Monday
Feb222010
How to report unethical promotion of formula, bottles and other breastmilk substitutes
Monday, February 22, 2010
The continued marketing of formula, bottles, pacifiers, or complimentary foods for babies under six months of age is dangerous and unethical. Not only do they undermine the efforts of moms who want to breastfeed, but they also create risks to the health of mothers and babies, and have a detrimental impact on the environment.
According to Marsha Walker, a registered nurse, International Board Certified Lactation Consultant, and Executive Director of the National Alliance for Breastfeeding Advocacy:
According to the WHO ’s FAQs on the International Code:
No one disputes the fact that formula and bottles should exist. However, the World Health Organization, breastfeeding and health advocacy organizations, and many governments agree that they should not be marketed to expectant mothers, new mothers, and health professionals. People should be able to access these products when they are needed, but should not be faced with deceptive messages and imagery that suggest that a bottle is the standard way to feed a baby or that formula is as good as breastmilk.
In order to reduce the negative effect of formula marketing and save lives, the World Health Organization developed the International Code of Marketing of Breast-milk Substitutes (World Health Organization). The Code restricts marketing and related practices of the following products:
Some of the provisions in the Code include:
Governments in more than 60 countries have adopted the Code and made it law. Some countries have gone a step further by making formula available only by prescription or requiring warnings on labels. In the absence of legislation, the Code encourages manufacturers and distributors to comply with its provisions.
Unfortunately, many of the countries that are signatories to the Code have not gone through the process of turning it into a law. Even in cases where there are laws in place, governments often do not have sufficient resources to monitor compliance and penalize non-compliance. So companies continue to do what they want and continue to aggressively promote their products in order to increase their profits. Nestle, for one, has made it clear that it does not even attempt to comply with the Code in developed countries (like Canada, United States, United Kingdom, Australia and others) and it falls short in developing countries. Other companies like Enfamil, Similac, and Heinz continue to violate the code regularly, as do bottle manufacturers such as Avent, Medela and many others. Despite what they may tell you, these companies are more focused on profits than on the health of babies.
Again, in other countries you can use the standard monitoring form and send it to the Code monitoring organization for your country.
If you see a violation, please take the time to take a picture/scan it in, note when and where you saw it, and report it. I have a few photos on my blackberry that I will be sending in to INFACT Canada, including several in-store coupons, discounts and promotions by Heinz that I have seen recently at IGA and Loblaws.
Thank you to Marsha Walker from NABA and Mike Brady from Baby Milk Action for their input into this post.
According to Marsha Walker, a registered nurse, International Board Certified Lactation Consultant, and Executive Director of the National Alliance for Breastfeeding Advocacy:
Many people feel that they are too savvy to fall for deceptive claims but this is not true. Research has shown that more and more people feel that infant formula is equivalent to human milk, based on manufacturer claims that are false, misleading, and not supported by the evidence. Many mothers fall prey to thinking that fancy feeding bottles and artificial nipples are similar to their breast, but this is not true either.
According to the WHO ’s FAQs on the International Code:
The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.
No one disputes the fact that formula and bottles should exist. However, the World Health Organization, breastfeeding and health advocacy organizations, and many governments agree that they should not be marketed to expectant mothers, new mothers, and health professionals. People should be able to access these products when they are needed, but should not be faced with deceptive messages and imagery that suggest that a bottle is the standard way to feed a baby or that formula is as good as breastmilk.
What is the International Code of Marketing of Breastmilk Substitutes?
In order to reduce the negative effect of formula marketing and save lives, the World Health Organization developed the International Code of Marketing of Breast-milk Substitutes (World Health Organization). The Code restricts marketing and related practices of the following products:
- breast-milk substitutes, including infant formula and other milk products
- any foods and beverages, including bottle-fed complementary foods, when marketed for babies under 6 months of age (e.g. baby food and cereals marketed for young babies)
- baby bottles
- teats, like bottle nipples and pacifiers
Some of the provisions in the Code include:
- No advertising to the public of any product within the scope of the Code. This includes ads in any media--print, websites, TV, radio. It also includes in-store promotions, special displays, coupons and discounts (lowering the price of formula is allowed, but promoting a sale price or offering a coupon is not).
- No free samples to mothers. Cans of formula or gifts from formula or bottle manufacturers sent to homes, given to mothers by pediatric or obstetric offices, given to mothers when they leave the hospital, given as prizes or in contests, given at clinics or anywhere in the healthcare system
- No promotion of products through healthcare systems. Booklets, leaflets, posters,name badge holders, crib cards, tape measures, calendars, etc
- No gifts to healthcare providers. Anything from formula companies or feeding bottle manufacturers that are given to physicians, nurses, dietitians
- No words or pictures idealizing artificial feeding or pictures of infants on labels of formula cans, feeding bottles, etc. Packaging of these products should not have idealizing language or pictures of infants and mothers. Idealizing language means that claims are made such as "most like mother herself" or claims that the products are similar to breastmilk or breastfeeding
Governments in more than 60 countries have adopted the Code and made it law. Some countries have gone a step further by making formula available only by prescription or requiring warnings on labels. In the absence of legislation, the Code encourages manufacturers and distributors to comply with its provisions.
Why are companies still violating the International Code of Marketing of Breastmilk Substitutes?
Unfortunately, many of the countries that are signatories to the Code have not gone through the process of turning it into a law. Even in cases where there are laws in place, governments often do not have sufficient resources to monitor compliance and penalize non-compliance. So companies continue to do what they want and continue to aggressively promote their products in order to increase their profits. Nestle, for one, has made it clear that it does not even attempt to comply with the Code in developed countries (like Canada, United States, United Kingdom, Australia and others) and it falls short in developing countries. Other companies like Enfamil, Similac, and Heinz continue to violate the code regularly, as do bottle manufacturers such as Avent, Medela and many others. Despite what they may tell you, these companies are more focused on profits than on the health of babies.
How can I report a violation of the International Code of Marketing of Breastmilk Substitutes?
The Code is monitored by public interest organizations in various countries that are part of a network called the International Baby Food Action Network (IBFAN). A standard monitoring form can be downloaded and sent to the respective Code monitoring organization for your country. Here is specific information and forms for a few countries:
- United States: In the US, that organization is the National Alliance for Breastfeeding Advocacy (NABA). Violations of the Code can be sent via mail to NABA, 254 Conant Rd, Weston, MA 02493, email Marshalact@aol.com, fax 781 893-8608 along with the monitoring form.
- Canada: INFACT Canada monitors the Code in Canada and has a form you can fill in on its website. It also offers some sample letters you can use to contact politicians, health care institutions and store managers with regards to violations in their jurisdiction.
- United Kingdom: In the UK, you can report violations to the WHO Code and there is also a banner you can add to your blog/website to inform other people about the need to report violations to the code.
Again, in other countries you can use the standard monitoring form and send it to the Code monitoring organization for your country.
Go forth and report!
If you see a violation, please take the time to take a picture/scan it in, note when and where you saw it, and report it. I have a few photos on my blackberry that I will be sending in to INFACT Canada, including several in-store coupons, discounts and promotions by Heinz that I have seen recently at IGA and Loblaws.
Thank you to Marsha Walker from NABA and Mike Brady from Baby Milk Action for their input into this post.
Reader Comments (122)
Ack! Sorry I spelled your name wrong in my other post! =/
I do agree that medical insurance is screwed up, but that's a topic for a different day. I'm not saying that having formula be Rx and having it covered by insurance is a magic bullet for all the problems associated with formula marketing, but I do think the potential benefits outweigh the disadvantages.
We will have to agree to disagree: I don't think it's asking too much for a mom to get a prescription for formula. There's a plethora of situations in which formula is appropriate; I don't think it's asking too much to run those circumstances by a doctor. In order for that to be effective, it's also crucial that healthcare providers get better education and training in breastfeeding. It's not a simple solution, but I think it has the best long-term potential.
So, no, I wouldn't tell your friend to "get past it" and that she had to breastfeed. But I would say that in both her case and yours, talking to a doctor before switching to formula stood to benefit all involved. Having that conversation alerts that doctor to your circumstances. It might prolong the breastfeeding relationship. It might end it with a switch to formula, too. But in either case, having that conversation stands to ensure that a care provider is closely examining both the needs of the mother and the baby, and referring out where necessary (psychologists for suspected postpartum depression, IBCLCs for those in need of extra help with BFing, etc-).
I'm not knocking formula here. I am saying that it's over-used and that it's sub-standard to breast milk. Those are just facts, not judgments.
Here's where we will likely disagree, and that's ok. I realize it's a conservative line to take. I firmly believe in parents' rights to choose what they see is fit and best for their children. However, there are instances where things are so abundantly clear and black-and-white that legal provisions and societal standards are put in place to ensure that children are cared for in the best, safest way possible.
I'll use the analogy of the car seat here: car seats are 100% the best and safest way to transport a child. That's a fact. The law compels parents to employ this safety device because it protects children. In the same way, breastfeeding is 100% the best way to feed a baby. That's as objective as the fact that car seats are the safest way to transport a child. I believe that before there is deviation from the breastfeeding path, parents should have to consult with their healthcare providers. It's in the best interest of the child for that conversation to occur, and I also think that often times, it would be to the benefit of the parent, as well (regardless of how inconvenient or personal that conversation might be).
Fearless Formula Feeder:
I'm curious why you think that not allowing advertising = taking personal choice away from women?
There's a LOT there, and I need to got get dinner going, so I'll just poke my head in with one comment:
Think of it like the restrictions placed on cigarette advertising. No one is taking away the choice of smoking or not smoking, they're just restricting how it can be marketed. How is the WHO Code any different? (I do realize that the WHO Code bans marketing certain products, aimed at a specific demographic, entirely; the analogy still stands, though. No choice or option has been removed.)
Sharon:
I do think it is a choice. I don't think that makes it an equal choice and certainly not a better choice, but it is still a choice.
I do not feed my children THE best meal every day of the week. I do not dole out THE best discipline every day of the week. I try. I do my best as a parent. I am constantly trying to improve. But I recognize that I am not perfect. I also do not expect perfection from anyone else. I may have breastfed, but someone else out there that was a formula feeder is probably doing something else better than I am.
Kayris, I admire your thoughtful exploration of this issue. I didn't want to breastfeed and didn't tell anyone for fear of being judged or brow-beaten. I had a horrible breastfeeding experience with my first child (and I did use formula, too) and it prompted me to research why so many moms like me didn't want to breastfeed, or if they did, didn't make it to the minimum recommended by the AAP. I was shocked by what I learned about the marketing of formula (and I worked at Merrill Lynch in marketing!). Bottom line, it has resulted in "booby traps" that pervade our culture and trip expecting and new mothers up at every turn. http://www.bestforbabes.org/breastfeeding-booby-traps/. Moms are being pressured to breastfeed but set up to fail, and too many women (including myself) feel that they are in a "damned if I do, damned if I don't" situation. I for one am horrified by the judging of women who don't breastfeed for whatever reason, as much as I am horrified by the judging of women who breastfeed in public or advocate for breastfeeding. What I believe we need to do, is to cheer on, coach and celebrate ALL moms, make sure that they are able to make informed decisions and that they can carry them out as they choose, without pressure, judgment or guilt. I hope you will join us, we need you!
I think you need to remember that not everyone has health insurance. So if formula was Rx, what would families without insurance do? And you just can't ignore that making formula Rx could theoretically lead to discrimination. Women who delivery by c-section can already be denied insurance. It's not much of a stretch to imagine companies denying coverage to formula feeding families.
Honestly, actually experiencing breastfeeding has tempered some of my feelings on the topic, and I find it makes me much more understanding of women who choose not to breastfeed for non-physical reasons. Prior to the birth of my first, I just did not fathom why a woman wouldn't even give it a try. But I bf both my kids for a total of 20 months and at times, I absolutely hated it, it made me MISERABLE and when my milk did finally dry up, I was relieved because it was over with.
You said: "In the same way, breastfeeding is 100% the best way to feed a baby. "
We'll have to disagree on this one too, because I think it's open to so many interpretations. From a nutritional standpoint, breastmilk is better. And for a mother who lives in a 3rd world country and risks giving her baby dystentery from dirty water, of course breastfeeding is the smartest choice. But in the USA or Canada, or other developed countries, how many deaths are attributed directly to formula use? And in any such deaths, can the doctor unequivocably say that breastfeeding would have saved that child's life?
In my case, I'm smart enough to weigh the odds. We're a middle class family in a developed city with access to great healthcare, and my kids were home with me or another family member until they entered preschool. Had I known how much I would have not enjoyed breastfeeding, would I still have chosen to do it? I'm not sure, but I shouldn't have to go see a doctor to make that decision. As a commenter below me pointed out, plenty of women plain don't want to breastfeed. And that's their business.
So if you feel that the idea of it being a choice is a problem, then what's the solution? It not being a choice? Should women be forced to breastfeed if they do not want to? Whether or not to breastfeed is a womens issue, because it affects many aspects of our lives. Women are not mere vessels who should suddenly have to negate all their own needs simply because they have had a baby. Of course breast milk is nutritionally superior to artificial milk, but formula is not poison, and the fact is that the majority of western babies do fine on it.
I am passionately pro breastfeeding. It's better for babies full stop. I loved breastfeeding my own children. But just because something works well for me does not mean I think it would or should work well for everybody.
It makes me feel very uncomfortable to see women beating eachother up over this issue. If we want society in general to give the job of mothering the respect and value it deserves, we need to support and value eachother as mothers and just accept that we don't all have the same priorities and values.
I don't think you can compare cigarettes to formula. I fed both my kids formula and in no way do I consider it as dangerous as lighting up myself or around a child. Smoking is proven to significantly raise your risk of cancer and certain lung diseases. Feeding formula won't give your kid cancer.
And back to the prescription thing: breastfeeding alone is not the litmus test for what makes a mother a good parent, or what makes a child a healthy one. My kids are both extremely healthy, but I don't really attribute that to nursing them, I attribute it to our handwashing rules and our excellent diets and the fact that they both get enough exercise and enough rest. And they ate Sun Chips with their dinners tonight. What's next, having to get a waiver signed to feed my kids junk food? Having to step on a scale before buying them the ocassional Happy Meal? You can only regulate what a person puts into their body so much. Is breastfeeding really so great if it makes the mother resent her baby, or if it takes away something from the time she spends with her infant?
Being a doctor doesn't make a person infallible. My pediatrician friend, trained in med school about BF, and who counsels the mothers of her patients about it, ended up formula feeding both her children because BF didn't work for her. And as many LCs point out, pediatricians are not always the best source of information when it comes to successfully breastfeeding. We ended up switching pediatricians because the old one was way too hung up on the growth charts and had counseled me on several ocassions to switch both children to formula. I ignored her. I switched when I no longer had a say in the matter, but my point is that some are advocating going to see a DOCTOR about establishing a reason for the need for formula, when that DOCTOR might have it wrong to start with.
I didn't compare infant feeding with cigarettes, I think that's crystal clear. I compared how cigarrette manufacturers are regulated with how formula manufacturers might be regulated in the future. No reference to smoking and health, nor breast or formula feeding and health, was made.
Clearly, the interpretation of my post was that I was comparing formula feeding and smoking: to be clear, I am absolutely not.
I also haven't mentioned judging parents with regard to how they choose to feed their children here. I'm not about judgment, I'm about facts. I've tried to make it very clear that this isn't personal and it's not about looking down on anyone, for anything.
If breastfeeding is making a mother resent her baby, she needs to talk to someone about that. You may disagree. I don't think the solution to that particular problem is going out and buying formula; I think it's discussing it with a healthcare provider and coming up with a solution together. I'm not about over-regulation. But, I feel that there's a sound case to be made for baby formula to be treated as a medicine.
I have also already acknowledged that the medical profession in general needs a LOT more training and education in breastfeeding before any of this could come about. I haven't said and I don't believe that doctors are infallible. Most health care practitioners receive little to no education in breastfeeding; as I said prior, for formula to be Rx, that must change. In fact, I just wrote this post for Best for Babes detailing why the InfantRISK Center is going to become crucial in how breastfeeding and medicine interact: http://www.bestforbabes.org/2010/02/breastfeeding-medications-the-infantrisk-center-to-the-rescue/
I"m not getting into the nitty-gritty of a healthcare debate and speculating on whether or not formula-feeding parents would be denied insurance coverage.
What I will point out is that people without insurance will do the same thing they do now: pay out-of-pocket for formula. Making formula Rx would likely improve savings on procuring it for most families. Those without insurance, will carry on just as formula feeding families do now.
And yes, in the US and Canada, and around the world, there are infant deaths each year directly attributable to not breastfeeding. Granted, those numbers are much higher in the developing world, but don't think that the US and Canada and other similar countries are impervious to this problem. According to this study by the AAP, breastfeeding alone could save or delay the deaths of ~720 babies each year. That's a lot. This isn't the only research of its kind, but it's the one I found fastest (so that number isn't definitive). http://pediatrics.aappublications.org/cgi/reprint/113/5/e435
Just for whatever it's worth, I'm approaching 18 months of breastfeeding my daughter. I didn't want to do it in the first place (frankly, I thought breastfeeding was gross), I haven't ever particularly enjoyed it, and at times it's been really, really difficult. I can empathize 100% with moms who feel ambivalent at best, and resentful and just awful, at worst, about breastfeeding.
OK, lots to say--first of all, I skimmed the study you linked to and it still doesn't answer my question, The authors use words like "plausible" or "likely." And the sample group used in the study was from 1988. And the authors also mention that many of the babies that died belonged to younger, less educated mothers who may have also smoked. So some of those babies may have lived if they were in different families in a different part of the country at a different hospital.
Breastfeeding was a huge blow to me, because people always insisted when I was pregnant that I would love it. And it turned out it was hard as hell, it hurt a lot, and while I came to enjoy the time I spent with my babies, I never enjoyed the actual process of BF. When it was over, I was was sad that my babies were growing up, but not the slightest bit sad that I was done. And perhaps it would have been better for me to stop earlier. As Ii said before, the risks to me continuing were probably higher than the risk from feeding formula. And as the saying goes, if momma ain't happy, no one's happy. As far as I'm concerned, being happy is a perfectly good reason to wean, but that shouldn't require a prescription.
As far as insurance, it seems awfully unfair that someone unlucky enough to not have coverage would still have to pay out of pocket, despite having a valid reason to use it. But that's another topic.
I know you're not directly comparing cigarettes with formula. My point was that cig ads are more restricted because smoking gives you cancer. Smoking is a vice. Formula won't give you cancer, and babies need to eat to live.
Also, my comments about judgement were not directed at you. Rather, they were general comments. I feel, quite often, from this topic, that some people want to make it difficult or impossible to get formula because "breastfeeding is best for babies!" But it's not always best for moms and a baby is nothing without it's parent. I think women should have the right to make their own decisions about what is best for their families, be it how they feed or how they discipline, without having to explain why. To me, it's a slippery slope, in trying to treat formula as medicine.
As I said before, I really don't get why a woman capable of BF wouldn't at least give it a try. But I will defend to the death her right to do so.
I think I've clogged up Annie's post enough. There's a lot to think about here, and I think I'll form further thoughts into my own blog post.
First off, I am really sorry you feel that way about breastfeeding. I think you and I had remarkably similar experiences. I can directly relate to almost everything you've said, and you and I are and our experiences are the minority, from what I've seen. It's difficult to mitigate those feelings with how we're "supposed" to feel. Some moms just don't get the warm & fuzzies from bfing, & that's ok! Kudos to you for continuing in the face of what you felt.
I don't want to start dissecting that specific study here. Frankly, this has been an exhaustive discussion and I'm just not up for taking it to that round. That isn't the only research on the subject, and I think you'll find that there IS research that shows that there are infant deaths in developing countries from not breastfeeding.
Thanks for the really good discussion!! Despite our opposing views, I feel like we actually share a lot of common ground here and I appreciate the discourse. :)
Thanks to you too. I've spent way too much time on this post today, so I'll just say this and I'm done. If women who don't enjoy breastfeeding already feel confused or at odds with how you're "supposed" to feel, theoretically making them go to a doctor to get an Rx, and then go wait in line at the pharmacy to buy it, make them feel any better? Evem if Rx formula could increase the amount of women who breastfeed or at least try it, I'm not sure the benefit is worth the cost.
FYI, Leadership in the breastfeeding movement has moved away from using the word "choice". It implies choosing between two equivalent items, which formula and breast milk are not, no judgment, they are just not equal. See "Watch your language" by Diane Weissinger. A better word might be decision, because it implies a thought process and a weighing of risk and rewards.
I agree that the health care debate is a separate issue. Seperate enough that I don't think requiring a prescription for formula would work in the United States at the moment. The health care system is just too broken to ensure equitable treatment.
It could, theoretically work in Canada where we have universal health care and where if your doctor prescribes something, it is generally covered (either by the basic provincial health plan or by a supplemental employer drug plan, depending on the situation you are in, but no one is without basic coverage).
But even if it would theoretically work I would have two objections:
(1) Some doctors are known as "drug pushers" or "formula pushers" whereas other doctors will make it difficult for people to get even the drugs that they do need. Some doctors feel it is their duty to try to wean people off of drugs that they need over time. Whether it is or not is not my place to judge, but access to prescriptions is not equally easy with all doctors.
(2) I do believe that the decision of whether to breastfeed or formula feed should be up to the parents. While a doctor can counsel his/her patient and make recommendations, I do not think it should be up to the doctor to make a decision or to force a mom to go in one direction versus another.
Kayris:
I look forward to your post. Please come back and post a link when it is up.
I like the word decision and agree that there should be a thought process and weighing of risk and rewards, but I don't see that as being separate from choice. I see the decision as the end product of choice. Choices are not always completely free and are certainly not always equal. But http://www.phdinparenting.com/2008/08/30/choice/" rel="nofollow">I do believe in choice.
PhD:
I don't feel that restricting advertising of formula in EVERY way takes away personal choice - like I said, I think the freebie bags might not be the best idea, nor should formula companies go around making claims that their product is "closest to breastmilk" - but I do think that following the WHO code to the letter DOES infringe on choice, because, like Kayris, I do not see formula as being something we need to restrict; rather, the marketing should not be conducted in a way that DISCOURAGES a woman from nursing. If she ALREADY does not want to breastfeed, or finds it too difficult to do so, then she should be able to freely buy formula, receive coupons, and compare products. Competition also drives down prices and encourages formula companies to keep making improvements - regardless of what you feel about formula, I hope you can agree that it that has changed and improved throughout the years, thanks to consumer-driven need.
Like Kayris said, if the only other substance that must follow these marketing limitations is cigarettes, then that is farked up. Formula may not be as good as breastmilk for the average kid, but it is still a darn good substitute. It's a food like any other. Maybe not the magical elixir many believe breastmilk to be, but food all the same, and millions of kids have been raised on the stuff and are doing just fine (myself included).
(But on that note...I'm not a huge fan of restricting cigarette ads either. I don't smoke, but I don't care if YOU do, as long as you don't do it around me or my kids. If you want to give yourself cancer, go right ahead. Not my business. And if you are going to do so, then you should have a choice in which cancer stick to do it with.)
Here's how I see it: I don't believe eating meat is a good idea. I think it is unethical to eat animals and if we were all vegetarian we would be a heck of a lot healthier as a society. When I see kids scarfing down Lunchables, I cringe. But I would NEVER force that belief on anyone, nor would I insist that Oscar Meyer stop marketing to kids. It's a free country (well, kind of). And besides, there are some studies that suggest a lack of protein and fat from animal sources can do more harm than good. Some might say that my vegetarian lifestyle is actually more detrimental to my child than feeding him processed meat, so long as he was getting meat of some kind. I can understand where that logic is coming from, and politely agree to disagree.
My brain is fried from taking care of a toddler all day, but I *think* that is a good enough analogy to illustrate my point...?
My favourite analogy for breastfeeding and formula feeding is this:
Consider formula feeding as convenience food. Not fast food, not Maccy Ds, but long life food, reconstituted food, tinned food. It can be fortified with vitamins to make it healthier for people to eat, it may have a few questionable ingredients (ie preservatives) but overall, you can live a healthy enough life on it, you'd get all your food groups in, and your vitamins.
Breastfeeding by comparison is fresh food, organically grown, direct from the farm. It would take more time setting up the farm, and some support from family members and outsiders to get things going. Once you were up and running, it would become easy, second nature. But if you worked outside of the home, or had limited help available, it would become more difficult than eating packaged food from the supermarket. Some people might have to do a little bit of both. Some people may be unable to do farm work due to physical problems, or lack of support/help in the day to day running. Some people may not want to farm, and choose to go straight to buying their packaged food at the supermarket.
You could even say that choosing to buy fresh organic food at the supermarket is the equivalent of pumping, or obtaining donor milk. Not the same as producing it yourself, and it would not be as fresh, but it would still be good.
Not a perfect analogy, but you get the idea.
I think most people accept that fresh organic produce is healthier for you than convenience food. But there isn't a big debate over it. The only reason there is with bf vs formula is because it involves parenting which is always a hot topic ;)
I'm sort of left here scratching my head, wondering how anyone could think that the formula checks actually help parents afford formula. Formula costs about 15 cents a can to produce, yet costs $15 at the store. That's a huge mark-up and most of the extra cost covers the aggressive marketing of formula, which includes those hospital freebies and the mailing of checks. So not really free at all, you're paying for it when you buy the brand name formula. The largest supplier of formula in the US is the US government, through the WIC program. The government pays pennies for cans of formula because the formula companies consider it free marketing. They know parents on WIC don't get enough free formula to last them the entire month, so once they go to the store and are paying full-price, they'll stick to the brand they get for free at WIC. So again, consumers are paying for all of these marketing tactics.
If formula weren't advertised the way it is now (stop the bags at hospitals, no more formula cans showing up on parents' doorsteps, no more coupons, tv commercials, $40,000 spreads in People magazine, etc.) the cost of formula to the consumer would have to go down. The US government should also have to pay full price for formula that it supplies for WIC, as should hospitals who use it to supplement. Again, with all of these things in play, governments and hospitals would not be willing to pay those exorbitant costs and I truly believe we'd see the pricing of formula come down to reflect a more realistic profit margin and that would make formula more affordable for those who truly need it. Of course, I am sure many breastfeeding advocates would then say formula was too easy to get and more people would start to use it and maybe that is true as well. But my main point is that formula checks don't help anyone, least of all people who have already chosen to formula feed full time and NEED it.
This is such an excellent point. I hadn't thought about how much marketing itself contributed to the high cost of formula. I am now remembering my marketing class in college and why generic products cost less than name brand. It's all the advertising costs. :)
Blacktating-
Those are excellent points. The only thing I'd argue is that it is important for formula to keep improving. And for it to do so, the formula companies need money, which is one argument for the high costs. Not that I am a fan of the cost of formula, believe me. I swear my kid's entire college fund went into his hypoallergenic formula.
It's the same argument that the drug companies make: research costs money, and the government can't fund all of the necessary research (and FWIW, I highly doubt that the govt could rationalize funding formula research when it is simultaneously funding/supporting programs to bring the breastfeeding rates up). I see your point, but then the same point could be made for any type of product - food, diapers, toys, etc. If no one advertised, the costs would certainly go down... but we live in a capitalistic society, so I don't see that happening anytime soon, and I guess I just don't see why formula manufacturers need to conduct their business in a way that markedly different than anyone else.
But I certainly understand your argument and agree with it on certain levels. Excellent points.
Sorry... that should read, "I just don’t see why formula manufacturers need to conduct their business in a way so markedly different from anyone else."
These 6 am wake-ups are frying my brain.
As usual - you're such a pro Annie. Wish I knew what to do when I got those FREE bottles with my first. I was so mad that the hospital even had them, let alone sent them home with me.
Sharing with the world....
Oh my gosh thank you for saying this. Because I read the suggestion about turning formula into a prescription-only product - and besides the whole stigma of having to go to get a prescription, justify your choice, deal with insurance, have a doctor validate it as if you were a child yourself, and then wait on line at a special counter like a pariah simply to FEED YOUR CHILD... oh wait.
yeah, that was it.
Geezus.
Fearless Formula Feeder:
I don't think cigarette marketing is the only example. At least not in Canada (I don't know US regulations very well). In Canada there are restrictions on the marketing of tobacco, alcohol, pharmaceuticals, and even things like breakfast cereals in some instances.
I will re-iterate again that I do not think advertising is necessary to choice. You said that you are "not a huge fan of restricting cigarette ads......if you are going to [smoke], you should have a choice in which cancer stick to do it with". I live in an area where cigarette advertising AND breakfast cereal advertising are both restricted. That means that when I bring home the healthy cereal from the grocery store, my kid isn't saying "BUT MOMMY....I WANTED THE PINK FLUORESCENT ONE ON TV". But I still have the CHOICE to buy the pink fluorescent one if I want. It is there in the aisle with the rest of them. It just hasn't been pushed on my kid with a bunch of dancing bunnies or promises about how pretty or cool it will make her.
Choice is about availability.
Advertising and promotion is about convincing.
They are two very different concepts to me. People can certainly argue for or against either of them, but we should not mix the two together because they are not the same beast.
Okay, point taken. And maybe this is a philosophical difference between Americans and Canadians (and I am obscenely generalizing here, so bear with me). While there are many reasons that public health care has not succeeded to be a viable option in the US, one is because many Americans on the "right" feel that they do not want government in their private affairs. We tend to cringe about "big brother" here. This has certainly harmed us in some ways; we don't have access to free health care like you guys do... but it is part and parcel of our national "personality". I'm sure many Americans would like restrictions on cereals, but there are just as many who would balk at that suggestion - including me.
My mom never let us watch anything but PBS until we were old enough to sneak in the Cosby Show when she wasn't watching. We also were raised with no sugary cereals or snacks except for Friday nights when we would get ONE small treat for Shabbat (we were Jewish). It was never a problem, b/c I didn't see any ads that would make me scream for Cocoa Puffs. Granted, as I got older and went to friends' homes who did have such snacks, I started asking for it - but my mom just said no and that was that. Parents need to take some responsibility. And with the advent of the DVR, if you ARE going to let your kids watch tv, then you can always just outlaw commercials.
For me, it all comes back to taking personal responsibility. Regardless of ads, we can make choices; I don't like positioning ourselves as victims of anything, marketing included. And I'm sorry, but I don't see you or anyone else railing against the promotion of breastfeeding - so how can women be expected to make an informed choice if the only "choice" they are presented with is nursing?? I would rather see women getting ALL the information and then be left to make a decision on their own.
Claire- I think that is a really good analogy. Probably the best I've seen. :)
Yes, it is important for formula to keep improving, because basically formula is a giant experiment and our babies are the guinea pigs (I used formula for my son from months 9-12). The reason why formula keeps having to change is because babies have died, had seizures, failed to thrive on formula, etc. But formula companies are billion dollar businesses. They are in some cases also produced by pharmaceutical companies. So there is plenty of money there to do scientific research and still make a ton of money. There is no justifying the cost of formula. None. It's made from the cheapest ingredients and packaging possible.
I don't see why formula has to be advertised at all. As others have already stated, everyone knows formula exists and where to buy it if you need/want it. The marketing formula companies use undermines breastfeeding and idealizes bottle feeding. They purposefully send formula to parents' homes during growth spurt months, when women are more likely to think their milk is "drying up." Their tactics are calculated to convince moms to stop breastfeeding or never breastfeed at all. It would be one thing if they were only trying to convince moms who had already decided on formula to buy their brand over the next guy's, but they are trying to convince moms who don't need or WANT their products that their bodies are deficient and formula is a necessary part of parenting when it's NOT. That is the problem with formula marketing.
And FWIW, I do NOT think formula should be RX only.
I have, in some cases, complained about the nature of breastfeeding promotion. For example: http://www.phdinparenting.com/2009/07/19/can-breastfeeding-promotion-learn-something-from-drunk-driving-ads/" rel="nofollow">Can breastfeeding promotion learn something from drunk-driving ads?
AMEN!!!! AMEN A-FREAKING-MEN!!!!!
We don't have cable. My kids watch videos or PBS. So their exposure to Dora or Sponge Bob (vomit) or other character crap is pretty much through their friends. But you know what? I'm the parent. I'm the one with the power and the credit card. If I say no, I say no. Period.
This was the basic premise of my post. At some point, we need to use our brains to look past advertising and their lofty claims. No magic pill will make you look like Jillian Michael's without lifting a finger or watching what you eat. No number of Baby Einstein videos will turn your infant into a genius. Formula supplemented with DHA and ARA to be like breastmilk? Give me a break.
I asked my friend who never wanted to BF how she felt about Rx formula. And her reaction was pretty pissed off. If a woman can choose to abort a baby, she can choose to smoke, even while pregnant, she can choose to eat raw fish or deli meat while pregnant, or she can choose to not wear a seatbelt or a million other things that may or may not put her fetus at risk. So how can you take away her choice to feed her baby formula, even if it's a completely selfish reason, if she wants to?
It would be great if formula companies would stop advertising and lower the price and all the other things mentioned in these comments. But it's not going to happen. It's not. There's too much money at risk and formula companies would fight tooth and nail, they have billions of dollars and powerful lawyers behind them. SO that's why I think taking coupons away from FF moms would hurt them...and not the formula companies.
Kayris,
I think I love you.
If everyone were so smart, a lot of people in the marketing industry would be out of jobs. Somehow, what they do must be convincing someone or they wouldn't bother.
PhD,
Yes, marketing does work on some. But so does peer pressure. I can't tell you the number of women I've talked to who have been torturing themselves for years over their inability to breastfeed. Considering the only "formal" breastfeeding ads in recent history in the US were pulled shortly after they first ran (the log-rolling/mechanical bull debacle of '06 or so), I would venture to guess that this has little to do with marketing. So obviously, there is more at play then just the ads we see on tv or in magazines/billboards.
The reverse argument to this would be that we live in a bottle-feeding society, yada yada, which I certainly won't dispute (the society I live in is 100% a breastfeeding one, but I realize that is one specific region and this is not true everywhere - watching "16 and Pregnant" on MTV is enough to convince me of that). From what I've heard from some lactivists, it is more than just formula companies and their marketing techniques; it is also the portrayal of breastfeeding (or lack thereof) in the media and the lack of peer support that really damages breastfeeding rates.
Regardless... I want to tell you that I always appreciate your take on things; I really enjoyed that post on drunk driving ads you linked to (I actually commented on it a ways back) and respect your writing and passion immensely. I am not trying to be combative at all - I appreciate the points you have made and they have given me some substantial food for thought.
I just reported this current Toys R Us circular to the email given in your blog. $10 Toys R Us gift certificate with $50+ formula purchase. Unbelievable.
http://trus.imageg.net/graphics/media/trus/022610-msw-cpns.pdf?csm=125731816&csc=728089&csa=125730080&csu=730715
Sarah:
That's awful... :(
Ok, but now I am even more confused.
How is this particular ad problematic? Would you have the same problem if it was a $10 gift card with the purchase of a breast pump? Why are we penalizing Toys R Us for helping their customers offset the cost of formula??
If it was a general "Spend $50 and get a $10 gift card" I would have no problem with it. In this case, it is used specifically as a formula promotion. Breastfeeding mothers who are there purchasing a nursing pillow, nursing pads, or any other nursing supplies do not have the opportunity to access these same savings.
I'm with you FF. What's the big deal?
I've seen sales specifically aimed at breastfeeding. Buy a tube of nipple cream and get a box of breast pads free. Buy a Boppy and get a cover for half off. Didn't Dr Sears offer a nursing cover through his site in conjunction with something else?
It's not like a 10 dollar gift card is going to keep someone from BF. If you're at the store buying formula, you've already made the choice.
Dr. Sears offered a free copy of his breastfeeding book if you bought a nursing cover. I wasn't thrilled with that either! http://www.phdinparenting.com/2009/03/30/a-slap-in-the-boobs-by-dr-sears/
There comes a time for every new mother when she is exhausted, still learning to breastfeed and unsure of herself. It's 3:00 in the morning and the baby has been screaming for what seems like hours. The shiny cans of free formula from the hospital beckon. They're hard to resist when you lack the confidence that the baby is " getting enough".
We need to be supportive and encouraging to each other. We need to educate women to the benefits and the JOYS of breastfeeding. It's not that women aren't smart enough to resist the marketing. It's the lack of confidence, knowledge and support that many new moms experience.
I breastfed my daughter for 19 months. She is 23 now and happily breastfeeding her daughter. But surprisingly, she has had to explain/justify her decision to her in-laws who think we are root-chewing hippies.
And here's a suggestion since it seems wasteful to just throw away the free formula. Use it to make pancakes...;)
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Thanks a lot for this post. I see romania is not on the list, i think i'll have to write to geneva...
Anyway, just to let you know, one in milion facts abot nestle. So romania is a eastern european developing country, 20 ears after comunism felt, so not exactly africa. This is not stopping them. In about 70% of nestle prints (ads, formula boxes) they have written in a size 5 font (yes, try to read this after 12, 14, and 24 font) ' brest milk is the best'. But in none of the tv adds.
Plus, this weekwnd I attended a fair with my babywearing stuff. Of course, nestle was there too. Asking all the moms how old the babies are and then, if babies are more then 3,5 month, tring to convince them to give the babies nestle;s food jars. See, it's writen here 4+, it's perfect. Some moms were explaining they were brestfeeding but no, from 4 month you need to give them food. And look, how convenient, we offer you exaclty what you need. Oh, and don't wait, 6 month could be too late. BLEAH!
Ah, and some of them looked very professional dressed, as if they had any ideea what they were talking about.
Ha, the new nestle trick (in romania): mother's milk is ideal! like, you know, in a perfect world...but it's not perfect, so it's ok if you,like many others, can't BF, we have nestle...They don't say 'mothers' milk is the best' anymore, you might understand that you could BF too...
More than million Americans don't have health insurance and those that do are usually required to pay a copay to visit their doctor. What you are proposing is prohibitively expensive for many Americans and comes off as elitist.
Just my two cents,
Heather
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