Thursday, June 11, 2015

Have you seen the recent Similac ad?

Thanks to Casey Rosen-Carole for this excellent commentary on

Worth the read!

Two lies and a truth: Formula Feeding campaign is off base

 The ad starts by asking “do you ever feel judged?” and shows a woman on a bench outside of a playground, holding her baby in a sling and looking unsure of herself. She is progressively joined by different stereotyped groups of women, including the “breast police,” that start a playground “brawl” of sorts. They argue in shallow derogatory terms that one group has the better form of parenting: breast vs bottle, work vs stay at home, disposable vs cloth diapers, etc… When they finally charge each other, a baby carriage is left hurtling down a hill and all the families join together to chase it. They bond over their concern for saving the baby in the carriage, and the text reads: “Whatever your beliefs, we are all parents first.”…”Sisterhood of Motherhood,” cue to “Similac.”

 First, let’s start with the two lies. This form of advertising, which appeals directly to emotion rather than to the product itself, can be traced to Edward Bernays, known as the “father of public relations”, the Austrian-American son of Anna Freud (and therefore nephew of Sigmund Freud). Through his consultancies to government and industry starting as early as World War I, Bernays is responsible for establishing the link between consumerism and a “feel good culture,” such as creating the links between pretty women and cars, cigarettes and the liberated woman. The first “lie” of Similac’s recent ad is in its appeal to the emotionally charged atmosphere of new parenthood, rather than presenting any benefits of the products themselves. Unfortunately, without being regulated as a medication (which would require a listing of harms as well as benefits in commercials) or signing on to the WHO code of international formula marketing (which would restrict direct-to-consumer advertising altogether), infant formula is in the unique position in health care of being able to market its product without any referent to fact. As such, this ad functions to convince women of the benignity of formula companies and their supportive mission, rather being understood as a company using extensive marketing strategies to make more money. The money they are making is in a direct negative relationship to the health of their consumers. It is well proven that formula marketing decreases breastfeeding rates and that lower breastfeeding rates mean more disease and death from causes as varied as breast cancer to SIDS (Sudden Infant Death Syndrome).

 The second lie is that the ad posits an equivalence between the choice to formula vs breastfeed and other parenting choices, like those to work or stay home, use paper or cloth diapers, or hold your baby in a sling or stroller. This equivalence is not supported in the medical literature, and while some of the other choices have personal or environmental impacts, there is no single decision that impacts infant and mother health more strongly than the decision to breastfeed a baby (or not). A subtle move the ad makes at the end, is in calling all of these choices, including infant feeding, “beliefs.” Establishing the primacy of these decisions as “beliefs” tells society, physicians and community organizations to back off, they are foundational and can’t be touched. These beliefs shouldn’t be judged or challenged, or you will intrude on sacred ground. However, unlike the other “beliefs” presented in the ads, breastfeeding is not a simple “choice”, it is best understood as a health behavior…that is, a decision one makes that has heavy health consequences and should be duly informed and supported by the medical community and public health infrastructure.

There is also a truth in the ad, which breastfeeding advocates should not ignore, and was likely carefully researched by Similac. This is that women feel judged in their parenting, and that, unfortunately, the “breast police” are linked in our cultural consciousness as judgmental of, and condescending to, other women. With the increase in pressure from the medical community to breastfeed, much of the resistance to recommending breastfeeding has been because no provider wants to make “women feel guilty.” Hospitals are increasing breastfeeding friendly practices, through worldwide initiatives such as the Baby Friendly Hospital Initiative©, and increasing support for WIC has helped that program increase its ability to provide breastfeeding education and support.

However, what this country has failed to do is as important as what we have done. We have not provided adequate resources for breastfeeding mothers after they leave the hospital, we have not ensured that labor laws provide for adequate paid maternity leave, or that women live in safe and supportive communities, and we have not ensured that our breast milk banks have adequate support and appropriate regulation to provide breast milk for those babies whose mothers cannot breastfeed. Further, we have failed to adequately train providers and staff in discussing breastfeeding in an open-ended and supportive manner, so that they feel that they may provide information without activating this very palpable cultural undercurrent of guilt, grief and anger around breastfeeding. When we as providers discuss the benefits of breastfeeding (and increasingly refer to the risks of formula feeding), how can we expect women to not feel guilty when their breastfeeding efforts fail if we, as a nation, do not also provide the essential conditions that can help women succeed? We will instead raise a generation of neurotics…Fortunately, when this happens, the formula companies will be there with Bernaysian advertising to pat them on the back and tell them it’s OK (and take their money while they’re at it).

Casey Rosen-Carole, MD, MPH

Academic General Pediatrics Fellow

Breastfeeding Medicine Fellow

University of Rochester Medical Center


Saturday, April 18, 2015

Caretakers' rights to support what is best for their family

Dear Friends:

I just attended the CORE Group meeting near DC with hundreds of representatives from NGOs that work around the world. The good news is that since I last attended, about 15 years ago, breastfeeding has become a normative part of general thinking. The sad part is that it seems that resources have shifted pretty much to complementary feeding without much mention of the vital importance of supporting continued breastfeeding for health, nutrition and for extended LAM use.
Let's get the word out that there is no complementary feeding without well established exclusive then continued breastfeeding AND that parental understanding of cues and responsive feeding is mandatory for child and adult health, nutrition and development.  I truly believe, based on evidence and experience, that we must support  women and families to do what is possible rather than exhort them to do what is not sustainable.

Optimally,  mothers, fathers and other caretakers are involved in the life of the child, actively responding positively to infant cues and young child needs. This begins to address the rights of the child. But to succeed in this, and to fulfill this responsibility, parents and caretakers have the right to support for the time and the means to be there for the child.  We need to push for paid parental leave and for adequate livelihoods globally.

Wednesday, February 11, 2015

Saddened by a great loss in the world of breastfeeding...

I was informed just today of the heartbreaking news of the death of my colleague and friend, Sylvia R. Pager, MD, MS, FAAP, FABM, IBCLC (AAP Hawaii Chapter Breastfeeding Coordinator) last week. 

She had a stroke on Thursday afternoon after testifying in support of the Paid Family Leave bill. 

Dr Pager served as the Chapter Breastfeeding Coordinator for the AAP Hawaii Chapter. Dr Pager was involved in a variety of breastfeeding-related projects and initiatives. She provided legislative testimony (and lobbied) for Breastfeeding. She kept her chapter informed of national breastfeeding movements such as ‘Ban the Bags,’ which was finally implemented in Hawaii’s level 3 perinatal center (Kapiolani Medical Center for Women and Children). Dr Pager worked closely with her state breastfeeding coalition to organize and host a number of breastfeeding conferences statewide. In addition, Dr Pager interfaced with local Blue Cross Blue Shield insurers regarding payment for breastfeeding services supported by the Affordable Care Act.

Personally, I have lost a great friend with whom I made plans for retirement visits.  She worked with all of her being to make a difference in the lives of mothers and children near and far.

Rest in peace, my friend.

Monday, January 12, 2015

Paying Moms for their Milk - a slippery slope

There is no question that human milk saves human babies. But when a mother cannot produce sufficient milk for her infant, what are the options? Certainly, for the very premature, there has been a bit of a resurgence of nonprofit milk banks, especially HMBANA (Human Milk Banking Association of North America) in the US and Canada. Conceptually, this is for milk sharing and pasteurization to attempt to avoid any disease passage to these most vulnerable infants.

There has also been a resurgence in milk sharing. Again, when between consenting adults, this also can play an important role.

But, as with all things where there is a possibility of profit,  the slippery slope of commercialism comes in. Don't get me wrong - I believe in enterprise. However, when the profit motive slips in to health care and wellness activities, or for purchase of human cells or organs, we have many many additional considerations to explore.

There is another word for when women accept payment for their bodies. And the women involved in this trade are forced into it due to poverty of one sort or another.

When we ask for women to sell their milk when their child is still nursing, we are asking that the the milk, even if there is surplus, be denied to their own child. Conversely, one might say, this may be the only product a poor woman has to sell, and why not allow payment for their careful collection and sharing of excess milk? We pay for the sweat of the brow, shouldn't we pay for other productive work? When a poor person is offered money for something they can spare, especially in this country, where WIC can provides a "substitute" for free for them to feed their infant, offering payment may seem generous.....or coercive.

The heart of the issue to me is one of availability full unbiased information and free choice among choices in a system that is free of fiscal or personal or health system coercion. Unfortunatley, ours is not such a system.

Black Mothers' Breastfeeding Association of Detroit has taken a stand on this. If you would like to know more, please visit: