The continued marketing of formula, bottles, pacifiers, or complimentary foods for babies under six months of age is dangerous and unethical. Not only do they undermine the efforts of moms who want to breastfeed, but they also create risks to the health of mothers and babies, and have a detrimental impact on the environment.
According to Marsha Walker, a registered nurse, International Board Certified Lactation Consultant, and Executive Director of the National Alliance for Breastfeeding Advocacy:
Many people feel that they are too savvy to fall for deceptive claims but this is not true. Research has shown that more and more people feel that infant formula is equivalent to human milk, based on manufacturer claims that are false, misleading, and not supported by the evidence. Many mothers fall prey to thinking that fancy feeding bottles and artificial nipples are similar to their breast, but this is not true either.
According to the WHO ’s FAQs on the International Code:
The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.
No one disputes the fact that formula and bottles should exist. However, the World Health Organization, breastfeeding and health advocacy organizations, and many governments agree that they should not be marketed to expectant mothers, new mothers, and health professionals. People should be able to access these products when they are needed, but should not be faced with deceptive messages and imagery that suggest that a bottle is the standard way to feed a baby or that formula is as good as breastmilk.
What is the International Code of Marketing of Breastmilk Substitutes?
In order to reduce the negative effect of formula marketing and save lives, the World Health Organization developed the International Code of Marketing of Breast-milk Substitutes (World Health Organization). The Code restricts marketing and related practices of the following products:
- breast-milk substitutes, including infant formula and other milk products
- any foods and beverages, including bottle-fed complementary foods, when marketed for babies under 6 months of age (e.g. baby food and cereals marketed for young babies)
- baby bottles
- teats, like bottle nipples and pacifiers
Some of the provisions in the Code include:
- No advertising to the public of any product within the scope of the Code. This includes ads in any media–print, websites, TV, radio. It also includes in-store promotions, special displays, coupons and discounts (lowering the price of formula is allowed, but promoting a sale price or offering a coupon is not).
- No free samples to mothers. Cans of formula or gifts from formula or bottle manufacturers sent to homes, given to mothers by pediatric or obstetric offices, given to mothers when they leave the hospital, given as prizes or in contests, given at clinics or anywhere in the healthcare system
- No promotion of products through healthcare systems. Booklets, leaflets, posters,name badge holders, crib cards, tape measures, calendars, etc
- No gifts to healthcare providers. Anything from formula companies or feeding bottle manufacturers that are given to physicians, nurses, dietitians
- No words or pictures idealizing artificial feeding or pictures of infants on labels of formula cans, feeding bottles, etc. Packaging of these products should not have idealizing language or pictures of infants and mothers. Idealizing language means that claims are made such as “most like mother herself” or claims that the products are similar to breastmilk or breastfeeding
Governments in more than 60 countries have adopted the Code and made it law. Some countries have gone a step further by making formula available only by prescription or requiring warnings on labels. In the absence of legislation, the Code encourages manufacturers and distributors to comply with its provisions.
Why are companies still violating the International Code of Marketing of Breastmilk Substitutes?
Unfortunately, many of the countries that are signatories to the Code have not gone through the process of turning it into a law. Even in cases where there are laws in place, governments often do not have sufficient resources to monitor compliance and penalize non-compliance. So companies continue to do what they want and continue to aggressively promote their products in order to increase their profits. Nestle, for one, has made it clear that it does not even attempt to comply with the Code in developed countries (like Canada, United States, United Kingdom, Australia and others) and it falls short in developing countries. Other companies like Enfamil, Similac, and Heinz continue to violate the code regularly, as do bottle manufacturers such as Avent, Medela and many others. Despite what they may tell you, these companies are more focused on profits than on the health of babies.
How can I report a violation of the International Code of Marketing of Breastmilk Substitutes?
- United States: In the US, that organization is the National Alliance for Breastfeeding Advocacy (NABA). Violations of the Code can be sent via mail to NABA, 254 Conant Rd, Weston, MA 02493, email Marshalact@aol.com, fax 781 893-8608 along with the monitoring form.
- Canada: INFACT Canada monitors the Code in Canada and has a form you can fill in on its website. It also offers some sample letters you can use to contact politicians, health care institutions and store managers with regards to violations in their jurisdiction.
- United Kingdom: In the UK, you can report violations to the WHO Code and there is also a banner you can add to your blog/website to inform other people about the need to report violations to the code.
Again, in other countries you can use the standard monitoring form and send it to the Code monitoring organization for your country.
Go forth and report!
If you see a violation, please take the time to take a picture/scan it in, note when and where you saw it, and report it. I have a few photos on my blackberry that I will be sending in to INFACT Canada, including several in-store coupons, discounts and promotions by Heinz that I have seen recently at IGA and Loblaws.
Thank you to Marsha Walker from NABA and Mike Brady from Baby Milk Action for their input into this post.
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I must say that I have become more informed about WHO codes and formula by following you on Twitter and Facebook. Though I am currently breastfeeding a 17 month old, I certainly could have been sucked into formula marketing attempts. I received many bottles and samples of formula while pregnant. I kept them all just in case breastfeeding didn’t work out. Also, I must have received over 30 coupons for formula. I didn’t realize that was a WHO code violation until reading your article here. I have come across many instances that you list as WHO code violations.
If I take measures to report, what is WHO going to do about it?
The WHO unfortunately cannot directly do anything about it. They cannot force countries or companies to do anything they don’t want to. However, the IBFAN organizations around the world continue to produce reports on violations and to put pressure on governments to legislate. Reporting violations helps them with their work and helps them to make a stronger case.
I have reported some violations through INFACT. I am not sure what came of it, if anything, but it made me feel better, and stopped me from ranting at my poor beleaguered husband, so on the whole it was a good thing.
Thanks for that – great to see you putting that information up. Just a question – I could not find any reference in the WHO document to pacifiers – I was under the impression that pacifiers were not on the hit list.
Michelle:
The document refers to “teats”, which includes pacifiers and any other type of artificial nipple.
I didn’t know about this. I should’ve known about this, but I didn’t. So thank you for enlightening someone who’s supposed to be “in the know.” You never know who needs this information until you post it and they tell you it made a difference hey?
Thanks for the “how to” – I’ve got my eyes peeled and camera ready. I know last year that Nestle sponsored a health practitioners’ forum on nutrition in Lesotho. It’s not clearly defined in the guidelines above, but I’d think it would still be a violation – does it count as a gift? As promoting products within the system? Seems to me the answer is yes.
Elizabeth:
Nestle also tried to sponsor a pediatric nutrition conference in Canada. INFACT Canada led a protest against it and the conference ended up being cancelled. Here is a link to INFACT Canada’s Action Alert.
Something that is annoying me mightily in the UK at the moment is the recent rash of adverts for “follow-on” milk – ie adverts for formula for infants over 6 months old. I don’t think this is against the code and obviously it’s not illegal in the UK (which bans the advertising of formula for infants under 6 months old), but some of the advertising is pretty close to the wire as far as I am concerned, with some very small print being utilised, and the packaging of these products being virtually identical to those for infants under 6 months old.
Any info/guidance on whether there is any WHO restrictions on products ostensibly being marketed for infants over 6 months old?
Sorry, just went to the UK link you provided and I see that there is lots of information there. Thanks though for bringing this up, because I seeth every time I see those adverts and I’m never quite sure whether there is anything I can do about it.
Great “how to…” post, like Melodie said, this is something I should have known as well… I have seen a few instances of unethical marketing of formula and wish I would have known how to report it.
I’m going to share this on my facebook page for my friends.
I received some free samples when my daughter was born and they were just emptied into the garbage, next time I know what to do with them!
Call me uninformed (and I may regret jumping in here) but if it weren’t for bottles and my ability to pump, as the breadwinner of the family my kids would have been weaned a whole lot sooner. I respect your commitment to this cause, but is there a point at which the all or nothing pov becomes self-defeating?
Honest question. Would love to know your thoughts.
mom101:
That is a good question and one that people often ask. The Code does not state that formula and bottles should not exist or should not be available to moms. It does, however, say that they marketing and promotion of formula and bottles needs to be restricted.
I also worked and pumped for both of my kids. I pumped at work for 9 months for my son (went back to work when he was 3 months and pumped until 12 months) and for a year for my daughter (went back to work when she was 6 months and pumped until 18 months). I am glad that bottles were available. However, I didn’t need bottle companies telling me that their nipples are “almost like a breast” (especially ones that are dangerously unlike a breast and create significant risk for nipple confusion) or that they will “make my baby sleep better” (because whose baby doesn’t sleep badly, really, and who wouldn’t want to give a bottle before bed if it meant the baby would sleep). Instead, when I needed to know which bottles to use I asked my lactation consultant, I asked the moderators and moms on working and pumping message boards, I referenced objective guides on different types of bottles written by trusted third party organizations.
There are many things that are useful and even necessary in some cases that cannot be ethically advertised. Lots of kids need medication to keep symptoms of ADHD under control. But I don’t want to see ads popping up on websites that I am visiting saying “Does your kid get excited at birthday parties? Give him a couple of these before you leave for a calm experience for all”. Some moms end up needing c-sections and hospitals make more money doing c-sections than assisting in a vaginal birth, but it would be unethical for them to advertise saying “choose your baby’s birthdate” or “don’t let your nethers get all stretched out”. Formula, bottles, ADHD medication, and c-sections are all things that I think should be available, but shouldn’t be promoted or advertised. The risks of advertising those products are greater than the benefits of advertising them.
Comparing c-sections and ADHD meds to bottles and pumps is a really big stretch. Pumps and bottles are *good* things, things that allow babies to get breastmilk when they otherwise would not (case in point over here – without a pump, my kid would have been on formula from birth). C-sections and meds are medical procedures and in a totally different realm.
zchamu:
I think a lot of people would argue that c-sections and ADHD meds are *good* things too when used appropriately. Bottles do create risks to breastfeeding, even if it is breastmilk in the bottle. Some moms give “just one bottle” here and there and then don’t pump to make it up and find their milk supply depleting. Some moms give “just one bottle” here and there and find that their baby prefers the faster flow and easier to latch on to nipple and then refuses the breast. I’m all for moms using bottles if they have to go back to work, but I think the appropriate place to get information on how to use them and which bottles/nipples are the right ones is NOT through advertising from the companies who are trying to maximize their profits.
I don’t think comparing ADHD meds to formula is a big stretch. If a baby truly needs formula then it is a medical i.e. nutritional need. Bottles are of course necessary for working mothers to be able to pump and feed their babies, but they don’t need to be advertised. Everyone knows bottles and pumps exist. I could do my own research on-line or go the store and find what I needed without seeing ads. And since I’m choosing to breastfeed any claim that certain nipples/bottles are “just like” mother’s breast is ridiculous. I chose to breastfeed because I don’t believe artificial nipples are equivilant to my own breasts.
This applies to formula, as well. If a mother wants or needs to give her baby formula, she can find it easily in any store (in the U.S. or Canada anyway). There is no need for promotions to get the word out.
That is the point, they are not all that different at all. over 30% of c-sections performed in the united states are not necessary and many of them are planned. medical proceedure they may be but they are mostly unnecessary. And in the case of bottles, formula and pumps – you require a prescription for these in some countries because they are considered medical devices and regulated supplemental foods. Only in countries that blatantly violate this code of conduct do we even have the opinion that these items should be available at the corner store.
However, part of the argument is apples and oranges. Since all formula is required to meet a minimal nutritional guideline saying that one is better than another or safer than another is a blatant lie. Saying that a nipple helps your child sleep is simply a justification for charging 10$ for that bottle. You need to differentiate between false advertising and general knowledge of products available for use in the event of problems. Reporting companies and resellers for violating the code is not to encourage people not to sell or offer these products – it is to do it in an ethically responsible way without using guilt or fear tactics to promote and sell items which are very serious.
studies show time and time again that formula increases risks for diabetes, lower i.q. and now soy formula has been linked to fibroid tumors, has always been linked with malnutrition and hormone disruption. So to say that these items are not on par with medication is simply a fallacy. The first item I received in the hospital room, before the baby even arrived was a bag with containers full of formula, powder samples, bottles and liners, coupons for same and a packet of information on how beneficial formula was. at the bottom was a piece of paper, photocopied so many times it was nearly illegible, about breast feeding and all the benefits thereof. There is something inherently wrong with that and we need to realize that as a society – there is a PROBLEM when we see formula as no big deal.
Thanks for the thorough response Annie, I appreciate it. I can’t say I agree– my take is that false advertising is already regulated and should be enforced (“helps baby sleep?” Oy.), and I’m of the mindset that we don’t take away a woman’s personal choices for fear she’ll make the one that we don’t prefer. But still, I do understand the perspective more now.
mom101:
Just to clarify, I also do not believe in taking away a woman’s personal choices for fear she’ll make one that we don’t prefer. I’m just in favour of removing some of the obstacles that may push her down a hill even she didn’t want to go down.
How effectively is advertising really regulated? As far as I can tell it is incredibly powerful . . . for example, can the government’s new anti-obesity campaign compete with McDonald’s advertising dollars and marketing prowess? And why should moms have to wait for what little regulation there is to be enforced? Having seen how powerful lobbyists are in influencing government regulation (BPA is a great example), I’m afraid that hoping for more regulation will be like waiting for the Easter Bunny. Actually, misleading advertising takes away women’s choices: 86% of expecting mothers say they want to breastfeed, by the time they deliver, only 74% even try ONCE . . . clearly they have been persuaded or even pressured otherwise. And of the 74% who do choose to breastfeed, only 40% achieve their personal breastfeeding goal, only 12% achieve the minimum recommendation of every health agency in the world. Don’t ALL mothers deserve to make and CARRY OUT an informed decision, whether that is to formula feed or breastfeed, free of judgment, pressure or guilt?
Pumping saved my breastfeeding relationship, (and I also used formula–GASP!), and I will staunchly defend any woman’s right to make decisions that are best for her and her family. But allowing companies to heavily market bottles undermines breastfeeding ultimately because it further normalizes bottle-feeding, not breastfeeding. Moms need to see more mothers breastfeeding in public, not bottle-feeding, to get comfortable with nursing and for it to become culturally acceptable. Also, the more bottles (and pumping) are marketed to moms, the less effort will be made to work towards better (longer & paid!) maternity leave policies–the U.S. has the worst policies of most industrialized nations. When bottles and pumping are marketed, less effort is made to get mothers off to the best breastfeeding start because if she is breastfeeding successfully, she may decide she doesn’t need those accessories!
Really important points highlighted here about how the marketing of formula feeding plays into the abysmal maternity leave policies in this country!
Found out about this a while ago when I was enraged at a follow-on milk advertisement that blatantly compares formula to breastmilk and strongly suggests that the formula is just as good. The advertisers had even been taken to court about it, but alas they got away with it. Depressing, isn’t it.
Thanks for the info. I didn’t know violations included coupons. I’ve got a coupon in my purse right now, handed to me with other coupons when I made a purchase at a big box store. This same store sends out mailers almost every week and coupons or ads for sales on formula are always in them along with bottle ads. I’m going to scan the coupon I have now and keep on doing it.
Great, informative article, Annie. Well done! It’s awesome to see all this info gathered into one spot.
Unfortunately, by reporting WHO Code violations, we are currently preaching to the choir. Since the US hasn’t legislated anything in the WHO Code, reporting is a dead end. There is no recourse and there are no consequences for these violators. And frankly, until then, I think the effort might be better spend on pushing legislators to put the Code into law. Until then, I’m not sure what the point of reporting really is. (Of important note: I’m only familiar with the US, so please don’t extrapolate this opinion into other areas of the world who have put tenets of the Code into law.)
I know this sounds really negative and pessimistic, but it’s the reality of the situation until the US steps up and actually cares to enforce the Code.
Amy:
By reporting WHO Code violations, you are helping NABA in its mission to lobby for better protection for breastfeeding. From what I understand, NABA’s advocacy role includes putting pressure on lawmakers. By reporting violations to them, you help them to make a stronger case.
But certainly any efforts you wish to make to put pressure on legislators independently of what NABA does would certainly be beneficial too. The more voices, the better.
Sorry! I should have replied here but posted a separate comment. My response is below.
Amy makes a good point. While the US has not legislated any part of the Code, there is some recourse. Any time you see Code violations, i.e., false, misleading, or deceptive advertising of infant formula, feeding bottles, or nipples consider also reporting this to the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA). These agencies are supposed to protect the public from advertising that misrepresents the product. Reports can be made online at https://www.ftccomplaintassistant.gov/ for the FTC and at https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm for the FDA.
Thanks for a great article!
Marsha Walker, RN, IBCLC
Executive Director
National Alliance for Breastfeeding Advocacy
Marsha,
Thanks for the links to the FDA and FTC. Unfortunately, I think that these government agencies tend to function at a barely passing level. I do, however, think that they’re currently the best chance at any real consequences for the formula companies violating the Code. Here’s to the day when the Code becomes a law in the US!
Amy
Respectfully, I don’t think there’s any shortage of ammunition when it comes to indicting WHO Code violators.
Considering that the Code was introduced in 1981 and the US has yet to legislate it or take any real action whatsoever against Code violators, I think there is a lack of action, plain and simple.
The Code is reviewed every two years (as mandated by the World Health Assembly). While the US has silently “supported” revisions and resolutions, it hasn’t voted on anything since 1991, thereby eliminating any compulsion to support the Code in any official manor.
While I’m not opposed to reporting violations of the WHO Code, I think the more realistic and beneficial thing to do is spend that energy on getting the Code put into law. Until then, we can report until every violation is reported, but nothing is going to stop the cycle from continuing.
Great post and a tremendous resource. To add to Amy’s point and Marsha’s reply, I would like to suggest that we need to educate the media about this issue, and market and publicize the work of NABA in the mainstream so that MOMS are aware and start taking their dollars elsewhere . . . mothers are a powerful force! If the New York Times writes about it, and if mothers start changing which doctors and hospitals they use to those that are WHO-code compliant, and stop buying pregnancy and popular magazines that carry formula advertisements (and changing their editorial content in the process to reduce mention of which celebrities are breastfeeding, as PEOPLE magazine did), perhaps things will change. Especially given the recent FDA & BPA shenanigans and the power of the formula lobbying influence on the US government, including the DHHS, the FDA, etc., it is questionable as to whether going through such channels will be effective.
Bettina:
Those are important points too. Members of the media are huge enablers in this process and if they started complying with the Code, then companies wishing to advertise products within the scope of the Code would have fewer options. That is one of the points I was trying to make in Are we asking the wrong people to comply with the International Code of Marketing of Breast-milk Substitutes? and why I was so glad that BlogHer agreed to create an opt-out category so that bloggers that do not want to carry formula, bottle and pacifier ads can ensure that they do not run on their blogs.
This is where support for the Baby Friendly and Mother Friendly Hospital Initiatives comes in!
I was unable to breastfeed to a year because of a thyroid condition. And I didn’t feel like it was anyone’s business. I should have been able to mix a bottle of formula in public and not have to explain why or get the evil eye from other mothers. Breastfeeding isn’t SO much better than formula that it’s worth it to make other mothers feel bad for their choices (or in my case, lack of choice) or to divide women that should be standing together.
As a SAHM in a family on a budget, I was thankful for the coupons that came in the mail, because formula was an unavoidable cost and it helped to have the coupons. My kids are long since weaned, but the coupons are still coming. I give them to needy families in my neighborhood that could use the extra help. Especially in this economy, I don’t see how taking away coupons from struggling families will help. Formula companies certainly aren’t going to lower their prices if the coupons go away.
Kayris:
I agree that we shouldn’t make mothers feel bad for their choices. I don’t think that asking or requiring companies to abide by certain standards equates to giving other moms the evil eye. I believe that women should be standing together. But I don’t think that means we have to accept companies trying to sabotage the efforts of moms who want to breastfeed. Some moms may have to stop breastfeeding due to a medical condition, but many many more stop because of societal barriers.
Coupons are used to convince you to buy/try a product with the hope you will continue to buy it at the higher price. If that weren’t true, they could just reduce the prices (which is allowed under the Code) and everyone could get it at a cheaper price if they want/need it.
Honestly, I’d like to know exactly how many women DO stop or opt not to breastfeed because of advertising or societal barriers. In my part of the US, women are incredibly supportive of other women BFing. My daughter’s preschool class has several students with infant siblings and their mothers all sit in the parents group and breastfeed freely. I’ve seen this repeated over and over and over, in many different venues in my state and I have never heard of a local instance in which a woman was asked to leave/cover up, etc. Not to say that it doesn’t happen, but it hasn’t happened here.
I’m an educated woman. I’m smart enough to realize that formula companies use all the power they have to convince you to buy the product and I’m smart enough to know that breastfeeding is the better choice for me. I’m smart enough to see past the pretty pictures and the code violations. So I’m really curious how many women REALLY are influenced by marketing and how many choose formula because they’re not “smart enough” to know the difference.
Formula companies will NOT lower the price if they stop offering coupons. They’ll make less money that way, and let’s face it, it’s not about providing options for women who can’t BF, it’s about making money. Period. So, IMO, getting rid of the coupons is only going to hurt the families that depend on them.
There comes a time for every new mother when she is exhausted, still learning to breastfeed and unsure of herself. It’s 3:00 in the morning and the baby has been screaming for what seems like hours. The shiny cans of free formula from the hospital beckon. They’re hard to resist when you lack the confidence that the baby is ” getting enough”.
We need to be supportive and encouraging to each other. We need to educate women to the benefits and the JOYS of breastfeeding. It’s not that women aren’t smart enough to resist the marketing. It’s the lack of confidence, knowledge and support that many new moms experience.
I breastfed my daughter for 19 months. She is 23 now and happily breastfeeding her daughter. But surprisingly, she has had to explain/justify her decision to her in-laws who think we are root-chewing hippies.
And here’s a suggestion since it seems wasteful to just throw away the free formula. Use it to make pancakes…;)
Karys,
If formula were a prescription-only product, it would have removed the entire stigma around how you fed your little one. If formula were Rx-only, it would remove all doubt as to the parents’ motives for its use and make the clear statement that when we saw it, it was absolutely necessary.
Unfortunately, I think moms like you, who feed formula out of necessity, bear the brunt of the undue sour looks and questioned motives.
I also agree w/ Bettina that formula should be covered by insurance (as should a breast pump, where it’s medically necessary). And, if formula were Rx-only, it would likely be covered by insurance. It not only helps remove the public stigma, but helps those who truly NEED it, attain it.
Amy
Define “neccesary.” Because that goes so much further than the physical capability of producing milk. And we all know that medical insurance is so screwed up, I could totally see that backfiring.
For example–a woman I know of in my area gave birth to her second child 2 weeks after her husband dropped dead of an undiagnosed heart defect. She had so much on her plate–grieving for her husband, suddenly being a single mother of two, facing having to go back to work to provide for her kids, finding a new place to live, recovering from childbirth. She BF her first kid, but she formula fed her second because the stress in the rest of her life was overwhelming. Something had to give. Could you honestly tell her that she needed to get past it and breastfeed because she didn’t really “need” formula?
In my own case, I suffered terribly following the birth of my second child. And at times, it was SO EFFING HARD to continue to breastfeed when I just wanted to shrivel up and die. Should I really have to hash out my personal and private problems with a doctor to get an Rx for formula or to get insurance to pay for it? And even if that did happen, wouldn’t formula feeding in public be the equivalent of announcing “there is something wrong with me or my baby that we have to use formula?” How is that not a stigma?
So much of the “support breastfeeding” movement, IMO, is focused on “formula is bad.” It would be much more effective to focus on “breastfeeding is good.”
A friend of mine has a college degree, worked previously as a preschool teacher, and has no health problems and no physical reason why she couldn’t breastfeed. Yet, she chose to bottle feed both her babies. I don’t get it, but I also don’t feel like it’s my business to question her motives. I feel like the more restrictions are placed on formula, bottles, etc, the less it becomes a choice.
Ack! Sorry I spelled your name wrong in my other post! =/
I do agree that medical insurance is screwed up, but that’s a topic for a different day. I’m not saying that having formula be Rx and having it covered by insurance is a magic bullet for all the problems associated with formula marketing, but I do think the potential benefits outweigh the disadvantages.
We will have to agree to disagree: I don’t think it’s asking too much for a mom to get a prescription for formula. There’s a plethora of situations in which formula is appropriate; I don’t think it’s asking too much to run those circumstances by a doctor. In order for that to be effective, it’s also crucial that healthcare providers get better education and training in breastfeeding. It’s not a simple solution, but I think it has the best long-term potential.
So, no, I wouldn’t tell your friend to “get past it” and that she had to breastfeed. But I would say that in both her case and yours, talking to a doctor before switching to formula stood to benefit all involved. Having that conversation alerts that doctor to your circumstances. It might prolong the breastfeeding relationship. It might end it with a switch to formula, too. But in either case, having that conversation stands to ensure that a care provider is closely examining both the needs of the mother and the baby, and referring out where necessary (psychologists for suspected postpartum depression, IBCLCs for those in need of extra help with BFing, etc-).
I’m not knocking formula here. I am saying that it’s over-used and that it’s sub-standard to breast milk. Those are just facts, not judgments.
Here’s where we will likely disagree, and that’s ok. I realize it’s a conservative line to take. I firmly believe in parents’ rights to choose what they see is fit and best for their children. However, there are instances where things are so abundantly clear and black-and-white that legal provisions and societal standards are put in place to ensure that children are cared for in the best, safest way possible.
I’ll use the analogy of the car seat here: car seats are 100% the best and safest way to transport a child. That’s a fact. The law compels parents to employ this safety device because it protects children. In the same way, breastfeeding is 100% the best way to feed a baby. That’s as objective as the fact that car seats are the safest way to transport a child. I believe that before there is deviation from the breastfeeding path, parents should have to consult with their healthcare providers. It’s in the best interest of the child for that conversation to occur, and I also think that often times, it would be to the benefit of the parent, as well (regardless of how inconvenient or personal that conversation might be).
I think you need to remember that not everyone has health insurance. So if formula was Rx, what would families without insurance do? And you just can’t ignore that making formula Rx could theoretically lead to discrimination. Women who delivery by c-section can already be denied insurance. It’s not much of a stretch to imagine companies denying coverage to formula feeding families.
Honestly, actually experiencing breastfeeding has tempered some of my feelings on the topic, and I find it makes me much more understanding of women who choose not to breastfeed for non-physical reasons. Prior to the birth of my first, I just did not fathom why a woman wouldn’t even give it a try. But I bf both my kids for a total of 20 months and at times, I absolutely hated it, it made me MISERABLE and when my milk did finally dry up, I was relieved because it was over with.
You said: “In the same way, breastfeeding is 100% the best way to feed a baby. ”
We’ll have to disagree on this one too, because I think it’s open to so many interpretations. From a nutritional standpoint, breastmilk is better. And for a mother who lives in a 3rd world country and risks giving her baby dystentery from dirty water, of course breastfeeding is the smartest choice. But in the USA or Canada, or other developed countries, how many deaths are attributed directly to formula use? And in any such deaths, can the doctor unequivocably say that breastfeeding would have saved that child’s life?
In my case, I’m smart enough to weigh the odds. We’re a middle class family in a developed city with access to great healthcare, and my kids were home with me or another family member until they entered preschool. Had I known how much I would have not enjoyed breastfeeding, would I still have chosen to do it? I’m not sure, but I shouldn’t have to go see a doctor to make that decision. As a commenter below me pointed out, plenty of women plain don’t want to breastfeed. And that’s their business.
I”m not getting into the nitty-gritty of a healthcare debate and speculating on whether or not formula-feeding parents would be denied insurance coverage.
What I will point out is that people without insurance will do the same thing they do now: pay out-of-pocket for formula. Making formula Rx would likely improve savings on procuring it for most families. Those without insurance, will carry on just as formula feeding families do now.
And yes, in the US and Canada, and around the world, there are infant deaths each year directly attributable to not breastfeeding. Granted, those numbers are much higher in the developing world, but don’t think that the US and Canada and other similar countries are impervious to this problem. According to this study by the AAP, breastfeeding alone could save or delay the deaths of ~720 babies each year. That’s a lot. This isn’t the only research of its kind, but it’s the one I found fastest (so that number isn’t definitive). http://pediatrics.aappublications.org/cgi/reprint/113/5/e435
Just for whatever it’s worth, I’m approaching 18 months of breastfeeding my daughter. I didn’t want to do it in the first place (frankly, I thought breastfeeding was gross), I haven’t ever particularly enjoyed it, and at times it’s been really, really difficult. I can empathize 100% with moms who feel ambivalent at best, and resentful and just awful, at worst, about breastfeeding.
OK, lots to say–first of all, I skimmed the study you linked to and it still doesn’t answer my question, The authors use words like “plausible” or “likely.” And the sample group used in the study was from 1988. And the authors also mention that many of the babies that died belonged to younger, less educated mothers who may have also smoked. So some of those babies may have lived if they were in different families in a different part of the country at a different hospital.
Breastfeeding was a huge blow to me, because people always insisted when I was pregnant that I would love it. And it turned out it was hard as hell, it hurt a lot, and while I came to enjoy the time I spent with my babies, I never enjoyed the actual process of BF. When it was over, I was was sad that my babies were growing up, but not the slightest bit sad that I was done. And perhaps it would have been better for me to stop earlier. As Ii said before, the risks to me continuing were probably higher than the risk from feeding formula. And as the saying goes, if momma ain’t happy, no one’s happy. As far as I’m concerned, being happy is a perfectly good reason to wean, but that shouldn’t require a prescription.
As far as insurance, it seems awfully unfair that someone unlucky enough to not have coverage would still have to pay out of pocket, despite having a valid reason to use it. But that’s another topic.
First off, I am really sorry you feel that way about breastfeeding. I think you and I had remarkably similar experiences. I can directly relate to almost everything you’ve said, and you and I are and our experiences are the minority, from what I’ve seen. It’s difficult to mitigate those feelings with how we’re “supposed” to feel. Some moms just don’t get the warm & fuzzies from bfing, & that’s ok! Kudos to you for continuing in the face of what you felt.
I don’t want to start dissecting that specific study here. Frankly, this has been an exhaustive discussion and I’m just not up for taking it to that round. That isn’t the only research on the subject, and I think you’ll find that there IS research that shows that there are infant deaths in developing countries from not breastfeeding.
Thanks for the really good discussion!! Despite our opposing views, I feel like we actually share a lot of common ground here and I appreciate the discourse.
Thanks to you too. I’ve spent way too much time on this post today, so I’ll just say this and I’m done. If women who don’t enjoy breastfeeding already feel confused or at odds with how you’re “supposed” to feel, theoretically making them go to a doctor to get an Rx, and then go wait in line at the pharmacy to buy it, make them feel any better? Evem if Rx formula could increase the amount of women who breastfeed or at least try it, I’m not sure the benefit is worth the cost.
I agree that the health care debate is a separate issue. Seperate enough that I don’t think requiring a prescription for formula would work in the United States at the moment. The health care system is just too broken to ensure equitable treatment.
It could, theoretically work in Canada where we have universal health care and where if your doctor prescribes something, it is generally covered (either by the basic provincial health plan or by a supplemental employer drug plan, depending on the situation you are in, but no one is without basic coverage).
But even if it would theoretically work I would have two objections:
(1) Some doctors are known as “drug pushers” or “formula pushers” whereas other doctors will make it difficult for people to get even the drugs that they do need. Some doctors feel it is their duty to try to wean people off of drugs that they need over time. Whether it is or not is not my place to judge, but access to prescriptions is not equally easy with all doctors.
(2) I do believe that the decision of whether to breastfeed or formula feed should be up to the parents. While a doctor can counsel his/her patient and make recommendations, I do not think it should be up to the doctor to make a decision or to force a mom to go in one direction versus another.
Oh my gosh thank you for saying this. Because I read the suggestion about turning formula into a prescription-only product – and besides the whole stigma of having to go to get a prescription, justify your choice, deal with insurance, have a doctor validate it as if you were a child yourself, and then wait on line at a special counter like a pariah simply to FEED YOUR CHILD… oh wait.
yeah, that was it.
Geezus.
More than million Americans don’t have health insurance and those that do are usually required to pay a copay to visit their doctor. What you are proposing is prohibitively expensive for many Americans and comes off as elitist.
Just my two cents,
Heather
Wouldn’t it be better if formula were covered by your health insurance? It should be! Then you would not have to rely on coupons. It is a crime that a woman who had a double mastectomy due to breast cancer has to pay for formula and that it is not considered a medical expense. Health insurance should also cover the cost of pasteurized, screened, donated human milk which is superior to formula according to the World Health Organization.
I agree with this 100%. We purchased 3 breast pumps, not including the portable, non battery ones, with my 2 births because two broke. The insurance company should have been able to pay for it since my children had latch problems… but if birth control isn’t regularly covered how the hell are we going to get pumps and formula covered?
Formula marketing is so successful that it is routinely heralded in marketing textbooks. Just placing a can of formula on the windowsill of new mom’s hospital room has been shown to decrease breastfeeding rates. And the “free” formula in hospital giveaway bags enjoys a 90% brand loyalty. Let’s not forget that ads, though powerful, are only a portion of the marketing budget. If it wasn’t working, would the formula industry spend between $2 and $3 BILLION annually on it?
I think an important point here is that breastfeeding is not always easy. Even for someone who is dedicated to making it work and who has the physical ability to make it work, it takes a lot of willpower. Just as people who are on a diet are advised not to keep junk food in their home, women who want to breastfeed successfully are more likely to do so if they are not constantly tempted by free formula or other promotional tactics. When I was struggling with breastfeeding my son and went into a store like Wal Mart or Babies R Us looking for something, anything, to soothe my cracked and bleeding nipples and my throbbing breasts, you’d better believe that those formula coupons were calling my name.
Kayris, not all women are as informed about breastfeeding as you are, nor are they surrounded by a culture of breastfeeding. I attend a weekly parenting class for low income families and week after week I see babies being bottle fed. Perhaps some of them are pumped milk, but I’m sure the majority are formula. There is no way that ALL those mothers are absolutely unable to breastfeed. They are no doubtedly influenced by ads that say formula is “just as good” as breastmilk, and by the lack of breasfeeding support at large in our communities.
I think the general logic goes something like this: “If it’s advertised that way, it must be true, because it’s illegal to employ false advertising. So, I can be safe in believing what the formula company tells me.”
The main problems with this logic are that the FTC doesn’t always do its job and that, especially with products marketed for infants, there is a tendency to believe that no one would market something known to harm a baby.
While being immersed in this type of conversation and becoming educated about these crucial parenting topics is great for those who have the interest to pursue it, this type of discourse isn’t what most new parents are surrounded by.
With the constant in-your-face marketing of the formula companies, it’s easy to see how even educated parents fall into these traps. And while parents ought to be critical of everything they purchase for their babies, it takes some time to realize how frequently baby products are recalled and to develop that critical eye. By then, they may well have bought into the formula lifestyle (because it’s perfectly healthy and fine, right?). Formula marketers hit parents at their most vulnerable, inexperienced stage; it’s no wonder that they’re so successful.
One of my good friends is a pediatrician and she said the majority of the low income families she sees (mostly Hispanic) do not breastfeed. But it’s not because they think formula is just as good as breastfeeding. It’s for a lot of other reasons. For example, it’s because they work and don’t have the 200-300 dollars to shell out for a breast pump, but can get formula for free through WIC (although another friend recently told me WIC provided her with a Medela Pump for free. I guess the benefits vary.). It’s because even if they can afford to get a pump, the daycare charges more per week for babies eating pumped breast milk, or because they work at McDonalds and the manager is a teenager who doesn’t know how important it is to give employees breaks in which to express milk.
I don’t think it’s right for formula companies to falsely advertise that their product is just as good as breast milk. But I still don’t think taking coupons away from people who need them will help, because the formula companies are certainly not going to lower their prices. There are so many things that would be more effective than taking pictures of coupons and keeping them from people who are already formula feeding.
Where I live, name brand formulas all cost roughly the same, regardless of where you buy it. Neither kid tolerated generic formula well, so for the short time we used it, both were on name brand formula. I checked prices obsessively, but the top brands only differed by maybe 40 cents. Having a coupon for anywhere from 1 to 5 dollars off was a huge help to us for something we needed to buy anyway.
Your pediatrician friend is very right! And that’s exactly why WIC benefits need to be shored up in favor of breastfeeding and employers need to have the Business Case for Breastfeeding presented to them. Just as too many parents don’t know that formula is not a breast milk equivalent, too many employers don’t realize that it’s generally in the best interest of their bottom line to be breastfeeding-friendly.
With regard to the coupons: I haven’t advocated for that, personally. While I’m staunchly against anything that violates the WHO Code, I don’t think the way to address violators is to go after the coupon programs first. Cutting out their other direct advertising efforts (all the imagery we see of the blissful bottle-feeding dyad, for instance) would be a better start, in my opinion.
On the whole, though, I think the coupons need to go and formula needs to be a prescription product covered by insurance (or medicaid, etc-….not getting into a healthcare debate here). You’re right: formula companies lowering their prices is about as likely as pigs flying. But, but formula becoming Rx, insurance would pick up some or all of the cost, which would actually save parents more money than the coupons (in most cases; again, not debating healthcare here).
In order for the WHO Code to be adhered to, there will have to be a transitional period where those already formula feeding stop getting coupons. That’s the reality of the situation and I do sympathize with the loss of savings they’d experience (I’m on a tight budget here, I really do get it). That transition is necessary for the greater good, though.
One thing I will suggest for those who formula feed is to go with an organic generic. It might not work for everyone, but it’s one way to quit supporting the major offenders. Top brand doesn’t necessarily equal best product, and formula is one of those cases.
The point you make about why many low-income mothers formula feed is a major reason why formula advertising needs to be restriscted. Since formula is so easy and available that even WIC provides it* there is no reason for employers to provide time/space for pumping and daycares can get away with charging more for handling breastmilk (even though it’s less work than preparing a bottle of formula). If formula was seen by society as a medical need more than just a convenience, then ostensibly there would be more resources for breastfeeding. Formula is exspensive, so why do we let the companies market and convince parents it’s easier to feed formula then to save up for a pump?
For someone in your situation, it would be better if your doctor could submit to your insurance to help pay for formula. It doesn’t make sense to throw coupons into the wind if they are only needed be a few people.
*WIC has changed a lot of their benefits to be more supportive of breastfeeding in the last year. The formula they provide is not nearly enough to support infants and families are left to still purchase most of what is needed.
Kayris, I admire your thoughtful exploration of this issue. I didn’t want to breastfeed and didn’t tell anyone for fear of being judged or brow-beaten. I had a horrible breastfeeding experience with my first child (and I did use formula, too) and it prompted me to research why so many moms like me didn’t want to breastfeed, or if they did, didn’t make it to the minimum recommended by the AAP. I was shocked by what I learned about the marketing of formula (and I worked at Merrill Lynch in marketing!). Bottom line, it has resulted in “booby traps” that pervade our culture and trip expecting and new mothers up at every turn. http://www.bestforbabes.org/breastfeeding-booby-traps/. Moms are being pressured to breastfeed but set up to fail, and too many women (including myself) feel that they are in a “damned if I do, damned if I don’t” situation. I for one am horrified by the judging of women who don’t breastfeed for whatever reason, as much as I am horrified by the judging of women who breastfeed in public or advocate for breastfeeding. What I believe we need to do, is to cheer on, coach and celebrate ALL moms, make sure that they are able to make informed decisions and that they can carry them out as they choose, without pressure, judgment or guilt. I hope you will join us, we need you!
I breastfed all my three children and have also worked voluntarily as a breastfeeding peer supporter. I am very much pro breastfeeding. I do not think that artificial milk should be advertised to new mothers or health professionals.
But nor do I think that it should only be available on prescription. Whether to breastfeed or not is a womans own personal choice – some women just don’t want to. Others have to work. Others find that despite their best efforts it just does not work out for them. In that case they should be free to buy formula, without stigma or guilt or having to wait for an appointment with a doctor to get a prescription in my opinion.
I personally think that the idea formula feeding should be a choice is part of the problem. We have become more comfortable with the idea of formula than with breastmilk. Of course there are situations where it is necessary and that is where doctors and midwives should step in and say we need to find something else… but the problem is that unconsciously we all have the idea that we can just use formula and it is no big deal. we have turned it into politically correct woman’s choice issue instead of medical need/children’s nutritional issue.
Sharon:
I do think it is a choice. I don’t think that makes it an equal choice and certainly not a better choice, but it is still a choice.
I do not feed my children THE best meal every day of the week. I do not dole out THE best discipline every day of the week. I try. I do my best as a parent. I am constantly trying to improve. But I recognize that I am not perfect. I also do not expect perfection from anyone else. I may have breastfed, but someone else out there that was a formula feeder is probably doing something else better than I am.
FYI, Leadership in the breastfeeding movement has moved away from using the word “choice”. It implies choosing between two equivalent items, which formula and breast milk are not, no judgment, they are just not equal. See “Watch your language” by Diane Weissinger. A better word might be decision, because it implies a thought process and a weighing of risk and rewards.
I like the word decision and agree that there should be a thought process and weighing of risk and rewards, but I don’t see that as being separate from choice. I see the decision as the end product of choice. Choices are not always completely free and are certainly not always equal. But I do believe in choice.
So if you feel that the idea of it being a choice is a problem, then what’s the solution? It not being a choice? Should women be forced to breastfeed if they do not want to? Whether or not to breastfeed is a womens issue, because it affects many aspects of our lives. Women are not mere vessels who should suddenly have to negate all their own needs simply because they have had a baby. Of course breast milk is nutritionally superior to artificial milk, but formula is not poison, and the fact is that the majority of western babies do fine on it.
I am passionately pro breastfeeding. It’s better for babies full stop. I loved breastfeeding my own children. But just because something works well for me does not mean I think it would or should work well for everybody.
It makes me feel very uncomfortable to see women beating eachother up over this issue. If we want society in general to give the job of mothering the respect and value it deserves, we need to support and value eachother as mothers and just accept that we don’t all have the same priorities and values.
Kayris has already expressed 99% of what I came on here to say, so I won’t rehash it. However, I want to add that while I certainly see Annie’s point about formula “calling her name” when things were rough on the nursing front, I don’t see that as sufficient reason to make formula a controlled substance (that might be too strong a term – but you get my point).
Having said that, I guess I should admit that I also get pissy about McDonalds being blamed for the obesity epidemic. I’ve actually used that argument before regarding formula coupons – just b/c I get McDonalds coupons in the mail (daily), doesn’t mean I EVER eat there. I’m not even tempted. Even if it is wayyy cheaper than the organic produce and vegetarian products that I buy, I have chosen to live a lifestyle that does not include junk food, so I have no interest. If someone is having that much trouble with breastfeeding, and is so miserable, that an ad would erase all their commitment to nursing… then maybe formula IS the best option for them. Especially as I feel breastfeeding does not need to be all or nothing. I bet that if we didn’t give women these ultimatums that they MUST nurse, and nurse exclusively, for at least 6 months (as a bare minimum – we’re talking at least a year if you REALLY love your kid and want him to be a healthy, productive member of society), more women would stick with it. It is possible to use both formula and breastmilk; to both pump and nurse… isn’t some breastmilk better than nothing?
Anyway – back to my point (sorry, I’m a digression junkie). I appreciate everything Bettina is trying to do – I think her organization is great. Taking obstacles away from women to make it easier for them to nurse is fantastic. However, I am not a fan of WHO code. I think it is very “big brother” and takes personal choice away from women. (We all need to start taking some responsibility for our own parenting choices… did you hear that they want to reshape hot dogs now b/c they are a choking hazard? Like parents can’t figure that out and just not give their kids hot dogs. Jeez loueeze.) I will concede that giving women formula bags in the hospital is probably rather silly if we are trying to encourage breastfeeding – but I don’t think getting formula coupons in the mail or seeing ads for formula (taking the “just like breastmilk” language out is a no-brainer too; of COURSE formula isn’t just like breastmilk – if it were, my son would have died, since he couldn’t tolerate breastmilk and could only take hypoallergenic formula, so thank god it isn’t “just like” breastmilk) is that much of a problem.
It’s pretty paternalistic to assume that low-income or “uneducated” women are so vulnerable to this type of marketing that they can’t make informed choices for themselves. As Kayris so eloquently put it, there are many more important issues coming into play here, on a socioeconomic level. Wouldn’t it be better for ALL kids and ALL women to focus our energies on making sure motherhood in and of itself is valued (not just how we feed out kids) and that all children are afforded good education, clean air, exercise, and healthy foods (after 6 months of age)?
I understand we probably disagree on a fundamental level about my last comment – because most of you probably feel that feeding kids formula has long-lasting consequences on health and intellect. I obviously don’t, being the “fearless formula feeder” (ya think?). So I can understand why you are so incensed with formula marketing…I’m not belittling that; I just wish we could all focus on what is going to make the world better in ways that do not require tremendous sacrifice on the part of women, since breastfeeding without the ability to pump and bottle feed is asking a LOT of those of us who work.
Fearless Formula Feeder:
I’m curious why you think that not allowing advertising = taking personal choice away from women?
There’s a LOT there, and I need to got get dinner going, so I’ll just poke my head in with one comment:
Think of it like the restrictions placed on cigarette advertising. No one is taking away the choice of smoking or not smoking, they’re just restricting how it can be marketed. How is the WHO Code any different? (I do realize that the WHO Code bans marketing certain products, aimed at a specific demographic, entirely; the analogy still stands, though. No choice or option has been removed.)
I don’t think you can compare cigarettes to formula. I fed both my kids formula and in no way do I consider it as dangerous as lighting up myself or around a child. Smoking is proven to significantly raise your risk of cancer and certain lung diseases. Feeding formula won’t give your kid cancer.
And back to the prescription thing: breastfeeding alone is not the litmus test for what makes a mother a good parent, or what makes a child a healthy one. My kids are both extremely healthy, but I don’t really attribute that to nursing them, I attribute it to our handwashing rules and our excellent diets and the fact that they both get enough exercise and enough rest. And they ate Sun Chips with their dinners tonight. What’s next, having to get a waiver signed to feed my kids junk food? Having to step on a scale before buying them the ocassional Happy Meal? You can only regulate what a person puts into their body so much. Is breastfeeding really so great if it makes the mother resent her baby, or if it takes away something from the time she spends with her infant?
Being a doctor doesn’t make a person infallible. My pediatrician friend, trained in med school about BF, and who counsels the mothers of her patients about it, ended up formula feeding both her children because BF didn’t work for her. And as many LCs point out, pediatricians are not always the best source of information when it comes to successfully breastfeeding. We ended up switching pediatricians because the old one was way too hung up on the growth charts and had counseled me on several ocassions to switch both children to formula. I ignored her. I switched when I no longer had a say in the matter, but my point is that some are advocating going to see a DOCTOR about establishing a reason for the need for formula, when that DOCTOR might have it wrong to start with.
I didn’t compare infant feeding with cigarettes, I think that’s crystal clear. I compared how cigarrette manufacturers are regulated with how formula manufacturers might be regulated in the future. No reference to smoking and health, nor breast or formula feeding and health, was made.
Clearly, the interpretation of my post was that I was comparing formula feeding and smoking: to be clear, I am absolutely not.
I also haven’t mentioned judging parents with regard to how they choose to feed their children here. I’m not about judgment, I’m about facts. I’ve tried to make it very clear that this isn’t personal and it’s not about looking down on anyone, for anything.
If breastfeeding is making a mother resent her baby, she needs to talk to someone about that. You may disagree. I don’t think the solution to that particular problem is going out and buying formula; I think it’s discussing it with a healthcare provider and coming up with a solution together. I’m not about over-regulation. But, I feel that there’s a sound case to be made for baby formula to be treated as a medicine.
I have also already acknowledged that the medical profession in general needs a LOT more training and education in breastfeeding before any of this could come about. I haven’t said and I don’t believe that doctors are infallible. Most health care practitioners receive little to no education in breastfeeding; as I said prior, for formula to be Rx, that must change. In fact, I just wrote this post for Best for Babes detailing why the InfantRISK Center is going to become crucial in how breastfeeding and medicine interact: http://www.bestforbabes.org/2010/02/breastfeeding-medications-the-infantrisk-center-to-the-rescue/
I know you’re not directly comparing cigarettes with formula. My point was that cig ads are more restricted because smoking gives you cancer. Smoking is a vice. Formula won’t give you cancer, and babies need to eat to live.
Also, my comments about judgement were not directed at you. Rather, they were general comments. I feel, quite often, from this topic, that some people want to make it difficult or impossible to get formula because “breastfeeding is best for babies!” But it’s not always best for moms and a baby is nothing without it’s parent. I think women should have the right to make their own decisions about what is best for their families, be it how they feed or how they discipline, without having to explain why. To me, it’s a slippery slope, in trying to treat formula as medicine.
As I said before, I really don’t get why a woman capable of BF wouldn’t at least give it a try. But I will defend to the death her right to do so.
I think I’ve clogged up Annie’s post enough. There’s a lot to think about here, and I think I’ll form further thoughts into my own blog post.
Kayris:
I look forward to your post. Please come back and post a link when it is up.
PhD:
I don’t feel that restricting advertising of formula in EVERY way takes away personal choice – like I said, I think the freebie bags might not be the best idea, nor should formula companies go around making claims that their product is “closest to breastmilk” – but I do think that following the WHO code to the letter DOES infringe on choice, because, like Kayris, I do not see formula as being something we need to restrict; rather, the marketing should not be conducted in a way that DISCOURAGES a woman from nursing. If she ALREADY does not want to breastfeed, or finds it too difficult to do so, then she should be able to freely buy formula, receive coupons, and compare products. Competition also drives down prices and encourages formula companies to keep making improvements – regardless of what you feel about formula, I hope you can agree that it that has changed and improved throughout the years, thanks to consumer-driven need.
Like Kayris said, if the only other substance that must follow these marketing limitations is cigarettes, then that is farked up. Formula may not be as good as breastmilk for the average kid, but it is still a darn good substitute. It’s a food like any other. Maybe not the magical elixir many believe breastmilk to be, but food all the same, and millions of kids have been raised on the stuff and are doing just fine (myself included).
(But on that note…I’m not a huge fan of restricting cigarette ads either. I don’t smoke, but I don’t care if YOU do, as long as you don’t do it around me or my kids. If you want to give yourself cancer, go right ahead. Not my business. And if you are going to do so, then you should have a choice in which cancer stick to do it with.)
Here’s how I see it: I don’t believe eating meat is a good idea. I think it is unethical to eat animals and if we were all vegetarian we would be a heck of a lot healthier as a society. When I see kids scarfing down Lunchables, I cringe. But I would NEVER force that belief on anyone, nor would I insist that Oscar Meyer stop marketing to kids. It’s a free country (well, kind of). And besides, there are some studies that suggest a lack of protein and fat from animal sources can do more harm than good. Some might say that my vegetarian lifestyle is actually more detrimental to my child than feeding him processed meat, so long as he was getting meat of some kind. I can understand where that logic is coming from, and politely agree to disagree.
My brain is fried from taking care of a toddler all day, but I *think* that is a good enough analogy to illustrate my point…?
Fearless Formula Feeder:
I don’t think cigarette marketing is the only example. At least not in Canada (I don’t know US regulations very well). In Canada there are restrictions on the marketing of tobacco, alcohol, pharmaceuticals, and even things like breakfast cereals in some instances.
I will re-iterate again that I do not think advertising is necessary to choice. You said that you are “not a huge fan of restricting cigarette ads……if you are going to [smoke], you should have a choice in which cancer stick to do it with”. I live in an area where cigarette advertising AND breakfast cereal advertising are both restricted. That means that when I bring home the healthy cereal from the grocery store, my kid isn’t saying “BUT MOMMY….I WANTED THE PINK FLUORESCENT ONE ON TV”. But I still have the CHOICE to buy the pink fluorescent one if I want. It is there in the aisle with the rest of them. It just hasn’t been pushed on my kid with a bunch of dancing bunnies or promises about how pretty or cool it will make her.
Choice is about availability.
Advertising and promotion is about convincing.
They are two very different concepts to me. People can certainly argue for or against either of them, but we should not mix the two together because they are not the same beast.
Okay, point taken. And maybe this is a philosophical difference between Americans and Canadians (and I am obscenely generalizing here, so bear with me). While there are many reasons that public health care has not succeeded to be a viable option in the US, one is because many Americans on the “right” feel that they do not want government in their private affairs. We tend to cringe about “big brother” here. This has certainly harmed us in some ways; we don’t have access to free health care like you guys do… but it is part and parcel of our national “personality”. I’m sure many Americans would like restrictions on cereals, but there are just as many who would balk at that suggestion – including me.
My mom never let us watch anything but PBS until we were old enough to sneak in the Cosby Show when she wasn’t watching. We also were raised with no sugary cereals or snacks except for Friday nights when we would get ONE small treat for Shabbat (we were Jewish). It was never a problem, b/c I didn’t see any ads that would make me scream for Cocoa Puffs. Granted, as I got older and went to friends’ homes who did have such snacks, I started asking for it – but my mom just said no and that was that. Parents need to take some responsibility. And with the advent of the DVR, if you ARE going to let your kids watch tv, then you can always just outlaw commercials.
For me, it all comes back to taking personal responsibility. Regardless of ads, we can make choices; I don’t like positioning ourselves as victims of anything, marketing included. And I’m sorry, but I don’t see you or anyone else railing against the promotion of breastfeeding – so how can women be expected to make an informed choice if the only “choice” they are presented with is nursing?? I would rather see women getting ALL the information and then be left to make a decision on their own.
I have, in some cases, complained about the nature of breastfeeding promotion. For example: Can breastfeeding promotion learn something from drunk-driving ads?
AMEN!!!! AMEN A-FREAKING-MEN!!!!!
We don’t have cable. My kids watch videos or PBS. So their exposure to Dora or Sponge Bob (vomit) or other character crap is pretty much through their friends. But you know what? I’m the parent. I’m the one with the power and the credit card. If I say no, I say no. Period.
This was the basic premise of my post. At some point, we need to use our brains to look past advertising and their lofty claims. No magic pill will make you look like Jillian Michael’s without lifting a finger or watching what you eat. No number of Baby Einstein videos will turn your infant into a genius. Formula supplemented with DHA and ARA to be like breastmilk? Give me a break.
I asked my friend who never wanted to BF how she felt about Rx formula. And her reaction was pretty pissed off. If a woman can choose to abort a baby, she can choose to smoke, even while pregnant, she can choose to eat raw fish or deli meat while pregnant, or she can choose to not wear a seatbelt or a million other things that may or may not put her fetus at risk. So how can you take away her choice to feed her baby formula, even if it’s a completely selfish reason, if she wants to?
It would be great if formula companies would stop advertising and lower the price and all the other things mentioned in these comments. But it’s not going to happen. It’s not. There’s too much money at risk and formula companies would fight tooth and nail, they have billions of dollars and powerful lawyers behind them. SO that’s why I think taking coupons away from FF moms would hurt them…and not the formula companies.
Kayris,
I think I love you.
If everyone were so smart, a lot of people in the marketing industry would be out of jobs. Somehow, what they do must be convincing someone or they wouldn’t bother.
PhD,
Yes, marketing does work on some. But so does peer pressure. I can’t tell you the number of women I’ve talked to who have been torturing themselves for years over their inability to breastfeed. Considering the only “formal” breastfeeding ads in recent history in the US were pulled shortly after they first ran (the log-rolling/mechanical bull debacle of ’06 or so), I would venture to guess that this has little to do with marketing. So obviously, there is more at play then just the ads we see on tv or in magazines/billboards.
The reverse argument to this would be that we live in a bottle-feeding society, yada yada, which I certainly won’t dispute (the society I live in is 100% a breastfeeding one, but I realize that is one specific region and this is not true everywhere – watching “16 and Pregnant” on MTV is enough to convince me of that). From what I’ve heard from some lactivists, it is more than just formula companies and their marketing techniques; it is also the portrayal of breastfeeding (or lack thereof) in the media and the lack of peer support that really damages breastfeeding rates.
Regardless… I want to tell you that I always appreciate your take on things; I really enjoyed that post on drunk driving ads you linked to (I actually commented on it a ways back) and respect your writing and passion immensely. I am not trying to be combative at all – I appreciate the points you have made and they have given me some substantial food for thought.
My favourite analogy for breastfeeding and formula feeding is this:
Consider formula feeding as convenience food. Not fast food, not Maccy Ds, but long life food, reconstituted food, tinned food. It can be fortified with vitamins to make it healthier for people to eat, it may have a few questionable ingredients (ie preservatives) but overall, you can live a healthy enough life on it, you’d get all your food groups in, and your vitamins.
Breastfeeding by comparison is fresh food, organically grown, direct from the farm. It would take more time setting up the farm, and some support from family members and outsiders to get things going. Once you were up and running, it would become easy, second nature. But if you worked outside of the home, or had limited help available, it would become more difficult than eating packaged food from the supermarket. Some people might have to do a little bit of both. Some people may be unable to do farm work due to physical problems, or lack of support/help in the day to day running. Some people may not want to farm, and choose to go straight to buying their packaged food at the supermarket.
You could even say that choosing to buy fresh organic food at the supermarket is the equivalent of pumping, or obtaining donor milk. Not the same as producing it yourself, and it would not be as fresh, but it would still be good.
Not a perfect analogy, but you get the idea.
I think most people accept that fresh organic produce is healthier for you than convenience food. But there isn’t a big debate over it. The only reason there is with bf vs formula is because it involves parenting which is always a hot topic
Claire- I think that is a really good analogy. Probably the best I’ve seen.
I’m sort of left here scratching my head, wondering how anyone could think that the formula checks actually help parents afford formula. Formula costs about 15 cents a can to produce, yet costs $15 at the store. That’s a huge mark-up and most of the extra cost covers the aggressive marketing of formula, which includes those hospital freebies and the mailing of checks. So not really free at all, you’re paying for it when you buy the brand name formula. The largest supplier of formula in the US is the US government, through the WIC program. The government pays pennies for cans of formula because the formula companies consider it free marketing. They know parents on WIC don’t get enough free formula to last them the entire month, so once they go to the store and are paying full-price, they’ll stick to the brand they get for free at WIC. So again, consumers are paying for all of these marketing tactics.
If formula weren’t advertised the way it is now (stop the bags at hospitals, no more formula cans showing up on parents’ doorsteps, no more coupons, tv commercials, $40,000 spreads in People magazine, etc.) the cost of formula to the consumer would have to go down. The US government should also have to pay full price for formula that it supplies for WIC, as should hospitals who use it to supplement. Again, with all of these things in play, governments and hospitals would not be willing to pay those exorbitant costs and I truly believe we’d see the pricing of formula come down to reflect a more realistic profit margin and that would make formula more affordable for those who truly need it. Of course, I am sure many breastfeeding advocates would then say formula was too easy to get and more people would start to use it and maybe that is true as well. But my main point is that formula checks don’t help anyone, least of all people who have already chosen to formula feed full time and NEED it.
This is such an excellent point. I hadn’t thought about how much marketing itself contributed to the high cost of formula. I am now remembering my marketing class in college and why generic products cost less than name brand. It’s all the advertising costs.
Blacktating-
Those are excellent points. The only thing I’d argue is that it is important for formula to keep improving. And for it to do so, the formula companies need money, which is one argument for the high costs. Not that I am a fan of the cost of formula, believe me. I swear my kid’s entire college fund went into his hypoallergenic formula.
It’s the same argument that the drug companies make: research costs money, and the government can’t fund all of the necessary research (and FWIW, I highly doubt that the govt could rationalize funding formula research when it is simultaneously funding/supporting programs to bring the breastfeeding rates up). I see your point, but then the same point could be made for any type of product – food, diapers, toys, etc. If no one advertised, the costs would certainly go down… but we live in a capitalistic society, so I don’t see that happening anytime soon, and I guess I just don’t see why formula manufacturers need to conduct their business in a way that markedly different than anyone else.
But I certainly understand your argument and agree with it on certain levels. Excellent points.
Yes, it is important for formula to keep improving, because basically formula is a giant experiment and our babies are the guinea pigs (I used formula for my son from months 9-12). The reason why formula keeps having to change is because babies have died, had seizures, failed to thrive on formula, etc. But formula companies are billion dollar businesses. They are in some cases also produced by pharmaceutical companies. So there is plenty of money there to do scientific research and still make a ton of money. There is no justifying the cost of formula. None. It’s made from the cheapest ingredients and packaging possible.
I don’t see why formula has to be advertised at all. As others have already stated, everyone knows formula exists and where to buy it if you need/want it. The marketing formula companies use undermines breastfeeding and idealizes bottle feeding. They purposefully send formula to parents’ homes during growth spurt months, when women are more likely to think their milk is “drying up.” Their tactics are calculated to convince moms to stop breastfeeding or never breastfeed at all. It would be one thing if they were only trying to convince moms who had already decided on formula to buy their brand over the next guy’s, but they are trying to convince moms who don’t need or WANT their products that their bodies are deficient and formula is a necessary part of parenting when it’s NOT. That is the problem with formula marketing.
And FWIW, I do NOT think formula should be RX only.
Sorry… that should read, “I just don’t see why formula manufacturers need to conduct their business in a way so markedly different from anyone else.”
These 6 am wake-ups are frying my brain.
As usual – you’re such a pro Annie. Wish I knew what to do when I got those FREE bottles with my first. I was so mad that the hospital even had them, let alone sent them home with me.
Sharing with the world….
I just reported this current Toys R Us circular to the email given in your blog. $10 Toys R Us gift certificate with $50+ formula purchase. Unbelievable.
http://trus.imageg.net/graphics/media/trus/022610-msw-cpns.pdf?csm=125731816&csc=728089&csa=125730080&csu=730715
Sarah:
That’s awful…
Ok, but now I am even more confused.
How is this particular ad problematic? Would you have the same problem if it was a $10 gift card with the purchase of a breast pump? Why are we penalizing Toys R Us for helping their customers offset the cost of formula??
If it was a general “Spend $50 and get a $10 gift card” I would have no problem with it. In this case, it is used specifically as a formula promotion. Breastfeeding mothers who are there purchasing a nursing pillow, nursing pads, or any other nursing supplies do not have the opportunity to access these same savings.
I’m with you FF. What’s the big deal?
I’ve seen sales specifically aimed at breastfeeding. Buy a tube of nipple cream and get a box of breast pads free. Buy a Boppy and get a cover for half off. Didn’t Dr Sears offer a nursing cover through his site in conjunction with something else?
It’s not like a 10 dollar gift card is going to keep someone from BF. If you’re at the store buying formula, you’ve already made the choice.
Dr. Sears offered a free copy of his breastfeeding book if you bought a nursing cover. I wasn’t thrilled with that either! http://www.phdinparenting.com/2009/03/30/a-slap-in-the-boobs-by-dr-sears/
Thanks a lot for this post. I see romania is not on the list, i think i’ll have to write to geneva…
Anyway, just to let you know, one in milion facts abot nestle. So romania is a eastern european developing country, 20 ears after comunism felt, so not exactly africa. This is not stopping them. In about 70% of nestle prints (ads, formula boxes) they have written in a size 5 font (yes, try to read this after 12, 14, and 24 font) ‘ brest milk is the best’. But in none of the tv adds.
Plus, this weekwnd I attended a fair with my babywearing stuff. Of course, nestle was there too. Asking all the moms how old the babies are and then, if babies are more then 3,5 month, tring to convince them to give the babies nestle;s food jars. See, it’s writen here 4+, it’s perfect. Some moms were explaining they were brestfeeding but no, from 4 month you need to give them food. And look, how convenient, we offer you exaclty what you need. Oh, and don’t wait, 6 month could be too late. BLEAH!
Ah, and some of them looked very professional dressed, as if they had any ideea what they were talking about.
Ha, the new nestle trick (in romania): mother’s milk is ideal! like, you know, in a perfect world…but it’s not perfect, so it’s ok if you,like many others, can’t BF, we have nestle…They don’t say ‘mothers’ milk is the best’ anymore, you might understand that you could BF too…
I’m thoroughly confused. Have things changed since I had my babies?? Because my hospital sent me home loaded with formula samples, and I was nursing. Why is that okay and a coupon on a grocery store shelf is not?
Musings of a Housewife:
Sending formula samples home from the hospital is also not okay.
As I wrote in my post above, some of the provisions in the Code include:
* No advertising to the public of any product within the scope of the Code. This includes ads in any media–print, websites, TV, radio. It also includes in-store promotions, special displays, coupons and discounts (lowering the price of formula is allowed, but promoting a sale price or offering a coupon is not).
* No free samples to mothers. Cans of formula or gifts from formula or bottle manufacturers sent to homes, given to mothers by pediatric or obstetric offices, given to mothers when they leave the hospital, given as prizes or in contests, given at clinics or anywhere in the healthcare system
* No promotion of products through healthcare systems. Booklets, leaflets, posters,name badge holders, crib cards, tape measures, calendars, etc
* No gifts to healthcare providers. Anything from formula companies or feeding bottle manufacturers that are given to physicians, nurses, dietitians
* No words or pictures idealizing artificial feeding or pictures of infants on labels of formula cans, feeding bottles, etc. Packaging of these products should not have idealizing language or pictures of infants and mothers. Idealizing language means that claims are made such as “most like mother herself” or claims that the products are similar to breastmilk or breastfeeding
My daughter is the mother of an 11 month old baby who is still almost entirely breastfed. No jarred food. No formula. They qualified for Assistance from WIC , the federally funded Women, Infants and Children Supplemental Nutrition Program. The coupons she was given were for free formula and jarred baby foods which her baby does not eat. Pregnant women can receive assistance for vegetables, cheese, milk, bread, cereal, fish, etc. But once the baby is born the only available assistance is for formula and jarred baby food.
As a mama of two who never gave a drop of formula…I was ignorant of the WHO code until now. I knew the WHO recommended nursing until age 2 minimum, but wow. I am floored because here in Chicago, major hospitals are STILL giving out formula samples galore and violating every section of that code.
I also saw samples of formula at my ped’s office last week.
Looks like it’s time for me to write a few nasty emails, eh?