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Monday
Feb222010

How to report unethical promotion of formula, bottles and other breastmilk substitutes 

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?


The Code is monitored by public interest organizations in various countries that are part of a network called the International Baby Food Action Network (IBFAN). A standard monitoring form can be downloaded and sent to the respective Code monitoring organization for your country. Here is specific information and forms for a few countries:


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.
« Healthier Olympic Sponsorship Videos | Main | Are these your kids' heroes? Olympians, sponsorship, McDonald's and more »

Reader Comments (122)

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?

February 22, 2010 | Unregistered Commentersmoaksmom

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.

February 22, 2010 | Unregistered CommenterAmber

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.

February 22, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered CommenterMichelle

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?

February 23, 2010 | Unregistered CommenterMelodie

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.

February 23, 2010 | Unregistered CommenterElizabeth

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?

February 23, 2010 | Unregistered CommenterKatherine

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.

February 23, 2010 | Unregistered CommenterKatherine

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!

February 23, 2010 | Unregistered CommenterCindy Ambrose

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.

February 23, 2010 | Unregistered Commentermom101

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.

February 23, 2010 | Unregistered CommenterCave Mother

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.

February 23, 2010 | Unregistered CommenterOlivia

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.

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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 "http://www.phdinparenting.com/2009/09/14/are-we-asking-the-wrong-people-to-comply-with-the-international-code-of-marketing-of-breast-milk-substitutes/" rel="nofollow">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.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered Commenterzchamu

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

February 23, 2010 | Unregistered CommenterMarsha Walker

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.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered CommenterOlivia

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.

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

Michelle:

The document refers to "teats", which includes pacifiers and any other type of artificial nipple.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered CommenterSharon

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 http://www.infactcanada.ca/whatsnew/nestle-sponsors-conf-sept-2009.html" rel="nofollow">INFACT Canada's Action Alert.

February 23, 2010 | Unregistered Commenterphdinparenting

Sorry! I should have replied here but posted a separate comment. My response is below.

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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.

February 23, 2010 | Unregistered CommenterBettina at Best for Babes

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!

February 23, 2010 | Unregistered CommenterBettina at Best for Babes

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 http://www.phdinparenting.com/2009/09/14/are-we-asking-the-wrong-people-to-comply-with-the-international-code-of-marketing-of-breast-milk-substitutes/" rel="nofollow">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 http://www.phdinparenting.com/2009/10/02/blogher-listens-and-acts-check-out-my-who-international-code-compliant-ads/" rel="nofollow">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.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered Commentermom101

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.

February 23, 2010 | Unregistered Commenterphdinparenting

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.

February 23, 2010 | Unregistered CommenterKayris

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.

February 23, 2010 | Unregistered Commenterphdinparenting

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?

February 23, 2010 | Unregistered CommenterBettina at Best for Babes

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.

February 23, 2010 | Unregistered CommenterBettina at Best for Babes

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?

February 23, 2010 | Unregistered CommenterSharon

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?

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.

February 23, 2010 | Unregistered CommenterKayris

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.

February 23, 2010 | Unregistered CommenterOlivia

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.

February 23, 2010 | Unregistered Commenterphdinparenting

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

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

This is where support for the Baby Friendly and Mother Friendly Hospital Initiatives comes in!

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

Really important points highlighted here about how the marketing of formula feeding plays into the abysmal maternity leave policies in this country!

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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.

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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.

February 23, 2010 | Unregistered CommenterKayris

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.

February 23, 2010 | Unregistered CommenterKayris

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.

February 23, 2010 | Unregistered CommenterGappy

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.

February 23, 2010 | Unregistered CommenterAmy (@HappyMomAmy)

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.

February 23, 2010 | Unregistered CommenterSharon

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.

February 23, 2010 | Unregistered CommenterOlivia

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.

February 23, 2010 | Unregistered CommenterFearless Formula Feeder

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