Vol. 26 No 2 | Winter 2024
Can Breastfeeding Mitigate the Impact of Climate Change?
Dr Libby Salmon

Policies for sustainable health systems often focus on the carbon footprint of technologies and buildings. The 2023 National Health and Climate (NHC) Strategy1 goes beyond these initiatives, with a package of climate change mitigation and adaptation measures that cover nutrition standards, waste reduction, supply chains and models of care. These measures include attention to regional and preventative health, emergency and disaster planning, food security and communicable disease risks, including antimicrobial resistance. Breastfeeding is relevant to most of these measures, but often overlooked as a powerful means to build climate-resilient health systems. This article summarises the contribution of breastfeeding to sustainability, using recent evidence. However, lifting rates of breastfeeding nationally requires institutional support and investment from the top, not more pressure on individual mothers. Health professionals interested in sustainable health systems can influence government in two key areas: funding for the 2019 Australian National Breastfeeding Strategy2 and the regulation of marketing of infant formula and toddler milks3, currently before the Australian Competition and Consumer Commission4.

O&Gs have key leadership roles to champion breastfeeding and models of maternity care that protect and support it. In doing so, they contribute to “the highest quality, local, sustainable first-food system for generations to come”.5

Breastfeeding as climate change adaptation

Increasing breastfeeding builds national capacity to adapt to climate change. At the population level, breastfeeding prevents infant and maternal illness 6, reduces health system costs7-9, and builds a climate-resilient health sector. Breastfeeding provides antibodies and other immunologically protective factors that reduce the incidence of infections in infants and young children6,10  — issues that are relevant to the threat of antimicrobial resistance. However, many mothers do not live and work in environments that provide the social and institutional support necessary to breastfeed. Despite the intentions to breastfeed by the vast majority of Australian mothers (over 90%), many face multiple obstacles11-16. For example, only 21% of Australian maternity hospitals are Baby Friendly Hospital Initiative (BFHI)-accredited17-19. The reasons for inadequate breastfeeding are complex and include under-investment in breastfeeding support for mothers20 and insufficient protection from inappropriate marketing of commercial milk formulas21. These problems are compounded by inadequate health professional training in breastfeeding and unsupportive social, childcare and workplace environments20,22,23. Consequently, more than two thirds of Australia’s infants and young children are fed commercial milk formulas24,25. These products include infant formula (for ages 0–6 months) and follow-on formula (6–12 months), toddler formula (13–36 months) and special requirements formula (0–6 months).

Breastfeeding is disrupted whenever infants are separated from their mothers. In addition to unsupportive work environments, breastfeeding is threatened by separation through medical emergencies, hospitalisation and incarceration26, and hospital protocols, as seen in the early stages of the COVID-19 pandemic27. Breastfeeding is disrupted when models of maternity care or medical conditions limit breastfeeding, for example maternal obesity, diabetes type 2 and premature or caesarean birth28,29. Many of these conditions are associated with social disadvantage, compounding the first food insecurity of these communities11-16.

Barriers to breastfeeding follow social gradients, and mothers of higher socioeconomic status are better equipped to sustain breastfeeding than mothers in lower socioeconomic groups, culturally and linguistically diverse communities and regional areas30-32. For Australian Aboriginal and Torres Strait Islander mothers, rates of breastfeeding may vary with cultural knowledge, remoteness, culturally safe models of maternity care and breastfeeding support within Aboriginal controlled health services33. Social inequities explain why poor households are the least likely to breastfeed, despite having the least capacity to afford commercial milk formula, a situation referred to as the ‘breastfeeding paradox’ in the food security literature34,35.

Infant feeding in natural disasters & emergencies

Climate change is predicted to increase the frequency and intensity of natural disasters, wars and civil unrest. Health districts and communities with high rates of breastfeeding are better placed to withstand these challenges. Community resilience to emergencies and disasters requires the short supply chain and health benefits of breastfeeding. Breastfeeding provides the shortest possible food ‘supply chain’ for infants and young children. However, this supply chain is readily disrupted when breastfeeding is not protected, promoted and supported. Emergencies and natural disasters highlight the extreme vulnerability of infants and young children to acute food insecurity and infection if they are not fed properly, and disadvantaged population groups are more exposed to harm. Breastfed infants are food secure as long as they are with their mothers, and the mother’s health and wellbeing are prioritised. In bushfires, cyclones, floods and other disasters supplies of commercial milk formula and their hygienic preparation may be compromised by disruptions to transport, clean water and electricity. These hazards make bottle feeding unsafe and rapidly create conditions that expose non-breastfed infants to increased risks of infection, which may be life threatening.

However, Australian disaster management plans have been slow to include policies for feeding infants and young children, despite extensive international guidelines36. These plans need to include protocols to protect and support breastfeeding and ensure that non-breastfed infants are fed safely. In contrast to the short ‘supply chain’ of breastfeeding, supply chains for commercial milk formula are complex, globalised and highly vulnerable. These supply chains are subject to logistic disruptions and recalls that affect availability37,38. For instance, in the United States in 2022 a recall of a major infant formula brand and reported deaths of three infants resulted in a crisis arising from shortages of milk formula products39.

Breastfeeding is a secure, sustainable way to feed infants and children as long as they’re with their mothers and the mother’s health is prioritised. Photo: Australian Breastfeeding Association

Breastfeeding can lower carbon footprints

Breastfeeding has long been recognised as an environmentally sustainable way to feed infants and young children, because it does not generate the substantial greenhouse gas emissions, water and fertiliser consumption, contamination and other environmental degradation, (including land fill) associated with the dairy industry and the manufacture, transport and packaging of commercial milk formulas40,41. The production of commercial milk formulas doubles the ‘carbon footprint’ of breastfeeding. Annual emissions for commercial milk formulas range from 4-14 kg CO2 eq across the full life cycle of product production and use1,5,42. In addition, each kilogram of formula requires 6280L of water (including 699L of ‘blue’ water and rainwater for fodder for raw milk production43.

The sustainability of diets is a new initiative in the current review of the Australian Dietary Guidelines, with the NHMRC forming a Sustainability Working Group44, to advise on “accessible, affordable and equitable diets with low environmental impacts.” Priority areas in the review includes the effects of maternal diet on pregnancy and breast milk production and food security45. While the review’s scope excludes infant feeding, it includes children older than 12 months and the effects of diet on children’s allergies, growth (including overweight/obesity) and development, in which breastfeeding plays a role. The review will also examine evidence surrounding ultra-processed foods, a classification applied in some countries to infant formula and “toddler milk”46,47.

‘First food security’ recognises the centrality of breastfeeding to food security of infants and young children in households every day and during emergencies37, based on concepts of breastfeeding as the ‘first food system48,49. Breastfeeding has the potential to fulfil every aspect of food security, defined by the United Nations and others in terms of appropriateness, (a crucial factor for developing infants), and food availability, accessibility (which includes affordability), utilisation, stability and sustainability37. Food security came to national attention during the recent bushfires, floods and COVID-19 pandemic, which disrupted the labour force and food supply chains and was investigated in a recent parliamentary Inquiry into Food Security in Australia50. The relevance of breastfeeding to national food security was argued in a detailed submission to the inquiry by the World Breastfeeding Trends Initiative Australia and the Australian Breastfeeding Association51. Breastfeeding was recognised as ‘first food security’ in the inquiry’s recommendations for a National Food Security Strategy52, and food security is prioritised in the scope of the current review of the Australian Dietary Guidelines53. Global reporting on food security now includes breastfeeding54.

Decarbonising the health system

To ‘decarbonise the health system’ and help build community and health system resilience to climate change, we need the government to take urgent action and invest in Australia’s national capacity to breastfeed. How? By protecting breastfeeding from the influence of commercial milk formula companies in policy making, the health system and homes by strengthening, in law, Australia’s implementation of the WHO International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly resolutions. This action is critical, following the review of the Marketing in Australian of Infant Formula (MAIF) Agreement, (a report released on 11 April 2024)55, in response to the Australian Competition and Consumer Commission (ACCC)’s concerns about the marketing toddler milks56.

Rolling out the 2019 Australian National Breastfeeding Strategy. This is long overdue: we need an implementation plan and funding for all sections of the strategy in federal budgets. Single actions are not enough: a national boost to breastfeeding needs coordinated investment over ten policy areas, not “cherry-picked” policy and funding. The importance of breastfeeding to climate health, makes it highly relevant to planning the implementation of the National Health and Climate Strategy 1 and consistent with the National Women’s Health Strategy 2020-203057 – a ‘win’ for all.

Libby Salmon BVSc, MVCS, PhD, Australian Research Centre for Health Equity (ARCHE) School of Regulation and Global Governance, The Australian National University, Canberra.



  1. Department of Health and Aged Care. National Health and Climate Strategy. Canberra: Commonwealth of Australia; 2023. Contract No.: 17 May 2024.
  2. COAG Health Council. Australian National Breastfeeding Strategy: 2019 and Beyond Canberra: Council of Australian Governments 2019.
  3. Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, et al. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet [Internet]. 2023; 401(10375): [486-502 pp.]. Available from:
  4. Australian Competition and Consumer Commission. Authorisations register: Infant Nutrition Council Ltd, 25 March 2024 Australian Competition and Consumer Commission: Commonwealth of Australia; 2024.
  5. Smith JP, Baker P, Mathisen R, Long A, Rollins N, Waring M. A proposal to recognize investment in breastfeeding as a carbon offset. Bull World Health Organ. 2024;102(5):336.
  6. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet [Internet]. 2016; 387(10017): [475-90 pp.]. Available from:
  7. Smith JP, Thompson JF, Ellwood DA. Hospital system costs of artificial infant feeding: estimates for the Australian Capital Territory. Aust N Z J Public Health [Internet]. 2002; 26(6): [543-51 pp.]. Available from:
  8. Walters DD, Phan LTH, Mathisen R. The cost of not breastfeeding global results from a new tool. Health Policy Plan. 2019;34(6):407-17.
  9. Renfrew MJ, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, et al. Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. London: UNICEF UK; 2012.
  10. Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeed Med. 2009;4(S1) :S-17-S-30.
  11. Morrison AH, Gentry R, Anderson J. Mothers’ reasons for early breastfeeding cessation. MCN: The American Journal of Maternal/Child Nursing. 2019;44(6):325-30.
  12. Scott J, Ahwong E, Devenish G, Ha D, Do L. Determinants of Continued Breastfeeding at 12 and 24 Months: Results of an Australian Cohort Study. Int J Environ Res Public Health. 2019;16(20):3980.
  13. Chimoriya R, Scott JA, John JR, Bhole S, Hayen A, Kolt GS, et al. Determinants of full breastfeeding at 6 months and any breastfeeding at 12 and 24 months among women in Sydney: findings from the HSHK birth cohort study. Int J Environ Res Public Health [Internet]. 2020; 17(15):[5384 p.]. Available from:
  14. Gallegos D, Parkinson J, Duane S, Domegan C, Jansen E, Russell-Bennett R. Understanding breastfeeding behaviours: a cross-sectional analysis of associated factors in Ireland, the United Kingdom and Australia. Int Breastfeed J [Internet]. 2020; 15(1):[103 p.]. Available from:
  15. Moss KM, Dobson AJ, Tooth L, Mishra GD. Which Australian Women Do Not Exclusively Breastfeed to 6 Months, and why? J Hum Lact. 2021;37(2):390-402.
  16. Andrew MS, Selvaratnam RJ, Davies-Tuck M, Howland K, Davey M-A. The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study. Int Breastfeed J. 2022;17(1):48.
  17. Esbati A, Henderson A, Taylor J, Barnes M. The uptake and implementation of the Baby Friendly Health Initiative in Australia. Women Birth. 2019;32(3):e323-e33.
  18. BFHI Australia. About BFHI Australia: Baby Friendly Health Initiative (BFHI) Australia; 2024 [Available from:
  19. Pramono A, Smith J, Desborough J, Bourke S. Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study. International Journal for Equity in Health. 2021;20(1):22.
  20. WBTi Australia. Assessment Report Australia 2023 Delhi: World Breastfeeding Trends Intiative. Breastfeeding Promotion Network of India (BPNI) and The International Baby Food Action Network (IBFAN); 2023 [Available from:
  21. Australian Competition and Consumer Commission. Determination: Application for revocation of authorisations A91506 and A91507 and the substitution of authorisation AA1000534 lodged by Infant Nutrition Council Limited in respect of the Marketing in Australia of Infant Formula: Manufacturers and Importers Agreement, and associated guidelines. 27 July 2021 Canberra: Commonwealth of Australia; 2021.
  22. Yang S-F, Salamonson Y, Burns E, Schmied V. Breastfeeding knowledge and attitudes of health professional students: a systematic review. Int Breastfeed J. 2018;13(1):8.
  23. Smith JP, Javanparast S, McIntyre E, Craig L, Mortensen K, Koh C. Discrimination against breastfeeding mothers in childcare. Australian J Lab Econ. 2013;16(1):65-90.
  24. 2010 Australian national infant feeding survey: indicator results Canberra: Australian Institute of Health and Welfare; 2011. Report No: 978-1-74249-269-8
  25. Australia’s mothers and babies 2023. Canberra: Australian Institute of Health and Welfare; 2024.
  26. Stewart C, Bourke SL, Green JA, Johnson E, Anish L, Muduwa M, et al. Healthcare challenges of incarcerated women in Australia: An integrative review. International Journal of Healthcare. 2021;7(1).
  27. Gribble K, Cashin J, Marinelli K, Vu DH, Mathisen R. First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined. Front Nutr. 2023;9.
  28. Miller YD, Tone J, Talukdar S, Martin E. A direct comparison of patient-reported outcomes and experiences in alternative models of maternity care in Queensland, Australia. PLoS One. 2022;17(7):e0271105.
  29. Talukdar S, Dingle K, Miller YD. A scoping review of evidence comparing models of maternity care in Australia. Midwifery. 2021;99:102973.
  30. Ogbo FA, Ezeh OK, Khanlari S, Naz S, Senanayake P, Ahmed KY, et al. Determinants of exclusive breastfeeding cessation in the early postnatal period among culturally and linguistically diverse (CALD) Australian mothers. Nutrients [Internet]. 2019; 11(7):[1611 p.]. Available from:
  31. Ogbo FA, Eastwood J, Page A, Arora A, McKenzie A, Jalaludin B, et al. Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. Int Breastfeed J [Internet]. 2017; 12(1):[16 p.]. Available from:
  32. Amir LH, Donath SM. Socioeconomic status and rates of breastfeeding in Australia: evidence from three recent national health surveys. Med J Aust [Internet]. 2008; 189(5):[254-6 pp.]. Available from:
  33. Brown S, Stuart-Butler D, Leane C, Glover K, Mitchell A, Deverix J, et al. Initiation and duration of breastfeeding of Aboriginal infants in South Australia. Women Birth. 2019;32(3):e315-e22.
  34. Frank L. The breastfeeding paradox: a critique of policy related to infant food insecurity in Canada. Food, Culture & Society. 2015;18(1):107-29.
  35. Venu I, Van Den Heuvel M, Wong JP, Borkhoff CM, Moodie RG, Ford-Jones EL, et al. The breastfeeding paradox: relevance for household food insecurity. Paediatr Child Health. 2017;22(4):180-3.
  36. Gribble K, Peterson M, Brown D. Emergency preparedness for infant and young child feeding in emergencies (IYCF-E): an Australian audit of emergency plans and guidance. BMC Public Health. 2019;19:1-11.
  37. Salmon L. Food security for infants and young children: an opportunity for breastfeeding policy? Int Breastfeed J. 2015;10(1):7.
  38. Gribble K. Supporting the most vulnerable through appropriate infant and young child feeding in emergencies. J Hum Lact [Internet]. 2018; 34(1):[40-6 pp.]. Available from:
  39. Salmon L, Smith J, Baker P. Australia’s Role in Global Infant Food Security: Implications of the US Milk Formula Shortage. Australian Outlook. 8 June 2022.
  40. Linnecar A, Gupta A, Bidla JDN. Formula for Disaster: weighing the impact of formula feeding vs breastfeeding on environment. BPNI / IBFAN Asia; 2014.
  41. Smith JP. A commentary on the carbon footprint of milk formula: harms to planetary health and policy implications. Int Breastfeed J. 2019;14(1):49.
  42. Dadhich J, Smith JP, Iellamo A, Suleiman A. Climate Change and Infant Nutrition: Estimates of Greenhouse Gas Emissions From Milk Formula Sold in Selected Asia Pacific Countries. J Hum Lact. 2021;37(2):314-22.
  43. Pope DH, Karlsson JO, Baker P, McCoy D. Examining the Environmental Impacts of the Dairy and Baby Food Industries: Are First-Food Systems a Crucial Missing Part of the Healthy and Sustainable Food Systems Agenda Now Underway? Int J Environ Res Public Health. 2021;18(23):12678.
  44. National Health and Medical Research Council. Dietary Guidelines Sustainability Working Group Canberra: Commonwealth of Australia; 2024
  45. National Health and Medical Research Council. Review of the Australian Dietary Guidelines: Priority research questions Canberra: Commonwealth of Australia; 2024
  46. Baker P, Santos T, Neves PA, Machado P, Smith J, Piwoz E, et al. First-food systems transformations and the ultra-processing of infant and young child diets: The determinants, dynamics and consequences of the global rise in commercial milk formula consumption. Matern Child Nutr [Internet]. 2021; 17(2):[e13097 p.].
  47. Sarmiento-Santos J, Souza MBN, Araujo LS, Pion JMV, Carvalho RA, Vanin FM. Consumers’ Understanding of Ultra-Processed Foods. Foods. 2022;11(9):1359.
  48. Baker P. Breastfeeding, first food systems and corporate power. Breastfeed Rev [Internet]. 2020; 28(2):[33-7 pp.]. Available from:
  49. Baker P, Russ K, Kang M, Santos TM, Neves PA, Smith J, et al. Globalization, first-foods systems transformations and corporate power: a synthesis of literature and data on the market and political practices of the transnational baby food industry. Glob Health [Internet]. 2021; 17(1):[1-35 pp.]. Available from:
  50. House of Representatives Standing Committee on Agriculture. Inquiry into food security in Australia Canberra: Parliament of Australia; 2022
  51. World Breastfeeding Trends Initiative Australia, Australian Breastfeeding Association, Salmon L, Smith J, Gribble K, Baker P. Joint Submission to Inquiry into Food Security in Australia. Canberra: House of Representatives Standing Committee on Agriculture; 2022.
  52. House of Representatives Standing Committee on Agriculture. Australian Food Story: Feeding the Nation and Beyond. Inquiry into food security in Australia. Canberra: Parliament of Australia; 2023.
  53. National Health and Medical Research Council. Review of Australian Dietary Guidelines: Scoping activities and research question development: Commonwealth of Australia; 2021
  54. FAO, IFAD, UNICEF, WFP, WHO. The State of Food Security and Nutrition in the World 2023. Urbanization, agrifood systems transformation and healthy diets across the rural–urban continuum. Rome; 2023.
  55. Allen + Clarke Consulting. Review of the Marketing in Australia of Infant Formulas: Manufacturers and Importers (MAIF) Agreement Final Report. 5 October 2023. Canberra: Department of Health and Aged Care; 2024 11 April 2024.
  56. Australian Competition and Consumer Commission. Restrictions on marketing of infant formula reauthorised 2021 [updated 27 July 2021.
  57. Department of Health and Aged Care. National Women’s Health Strategy 2020–2030 Canberra: Commonwealth of Australia; 2019

*Approximately 6.6kg raw milk is used to produce 1kg of commercial formula.


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