New edition Gyldendal Norwegian Publishing Company, Oslo, 1995 Translated from the original by Rachel Myr 

here is much to be gained from the direct, pleasant and resource-saving transfer of milk from mother to baby, compared to the far more energy-costly and environmentally damaging use of cartons, cans, bottles, nipples and energy for production of artificial substitutes at the various steps of the process.

The Norwegian breastfeeding mothers' support association, Ammehjelpen, has calculated that six months of artificial feeding actually results in 4.3 kg of waste of this kind. If all Norwegian babies were to be artificially fed-which is far from the case-it would result in at least 260 extra tons of solid waste annually! Ammehjelpen has further calculated that, at 1995 prices, each mother saves about 3000-4000 Norwegian crowns (about 650 US$) by breastfeeding the first six months-and that includes only milk powder, bottles, teats, but not electricity and labor. 

The Norwegian Nutrition Council has calculated that Norwegian mothers in the nineties produce over 8.2 million litres of milk annually-and the value of this milk, based on the rate paid by milk banks for the precious drops, equals nearly 3 billion Norwegian crowns ($460 000 000)-right into the state's coffers without anyone even noticing...

Environmental Pollution

At regular intervals there will be reports in the press about scientists having found substances in mother's milk with the most frightening names-polychlorinated biphenyls, hexachlorocyclohexane, and dioxin. One must remember that these articles, which are always considered good "stuff' because they are about environmental toxins and innocent babies, were usually not undertaken because of suspicions about ill-health in babies. 

Most often it is simply in the newspapers because authors of some new study want to draw attention to their work. The real reason we have such information in the first place, is simply that the environmental health authorities in all countrries are obliged to keep themselves updated about changes in the toxic load borne by the population which they are responsible for. To do that, one must know what is being stored in people's bodies.

As most of the substances mentioned above are fat soluble, they end up in the adipose tissue of the citizenry. It is quite demanding (and not very pleasant for anyone involved) to obtain samples of the fatty tissue from hundreds of people. Breastmilk is therefore a practical alternative: we know that a certain portion of the fat in milk comes from the mother's own fatty tissue, so that if environmental toxins are stored in her tissue they will be proportionally excreted in the milk. The toxicologist does not need to stick huge biopsy needles into people's fattest body parts, all one needs is a small milk sample. Hence all the studies of levels of toxins in human milk!

The press attention this regularly receives is out of all proportion to the health problem posed, but naturally mothers do become very unhappy when they read that these poisons exist in their bodies and in their milk. Thus, it is fortunate that there are a couple of very important and quite comforting points to keep in mind: Several reports from the beginning of the nineties show that the level of these substances has fallen quite significantly over recent years, probably as a result of more limited use in many western countries. 

Such reports have come from countries as far apart as Sweden, Germany and Canada. One of the reasons one hasn't found health problems in babies may be that a baby actually increases its body fat quite a bit in the first year of life. This means that the fat soluble substances in breastmilk go from the mother's stores straight into the baby's. 

At the same time, one should be aware that the levels referred to as "lowest daily dose" or minimum levels are set very high, because one wants to be on the safe side one can not do human experiments to find just where the limit is for health risk, so the recommendations are made based on animal studies, and include a very solid margin of safety. WHO, after a careful evaluation of the current situation with regard to environmental toxins and possible risks to children, has concluded that the advantages of breastmilk far outweigh the possible risk, and has recommended breastfeeding as preferable to any of the alternatives. 

Still, as parents to future generations we ought to support all efforts to replace the more persistent environmental toxins with substances which may be rapidly broken down or which are not poisonous to people or animals.

Radioactive substances

There are surprisingly few studies of breastmilk with regard to radioactivity, perhaps in part because the amounts one has been able to measure have been so small that it is difficult to determine their identities, and perhaps because for the same reason this has not been viewed as a major problem.

Many mothers, however, worry a great deal about precisely this kind of contamination. After the accident at the nuclear power plant in Chernobyl in April 1986, there were at least a few European laboratories which followed the situation with regard to the content of radioactive substances in breastmilk, and reports from Sweden, Italy, Norway and Austria were later published in scientific journals. 

The substances studied were radioactive iodine (designated by the chemical sign '3'I) and two forms of radioactive cesium, '137Cs and '134Cs. Briefly, one may say that the amounts found were in no case so great that they exceeded even the strictest limits set for infant food. Should a similar accident occur again, one will always wonder whether there is something one can do to protect oneself and one's children. In the case of radioactive iodine, it disappears very quickly; and after a couple of weeks it has reverted to its normal, non-radioactive form. 

A mother with sufficient iodine in her body (and this means most women who eat some fish or seafood) will absorb almost no radioactive iodine even if exposed to it. One may be vulnerable if in the first few days following a nuclear power plant accident one bareheaded takes a stroll in the rain, just as a cloud of radioactive iodine dust is passing over the area. 

Avoiding this, and if possible taking a capsule of potassium iodide, which won't hurt in any event, is the best protection one could get if this should ever happen again. This does however illustrate the importance of pregnant and lactating mothers having sufficient stores of iodine - not only to protect themselves and their babies in the (fortunately) unlikely event of nuclear fallout, but also to safeguard the health and development of their developing baby.

We have little information about other radioactive substances. The Norwegian study mentioned above showed that when milk from mothers living in areas where the ground was not contaminated by radioactive cesium was compared with that of mothers from areas where such contamination was up to 200 times higher, the variation in the cesium content of the breastmilk was extremely small. And, as mentioned above, it was in all cases so low that it did not even approach dangerous levels.

Concentration of 137Cs in breastmilk from three areas of Norway with different degrees of radioactive fallout.

From Lindemann R & Christensen GC ( 1987) Radioactivity in Breastmilk after the Chernobyl accident Acta Paediatrica Scandinavica 76:981-986