Helping Themselves: Breastfeeding Advice Nestle-Style

by phdinparenting on November 4, 2009

This is a guest post by Erin, a breastfeeding counselor who teaches women how to succeed at breastfeeding. This post is a reflection of her opinion on Nestle’s breastfeeding advice. Read what follows and decide for yourself what the company’s true intentions are.

Why would the world’s largest infant formula company want to help mothers breastfeed? Huge spoiler ahead. Ready? They don’t. Yes, Nestle runs a glossy US website called the Start Healthy Stay Healthy Resource Center which claims that it gives expert advice about infant nutrition. Yes, the website’s informational section on breastfeeding is actually larger than the corresponding section on formula feeding. And yes, of course, some of the advice is accurate. It has to be. If they gave nothing but blatantly bogus information that would look pretty bad and a certain level of credibility is essential. Instead, the advice is misleading and manipulative in subtle ways. The “why” part should go without saying; if they can turn a mother who plans to breastfeed (as the majority do these days) into a mother who feeds her baby Good Start, they have just earned thousands of dollars. Switzerland is not in fact neutral.

Confident commitment before initiation is important to breastfeeding success. If a mother’s desire to nurse her baby, her trust in the process, or her confidence in her own abilities can be eroded then that is a win for Big Formula. Take a look at the pages that follow and you will see that those are precisely the types of subliminal messages (breastfeeding is difficult, painful, icky, and unnecessary) in Nestle’s breastfeeding information. I have provided screen captures after the links for readers outside the US who may not be able to access the website. (Clicking the photos again will make them large enough to read, by the way.)

  • Breastfeeding accessories (screen capture) This page is bound to get traffic since shopping for a new baby is perennially popular. According to Nestle, a nursing bra is “designed to let you inconspicuously open a cup to expose a breast for your baby.” That’s right– if you want to breastfeed you’re going to have to expose yourself to your child (who incidentally wants “easy access“) while trying to hide the fact. Pervert! Anyway so, oh yeah, you wanted something to put on your gift registry? How about some special (read: weird) nursing clothes. More “oversize shirts with buttons down the front” are going to sound awesome to women who have been stuck in maternity clothes for months.
  • Nutritious choices for breastfeeding moms (screen capture) Wait, what, you thought you were going to be able to eat? Make sure that pasta is “lightly sauced” and have some more vegetables with your vegetables. This reinforces the myth that a mother has to be really careful about what she eats while breastfeeding, which in turn makes nursing seem like an ideal that is probably unattainable for the average mother. Sure it’s a great idea for everyone to eat healthier, including nursing mothers, but this page is conspicuously lacking one important fact: what a mother eats usually has zero effect on the quality of her milk.
  • Breastfeeding problems and solutions (screen capture, screen capture) There is no mention of colostrum in the section titled “Understanding your lactating breasts.” From reading that someone might think that it could be up to 6 days before there is anything for the baby to eat. And how about the description of the milk coming in? Pain in the mother’s breasts and the baby having a hard time latching are emphasized. Then in case you missed the part about the pain they’ve got “chapped or tender nipples” next in bold. The information given on how to deal with that is flat-out wrong; “lanolin-free moisturizing balms” are not recommended and hydrogel patches are controversial. Next up is “inflamed milk ducts.” Huh? I think they mean “blocked ducts” there. If they were a bigger, richer, more powerful company maybe they could Google the proper term. Or, maybe “inflamed” sounds more painful. To “feed a baby right,” Nestle then tells you, it necessary to make sure your nipple is “covered almost completely by the baby’s mouth, with her tongue on the underside of your nipple.” Poorly written, details and phrasing chosen for creep-factor, and last but not least totally wrong. If your baby doesn’t have the entire nipple far back in her mouth, as well as a good portion of areola, you are going to have some serious pain as well as a baby who cannot get milk from your breasts. In closing, they advise that you should “pay attention to your milk supply” and that fatigue can reduce it. That’s okay though because no new mom is fatigued, right?
  • Solve breastfeeding dilemmas (screen capture, screen capture) You supposedly learned how to solve breastfeeding problems so now you can move on to the dilemmas. Nipple confusion, they say, happens because the bottle is “easier” for the baby and apparently can be avoided by not giving bottles “during the first week.” Then a few sentences later it says to wait three weeks. Oh hell, it sounds like one week is probaby good enough, right? The sooner the better since this breastfeeding stuff is so garbled and confusing. For latch on problems, make sure your baby is taking in “approximately one inch from the tip of your nipple.” Which is unlikely to be a deep enough latch and certainly won’t solve any existing problem.
  • When your baby loses interest in breastfeeding (screen capture) Even if your baby is only 3 months old, a nursing strike might mean that “she’s ready to give up nursing.” No, wrong answer, but it plays right into the hope that just a little bit of breastfeeding is enough (surely if baby herself is ready to stop there is no harm) and transforms normal occurences like temporary disinterest into pseudo-self weaning.
  • Why breastfeeding is best (screen capture) By this time maybe the resolve to breastfeed is beginning to waver. Why would anyone undertake such a confusing, embarassing, inconvenient sacrifice? Surely reading about why breastfeeding is “best” will affirm that choice. Well, it says here that breastmilk “contains the perfect balance of nutrients including DHA & ARA.” It is also “naturally gentle on baby’s developing digestive system.” Furthermore it “contains antibodies to help protect your baby from illness.” That sounds kind of good. But the language sort of rings a bell. Let’s check the description of Nestle Good Start Protect Plus. (screen capture, screen capture) This stuff has “complete nutrition,” “DHA & ARA for baby’s brain and eye development,” is “easy to digest” and it “supports baby’s healthy immune system.” Wow that’s almost exactly the same! (Except, of course, it isn’t. Not even close.)

Have you come to your senses yet, new mothers? If so, then it’s time to either start supplementing your breastmilk (screen shot) or you might want to just go ahead and transition to formula (screen shot). Nestle treats these two situations as different events even though they usually aren’t. There is no mention of milk supply dropping when supplements are introduced. Any doubts you might have about whether or not this is the right thing to do should be soothed by the assurance that formula could be a “nourishing, nurturing choice for your baby” as well as the helpful transitioning chart, where formula feedings are represented by cute little red hearts that multiply and breastfeedings are the faded blue dots getting nudged off the edge.

You may have noticed that in multiple places these marketing materials (we can stop playing along by calling them breastfeeding information) carry disclaimers. This is one crops up frequently: “Breastmilk is the ideal food for babies. Talk with your doctor about your feeding choices.” For an explanation of why “ideal” is a description of human milk that is ineffective in terms of breastfeeding promotion, check out this classic piece by Diane Weissinger called Watch Your Language. As for the second part about looking to your doctor for guidance, although many health organizations worldwide have very strongly worded recommendations to breastfeed, unfortunately doctors in America don’t necessarily recommend it to their patients. In fact, according to the American Academy of Pediatrics, “Obstacles to initiation and continuation of breastfeeding include…lack of encouragement and guidance from health care professionals.” The disclaimer is probably there at least in part for legal purposes; the company needs to avoid looking as if it is giving out medical advice. But really why wouldn’t Nestle spam this disclaimer all over the place anyway? It makes them look more honest and credible while risking little or nothing. Maybe even gaining.

There is, however, a disclaimer on the site that they probably benefit less from. Not coincidentally it is a little more difficult to find. After trumpeting all over the website that breastmilk has DHA and ARA but so does formula, they quietly admit in the fine print at the bottom of this page that “studies to date have not established brain and eye development like breastmilk based on the levels of DHA and ARA added to infant formula.” Surprisingly, US FDA regulations do not require novel ingredients like these new oils (which are chemically extracted from algae, by the way) to prove their usefulness before being added to an infant formula. If formula companies wanted to, they could throw some blue food coloring into their recipe. Why not. It’s a food product that has “GRAS” (generally recognized as safe) status according to the government. That might be a good idea actually; since human milk often has a slightly blue hue, this new and improved formula could then be marketed as “closer than ever to breastmilk.” If you think that’s way over the top, read this document from the California WIC Association about the lengths that formula manufacturers will go to increase their profits, and also this report from the Cornucopia Institute, a food safety watchdog group.

So, should Nestle revise the faux “breastfeeding advice” given on their website? Should they post links to La Leche League International instead? Or should they remove all mention of breastfeeding and just stick to formula? No. None of those options would be the ethically and morally correct course of action for the company to take. They should delete the entire website. All advertising or promotion of infant formula to the general public is forbidden by the International Code for the Marketing of Breastmilk Substitutes (Article 5.1) and furthermore marketing personnel are not permitted to seek contact of any kind with pregnant women or mothers of young children (Article 5.5.) Within the gigantic and blatant violation that is the “Start Healthy Stay Healthy Resource Center” are many more transgressions, such as idealizing artificial feeding (Article 4.2.) Essentially the company breaks every rule that it possibly can ands get away with it because in the United States there are no legal repercussions for doing it.

If any of this makes you angry, and you live in the US, take action. One quick and easy thing you can do is to file a complaint with the FTC online. Companies aren’t supposed to advertise in a way that is false and deceptive. If anyone comes away from that website thinking that any formula is similar to breastmilk then they have been misled. Each time the advertisement is seen it’s a separate violation, so go ahead and bookmark that page. The next thing you can do is to contact Congress. Tell your state Representatives and Senators that you want the Code put into law, in its entirety, so that companies are forced to start honoring it. You may also want to consider joining the Nestle boycott. Speaking to the company in the language they understand, in other words money, is probably the best hope outside legislation for creating change. Finally, perhaps the most important thing we can do is to spread the truth about infant feeding and to reach out and help other mothers whenever possible. Propaganda like we’ve just seen can only be taken seriously enough to do harm in a world where a motley mixture of myth, advertising copy and wishful thinking is routinely allowed to pass as fact.

Note from Annie (PhD in Parenting): If you are in Canada, you may wish to read up on Misleading Representations and Deceptive Marketing Practices and consider filing a complaint with the Competition Bureau.

Erin (@Artemnesia) is a breastfeeding counselor from central Massachusetts.  When she isn’t busy kissing boo-boos and nursing in public, she may be found playing no-limit Texas hold’em online. She isn’t a blogger yet, but is thinking of it…would you all give her some encouragement?

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Being a Woman is Not a Pre-Existing Condition

by phdinparenting on November 4, 2009

As a blogger on Moms Rising, I feel it is important to raise awareness about issues of importance to women and mothers and to ensure that our voices are heard. Although this one doesn’t affect me specifically as a Canadian, I know many of my readers are Americans. Please watch this video and raise your voice on this issue. We need to be heard.

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Are people who don’t get the H1N1 vaccine idiots?

by phdinparenting on October 30, 2009

Today I read a post by@curiousdad on his blog over at the Vancouver Sun. He wrote H1N1 flu vaccine: What the skeptics aren’t telling you. In his post he outlines a case for getting the vaccine and especially for getting your kids vaccinated. His post starts out with:

As the H1N1 vaccine starts to become available across the country, it seems like everywhere I turn there’s someone telling me they’re not going to get it — whether it’s friends on Facebook, people on the street or even a columnist in my own paper.

When this happens, I try to be polite and not say anything. After all, everyone has the right to make their own decision about whether to get the vaccine or not. And, if polls are to be believed, those forgoing the vaccine have plenty of company.

But what I really want to say — what would come out of my mouth if I didn’t always bite my tongue quick enough — is this: Are you an idiot?

The evidence in favour of the flu vaccine (much as with routine childhood vaccinations) is so overwhelming and clear that getting the vaccine — and making sure your children get it — seems about as clear and straightforward as buckling up before you go for a drive.

He goes on to explain a number of reasons for getting the vaccine, to express dismay at the natural parenting community who try to avoid dangerous chemicals in their food and personal use products, but that would be willing to let their children be exposed to H1N1.  He ends with his strong disapproval of parents who refused to get their kids vaccinated:

It’s one thing to decide not to get the vaccine yourself. But with evidence mounting that kids are particularly vulnerable to this flu strain, not getting them vaccinated, in my view, borders on negligence — no different than failing to buckle them up in the car or put a safety gate across your stairs.

Sounds straight forward right? Perhaps, if you are only listening to certain sources.

My reply

My quick response to him turned out to be quite lengthy. It is not as well articulated perhaps as I usually like my posts to be, but since I went to the trouble of writing it I thought I would share it here too:

There are some very well respected doctors and pediatricians that are questioning the safety of the vaccine and the degree of panic around H1N1, including Dr. Jay Gordon and Dr. Bob Sears. Do their opinions count less than your average family doctor in Canada who is pushing the vaccine? Unlike my doctor who shows up at work, does what the Canadian Pediatric Society tells her to do, and maybe does a bit of continuing education here and there, Dr. Gordon and Dr. Sears and others actively analyze and research these issues.

I’m still on the fence about whether to get the vaccine or not. Also, it isn’t available yet in my area. Not for priority groups, not for the general population. From that perspective we have both (a) the risk of getting H1N1 because we don’t have access to the vaccine and (b) the opportunity to watch and see a bit with regards to any adverse reactions to the vaccine in the areas that have been first to receive the vaccine. The PHAC has promised weekly reports on adverse reactions to the vaccine on fightflu.ca and I am checking each day to see if the first one has been released.

In the meantime, we are taking precautions to try to limit our chances of getting H1N1 and spreading it to others. If we are sick, we stay home. We wash our hands frequently, cough into our sleeves, etc. We are taking significant amounts of Vitamin D. I am taking 5000 IU myself and giving between 1000 IU and 2000 IU per day to the kids. Personally, I feel like taking these types of precautions is likely to be better protection from H1N1 than being put in a crammed enclosed space for 7 hours with a bunch of potentially infected people waiting to get the vaccine. I hope that by the time the vaccine is available in my area they will be taking appointments by phone (like they are in Sault Ste Marie, Ontario) so that people are not exposed to those ridiculous conditions (because the vaccine isn’t immediately effective after getting it, so you can get sick waiting in that stupid line).

Finally, there are vaccines out there that have been approved and later removed from the market when it was discovered that they were causing serious adverse effects that went undetected in testing. That is in vaccines that were thoroughly tested, unlike the H1N1 vaccine which has not been properly tested on children, pregnant women, etc. Don’t believe me? Look up rota virus, which in the United States annually sickens about 2.7 million children younger than five, sends up to 70,000 to the hospital and causes 20 to 70 deaths.  One vaccine was pulled from the market in 1999 and another one later introduced has significant concerns/adverse effects. My son was hospitalized for rota virus. It sucked. It was scary. But I’m glad he didn’t have the vaccine.

I am on the fence, but leaning towards getting the H1N1 vaccine for my kids and for myself. However, I think it is smart to:

Sticks and stones may break my bones, but being called an idiot won’t bully me into not questioning things.

H1N1 flu vaccine: What the skeptics aren’t telling you

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Nestle Answers: Canada being a signatory to the International Code of Marketing of Breastmilk Substitutes means nothing

by phdinparenting on October 28, 2009

This is one of a series of posts that features Nestle’s answers to my questions that came out of the Nestle Family event. To access the other questions and answers, go to follow-up questions for Nestle and click on the questions you are interested in. Answers will be posted as they are received and analyzed.

Question

You say that you comply with the WHO International Code of Marketing of Breast-Milk Substitutes in all countries that have adopted the code. Canada is a signatory to the Code and the Canadian government actively encourages companies to comply with it. However, despite Canada being a signatory to the Code, you do not comply with the code in Canada. When you say “adopted” is it fair to assume then that you mean “legislated” and that you will not comply with a developed country’s will unless it puts regulations in place to force you to?

Nestle’s Answer

The WHO Code was adopted by the WHO Member States as a recommendation to governments, which are required to implement the Code as appropriate to their social end legislative framework. Nestlé universally follows all countries’ implementation of the WHO Code. [emphasis mine]

In addition, Nestlé decided over two decades ago to voluntarily and unilaterally apply the WHO Code in all developing countries, whether or not they have implemented it in their own legislative framework. If the local legislation is stricter than the Code, we apply local legislation.

My Response

On September 30, in response to a tweet by @momslant from The Mom Slant, Nestle Family said:

tweetwhocode

There is some hair splitting going on here. Canada is a signatory to the WHO International Code of Marketing of Breast-Milk Substitutes. In my mind, becoming a signatory means the same thing as adopting. The Canadian government put its signature on the dotted line and said this is something we support. Nestle on the other hand obviously has a different definition of adopt. In its answer above Nestle is essentially saying being a signatory to the WHO International Code of Marketing of Breast-Milk Substitutes means nothing. Nestle will do whatever they want unless a country uses legal means to force them to comply with the code. Let me explain…

The responsibility of governments

As Nestle states in its answer, the WHO code does put some responsibility on governments.Article 11.1 of the WHO International Code of Marketing of Breast-Milk Substitutes states that:

Governments should take action to give effect to the principles and aim of this Code, as appropriate to their social and legislative framework, including the adoption of national legislation, regulations or other suitable measures. For this purpose, governments should seek, when necessary, the cooperation of WHO, UNICEF and other agencies of the United Nations system. National policies and measures, including laws and regulations, which are adopted to give effect to the principles and aim of this Code should be publicly stated, and should apply on the same basis to all those involved in the manufacture and marketing of products within the scope of this Code. [emphasis mine]

The United States has, for the most part, completely missed the boat on this one. Canada, however, is in a different position.  Canada is a signatory to the Code. The Canadian government also made amendments to the Food and Drug Regulations pertaining to nutritional labelling, nutrient content claims and diet related health claims, which came into force on December 12, 2005.  In 2007, the Canadian Food Inspection Agency outlined, in a letter to industry, its Requirements Related to Nutrition Information and Health Claims for Infant Formula.  Among other things, the letter clearly states that:

It is the responsibility of all manufacturers, importers and distributors of infant formula to ensure that their products comply with Canadian legislation.  The CFIA and Health Canada also strongly urge the infant formula industry to support and implement the principles of The International Code of Marketing of Breastmilk Substitutes. [emphasis mine]

This last bit in bold is not a law. However, Canada is a signatory to the Code and via these guidelines to industry is using a social framework/other suitable measure to seek the industry’s cooperation in implementing the Code. However, Nestle and other formula manufacturers are doing a good job of proving that this is in fact not a suitable measure since the industry refuses to go along with the strong urging of the government.

In Canada, Nestle and other formula manufacturers aggressively promote their infant formula using traditional and online advertising, samples, sponsoring conferences for health professionals, wining and dining health professionals, coupons, promotions, and so on. Quoting again from the Canadian government’s letter to industry:

Comparing infant formula to breast milk, including comparisons of the levels of a nutrient in infant formula to the levels of the same nutrient in breast milk, is contrary to the message embodied in the Code. While the Code has not been incorporated into Canadian domestic legislation, the infant formula industry is encouraged not to make a reference to breast milk on a label or advertising of infant formula, other than a statement regarding the superiority of breastfeeding or that breast milk is the optimal method of feeding infants.

Also, highlighting an ingredient in infant formula as a key component of breast milk is considered misleading and is contrary to section 5(1) of the Food and Drugs Act as many components in breast milk are equally important.

…

The International Code of Marketing of Breastmilk Substitutes also recommends that labels do not carry pictures of infants on the container or label of infant formula. The infant formula industry is encouraged to support the Code and refrain from displaying pictures of infants or young children on labels or advertisements for infant formula. All other pictorial representations should meet the guidelines set out in the 2003 Guide to Food Labelling and Advertising.

…

All advertising for infant formula should comply with all the above provisions. This includes advertisements in magazines, websites, advertising flyers, shelf talkers, and advertisements and pamphlets displayed in physicians’ offices and hospitals.

That is what the Canadian government has set out as a social framework that it perceived as a suitable measure for obtaining the cooperation of industry. But then Nestle has ads like this splattered across its own Canadian website and magazines (like Today’s Parent, Canadian Family) and who knows where else:

nestlecanadagoodstart

Anyone want to count how many of the above provisions this ad violates? Comparing to breastmilk. Insinuating that they have copied the ingredients of breastmilk. Includes images of infants in formula ad. Is advertised in a variety of different media.

Nestle is not the only company that does this. For example, Enfamil has ads with smiling babies splattered all over websites right now. But that shouldn’t be an excuse. Even my five year old understands that saying “but Johnny did it too” doesn’t hold any water.

The responsibility of manufacturers and distributors

It is ironic that Nestle chooses to pick at Article 11.1 of the Code, while at the same time ignoring Article 11.3, which states that:

Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them.

The Code clearly states that manufacturers and distributors are responsible for complying with the Code even if countries have not taken any measures to implement it. So Nestle’s statement that it “voluntarily and unilaterally” applied the Code in developing countries, essentially means that it chose to only partially comply with Article 11.1. This is not an altruistic step by Nestle. It is a half-assed job.

Conclusion

In conclusion, let me reiterate in simple terms. Nestle does aggresively promote formula in countries that are signatories to the Code and that have explicity requested that formula manufacturers comply with the Code. Nestle has also chosen not to live up to its responsibilities under Article 11.1 of the Code.

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New Product Reviews and Giveaway

October 27, 2009

I just finished writing a couple of product reviews and posting a giveaway.
Go check it out here:
Toys from KidBean: Funny Face Game and Honeysuckle Dreams Doll
Good luck!

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Nestle-Free Week: October 26 to November 1

October 25, 2009

As I continue to work on my responses to Nestle’s answers to my questions that came out of the Nestle Family blogger event, I thought I’d put in a quick reminder that this week (October 26 to November 1) is Nestle-Free Week. Even if you do not or feel you can not fully support the [...]

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All about my mom (by Julian)

October 25, 2009

If you’ve been wanting to learn more about me, this is your chance. This morning I sat down and asked Julian some questions about mothering and about his mother (that’s me!).  I saw these questions in the mumsy meme post on blue milk and she got them from Out of the mouths of… on Wallaby. [...]

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Introducing Julian and Emma

October 25, 2009

Since I started my blog, I’ve been calling my kids “our daughter” and “our son”. While I don’t want to use their real names on the blog, I wanted them to have online names to help make the descriptions of them less impersonal. They have also expressed interest in being able to post here from [...]

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Would you answer a survey about your breastfeeding experience?

October 22, 2009

I’m really pleased to see more and more organizations stepping up to provide positive messages and support for breastfeeding. I’ve been thrilled to be working with Best for Babes for a while now to try to spread their message about beating the booby traps (and can’t wait to tell you all about some exciting upcoming [...]

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Nestle Answers: Shifting Blame for Infant Deaths

October 22, 2009

This is one of a series of posts that features Nestle’s answers to my questions that came out of the Nestle Family event. To access the other questions and answers, go to follow-up questions for Nestle and click on the questions you are interested in. Answers will be posted as they are received and analyzed.
Question
In [...]

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