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Instead, it would be better to promote breastfeeding as the normal and natural way to feed babies.42 Others suggested that a public health campaign on breastfeeding would be more effective if the risks of formula-feeding were more heavily emphasised.43 However, focusing on the risks of infant formula may have the effect of alienating those mothers whose sincere efforts to breastfeed have not been supported strongly enough by the community and health profession.
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The committee believes that a positive campaign promoting breastfeeding as normal would be the most effective way to present the breastfeeding message. Any public health campaign must also be supported by wider practical action and structural changes in the community and health profession to help breastfeeding mothers.
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The committee supports breastfeeding for as long as the mother and child are comfortable to continue, but agrees with experts such as Professor Binns, who noted that more benefit would be gained from 41 Werner C, sub 6, pp 2-3; Jeffery L, sub 34, p 3; Wighton M, sub 41, p 2; Pollock R, sub 60, p 1; Trinder M, sub 128, p 1; Tattam A, sub 199, pp 2-3; Australian Nursing Federation, sub 271, p 3; Pharmacy Guild of Australia, sub 331, p 2; Bowen M, sub 337, p 8.
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42 Dixon G, sub 30, p 2; Binns C, sub 86, p 2; O’Dowd Y, sub 33, p 2; David Q, sub 37, p 1; Rothenbury A, sub 87, p 2; Hay L, sub 153, p 5; Day S, sub 157, p 2; Marazakis M, sub 202, p 1; Australian Breastfeeding Association (Queensland Branch), sub 207, p 3; Stephenson C, sub 278, p 1. 43 Walsh A, sub 20, p 1; Ward K, sub 56, p 2; Christoff A, sub 72, p 2; Dawson P, sub 98, p 2; Mathewson S, sub 111, p 2; Hinkley T, sub 115, p 1; Buckley M, sub 160, p 1; Eldridge S, sub 214, p 3; Fuller R, sub 228, p 2.
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46 promoting exclusive breastfeeding for the first six months of a baby’s life, than to promote prolonged breastfeeding beyond 12 months of age.44 It should be noted that the health benefits of breastfeeding are at a maximum in the earliest months of life.45 ‘The gift of human milk’ 3.34 A human milk bank is a service that collects, screens, processes and distributes donated human milk, primarily for babies who cannot be breastfed.46 Given that breast milk provides the best protection against infection and promotes proper growth and nutrition for healthy full-term babies, it is particularly important that sick and premature babies also have access to breast milk, especially when their own mother cannot provide it (for example, due to low milk supply, HIV infection, breast cancer treatment, or when the baby is on life support).
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3.35 The WHO’s Global Strategy for Infant and Young Child Feeding lists a number of feeding options for those few health situations where infants cannot, or should not, be breastfed.
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The alternatives are: expressed milk from the baby’s mother, breast milk from a wet nurse or a human milk bank, or a breast milk substitute.47 The WHO has long affirmed the value of milk banks in its policies on infant feeding.48 In 1980, the World Health Assembly endorsed a joint WHO/UNICEF resolution which stated: ‘Where it is not possible for the biological mother to breastfeed, the first alternative, if available, should be the use of human milk from other sources.
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Human milk banks should be made available in appropriate situations.’49 3.36 Milk banking originated in Europe in the early twentieth century as technological and hygienic advances allowed human milk to be refrigerated and stored. Prior to this, it was common practice for 44 Binns C, sub 86, p 3. 45 National Health & Medical Research Council, Dietary Guidelines for Children and Adolescents in Australia (2003), p 14. 46 Lording R, sub 186, p 7.
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46 Lording R, sub 186, p 7. 47 WHO Global strategy for infant and young child feeding, 2002, viewed on 30 July 2007 at http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf, p 10. 48 Arnold L, ‘Global health policies that support the use of banked donor human milk: a human rights issue’, International Breastfeeding Journal (2006), vol 1, no 26, pp 5-6.
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49 WHO/UNICEF Joint Resolution, 1980, quoted in Wight N, ‘Donor Human Milk for Preterm Infants’, Journal of Perinatology (2001), vol 21, p 251. THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 47 babies whose mothers could not breastfeed to receive milk from another lactating mother or a ‘wet nurse’. The number of milk banks grew across the developed world throughout the century, although many milk banks closed their doors during the 1980s due to fears surrounding HIV/AIDS transmission.
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However, as research demonstrated the safety of pasteurisation techniques in eliminating HIV and other viruses, milk banks experienced a resurgence as a safe source of donor milk.50 3.37 Milk banks provide an important alternative source of human milk. Because of human breast milk’s unique immunologic properties, access to this milk is often critical to the survival of sick and premature babies with under-developed immune systems.
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Donated breast milk has also been used successfully to treat babies with intolerance to formula, severe allergies, immune deficiencies and congenital abnormalities. It also helps babies recover from surgery.51 3.38 One of the most serious health risks faced by premature babies is neonatal necrotising enterocolitis (NEC), a gastrointestinal infection which effectively causes a death of the bowel area.52 Mortality rates from NEC in neonatal intensive care units can be as high as 40 per cent.
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Premature babies fed exclusively with breast milk, which promotes the maturation of the gut, have a reduced chance of succumbing to NEC. In a study of 900 premature babies, NEC was six to ten times more common in those who received only formula, than in those fed breast milk alone.53 3.39 Today human milk banks operate across North and South America, Europe and Asia.54 Brazil is renowned for its large network of milk banks.
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In 1999-2000, more than 150 milk banks processed over 218,000 litres of milk that was given to 300,000 premature and low birth weight babies, saving the Brazilian Government an estimated $620 million that year.55 50 Human Milk Banking Association of North America, ‘The History of Milk Banking’, 2003, viewed on 30 July 2007 at http://www.hmbana.org/index.php?mode=history.
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51 Lording R, ‘A review of human milk banking and public health policy in Australia’, Breastfeeding Review (2006), vol 14, no 3, p 22; Wight, p 251. 52 Moorhead A, Royal Women’s Hospital, Melbourne, transcript, 7 June 2007, p 31. 53 Lucas A and Cole TJ, ‘Breast milk and neonatal necrotising enterocolitis’, The Lancet, (1990), vol 336, pp 1519-1523. 54 Lording R, ‘A review of human milk banking’, p 23. 55 Arnold L, p 7 (note, adjusted to AUD).
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55 Arnold L, p 7 (note, adjusted to AUD). 48 When my mother had her babies in the mid to late 1960s, she was asked by midwives to wet-nurse other babies on the maternity ward. Indeed, across the world, wet-nursing and the giving of human milk to mothers and babies in need is a regular practice, accepted as a gift between women. With fear of AIDS and legal implications, this culture of sharing has been taken away from women and we are the poorer for it.
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To set up a network of milk banks across the country would reintroduce the opportunity for giving the gift of human milk.56 Milk banks in Australia 3.40 Australia currently has only two donor milk banking facilities, although the Royal Women’s Hospital in Melbourne noted its capacity (and that of other hospitals) to freeze a mother’s expressed milk for her own baby’s consumption.57 In 2006, Australia opened its first milk bank in more than two decades at the King Edward Memorial Hospital in Perth, which caters for premature babies.58 The ‘PREM Bank’ in Perth is sponsored by the Rotary Clubs of Thornlie and Belmont, the Perron Charitable Trust and Telethon and is the result of a collaboration between North Metropolitan Health Service, The University of Western Australia and the Women and Infants Research Foundation.
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3.41 The Mothers Milk Bank, operating at the John Flynn Medical Centre on the Gold Coast, is Australia’s only other milk bank. The committee visited this site in the course of the inquiry. The Mothers Milk Bank presently operates as a pilot program with limited funding and support from volunteers. There are about 500 registered donors, with around 280 currently donating milk.
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After instruction in sterile techniques, these women express once a day and freeze the milk which is collected by a volunteer every week. The milk is then screened, pasteurised, re-tested, and delivered to babies and mothers in need. On a weekly basis the Mothers Milk Bank pasteurises nine litres of milk.59 3.42 The committee heard from parents whose babies had thrived on donations from the Mothers Milk Bank. Twins born prematurely were 56 Eldridge S, sub 214, p 9.
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57 Moorhead A, Royal Women’s Hospital, Melbourne, transcript, 7 June 2007, p 31. 58 Lording R, ‘A review of human milk banking’, p 23. 59 Jones J and Ryan M, Mothers Milk Bank, transcript, 18 April 2007, p 8. THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 49 fed with their mother’s expressed breast milk and supplemented with donor milk for two months.60 Another mother, whose son had severe allergic reactions to formula, struggled with her own low milk supply.
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With donor milk, her son’s nutritional and health needs are being met.61 Box 3.1 Mothers Milk Bank Pty Ltd Mothers Milk Bank Pty Ltd is a private not-for-profit company formed by Midwife and Nurse Manager, Marea Ryan, of the John Flynn Private Hospital on the Gold Coast. This vital health service, the first of its kind on the East Coast, provides pasteurised donor mother’s milk to infants where human milk is not available, ensuring optimal physical and neurological development for these infants.
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In conjunction with a similar initiative established in Perth, the Mothers Milk Bank (MMB) is committed to seeing a network of donor milk banks operational around Australia within ten years. MMB shares a common vision with our Perth colleagues – ‘Human Milk for Human Babies’ – every baby needs to have the best food source available. Initially MMB will offer pasteurised milk on demand to premature and sick infants.
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In the long-term, MMB aims to provide an avenue whereby human milk is available for all babies up to the age of at least six months. This will lay the foundation of the future health of Australian children. Source: Mothers Milk Bank, sub 217. Barriers to milk banking 3.43 Roslyn Lording, a health promotion practitioner and hospital social worker, is the author of a 2006 review of human milk banking in Australia. She has analysed some of the barriers to milk banking in the Australian context.
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There is anecdotal evidence that there would be ‘initial reluctance’62 towards milk banking amongst health professionals, including neonatologists, who may be unconvinced about the value of donor milk over formula.63 The costs and logistics of establishing milk banks may also be a disincentive, especially when formula is more readily accessible.64 60 Community statements, transcript, 18 April 2007, pp 46-47.
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61 Community statements, transcript, 18 April 2007, pp 49-50; McMaster D, transcript, 18 April 2007, p 41. 62 McMaster D, transcript, 18 April 2007, p 42. 63 Lording R, ‘A review of human milk banking’, pp 25-26. 64 Lording R, ‘A review of human milk banking’, pp 25-26; Schmidt P, Gold Coast Hospital, transcript, 18 April 2007, p 36.
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50 3.44 Concerns about the safety of milk banking and infection control have also been raised.65 However, evidence from Australia and around the world shows that modern pasteurisation techniques are effective in preventing the transmission of infection and maintaining the quality of the milk.66 3.45 Another minor issue relates to the classification of breast milk as a body tissue in some jurisdictions and as a food in others.
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There are calls for milk to be classified consistently as a food across Australia. The matter is currently under review in Queensland. 67 3.46 NSW Health notes that given the increasing community interest in human milk banks, a review should be undertaken prior to any wider establishment in Australia. Comprehensive evidence assessing the benefits of donor human milk for premature babies and the possible risks of disease transfer has not yet been compiled in Australia.
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Therefore, a review should address these issues and also look at a national regulatory and quality framework within which a network of milk banks in Australia could operate.
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The framework would need to address a number of minimum standards, including donor recruitment and selection, storage and handling of milk, testing and pasteurisation of milk, and incident reporting.68 3.47 Keeping these issues in mind, the committee believes that government support for milk banks would constitute an important public health investment.69 With sufficient funding, strict safety measures and greater awareness of the benefits of breast milk amongst health professionals and the public, the barriers to milk banking can be overcome.
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65 Lording R, ‘A review of human milk banking’, p 26; Schmidt P, Gold Coast Hospital, transcript, 18 April 2007, pp 35-36. 66 Lording R, ‘A review of human milk banking’, p 26; Ryan M, Mothers Milk Bank, transcript, 18 April 2007, p 5. 67 Ryan M, Mothers Milk Bank, transcript, 18 April 2007, p 3. 68 NSW Health, sub 479, p 35.
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69 Eldridge M, sub 25, p 2; Cheers A, sub 29, p 6; Dixon G, sub 30, p 2; Long H, sub 80, p1; Moore E, sub 102, p 2; Beyer L, sub 105, p 1; MacDonald H, sub 106, p 1; Clements F, sub 122, p 5; Dickson E, sub 162, p 2; Public Health Association of Australia, sub 181, p 10; Australian College of Midwives, Baby Friendly Health Initiative, sub 185, p 13; Lording R, sub 186, pp 7-8; Eldridge S, sub 214, p 8; Australian Breastfeeding Association, New South Wales Branch, sub 276, p 13; Australian Breastfeeding Association, sub 306, p 28; Women’s Electoral Lobby, sub 310, p 5; New South Wales Baby Friendly Health Initiative, sub 339, p 15; de Vries L, sub 359, p 2; Campbell A, sub 361, p 2; Martin P, sub 373, p 1; Cuff S, sub 382, p 1; Brittain H, Logan Hospital, transcript, 18 April 2007, p 31.
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THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 51 The future of milk banks in Australia 3.48 It is clear to the committee that a national network of publicly funded milk banks would give Australian babies a healthier start to life, reduce health care costs and provide real support for mothers who are unable to provide their baby with breast milk. Gwen Moody from the Australian Lactation Consultants Association described to the committee an example of a woman who is unable to breastfeed.
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I have got a woman with breast cancer at the moment who is seven or eight months pregnant. She was starting chemotherapy on Friday, so in the week before, because the baby is potentially going to be born early, we got her expressing colostrum crazily so we would at least set the baby’s gut up because she had breastfed her two previous children.
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She has got inflammatory breast cancer, which is fairly advanced.70 3.49 Professor Peter Hartmann of the King Edward Memorial Hospital milk bank estimated that if a premature baby in their unit is given breast milk instead of formula, the recovery period is shortened by two weeks with cost savings of $18,200.
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71 In Queensland, there were 4,300 premature babies in one year who did not receive any breast milk and were therefore at greater risk for complications, infections and longer hospital stays.72 3.50 Interest in being a milk donor is steadily growing.73 Milk banks could also offer solutions to those mothers, such as the woman below, who despair at having to dispose of their own excess milk, knowing that it would be invaluable to other mothers and babies.
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It was a real tragedy, I had at least 12 bottles of milk (240ml each) in my refrigerator, and I was forced to dispose of it all down the sink when I got home, all this liquid gold. It broke my heart to do so, especially when I think of any premmie baby that could have really benefited from having breast milk, as opposed to formula.74 70 Moody G, Australian Lactation Consultants Association, transcript, 4 June 2007, p 34. 71 Australian Breastfeeding Association, New South Wales Branch, sub 276, p 13.
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72 Ryan M, Mothers Milk Bank, transcript, 18 April 2007, pp 2-3. 73 Ryan M, Mothers Milk Bank, transcript, 18 April 2007, p 9; Jeffery L, sub 34, p 5; Greenlees N, sub 324, pp 1-2; Robins J, sub 50, p 1; Virgo H, sub 155, p 1; Fellows M, sub 304, p 2; Nielsen L, sub 355, p 2; community statements, transcript, 18 April 2007, p 47; community statements, transcript, 18 April 2007, p 49.
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74 Smith A, sub 110, p 2; 52 3.51 Mothers and babies in remote communities would also benefit from a system which provided the infrastructure to transport breast milk as required.
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With a proper courier service, the Mothers Milk Bank could have delivered milk daily to a mother in a remote area of Queensland whose milk supply was low and who had no access to formula.75 3.52 A commitment to a national system of milk banks in Australia should not only be a stand-alone policy, but complement a range of other measures to support breastfeeding and value of breast milk76 (see chapter 4).
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In Brazil, donor milk banking goes hand in hand with efforts to promote breastfeeding as the cultural norm.77 This mutually reinforcing approach would help to secure the health of Australia’s next generation for years to come. Recommendation 8 3.53 That the Department of Health and Ageing fund a feasibility study for a network of milk banks in Australia including the development of a national regulatory and quality framework within which a network of milk banks in Australia could operate.
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The feasibility study should include funding pilot programs at the Mothers Milk Bank at the John Flynn Private Hospital, Gold Coast and the King Edward Memorial Hospital milk bank in Perth. The economic benefits of breastfeeding 3.54 One of the committee’s main interests in undertaking this inquiry was to investigate the short and long-term impacts on the health of Australians if breastfeeding rates were increased. The effect of breastfeeding on the sustainability of the health system was also examined.
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3.55 There are strong economic arguments in favour of increasing breastfeeding rates in Australia. As already shown in this chapter, breastfeeding and breast milk provide well-established health benefits, including greater protection against some chronic diseases, for both mothers and babies. These advantages should also be viewed 75 Ryan M, Mothers Milk Bank, transcript, 18 April 2007, p 7. 76 Lording R, sub 186, p 8. 77 Arnold L, ‘Global health policies’, p 7.
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77 Arnold L, ‘Global health policies’, p 7. THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 53 from an economic perspective, given that fewer cases of illness and hospitalisations at the population level translate into significant cost savings for the health care system. Economists have rarely considered economic aspects of breastfeeding, focusing their attention on the market economy. In recent years the importance of the unpaid economy including the care work of mothers has become more visible.
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It has also become evident that the policy needs to take account of the unpaid household economy to avoid unintended impacts on the work that families do in raising children – Australia’s ‘human capital.’ Breastfeeding is a good example of women’s reproductive work that is neither visible nor properly valued by existing economic statistics.
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Because it is neither visible nor valued, and because it competes in the market on unequal terms, breastfeeding remained unprotected from pressure of social and economic change and from ‘unfair’ market competition.78 3.56 Dr Julie Smith, a research fellow at the Australian Centre for Economic Research on Health, has conducted a number of studies into the economic impacts of breastfeeding in Australia.
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The committee has drawn extensively on her work and the evidence she presented in the following discussion of the economic aspects of breastfeeding.79 The economic value of breast milk and breastfeeding 3.57 A number of inquiry participants argued that the economic value of breast milk should be recognised as a proportion of Australia’s gross domestic product (GDP).
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Dr Smith estimates that around 33 million litres of human milk per year is produced in Australia at present breastfeeding rates.80 Using the milk bank prices in Europe, she estimates that the value of breast milk produced by Australian women is around $2 billion per year. The annual retail value of formula is considerably less at around $135 million.81 Breast milk’s estimated value is equivalent to around 0.5 per cent of GDP, or six per cent of national food consumption.
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The impact of breastfeeding on the 78 Smith J, Australian Centre for Economic Research on Health, sub 313, p 2. 79 Smith J, Australian Centre for Economic Research on Health, sub 313; Smith J, Harvey P, Australian Centre for Economic Research on Health, sub 319. 80 Smith J, transcript, 26 March 2007, p 18. 81 Smith J, Australian Centre for Economic Research on Health, sub 313, p 4.
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54 economy would be even greater if exclusive breastfeeding to six months was widely practised: If all Australian mothers were to breastfeed as the World Health Organization recommended, there would be an increase in economic output in the form of milk of around $3 billion.82 3.58 Another concern raised by some inquiry participants was that the time invested in breastfeeding by mothers is not given economic value in Australia.
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Dr Smith examined this ‘economic time cost’ in the nationwide Time Use Survey of New Mothers, which showed that mothers who breastfeed to recommended levels spend around 16 to 17 hours per week on this activity for the first three to six months. The emotional component to breastfeeding should also be seen as a significant human capital investment. These mothers spend an additional six to eleven hours per week in ‘emotional care’, which contributes positively to the child’s mental and emotional health.
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While the baby undoubtedly benefits from these breastfeeding interactions, such time-intensive unpaid care on the part of the mother is not recognised in economic terms.83 Cost savings to the health system 3.59 Breastfeeding protects against a range of diseases and therefore has the potential to alleviate costs to the health care system in both the short and long-term.
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The Australian Medical Association notes that the potential benefits of increasing the breastfeeding rate would be extremely cost-effective, ensuring improved health outcomes and the sustainability of health care in Australia.84 The NHMRC states in the Dietary Guidelines that: The total value of breastfeeding to the community makes it one of the most cost-effective primary prevention measures available and well worth the support of the entire community.85 82 Smith J, transcript, 26 March 2007, p 26 83 Smith J, Australian Centre for Economic Research on Health, sub 313, p 9; Smith J, transcript, 26 March 2007, pp 22-23.
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84 Australian Medical Association, sub 358, p 2. 85 National Health & Medical Research Council, Dietary Guidelines for Children and Adolescents in Australia (2003), p 14. THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 55 Short-term impacts – economic costs of premature weaning 3.60 According to a 2002 study conducted by Dr Smith and colleagues at the Canberra Hospital, there are significant hospital costs associated with early weaning.
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It was found that less than 10 per cent of babies in the ACT were exclusively breastfed until the recommended six months of age. Early weaning was estimated to add around $1 to $2 million to annual hospitalisation costs for gastrointestinal illness, respiratory and ear infections, eczema and neonatal necrotising enterocolitis (NEC).
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Using these figures, savings across the Australian hospital system could be $60 to $120 million for these illnesses alone.86 3.61 A preliminary economic analysis of breastfeeding in Australia in 1997 found that a minimum of $11.75 million could be saved if the prevalence of exclusive breastfeeding at just three months was increased from 60 per cent to 80 per cent. This analysis only took into account four illnesses – gastroenteritis, NEC, eczema and type 1 diabetes.
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The author noted that further cost savings could be achieved if other illnesses and reduced maternal absenteeism were also taken into account.87 3.62 International studies have also shed light on the extent of savings to health systems.
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For example, an Italian study showed that for babies exclusively breastfed at three months, there were lower health care costs during the first year of life because of fewer hospital admission and ambulatory care episodes.88 A US study found that for every 1,000 babies never breastfed (compared to 1,000 babies exclusively breastfed), there were more than 2,000 extra visits to the doctor, 212 extra days of hospitalisation and 609 extra prescriptions in the first year of life.89 3.63 A number of submissions also highlighted the Commonwealth Government’s recent funding commitment of $25 million for a rotavirus vaccine.
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There are around 20,000 hospital admissions every year for this common gastrointestinal infection in children under five years old. It is suggested that an investment of the same extent 86 Smith J et al, ‘Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory’, Australian and New Zealand Journal of Public Health (2002), vol 26, no 6, pp 543-551.
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87 Drane D, ‘Breastfeeding and formula feeding: a preliminary economic analysis’, Breastfeeding Review (1997), vol 5, no 1, pp 7-15. 88 Cattaneo A et al, ‘Infant feeding and the cost of health care’, Acta Paediatrica (2006), vol 95, no 5, pp 540-546. 89 Ball T and Wright A, ‘Health care costs of formula-feeding in the first year of life’, Pediatrics (1999), vol 103, no 4, pp 870-876.
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56 towards breastfeeding promotion could further reduce the burden on the health system caused not only by rotavirus, but a range of common early childhood infections.90 3.64 These findings strengthen the case for lifting Australia’s breastfeeding rates, given the immediate health benefits and the reduced day-to-day strain on the health care system.
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Long-term impacts – reducing the burden of chronic disease 3.65 As demonstrated earlier in this chapter, breastfeeding can protect against the development of a number of chronic conditions later in life, including obesity, diabetes and cardiovascular disease. Although this is a relatively new field of inquiry, international research suggests there are significant health system savings to be gained from improving breastfeeding rates.
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For example: (cid:132) a 2002 study of more than 500,000 babies born in England and Wales estimated that 33,100 asthma cases and 13,639 cases of obesity were directly attributable to a lack of breastfeeding91; and (cid:132) another UK study suggested that breastfeeding’s protective effect against high blood pressure could prevent 3,000 coronary heart disease events and 2,000 strokes annually in those under 75 years of age.92 3.66 Dr Smith and Dr Peta Harvey are currently investigating the links between breastfeeding and the costs of chronic disease treatment in Australia.
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Their preliminary findings suggest that between 11 and 28 per cent of the chronic disease burden in Australia could be attributed to a lack of breastfeeding during infancy.93 3.67 Another factor to consider is the ongoing special education costs arising from poor health. For example, as discussed earlier, breastfeeding offers significant protection against middle ear infections.
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Recurrent infections can lead to language and learning difficulties in early childhood, with a need for speech therapy and 90 Clements F, sub 122, p 4; Davis A, sub 237, pp 1-2; Gribble K, School of Nursing, University of Western Sydney, sub 251, p 2; Davis A, sub 367, p 1. 91 Akobeng A and Heller R, ‘Assessing the population impact of low rates of breastfeeding on asthma, coeliac disease and obesity: the use of a new statistical method’, Archives of Disease in Childhood (2007), vol 92, pp 483-485.
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92 Martin R et al, ‘Breastfeeding in infancy and blood pressure in later life: systematic review and meta-analysis’, American Journal of Epidemiology (2005), vol 161, no 1, pp 15-26. 93 Smith J, Harvey P, Australian Centre for Economic Research on Health, sub 319, p 2. THE HEALTH AND ECONOMIC BENEFITS OF BREASTFEEDING 57 remedial education programs.94 The broader impact of chronic disease on economic productivity should also be investigated.
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3.68 It is clear that the relatively small effects from improving breastfeeding rates among individuals can have a potentially large impact on population health: Breastfeeding is a one off ‘intervention’ that continues to reduce chronic disease risk throughout the life cycle. Unlike other interventions, such as exercise programs, or dietary changes, it does not have to be continued throughout the life cycle in order to maintain this protection, and so has no ongoing costs.
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This point means that it is likely to be very cost effective as a disease prevention measure. There are few other preventative health interventions which have proven permanent effects in reducing risk factors for chronic disease in such a variety of settings.95 3.69 Thus, the committee sees merit in gathering further evidence on the economic impacts of breastfeeding. This would strengthen the case for government action and investment to improve breastfeeding rates in Australia.
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Recommendation 9 3.70 That the Department of Health and Ageing commission a study into the economic benefits of breastfeeding. 94 Australian Breastfeeding Association, sub 306, p 10. 95 Smith J, Harvey P, Australian Centre for Economic Research on Health, sub 319, p 7. 58
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PRESS CONFERENCE FAO, IFAD, PAHO/WHO, UNICEF, WFP January 18, 2023, 11:30 Chile/ 09:30 Panama New UN report warns that Latin America and the Caribbean has the highest cost of access to a healthy diet compared to the rest of the world.
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The Food and Agriculture Organization of the United Nations (FAO), the International Fund for Agricultural Development (IFAD), the Pan American Health Organization (PAHO/WHO), the World Food Programme (WFP), and the United Nations Children's Fund (UNICEF) will present the latest Regional Overview of Food Security and Nutrition in Latin America and the Caribbean on Wednesday, January 18.
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The document will be presented in a virtual press conference (with registration) and open broadcast from FAO's regional office in Santiago, Chile, starting at 11:30 AM (GMT-3), with the participation of the representatives of the five UN agencies responsible for the publication. Panorama 2022 analyzes the cost of healthy diets and warns that Latin America and the Caribbean currently has the highest cost of a healthy diet compared to the rest of the world.
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In addition, the publication highlights the challenges to improving its affordability, as well as the relevance of addressing the high cost of this type of diet in the region and countries to address the rising numbers of hunger, food insecurity, and malnutrition in all its forms.
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The publication presents data and analysis of the effects of the pandemic and other crises on food insecurity and food prices, as well as evidence of national policies that have increased economic access to nutritious food and improved food and nutrition security.
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The UN report shows the link between diet quality and food security and nutrition; and how lack of economic access to a healthy diet is related to different forms of malnutrition such as hunger, stunting and overweight in children under five, and anemia.
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WHAT Launch of the Regional Overview of Food Security and Nutrition 2022 WHEN January 18, 2023, 11:30 Chile/ 09:30 Panama WHO · Mario Lubetkin, FAO’s Regional Representative for Latin America and the Caribbean · Rossana Polastri, IFAD’s Regional Director for Latin America and the Caribbean · Anne-Claire Duffay, Regional Director OIC for Latin America and the Caribbean of UNICEF · Lola Castro, Regional Director of WFP for Latin America and the Caribbean · Marcos Espinal, Subdirector of PAHO/WHO HOW TO PARTICIPATE Journalists interested in participating in the press conference can access the meeting via Zoom and send their questions via chat.
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Please register at the following link: https://fao.zoom.us/webinar/register/WN_GQJwB5vWQlyrcvPAqNWdRg The Conference can also be followed on the FAO website or on the FAO Youtube, FAO Facebook and Twitter account: @FAOCaribbean Interviews and full report under embargo To request an interview, or request the full report under embargo, please write to María Elena Álvarez, maria.alvarez@fao.org y Diana Pamela Rosero diana.rosero@fao.org Press Contacts: FAO / Diana Rosero, diana.rosero@fao.org IFAD / Ana Lucia Llerena, a.llerenavargas@ifad.org PAHO / WHO / Arantxa Cayon cayona@paho.org UNICEF / María Alejandra Berroterán maberroteran@unicef.org WFP / Elio Rujano, elio.rujano@wfp.org
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CONCLUSION Breastfeeding is the biological reference point for infant feeding against which all other alternatives should be measured. There is convincing evidence to show that premature weaning results in increased risk of disease and poorer outcomes for infants and their mothers both in the short and long term. The effects of which are dose-related i.e. the more breastmilk, the lower the risk of disease.
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Breastfeeding belongs to women, it is not something that makes anyone any money and therefore is not seen as a valuable resource in terms of competing in international markets with large corporations that manufacture infant formula. These companies have the resources to spend large amounts on research and in marketing their product because there is profit involved. It is clear that the health consequences associated with premature weaning from breastfeeding are manifold and serious.
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Breastfeeding is an investment in the future health of our children and adults. It therefore makes sense for the government to seek to increase breastfeeding duration in Australia. Australian Breastfeeding Association Breastfeeding Inquiry Submission 2007 Page 37 of 53 References 1. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. American Academy of Pediatrics. Section on Breastfeeding. Pediatrics 2005; 115(2): 496-506. 2.
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Pediatrics 2005; 115(2): 496-506. 2. WHA 34.22. International Code of Marketing of Breastmilk Substitutes. In. Geneva; 1981. WHO. Global Strategy for Infant and Young Child Feeding, http://www.who.int/child- 3. adolescent-health/publications/NUTRITION/IYCF_GS .htm 2003. 4. Shealy KR, Ruowei L, Benton-Davis S, Grammer-Strawn LM. The CDC Guide to Breastfeeding Interventions. Atlanta: US Department of Health and Human Services, Centres for Disease Control and Prevention; 2005.
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Australian Breastfeeding Association. Breastfeeding Leadership Plan: 5. www.breastfeeding.asn.au/advocacy; 2004. Haynes SG. National Breastfeeding awareness campaign results: babies were born to be 6. breastfed: Office on Women's Health (OWH) US Department of Health and Human Services; 2005. Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of Breastfeeding and Risk 7. of Overweight: A Meta-Analysis. Am. J. Epidemiol. 2005; 162(5): 397-403. Dewey KG.
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J. Epidemiol. 2005; 162(5): 397-403. Dewey KG. Is breastfeeding protective against child obesity? Journal of Human Lactation. 8. 2003; 19(1): 9-18. Dewey K, Lonnerdal B. Infant self-regulation of breastmilk intake. Acta Paediatrica 9. Scandinivica 1986; 75:893-898. 10. Fisher JO, Birch LL, Smiciklas-Wright H, Picciano MF. Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes.
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Journal of the American Dietetic Association 2000; 100(6): 641-646. Dewey. KG. Growth characteristics of breast-fed compared to formula-fed infants. Biology of 11. theNeonate. 1998; 74(2): 94-105. 12. McGill HC, Jr., Mott GE, Lewis DS, McMahan CA, Jackson EM. Early determinants of adult metabolic regulation: effects of infant nutrition on adult lipid and lipoprotein metabolism. [Review] [52 refs]. Nutrition Reviews. 1996; 54(2 Pt 2): S31-40.
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https://docs-lawep.s3.us-east-2.amazonaws.com/1694573087798.pdf
https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
Nutrition Reviews. 1996; 54(2 Pt 2): S31-40. Locke R. Preventing obesity: the breast milk-leptin connection. Acta Paediatrica. 2002; 13. 91(9): 891-894. 14. Burke V, Beilin LJ, Simmer K, Oddy WH, Blake KV, Doherty D, et al. Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort. Journal of Pediatrics. 2005; 147(1): 56-61. Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ.
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Malnutrition stunting pasteurizing legislation
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https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ. Risk factors for suboptimal infant 15. breastfeeding behaviour, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003; 112(3 P t l ): 607-619. Australian Breastfeeding Association Breastfeeding Inquiry Submission 2007 Page 41 of 53 Lawlor DA, Smith GD. Early life determinants of adult blood pressure. Current Opinion in 16. Nephrology & Hypertension. 2005; 14(3): 259-64. 17. Martin RM, Gunnell D, Smith GD.
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Malnutrition stunting pasteurizing legislation
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https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
17. Martin RM, Gunnell D, Smith GD. Breastfeeding in infancy and blood pressure in later life: systematic review and meta-analysis. American Journal of Epidemiology 2005; 161(1): 15-26. Fewtrell MS. The long-term benefits of having been breast-fed. Current Paediatrics 2004; 18. 14(2): 97-103. Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Infant feeding and blood cholesterol: 19. a study in adolescents and a systematic review. Pediatrics. 2002; 110(3): 597-608.
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Malnutrition stunting pasteurizing legislation
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Pediatrics. 2002; 110(3): 597-608. Villalpando S, Hamosh M. Early and late effects of breast-feeding: does breast-feeding really 20. matter? [Review] [144 refs]. Biology of the Neonate. 1998; 74(2): 177-91. Couper JJ. Environmental triggers of type 1 diabetes. Journal of Paediatrics & Child Health. 21. 2001; 37(3): 218-20. Akerblom HK, Virtanen SM, Ilonen J, Savilahti E, Vaarala O, Reunanen A, et al.
Maternal health care and reproductive rights
Malnutrition stunting pasteurizing legislation
Australia
https://docs-lawep.s3.us-east-2.amazonaws.com/1694573087798.pdf
https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
Dietary 22. manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia. 2005; 48(5): 829-837. 23. de Onis M. Foreword. Acta Paediatrica 2006; 95(Supplement 450): 5-6. Reader D, Franz MJ. Lactation, diabetes, and nutrition recommendations. Current Diabetes 24. Reports. 2004; 4(5): 370-6. 25. Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, et al.
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Malnutrition stunting pasteurizing legislation
Australia
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https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 1999; 319(7213): 815-819. Oddy WH, de Klerk NH, Sly PD, Holt PG. The effects of respiratory infections, atopy, and 26. breastfeeding on childhood asthma. Eur Respir J 2002; 19(5): 899-905. 27. Marra F, Lynd L, Coombes M, Richardson K, Legal M, Fitzgerald J, et al. Does antibiotic exposure during infancy lead to development of asthma? A systematic review and meta-analysis.
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Malnutrition stunting pasteurizing legislation
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https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf
A systematic review and meta-analysis. Chest 2006; 129:610-618. Flors MS, Fairchok MP. The relationship of breastfeeding to antimicrobial exposure in the 28. first year of life. Clinical Pediatrics 2004; 43:631-363. Friedman NJ, Zeiger RS. The role of breast-feeding in the development of allergies and 29. asthma. [Review] [84 refs]. Journal of Allergy & Clinical Immunology. 2005; 115(6): 1238-1248.
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Malnutrition stunting pasteurizing legislation
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2005; 115(6): 1238-1248. Oddy WH, Peat J. Breastfeeding, asthma, and atopic disease: an epidemiological review of 30. the literature. Journal of Human Lactation 2003; 19:250 - 261. Kull I, Bohnie M, Wahlgren CF, Nordvall L, Pershagen G, Wickman M. Breast-feeding 31. reduces the risk for childhood eczema. Journal of Allergy & Clinical Immunology. 2005; 116(3): 657-661. 32.
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2005; 116(3): 657-661. 32. Kull I, Wickman M, Lilja G, Nordvall SL, Pershagen G. Breast feeding and allergic diseases in infants-a prospective birth cohort study. Archives of Disease in Childhood. 2002; 87(6): 478-481. Australian Breastfeeding Association Breastfeeding Inquiry Submission 2007 Page 42 of 53 Oddy WH, Holt PG, Sly PD, Read AW, Landau LI, Stanley FJ, et al. Association between 33. breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ.
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BMJ. 1999; 319(7213): 815-819. Donath SM, Amir L. Breastfeeding and the introduction of solids in Australian infants: data 34. from the 2001 National Health Survey. 2005; 29:171-175. Oddy WH. A review of the effects of breastfeeding on respiratory infections, atopy, and 35. childhood asthma. Journal of Asthma. 2004; 41(6): 605-621. Peat J, Li J. Reversing the trend: reducing the prevalence of asthma. Journal of Allergy & 36. Clinical Immunology. 1999; 103:1-10. Oddy WH.
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Clinical Immunology. 1999; 103:1-10. Oddy WH. A review of the effects of breastfeeding on respiratory infections, atopy, and 37. childhood asthma. Journal of Asthma. 2004; 41 (6): 605-21. Host A. Cow's milk protein allergy and intolerance in infancy: Some clinical, 38. epidemiological and immunological aspects. Pediatric Allergy and Immunology 1994; 5 Suppl: 5- 36. Golding J, Emmett PM, Rogers IS. Gastroenteritis, diarrhoea and breastfeeding. Early 39. Human Development 1997; 49 Suppl: S83-103.
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Human Development 1997; 49 Suppl: S83-103. Duffy LC, Faden H, Wasielewski R, Wolf J, Krystofik D. Exclusive breastfeeding protects 40. against bacterial colonization and day care exposure to otitis media. Pediatrics 1997; 100:e7. Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast- 41. feeding for at least 4 months protects against otitis media. Pediatrics. 1993; 91(5): 867-872. 42. Teele DW, Klein JO, Rosner B.
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Australia
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42. Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life of children in greater Boston: a prospective cohort study. Journal of Infectious Diseases 1989; 160:8-94. Fosarelli PD, Deangelis C, Winkelstein J, Mellits ED. Infectious illnesses in the first two 43. years of life. Pediatric Infectious Diseases 1985; 4:153-159. Alho OP, Koivu M, Sorri M. Risk factors for recurrent acute otitis media and respiratory 44. infection in infancy.
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International Journal of Pediatric Otorhinolaryngology 1990; 19:151-161. Schlieper A, Kisilevsky H, Mattingly S, Yorke L. Mild conductive hearing loss and language 45. development: a one year follow-up study. Journal of Developmental and Behavioural Pediatrics 1985; 6:65-68. Friel-Patti S, Finitzo-Hieber T, Conti G, Brown KC. Language delay in infants associated 46. with middle ear disease and mild, fluctuating hearing impairment.. Pediatric Infectious Disease 1982; 1:104-109.
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Golz A, Netzer A, Westerman ST GD, Joachims HZ, Goldenberg D. Reading performance in 47. children with otitis media. Otolaryngology: Head and Neck Surgery. 2005; 132:495-499. Carlin JB, Chondros P, Masendycz P, Bugg H, Bishop RF, Barnes GL. Rotavirus infection 48. and rates of hospitalisation for acute gastroenteritis in young children in Australia, 1993-1996. Medical Journal of Australia. 1998; 169(5): 252-256.
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1998; 169(5): 252-256. Australian Breastfeeding Association Breastfeeding Inquiry Submission 2007 Page 43 of 53 Elliott EJ, Dalby-Payne JR. 2. Acute infectious diarrhoea and dehydration in children. 49. Medical Journal of Australia. 2004; 181(10): 565-570. Gianino P, Mastretta E, Longo P, Laccisaglia A, Sartore M, Russo R, et al. Incidence of 50. nosocomial rotavirus infections, symptomatic and asymptomatic, in breast-fed and non-breast-fed infants. Journal of Hospital Infection.
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Journal of Hospital Infection. 2002; 50(1): 13-17. Duffy LC, Byers TE, Riepenhoff-Talty M, La Scolea LJ, Zielezny M, Ogra PLT-. The effects 51. of infant feeding on rotovirus-induced gastroenteritis: a prospective study. American Journal of Public Health 1986; 76:259-263. Sethi D, Cumberland P, Hudson MJ, Rodrigues LC, Wheeler JG, Roberts JA, et al. A study 52. of infectious intestinal disease in England: risk factors associated with group A rotavirus in children. Epidemiology & Infection.
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Malnutrition stunting pasteurizing legislation
Australia
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https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/breastfeeding/subs/sub306c.pdf