenomenon, usually described in invertebrate taxa of animals. In humans, it is viewed as an Immunologic tolerance – a state of unresponsiveness of the immune system to substances that can result in an immune response.
Further research in this direction may lead to novel strategies of early life vaccination, taking advantage of the possibility to stimulate antigen-specific immune responses through breast milk (immunizing children through maternal milk), giving them long-term protection from infectious disease as a result.
In 1993, a study of 10,000 immunised infants was conducted to measure their immune responses to childhood vaccinations. This particular study came to a very interesting conclusion. It discovered that infants that were breastfed for a minimum of 6 months produced significantly more antibodies after vaccination. In layman’s terms, these breastfed children responded exceedingly well to vaccines; producing far more protective immunoglobulins.
The prevalence of evidence suggests that exclusively breastfeeding, for at least the first 6 months, can decrease the occurrence of atopic allergies. However, multiple factors contribute to autoimmune diseases/allergies such as genetics, maternal diet and environment. Thus,
“The effect of breastfeeding should be viewed as one word in a very long sentence”
The traditionally recommended allergy prevention method is for a mother to avoid consuming allergens such as peanuts, egg or wheat. This allergen avoidance is suggested for both pregnancies and while breastfeeding. Despite this, no direct correlation has been found between maternal food antigen intake and the antigen concentration in breast milk.
In animal studies, it was concluded that breast milk actually reduced antigen-specific immune responses. Using strict antigen administration controls, this study showed breastfeeding mediated the transfer of antigens to the baby.
These long-lasting effects can prevent allergies ever occurring with just natural human milk. As allergies can cause symptoms from itching to sickness or a bleed, this precaution can give parents peace of mind.
Autoimmunity is a detrimental process in which the body can attack its own healthy cells and this only worsens with age. It has been debated and tested many times through the years as to whether breastfeeding decreases autoimmunity.
In 2007 Mimouni Bloch and co-investigators answered this question. Analysing studies conducted between 1966 and 2000, they found that babies breastfed for 3 months exclusively after birth were protected against allergic rhinitis, a group of symptoms that cause the nose to react when in contact with allergens such as pollen, dust etc.
Even in cases where a family history of atopy (allergies) was present, this immunoprotection remained in place.
The provision and quality of postnatal and health care visiting play an important role in encouraging mothers to breastfeed (Bhutta and others, 2013). An important step is in ensuring all maternity units across the UK
achieve and maintain Unicef UK Baby Friendly Initiative accreditation.1 Health visiting services, which are so vital in providing breastfeeding support after discharge from hospital, must be preserved.
More broadly, policies that reduce socioeconomic inequality and create working environments which support mothers who are returning to work and wish to continue breastfeeding, are likely to bring about improvements
in breastfeeding rates (Shealy and others, 2005). The four UK governments should introduce supportive legislation for breastfeeding breaks and facilities suitable in all workplaces for breastfeeding or expressing breast milk, and employers must ensure career or life-time salaries are not adversely affected
by a woman’s choice to breastfeed.
A study exploring Australian, Irish and Swedish women’s perceptions of what assisted them to breastfeed for six months found that influencing factors reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Despite this, categories ranked in the top five across the three countries were ‘informal face to face support’ and ‘maternal determination’ however Ireland ranked ‘informal online support’ second compared to ninth and tenth for Swedish and Australian women.
“We need to invest more in breastfeeding initiatives. At the moment, no one has breastfeeding as part of their remit in government but someone needs to be made responsible for it, put it on the agenda and then improve the support that women have got.”
– Kate Quilton, Dispatches
The support required to assist breastfeeding women is complex and multi-faceted. We must recognize how the cultural context of breastfeeding support can vary for women in differing countries and acknowledge the resourcefulness of women who embrace innovations such as social media where face to face formal and informal support are not as accessible.
The recurring pattern indicates the importance of the first 6 months of exclusive breastfeeding. It portrays the lifelong impact breastfeeding can have upon your body, your immune responses, allergies and autoimmune diseases.
Breastfeeding promotion is an important means to change social norms around the initiation and duration of breastfeeding (Balogun and others, 2016), and national strategies must address both the initiation and
continuation of breastfeeding, supporting mothers to breastfeed their babies exclusively for up to 6 months. Information about breastfeeding should also be included as part of statutory personal, health and social education in schools.
Get out there and educate your peers!
This CPD accredited course explores some of the challenges women face and provides the evidence-based advice women need to overcome them and continue breastfeeding for longer.
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