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Saturday
Nov072009

Nestle Answers: Can a formula company support breastfeeding?

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.

Questions


1. When meeting with bloggers, you characterized your 1-800-4Gerber line as a breastfeeding support line. Is that number just for breastfeeding support? If not, what is the scope of that phone line?

2. What are the qualifications of the staff that work on your 1-800-4Gerber help line? What percentage of them are International Board Certified Lactation Consultants?

3. Do you have any statistics on your 1-800-4Gerber help line? (e.g. how many calls? nature of questions asked? recommendations given?)

Nestle's Answers


Our trained experts are able to discuss a wide variety of topics with both new and experienced moms that include a wide array of questions ranging from breastfeeding to infant, toddler and preschooler feeding and nutrition questions. We help provide parents and caregivers with answers to the nutritional needs of children aged up to age 4. Parents are able to reach us 24 hours a day 7 days a week and help is always available.

The contact center for Nestle Infant Nutrition has a staff of feeding experts including registered dietitians and breastfeeding educators. All registered Nestlé Infant Nutrition call center dietitians are members of the American Dietetic Association (ADA) and have an average of ten years of experience in Pediatric Nutrition. Our Breastfeeding Educators have completed their certification requirements through UCLA (University of California, Los Angeles UCLA Extension) and The Lactation Institute. The program provides both comprehensive “hands-on” and theoretical training. The length of the time it takes to complete the program varies, as is the case with many educational endeavors, however certification is granted only when all requirements for certification have been met. Our breastfeeding educators are not board certified by IBCLC.

Our trained experts are able to discuss a wide variety of topics with both new and experienced moms that include a wide array of questions ranging from breastfeeding to infant, toddler and preschooler feeding and nutrition questions. We help provide parents and caregivers with answers to the nutritional needs of children aged up to age 4. Parents are able to reach us 24 hours a day 7 days a week. We never close. We are the only infant nutrition company who is always there for mom and her baby 24/7/365. Regarding the specific questions about the exact number of contacts, we treat this and any other sensitive information as confidential.

My Response


When Nestle met with the bloggers at the Nestle Family event, they stated that they are pro-breastfeeding and that they have a 24-hour breastfeeding helpline at 1-800-4Gerber.

My initial thoughts were:


  • With "4Gerber" in the phone number, could this really be a breastfeeding support line? Gerber offers a variety of baby products and it didn't seem logical to me that the same people who would be answering questions about spoons, toddler snack food and bath products would be giving breastfeeding help.


So I wanted to learn more about who was actually tending the phone lines and whether they actually get any breastfeeding questions.

The People Providing Nestle Breastfeeding Support

With regards to the qualifications of their staff, they rattled off a bunch of impressive sounding stuff:

  • Call center dietitians are members of the American Dietetic Association (ADA) and have an average of ten years of experience in Pediatric Nutrition.


Good. I hope the ADA members take note of the updated ADA position paper on breastfeeding, in particular the parts about the increased risk of acute and chronic illnesses as a result of not breastfeeding and the fact that real support for breastfeeding is critical. That said, being an ADA member and understanding the importance of breastfeeding does not make one qualified to give breastfeeding advice.

  • Our Breastfeeding Educators have completed their certification requirements through UCLA (University of California, Los Angeles UCLA Extension) and The Lactation Institute. The program provides both comprehensive “hands-on” and theoretical training.


The UCLA Lactation Educator Training Program is a one-week (5 day) breastfeeding training course. That is better than nothing, but I would not characterize it as comprehensive. It does not compare with the minimum of 900 hours working directly with breastfeeding mothers and rigorous examination process required to be certified as an International Board Certified Lactation Consultant.

  • Our breastfeeding educators are not board certified by IBCLC.


This last point is not as impressive, but somewhat self evident. None of their breastfeeding educators are International Board Certified Lactation Consultants (IBCLC). Do you know why? Because their Code of Ethics would prevent them from working for a formula company. Some of the clauses in their Code that would make it impossible to work for a formula company include:


  • Remain free of conflict of interest while fulfilling the objectives and maintaining the integrity of the lactation consultant profession.

  • Disclose any financial or other conflicts of interest in relevant organizations providing goods or services. Ensure that professional judgment is not influenced by any commercial considerations.



So Nestle can take people that it has hired and give them some breastfeeding training, but it cannot hire real breastfeeding professionals because it would be unethical for them to work for a formula company.

Number and Nature of Calls Received

On the second point regarding the number and nature of calls received, they didn't answer the question. Nestle called it sensitive and confidential. I wasn't asking for specific names and phone number of the people who called. I was asking for statistics on those calls. Maybe it is sensitive and confidential because the number of breastfeeding questions received were very few to none, which would discredit the phone line's role as a 24-hour breastfeeding support line. If that is the case, I'm thrilled. It means people are smart enough not to call Nestle with their breastfeeding questions.

My guess, in absence of any data, is that they rightfully probably get a lot more phone calls from people who have formula questions than from people who have breastfeeding questions. Which is good in one way - I don't think Nestle is the place to get breastfeeding advice. But it is also bad, in that the five day training that their breastfeeding counselors received could get pretty stale pretty quickly if they are not putting it to use regularly. A lactation consultant or breastfeeding counselor who sees people with breastfeeding questions every day is going to have a much fresher memory of breastfeeding knowledge and also be able to learn from the experience of working with so many women.

How is the Breastfeeding Help?

I tried to call the 1-800-4Gerber phone number from here (Canada) and it worked, but got me just to a call centre for information and advice on Gerber products with three options that had nothing to do with breastfeeding. So asked a friend, Danielle Friedland, who also happens to be a Certified Lactation Counselor to give them a call. She ended up calling them twice.

  • Call 1: Do I need to supplement? Danielle called them during the day on a weekday about her 4 week old baby. She said that her baby was fussy after nursing on both breasts. She said that her mom said the  baby looked hungry and that she should give a bottle. The woman responded that sometimes it is not hunger, she may want to suck and may need a pacifier if she is a little fussy. She also said that grandmas always think the baby is hungry if she is fussing. She also said that as long as the baby is eating every 2 to 2.5 hours, having wet/poopy diapers, then it is fine. Danielle then asked: "So when should I start giving formula? My mom said to give formula by six months". The Nestle woman responded that you don't ever have to give formula and that breastmilk can be the whole source of nutrition for the ifrst year. She said that some moms supplement if they go out, but it can be pumped breastmilk. Then she finished with the soft marketing pitch...if you do want to give formula, Good Start is 100% whey protein, same breakdown in the tummy as breastmilk, etc.



  • Call 2: How often to feed baby? Danielle called again on a weekend during the day and asked how many times per day she should be feeding her baby. The woman who answered the phone asked how much she was giving the baby. Danielle said that she didn't know because she was breastfeeding and said she was nursing her 2 week old baby every 4 hours (**which we know is not often enough**). The woman said she has info for formula fed babies only and put Danielle on hold to get the information. When she came back, she said Danielle should be feeding 8 to 10 times per day but that she didn't have to wake him if he was sleeping. She asked for Danielle's contact information and said that a Certified Lactation Educator would call her back. Danielle said "oh, you're not a lactation person - my friend said she called the number to get breastfeeding help". The woman said "no, but they are available 24 hours per day". Danielle said "but not now?". The woman said they would call her back within an hour. Danielle didn't want to give her phone number, so she said she had to go.


All in all, the breastfeeding help was not awful. A lot of the information was accurate. But in the first call there were certainly things that you wouldn't hear from La Leche League (like suggesting a pacifier, or talking about the benefits of formula) and the depth of the breastfeeding advice is certainly also questionable (not probing further for reasons that the baby might be fussy such as oversupply and in the second call not having someone on hand to answer the breastfeeding questions). While these were just two examples, I expect that on the whole, the phone help is probably quite similar to Nestle's Web help that was documented in my recent guest post by @Artemnesia called Helping Themselves: Breastfeeding Advice Nestle Style, which documented specifically a number of ways that Nestle tries to undermine a mother's confidence in her ability to breastfeed.

What should Nestle do?

I don't think Nestle or other formula manufacturers should be providing breastfeeding advice. I think at the most they should refer mothers to reputable organizations or websites that can assist them, like La Leche League or seeing an International Board Certified Lactation Consultant. In an ideal world, perhaps Nestle would contribute financially to breastfeeding promotion through independent organizations, but in reality I think most breastfeeding advocacy organizations would turn down money from Nestle due to the potential conflict of interest (e.g. pressure to downplay the risks of formula, pressure to recommend Nestle as the best alternative when supplementing is necessary, etc.).

So, I think Nestle should focus on the societal barriers to breastfeeding that it can directly do something about. By eliminating any marketing of formula, Nestle can:

  • Ensure that mothers are not exposed to formula advertising and formula samples.

  • Ensure that medical professionals are not courted and used as an indirect means of marketing to mothers.

  • Lobby the government and insurance companies to make access to lactation consultants and breast pumps easy and free.

  • Eliminate any Nestle imagery that includes babies using bottles in order to reduce the preponderance of bottle imagery.


But I doubt that will happen. Because in its answer to @MediaMum, Nestle could only name medical reasons for low breastfeeding rates in the United States. The barriers to breastfeeding are not just medical. In fact only a small number of women face true medical issues that prevent them from breastfeeding. Most of them face societal barriers, many of which are facilitated by the actions of formula companies like Nestle.

Thank you to A Mother in Israel and That Danielle for their input into this post. Photo credit: Blogpocket on flickr
« "While you were out": Emma and Julian's redecorated rooms | Main | Helping Themselves: Breastfeeding Advice Nestle-Style »

Reader Comments (30)

The fact is that anyone running a call center knows the trends of why people call. So the "confidential" indicates that they don't want to share it with you and your readers. For the reason you state, that it would reveal they don't get breastfeeding calls. They most likely get weaning questions.

November 8, 2009 | Unregistered CommenterRachel

I agree with you totally. I am glad that people aren't calling Nestle for breastfeeding help. They're not the ones to call. And I also agree that they shouldn't even be offering breastfeeding help. If you want to support breastfeeding, stop marketing your formula so aggressively.

November 8, 2009 | Unregistered CommenterAmber

I'm not so sure that Nestle doesn't want to share their data about support calls for lack of numbers. I'd venture to suggest they get more calls than they want us to know about. Consider a barrier to breastfeeding as being society, I believe the average mother that really, truly wants to breastfeed likely has the ability to find at least *some* resources for support. But with support like this http://www.phdinparenting.com/2009/11/04/helping-themselves-breastfeeding-advice-nestle-style/ given to the mothers that don't know where to turn, I highly doubt they want their competition to learn how 'successful' a toll-free support line is.

If you were looking for breastfeeding support, would you really ring a number that you found on the side of a formula tin? Well, quite possibly some people would, but you kind of hope they would be intelligent enough to realise that it would perhaps not be the most supportive place to call. But on the other hand, there probably is a need for a formula feeding helpline - I know I would have no idea of where to start if I had to start giving formula. Can you trust the consumer to differentiate between a true breastfeeding support helpline and a formula feeding support helpline?

I don't know, this is difficult issue to sort out. While advertising is allowed, it is impossible to stop any formula manufacturer from promoting its product, and its advertising is certainly not going to encourage breastfeeding. Personally, I think all advertising of breastmilk substitutes should be banned, and this could include helplines as well. But as we all know, that's not going to happen.

November 8, 2009 | Unregistered CommenterCave Mother

I can't imagine anyone would call a formula company for breastfeeding advice. I really can't. I don't care who they are, where they live, what their literacy level is, or even what their IQ level -- they are not going to call a formula company for breastfeeding support.

I do, however, agree with Cave Mother that a 1-800 number should be prominently placed on the formula tin for formula-feeding help. For a number of reasons: (1) I was surprised to hear a number of commentators on another post note that they weren't aware that they should boil water before using it in formula, so it proves there is a need, and (2) since it's possible that hospital, nursing and other medical staff are no longer familiar with formula as they used to be and may not be in a position to provide accurate information.

Overall, on the larger issue, I am fine with formula companies advertising in print or online and using bottle imagery (I recognize that this runs contrary to majority opinion here). I am not fine with formula companies providing samples, courting medical professionals, or using manipulative strategies such as breastfeeding support lines, websites such as the "healthy start" one discussed in your previous posting, and the purchasing of key words related to breastfeeding/nursing.

November 8, 2009 | Unregistered Commentercoffeewithjulie

I also have a counter opinion, though I breastfed my last child almost exclusively for one year. Kid just wouldn't eat food. He's still nursing at a two and a half. (His sister broke my heart when she self-weaned at 20 months.)

I work full-time and I used all my breaks to pump breastmilk. I was lucky I could do that; some jobs just don't have that kind of flexibility. If I were on the road, or having to attend long meetings that might not have been possible.

I mention this because I believe in breastfeeding.

But I would never want to ban the responsible advertising of formula and the setting up of toll-free numbers for assistance. I know a number of women who simple couldn't breastfeed.
Some needed medication incompatible with breastfeeding. Others tried and their babies lost weight. Nothing they did boosted their supply. Formula made their babies full and them less anxious. Some of them continued nursing for comfort, some gave it up entirely. Most felt some amount of guilt and disappointment in themselves.

I wish they'd all felt they were making the best choice for their babies.

November 8, 2009 | Unregistered Commentertoyfoto

@toyfoto: I often compare formula to c-sections. C-sections are sometimes necessary. They save lives. However, c-sections are riskier, more expensive (and more profitable) than natural birth. It would be irresponsible for hospitals or doctors to advertise c-sections ("avoid vaginal tearing" or "choose your baby's birth date"). Everyone knows that c-sections are available. There is no need to advertise them. Placing restrictions or a ban on the advertising of formula does not mean placing restrictions on the availability of formula to those who need it or even those who want it.

November 8, 2009 | Unregistered Commenterphdinparenting

@coffeewithjulie: I also don't object to Nestle having a 1-800 number for people who need information on how to use their products safely. However, when Nestle met with a group of bloggers recently and was asked what they do to support breastfeeding, they mentioned that they have a 24/7 breastfeeding support line, 1-800-4Gerber. That is how they characterized it - as a breastfeeding help line.

November 8, 2009 | Unregistered Commenterphdinparenting

This post isn't about the use of formula but the total conflict of interest of a formula company offering ANY advice about breastfeeding. The fact that the "breastfeeding educator" followed the accurate statement that I didn't ever HAVE to give my baby formula with a plug for their Good Start formula being the best substitute for breastmilk is so totally questionable it's laughable.

Their people aren't certified "by IBCLC?" Umm I think they meant "by IBLCE." Rolleyes. "IBCLC" is a credential, "IBLCE" is the board providing certification.

@toyfoto, the International Code does not try to prevent formula from being marketed. It is supposed to prevent it from being marketed in unethical ways, including direct advertising to the public.

"Article 1. The Aim of the Code

The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes,
when these are necessary, on the basis of adequate information and through appropriate marketing
and distribution."

Much more could be explained by checking out the preamble and beginning articles of the Code:

http://www.ibfan.org/issue-international_code-full.html

November 8, 2009 | Unregistered Commenter@Artemnesia (Erin)

[...] 1. When meeting with bloggers, you characterized your 1-800-4Gerber line as a breastfeeding support line. Is that number just for breastfeeding support? If not, what is the scope of that phone line? ANSWER HERE [...]

To play devil's advocate, c-sections are a public-sector service from our health care system. Whereas, formula is a product made by a private-sector manufacturer. I think it's unreasonable to expect a private-sector manufacturer not to advertise their product. Why would a private-sector company make a product if it can not make reasonable profits from it? If no advertising is allowed, then the public sector might as well take over its manufacture (and all the ongoing product development research). The argument that "everyone know that they are available, and therefore there is no need to advertise them" doesn't hold up to me. For instance, would you expect tampon manufacturers not to advertise their products?

November 9, 2009 | Unregistered Commentercoffeewithjulie

@coffeewithjulie:

Is there well documented evidence that there are risks to human health in using tampons versus another alternative?

Many other products that pose potential risks to human health (like formula does) do have advertising restrictions, e.g. tobacco, firearms, a http://www.hc-sc.gc.ca/dhp-mps/advert-publicit/fs-fi/advert-publi_fs-fi-eng.php" rel="nofollow">variety of health products. There are plenty of products manufactured by the private sector that have enough demand that they do not need to be advertised.

With regards to c-sections, Canada has a single-payer health care system that pays health care providers on a fee for service basis. I believe those health care providers do get paid more to do a c-section than to do a natural birth. Other countries that have fully private health care systems still generally do not see the type of advertising for c-sections that we see here for infant formula.

November 9, 2009 | Unregistered Commenterphdinparenting

Interesting information here on what Canada considers advertising vs. information when it comes to a 1-800 line for drug manufacturers. Same principles could be applied for Nestle's 1-800 number I believe:

http://www.hc-sc.gc.ca/dhp-mps/advert-publicit/pol/actv_promo_vs_info-eng.php#Telephone

November 9, 2009 | Unregistered Commenterphdinparenting

I agree That Danielle - it is so ridiculous, it is laughable!

November 10, 2009 | Unregistered Commentercoffeewithjulie

I guess we'll have to agree to disagree on this one.

My general point was that formula is a manufactured product in the private sector, whereas c-sections are a public-sector service. I don't see them being comparable.

Then again, I also don't see how formula would fall into the same category as tobacco and firearms. And I'm confused why formula would be classified as a "health product." Isn't it a "milk substitute" or "artificial milk product" and therefore a food product?

There's no doubt that you know far more about this issue than I do. Your blog has sparked my interest in it all though, so thanks for that.

November 10, 2009 | Unregistered Commentercoffeewithjulie

@coffeewithjulie:

Sorry, I wrote my reply in a hurry, so perhaps I wasn't clear.

Formula isn't classified as a health product. It is a food product.

I gave the examples of tobacco, firearms, and health products because they are all products manufactured in the private sector that face significant restrictions or prohibitions with regards to advertising. You said:

I think it’s unreasonable to expect a private-sector manufacturer not to advertise their product. Why would a private-sector company make a product if it can not make reasonable profits from it? If no advertising is allowed, then the public sector might as well take over its manufacture (and all the ongoing product development research).

My point was simply that these types of restrictions do exist where warranted and that the companies still can and do make reasonable profits. I'm very happy that the public sector is not involved in drug manufacturing, but I am also happy that there are significant restrictions on drug advertising. Does that make sense?

November 10, 2009 | Unregistered Commenterphdinparenting

Nestle could do a lot to help breastfeeding, and I think they could start by fixing their latest commercial. It starts off by saying that breastfeeding is best, but their formula is the next best thing. However, when they talk about breastfeeding, they show a women nursing her baby with her entire breast out of her shirt and exposed. The rest of the commercial then shows a women modestly dressed using a bottle to feed her child.

The nursing scene totally plays on the fears that some women have of exposing themselves, fears that make them too uncomfortable and self-conscious to enjoy nursing their babies.

You can see the image comparison on their site:
http://www.nestle-baby.ca/en/products/formula/index.htm

I don't believe for a moment that Nestle is pro-breastfeeding. How could it be? Its a complete conflict of interest. So I'd always be suspicious of their breastfeeding support line, as I think most other people would be -- what a bizarre marketing strategy.

November 10, 2009 | Unregistered Commentertea4tamara

When I compared the breastfeeding advice coming from formula companies with smoking cessation advice coming from tobacco companies earlier I was not likening formula to tobacco.

I do think that formula companies should be held accountable for medical benefits they claim, however I don't think it's a toxic substance nor should it be treated so by way of advertising.

November 10, 2009 | Unregistered Commentertoyfoto

@toyfoto: I knew you weren't comparing tobacco with formula and I am not either. But I do think the advertising and promotion tactics of formula companies and tobacco companies are similar.

November 10, 2009 | Unregistered Commenterphdinparenting

I believe ALL advertisers should be held accountable for their product claims. I don't think, however, showing people happily feeding their healthy, happy children formula is on the same level as people happily drinking in a bar or smoking a cigarettes.

The reason those ads are banned, in large part, is because of the people they reach are minors, not the general, legal-aged audience.

I still think education and not legislation is the best and most effective way to reach mothers. I think it's already done wonders.

November 10, 2009 | Unregistered Commentertoyfoto

[...] answer: Breastmilk is best. Even Nestle agrees (even if it is only a marketing gimmick and because they have to say [...]

When I called the line, I did give my number so the person with some lactation support training could get back to me--although I had to specifically insist that I needed to speak with someone who could provide breastfeeding support. She explained that she was not qualified to offer "medical" advice like a certified LC but could help with things like latch. I didn't quite understand what she was able to discuss and what she could not. As you said, I get the feeling that the advice is generally accurate but not deep enough to help breastfeeding mothers in a meaningful way--similar to the print advice from formula companies.

November 11, 2009 | Unregistered CommenterCandace

It sounds like the person you spoke to wasn't even clear on what she was able to discuss or not discuss.

Even a certified lactation counselor can't give medical advice. We give breastfeeding advice and support and refer to doctors when there's a concern about medical issues or medication. For example, if it looks like a mom might have mastitis, we need to refer to her physician.

Yes, that raised a flag for me even though I don't have the training you have.

November 12, 2009 | Unregistered CommenterCandace

Even an IBCLC will refer you to a doctor regarding mastitis. When I got mastitis I kept seeing the IBCLC with regards to latch, maintaining supply, breast care, while seeing my family doctor for the antibiotics.

November 12, 2009 | Unregistered Commenterphdinparenting

Thank you for all the research you have done on this topic, I was very impressed that I linked this article to my home page.
I agree that formula companies are not the places to get breastfeeding help from. Were it not for the help of the lactation consultants and breastfeeding group that I joined I don't think I would have been breastfed for as long as I did.
We need accurate information and formula companies are not the place to get it.

November 13, 2009 | Unregistered CommenterRuby

[...] of us (including Dou-la-la and I) realize that infant formula companies are not really there to support breastfeeding moms, they are [...]

[...] Nestle Answers: Can a formula company really support breastfeeding? [...]

I work for a division within Nestle and just recently had a baby. They give us coupons for formula but they also give us all of the What to Expect books, breastfeeding books, a $50 coupon for a breastpump and around the clock phone help. This is all part of a larger offering- they also help find childcare, answer any questions about infants through teenagers, and a whole bunch of other things. They encourage breastfeeding and am very thankful I work for a company like them!

November 30, 2011 | Unregistered CommenterErin

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