Infant formula, the environment, and The BMJ
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5816 (Published 04 October 2019) Cite this as: BMJ 2019;367:l5816
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Thank you for your comment. As explained in the editorial,[1] we are honouring advertising that was booked prior to our decision to stop taking these adverts. The advertisement you spotted was one of these.
1 Godlee F, Cook S, Coombes R, El-Omar E, Brown N. Calling time on formula milk adverts. BMJ 2019;364:l1200. doi: https://doi.org/10.1136/bmj.l1200 (Published 18 March 2019)
Competing interests: No competing interests
Naomi Joffe and colleagues have made excellent research into the ecological impact of infant formula and I am pleased to see The BMJ making environmentally sound changes to their distribution packaging. However, it makes me realise how little environmental change I have seen in the pharmaceutical sector.
Plastic packaging is extremely common in pharmaceutical manufacture and it is often comprised from plastics which are not commonly recyclable around the UK. There are strict requirements for packaging to protect and preserve medications, but little progress appears to have been made to make these materials environmentally friendly too. Furthermore, improper disposal of the actual medication (methods such as flushing them down the toilet) has lead to the detection of pharmaceuticals in water courses; these possess the potential to be harmful to the aquatic wildlife.
Clearly, further progress needs to be made to make the pharmaceutical industry more environmentally friendly. Perhaps though, patients also require more education of the environmental harm their prescriptions can cause and how they can ameliorate this through proper disposal and only ordering what they need.
Competing interests: No competing interests
I am slightly confused as the paper edition of the BMJ of 28.9.2019 has an advert for a milk substitute following page 398. This appears to be in conflict with the editorial saying the BMJ has stopped taking these adverts
Competing interests: No competing interests
Breast is best, and the importance of universal contraception and family planning. Re: Infant formula, the environment, and The BMJ
In my opinion, it is fantastic that The BMJ and its sister journals have stopped accepting advertisements for breast milk [1,2]. This supports both the health benefits of breast feeding, for mother and child [3], and the numerous planetary health benefits of avoiding formula as discussed by Joffe, Webster and Shenker [4].
I was pleased to read in your sister journal, BMJ Sexual & Reproductive Health, the commentary on “Climate change and contraception” [5]. Herein, Bongaarts and Sitruk-Ware highlight the projected population growth (10.9 billion people by 2100, up from today’s 7.7 billion [6]) and the devastating impact this would have on our climate [5,7].
Worldwide, 99.1 million pregnancies are unintended each year (2010-14 data) [8]. Bongaarts and Sitruk-Ware argue that universal access to effective contraception should be given high priority by policymakers. I agree wholeheartedly. Improving access to contraception and effective family planning programmes have to date been largely ignored by climatologists and thus climate policy [5,9]. Slowing the projected population growth could reduce global emissions by an estimated 40% [7].
Bongaarts and Sitruk-Ware highlight that dissatisfaction with available contraceptive methods is one of the key reasons why women can be reluctant to use contraception. I therefore welcome the innovative contraceptive technologies under development [5,10]. However, I agree with Bongaarts and Sitruk-Ware that greater investment in family planning programmes with improved access to currently available contraceptives is a vital next step. In the future, the affordability of and health education regarding any new contraceptive methods will be key.
Footnote: Opinions expressed are the author's own and do not necessarily reflect the views of the University of Manchester or the Royal College of Physicians of Edinburgh.
References
1. Godlee F. Infant formula, the environment, and The BMJ. BMJ 2019; 367: l5816.
doi: https://doi.org/10.1136/bmj.l5816
2. Godlee F, Cook S, Coombes R, et al. Calling time on formula milk advert. BMJ 2019; 364: l1200.
doi: https://doi.org/10.1136/bmj.l1200
3. Victora CG, Bahl R, Barros AJD, et al., for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st Century: epidemiology, mechanisms and lifelong effect. (Breastfeeding Series 1). Lancet 2016; 387: 475-90.
Available from: https://www.thelancet.com/series/breastfeeding
4. Joffe N, Webster F, Shenker N. Support for breastfeeding is an environmental imperative. BMJ 2019; 367: l5646.
doi: https://doi.org/10.1136/bmj.l5646
5. Bongaarts J, Sitruk-Ware R. Climate change and contraception. BMJ Sexual & Reproductive Health Published Online First: 15 October 2019.
doi: https://doi.org/10.1136/bmjsrh-2019-200399
6. United Nations. World population prospects: the 2019 revision. United Nations Population Division, 2019.
Available from: https://population.un.org/wpp/
7. O'Neill BC, Liddle B, Jiang L, et al. Demographic change and carbon dioxide emissions. The Lancet 2012; 380: 157–64.
Available from: https://www.sciencedirect.com/science/article/pii/S0140673612609581
8. Bearak J, Popinchalk A, Alkema L, et al. Global, regional, and sub-regional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Global Health 2018; 64: e380-9.
Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(18)30029-9
9. Bongaarts J, O'Neill BC. Global warming policy: is population left out in the cold? Science 2018; 361: 650–2.
doi: https://doi.org/10.1126/science.aat8680
10. Anderson DJ. Population and the environment — time for another contraception revolution. N Engl J Med 2019; 381: 397–9.
doi: https://doi.org/10.1056/NEJMp1906733
Competing interests: No competing interests