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