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Sunday
Nov202011

Infant formula advertising DOES influence mothers 

Advertising is a tricky subject. People claim it is necessary to inform us about the choices we have as consumers. People say that putting restrictions on it goes against the principles of free speech. People claim that we are smart and we can see past the the marketing spin. To say otherwise, is to call people stupid.

Because, c'mon, who really believed that Nutella was a part of a nutritious breakfast? You didn't, did you? We're all smart enough to see past that and read the labels. So the mom who did believe it, she must be the one who is stupid. Smart people don't fall for ads. So despite the German courts  ruling that Nutella's nutrition claims are misleading, the problem isn't so much with the manipulative ads, but with stupid people who believe them. If we could get rid stupid people, manipulative ads would totally be okay.

The advertisers are smart though. They know that ads work. They know that either smart people do fall for ads often enough or that there are enough stupid people out there to make them worthwhile. They don't need a study to prove that. They have years and years of first hand experience. They know that everyone has moments of weakness and gaps in knowledge and they know that those are opportunities to influence.

But some people may need a study to convince them of this. Some people believe that formula ads don't influence a woman's choice of how to feed her baby. The ads simply inform mothers who have chosen formula about the products that are available. That might, arguably, be useful to some women if the claims made by formula companies were accurate (but the Canadian government says they are not).  But that isn't the extent of the problem. You see, formula ads do actually influence how a mother chooses to feed her baby.

A study by six researchers from the World Health Organization, that was published in the Social Science and Medicine Journal, found that both formula ads and doctors suggestions to use formula did influence mothers feeding choices:

According to their findings, 59.1 percent of the mothers recalled an infant formula advertisement message and one-sixth reported a doctor recommended using formula. Those who recalled an ad message were twice as likely to feed their babies infant formula, while whose advised by a doctor where four times as likely to do so.


Twice as likely. Yes, moms who saw a formula ad were twice as likely to feed their babies formula. And with regards to the doctors, when Dr. Brian Goldman, host of White Coat, Black Art on CBC Radio 1, suggested that more doctors need to tell moms to try formula, I responded over at Best for Babes with a post called Is "Try Formula" the Answer to Breastfeeding Guilt, where I concluded that:

There is a big gaping hole between “Thou Shalt Breastfeed” and “Try Formula”. The gaping hole needs to be filled with affordable, accessible, quality breastfeeding support. Instead, that hole is too frequently filled with pressure and guilt, from society and from within.

I don’t think that mothers need to be told that they must breastfeed and I also don’t think that mothers need to be told that they must try formula. What would happen if, instead of feeling the need to TELL mothers what to, health professionals simply asked: “How can I support you in your feeding decision?” From there, the conversation needs to combine compassion and knowledge, supporting the mother while also answering her questions and educating her without judgement or pressure.


Back to the formula ads. Yes, infant formula ads on articles and websites about infant feeding bother me. Not because I think women are stupid, but because I know that humans are human. They are vulnerable and emotional and get drawn into things that are shiny and pretty and helpful and easy and supposedly good for us. I know this because I am human too and while I resisted the allure of formula ads, there are other ads that do draw me in and cause me to make purchases that I wish I hadn't . But maybe I'm just weak or stupid.

So for the weak or stupid people out there (or for the humans), I would support a legislated ban of infant formula advertising as recommended by the World Health Organization. But in the absence of a law, I would also support publishers and broadcasters who are willing to take a stand and not allow infant formula advertising or, at the very least, not allow infant formula advertising on websites and publications that are aimed specifically at the mothers of babies. Not because formula is evil, but because moms who have chosen to breastfeed deserve a fighting chance and shouldn't be bombarded with booby traps every time they turn around.

Image credit: M J M on flickr

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Reader Comments (63)

amen sister!

November 20, 2011 | Unregistered CommenterKelli

I think banning advertising for formula is a bit harsh. I don't know why there isn't more advertising for breastfeeding products to even the field though - pads, pumps, salve etc. Where are the ads for those items? I wonder if we would see an increase of nursing mothers if there were ads for the other side?

As a side note - the only advertising Nutella needs, is to say: 'it tastes like nutella.' SOLD.

November 20, 2011 | Unregistered CommenterHeather @ Eclectic Six

well said, and well linked! love that photo..Maybe if i win the lottery I'll run a whole bunch of breastfeeding ads...TV, Billboards, magazines...i can dream.

November 20, 2011 | Unregistered Commentermelia

The field can never be "evened". First, because of the sheer volumes of money required to "even" it. Formula advertising is just big, big, big bucks. Second, because pump companies, salve companies and pad companies aren't really in the business of selling breastfeeding, a lot of what they do actually undermines breastfeeding. These products often convey the message that you can't breastfeed without them: It goes something like this...breastfeeding is so difficult women can't possibly do it without (insert product name). Breastfeeding by its nature often works best without the middlemen. And third--this is the most important point-- it's because breastfeeding isn't like any other product. With other products, if you decide you don't like your choice, you can simply switch back to the other brand that you liked. If you decide to use formula, and later you think, whoops, this is not for me, it is much much much harder (for many mothers and babies, it's nigh on impossible) to switch back to breastfeeding.

November 21, 2011 | Unregistered CommenterAlison

Totally against advertisers outright lying or misleading, but they can get you anyway by following all the rules because they know more psychology . Whatever rule, besides just totally banning the product (basically what you're saying), will still allow them to "get you". At least it'll be more difficult and they'll get you less. Buyer does need to educate themselves somewhat, and that might be where the government and public service messages like you come in.

November 21, 2011 | Unregistered CommenterAlex | Perfecting Dad

There definitely have to be more restrictions on formula advertising. I'd like to see no advertising of it at all, but that is hardly likely. At the very least, it should be treated in the same vein as all medications that are advertised with the required disclosure of the risks involved in using it. Period. Formula is not just any old product or food choice - it's use can have serious health implications for both the mother and the baby over their lifetimes.

And many doctors really do need to have education and skill honing on how to phrase what they say when a mother is experiencing difficulties breastfeeding or if any medical situation comes up. I find it so frustrating when I am counseling a breastfeeding mother and I hear some of the misinformation and lack of support that comes from some medical professionals. Some times it's truly shocking and outrageous. A lot of people don't question what their doctor says and just blindly follow their advice with some sad results. I think most doctors mean well, they just don't realize the full impact and implication of what their words will result in. The medical profession overall needs to seriously look at how they are training doctors who have great influence in the lives of families. Their actions or lack of actions can have far reaching effects. They are seriously lacking in the breastfeeding department.

November 21, 2011 | Unregistered CommenterSusan

Unfortunately, the majority of the companies selling "breastfeeding" products also break the WHO code, and do so at the expense of breastfeeding (rather than in support of it).

November 21, 2011 | Unregistered CommenterJem

I don't think choosing to use formula is the same as falling prey to buying some pretty, shiny thing on impulse, like you said you did and we all do. Using formula is much more than that. It is a full on lifestyle, and a lifestyle essential of pathology. You can't make milk, it's a physical problem. You won't breastfeed, it's a mental problem. I also think the idea of "trying" formula is dangerous. If you're not diabetic, you don't "try" insulin injections and see if you like that better than your own body making it. Using formula at all undermines breastfeeding. In my view you either breastfeed or you formula feed. People who supplement and still somehow manage to breastfeed much be incredibly lucky, are lying, or don't really breastfeed that long. The message needs to be that breastfeeding is the normal, healthy thing to do and formula is a "medicine" or an answer to a pathology. It is wonderful that we have it in modern times for those women who really, truly cannot make milk, but formula would most accurately be considered a "prosthetic" or stand in. As far as the question of advertising, I don't even know what to say. It's a "free market" so companies can advertise as they wish within the boundaries of FDA/FTC regs. And there are no "breastfeeding" companies just like we don't see ads really for tomatoes or apples...maybe there are "fresh vegetable councils" that have small scale campaigns....but you see where I am going with this...I don't know what the answer is. To me, I didn't know much about the breast/formula thing til I took childbirth classes. My assumption was that I would breastfeed because that's what mammals do. Perhaps those who don't just get what they deserve, if they are so warped?

November 21, 2011 | Unregistered CommenterMrs Rochester

I'm not sure how I feel about banning advertising. I think it would be much, much better to push back against formula (which is a healthy alternative) with pro-breastfeeding support. I would be totally for banning formula companies from paying hospitals to hand out formula when new mothers are discharged. That's taking advantage of mothers when they are at their most vulnerable. My doctor knew I was nursing, and she supported that. The hospital had 24-hour LLL reps to help. When I was discharged, my doctor gave me a "new mom" gift package, which was mostly formula. She told me they had to do it, and to donate it when I got home (which I did). The problem is that new moms have no idea what they're doing that first week. Is the baby getting enough food? It's easy to fall back on formula when it's in your house!

November 21, 2011 | Unregistered CommenterNo Drama Mama

Formula should face the same advertising resrictions as perscription drugs. ( not sure if it should require a prescription- that's another question) . Perscription drugs, like formula, are legitimate, sometimes life-saving products but we still restrict their advertising because of the potential harm from uninformed use. Why not formula too?

November 21, 2011 | Unregistered CommenterAurora

I think perhaps formula should be an Rx item only for people who can't make milk. But we'd have to come a LOOOOONG way in the area of BFing education before we did this because there are lots of people who THINK they can't make milk or make enough and its just because nobody knows what they're doing, right down to the docs.

November 21, 2011 | Unregistered CommenterMrs Rochester

I'm not going to get into a long discussion about this, but http://www.phdinparenting.com/2009/05/14/when-it-is-not-breast/" rel="nofollow">I do understand why some women opt not to breastfeed. It doesn't mean that they are warped or that they "get what they deserve".

I do think, in a lot of ways, that trying formula is like falling prey to buying some pretty, shiny thing on impulse. I think most moms who make the decision to try formula do so out of desperation when they are frustrated with the way things are going and formula seems like a bottled solution to that frustration.

November 21, 2011 | Unregistered Commenterphdinparenting

I'm not saying ban the product, I'm saying ban promotion of it. It should be available to those who want/need it, but it doesn't need to be pushed in people's faces constantly.

November 21, 2011 | Unregistered Commenterphdinparenting

Yes, that is true too.

November 21, 2011 | Unregistered Commenterphdinparenting

There are ads for breastfeeding items on places like my blog. Some of the bigger companies (the Medelas of the world) can afford to advertise on larger networks too, but most of the companies providing breastfeeding products and especially the ones truly supporting breastfeeding, do not have the budget to be on the Babble, Babyzone and Parents.com's of the world.

The other thing to keep in mind is that breastfeeding products are mostly "nice to have", not essentials. So I still don't think advertising those products would even the field. I think we need more promotion of breastfeeding support (maybe groups of IBCLCs banding together to advertise their services or the government promoting any free breastfeeding support it offers). I have supported LLL and Best for Babes campaigns financially in the past and hope to in the future too. The problem is that they don't make a profit and therefore don't have big ad budgets.

Re: Nutella -- I agree, but that won't get parents to lather it on their kids' toast for breakfast each morning. :)

November 21, 2011 | Unregistered Commenterphdinparenting

Totally agree with this. If advertising didn't work on the average consumer, companies wouldn't pay for it. I'd love to see formula advertising banned, but since that probably won't happen in my lifetime I'll settle for no formula ads or samples in hospitals and medical clinics.

November 21, 2011 | Unregistered CommenterOlivia

"They had to do it"? Seriously?

There's a good Martin Luther King Jr quote about how the well-meaning adversary is a lot harder to take on than the downright hostile one, since you can face the hostile one head-on.

I can see how a "breastfeeding supportive" doctor who gives you a bag full of formula when you're having no problems and have clearly expressed your desire to breastfeed is more harmful than the downright hostile hospital -- you'd just ignore the pro-formula bag-o-formula if it came from someone you knew didn't want you to succeed in your breastfeeding goals (whatever those may be), but since it came from such a nice, well-meaning person, well, they wouldn't have given it to you without a reason, right?

November 21, 2011 | Unregistered Commentercrystal_b

I think that getting rid of samples is probably the biggest priority, but I would love to see the ads disappear as well, especially on websites that are aimed at mothers of babies.

November 21, 2011 | Unregistered Commenterphdinparenting

When is a "bottled solution" the answer to anything? Really, now............

November 21, 2011 | Unregistered CommenterMrs Rochester

There are plenty of scenarios when the "bottled solution" is warranted and neccesary. I could list them here, but I'm sure it's pointless to try and have a reasonable discussion with a troll.

November 21, 2011 | Unregistered CommenterK

There's also the issue that doctors who remain neutral on feeding choices don't help breastfeeding rates either. They think they are being nice by not "pushing" breastfeeding, but then mothers get the samples and see all the advertising and listen to their best friend/mother-in-law/cousin and without their doctor telling them breastfeeding is preferred they get the message that formula is just as good.

November 21, 2011 | Unregistered CommenterOlivia

As a public health IBCLC, I have seen more than one mom tell me it's ok that breastfeeding "didn't work out," because she's giving her baby "the formula that's just like breastmilk." Clearly these moms want to breastfeed; clearly formula advertising influences their decision to use fomrula.

November 21, 2011 | Unregistered Commenteramy

Wow.

November 21, 2011 | Unregistered Commenterphdinparenting

I so disagree with this. I am pro choice on this issue and I don't think ads diminish anyone's ability to think for themselves. Worrying about the ads promoting formula is akin to worrying that condoms in schools promote sex. Oops. Guess we won't agree on that either. Formula is not Oxycontin and any suggestion that it be treated that way is a slap in the face to millions of women!

November 21, 2011 | Unregistered CommenterChantal

That seems simplistic as a correlation. There are a lot of reasons that go into a mother's decision to formula feed.

November 21, 2011 | Unregistered CommenterChantal

I won't attempt to speak for Mrs Rochester (that wouldn't work out very well!), but I don't have any problem with teaching about condoms in schools. I think that is a good thing. Even if a study found out that teens who were exposed to information about condoms were twice as likely to have sex, I would say "so what?". Were they having safe sex? Because 40 teens having safe sex is better to me than 20 teens having unsafe sex. But that doesn't really have anything to do with infant formula (unless they were having unsafe sex, in which case it might have a lot to do with it 9 months later!).

November 21, 2011 | Unregistered Commenterphdinparenting

Being a new mom is confusing and if someone's going to tell you how to do it, it often seems easier that way, even if wrong info is being dispensed. I have a 6 month old who is EBF but had a similac 'breastfeeding helpline' advertisement magnet on my fridge when she was born because I didn't know what breastfeeding problems we might encounter and they were the ones 'offering' to help. We do have a local LLL, who's meetings I've attended since baby was born, but before it seemed they might have some unknown protocol to follow to get help, whereas formula sends their message straight to your door with a toll-free 'helpline'. I have a PhD in a biology field so not uneducated and I still put the similac helpline on my fridge. I still have all my free formula samples in our cabinet, which we never had to use. I actually still don't mind having the access to samples, I was more disappointed in the lack of such easy access to breastfeeding info.

November 21, 2011 | Unregistered CommenterBeth

Hmm Beth, what gave you the idea that LLL had 'some unknown protocol' to get help? Just wondering, to make sure our local LLL doesn't somehow give that (incorrect!) message. It's fairly easy to find an online Helpform via the LLLI website, anywhere in the world, and you can click through to get local group information and national LLL Helpline numbers on www.llli.org. Glad you found your local group anyway!

November 21, 2011 | Unregistered CommenterRachel

I just gave birth to my first baby in September and we had a ROCKY road of breastfeeding. I mean, every single thing that could go wrong did. Now, I'm a CLE and so I knew how important that relationship was for the long term, so despite the outrageaous amount of pain I was in, I breastfed my son on cue for six weeks before I got serious help and things evend out. It wasnt until eight weeks PP that I was able to nurse my baby pain free.

I had a pediatrician mention formula, and my aunt (who is nothing but supportive of me) also mention that I should consider letting daddy giving a bottle so I could get some sleep. Actually, My mother, sister, and friends said the same thing. Instead of making me feel like I could absolve myself of this difficult and painful duty, it made me feel like I was a failure, an everyone could see it but me. I already felt like I failed at birthing my son (something I bleive a lot of women deal with), and here I was, trying to hard and sacrificing myself for the good of my baby, and the people I loved were making me feel like I was doing the wrong thing.

To his credit, my husband never ONCE said we should just give him a bottle, in fact, he would look me in he eyes when I was feeling too anxious or too weak to feed the baby, and he would say "Only you can feed our baby, he needs you, I will hold your hand, but you need to do this". Incidentally, that was exactly what I needed to hear every time.

I held out until sixe weeks when I knew the nipple preference danger period had passed, and I went on a 5 day nipple rest and pumped exclusively...there was no way around it, I had massive open wounds that would not heal under wet conditions. Durin that 5 days I was the only one who fed him, even though it was with a bottle, because I knew that he needed that for ME at that point.

Birth has been undermined by (often well meaning) people pushing what is 'easy'...pain meds, etc. just as breastfeeding has (bottles are easier...get some sleep...etc), but we have not paid attention as a society to the effect this has on the women who are going through this process. Our power is subverted in so many ways, and these two are the most damaging, I believe. To fail at birth (not because we are weak, but because we are unsupported), and then to fail at breastfeeding...the two most basic powerful things we women do, it's devastating. I made it, but I understand why others do not.

And as a side note, we in he breastfeeding community ned to stop towing this "if it hurts you are doing something wrong" crap...most likely it's going to hurt to begin with, just like sex did the first few times you did that (yeah yeah, sexualizing breasts, yadda yadda...the point is they are two natural biological functions that take practice). What we need to say is "I will be there for you when it is hard, and I promise it will get easy".

Artificial baby milk ads infuriated me before I gave birth, they make me physically sick now. I'm in the US though, and pharmaceutical ads are everywhere, we advertise medicine as though people can diagnose themselves. Let's be real here, ABM is a medication that is necessary sometimes...too bad our doctors have no idea when those times really are.

November 21, 2011 | Unregistered CommenterChelsea

Formula advertising must be wildly successful for the companies, or else they could not afford to give away SO MUCH free product. Its success must mean that the advertising is working in swaying women to formula feed instead of breastfeeding.

As for breastfeeding product ads undermining breastfeeding, well, I don't judge it as harshly because I am a working mom who does extended breastfeeding. So yes, a pump is absolutely necessary for women like me. A pump will save other working mothers from switching to formula at the end of maternity leave, which happens ALL THE TIME. I'd actually like to see more ads geared at working women who breastfeed, ads that suggest it is very do-able. I don't think most of the breastfeeding products are so complicated that they give the impression it's too hard to breastfeed. A pillow? Some pads for the bra? I'd agree that the nursing covers are a bit much, since they promote embarrassment over nursing in public.

November 22, 2011 | Unregistered CommenterKatie

And hey, I see an ad on this very page showing a happy mom pumping hands-free while on the phone in front of her laptop. Ask and ye shall receive!

November 22, 2011 | Unregistered CommenterKatie

[...] In my view you either breastfeed or you formula feed. … … Read the original here: Infant formula advertising DOES influence mothers — PhD in … ← Breastfeeding Products and Tips Part 3-Cleaning Parts on the Go and [...]

I didn't know our town had a local LLL for most of my pregnancy and honestly before I was pregnant LLL wasn't something that ever crossed my mind as a resource. Someone gifted me a LLL breastfeeding book and that's what made me look up to see if there were any meetings. The site I got to for our local LLL chapter hadn't been updated in 2 years so I wasn't confident that the information was correct. There was a phone number but again I had no idea what that number was to, a person's cell phone, an office, a doctor's office, not even working anymore for all I knew. I then saw a flyer when I went to a drs appointment, never noticed it before but I couldn't make the 2 meetings a month time while I was pregnant. So I had a phone number to an unknown place and meetings I couldn't go to. I had no idea there is a national LLL hellpline until you just posted it and I have their breastfeeding book and have gone to several meetings now. LLL may be on the tip of everyone's tongue in the breastfeeding community but it's still not mainstream enough, at least where I'm from, to be thought of as a resource, and then if you do think of them as a resource finding out what's the appropriate way to reach them is more difficult then just having the phone number be mailed to you on a magnet.

November 22, 2011 | Unregistered CommenterBeth

I guess this is another plus for not having broadcast/cable TV access at the house. I did end up using formula to supplement for the first 15 weeks (bad advice from pediatrician plus telling me if I did not use formula to clear up jaundice he would have Claudia admitted). I knew formula existed and they are more or less the same (thus the name "formula"). I first used the samples mailed to me by one of the companies and continued using that product for those 15 weeks. No one had to tell me that formula existed, everyone knows that it is there and the pediatrician told me to use it or else.

November 22, 2011 | Unregistered CommenterFlautaMom

Those free samples are a form of advertising. The company hopes that once a person uses that sample, they will continue buying their brand because of familiarity. Which is why the give the samples and don't just stop at print or tv ads.

November 22, 2011 | Unregistered CommenterOlivia

When I was still having lots of trouble breastfeeding my first son about 6 weeks after his birth (bad latch, bad thrush), I opened my front door to find a package with three big cans of formula inside it! I think it was Enfamil? It felt to me like a giant sabotage attempt because of where I was emotionally and physically with breastfeeding. I ended up donating the formula to charity and continuing to breastfeed, but it really bothered me and could have been the beginning of the end if I had decided to supplement to "give myself a break."

I also remember getting coupons and a booklet from the company that Brooke Shields used to promote. The book was superficially pro-breastfeeding but had a little table showing how you could gradually swap certain nursing sessions for formula bottles (red dot for breastfeeding session converted to blue dot for bottle of formula) so that you could go back to work and bottlefeed formula during the day. Of course, there was no mention of how your milk supply would probably tank if you did that, and you would probably end up exclusively formula feeding within a month.

November 22, 2011 | Unregistered CommenterKatie

I agree that the ingredients are mostly the same. There are some minor variations and some that include horrible stuff (HFCS) that isn't in others, but for the most part which brand you choose isn't a big deal (unless your infant reacts to one). If I did have to use formula, I would probably choose one more on the company's ethics than on any hyped up claim they were making on their packaging.

November 22, 2011 | Unregistered Commenterphdinparenting

Yes there is. :) There is also one for nursing wear.

November 22, 2011 | Unregistered Commenterphdinparenting

Not to undermine the opposition to advertising (I'd just as soon we did away with advertising for formula *and* prescription drugs *and* iphones too, while we're at it), but that study does not show what you said it showed.
It's based on recall. It stands to reason that you are more likely to *try* to remember an ad for a product you already have interest in buying. The very ubiquity of the ads is what makes it hard to believe very many women were actually not exposed to any infant formula ads. So if everybody sees them, and women who *recall* seeing them are twice as likely to use formula than those who don't recall seeing them, that tells us... not very much.

I agree with the logic the *formula* companies (and drug companies, and iPhone companies, ect.) all think advertising will work, so I strongly suspect there's a good deal to it. I wouldn't be at all surprised if formula advertising *did* make a woman twice (or even more) likely to formula feed. But the study as you've described it does not do that.

As a side note- it's very possible to supplement extensively and continue to breastfeed, at least for some people. And many (albeit not all) of the benefits of breastfeeding are not at all invalidated by having some formula. Making it more "all or nothing" than it really is puts undue stress on women.

November 22, 2011 | Unregistered Commenterbecca

That ad is fantastic! I wish that there were more like it but sadly I am positive there would be a revolt over it...which is just so frickin sad.

November 22, 2011 | Unregistered CommenterJen

I remember a few times when I was still trying to figure out breastfeeding with my firstborn, and being tempted to throw in the towel and go with formula. When you're in pain every time your baby latches, when you're exhausted from lack of sleep, when you feel trapped because you can't be away from your baby for longer than 2 hours because he needs to feed that often... yes, that bottled solution looks MIGHTY tempting.

In a rational state of mind, and with the knowledge and foresight to see that the early days are temporary, yes obviously breastfeeding is often easier (at least for those of us with the luxury of staying home with our babies). But in those moments of frustration, sleep deprivation, exhaustion, things are not nearly that clear, and bottlefeeding often looks like a much, much easier and simpler way to go.

(btw- I went on to breastfeed my first baby for 14 months, and am still breastfeeding my second child who is 11 months old. I did not fall prey to formula after all... in large part thanks to my very supportive husband)

November 22, 2011 | Unregistered CommenterMarcy

I had a similar experience when looking for LLL information once. The information that I found about who to contact or how to contact that person was not crystal clear. (I'm not completely remembering what gaps there were, but I remember the feeling I had.) It was all rather nebulous, and it didn't inspire enough confidence in me to actually pick up the phone.

November 22, 2011 | Unregistered CommenterNatalie

I'm one of the authors of the article that you quoted ("Does unimpeded marketing..."). I'm impressed with the balanced comments and feel compelled to write.

I have been involved in the field for about a decade and have been a supportive dad and a main reason my son was breastfed without any formula. I work extensively in poor areas. I repeatedly find women from poor families using formula (in circumstances where the water consumed I would not want to wash my clothes let alone drink). The ones that don't, wish they did. Why is this? Lets start with the assumption that people want what is best for them and their families. And lets not blame them for their decisions.

1) Formula represents perceptions of better lives, better development. Their models, the more educated, the more rich, the famous actresses, use formula. They want to be like their models. The ads propagate this idea that formula = a better future.

2) Misconception that formula is a good alternative. People generally will dryly say they know breastfeeding is best, but under their breath, formula is almost as good. It shocks health workers and community members alike when I tell them that formula feeding increases risk of death 6 times in the first two months. This is 2 - 3 times more dangerous than cigarette smoking to adults. The risk remains in the second year of life. The US estimates they could save US$ 13 billion from health care costs if breastfeeding rates were to rise. If there was truth in advertising, they would have to say in rich countries and poor countries alike, use of this product increases the risk of illness and death many times and your out of pocket costs to pay for the illnesses.

3) The world's greatest breastfeeding myth: not enough milk. This has been found in virtually every Demographic and Health Survey done. I encounter it virtually every day. There are several reasons I encounter why Not Enough Milk.

First, a lack of understanding that the stomach of the newborn is tiny, the size of a thumbnail. A few drops of collostrum is all it takes to fill it. My PhD wife panicked when my son let go of the breast and went to sleep. She was convinced he did not get enough. No amount of pediatric clinical work prepared me to deal with her. Eventually I asked her if she wanted to awaken him. Fortunately, she was too tired and happy he had gone to sleep.

Second, addition of pre-lacteal feeds, i.e., formula or other things given before the first breastfeed. This dramatically decreases the likelihood of exclusive breastfeeding. Health workers receive incentives to give their favorite flavor of formula.

Third, addition of formula. As our study showed, addition of formula increases the risk of breastfeeding cessation 6 times. You saw in our article a doctor recommendation increased 4 times the likelihood of mothers using formula. Doctors would not do this if there was no incentive.

Fourth, hospital practices that interfere with breastfeeding. These include routine and unnecessary suctioning of the mouth and nose at birth; not-maintaining the baby in skin-to-skin contact immediately after drying; early bathing; separation of the baby from the mother prior to a breastfeed; and inappropriately forcing a baby to breastfeed before feeding cues occur. The consequence is that when babies are ready to breastfeed, they are not given the opportunity, and formula often follows.

In studies in Ghana and Ecuador, all of 10,000 mothers were able to breastfeed. Mothers in both countries had high malnutrition rates. Thus, virtually every mother has the physiologic capacity to breastfeed. We need to relearn how to value it and support it; but avoid the caustic discussion that often surrounds it. Advertising, however factual, impedes this.

One last point, the amount spent on formula advertising in Philippines was nearly that of the entire health departments budget. There is no way to compete on a level field.

November 26, 2011 | Unregistered CommenterAuthor

You're right about recall. We probably did not develop well enough in the abstract that the focus group discussions backed the finding that the advertisements were effective. They made women desirous of using formula. I should mention, this was in Philippines. I can't say how it would apply in US.

About mixing breastfeeding and formula feeding, it has intermediate risks compared with formula only (highest) and exclusive breastfeeding (lowest). I'm not sure how many would accept a doubling or tripling of risk of death of <2 month old infants compared to exclusively breastfed ones. This relation holds in industrialized and poor countries alike.

November 26, 2011 | Unregistered CommenterAuthor

"In studies in Ghana and Ecuador, all of 10,000 mothers were able to breastfeed. Mothers in both countries had high malnutrition rates. Thus, virtually every mother has the physiologic capacity to breastfeed. We need to relearn how to value it and support it; but avoid the caustic discussion that often surrounds it. Advertising, however factual, impedes this."

"One last point, the amount spent on formula advertising in Philippines was nearly that of the entire health departments budget. There is no way to compete on a level field."

These two statements are staggering. The fact that ALL women in the group could breastfeed is amazing and inspires hope but to imagine advertising budgets are higher than a countries health department budget is so disheartening....and people think that advertising doesn't work .

November 26, 2011 | Unregistered CommenterHelen Marshall

I am so glad I read this and the comments following.

To be honest, I never even "considered" formula and am not easily influenced by advertising on a whole. Guess I'm not one of the stupid ones? However, I was told by a friend that breastfeeding was going to be "two weeks of hell" and then it's all good. Whether it was or not, I liked that someone gave me their honest opinion and I was prepared. My daughter was severely jaundiced and we spent 10 days in the hospital. Had I not had this two weeks in my head....well who knows. It was a tough road. In the end I nursed both my girls for over a year and am so glad I did.

I Have always been a HUGE believer in choice. It's your baby - feed it however you feel comfortable, necessary etc. However, I never even thought of the lack of breastfeeding advertising and support not giving a fair playing field. It's so pathetic and disgusting, I can't believe I didn't see it before.

This is such a powerful message and I love your suggestion that doctors should say "how can I support you in your feeding decision.." It's so simple.

November 26, 2011 | Unregistered CommenterSamantha Montpetit-Huynh

I read an article recently that featured a starving three-month-old in Africa who fortunately survived with nine months of intensive medical care. I was quick not to jump to conclusions- the mother looked not so well-nourished herself and she could have had other legitimate breastfeeding problems but my gut said that she was duped into using formula and then couldn't afford it. The article reiterated that people there need food and water but a three-month-old doesn't need food and water! I can't imagine how much it cost to save that baby's life and it makes me sick that the burden falls on governments and charitable organizations while formula companies are turning a profit.

November 26, 2011 | Unregistered CommenterManchan

Personally, I think formula needs to be accessible. But not promoted nearly as much as it is. Having the back up option of formula should my breastfeeding not have been sufficient for my children was a massive stress-relief. I did use some formula with both my children, yes, but primarily breastfed them. When issues arose and both my children needed formula when they were less than a day old I was okay with it. Once the hospital stay for me ended and I was able to go home, we worked more on the breastfeeding and it worked out. When I had later to make the decision for the best of my family of either formula for my son and anti depressants for me, or breastfeeding for both of us and the overall decline of family life and managing every day, I chose the formula and anti depressants (which were yes, truly needed. It's years later and I have had to switch them but I am still on them and everyday life is much more manageable for me). I wish I could have breastfed him for longer (hey, we did make it to 6 months of breastfeeding and then up to nine with a combo of formula/weaning him so I could take a more suitable anti depressant that was not breastfeeding friendly) but what was best for my whole family came over the needs of my son and me.
The high cost of formula alone should discourage people from using it. The spit up stains that formula fed babies leave behind compared to breastfed children say something. I don't think formula is bad for our babies, but breastmilk is definitely the better option.
Kudos to all those that are able to breast feed exclusively, and to those that educate people on the benefits of breastfeeding and provide assistance to help mom's breastfeed.

November 26, 2011 | Unregistered Commenteraww

Just want to give you a round of applause for getting through that. And another one for your husband. I had a rocky start with my 1st born, got through it within the 1st 10 days and he went on to feed forever (over 4 years). I have 4 kids and have now been breastfeeding for 12 years.
I absolutely agree that baby formula advertising should be banned. Including the placement of free samples of formula and other advertising tricks in hospitals.
Michelle

November 26, 2011 | Unregistered CommenterMichelle

People who supplement and manage to still breastfeed are lucky or lying??? I am a diehard believer in nursing, however, after a complicated csection and recovery my milk supply wasn't enough. I was hard headed and refuses to supplement, as a result my son was not gaining weight after almost 2 weeks. I nursed and pumped so much my nipples were terribly sore and I was exhausted. After a talk with pediatrician I was convinced to mix breastmilk with formula to help my son gain weight. Everytime i used formula I cried and felt terrible...but it was obvious my son was thriving more. Now after sticking to nursing, pumping, drinking tons of water, taking supplements and reading everything I could get my hands on, my son is no longer on formula. Not because I am lucky or am lying but because I worked my butt off and remain dedicated. Never in a million years did I think I would have to use formula but you never know what circumstances you will be faced with. Let's consider that before we judge each other. By the way, csection wasn't my choice either...

November 26, 2011 | Unregistered CommenterTeri

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