Today's guest blogger is Diane L. Spatz, PhD, RN-BC, FAAN, a Nurse Researcher and Director of the Lactation Program at the Children's Hospital of Philadelphia and Professor of Perinatal Nursing and the Helen M. Shearer Professor of Nutrition at the University of Pennsylvania School of Nursing.

In the United States and worldwide, manufacturing of infant formula is big business (44.8 billion U.S. dollars per year).  Formula companies spend billions of dollars marketing their products, as well as funding research on human milk to attempt to discover substances to add to their product.

A recent report from the Rudd Center on Food Policy and Obesity found that marketing for infant formula often includes promises of benefits for infants, such as less fussy baby, better digestion, and brain development. This may lead parents to believe that these products are more beneficial than breastmilk. Currently, companies are not required to support these claims with scientific research.

Last September, the U.S. Food and Drug Administration reopened the public comment period for 90 days on its draft guidance, encouraging infant formula manufacturers and distributors to substantiate with "competent and reliable evidence" any claims about effects of their products on the body. The comment period is open until February 21 this year.

The Lancet provided an entire series on the critical need to improve breastfeeding globally.  If breastfeeding could be scaled up to a near universal level, 823,000 deaths of children under age five could be prevented annually, and an additional 20,000 deaths of women from breast cancer could be prevented annually.  Furthermore, not breastfeeding is associated with lower intelligence of children and economic losses of $302 billion annually.

Breastfed infants have substantially different brain architecture than infants fed formula. Both white matter and gray matter are increased in breastfed infants, which directly translates into improved tests of intelligence and developmental outcomes.

Both infant formula and human milk provide nutrition for an infant, however only human milk can act as nutrition, plus aid in the development of the infant's immunobiological system and brain development. Human milk can also change and adapt - each mother specifically tailors her milk to meet the needs of her infant.  Human milk contains a multitude of immune and anti-infective agents such as lactoferrin, cytokines, and lysozyme.  Through breastfeeding, human milk-associated microbes colonize the infant gut and are critical in shaping both short and long term infant health outcomes.  Infant formulas are dead and cannot adapt to specific immunobiological and developmental needs of the infant.

Unfortunately, those infants who may benefit the most from human milk are often at the highest risk for not receiving human milk due to the tremendous health disparities that exist in the U.S. surrounding breastfeeding.  White women are almost 20 percent more likely to initiate breastfeeding (84.3 percent initiation) versus only 66.3 percent initiation in black women. Additionally, women in the highest income ratio have a 91.7 percent initiation rate versus only a 72.8 percent initiation rate in the lowest poverty ratio.

Human milk and breastfeeding may play an important role in mitigating against toxic stress. Assisting families to make an informed choice to both initiate and continue breastfeeding has the potential to address both the disparity in the quality of nutrition and the economic stress experienced by families who purchase infant formula.

My 10 step model has been effective in improving human milk and breastfeeding in vulnerable infants in the U.S. and worldwide. While formula is adequate to provide nutrition to an infant—it does not provide all the irreplaceable ingredients in human milk. The first step of the model highlights the importance of informed decision making: the science shows human milk and infant formula will never be equivalent.

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