The public health community is a great advocate for breastfeeding–and why not? Breastfeeding is not only the normal way mammals feed their young, it’s the ideal way, and it’s almost free.
On the other hand, some human mothers struggle with breastfeeding, sometimes because they don’t get the support they need, they have severe postpartum depression, they need to take incompatible medications, they have been sexually abused, or a whole host of other reasons. Sometimes it just doesn’t work out, and the most important thing a baby needs is loving parents. The risks associated with formula feeding are relatively slight compared to its benefits for many families. Guilt tripping women about formula feeding is shameful.
That said, companies spend about 8 billion (yes, billion) dollars per year marketing infant formula, and they also have a trade group, the International Formula Council (IFC), that does lobbying and other advocacy on behalf of manufacturers. The IFC also sets up sham maternal advocacy sites to press the idea that breastfeeding advocates want to take away the right to bottlefeed. In contrast, La Leche League International (LLL), the best-known breastfeeding advocacy group, has an annual budget of about 3.5 million. I find La Leche League’s philosophy falls into demagoguery, especially regarding gender and parenting, but that’s what the breastfeeders have. LLL is certainly a David to the Goliath IFC.
The American Public Health Association (APHA) has been a great supporter of breastfeeding, and they created a new policy statement on the topic at their 2013 annual meeting. Their press release states that their Breastfeeding Call to Action (emphasis mine):
Continues APHA’s strong support of breastfeeding and recognizes efforts to increase breastfeeding rates and narrow breastfeeding disparities as fundamental public health issues. Calls for increasing access to lactation services, especially among under-served populations, and making sure such services are properly reimbursed. Also urges restricting infant formula marketing practices that can discourage breastfeeding, promoting breastfeeding in developing nations to help decrease HIV infection rates and endorsing the breastfeeding actions outlined in the 2013 federal “Report of the Secretary’s Advisory Committee on Infant Mortality.”
The thing is, there is already a policy on formula marketing practices from the World Health Organization. It’s official title is the WHO International Code of Marketing of Breast-Milk Substitutes (the WHO Code for short), and it was published in 1981. The United States was the only member nation in the world that did not vote to adopt the code, and it wasn’t until 1994 that President Clinton finally signed on. The U.S. Breastfeeding Committee has a quick version of the WHO Code:
- NO advertising of breast milk substitutes directly to the public.
- NO free samples to mothers.
- NO promotion of products in health care facilities.
- NO company “mothercraft” nurses to advise mothers.
- NO gifts or personal samples to health workers.
- NO words or pictures idealizing artificial feeding, including pictures of infants on the products.
- Information to health workers should be scientific and factual.
- All information on artificial feeding, including the labels, should explain the benefits of breastfeeding, and the costs and hazards associated with artificial feeding.
- Unsuitable products, such as condensed milk, should not be promoted for babies.
- All products should be of a high quality and take into account the climatic and storage conditions of the country where they are used.
The IFC and its members try to portray the WHO Code as discriminatory against mothers who have to or choose to formula feed. For instance, a press release on one of their websites links to a Cafe Mom piece, “Formula Restrictions are Unfair to New Moms.” What is the unfair restriction? China is banning the use of pictures of babies on formula containers (see bullet 6 above). While the piece makes the important point that bullying or guilt-tripping mothers about their feeding choices is asshole behavior, I don’t understand how following this aspect of the code qualifies as “bullying.” The author refers to it as “[t]he latest strike in the war against moms who don’t want to breastfeed.”
Let me explain something. There is almost no advertising for breastfeeding. There is no product placement, there are not free goody bags from the breastfeeding fairy, there are no samples delivered to your door. If a baby needs formula, parents know where to find it. They don’t need cute pictures or slick ads to be able to pick up a can of formula and follow the directions for its preparation. All formula sold in the United States has to meet safety and health standards. The advertised additives that many name brands throw in are, in the words of pediatrician David Paige, “chemical soup.” Touting the benefits of these additives through advertising doesn’t help anyone but those profiting from the sale of brand-name formulas.
I do agree that the bullet “All information on artificial feeding, including the labels, should explain the benefits of breastfeeding, and the costs and hazards associated with artificial feeding” is controversial. Certainly if a woman wanted to breastfeed and then saw “risks” touted on her baby’s best alternative food, it could cause unwarranted guilt. That’s wrong.
Everyone thinks of him or herself as a rational being who is somehow immune from the influences of advertising. Each of those people is delusional. Consumers actually have more trust in advertising now than ever. Jean Kilbourne has some great work on the ways advertising influences us all. I once argued at a presentation on food advertising that teaching children media literacy skills could help combat ads, and the presenters laughed. They said that as adults who studied food advertising for a living, watching ads for Dairy Queen Blizzards still made them all want to run out and buy one immediately. Which of the two cans pictured above would you buy? Why would formula corporations spend 8 billion dollars if that investment had no return?
There is no reason for formula to be marketed at all. If people need it, they need it–they shouln’t need to be persuaded. The message should be out that formula is the safest alternative to breastmilk, and families should be taught to prepare and feed formula safely. Past that, what’s to market? All formula marketing has the potential to discourage breastfeeding. We should stop it.
We do not need to fight for the right of formula companies to make a profit. The only people who should win in the infant feeding debate are parents and their babies.
human with uterus 
Of course breastfeeding doesn’t have the same amount of advertising as formula — formula is a product to be sold, breast milk is not. But companies still make a hefty dime off of breastfeeding products such as pumps, breast pads, nursing bras, nursing tank tops and shirts, Boppy pillows, nipple shields, nipple creams, expensive bottles that helps prevent nipple confusion, nursing covers, and extra vitamin supplements.
While I do not agree with all the advertising tactics used by formula companies — it is still a food to be consumed by infants — a food purchased by parents — a purchase that parents want to make an informed decision about.
Infant formula is not all the same. Some babies have milk allergies and need a soy based formula, and some babies have GI problems with certain brands. Different formulas work for different babies. No I don’t need slick ads to buy formula — but I like to be informed. I like to know what I’m buying. I like to know what types of formula are being offered so I can make an informed decision. To take that away to “protect” women from making the wrong decision IS “unfair to new moms.” I do not claim to be immune from the influences of advertising, but advertising is used as a medium to inform the public of what is available to be purchased — and yes, I know their main aim is to make money — but hey, welcome to capitalism!
I enjoyed your piece by the way, and I enjoy your blog. I just disagree with you on this point.
I love civil disagreements–that’s the way I learn new ideas. Let me disagree some more: Up until fairly recently, formula was not advertised to the public, only to physicians, and families still seemed able to purchase it–in fact, fewer women breastfed then–advertising directly to the public was a way to combat renewed interest in breastfeeding. Advertising does convey information, but in a biased way, and it’s primarily propaganda rather than education. It seems as if the cans were properly labeled, there wouldn’t need to be special ads. I understand that we live in a capitalistic society, and certainly companies have capitalized on market niches for breastfeeding (I have written about that too, though not on this blog yet). I’m actually more concerned about following the WHO Code, a worldwide public health policy. The U.S. is on of only a tiny handful of nations that has not implemented any aspect of the code (another one of the nations is Chad, just to give you an idea of the company we keep). Our ads and lifestyle portrayals here in the US have a huge global impact. Women in developing countries who want to appear “modern” often see formula as a status symbol. Unfortunately, formula is not as safe in other countries, either because the product is not manufactured properly or because there are not clean water supplies. I fully support safe formulas being readily available to families, but I still can’t see why there is any need to advertise them. If the baby has special food needs, consulting the pediatrician about appropriate formulas would be in order in any case. A breastfeeding mother does not need a case of formula samples delivered to her door (this happened to me) to know that formula exists. Saying that there is no reason to advertise formula is in no way a slur against formula feeding families–formula is a lifesaver, and we should all be grateful that it exists for when it is needed.
I agree that the advertising tactics of formula companies can be misleading. Developing countries are especially negatively impacted because of illiteracy, low income, and lack of clean water. I have seriously considered boycotting Nestle in the past for their immoral and life-threatening tactics.
I also agree that formula companies WANT women to buy their formula. And I surely didn’t need formula samples (which were sent to me as well). My first two kids were breastfed for well over a year without issues. But receiving formula samples didn’t sway me to formula feed. They just sat in my cupboard, were donated or just ended up in the trash. But the reality is, in the U.S. — a developed country — the health risks of formula are marginal. There are some risks associated with formula — I know that full well. But they are no greater than the risks of driving in a car, breathing in gas fumes from a city street, or coming into daily contact with our chemically infused plastic toys.
The bottom line for me — is that formula feeding SHOULD be advertised. Why? Because how women feed their baby is their choice. If a woman chooses not to use a part of her body to feed her child, we should support that. Shielding women from advertising is — to me — backwards and anti-woman. The entire aim of refusing to advertise a food product to women is to say — “Well, she shouldn’t be formula feeding anyway. If she wants to do that she can just go find it herself.” It further alienates a large percentage of women. Women who can’t breastfeed due to health issues, psychological issues and even by choice. And what about parents who adopt?
I agree that something should be done about advertising infant formula in developing counties — but here, in the United States — where our resources are plentiful and where the health risks of formula are marginal — formula should remain a product openly advertised for those that need or want to use it.
If breastfeeding were marketed with the same budget as formula, one could view them as competitive. But when only one side can advertise because there is no profit in the other, so one has an 8 billion dollar marketing budget (and that does not count money for lobbying) and the other gets a few public health dollars, we can’t assume people are getting an equal balance or saturation of information. Studies have demonstrated when there is formula in the house, people are more likely to use it. Studies also show that families tend to buy the brand of formula that they were given at the hospital (even though all formulas, generic and otherwise, must meet the same standards). You may not have been influence by the case of formula you got (I wasn’t either), but we are not everyone. I have spent most of my public health career working with low-income women, many of whom have not finished high school and who certainly are not running in circles of middle class professionals for whom breastfeeding is de rigueur. I am a fierce advocate for women to do whatever they darn well please with their bodies, but I don’t understand why they need advertisements to help them know that formula is available. The WHO Code is an international effort, crucial for saving babies in developing countries, and only works as a collective effort, especially by the most powerful societies. The U.S. has a greater responsibility to world public health than the bottom line of formula companies. As for some of the breastfeeding “promotion” out there–shame on those who would shame women. I was passionately opposed to the U.S. government campaign that compared formula feeding to riding a mechanical bull in late pregnancy, and to the posters (that were never released) that showed things like a bottle nipple on the end of an asthma inhaler. Shame on them. Mothers need support, not guilt, and shame on anyone who tries to persuade a mother to make a feeding choice through threats.
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