The Carolina Global Breastfeeding Institute(CGBI), also recognized as the Carolina Breastfeeding Institute, in the MCH Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, is dedicated to enabling every mother to choose and succeed in optimal infant feeding - exclusive breastfeeding - and optimal young child feeding.
THIS BLOG OFFERS COMMENTARY ON ISSUES AND CONTROVERSIES CONCERNING INFANT FEEDING AND THE MOTHER/BABY DYAD. PLEASE COMMENT!!
Two lies and a truth: Formula Feeding campaign is off
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
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.
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).
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.
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
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.
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.