Continued ...
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
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.
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