About
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Introduction
Dr Smith is an Honorary Associate Professor at the ANU Crawford School of Public Policy, and an awarded ARC Future Fellow. She is also an Associate Professor at the University of Canberra. Her work applies feminist economics and focuses on measuring the economic value of breastfeeding and regulation of markets in mother’s milk. Currently her research focusses on the Baby Friendly Hospital Initiative. Previously she worked in the Australian and New Zealand treasury and finance departments.
Current institution
Additional affiliations
June 2018 - May 2019
June 2018 - present
Australian National University. College of Health and Medicine
Position
- Professor (Associate)
March 2002 - June 2002
Department of the Parliamentary Library
Position
- Researcher
Publications
Publications (221)
To estimate the attributable ACT hospital system costs of treating selected infant and childhood illnesses having known associations with early weaning from human milk.
We identified relative risks of infant and childhood morbidity associated with exposure to artificial feeding in the early months of life vs. breastfeeding from cohort studies cited...
Thoughtful economists have long been aware of the limitations of national accounting and GDP in measuring economic activity and material well-being. Feminist economists criticize the failure to count women's unpaid and reproductive work in measures of economic production. This paper examines the treatment of human milk production in national accoun...
Background:
Infant formula requires mass production by the dairy industry, with plastic and other waste and degradation of land and waterways. Millions of babies, two thirds globally, now have milk formula, with breastfeeding in dramatic decline in Asia.
Economic cost externalities and commercial incentives:
Economic thinking clarifies that mark...
During emergencies and disasters infant survival can depend on their access to breastfeeding or human milk. Wet nursing and donor human milk sharing are options endorsed by the World Health Assembly (WHA). This study looks at regulatory environments for wet nursing and donor human milk sharing and considers the wider food
security and resilience im...
Despite increasing evidence about the value and importance of breastfeeding, less than half of the world's infants and young children (aged 0–36 months) are breastfed as recommended. This Series paper examines the social, political, and economic reasons for this problem. First, this paper highlights the power of the commercial milk formula (CMF) in...
Background
Sales of commercial milk formula products (CMF) are rising rapidly. This study analysed key economic and environmental impacts CMF feeding in Indonesia, which are often overlooked in policy discussions despite their relevance.
Methods
We assessed the economic and environmental impacts of CMF in Indonesia in 2020 using the Mothers’ Milk...
Background
Indonesia is a middle-income country in Southeast Asia in which 2,394 disasters were recorded in 2022 alone, with a total loss of 178,367 lives. In 2018 governments at the World Health Assembly resolved to improve emergency planning using Operational Guidance on Infant and Young Child Feeding in Emergencies (OG IFE). Little is known abou...
Background: Sales of commercial milk formula products (CMF) are rising rapidly. This study aims to analyse the key economic and environmental impacts CMF feeding in Indonesia. Methods: We assessed the economic and environmental impacts of CMF in Indonesia in 2020 using the Mothers’ Milk Tool (MMT), the Green Feeding Tool (GFT) and the Cost of Not B...
Breastfeeding is important for women and children’s health, but less than half of infants worldwide begin life with optimal breastfeeding. A growing literature shows consistently large economic costs of not breastfeeding, with global studies showing economic losses of around US$300 billion globally. However, existing studies are highly diverse in a...
Carbon offset frameworks like the UN Clean Development Mechanism (CDM) have largely overlooked interventions involving food, health, and care systems, including breastfeeding. The innovative Green Feeding Climate Action Tool (GFT) assesses the environmental impact of commercial milk formula (CMF) use, and advocates for breastfeeding support interve...
Introduction
During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5...
Breastfeeding is important for health, but until now its broader environmental and economic significance has been in the shadows.
Two new resources – the Mothers’ Milk Tool and the Green Feeding Tool – switch on the light by calculating the environmental costs and economic losses of not breastfeeding. Launched by the Australian National University...
Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and bette...
Background: Paid maternity leave benefits all of society, reducing infant mortality and providing economic gains. It is endorsed by international treaties. Paid maternity leave is important for breastfeeding, bonding, and recovery from childbirth. Not all mothers have access to adequate paid maternity leave. Key Information: Paid leave helps meet s...
Women’s¹ lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women’s reproductive biology is closely linked to their social roles and situation, including regarding ec...
Women’s contributions to food production and food security are often overlooked, thus perpetuating inequitable and unsustainable globalized commercial food systems. Women’s role as producers in the first-food system, breastfeeding, is largely invisible and underfunded, encouraging the production and consumption of environmentally unsustainable comm...
The Mothers' Milk Tool was developed to make more visible the economic value contributed to society by women's unpaid care work through breastfeeding infants and young children. This manuscript describes the development and display key features of the tool, and reports results for selected countries. For the development, we used five steps: (1) def...
Breast milk substitute (BMS) marketing harms breastfeeding and public health. To control BMS marketing, the Member States of the World Health Organization is called upon to adopt all provisions of the International Code of Marketing of Breastmilk Substitutes (the Code) into national law. In 2017, Thailand adopted many provisions of the Code through...
Background
The in-hospital stay following childbirth is a critical time for education and support of new mothers to establish breastfeeding. The WHO/UNICEF ‘Ten Steps to Successful Breastfeeding (Ten Steps)’ was launched globally in 1989 to encourage maternity services to educate and support mothers to breastfeed. The strategy is effective, however...
Background
Baby food marketing undermines breastfeeding by influencing women’s attitudes and decision-making favourably toward commercial baby food. This study aimed to explore the effects of various baby food marketing techniques on Thai mothers’ opinions about commercial milk formulas (CMF) and commercial complementary foods (CCF) and their infan...
Background
The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding.
Research Aim
To...
Objective
The mother-child breastfeeding dyad is a powerful force for achieving healthy, secure and sustainable food systems. However, food systems reports exclude breastfeeding and mother’s milk. To help correct this omission and give breastfeeding women greater visibility in food systems dialogue and action, we illustrate how to estimate mother’s...
Objective:
To report on the prevalence of different types of breast-milk substitutes (BMS) marketing and the compliance of such marketing with the "Control of Marketing of Infant and Young Child Food Act 2017" (The Act) and the "International Code of Marketing of Breastmilk Substitutes (WHO Code)" in Thailand.
Design:
Cross-sectional quantitativ...
Background
Governments must protect and apply maximum feasible resourcing to the protection, promotion and support of breastfeeding in order to meet their international legal obligations with respect to the human rights of women and children. However, governments across the world have consistently failed in these duties. Breastfeeding has been nota...
Background
Recent studies show corporate political activity (CPA) can have detrimental impacts on health policy processes. The Control of Marketing Promotion of Infant and Young Child Food Act B.E. 2560 (the Act) was implemented in Thailand in 2017, but there have been no studies documenting CPA during its policy processes. Furthermore, the effects...
Background: Despite the known importance of breastfeeding for women's and children's health, global exclusive prevalence among infants under 6 months old is estimated at only 41%. In 2018, Indonesia had a lower exclusive breastfeeding rate of 37% at 6 months postpartum; ranging from 20% to 56%, showing unequal breastfeeding support throughout the c...
Background
The global milk formula market has ‘boomed’ in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets...
Background
There is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations.
Research Aims
To (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young c...
In the COVID-19 pandemic, people’s dwellings suddenly became a predominant site of economic activity. We argue that, predictably, policy-makers and employers took the home for granted as a background support of economic life. Acting as if home is a cost-less resource that is free for appropriation in an emergency, ignoring how home functions as a s...
Background
Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These wer...
Abstract Background Infant sleep is of great interest to new parents. There is ongoing debate about whether infants fed with breastmilk substitutes sleep longer than those exclusively or partially breastfed, but what does this mean for the mother? What expectations are realistic for mothers desiring to exclusively breastfeed as recommended by healt...
Responsive infant and young child feeding (IYCF) in formal early childhood education and care (ECEC) is integral to optimal child development and health outcomes. This research explored supportive environments for and educator perspectives on implementing responsive feeding in Australian ECEC settings. Data was collected from 19 Queensland long day...
The inappropriate marketing and aggressive promotion of breastmilk substitutes (BMS) undermines breastfeeding and harms child and maternal health in all country contexts. Although a global milk formula 'sales boom' is reportedly underway, few studies have investigated its dynamics and determinants. This study takes two steps. First, it describes tr...
Background
Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. Nevertheless, barriers to accessing high-quality breastfeeding support are evident in the low global exclusive breastfeeding rate of 41%. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) i...
The #WBW2020 program focuses on a framework to understand the associations between breastfeeding and planetary health - ‘Support breastfeeding for a healthier planet’
This presentation aims to provide an overview of key connections between planetary health and breastfeeding.
First, it outlines recent research on planetary health and the global po...
Breastfeeding and human milk provides an archetypical illustration of how feminist economic analysis has contributed new ways of thinking, and approaches to policymaking. Breastfeeding is an example of how the economy is mismeasured: the market value of milk formula production and sales are counted in a nation’s GDP, but the value of breast milk pr...
Breastfeeding will remain in decline in Australia until gaps in the new national breastfeeding strategy are filled with measures that genuinely value mothers and the work they do. And until federal and state governments, not only mothers, are held accountable for progress.
The strategy, launched with little fanfare at the weekend, suggests Austral...
If mothers are imprisoned, mother-baby units, where women keep their babies with them, should be routinely available, including to those on remand. Crucially, programs in mother-baby units should involve intensive parenting support, including for breastfeeding.
Australia’s new National Breastfeeding Strategy sets ambitious goals. By 2022 it wants 40% of Australian babies to exclusively breastfeed until they are six months old. At present it’s 25%.
By 2025 it wants 50%.
Beyond that it wants non-exclusive breastfeeding up until at least 12 months of age, and beyond that for as long as both mother and chil...
Early Childhood Education and Care (ECEC) services are vital in the establishment of optimal infant and young child feeding (IYCF) practices and long-term health. This qualitative study, informed by Social Cognitive Theory, aimed to describe ECEC infant feeding environments. Nineteen formal long day care and family day care ECEC services and 124 ed...
• The new tool for estimating the country costs of not breastfeeding is an important advance that highlights the extent of
women’s invisible economic contribution to national economies and health care systems in caring for infants and young
children.
• The tool excludes the costs of additional unpaid household care for sick children, making its cos...
“Going to have a baby? You might reasonably expect breastfeeding support from health professionals who have received adequate pre-service education, but is that the case?
The Greens have made a $10 million election promise for better maternity care and breastfeeding support, but how qualified are the health professionals who provide these importan...
The book examines the nature of maternity entitlements of women within the context of the totality of women's work. It brings together the findings of related to indicator 4 - Maternity Benefits - of the World Breastfeeding Trends Initiative, conducted in several Asian, LAC, African and European countries and explores the gaps in maternity protecti...
In 2018, the World Health Organization (WHO) issued the first revision of the 1989 WHO/UNICEF Ten Steps to Successful Breastfeeding. While there is evidence of the effectiveness of those Ten Steps in increasing breastfeeding rates, there has been no published analysis of the key differences between both versions. We aim to summarise the key changes...
Introduction by Croakey: An investigation published last week by the British Medical Journal has found that infant formula manufacturers have been funding the development of guidelines for the diagnosis and treatment of cows’ milk allergy as well as providing research and consultancy funds to those who wrote them.
That comes, it reports, amid a si...
The federal Department of Health is preparing a new national breastfeeding strategy, to be adopted by all Australian Governments in late 2018. So what can we expect and will it make a difference?
The aim of this research project was to develop, trial and deliver a gender budgeting framework for
breastfeeding that can be used to assess, monitor and evaluate government policies on breastfeeding that will
advance material and child health and gender equality, within established WHO public health goals. The
gender budgeting framework was to be...
The article discusses the initiatives that promote breastfeeding among women with infants in Australia. It talks about the decrease in the practice of breastfeeding among women for the recommended period of time. It tells about the importance of breastfeeding being recognised by the World Health Organization (WHO) as it promotes growth and developm...
The article discusses the initiatives that promote breastfeeding among women with infants in Australia. It talks about the decrease in the practice of breastfeeding among women for the recommended period of time. It tells about the importance of breastfeeding being recognised by the World Health Organization (WHO) as it promotes growth and developm...
This paper addresses debates about future reform of the SNA and its boundaries, through considering market valuation of human milk and breastfeeding. For over half a century, the UN System of National Accounts (SNA) framework has shaped how economies are viewed, economic performance is measured, and public policy priorities are set. Its central ele...
The assessment of implementation of policies and programs from the World Health
Organization’s Global Strategy for Infant and Young Child Feeding (GSIYCF).
The purpose of this review is to provide evidence that indicates the effectiveness of key strategies for an enduring Australian National Breastfeeding Strategy (ANBS-E). This is undertaken through a review of academic and grey literature during a period of 10 years (2007–2017).
The global public health recommendation of the World Health Organizatio...
Breastfeeding exemplifies the need to properly account for women’s unpaid caring
and reproductive work in economic statistics, and for the households’ creation of human
capital. Although all commodities including human milk are within the scope of GDP as
defined by international agreement since 1993,1 standard national accounting practices
exclude...
Human milk is employed as a reference substance to assess the equivocal language defining the three tests (enhancement, health and violation of the Spirit of Sport) for prohibiting substances and methods under the World Anti-Doping Code (the Code). Human milk is demonstrated to be consumed by athletes with intent to enhance performance, presents a...
Without better regulation, the global market for breast milk will exploit mothers
Markets in mothers’ milk could be a good or a bad thing for women and their children, depending on how governments respond. Making breast milk more easily available may help more mothers breastfeed, and improve the economics of the situation for women.
With maternal...
Background:
Breastfeeding supports child development through complex mechanisms that are not well understood. Numerous studies have compared how well breastfeeding and nonbreastfeeding mothers interact with their child, but few examine how much interaction occurs.
Subjects and methods:
Our study of weekly time use among 156 mothers of infants ag...
This paper addresses debates about the future beyond GDP, by arguing for the usefulness of measuring breastfeeding and human milk in GDP as an alternative indicator of population well-being, through experimental estimates within the System of National Accounts (SNA) framework. As the S-S-F Commission acknowledged, human milk epitomizes how current...
Breastfeeding is widely accepted as an important public health issue for babies and their mothers. Yet, despite this, Australia continues to struggle with reaching global targets for breastfeeding indicators. In 2007, the Best Start Parliamentary Inquiry Report was released and set the stage for the Australian National Breastfeeding Strategy (2010-...
In 1999, two leading Australian academics challenged Australian universities to lead moves to better manage employees' maternity and breastfeeding needs, and 'bring babies and breasts into workplaces'. This paper addresses the question of how universities cope with the need for women to breastfeed, by exploring barriers facing women who combine bre...
In the aftermath of World Breastfeeding Week, leading academics in infant nutrition from the Australian National University, Julie Smith, Libby Salmon and Phillip Baker, examine the challenges that remain in keeping breastfeeding on the global agenda.
Introduction: Pharmacists are one of the most accessible and trusted professionals in the Australian health care system and can have a large impact in supporting and encouraging breastfeeding.
Aim: This study aimed to research the knowledge, attitudes and training satisfaction of Australian pharmacists in the area of infant nutrition and breastfee...
OBJECTIVE: The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels...
Contrasting with social insurance taxes and the key revenue raising role of VAT for northern European welfare states, Australia's income tax has funded expansion of Australia's social security system. The uniform income tax plan of 1942 unified Australia's system of income taxes, and was central to funding the introduction of Australia's unique soc...
Climate change due to rising concentrations of greenhouse gases in the environment affects human health in many ways, including through effects on food production and prices, and changed patterns of disease including increased infectious illness.
Climate change acts as a threat multiplier that interacts both directly and indirectly with variables,...
Support in primary care can assist smokers to quit successfully, but there are barriers to general practitioners (GPs) providing this support routinely. Practice nurses (PNs) may be able to effectively take on this role.
The aim of this study was to perform a process evaluation of a PN-led smoking cessation intervention being tested in a randomized...
Objectives. To evaluate the uptake and effectiveness of tailored smoking cessation support, provided primarily by the practice nurse (PN), and compare this to other forms of cessation support.Methods. Three arm cluster randomized controlled trial conducted in 101 general practices in Sydney and Melbourne involving 2390 smokers. The Quit with PN int...
This introduction to a special issue on the economics of breastfeeding draws attention to the lack of economic justice for women.
Human milk is being bought and sold. Commodifying and marketing human milk and breastfeeding risk reinforcing social and gender economic inequities. Yet there are potential benefits for breastfeeding, and some of the wor...
Despite scientific evidence substantiating the importance of breastfeeding in child survival and development and its economic benefits, assessments show gaps in many countries' implementation of the 2003 WHO and UNICEF Global Strategy for Infant and Young Child Feeding (Global Strategy). Optimal breastfeeding is a particular example: initiation of...
Markets in mothers milk are emerging in various forms around the world. Reflecting its importance for infant health, breastmilk sells for over $100 a litre in North America and Europe, and commercial human milk products cost far more. However, women do not necessarily profit from this trend. The growth of such markets raises a number of questions o...
https://theconversation.com/profiles/julie-smith-145494/articles
Breastfeeding is rarely seen as an economic policy issue. Many view the idea of placing a dollar value on mothers’ milk as repugnant. Breastfeeding cannot be framed as simply an economic relationship. It is a complex, physiological, emotional and social relationship between mother and child, intricately related to the nature of the society, communi...
Method The actual and potential contribution of human milk and lactation to GDP in Australia, the U.S and Norway is estimated using United Nations guidelines for national accounting . 3 These are for GDP to include all significant non marketed commodities, and to value it using the market price of analogous products. Potential production is 95% of...
Aims We calculate and compare the economic value of national human milk production in India and China with the value of commercial baby foods in these countries, and with its potential value at optimal breastfeeding rates. Data and method The economic value of human milk in India and China countries was estimated using United Nations (System of Nat...
The debate over Prime Minister Tony Abbott's paid parental leave scheme is focused entirely on the cost of the scheme to the bottom line rather than a more sophisticated discussion about the social and budgetary value of caring for babies. The paid parental leave scheme introduced by the Gillard government in 2011 is a muddled acknowledgment of the...
Governments and development agencies worldwide commonly give lip service to supporting mothers to breastfeed, but keep their money in their pockets when it comes to investing in what is a valuable public health asset. In a report being launched this week at Parliament House, Canberra, a worldwide NGO network is calling for governments and internati...
Preface
The persistent failure of governments to invest significantly in breast feeding is hard to comprehend.
With evidence beyond doubt that tobacco kills around 1.5 million people a year from lung cancer, governments and agencies such as WHO now act forcefully and in unison to prevent its insidious promotion. Yet ten years after The Lancet seri...
Background:
The benefits of exclusive breastfeeding, including public health cost savings, are widely recognized, but breastfeeding requires maternal time investments.
Objective:
This study investigates the time taken to exclusively breastfeed at 6 months compared with not exclusively breastfeeding.
Methods:
Time use data were examined from an...
Australia may be at the forefront of tobacco control worldwide, but has dropped the ball in relation to global efforts to protect breastfeeding from company marketing.
This is the implication of a recently released paper in the Australian and New Zealand Journal of Public Health which examined the effectiveness of voluntary regulation by the infan...
Objective : This study addresses the issue of whether voluntary industry regulation has altered companies’ marketing of breast-milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast-milk Substitutes 1981.
Methods : Print advertisements marketing breast-milk substitutes w...
Background:
The contribution of breastfeeding and mothers milk to the economy is invisible in economic statistics.
Objective:
This article demonstrates how the economic value of human milk production can be included in economic statistics such as gross domestic product (GDP) and provides estimates for Australia, the United States, and Norway.
M...
This study investigates discrimination against breastfeeding mothers by childcare services in Australia. We conducted a cross sectional survey of 178 Australian childcare services from a population based sample during 2011-12. Analysis examined the awareness of relevant legislation and reported extent of discrimination, and explored relationships b...
