When Natural Disasters Strike, Breastfeeding Matters

Earthquakes, floods, tornadoes, fires. Recent years have seen their share of natural disasters and emergencies which will only continue to occur with the passing of time. Even now, a State of Emergency has been declared for Hurricane Matthew, and heightened seismic activity at the Salton Sea has prompted scientists to warn of the elevated risk for “The Big One” at San Andreas fault.

Disasters and emergencies, while incredibly devastating, invoke a sense of camaraderie as people from all walks of life and differing backgrounds join together to help; to donate. While the intention is good, the protocol of infant feeding during natural disasters in particular needs dire improvement. This problem springboards from the lack of education on the importance of breastfeeding as a whole.

Residents wait in line at the Superdome for shelter
during Hurricane Katrina. Image source: chron.com

Major health and aid agencies have come to a general consensus on how infant feeding issues should be addressed during disasters. They agree that the use of formula should only occur when mothers have weaned and relactation is not possible, or when the baby has lost its mother and wet nursing is not an option. They agree that ongoing support and assistance is necessary in such a case to limit the risks associated with artificial feeding, and that the distribution of breastmilk substitutes should be tightly controlled, carefully monitored and only provided to babies with a clear need.  

UNICEF, WHO, and the International Red Cross are active in alerting non-government organizations of the need to support breastfeeding and to be extremely careful in the distribution of breastmilk substitutes. Despite their efforts, and despite these guidelines, infant formula and bottles continue to be distributed unnecessarily during disaster situations.

During emergency situations, the cleanest, safest food is human milk.

Myth: Mothers who are under stress cannot breastfeed. Fact: Mothers will continue to lactate in times of stress but will need adequate support.

Myth: If a mother is malnourished, she either cannot breastfeed or the milk she produces is poor quality. Fact: Malnourished mothers or mothers with illnesses CAN provide healthy and safe milk for their babies.

The Problem with Formula Donations During Emergencies

One of the biggest tragedies during Hurricane Katrina was that almost no breastfeeding mothers were found. One-third of Louisiana’s population was displaced, which was about 1,300,000 people, and more than 100,000 evacuees remained in shelters more than one month later.

The distribution of formula and bottles by aid workers during this time disregarded the importance of clean water and utensils to make feeding infants possible and safe, and the more time that passed, the higher the risks for infant mortality continued to climb.

According to the American Academy of Pediatrics, in any given emergency, clean drinking water and a sterile environment may be inaccessible. Even in a potentially less catastrophic emergency, such as being trapped in gridlock for several hours, access to water to make formula as well as the ability to clean and sterilize bottles or feeding utensils is not possible. Infants need to be fed every 2 to 3 hours. When disaster strikes, reality hits, and panic can ensue.

The WHO states that artificially fed babies have a 1300 percent increased risk of death from diarrhoeal disease as compared to babies that are breastfed. The WHO adds that babies who are artificially fed are inherently more vulnerable to disease because they do not receive the disease-fighting antibodies that are in breastmilk.

“In past emergencies, 12–75% of all babies have died, so any factor that increases disease transmission and reduces the ability of babies to withstand disease may well result in their death.” - World Health Organization

At the time of Hurricane Katrina, information was not readily available to support optimal infant nutrition; rescue workers were not trained in breastfeeding support and management. Overall, the distribution of formula discouraged breastfeeding, decreased mothers’ confidence, and increased the risk of infection, illness, and death.

The Clear Advantages of Breastfeeding During an Emergency Provides comfort and relieves maternal anxiety Protects against infectious diseases Readily available Nutritionally perfect Perfect temperature Fights Illness

The Disadvantages of Formula-Feeding During an Emergency It may not be readily available May become contaminated Water mixed with powdered formula may be contaminated There may be no means of refrigeration to preserve it There may be no method to sterilize feeding utensils

While some strides have been made to educate about the importance of breastfeeding during disasters, the lack of normalcy is still present in our society and more efforts should be made to instill it in mothers, aid workers, and government agencies collectively. Milksharing or local donations of expressed milk should be a mainstream option to feed infants in dire cases.

Future natural disasters are inevitable and will continue to have a devastating effect on the economy and well-being of families. Protecting, promoting, and supporting breastfeeding during these natural disasters will help prevent long-term health and developmental problems that may occur as a result of alternative feeding methods. Encouraging breastfeeding will also lessen the economic blow, as the overall cost of the disaster is significantly reduced for both the families and societies affected. It is an investment that will pay for itself in more ways than one, several times over.

Contributing author: Samantha Johnson is a freelance writer, blogger, wife, and breastfeeding mom. Her Bachelor of Arts degree in journalism from California Baptist University has led to more than six years of full-time writing experience and countless exciting opportunities. Aside from writing, her passions include drawing, painting, iced coffee, reaching her goals, balancing life's priorities, and encouraging others. You can visit her blog at unlazylike.wordpress.com.

Breasts Plan to Breastfeed--Don't Let Them Down

I think advocates have exhausted the mantra that human milk is best for human babies, but breastfeeding does not exclusively benefit baby. I believe Mom is often left out of the equation. In fact, if breastfeeding were only about the baby's nutritional needs, than perhaps someday there could be an adequate substitute--but it isn't.

Approximately sixteen weeks into pregnancy, a mom is notified via tender mammary glands, that she is, indeed, expecting. Her body is starting the preparation for future breastfeeding. An amazing, complex factory has commenced production of cells, aveoli, ductile work and Montgomery glands. There is even an increase in the pigmentation around the areola to create an obvious target for the baby once he arrives--make no mistake, the breasts are planning on breastfeeding.

Milk Synthesis explained 
http://www.thevisualmd.com/videos/result/milk_synthesis_pathway

The attention given to every detail is absolutely mind boggling. The stage is set in precise detail. The breasts have prepared for breastfeeding like an athlete prepares for the Olympics. They are focused on their one job, and poised to perform. Imagine the disappointment when they are "letdown" postpartum. They never get to realize their full potential. Who is speaking up for the rights of the ta-tas? They have painstakingly prepared for this precise moment for nine consecutive months. Not only is is disappointing, it also poses serious health risks. Just like atrophy sets in when muscles cease to do what they were designed for, abandoning breastfeeding creates serious complications as well.

What happens when breasts are told, "You're Fired!" and are not chosen to fill the primary feeding position? Well, it isn't pretty.

Following birth, Mom's uterus is in need of some serious repair. The best way to return this muscle to it's pre-pregnancy shape is to contract the muscle--a phenomenon that is executed through breastfeeding. This is the most effective way to strengthen the muscle and reduce blood loss. Moms should plan on breastfeeding for a thorough workout, after all, they cannot walk into a 24 Hour Fitness and use the "uterus machine" to tone up.

Recovery continues as the baby continues to breastfeed. Mom may experience significant weight-loss as she burns more calories breastfeeding. The benefits do not stop when baby weans, they continue for a lifetime.

It is as though Baby says, "Mom, I need you to be around a very long time. I need your lap to sit on and your hand to hold...I need your advice when I'm a teen and in my adult years...I need your hugs on birthdays and every morning...I need your kisses on my scraped knee and broken heart...I need you at my wedding and at childbirth...I need you to be the grandmother to my children; and here's how I will make that happen--breastfeed me."

If Mom chooses to breastfeed, Baby will protect her from many immediate and future ailments. Breastfeeding moms experience a reduction in breast, uterine and ovarian cancer. Breastfeeding also lowers the risk of postmenopausal osteoporosis. Breastfeeding moms profit from the hormone Oxytocin, which helps to stabilize moods.

I hope we are encouraging women to listen to their bodies and listen to their babies. They should be entitled to receive all the advantages and bonding associated with breastfeeding. I know not everyone has the opportunity or freedom to select breastfeeding and they must rely on milk donations, supplements or a combination of both. I sympathize with them and understand their plight personally, but still want to convey for those who can, that they (not only their offspring) will reap the rewards.

Order your copy of the poster above http://www.birthingandbreastfeeding.com/store.html

Breastfeeding is a relationship. A bond between Mother and Baby. A beautiful contract to support each other in health and well-being. Maybe breastfeeding and mothering isn't a thankless job after-all, maybe we just aren't making moms aware that their baby has a tremendous gift they want to give, but only by breastfeeding can it be received. Let's commit to empower moms and enable them to accept this life-giving gift.

The Slippery Slope of Supplementing

There are a few pieces of education that can prevent unnecessary supplementation of formula or unintentional weaning. One problem is that many people misinterpret baby behavior. A baby communicates various ways. He uses body language, head movements, hand gestures and crying as forms of expression. The crying stage is usually what brings on the bottle.  A baby's cry brings full attention to the situation. The cry is annoying, upsetting and a "call to action." It was designed that way. If a baby just whispered, "Hello, up there, I'm over here and I need you." More often than not, the busy, distracted people around would not be aroused to take action. Since the cry demands a response, parents begin the ritual of calming baby. If the baby does not settle right away, parents will often resort to a bottle assuming that their baby is hungry. The bottle will elicit the suck reflex, making it difficult to cry. The baby also soothes by sucking so he continues to suck for comfort which reassures the parents that baby was indeed hungry. This sucking reflex is just that--a reflex. When we go to the doctor and he checks our patellar reflex with a hammer, if our leg spontaneously jerks forward, the doctor does not exclaim, "She wants to play soccer, see, just confirmed it!" That would be ridiculous, yet we use this reasoning when deciding that a baby needed supplements.

Everyone must also learn to appreciate and respect the fact that a woman's body and baby communicate through a series of events. Baby does at times need more milk and he must communicate this. The infant will "place his order" by frequently visiting the breast. He even tells his mother's body that he is not satisfied. He fusses, grunts, pulls his head back and arches his back. This arrangement convinces the mom's body to step up production. Many professionals used to refer to these stages as "growth spurts," until it was shown that growth does not necessarily coincide with the frequent breastfeeding. More recently, the feeding frenzies are being called, "frequency days." However they are labeled, they do occur and are necessary for regulating milk supply.

The body is amazing. It does not have to store all the milk the baby needs per day or week. It creates milk made to order. If a baby needs more, he expresses his desire and the breast-feeder complies.  Herein lies the problem. If a baby is given a bottle during these moments of frustration, it communicates with the woman's body, "Never mind, seems like baby is satisfied, it was a false alarm." The mom's body has no reason to produce more. The next time baby models the same behavior, parents may respond with the same solution. The baby will often take more from the bottle and if the supplement is formula, the ingredients are more difficult to digest and this "heavy" meal may encourage baby to sleep longer. A longer nap will also communicate to Mom's body that baby doesn't eat as frequently and she doesn't need to make milk as often. Next. the mom will notice a definite decline in milk, convincing her to supplement even more. Unfortunately, this unintentional weaning happens too often. Disappointed moms feel as though they were broken and could not effectively breastfeed. They think they were starving their newborn because he appeared unsatisfied with her milk, not knowing that this protesting was the exact recipe for increasing milk supply. If moms were encouraged to trust their amazing bodies and constantly put baby to breast so he could effectively communicate his needs and that the body would respond to meet those needs, we would see women empowered rather than defeated.

The good news is that the woman's body still wants to feed and meet the needs of her baby. The situation can be reversed. Mom must put baby to breast every time baby will nuzzle, suck, cuddle or nurse from the breast. It is also a good idea to practice skin-to-skin and get oxytocin freely flowing. Without this contact, the mother's body is persuaded that the baby is getting fed elsewhere and it needs to shut down production.

If breastfeeding has stopped completely, contact an IBCLC to help with re-lactation. Lactation Consultants can also help the mother who needs to supplement by sharing ways to continue the breastfeeding relationship and instruct on how much supplementation is necessary.

Interested in becoming a Certified Lactation Educator (CLE) and sharing evidence-based education with others? Sign up for an upcoming training on the Birthing, Bonding and Breastfeeding website.

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!

Breastfeeding Moms Have a Target on Their Breasts

The national increase in breastfeeding rates has caused the formula companies to stand up and take notice.  What is great news for moms, babies and society could prove disastrous for formula companies and their stock holders--unless they can grab part of the growing market.  

Formula companies, like most thriving companies, strive to make a profit and constantly plot how to increase their earning. Some companies do this in conscionable ways while others are not so scrupulous--allowing visions of profit to cloud their judgement, they tend to concentrate on profit regardless of quality or health implications. Any assumption that these companies have the best interest of baby in mind is ludicrous. They continue to use the cheapest ingredients (corn syrup, vegetable oil, sucrose, etc) to allow for greater income--the bottom line, their loyalty is to their stock holders and wallets, which leads to many of their marketing strategies. 

The earlier a company can obtain a loyal customer the better.  Many ads and products vie for the prenatal shopper. Brand loyalty can begin with a selection of prenatal vitamins or supplements.  Many pregnant women are succumbing to the offers of registering for baby formula for baby showers and collecting coupons before they even deliver a baby.    

Formula companies previously used more passive marketing techniques such as offering free feeding advice on warm lines, suggesting formula for moms on the go, or offering quality gifts to new moms; but the days of subtleties are over.  The breastfeeding market has become too large to ignore, so "if you can't beat them, market to them." 

Formula advertisers are the kings of spin.  Moms have switched to formula after the huge marketing campaign announcing that breastfed babies need a Vitamin D supplement since breast milk does not contain the sunshine vitamin.  Of course, none of the ads reveal that breast milk was not meant to contain Vitamin D, which ideally comes from the sun. Since formula contains it, mothers began to question whether or not their milk was complete--the marketing strategy paid off, consumers were either purchasing formula containing Vitamin D or the Vitamin D supplements (manufactures by Enfamil) that state clearly on the box, "Essential for all Breastfed Infants." Of course the box top boasts, the "brand recommended by Pediatricians."

Perhaps the most disturbing trend in formula marketing occurred this month with the release of a new product directly targeting and undermining breastfeeding moms.  The May 11, 2013, release of a Similac for Supplementation confirms the company is desperately trying to increase its customer base.  This blatant attempt to sabotage the breastfeeding relationship is outrageous.  This new product states, "for breastfeeding moms who choose to introduce formula" compared to the other formulas which are only for "formula moms who choose to introduce formula?" This is a pathetic bid for the breastfeeding audience.  Unfortunately, it could just work, especially since this message is being perpetuated by a new study released two days later in Pediatrics.  The article's release date (occurring the same week this formula hit the shelves) is highly suspect.  It may seem like a conspiracy theory, but as well-equipped as the strategists are, the timing is not a coincidence and neither is the correlation between Abbott and the co-author of the study, who was previously employed by the maker of Similac.

The timing could not have been better orchestrated. It would be interesting to see if an advertisement for Similac ran in some of the major papers who posted the flawed supplementation study.

Formula companies seem to have an uncanny way of acquiring prestigious spokespeople for free. First, the doctors in the hospitals, now researchers for Pediatrics. No wonder the companies boast billions in profit annually, they have inside help.

The flawed, and poorly-constructed study published by Pediatrics sent the media on a sharing frenzy. The article made its way into nearly every large newspaper with headlines proclaiming that formula helps to breastfeed (an oxymoron exemplified).  Similac, Enfamil, and other artificial human milk companies could not have been handed a better gift. Few editors critiqued or even read the study prior to plastering the headlines across front pages.  The study, released online May 13, 2013, and published in Pediatrics, consisted of forty subjects-- an anemic sample size. The conclusion, after confirming that  15 of 19 mothers were still breastfeeding at 3 months, compared to 8 of 19 in the control group--a difference of 7 babies--was that babies given formula continue to breastfeed at higher rates. Not only was the study not supported by a clear hypothesis, the subjects were not homogeneous.

The clear conflict of interest was also document by a disclosure statement by the co-author, who "served as a paid consultant for Abbot Nutrition, Mead-Johnson, Nestle SA and Pifzer Consumer Products." Obviously, he must have a bias towards the necessity of formula to serve as a consultant for these companies. In fact, a more responsible study could have centered around supplementation with donor milk, if marketing formula was not one of the goals of this study. Pediatrics and its peer review council will surely continue to come under fire for publishing such an insult to true research. They acted in an irresponsible and unethical manner by endorsing this premature study. Although much of the damage has irreversibly been done, there are several rebuttals and informative articles being shared that are well thought out and deserve recognition   It is unfortunate indeed that newspaper editors will not be publishing any of them.  Dr. Alison Stuebe a member of Breasfeeding Medicine provides a response to the published study. Dr. Jack Newman added valuable insight to the study by posting his own commentary. 

As a service to breastfeeding mothers, and a way to expose the flawed research Birthing, Bonding and Breastfeeding conducted a survey asking mothers to respond if they were able to exclusively breastfed without formula supplementation. Within 24 hours over 340 moms confirmed their breastfeeding relationship was protected by choosing not to supplement.  Maybe from this result we could conclude that 99% women who use Facebook exclusively breastfeed. As ridiculous as this statistic is, it shows the parallel to how numbers can be manipulated and the erroneous conclusions which were drawn from the Pediatrics study.

Formula companies are missing out on a large portion of the infant-feeding market. Breastfeeding moms stay vigilant.  If you desire to breastfeed exclusively, the evidence is overwhelming in support of avoiding supplementation.  Babies are born to breastfeed and the protecting the relationship by keeping Mom and Baby together is the best practice for success.  Women who need additional support or medical advice should consult with their breastfeeding-friendly physician, Lactation Consultant and Peer Support Groups.

Editor's Note: I hope we can promote the message that moms do indeed have the milk they need when their babies are born. Products and flawed studies continue to undermine instinct and nature. We need to dispose of the idea that milk will "come in" or that mother's around day 3...engorgement does not have to happen, and if any more milk were available on day one, theoretically the baby could overfeed since all he wants to do is suck! We don't need to "wait" for anything. Just keep the dyad together and all the "issues" can resolve themselves.

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.