Attack Formula Companies--Not Formula Feeders

It's here, another way to stop breastfeeding advocates and create a wedge between breastfeeders and formula-feeders. Blogs like, "I Don't Breastfeed and It's None of Your Business" exist to stir up emotions and create conflict. The problem I see with these posts and other seemingly anti-breastfeeding rants, is that they attempt to silence breastfeeding advocates, and encourage acceptance of formula "as is." The posts almost imply "leave my formula alone!"

But, alas, the formula companies had to do something fast to protect their market shares. There is a new battle on the forefront from both breastfeeding and formula-feeding families, it is a campaign worth of bipartisan support--improve formula ingredients and demand the manufactures use higher quality products in their manufacturing and eliminate harmful ingredients (like corn syrup solids and dangerous chemicals). Some countries do not even allow corn syrup solids in their infant foods, but in the United States we have them in spades. If formula companies can move the focus off of their companies to "nosy, judgmental, holier-than-thou, breastfeeders," well, then, they win. They strive to have a product that no one will oppose--an ambition I plan to thwart.

Similac formula in the US

Formula label in Australia

Enfamil ProSobee in the US

I have NEVER attacked a formula-feeder (and for those curious, I was one), but I definitely support breastmilk, and believe moms who must supplement deserve a better option than the ones currently on the market. If we, as a society, strive to protect babies and families who need supplements, we can affect great change. I do not know of one formula-feeding mom who does not want the best for her infant, and she has chosen the only option available to her. Unfortunately, the best alternative is not good enough. Formula companies use taglines such as, "Closer than ever to breastmilk," but in reality, that can refer to the color of the fluid or a myriad of other conditions. Formula is missing many key ingredients, some of which cannot be replicated.

Let's face it, we live in a world of ever-changing technology, Purchase a new state-of-the-art phone or computer and walk out the door of the electronics store only to discover your new purchase is already being replaced by another model. Markets are consumer driven. Companies make what sells and they are constantly fighting for the market. Since we are not demanding better quality from infant foods, no one is striving to make improvements. We cannot be ignorant of the strategies formula companies use--if they can keep breastfeeding moms fighting formula-feeding moms, no one will think to fight THEM. If we demand better ingredients, formula companies lose money. If we make banked-donor milk available, formula companies lose money, if we support breastfeeding and provide support to families, formula companies lose money--follow the money.

As an IBCLC and Public Health Educator, I have asked moms the question about why they are not breastfeeding and have heard a plethora of reasons. I have heard they were having difficulty and had no help; needed to return to wok and did not have a pump; were undergoing cancer treatment, which is contraindicated to breastfeeding; were getting ridiculed by family or partner; did not want to; and many more responses. Fortunately, I asked, because in asking I was able to learn their reasons and help them overcome some of their obstacles. I was also able to find supplements that worked for them, offer education and support, or just sit with them and helped them cry. When we show compassion, empathy, sincerity and love, people understand we genuinely care.

I am convinced this entire argument is less about the asking and more about how we ask; and, to be fair, it also has something to do with how the question is received. Take time to ask, but more importantly take time to listen.

Let me paint a different scenario on how formula-feeders have used their conditions to promote breastfeeding. I have worked with or consulted for over a dozen women with cancer or going through treatments,and they are using their struggles to educate and advocate. They honestly do not mind talking about why they cannot breastfeed and why their babies deserve better options than what is currently on the market. They use their conditions as an opportunity to shed light on how limited their feeding choices are. They advocate for more breastmilk banks (like blood banks), some even share their story publicly. I personally, love that approach.

Collecting donor milk for her baby to give while undergoing iodine treatment for thyroid cancer

No one should ever feel shamed or attacked for their feeding choice, but no one should feel silenced for sharing truth either. This is not a battle among mothers, this is a battle against large conglomerates that are forcing society to accept the status quo. Be nice, share evidence-based information, and stay sensitive. Seems simple.

Teaching Breastfeeding through Simple Analogies

We have to realize how vague our breastfeeding descriptions are to those who are unfamiliar with "normal breastfeeding behavior." Statements like, "babies breastfeed often" or "expect baby to wake frequently" can be misinterpreted based on the mom's expectations and definitions of the terms. The more specific lactation educators and consultants can be, the more successful moms will be. I try to use one of the "7 Laws of the Teacher": Teach from the Known to the Unknown.

Analogies can bring education to the forefront and help new parents relate to breastfeeding in a tangible way. I have shared these analogies or "advertisements" over the past year, but thought I would gather a few of them up and share them in one blog. I hope these analogies help others to educate on breastfeeding and convey the message that breastfeeding is the standard infant feeding practice.

I often describe breastfeeding anatomy and philology with house-hold items moms are familiar with. They may not have studied pictures of Dr. Coopers's Anatomy of the Breast, or read Dr. Hartman's research on the Mammary gland, but they have handled a bottle of glue.

Different posters convey the same message.  Having a variety of presentations can help reach the visual or auditory learner.  Some people like a quick, easy-to-read visual, while others prefer more detail. Advertisers state that a message must be seen at least ten times by an individual before it is "recognized." I think many educators can relate to this statistic.  I often feel like I am saying the same thing over and over again.

Unfortunately, some moms have been told that something is "wrong" with their breasts.  It is easy to blame a vulnerable, hormonal postpartum mom for difficult latch issues.  I like to remind moms that the baby doesn't come out of the womb, look at her breasts and announce, "those aren't like the ones I've seen in magazines." Babies have no basis for comparison.  There is a huge variation of nipples across the land and this could be a problem if babies were meant to "nipple" feed, fortunately for all the nipple challenged mommies out there, babies "breast" feed. I tell moms that nipples are like snowflakes--there are no two exactly alike. 

Anatomy concerns span from nipple formation to breast size. This is an easy description of "cup" size that everyone can relate to. 

Once moms gain the confidence that they will have what it takes to breastfeed, the next obstacle is milk supply. If I had a nickle for every time I heard the statement, "your milk hasn't come in," I would be a millionaire. 

I remind mothers that even though their meals were withheld from them, the baby had a steady supply of nutrient.  I sometimes joke that if they had been at the Home Town Buffet all day, they wouldn't be hungry right away either.  I encourage them to practice skin-to-skin, nuzzling, cuddling and offering the breast; but not be be discouraged if the baby is not ferociously hungry or "crawling to the breast right away.  In fact, the Breast Crawl has been documented to take up to 90 minutes to spontaneously occur. 

I invented the Lactation Lanyards as teaching tools to help with bedside education.  Seeing a formula bottle gives the impression that the baby should consume the amount in the container.  It is empowering to show a mom an accurate size of the newborn's stomach capacity.  The Lactation Lanyards are available from the Birthing, Bonding and Breastfeeding Store. 

Once a mom understands that her body is not only capable of growing her baby, it is also capable of 

nurturing her baby, the next obstacle is often overcoming any difficulties.  Prevention is key.  The first preventative step is not giving into the recommendation to bottle feed, or offer "just one bottle."

What about the accurately diagnosed "insufficient mammary tissue" or complications from breast surgery. What are those moms to do?  We have set the options as "breast or bottle" rather than "breast AND bottle." Some is still better than none, and this analogy points to that truth. 

I have many other posters and reminders about breastfeeding and breast milk.  I am working on my 2014 analogies.  Feel free to share misconceptions that frustrate you in the lactation field.  I may be able to make a visual to correct the erroneous advice. I hope you will join me on my Facebook Page: Birthing, Bonding and Breastfeeding and share some of the evidence-based information we post with others. Some of the posters are available for framing from the BBB Store. 

Happy New Year and let's work together to tackle myths and fears in 2014!

Preface to The Truth about Infant Formula

I have been asked to share the information about formula and advertising that I presented at a recent conference concerning infant formula and how it is marketed in our Western Culture. This will undoubtedly have to be a multi-part series, so let me begin with the Preface.

Scientists, doctors, nurses, medical professionals--all agree and validate the fact that breastmilk is not only the ideal food for infants, but also that children can experience sickness and disease if it is withheld from them, yet, mothers still turn to formula as a legitimate alternative to breastmilk.  Families are targeted by an industry that spends millions of dollars annually to advertise.  They invest heavily in misleading unsuspecting audiences and unfortunately, the payoff is great. According to Companiesandmarkets.com, baby foods and infant formula market is projected to reach about US $2.3 billion by the year 2015.

There's an entire history of formula that hopefully I will be able to write about later.  But in a nutshell, formula was just that a "formula" concocted to sustain life in a moment's notice--in emergencies when a mother was unable to provide breastmilk and a wet nurse was unavailable.  It was a scientific breakthrough and an incredible contribution to the medical world.

History does not only repeat itself in regards to formula advertising...it practically mimics the tone and inflection of each word as noted in this 1920s ad.

A good history lesson written can be found at Dispelling Breastfeeding Myths

I like to compare infant formula to Total Parenteral Nutrition (TPN). TPN is nutrition given via a catheter when a person cannot tolerate food.  There are risks of infection, blood clots and other complications.  It is not ideal, but is a legitimate substitute in dire circumstances.  As useful and necessary as TPN is, a medical professional would never say, "TPN is easier than preparing food and it has all the ingredients that food has, so you can just TPN feed."

I hope my point comes across graciously.  I know there is a place for formula (artificial baby milk), but its place is not in the gut of a baby when it is not medically necessary.  There is a hierarchy of infant feeding that begins with mother's own milk, goes through the list of donor milk and finally ends with formula, but make no mistake, formula does do it's job at sustaining life, and the "formula" has improved over the years. I don't think the formula product is the real culprit in our battle to encourage breastfeeding or to educate moms, but the advertising techniques and the misleading information being promoted is what we must expose and combat.

My next posting will undoubtedly contain several photos and formula labels depicting the false advetising, but as a sample, I will demonstrate some "misleading" advertising on the new Enafamil Premium box...the side of the box boasts: "New! Natural Defense Dual Prebiotics for digestive health.  Enfamil Premium provides these three proven* benefits...

The front of the box mirrors these statements:

The discerning individual will trace the asterisk (*) and try to locate the information that expounds on the study, one must look hard to locate the additional information...kind of like "Where's Waldo"...not only is it small print, but it also lays at an unnatural angle.  People read left to right and would naturally turn their head to read the statement, but the clever (well planned) placement of the note forces the reader to turn the box upside-down to solve the puzzle...yes, this is strategic.  Also, the phrase "Natural Defense" is a trademark, it does not mean that this formula has an actual natural defense, the trademark name suggests the like, but once again it is strategic advertising. Even the packaging and labeling attempt to lure consumers.  The new packaging is a gold, metallic box with the name "Premium." posted predominately on the front. Just a glance across the supermarket shelves reveals that a savvy advertiser has this box shouting, "Pick me!"

Another aspect of advertising would be the violation of the WHO Code, once again something that needs mentioning, but would constitute another writing segment.  There is some good information already in print about the Code and how it is being violated on a regular basis by formula companies.  Jump over to the 24 page pdf of the WHO Code of Marketing of Breastmilk Substitutes to read the original Code, then dive into some of the blogs and articles showing how the Code is violated on a regular basis.

• Nestle Violations and Obesity
• The International Baby Food Action Network
• The Spectrum of WHO Code Violations
• http://www.draparrilla.com/pdf/formula_labeling-violations.pdf
• Ontario Public Health Position Paper

My favorite media clip of the Code violation was created by some of my GOO Students as a class project this year.  They used the "CSI" approach and arrested a can of formula for being in violation of the Who Code and announced that the formula was going to be put in the "can."  I had it posted on my site for awhile, but lost it over time...great concept though...someone needs to hold the companies accountable.

This part may get a little off track, but what about Fair Advertising, violations of the WHO Code and class action litigation, and the National Advertising Division's involvement with regulating advertising?  Well, STATE COURT CLASS ACTION SETTLEMENTS:  A PATTERN OF ABUSE AND A 
PROPOSED SOLUTION made the following observations and cited the lawsuit Free v. Abott Laboratories

Every year, thousands of class actions are filed in the United States – the vast majority in our state court system.  The attorneys who file these lawsuits purport to represent thousands or even  millions of allegedly injured individuals.  But too frequently, the interests of the supposedly
injured parties are not really represented at all.  Instead of pursuing the interests of their supposed clients, the attorneys strike a deal under which the money ends up in their own pockets– rather than the hands of the supposedly injured parties they claim to represent.  The result is more and more class action filings, concentrated in certain state courts, and a growing pattern of settlement abuse.

 Free v. Abbott Laboratories

 In this infant formula antitrust action, the district court concluded that the proposed settlement was neither fair, nor adequate, nor reasonable, because members of the class would receive no more than four to six dollars (a tiny fraction of the $4.3 million dollar settlement) each, while their attorneys would receive $1.5 million dollars.  

Even when these companies have to "pay the price" they pay it to the pockets of attorneys and the media rarely considers the rulings newsworthy.  Exposure of lawsuits, recalls, detrimental chemicals found in formula, bug parts discovered in powdered cans--all need exposure and media attention on a regular basis, not just as a means of promoting breastfeeding, but to scrutinize formula for mothers that trust it to nourish their young.  Accountability is always a good thing.