What Every Parent Should Know About Infant Formula

by Katie Allison Granju

Continued ...

Physicians and other health-care providers in the developing world were influenced by formula manufacturers to steer patients away from breastfeeding and toward a particular brand of synthetic infant nutrition. Age-old cultural norms of exclusive and extended breastfeeding were disrupted as huge advertising campaigns convinced women that commercial infant-formula was the "modern, sterile, western" way to feed babies. New mothers were lured into giving birth in hospitals funded by infant formula manufacturers. There, these women were encouraged to offer bottles of artificial breast milk substitutes--a practice proven to disrupt breastfeeding.

Mothers and babies were then sent home with a small "free" supply of infant formula. By the time the supply ran out, baby was refusing the breast, mother's own milk supply was diminished, and the typical, impoverished family was unable to pay for any more infant formula. These practices, combined with an unsanitary water supply, lack of sterilization and refrigeration facilities, and poor access to medical care, conspired to kill millions of Third-World babies each year, according to the World Health Organization (WHO).

That is why, in 1977, a world-wide boycott was launched against Nestle Corporation, determined to be the most egregiously unethical actor in this sad drama. Consumers all over the world stopped purchasing Nestle products, and WHO convened a meeting to discuss what could be done to influence corporations marketing breast milk substitutes in the Third World. At the time, the acting World Health Director stated, "In my opinion, the campaign against bottle-feed advertising is unbelievably more important than the fight against smoking advertisements."

WHO subsequently drafted the International Code on the Marketing of Breast Milk Substitutes. The Code's main points called for no sales promotion to the public of products used as breast milk substitutes, and distribution of factual, ethical information to parents by health care workers. While the rest of the world signed onto the Code in the early 1980s, the United States withheld its support until the Clinton administration voiced its approval in 1994. Public-health and consumer activists have charged that Nestle and other corporations continue to violate the Code. According to WHO and UNICEF, between one and two million infants around the world still lose their lives each year due to artificial feeding. That is why, after a brief hiatus, the Nestle Boycott was relaunched in 1988 and continues to this day.

While American parents of the '90s may find information about bottle-feeding in the Third World interesting, most consider it irrelevant to their own infant-feeding choices, and believe that differing health outcomes between breastfed and artificially fed infants are minimized, if not negated, when the artificial breast milk substitute is a modern, commercially available product, regulated by the government and prepared in a sanitary fashion. Although it is estimated that the risk of death from diarrhea in less-developed nations is twenty-five times greater for bottle-fed infants than for breastfed ones, artificial feeding methods still carry significant health risks in the United States. Naomi Baumslag, M.D., MPH, and Dia Michels note in their book, MILK, MONEY AND MADNESS (Bergin and Garvey, 1995): "Even where bacterial contamination can be minimized, the risks of bottle-feeding are not inconsequential. Bottle-fed infants raised by educated women in clean environments, to this day, have significantly greater rates of illness and even death... In a study that analyzed hospitalization patterns for a homogeneous, middle-class, white American population, bottle-fed infants were fourteen times more likely to be hospitalized than breastfed infants."

According to Diane Weissinger, International Board Certified Lactation Consultant and nationally-known speaker on the topic of infant nutrition, "The only advantage that American women who formula-feed tend to have over Third-World women is better sanitation and medical care--and that's far from a culture-wide advantage. That in no way alters the long list of ailments to which their bottle-fed babies are prone."

The Texas Department of Health's Bureau of Nutrition Services says that artificially fed infants in the United States are three to four times more likely to suffer from diarrheal diseases (the number-one killer of infants worldwide), four times more likely to suffer from meningitis, and have an eighty-percent increase in the risk of lower respiratory infections. Marsha Walker, in her article, "A Fresh Look at The Risks of Artificial Feeding," published in the JOURNAL OF HUMAN LACTATION in 1993, refers to research demonstrating that artificially-fed babies see their risk for moderate to severe rotavirus gastroenteritis increase by five-fold. "Formula feeding is consistently associated with immune system disorders," she states. "Formula feeding accelerates the development of celiac disease, is a risk factor for Crohn's Disease and ulcerative colitis in adulthood, accounts for two to twenty-six percent of childhood-onset insulin dependent diabetes mellitus [and] imposes a five- eight-fold risk of developing lymphomas in children under fifteen if they were formula-fed or breastfed for less than six months." One of the most startling discoveries concerning artificial feeding is that it appears to increase an infant's risk for Sudden Infant Death Syndrome. The U.S. Centers for Disease Control's Morbidity and Mortality Weekly Review reported in 1996 that lack of breastfeeding (or artificial feeding), along with exposure to tobacco smoke and a prone sleeping position, is now recognized as one of the only known modifiable risk factors for SIDS.

Not surprisingly, in light of health risks associated with formula, is the 1995 study by Kaiser-Permanente Health Maintenance Organization in North Carolina finding that these babies' annual health costs averaged over $1400 more per infant than their breastfed counterparts. Unfortunately, even with the excellent medical care available to most American infants who become ill with formula-related maladies, the infant mortality rate has repeatedly been shown to be higher for U.S. infants who are fed infant formula. Research conducted by the U.S. National Institute of Environmental Health Sciences estimated that for every 1,000 infants born in this country each year, four will die because they were artificially fed. In another study, Dr. Miriam Labbock, a nutrition expert at Georgetown University, says that universal breastfeeding in the United States during the first twelve weeks of life could lower the overall U.S. infant-mortality rate by almost five percent.

Many Americans respond to the recent explosion of research into the hazards of artificial feeding by pointing out that most bottle-fed infants appear to be "just fine." Infant-health advocates counter that the vast majority of infants who ride without a car seat or who are placed to sleep in a face-down position will also be "just fine," yet concerned caregivers take the precaution of buckling children up and placing them to sleep in the medically recommended position in order to lessen risks to their health. The same is true for artificial feeding. While not every bottle-fed infant will become ill, a large and convincing body of information now demonstrates that as a group, these infants' risk for negative health outcomes is increased by a statistically significant margin.

Still, many parents simply cannot believe that their own doctor or hospital would take a neutral or even pro-formula stance if it posed such a threat to their babies' health. It would, indeed, be puzzling why physicians have continued to ignore the ever-growing mountain of evidence warning against routine artificial feeding for infants--if it were not for the close ties between formula companies and the medical establishment. The manufacture and sale of artificial breast milk substitutes is a hugely profitable venture. The average bottle-feeding family in the United States spends $1500 to $2000 per year on infant formula. According to the Attorney General of Florida, for each dollar charged for infant formula, the manufacturer spends only sixteen cents on production and delivery. This renders an astounding profit margin for the manufacturers. With such a lucrative product to promote, corporations have wisely enlisted the assistance of new parents' most trusted advisors--health care providers--in order to retain and increase their markets.

According to Baumslag and Michels in Milk, Money and Madness, the infant-formula industry contributes $1 million annually to the American Academy of Pediatrics (AAP) and provided at least $3 million toward the cost of building the AAP's headquarters. Formula manufacturers routinely host lavish parties and receptions for pediatricians at AAP functions. Other medical groups, such as the American College of Obstetricians and Gynecologists, the American Medical Association, the Association of Women's Health, Obstetric and Neonatal Nurses, and the American Dietetic Association receive cash grants and advertisements for their publications totaling hundreds of thousands of dollars annually.

Individual medical students and doctors receive loans, grants, and "gifts" from the pharmaceutical companies which produce infant formula, and a 1991 study found that the U.S. pharmaceutical industry spends $6,000 to $8,000 per doctor per year in promotion. Increasing amounts of medical research into infant health and nutrition is being underwritten by the infant formula industry. Physicians and nurses who choose to formula-feed their own infants frequently receive a year's free supply of formula. With all of this financial support, it's no wonder the U.S. medical community accommodates infant-formula manufacturers' distribution of advertising and "free samples" to parents in doctors' offices and hospitals, a practice which has been proven to discourage breastfeeding and which is in clear violation of the WHO Code on the Marketing of Breast Milk Substitutes. The infant-formula industry needn't worry, however, since health care providers are the group ethically responsible for reporting Code violations in the first place.

At present, concerned parents clearly cannot rely upon the medical community, the government, or the formula manufacturers themselves to effect change in favor of better quality commercial infant nutrition. It will require a consumer movement in the United States approaching the scale and intensity of the Nestle Boycott to bring about reforms. In the meantime, breastfeeding--an option available to an estimated ninety to ninety-five percent of new mothers--remains the safest, least expensive, and most healthful choice in infant feeding.

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copyright, 1997, 1998, Katie Allison Granju.
Breastfeeding.com would like to express our thanks to Katie for allowing her fine article to be reprinted here.