“Breastmilk makes the world healthier, smarter, and more equal,” an editorial (pdf) published in the medical journal The Lancet declared in 2016. The statement was part of a whole section devoted to the benefits of breastfeeding as a crucial part of development in a child’s early years.

But US government officials are not convinced, according to a new story in the New York Times. The Times reports that earlier this year, the US tried to weaken a World Health Organization proposal encouraging the health benefits of breastfeeding. In a surprise move,

“American officials sought to water down the resolution by removing language that called on governments to ‘protect, promote and support breast-feeding’ and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.”

When Ecuador tried to save the proposal, the US threatened trade sanctions and diminished military aid. Ecuador caved to the US. Ultimately, it was Russia that stepped in to save the day, endorsing the proposal and protecting most of it. An unnamed Russian official told the Times: “We’re not trying to be a hero here, but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world.” Lucy Sullivan, executive director of the early-childhood development 1000 Days, noted on Twitter that the language of the final resolution removed all but one reference to the International Code of Marketing for breast-milk substitutes, which the WHO first adopted in 1981 in an effort to ensure that baby-formula marketing would not discourage mothers from breastfeeding:

It’s hard to know what’s worse: the allegation that US officials were swayed by formula manufacturers, that the US bullied smaller and poorer countries in an effort to protect those interests, or that it fell to Russia—a country not currently known for its nurturing ways—to defend the evidence. But what, exactly, does the evidence say on breastfeeding? Here’s a review of what we know.

The scientific benefits of breastfeeding

In addition to the 2016 Lancet series, a 2017 Cochrane review of 73 studies from 29 countries, involving 74,656 mothers and babies, established some key benefits of breastfeeding. “Few health behaviours have such a broad-spectrum and long-lasting impact on population health, with the potential to improve life chances, health and well-being,” the review authors write. Evidence shows that children who are not breast fed face several health risks, including:

In addition, for women, evidence shows that not breastfeeding is associated with increased risks of breast and ovarian cancer, as well as diabetes (Chowdhury 2015).

Cesar Victora, a professor of epidemiology, estimated in 2016 (pdf) that each year, 823,000 deaths in children under five years of age and 20,000 deaths from breast cancer could be prevented by near-universal breastfeeding. Other research estimated the global health costs of not breastfeeding—that is, the amount of money spent caring for children and women with chronic disease and short-term illnesses that might have otherwise been avoided—at $300 billion, or 0.49% of world gross national income.

The science has translated to policy. The World Health Organization recommends exclusively breastfeeding infants for at least the first six months. The American Academy of Pediatrics (AAP) also advises that infants consume nothing but breast milk for the first six months of life and continue to breastfeed until at least their first birthday.

It’s important to note that there is some nuance to the evidence on the benefits of breastfeeding. As Dan Kopf and Corinne Purtill explain in a 2017 article for Quartz, “many of the benefits more commonly cited by advocates—like higher IQ and lower obesity rates—are impossible to disentangle from socioeconomic factors in observational studies, as Brown University economist Emily Oster points out.”

Indeed, in the US, research shows that social class predicts breastfeeding uptake. As Purtill and Kopf explain:

Well-off parents have access to the infrastructure that supports breastfeeding: longer maternity leaves, jobs that allow for pumping breaks, the ability to hire outside help to support a new mother, and—perhaps most importantly—immersion in a culture that unconsciously views breastfeeding as a desirable status symbol and pressures them to continue to that hallowed six-month mark and well beyond.

Women don’t breastfeed, or give it up quickly for many reasons. One: it can be painful in the beginning, and discomfort and cultural norms lead many women to give it up. Support for breastfeeding is therefore critical, including institutional provisions as well as emotional support, reassurance, practical help, and information. Paid maternity leave also influences whether women breastfeed, and for how long: “The more time a woman has at home with a baby on maternity leave, the more likely she is to breastfeed,” Purtill and Kopf explain.

A spokesperson for the US Department of Health and Human Services told the Times that American officials had wanted to change the language in the WHO proposal out of concern for the women who are unable to breastfeed. “We recognize not all women are able to breast-feed for a variety of reasons,” the anonymous officials said. “These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.”

It’s good to avoid stigmatizing women who do not breastfeed, or who give it up for many valid reasons. But if the US government really wants to help mothers and their children, it would be better served to focus on offering proper support and guidance rather than catering to the needs of formula manufacturers.

Read more from our series on Rewiring Childhood. This reporting is part of a series supported by a grant from the Bernard van Leer Foundation. The author’s views are not necessarily those of the Bernard van Leer Foundation.