Archive for the ‘ethics’ Category
The WHO Code is turning 35, and this vital public health policy is more critical than ever. The World Health Organization Code of Marketing of Breast Milk Substitutes was passed in 1981 to regulate predatory marketing tactics by infant formula companies. After World War II, formula sales boomed in the US, reaching their apex in the 1970s – the year I was born, just 22 percent of babies were ever breastfed. As they saturated the US market, formula companies looked overseas to expand markets for their products. They promoted formula as a modern, advanced approach to infant feeding, and dressed up sales representatives as nurses in clinics, pushing their product in communities where breastfeeding had been the norm for generations, and where clean water was in short supply.
Companies raked in profits, and babies died in droves. International outrage led the World Health Organization to adapt the Code, which banned marketing of artificial breast milk substitutes to consumers.
The US has never adapted the code, but formula companies did not market directly to consumers until the late 1980s – when, coincidentally, breastfeeding rates were rising in the US, cutting into formula profits. Today, families are inundated with formula marketing and free samples, and the formula market is big business in the US. Formula sales totaled US$4.8 billion in 2013 – that’s $1220.69 in sales for each of the 3,932,181 babies born in the United States in 2013. Read the rest of this entry »
Last month, I blogged on my growing discomfort with ‘risk-based language’ to support breastfeeding. I explained that rationale for risk-based language is that
… when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.
It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done.
In face, such a study has been done, by Lora Ebert Wallace and Erin N. Taylor, in the departments of Sociology and Anthropology and of Political Science at Western Illinois University. When they contacted me, they reminded me that I’ve blogged previously about their work on “shame” and “guilt” in discussions about breastfeeding. And – spoiler alert – they found that risk-based language did not increase breastfeeding intentions; rather, risk-based language reduced trust in the information provided. Read the rest of this entry »
Six years ago, I wrote a blog reflecting on Diane Wiessinger’s seminal essay, “Watch your language.” “There are no benefits of breastfeeding,” I wrote. “There are risks of formula feeding.”
That post remains the most-viewed piece I’ve ever written, with more than 74,000 views as of this writing. I’ve taken the lesson to heart. I’ve published a peer-reviewed study on the increased risk of hypertension among women with curtailed breastfeeding, and I’ve flipped odds ratios in teaching slides and review articles to frame associations as the “risk of not breastfeeding” or the “risk of formula,” rather than the “benefits of breastfeeding.”
Weissinger’s 1996 essay rests on the position that breastfeeding is the physiologic norm, against which all other feeding methods should be compared. Moreover, she notes, mothers who are facing difficulties will be more likely to seek help to avoid a risk than to achieve a benefit:
When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a ‘special bonus;’ but she may clamor for help if she knows how much she and her baby stand to lose.
Thus, when we talk about risks of formula, we will motivate mothers to “clamor for help,” and thereby increase breastfeeding rates and improve the health of mothers and babies.
It’s a compelling logical argument. And yet, I’ve been unable to find empirical evidence that it is true. To generate that evidence, we’d need to compare outcomes among mothers and babies counseled that formula increase risk with outcomes among those told that breastfeeding improves health and wellbeing. To my knowledge – and please let me know if there is a peer-reviewed study out there! – such a study has not been done. Read the rest of this entry »
I would like to reply to Courtney Jung’s op-ed, and many other similar editorials that attack breastfeeding advocacy as bad for women. This argument posits a false dichotomy, supported by formula advertising, that the true battleground for breastfeeding exists between “lactivists” and mothers who choose to, or must, formula feed their infants. Rather, breastfeeding advocacy today focuses on the social conditions that prevent women around the world from being able to make choices that support their health and empowerment, and the futures of their babies.
It is unclear why discourse on the “minimal” or “moderate” effects of breastfeeding continues; it is likely related to influence from both personal experiences of writers and influence from formula marketing. I will not engage this discourse here, as it is clear from every medical expert panel in every country in the world that the benefits of breastfeeding for health of mother and baby, decreasing economic and health inequities, and supporting a healthy environment, are well established. As breastfeeding is the physiologic norm, high rates of infant formula feeding negatively impacts all of these factors. Also, if what we are discussing is an over-emphasis on the social critique of women’s work, this is beside the point.
I am therefore saddened that media discourse on breastfeeding continues to undermine women by putting forth articles supporting the notion that a battleground exists between mothers. This classic patriarchal technique, of pitting women against each other, keeps the focus away from the systematic factors that undermine women around the world, including unequal access to paid maternity leave, evidence-based birthing practices, postpartum lactation support, breast milk banking, employer support of breastfeeding, and misleading advertising from infant formula companies. It is also the result of insufficient funding for public health infrastructures that therefore focus on breastfeeding promotion, without addressing breastfeeding support.
I urge us to notice that breastfeeding advocacy has moved on. The conflation of negative social experiences of mothers and breastfeeding advocacy is overstated. Advocacy has moved the dialogue, and we are saving our justified anger for the development of much-needed policies, medical practices and community movements that support women to have the real possibility of making choices that support the health and well-being of their families. The social and media conversation needs to move on as well. Editorials like Jung’s in the ‘Times’ only serve to continue the false conflation of advocacy and social blaming, and the false battleground between mothers.
ADDENDUM 10-19-2015 / 3 pm
Let me be clear: No one is saying this isn’t happening to moms. No one is saying that promotion without support is a good idea. Rather, I am criticizing the New York Times for continuing a conversation that pits women against each other and keeps our focus away from the ongoing structural inequities that women face. On both sides of this false battle, we are all agreeing that the battle shouldn’t be between each other, feeling critical or criticized for breastfeeding (or not). We should be joining together to force a conversation about how to create social conditions that actually support women in making choices that support their health and well-being. After all, what kind of choice is it if only one option is possible? As Gandalf would say: “YOU HAVE ONLY ONE CHOICE!” That is just improper diction…
(Also, FYI: research is being done on this, it’s just not getting published in the New York Times… exactly to my point. They are too busy with articles that radicalize breastfeeding advocates and dispute the value of breastfeeding.)
Casey Rosen-Carole, MD, MPH is an Academic General Pediatrics Fellow and Breastfeeding Medicine Fellow at the University of Rochester Medical Center
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.
May 21, 2014 marks the 33rd anniversary of the World Health Organization’s adoption of the International Code of Marketing of Breast-Milk Substitutes (or “the Code”) in an effort to promote breastfeeding and limit formula companies’ influence over women’s infant feeding decisions.
Today more than 20 organizations and thousands of moms and citizens are participating in a day of action led by Public Citizen, directed at the largest formula makers in the U.S. and Canada – Mead Johnson (manufacturer of Enfamil), Abbott (Similac) and Nestle (Gerber Good Start — and aiming to end the unethical practice of promoting formula in health care facilities, particularly through the distribution of commercial discharge bags with formula samples – a longstanding violation of the code. Efforts include the delivery of a petition with more than 17,000 signatures to Mead Johnson at its headquarters outside of Chicago as well as to Abbott and Nestle; sending photos and messages to companies on Facebook, Twitter and other online platforms; and blogs such as this one. The day of action is not meant to advocate against formula use in cases where it is necessary, but to focus on the need to give mothers unbiased information about infant feeding, information that hasn’t been influenced by formula companies.
In reflecting on the influence of formula companies, I realized that the history of my life parallels the history of the Code:
The 27th World Health Assembly in 1974 noted the general decline in breastfeeding related to different factors including the production of manufactured breast-milk substitutes and urged Member countries to review sales promotion activities on baby foods and to introduce appropriate remedial measures, including advertisement codes and legislation where necessary.
I was born a bit before this. My mom says that she wanted to breastfeed me but that nobody, including hospital personnel, could tell her how. My baby book contains the crib card with the formula company logo.
New Rochelle, NY, December 27, 2013—The Academy of Breastfeeding Medicine today asked the American Academy of Pediatrics to end its formula marketing relationship with Mead Johnson.
“AAP participation in formula marketing undermines consensus medical recommendations for exclusive breastfeeding for the first six months of life and is harmful to the health of mothers and infants,” wrote Wendy Brodribb, president of the Academy of Breastfeeding Medicine. “We urge the AAP to discontinue this relationship with Mead Johnson.”
In an email message to members of the AAP’s Section on Breastfeeding, AAP President Thomas McInerny stated, “The inclusion of formula in hospital discharge bags, along with the AAP educational materials Mead Johnson purchased, has sparked considerable discussion. The Academy has initiated conversations with Mead Johnson to ensure the AAP is not connected with distribution of formula samples in the future.”
The ABM executive committee urged the AAP to set strict guidelines regarding formula marketing, stating, “We further urge the AAP leadership to implement a formal policy prohibiting Academy participation in direct-to-consumer marketing of formula.”
As reported last week in The New York Times, the AAP has contracted with Mead Johnson to provide educational materials for the formula manufacturer’s hospital discharge bags. Rigorous studies have found that mothers who receive bags containing formula samples and coupons introduce formula earlier than mothers who receive non-commercial information.
Furthermore, families who plan to formula feed from the start perceive the brand-name discharge bags as an endorsement from their health care provider, leading them to spend hundreds of dollars on pricey brand-name formula, rather than equivalent generic products.
“Concern about these harmful effects of formula marketing has led two thirds of America’s 45 top hospitals to discontinue formula advertising in their maternity wards,” Dr. Wendy Brodribb, ABM President wrote. “It is therefore deeply troubling that the AAP has contracted with Mead Johnson to support this practice.”
The Annual ABM Meeting in Chicago this year was amazing–truly one of the best. Kudos to the conference planners, staff, and faculty. I was particularly interested in 1000 Days: The Window of Opportunity by Lucy Martinez Sullivan, MBA. Some of you may be familiar with this organization, but since I wasn’t, let me give you a bit of background. 1,000 Days
is a partnership between governments, the private sector and civil society organizations which promotes targeted action and investment to improve nutrition for mothers and children in the 1,000 days between a woman’s pregnancy and her child’s 2nd birthday when better nutrition can have a life-changing impact on a child’s future and help break the cycle of poverty…The partnership serves as a platform to encourage investment and strengthen policies to improve early nutrition in the developing world in alignment with the Scaling Up Nutrition (SUN) Framework, an approach that seeks to coordinate and accelerate international efforts to combat undernutrition.
It really is amazing that this organization is bringing together so many different types of organizations from all over the world to fight malnutrition and undernutrition. It makes sense that Ms. Sullivan came to speak to a room full of lactation specialists, right? It makes perfect sense since breastmilk is the normal nutrition for a baby/infant/toddler–and gives that child the best chance of survival. Nutrition from breastmilk is important for all babies, but especially vital for those born in developing countries since this can mean the difference between life and death. Read the rest of this entry »