Many new
parents think infant formula is
the next best thing to Mom, but nothing
could be further from the truth.
by Katie Allison Granju
When Tabitha Walrond's
7-week-old infant died of starvation last year, the fact that this young New York mother
had attempted to breast-feed her baby -albeit with obvious lack of success
- was widely
blamed for the complex and haunting tragedy. The national headlines regarding the Walrond
case were ongoing and sensational. "Nursed to Death" read one.
"Breast-feeding can kill?" inquired another.
During the same period, the similar death of the 6-week-old breast-fed baby of another
New York mother, Tatiana Cheeks, raised further breast-feeding concerns in the press and
with the public. This time one headline read "Nursing Death?" In 1995, a
widely-circulated Wall Street Journal article detailing dehydration in several
middle-class breast-fed babies whose mothers had experienced breast-feeding difficulties
led to a surge in phone calls to pediatricians and hospital hotlines across the country
from new parents worried that breast-feeding itself could somehow harm their infants.
Given this environment, many conscientious new parents may conclude that formula-feeding
represents a safer alternative to the potential "dangers" of breast-feeding. In
fact, nothing could be further from the truth.
In virtually all of the reported cases each year in which a breast-fed baby becomes
seriously ill as a result of her mother's feeding choice, the problem is actually one of not
breast-feeding -meaning that, as in the Walrond and Cheeks cases, some uninformed and
unsupported nursing mothers are not aware that they aren't effectively transferring milk
from their breasts to their babies. In sharp contrast, however, routine formula feeding
-even when done properly by parents -is itself a contributor to overall rates of
infant morbidity and mortality in the United States. This is because - despite what
manufacturers' advertising would have parents believe -today's commercial infant
formulas, while a marked improvement over the homemade concoctions of years past, still
represent a flawed and highly inferior imitation of our own, species-specific milk.
According to the American Academy of Pediatrics' most recent member survey, a majority
of baby doctors see slightly more formula-fed babies than breast-fed babies admitted to the hospital
for instances of malnutrition and failure to thrive. But this represents only the tip of
the iceberg when it comes to the differences in rates of morbidity and mortality between
formula-fed and breast-fed infants in this country. When the overall health of formula-fed
infants in the U.S. is compared to that of breast-fed infants -even after controlling
for variables such as parents' socioeconomic backgrounds - it becomes clear that
formula-fed babies are sicker, sick more often, and are more likely to die in infancy or
childhood. However, parents often lack access to this information, and in fact, are often
the recipients of misinformation, thus denied the ability to make truly informed choices
regarding how they will feed their babies. Although the phrase "breast-feeding is
best" is tossed around so liberally as to have been rendered almost meaningless, many
Americans are under the mistaken impression that today's commercial infant formulas are
nearly identical to human milk. And because of this, parents who routinely approach other
important infant health and safety issues in a thoughtful, deliberate way are largely
unaware that in epidemiological terms, the decision to formula-feed when breast-feeding is
an option places their child at demonstrably higher risk for a wide variety of ailments.
"Parents are not adequately informed regarding the real risks of artificial milks
[infant formula]," says Nancy Wight, MD, FAAP, IBCLC, and a neonatologist at
Children's Hospital in San Diego. She says that she considers it part of her job to
strongly encourage the parents of her patients to breast-feed. "Doctors never worry
about making parents feel guilty when we discuss childhood immunizations, car seats,
seatbelts, bicycle helmets or fencing around pools. I have an obligation to my patients to
give them correct information - not formula marketing slogans - and let them make the
choice."
Dr. Lawrence Gartner, MD, FAAP is a respected medical authority on infant feeding who
has played a role in drafting policy statements for the AAP regarding this issue. He
agrees that parents today aren't fully aware that the breast-or-bottle decision is more
than just another neutral lifestyle choice. "Compared to other equally important child
safety issues like car seat use or babies' sleep position, parents should understand that
the decision whether to breast- or bottle-feed ranks right up on top when it comes to
protecting babies. The AAP certainly puts it in that category."
In fact, the AAP explicitly
states that encouraging breast-feeding among parents is "as important to
preventive pediatric health care as promoting immunizations, car seat use, and proper
infant sleep position."
Katherine Dettwyler, Ph.D., associate professor of anthropology at Texas A&M
University and an internationally recognized expert on infant nutrition, agrees with
Gartner's assessment of the relative risks of "artificial feeding" for American
children. "I would rank the decision of how to feed your baby as the No. 1 infant
safety issue in this country," says Dettwyler.
Despite the widespread misperception that aggressive promotion of breast-feeding has
had a major impact on how we feed our babies, more than 70% of infants in the United
States are fed infant formula as their primary source of nutrition for most of their
critical first year of life. According to a recent
report in the Washington Post, although a federal survey in 1995 found that 58% of
American mothers start off breast-feeding their babies -- the same percentage as a decade
earlier - 20% fewer mothers today are still breast-feeding after three months.
While it is certainly true that many individual formula-fed infants will do "just
fine" (as will most unvaccinated individuals in the United States), the research
clearly indicates that, as a population, America's formula-fed babies are not
"fine" at all
Parents may reasonably ask why, with research demonstrating the many and serious
potential health hazards of routine bottle-feeding, do so many otherwise competent doctors
continue to take a neutral or even pro-formula stance with their patients? As pediatrician
and author Dr. Jay Gordon noted in the book "So That's What They're For:
Breastfeeding Basics," by Janet Tamaro-Natt: "This [infant feeding] seems to be
the one area where you can practice medicine in the 1990s -with 1960s know-how
- and
not get sued."
The failure of many medical professionals to fully inform their patients of the impact
of infant feeding choices is due in large part to their own ignorance of the facts. Most
obstetricians, pediatricians and nurses graduate from their professional training having
had little or no exposure to the most up-to-date literature or clinical practice in this
area. In fact, a recent AAP
survey revealed that 45 percent of pediatrician respondents stated that they see
formula-feeding and breast-feeding as equally acceptable methods for feeding an infant.
The survey further noted that "nearly equal proportions of pediatricians agree and
disagree as to whether formula-fed babies are just as healthy in the long run as
breast-fed babies (34 percent vs. 38 percent); 27 percent are undecided." These
statistics reveal a shocking unfamiliarity with the large and growing body of current
research on this topic.
In many cases, health care providers' views on infant feeding are based on their own,
highly personal experiences. A nurse who chose to formula-feed her own children or a
doctor whose wife weaned her baby at three weeks is unlikely to be an effective advocate
for breast-feeding. A large-scale study of physicians' knowledge of human lactation in a
1995 issue of the Journal of the American Medical Association reported that the most
important factor influencing the effectiveness and accuracy of a doctor's breast-feeding
advice to patients was whether the doctor herself, or the doctor's wife, had breast-fed
her children. In a March 1999 report on breast-feeding promotion efforts by American
doctors, Pediatrics
magazine concluded, "A majority of pediatricians believe that breast-feeding and
formula-feeding are equally acceptable methods for feeding infants. Furthermore, reasons
given for not recommending breast-feeding include medical conditions such as mastitis,
nipple problems, low milk supply, jaundice, and low weight gain, which have recognized
therapeutic approaches that generally do not preclude breast-feeding."
"Doctors need to do better in giving their patients good information and support
regarding infant feeding," says Dr. Gartner, who has traveled the country offering
lactation training to physicians and hospitals. "But it takes a great deal more
education to do this. It's easy to explain to parents why they should put their baby in a
car seat, but human lactation is much more complex. Many, if not most doctors are carrying
around a lot of wrong information about breast-feeding versus bottle-feeding. In order to
be effective, they have to unlearn those misconceptions."
Infant formula companies have traditionally targeted health-care professionals as the
quickest route to convincing mothers that formula-feeding represents a safe, nourishing
option for their babies. Physicians and nurses in the U.S. routinely receive gifts, office
supplies, meals, a year's supply of free infant formula for themselves or a relative and
even pricey vacations from the infant-formula marketing representatives who haunt their
offices. According to Dr. Dettwyler, some pediatric residency programs are largely
underwritten by infant-formula manufacturers, an allegation verified by the National
Association of Breastfeeding Advocacy and the International Lactation Consultants
Association. Not surprisingly, more than 70 percent of surveyed pediatricians recently
reported to the AAP that they recommend a particular brand of infant formula to their
patients. (In contrast, Pediatrics reported that only 65 percent of pediatricians surveyed
recommend exclusive breastfeeding for the first month after birth; only 37 percent
recommend breastfeeding for the first year, as recommended last year by the AAP.)
The 1996 annual report from Abbott Laboratories, makers of Similac infant formula, took
note of this cozy tie between the medical community and infant-formula manufacturers,
stating that, "Abbott's close relationship with pediatricians and other health-care
providers serves as the foundation for the company's solid market position in the United
States. Pediatricians are also key to the success of the consumer education programs, such
as the Welcome Addition Club ...a program that provides new and expectant parents with a
broad range of information, from nutrition and breast-feeding tips to basic parenting
skills."
In 1994, after years of stalling by Republican administrations that opposed it, the
United States joined every other developed nation in the world as a signatory to the "WHO Code,"
an international agreement that, among other things, calls for an end to formula promotion
and giveaways through the health-care system and includes a clause stating that "no
financial or material inducements should be offered by [infant formula] manufacturers or
distributors to health workers, or members of their families, nor should these be
accepted." Despite the WHO Code, virtually all hospitals in the United States
offering maternity services - as well as the majority of individual obstetricians and
pediatricians - continue to provide massive free advertising from the huge pharmaceutical
companies that produce and market formula in the United States. Such promotional material
comes in the form of formula giveaways, patient "educational literature"
produced by the formula companies and even free baby equipment such as diaper bags.
Obviously, marketing and product giveaways on this scale cost infant-formula companies
millions and millions of dollars each year. But it pays off. Their own market research, as
well as medical literature and anecdotal observations by lactation professionals, have
demonstrated that these tactics make it statistically less likely that a women will
breast-feed without supplementation or breast-feed at all. And once a woman stops nursing
and begins feeding infant formula, these companies know that they likely have her
"hooked" on their product, since even a brief interruption in the nursing
relationship can cause a woman's own milk supply to dwindle or the baby to begin refusing
breast in favor of bottle.
American hospitals have largely shrugged off the idea that accepting free formula and
large cash "donations" in return for a particular formula company's right to
market directly to its patients represents an ethical problem. Around the world, thousands of hospitals
have become certified by the World Health Organization as "Baby-Friendly" by agreeing to
aggressively and accurately promote breast-feeding and to end the practice of allowing
infant-formula companies to offer freebies to personnel or patients. In the United States,
however, fewer than 20 hospitals and birthing centers
have received the Baby-Friendly designation.
"Hospitals should not be accepting free infant formula from these companies. They
know that if they didn't accept it, they would have a reduced sense of obligation to
promote formula. Their continued acceptance of this practice says something
important," notes Dr. Cunningham.
Because the WHO Code hasn't been incorporated into federal law in the United States as
it has in some other countries, it is impossible to enforce. And although American infant
formula companies claim to voluntarily adhere to the code's provisions, including no
direct marketing of infant formula to consumers, they openly flout the code and their own
assurances of compliance. This can be made clear by flipping through any popular parenting
magazine or watching any television program geared toward women in which appealing ads for
infant formula are abundant. Nestle, the notorious maker of Carnation brand formulas, is
perhaps most disingenuous when it comes to adherence to the WHO Code. On its Carnation Baby Web site, parents who
live in other countries are asked to read a statement in which Nestle makes a feeble
attempt to comply with the code by warning against bottle-feeding. American parents
entering the site receive no such statement from Nestle.
copyright, 1997, 1998, Katie Allison Granju.
About the Authors
Katie Allison Granju is a writer and mother living in
Knoxville, TN. Her book on attachment parenting will be released by Pocket Books, a
division of Simon and Schuster, in 1999.
You can e-mail her at kgranju@aol.com
or visit her site at http://www.locoparentis.blogspot.com
Breastfeeding.com would like to express our thanks to Katie for allowing her fine
article to be reprinted here.
Formula
For Disaster
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