Environmental impacts of lactation type, accessories, purchasing habits, and diet: The GREEN MOTHER-I project, an observational study protocol

Abstract Introduction : Breastfeeding (BF) is the healthiest form of nutrition for babies and is recommended exclusively (EBF) for at least the first six months of life. The carbon footprint of formula feeding (FF) has been studied, but that of BF is unknown. Aim: To identify the environmental impact of EBF vs. FF and mixed feeding (MF), taking into account the accessories needed for BF and the diet of postpartum women during the baby’s first month of life. Methods: This is a multicenter, cross-sectional study conducted in the Barcelona North Metropolitan Area (Catalonia, Spain). The participating sites are primary care settings that will recruit 408 pregnant and/or postpartum women (4-6 weeks) as per inclusion/exclusion criteria. The data will be collected through a GREEN MOTHER Survey (Phase 1) that includes 4 dimensions: 1) socio-demographic and clinical data; 2) data on a newborn and accessories used in lactation; 3) general data on the mother's diet (includes habits on purchasing and cooking), and 4) 24h of the mother diet register. The data analysis will be performed to check the prevalence of BF types at month 0 and month 1, as well as a comparative analysis of three types of BF on environmental impact (carbon footprint; water consumption, and scarcity). Ethics : This project was approved by the Research Ethics Committee of the Jordi Gol i Gurina University Institute Foundation for Primary Health Care Research (IDIAP) under code 22/101-P dated 22/02/2023. Discussion : The results of the project will be disseminated during and after its duration: The CO2 impact of EBF, FF, and MF calculated in the current Study I will be included in the educational materials of the intervention program of Study II (the following step of the two-phases GREEN MOTHER project). We expect that the project results - through the publication and dissemination of scientific papers and reports - among relevant stakeholders (association of community midwives and the general public) will increase the public awareness of breastfeeding and its impact on sustainability. Keywords: Public health; Postpartum Women; Maternal medicine; Protocols & Guidelines; Health Education; Nutrition & Dietetics; Sustainability; Carbon footprint, climate impact, environmental impact