KRISTOF: A free source of food that will save lives

MOPTI, Mali

Can you name a miracle food that is universally available, free and can save children's lives and maybe even make them smarter? That's not a trick question. There really is such a substance, now routinely squandered, that global health experts believe could save more than 800,000 lives annually. While you're puzzling over the answer, let me tell you how I just saw it save a life here in West Africa.

I'm on my annual win-a-trip journey, in which I take a university student along with me so we can report on global poverty. The winner, Erin Luhmann of the University of Wisconsin, and I randomly stopped in a village near the Malian town of Mopti to ask about food shortages.

Then we spotted a baby boy who was starving to death. The infant, only 3 weeks old, was wizened from severe malnutrition and had the empty, unresponsive face of a child shutting down everything else to keep his organs functioning.

The teenage mother, Seyda Allaye, said that she didn't have much milk and that the baby wasn't nursing well. She saw that he was dying and that morning had invested in cow's milk in hopes of saving him.

Erin and I had a vehicle, so we offered to take her and her son to a hospital to see if doctors could save his life. At the hospital, a doctor examined the baby, asked his mother to try to nurse him and immediately diagnosed the problem.

"The mother doesn't know how to breast-feed properly," said the doctor, Amidou Traor? "We see lots of cases of child mortality like this." Traor?repositioned Seyda Allaye's arm, helped the infant latch on to her breast, and the baby came alive. And there's the answer to my opening question. The miracle food that could save so many lives is: breast milk.

The latest nutritional survey from The Lancet estimates that suboptimal breast-feeding claims the lives of 804,000 children annually. That's more than the World Health Organization's estimate of malaria deaths each year.

Look, I realize that there's something patronizing about a man griping about poor breast-feeding practices, and, in the West, the issue is linked to maternity leaves and other work practices. But, if we want to save hundreds of thousands of lives, maybe a step forward is to offer more support to moms in poor counties trying to nurse their babies.

Nursing a baby might seem instinctive, but plenty goes wrong. In some parts of the world, a problem has been predatory marketing by formula manufacturers, but, in the poorest countries, the main concern is that moms delay breast-feeding for a day or two after birth and then give babies water or food in the first six months. The World Health Organization strongly recommends a diet of exclusively breast milk for that first half year.

In a village in Mali, Erin and I watched a woman wash a baby — and then pour handfuls of bath water down his mouth. "It makes the baby strong," a midwife explained.

On hot days, African moms routinely give babies water to drink. In fact, breast milk is all infants need, and the water is sometimes drawn from unsanitary puddles.

Here in Mali, fewer than one-quarter of women breast-feed exclusively for six months. In Niger, where Erin and I are also traveling on this win-a-trip journey, it's 8 percent. In our third country, Chad, it's only 2 percent.

This isn't just an issue in poor countries. In the United States, 16 percent of children are exclusively breast-fed for six months. Then again, in the United States, the child's life does not normally hang in the balance.

Several studies highlight other advantages of breast-feeding, including increases of several points in a child's IQ and improved development of areas of the brain associated with language and planning.

While many moms think they don't produce enough milk, nutritionists say that that's rare. Even when moms are malnourished, the baby's frantic suckling will stimulate more milk.

Erin and I traveled partway on this trip with Shawn Baker, a public health expert with Helen Keller International. One day we asked him where he would invest a billion dollars if he had it.

"To me, the next big win in saving kids' lives is breast-feeding promotion," he said. "It's absolutely unacceptable that more than 800,000 kids are dying annually of suboptimal breast-feeding." Ghana is a model of a country that has successfully used public health campaigns to raise rates of exclusive breast-feeding very significantly.

There are many ways to save lives, some involving dazzling technologies. But maybe in our sophistication we've overlooked a way to ease childhood malnutrition that is sustainable, scalable, free — and so straightforward that all hungry newborns cry for it.

Nicholas D. Kristof is a columnist for the New York Times.