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.

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.

Formula Marketing Exposed

The 2010 Pediatric Products Handbook by Mead Johnson boasted of a "new" formula.  What is this brand new miracle in a can?  It's a sleep aid for children.  Well, it doesn't read exactly like that, but the actual words under "Product Features" are even more frightening.  I photographed the page, because as skeptical as I am, I would want to see it for myself and I believe my readers deserve the same consideration.
The product, Enfamil Restful "contains a rice carbohydrate that is designed to gently THICKEN IN BABY'S TUMMY."  They say it like it's a good thing!   Enfamil is marketing this product "For Bedtime Feeding."

The product claims that this is a "natural way to help keep baby feeling satisfied"...it's all there, read it...as many times as it takes to believe it.  Since when is throwing starch into a bottle "natural"?  

As you are still shaking your head, read the section about "Long-Term Usage"...yep, they say it..."it can provide a sole source of nutrition for infants UP TO AGE 6 MONTHS! Moms are being encouraged to start their newborn out on this stuff in order to make "better sleep a better possibility."  This formula is also available at local WIC agencies.  I think more counseling needs to be done during appointments concerning this product.

What problems do I see with this marketing scheme?  Where do I start?  First, we are setting moms up to think babies are supposed to sleep through the night.  Most of us know, or have heard, about the importance of brain development during the waking hours.  We should not encourage newborns to go several hours without waking right after they are born.  This is detrimental to their growth and development.

Also, formula is supposed to mimic the gold standard, which of course is human milk.  What do we know about human milk and digestion?  The proteins in breastmilk are easily digested and human milk is processed quickly--requiring regular feedings (small, frequent meals--spaced out throughout the day--is even a recommendation for children and adults).  These small, regular feedings do not require the stomach to stretch to hold an abundance of food that must be processed over a long period of time.  Formula is far-from replicating breastmilk in this instance.

This type of formula and teaching is contributing to the obesity problem in our country.  A big meal before bed and letting an infant "sleep it off" is absolutely ridiculous.  

Why do I think Mead Johnson created this formula...because moms wanted it and it would be a huge money maker.  Parents are exhausted.  They want and need sleep.  Then they hear about a company that makes a product that will "help them get better sleep..." and the geniuses in the marketing division have a slogan to get these cans flying off the shelves.

The funny thing is, this formula has been around quite awhile.  Look back at the printed page.  Let me draw your attention to the bottom of the first paragraph.  "Enfamil Restfull is the same fourmulation as Enfamil A.R."  Really, this miracle has been around?  Yes, and it was successful at helping with spit up and doctors would often recommend it for reflux...okay, so why wasn't it a best seller?  The name.  Parents may not remember what AR does and what it stands for, but "Restfull" they understand.  Sleep...that's a word they would like to have back in their vocabulary, so... "A Star is Born" a gold star...confusing parents and causing them to rely on a sleep aid for their child.  The company did not invent anything new, they re-purposed something old...gave a face lift to a can, revived a recipe with a "sleep better" slogan.

What's in this can that helps a baby sleep so well?  According to the rules of ingredients, let's just check out the first four, to see what constitutes the greatest percentage of this product:

1. Nonfat milk
2. Vegetable oil
3. Rice starch
4. Lactose

Okay, it may make an infant sleep better at night, but I sure couldn't sleep knowing I had given this to my baby.  It is crucial that we educate well-meaning parents about the marketing tactics being used on them.  Parenting is a difficult job...we lose sleep when our children are infants, when they have the flu, when it's thundering outside, when they learn to drive...parents will have some sleepless nights and sacrifice a lot more than sleep for their children, but what they get in return is priceless.

It is not my goal to target formula in general, but the deceptive marketing strategies being used on new parents.  I believe we must be informed in order to make "informed decisions."  I hope you can use this information as a teaching tool for prenatal and new moms.  I have not had a mom, nutritionist or dietitian disagree with me about my concerns once I shared this information with them...share...inform...support...

If families need additional breastfeeding help, share a link with them or encourage them to contact a Lactation Consultant.

I have some more marketing and advertising tactics I am looking forward to sharing in the near future.  Stay tuned as I reveal what I have found in my research...

Christy Jo Hendricks, IBCLC, RLC CD(DONA), CLE

www.birthingandbreastfeeding.com

I will be providing a CAPPA CLE Training in October.  Would love to have more Lactation Educators sharing this information.  Find out about the Training on my Website.

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.