Breastfeeding Medicine

Physicians blogging about breastfeeding

Appearances Mean Everything…or Do They?

with 3 comments

What does it mean when a pediatric health professional group makes a video on behalf of the Infant Formula Council (IFC)?  Do they, in some ways, becoming the ‘face’ of the organization??

This is the question that crossed my mind when I heard of NAPNAP’s (National Association of Nurse Practitioners) plan to partner with the Infant Formula Council (IFC) to film an educational video on infant formula preparation.  Why, I wondered, do you need a pediatric health professional to show the general public, mothers, women how to properly mix formula? Why can’t an IFC member do that?

The IFC is the trade group for formula manufacturers in the US, and its members systematically violate the World Health Organization International Code of Marketing of Breast Milk Substitutes.  On learning of NAPNAP’s plans, The Academy of Breastfeeding Medicine sent a letter to their president urging them to reconsider:

April 29th, 2010

Dear Ms. Beauchesne,

The Academy of Breastfeeding Medicine (ABM) is concerned to learn of NAPNAP’s affiliation with the Infant Formula Council (IFC). We understand your organization has formed a partnership to film an educational video on infant formula preparation. While proper formula preparation is an important issue, we feel that NAPNAP’s affiliation with the IFC is a conflict of interest. There is no reason that such an instructional video needs to feature a nurse practitioner, as opposed to someone from the IFC organization.

Indeed, this partnership directly conflicts with NAPNAP’s Position Statement on Breastfeeding: NAPNAP recommends all PNP educational programs provide comprehensive, culturally appropriate, and evidence-based education and clinical experiences in lactation in breastfeeding. NAPNAP encourages continuing education in management of the breastfeeding dyad. NAPNAP encourages its membership to: serve as an educational resource for other health professionals, the general public, and employers regarding the benefits of breastfeeding, thus correcting personal biases and knowledge deficits that may hinder support of breastfeeding.

As the trade organization for infant formula manufacturers, the IFC routinely violates the WHO Code of Marketing of Breastmilk Substitutes, thereby subverting breastfeeding. NAPNAP cannot work with this organization without contributing to very “personal biases and knowledge deficits that hinder support of breastfeeding” that your position statement commits to correcting. In addition, many NAPNAP Breastfeeding Interest Group members are IBCLC certified. Per the IBCLC Code of Ethics, an IBCLC may not be affiliated with an organization that doesn’t adhere to the WHO Code of Marketing Substitutes.

We strongly oppose NAPNAP’s affiliation with the IFC, and we feel that proceeding with this partnership would be a major step backward for breastfeeding mothers and babies in the U.S. Recent events have built momentum for the public health importance of breastfeeding, including the financial costs of formula use illustrated with Bartick’s recent study in Pediatrics and the passage of the new health care reform bill’s mandate for employee time and space to express breastmilk. A NAPNAP collaboration with the IFC would, in stark contrast to these developments, send a message that the nation’s pediatric nurse practitioners support and promote formula feeding.

We at ABM hope that NAPNAP leadership will strongly reconsider this partnership with the IFC. Thank you for your time and please feel free to contact us with any questions or concerns.


Jerry Calnen, ABM President

Beverly Curtis
Geri Fitzgerald

As a health care provider, I have serious concerns that an IFC video would essentially be a pediatric nurse practitioner infomercial for formula-feeding. I was also concerned about the other ethical issues after I reviewed the NAPNAP Policy Statement on Breastfeeding. How does this affiliation affect the NAPNAP members who are IBCLC’s and/or sit on the NAPNAP Breastfeeding Support Interest Group(BF-SIG) within the organization? Will this affect their standing in the IBLCE organization? Do NAPNAP members (BF-SIG/LC’s) now question the overall mission of their organization? Was this decision made with involving all members, including those on the BF-SIG?

Unfortunately, this isn’t a new phenomenon for medical organizations. Professional organizations, medical schools, and individual practices routinely accept funds and free samples from formula companies. Breastfeeding advocates sometimes cannot overcome the strength of the formula companies as they come into our organizations, hospitals, clinics, and teaching institutions.   As Dr. Thomas mentioned in her previous blog: Discussions with Doctors, many health providers receive minimal training about the health risks of formula feeding, and thus do not appreciate the ethical problems involved with promoting formula.

The good news is that over the past few months, breastfeeding has gotten a great deal of media attention (mostly positive).  Whether it’s a new study, policy issue, or discrimination case, breastfeeding is out there, and people are aware. I think this is the time where we, as health professionals, can use the latest studies, facts, and cost figures, along with changes in the health reform bill, to effect change in our health care settings, professional organizations, and within our community.

In this context, I very much hope that NAPNAP’s leadership will reconsider their partnership with the IFC.  And I hope that all of us can go back to our clinical settings and find ways to diminish the presence of formula marketing and promotion within our workplaces.

Natasha K. Sriraman is a general pediatrician and a professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by NKSriraman

May 9, 2010 at 9:23 am

Posted in Breastfeeding, ethics

3 Responses

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  1. Thank you.


    May 10, 2010 at 7:22 pm

  2. OMG – of course it is unethical! What are they thinking…. or is it more to the point to ask what they are being paid! I’m disgusted.


    May 10, 2010 at 8:54 pm

  3. To have nurse practictioners ally with the Infant Formula Council is a betrayal of their role as health professionals. This decision by NAPNAP horrifies me, and it is obviously not good ethical practice. I understand that it is important for parents to know how to safely and correctly prepare formula and bottles, and there is no reason for a nurse to be shown doing this in a video. This has long been a classic ploy of formula companies, to associate images of health professionals with formula. While nurses often are the ones to see the results of incorrect use of formula, they should be documenting how common this is, rather than partnering with formula companies to make feeding videos.

    Nurses want to be helpful, and still helpfully pass out “free” formula gift packs to new moms, completely missing the point that even a specially designed “breastfeeding” gift pack is just free promotion of formula. Pro-breastfeeding nurses, and RN IBCLCs have an uphill battle when it comes to convincing their fellow RNs of the negative effect of the bottle-feeding culture on breastfeeding, and that any display of gifts or products from formula companies is a promotion of their product, and discourages breastfeeding. That’s why it’s so important for more hospitals to work towards Baby Friendly certification, and more RNs in community agencies become at least lactation educaters, and better yet certify as IBCLCs.


    May 11, 2010 at 12:44 pm

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