Wednesday, 26 October 2011

The Problem with Nipple Shields

Nipple shields – friend or foe? They are often touted as a ‘necessary purchase’, but perhaps we should be paying more attention to just who is doing the suggesting.

Nipple shields are artificial nipples worn over the mother’s nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through. Research on the use of nipple shields has revealed reduced milk transfer of up to 58 percent. It is therefore unsurprising that in Brazilian law nipple shields are included in its list of unmarketable products because their promotion and use can do harm to breastfeeding. La Leche League has commented that:

“Often, with use of rubber shields, infants are not able to compress the maternal milk sinuses, which can lead to long-term milk production problems and increased nipple soreness and damage. Since the infant has to rely on suction alone to transfer milk, nipple shields can drastically reduce his milk intake, potentially causing slow or inadequate weight gain. There are reports that even the thin silicone nipple shields cause reduced milk intake and present a potential for reduced maternal milk supply and nipple damage with improper placement.”

Today I made the decision to complain to Boots (large UK chain of cosmetics and drug stores). The reason? In their Bump to Birth, Parenting Club Magazine they currently have a Hospital Bag Essential feature which at the top states the following: “Pop these b-day must haves in your hospital bag and put it ready to go, by your front door” and then they include Boots Maternity Silicone Nipple Shields.  There is some small print below which says “Not for use until breastfeeding is established”.  So logically, what are they doing in a hospital bag essentials list!?

Now don’t get me wrong, nipple shields have a place in helping a minority of mothers to continue with breast feeding where they would have otherwise given up; for instance, to improve latch when a mother has flat or inverted nipples. However I can’t help thinking that their inclusion in this pregnancy magazine is misleading. Even with the small print, the article could easily lead readers to assume that nipple shields are a good idea to use from the start. By suggesting that all mothers may need them, the article is subtly undermining breastfeeding. Surely nipple shields are a product that would be better to buy as and when needed rather than just in case? The only person that should be recommending their use is a qualified lactation consultant, or similar. It's important that the baby's latch is assessed by a professional before a mother resorts to using them.

So why did Boots feature an unnecessary and potentially sabotaging product in a pregnancy guide? The first, and most obvious reason, is to increase their sales of nipple shields. Currently the cost per pair is £4.39. If every new mother were to purchase just one pair, this would give Boots over three hundred million pounds every year in England and Wales alone.

It is also relevant to note that Boots work in partnership with other companies. Their parenting club is sponsored by formula company Cow&Gate and bottle manufacturer Phillips Avent. Furthermore, Boots Parenting Club sponsored The East Midlands Baby and Toddler Show last week, alongside their buddies Philips Avent and formula company SMA. With these facts in mind, it becomes easier to see why sabotaging breastfeeding might be in Boots and their ‘associates’ best interests. 'Trust Boots' is their slogan. Would you?

So how about joining me? Type an email, write a letter or pick up the phone. Boots claim that they aim to respond to emails within 2 days.


Click here


Boots Customer Care
PO Box 5300
NG90 1AA


UK – 0845 070 8090
ROI – 1890 708 091
(Monday to Friday – 08:30 to 19:00
Saturday and Sunday – 08:45 to 17:00)

Tuesday, 25 October 2011

10 Reasons To Give Up Your Seat For a Pregnant Woman

It's the displeasing paradox of pregnancy - the bigger you are, the more invisible you become. After enduring pregnancy after pregnancy of having to stand on public transport I’ve decided to break my huffing, puffing, belly swaying, passive-aggressive silence. I’m going to explain once and for all why you should shift your perfectly capable cheeks off that seat and give it to a pregnant woman.

Here are some actual comments made during online discussions on the topic:

“I've been drinking beer for the past 30 odd years and my belly is huge!!!!! In fact it's bigger than a woman who is 8 months pregnant. So why should I give my seat up for someone who is slimmer than me”.

“An exhausted man deserves a seat just as much as an exhausted woman. I'd sooner give up my seat for a man who looks worn down and ill, than a pregnant woman who looks well and able.”

“That's the two edged sword of equality ladies - deal with it.”

“She is pregnant, not ill old or infirm. she just got laid. that's all. why does everyone think they 'deserve' something.”

There’s obviously a lot of ignorance around, the abundance of which has prompted me to create this pregnant woman’s arsenal of comebacks...

10 reasons to give up your seat for a pregnant woman:

1. Back pain. Most pregnant women experience back pain at some point during their pregnancies. As a woman’s pregnancy progresses, her change in stance strains the back muscles and causes spinal curvature and pelvic inclination leading to backache (Bullock-Saxton. J). The ache might worsen near the end of pregnancy because not only is the weight getting heavier, but the baby’s head might be in a position that pushes against the lower spine. Furthermore, as the abdominal muscles expand, they lose some of their ability to keep the spine erect and stable. Lack of stability and a change in the center of gravity can cause posture to change during standing which aggravates back pain. The most common type of back pain experienced in pregnancy is called ‘lumbar pain’. It is felt in the lower back, at the level of, or slightly higher than, the waist. It often results in pain that radiates to the legs. Lumbar pain is triggered by excess periods of standing. Moreover, these changes to skeletal stability are exacerbated by the normal weight gain that all healthy pregnant women experience. The average weight gain for a pregnant woman is equivalent to the weight of a 2 year old.

2. Blood pressure. For a pregnant woman, standing in an almost motionless position is more dangerous than walking around. “Standing still for long periods tends to lower blood pressure, and being pregnant would make that worse. If your blood pressure drops, you can get light-headed and potentially even faint” (Artal. R).  When standing, a pregnant woman’s heart rate increases, cardiac output decreases and blood pressure falls. When the woman then takes a sitting position, her heart rate, cardiac output and blood pressure returned to normal. Concomitant with these maternal heart rate changes, different patterns of fetal heart rate have been observed. About 70% of fetuses showed reduction in the long-term variability, increase in fetal heart rate or periodic accelerations (Schneider. K).

3. Nausea. Up to 90 percent of pregnant women experience morning sickness to some degree. For a lot of women it is a constant feeling of seasickness. It is thought to be caused by the human chorionic gonadotropin (hCG) hormone, estrogen, enhanced sense of smell, and being just another victim of Nature's cruel jokes. Nausea and vomiting can even become severe enough to threaten the health of mother and baby. Studies have found that standing for long periods of time intensifies the symptoms of nausea (O’Brien. B).

4. Weak joints. The effects of hormonal changes on a pregnant woman’s ligaments can increase the likelihood of injury. Unsurprisingly this risk is increased further when she’s swaying around on public transport. During pregnancy, the hormone relaxin is released to soften the joints in preparation for the birth of the baby. It also makes them unstable, so seemingly simple twisting motions can cause painful sprains. Also for one in four pregnant women the relaxin hormone causes the ligaments to soften and stretch too much and become painful (NHS). This is commonly called Symphysis Pubis Disorder and can be unbearable.

5. Fatigue. Many women feel constantly tired in pregnancy, even before they're showing or carrying any extra weight. Being pregnant puts a strain on the entire body. Hormone levels (for instance, the dramatic rise in progesterone) and metabolism of a pregnant woman are rapidly changing, while her blood sugar and blood pressure tend to be lower, all contributing to her sense of fatigue. Add to this the growing weight of the abdomen and difficulties sleeping due to backache, heartburn, leg cramps and SPD. Unsurprisingly fatigue is worsened by long periods of standing. One study found “marked cyclic accelerations” in heart rate in two-thirds pregnant women when in a standing position (Schneider. K). Fatigue can also be a symptom of iron-deficiency anemia, which is common in pregnancy. Around 42 percent of pregnant woman are anemic as a result of their pregnancy (Stoltzfus. RJ et al). During pregnancy, the amount of blood in a woman’s body increases until she has almost 50 percent more than usual. Anemia can make feelings of tiredness, weakness, and dizziness more intense.

6. Cankles. Or swollen ankles, to use the common term. Excess water buildup in a pregnant woman’s body commonly causes swelling, so much so that the the ankle and the calf appear seamless - hence the term 'cankle'. In medical circles such swelling is called edema.  Standing for long periods of time can lead to blood pooling in a pregnant woman’s feet, giving them this puffy and swollen appearance (Andrei. R; Dogra. A). In fact, during pregnancy feet can grow by more than an entire size. A common accompaniment to cankles are leg cramps whereby pressure from a pregnant woman’s growing uterus causes sharp pains down her legs.

7. Premature birth. Standing in a continued upright position can increase the risk of delivering a premature baby. This is because standing causes pooling of blood in the lower extremities, and that means that less is available for the uterus. Moreover, the enlarging uterus and fetus press on the vessels coming out of the pelvis and add insult to injury by diminishing return of blood from the legs to the heart. All of this can compromise the blood-driven nutrition to the developing fetus (Hatch. M; Henriksen. T et al; Fortier. I; Klebanoff. MA; Naeye. R; Escribà-Agüir. V; Mozurkewich. E et al). These risks are particularly severe if a woman has a history of previous pre-term birth, multiple miscarriages, known abnormalities of her uterus or cervix, bleeding (especially after the second trimester), a small-for-gestation pregnancy, low levels of amniotic fluid (oligohydramnios), or multiple gestations (twins or more). Also, standing for long periods has been significantly associated with low birth weight babies (Eunhee. H et al). Low birth weight babies are at risk of extra health problems, not only as infants but also, sometimes, throughout their lives.  In addition, the infant mortality rate increases dramatically when babies are born with a low birth weight.

8. Varicouse veins. Another reason that standing for long periods is not advisable for pregnant women is that they are more prone to circulatory problems. Blood levels in a woman’s body increase during pregnancy, and rising hormone levels can cause the walls of her blood vessels to relax. Varicose veins appear when the walls of the blood vessels stretch so much that their valves don’t close properly, causing blood to pool. These veins pop out in pregnancy because the blood volume in the body is increased and the weight of the uterus affects lower-body circulation. (Cherry. N; Mommy Feet).

9. Hemorrhoids. Fondly known as ‘piles’, hemorrhoids are swollen veins that appear as painful lumps on the anus. Think of them as the various veins of the arse. You may assume that standing can ease haemorrhoids but that couldn’t be further from the truth – standing for long periods can actually cause haemorrhoids in pregnant women. They often form as a result of increased circulation and pressure on the rectum and vagina from the growing baby. Hemorrhoids can be itchy, uncomfortable, and downright painful, like sitting on shards of glass.

10. Frequent urination. During pregnancy, when your breasts, arse and feet have grown, it feels like the only part of your body to actually reduce in size is your bladder. Repeated trips to the toilet are an unfortunate hallmark of pregnancy. One of the reasons for this is not bladder reduction, rather it is caused by a woman’s growing uterus and growing baby pressing against her bladder making the urge to urinate more intense. This is exacerbated by standing as the force of gravity pulls the baby onto the bladder. A lot of pregnant women notice that they don’t need to urinate until they stand up for a period of time. If you’re stuck on a bus with a baby pressing on your bladder and no toilet in sight, it can be very uncomfortable and often painful. Not to mention the fact that around 50% of all pregnant women suffer from stress incontinence (McPherson. H and Patrick. K) - otherwise known as peeing your pants.

Why should other people pay for a woman’s choice to be pregnant?

Pregnancy is (in most cases) an elective choice. A woman chose to be pregnant, so surely she should deal with the consequences? Comments such as this appear to believe that choosing to have a child is purely an individual act. However they neglect the fact that having a child can be a contribution to society as a whole. In 30 years the engine of our economy will be dependent upon today’s ‘bumps’. If we don't safeguard babies, our engine will creak to a halt. Who will pay into social security and care for the growing elderly population in 30 years? Producing and raising children is a productive activity. When it is done well, everyone in society benefits.

Furthermore, let’s not forget karma. You might need someone to give up their seat for you one day. The less people that give up their seat, the weaker the expectation that those who are capable of standing should give up their seat to those less capable. That means elderly people, those carrying children, the disabled, and people with injuries are more likely to suffer. Many Governments recognise that random acts of kindness enhance social-cohesion and make communities more pleasant and productive. Recently the UK Government created the “Together for London” campaign which focused on social responsibility. Posters such as this one were placed around London, particularly in Tube stations:

To counteract the arguments of smart-arses who say that they won’t give up their seat because the woman in question may just be fat, a free supply of “baby on board” badges were distributed to pregnant women:

What about gender equality?

It’s clear from the comments at the start of this article that some people hold misconceptions about the relationship between pregnancy and equality. Women want equality with men, so why should they expect ‘special’ treatment when it comes to pregnancy? After all, a man has paid the same price as the pregnant woman for his transport ticket. These are common arguments from bitter lazybones unwilling to shift their ass. In response I would argue that equality is recognising, rather than denying, that men and women are physiologically different, and that this diversity is not equated with either inferiority or superiority. With regard to pregnancy, equality means that women should be treated differently, because their differences are such that same treatment cannot provide equity. Rights should be based on needs, and if women have needs that men do not, that should not limit their rights.  Although differences exist between men and women, equality should function to make these differences “costless”. The cost of standing for long periods is far greater for a pregnant woman than for an able-bodied man.

Next time I observe the naive, ignorant or bitter touting that giving up a seat for a pregnant woman is outdated, unnecessary or unfair, I will link to this article. Whatever happened to human kindness? Let's try to bring it back.

Agree? Pin it!

Wednesday, 19 October 2011

Why the way you feed your baby is MY business

“My baby, my choice”.
“It’s got nothing to do with you how I feed my baby”.
“Live and let live”.

These are classic lines you’ll hear from some defensive formula feeding mothers whenever a breastfeeding advocate points out the flaws of formula. The message from those who give formula to their babies is clear: “It’s none of your business”. Yet I argue that the way a mother chooses to feed her baby IS my business. Read on to discover what motivates my judgy stance.

1. The abuse of developing countries riles me

...and the frustration is even moreso when that abuse is concentrated on infants.

Formula feeding in developing countries can lead to serious illness and even death. Take the Philippines for example. Just 16% of children between four and five months old are exclusively breastfed. This is one of the lowest documented rates on earth. Every year, according to the World Health Organisation, some 16,000 Filipino children die as a result of “inappropriate feeding practices”. These deaths are caused only by feeding children with formula. An article in The Guardian has highlighted that:

“Both the Government of the Philippines and the UN blame the manufacturers of baby formula for much of the decline in breastfeeding. These companies spend over $100m a year on advertising breastmilk substitutes in the Philippines. Those who appear most susceptible to this advertising are the poor, who are also the most likely to be using contaminated water to make up the feed. Some spend as much as one third of their household income on formula. Powdered milk now accounts for more sales than any other consumer product in the Philippines. Almost all of it is produced by companies based in the rich nations.”

Another issue is that the promotion of formula in developing countries results in a greater likelihood of closely spaced pregnancies, thus burdening women more and increasing the risk of their own deaths and that of their newborns and existing children. Formula feeding means that the contraceptive effect of breastfeeding is lost.

Of course, the Oscar for abusing developing countries goes to Nestle and their “milk nurses” (click here for more info).

Every time someone buys a can of formula, whether in the UK or abroad, they are fueling an industry which causes the death of thousands of babies. We live in a capitalist driven economy, so in effect, each pound/dollar we spend can be thought of as a vote. If I spend money on an industry that thinks it's acceptable to use unethical practices to promote their products, or an industry that causes severe environmental destruction or death of people, then I am in effect, voting with my pound, to say that such behaviour is acceptable.

2. I find the suffering of my nation’s children equally offensive

As I pointed out in “15 Tricks of Formula Companies” (click here to view), the dangerous risks of formula are not limited to poor countries. Even in rich, industrialised countries such as the UK and USA, where formula is assumed to be safe, formula fed infants are more likely than breastfed infants to suffer from...

•  Diarrhoea
•  Meningitis
•  Ear infections
•  Blood infections
•  Sudden Infant Death Syndrome (cot death)
•  Diabetes
•  Childhood cancers
•  Obesity
•  High blood cholesterol
•  Asthma
•  Reduced effectiveness of vaccinations
•  Reduced effectiveness of organ transplants
•  Candidiasis
•  Enteroviruses
•  Gastroenteritis
•  Giardia
•  Haemophilus Influenza
•  Necrotizing Enterocolitis
•  Pneumococcal Disease
•  Respiratory Infections (general)
•  Respiratory Infections (protective effect against exposure to tobacco smoke)
•  Respiratory Syncytial Virus
•  Salmonellosis
•  Sepsis in Preterm Infants
•  Urinary Tract Infections
•  Anemia and Iron Deficiency
•  Autoimmune Thyroid Disease
•  Constipation and Anal Fissures
•  Cryptorchidism (undescended testicle)
•  Gastroesophageal Reflex
•  Inguinal Hernia
•  Lactose Malabsorption
•  Morbidity and Mortality
•  Plagiocephaly
•  Pyloric Stenosis
•  Wheezing and Asthma
•  More pain during medical procedures
•  Impaired jaw and teeth development
•  Allergies
•  Eczema
•  Reduced Development and Intelligence
•  Bedwetting
•  Reduced Brainstem, Cognitive, and Motor Development
•  Reduced IQ
•  Reduced Gastrointestinal and Immune Development
•  Hormone imbalance
•  Reduced Neurological, Psychomotor and Social Development
•  Disturbed Sleep Cycles and Arousal
•  Reduced Speech and Language Development
•  Reduced Thymus Development
•  Autism
•  Appendicitis
•  Poor Bone mass
•  Cardiovascular Disease (Atherosclerosis, Cholesterol Concentration)
•  Celiac Disease
•  Helicobacter pylori infection
•  Haemophilus Influenzae Meningitis
•  Inflammatory Bowel Disease (Crohn's Disease, Ulcerative Colitis)
•  Juvenile Rheumatoid Arthritis (JRA)
•  Poor Mental Health
•  Menopause (timing of) – I’m not joking
•  Multiple Sclerosis
•  Reduced Oral and Dental Health
•  Reduced Protection against toxins (environmental contaminants, chemicals, heavy metals)
•  Schizophrenia
•  Reduced Stress Resilience
•  Tonsillitis

This bumper sticker was found on the window of a hospital nursery in America (John D. Archbold Memorial Hospital in Thomasville, GA):

In the population of the 596,122 babies born in England and Wales in 2002, the number of cases of asthma, coeliac disease and obesity that could be prevented over 7-9 years if all babies were breastfed was 33,100, 2655 and 13639 respectively (Akobeng.AK and Heller.RF). In the USA, 720 babies under 12 months of age die each year because they are not breastfed (Chen.A and Rogan.WJ).

And don’t get me started on the issue of product recalls. “Most parents have taken for granted, when they buy a tin of formula, that the contents are of high quality, but they are overly complacent” (Palmer. G 2009, 'The Politics of Breastfeeding'). Formula has been found to contain disease-causing microbes and pathogens. Dr. Derrick Jelliffe has characterized the history of formula production as “a succession of errors.” If I outlined each recall I’d be here all day. Suffice to say formula has been recalled for being contaminated with polyvinyl chloride, excessive magnesium, beetle parts, beetle larvae, pieces of hard plastic, elevated levels of lead, salmonella, glass particles, and enterobacter sakazakii (which can cause meningitis), to name a few of the incidents (read more information here). Needless to say, breastmilk will never be recalled. If the formula companies ceased marketing, they could spend the money saved on better quality control. However this will not happen because sales would fall without marketing, which refutes the common claim of formula companies that they only sell formula to fulfil a need.

Even when formula is not contaminated and is prepared according to Government guidelines, babies fed on it are significantly more likely to suffer from lifelong health complications. These scenarios occur worldwide, regardless of the wealth or development of the nation involved.

As I don’t use formula you may wonder why I’m troubled by this. However just because I did not give birth to the children suffering or put at risk because of formula feeding, this does not prevent me from feeling compassion for them. I find it short-sighted and self-centred that people expect me to care only for children to whom I have a genetic link.

What’s more, Article 24 of the Convention on the Rights of the Child recognises “the right of the child to the enjoyment of the highest attainable standard of health”. Thus I would argue that access to breastmilk is every baby’s human right.

3. Formula feeding dumps on the environment

“The ecological consequences of cloth vs disposable diapers are debated routinely, yet they are small potatoes compared to the consequences of the breast vs. formula decision.” (Michels. D, 'Mother Nature Loves Breastmilk').

Every time a can of formula is purchased, the buyer is having a greater impact on the environment than they may be aware of. Let’s look at the stats:

  • “The production of formula, cans, bottles, nipples, labels, packaging, and advertising uses trees, metal, glass, plastics, paper, and fuel. Artificial feeding of infants creates an enormous volume of waste materials” (Family Education).
  • For every million formula-fed babies, 150 million tins are used, made from 23,706 tonnes of metal.
  • The paper labels amount to 341 tonnes and the wasted paper materials of marketing goes way beyond that.
  • A company director at Avent bottle manufacturer boasted that its UK factory distributed 20 million bottles per year. Manufacturing processes and disposal problems make infant feeding equipment environmentally harmful.
  • “Bottles and nipples require plastic, glass, rubber, and silicon; production of these materials can be resource-intensive and often leads to end-products that are not-recyclable” (Michels.D).
  • Cows’ milk is transported from farm to factory for processing into powdered milk, itself an energy intensive process. It then goes to another processing plant to be made into formula. This is marketed globally and imported over thousands of miles (Palmer.G).
  • Cows need pasture. As the population of the world increases and more women formula feed, more cows are needed to produce milk to make infant formula, so wooded lands are cleared to provide grazing (Stanway.P).
  • Livestock account for 18% of human-caused greenhouse emissions. In addition, cattle rearing is linked with water contamination and soil erosion. Cattle feed products are also transported across the world.
  • A woman can produce hundreds of litres of breastmilk for a zero carbon footprint.
Because the environment is our life-support system, it's impossible to truly estimate its value. The deterioration of the environment threatens the earth's natural resources such as our clean water supply, fossil fuels for energy and food supply. Many of these resources are non-renewable. Once they are gone, they are gone forever. This is the legacy being left for our children.

4. Formula feeding undermines womans lib

Is infant feeding a feminist issue? There are compelling arguments which suggest so. The act of breastfeeding provides stunning evidence of women’s physical prowess and their contribution to the economy and human welfare. By nursing her baby, a woman confirms that she has the power to control her own body, and challenges medical hegemony. When we hand over the feeding of our babies to formula companies, we relinquish some of our power as women.  As Palmer has maintained, “the production and aggressive promotion of commercial formula took power away from women and gave it to industry. Industry got richer and women got poorer.” The genius of formula marketing and advertising is to get women to withhold from their offspring that which they already have and to instead purchase a replacement product of questionable quality. It is akin to being a given a “choice” between the blood already flowing through your veins and a replacement product that marginally resembles blood (Remer).

Instead of commonly being seen as a roadblock to women’s empowerment, breastfeeding should be seen as a facilitator of it. As Van Esterik remarked in her essay, “Breastfeeding: A Feminist Issue”, “Conditions supportive to successful nurturing, are conditions which reduce gender subordination generally by contradicting negative images of women and emphasising the value of women's reproductive work.” In other words, to disvalue breastfeeding is to disvalue women.

The BBC has contended that “All mothers produce breastmilk”. If, for sake of argument, we concede that 98% of women can produce sufficient breastmilk (Baby Friendly UK) yet less than 3% do so exclusively until 6 months (Unicef), this means that at least 95% of women are unnecessarily surrendering their baby’s health to the will of multinational corporations such as SMA and Aptamil. As I said in my article, '15 Formula Company Tricks' (click here to view), the primary purpose of these companies is not to do good or even provide useful products. Rather they have a statutory duty to put the needs of their shareholders first, which makes profit their prime concern.

When we consider that the highest ranking executives of formula companies are men (Aptamil/ Cow&Gate - Mr. Jan Bennick; Heinz - Mr. William Johnson; Hipp - Mr. Klaus Hipp; Wyeth/SMA - Mr. Rober Essner), we begin to see the injustice from a gender perspective. Women have a gift that is highly valued in evolutionary terms (that of single-handedly birthing and nutritionally sustaining human infants), yet their competence in delivering this gift has been undermined by men.

Furthermore, a common conception of formula is that it aids a woman’s economic mobility through strengthening her role in the workplace. She is no longer tied to a dependant infant and can instead pass a bottle of formula to grandma and return to being economically active. However this perceived benefit is negated by the fact that formula fed children are significantly more likely to fall ill, and numerous studies have shown that a child’s illness commonly results in the mother rather than the father taking time off work (Journal of Early Childhood; Weimer.J; Nursery World; Mother and Baby; Working Mums Magazine). Thus when a woman is taking more time off work she is seen as a burden by her employer. This does not strengthen the role of women in the workplace. Consequently women of childbaring age are viewed as liabilities. This is not to mention the strain on employers caused by their employees sick children results in lower incomes for working families, thus reducing income tax revenues which pay for government programs and services that benefit everyone.

5. Widespread formula feeding distorts society’s perception of breasts

In our society we have an ironically degenerate view of breasts. They are seen first and foremost as sexual objects, while their nurturing function has been downplayed. This leads to a sizable proportion of women declining breastfeeding because it makes them feel uncomfortable. Although bottle-feeding is common in the mass media, visual images of breastfeeding are rare, and a mother may never have seen a woman breastfeeding (Shannon.T et al; Swanson.V et al).

The act of placing your breast inside an infant’s mouth is somehow “creepy”, a view which the deputy editor of Mother and Baby magazine propagates (The Telegraph; The BBC). Such beliefs make women feel embarrassed and fearful of being stigmatized by people around them when they breastfeed. In The Guardian Yvonne Roberts observed that:

“The contradictions are endless. Breasts are allowed out on the Sun's Page Three but not actually to feed in a public place without embarrassment. Sex is OK on television ... but breast feeding? Now, that is disgusting.”

As I wrote in my article: “For and Against Breastfeeding in Public” (click here to view) people who have a negative response to viewing breastfeeding need to view more of it, then the act will no longer elicit a sensational reaction. The more women that breastfeed, the faster society’s perception of breasts as purely sexualised objects will change. Instead breasts will be viewed first and foremost as nurturing devices and providers of nature’s gold standard of nourishment for babies. This natural view of breasts already prevails in countries where breastfeeding is the norm and there is little formula feeding (Britton.C).

Therefore, for every woman that chooses formula over breast there is one less woman to normalise breastfeeding. Widespread breastfeeding would counteract the objectification and sexualisation of breasts, which is an especially important message for children.

6. Formula-use lowers the IQ of the population

“The nutrient advantages of human milk coupled with the mother-infant relationship provide the matrix for the child to reach his/her full intellectual potential” (Lawrence. R).

Breastfed children are more cooperative and socially better students the longer they are breastfed. In a study by Horwood. LJ and Fergusson. DM the high school drop-out rate was higher among children who had been formula-fed and lowest among those who had been breastfed equal to or longer than eight months, even when factors such as mother’s age, education, marital status, socio-economic status and family income were taken into account.

In the same study increasing duration of breastfeeding was associated with consistent and statistically significant increases in 1) intelligence quotient assessed at ages 8 and 9 years; 2) reading comprehension, mathematical ability, and scholastic ability assessed during the period from 10 to 13 years; 3) teacher ratings of reading and mathematics assessed at 8 and 12 years; and 4) higher levels of attainment in school leaving examinations. Furthermore, these effects are 1) pervasive, being reflected in a range of measures including standardized tests, teacher ratings, and academic outcomes in high school; and 2) relatively long-lived, extending throughout childhood into young adulthood.

Another study hypothesised that breast milk has a beneficial influence on cognition by affecting brain growth. Isaacs. E et al maintained that breast milk promotes brain development, particularly white matter growth.

It used to be thought that breast milk’s promotion of intellectual potential was down to it containing long-chain polyunsaturated fatty acids (LCPUFAs), notably docosahexaenoic acid (DHA). However when a synthetic form of DHA was added to formula milk, it was shown to have no developmental benefits (Simmer K et al). Instead the IQ safeguarding benefits of breastfeeding have been linked to the fact that human milk contains a wide variety of other factors including hormones and growth factors, some of which (e.g. thyroxin, nerve growth factor) are likely to influence cerebral development.

The contention that breastfeeding protects a child’s intellectual potential has also been backed up by numerous other studies (Quinn PJ et al; Kramer M et al; Mortensen EL et al; Angelsen. NK et al; Andersen JW et al; Gustafsson PA et al). These findings are not surprising when one considers that “cows' milk (the main staple ingredient in most formula) is designed to rapidly grow an animal with a large body and a small brain whereas human milk is designed to grow a small body but a large and rapidly developing brain” (The Independent).

But why do I care about the IQ of other people’s children? As formula feeding lowers the IQ of the population, this means less scientific advancements. We’re talking about cures for cancers and other diseases, new amenities, new technologies, strategies to combat global warming, and so on. Our society is becoming much more of a service based economy than ever before, with most of our manufacturing jobs disappearing in favour of those jobs that require far more education and knowledge. Intelligence paves the way for societal developments which benefit the whole community. If the bulk of society carries on formula feeding we will never reach our potential for scientific advancement.

7. More formula – more child abuse

Breastfeeding mothers are less likely to abuse their children. Controversial? Yes. Can I back it up with stats and research? Indeed (Reuters; Strathearn et al; Lvoff NM et al; Picton. G; American Society of Registered Nurses).

There are many reasons why breastfeeding has been shown to have a protective effect against abuse. The most prominent hypothesis is that breastfeeding enhances maternal responsiveness by stimulating oxytocin release, which is associated with reduced anxiety and elevated mood, a blunted physiological stress response, and more-attuned patterns of maternal behaviour (Strathearn.LChiodera P et al; Heinrichs M et al; Uvnäs-Moberg K and Eriksson M). These findings are consistent with animal research on the effects of oxytocin on long-term maternal behavior.

In the same vein, research has found that non-breastfeeding mothers demonstrate reduced brain responses when they hear their baby cry (Time).

Another hypothesis suggests that mothers who decide to breastfeed may be more emotionally invested in motherhood and in their child; in turn, these mothers may be less likely to neglect or abuse their child (Strathearn et al).

An alternative, and in my opinion more compelling hypothesis, is that breastfed babies are less likely to be abused because they cry roughly half as much as formula-fed babies. This is because breastfed babies don't need to wait for formula to be mixed and bottles to be warmed up; also a mother’s breast is a more effective pacifier than an artificial plastic teat; moreover formula-fed babies are in gastric distress much of the time - because formula is significantly harder to digest than breastmilk. Consequently, breastfeeding reduces the chances that a baby will be abused by causing the baby to cry less. Crying is one of the main triggers of abuse in infants (Children’s Memorial Hospital; Barr. R; Lee.C et al; Kids Health).

Other research has shown that parents who are sleep deprived are more likely to abuse their babies (Meltzer. L & Mindell. J). It’s a common misconception that formula-feeding parents sleep longer. In reality breastfeeding mothers get more sleep and their sleep is of higher quality. A breastfed baby can eat as soon as she or he is hungry. If cosleeping, that means before the baby even starts to cry. A formula-fed baby has to wait for formula to be prepared and warmed, in the meantime getting more and more distressed and agitated as well as waking others in the household. When breastfeeding, even the mother does not need to wake up fully to nurse her baby. Furthermore, the hormones produced during nursing have a relaxing effect, and the mother is likely to sleep even better when she nurses her baby.

Regardless of which hypothesis one favours, the fact remains that formula fed babies are more likely to be abused. Abused children are more likely than unabused children to grow into abusers themselves (Pears KC, Capaldi DM; Pianta R, Egeland B, Erickson MF). Thus, a vicious circle is perpetrated. I’m sure I’m not alone in contending that any behaviour which is likely to increase child abuse should be avoided wherever possible.

8. More formula - more crime

Countries with a high rate of breastfeeding benefit through reduced crime, reduced unemployment and generally stronger attachments with family and community supports (Barker 2008). Children who are not breastfed have particularly higher rates of delinquent, aggressive and anti-social behaviour (Oddy.W; Reuters; Telethon Institute for Child Health Research; Fraiser.J; York University). In a large-scale study only 4% of the breastfed babies showed a tendency to behavioural problems compared with 16% of those fed formula milk (The Guardian).

As with the relationship between formula feeding and child abuse discussed above, the relationship between formula feeding and crime has been the subject of various different hypothesis. One study suggests that delinquency in formula fed children is the result of a weaker maternal bond through not breastfeeding. Fergusson and Woodward maintain that “children who were breast fed for a longer duration were more likely to report higher levels of parental attachment and tended to perceive their mothers as being more caring and less overprotective towards them compared with bottle-fed children.” This is the case even when data were adjusted for maternal demographics.

Another hypothesis looks at the IQ enhancing effects of breastfeeding (discussed above).  For some time, researchers have known that people with criminal records tend to have low IQ scores (Hunt. E). Furthermore it has been shown that low IQ leads to delinquency rather than results from it (Lynam. D). Therefore by formula feeding a parent is increasing the risk that their child will turn to crime when they are older. The consequences of crime impact on the whole of society.

9. Formula-feeding hinders herd-immunity

Before I explain the technicalities of ‘herd immunity’ it is important to recognise that breastfeeding ensures that vaccinations have full effectiveness. Breastmilk promotes the response to immunisation made by the still maturing immunologic and enterohepatic systems of infants. It “influences physiologic parameters that can change metabolism of ethylmercury derived from some vaccines” (Dorea. J). Following vaccination, antibody levels are significantly higher in the breast-fed than formula-fed infants (Pabst.HF and Spady.DW; Silfverdal.SA et al).

As breastfeeding is the biological norm it is a fact that the use of formula lessens the effectiveness of vaccinations. This has significant consequences for herd immunity, otherwise known as ‘community immunity.’ Herd immunity:

“describes a form of immunity that occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. In contagious diseases that are transmitted from individual to individual, chains of infection are likely to be disrupted when large numbers of a population are immune or less susceptible to the disease. The greater the proportion of individuals who are resistant, the smaller the probability that a susceptible individual will come into contact with an infectious individual” (Wikipedia - Herd Immunity).

Herd immunity protects people who cannot safely receive vaccines because of a medical condition such as an immune disorder or for organ transplant recipients. It also protects people who don’t respond to vaccines. Formula feeding reduces the effectiveness of vaccinations, thus weakening herd immunity, putting vulnerable members of society at risk.

10. More colds and flu floating about

As I touched upon above, breastmilk protects and nurtures a baby’s developing immune system (NHS). It has beneficial effects on intestinal flora (Oddy. W) and contains unmatchable immunological properties (Field. C). This protection can last many years (Hanson. L)

Prematurely discontinuing breastfeeding can facilitate pathogenesis of many chronic diseases later in life - e.g, autoimmune disorders (Jackson. K and Nazar. A). This is not only bad for formula fed babies, it also has implications for vulnerable members of society such as the elderly or persons with auto-immune diseases. The theory is similar to herd immunity in vaccinations. Formula fed infants have a weaker immune system than nature intended. This means that more cold and flu viruses are passed around.

11. The redundancy of nature’s contraceptive

Mothers who formula feed miss out on the contraceptive affect of exclusive breastfeeding (this is one of the reasons that they are at greater risk of ovarian cancer). Consequently they are more likely to have closely spaced pregnancies. The fact that this is a problem is not unique to developing countries. As mothers who formula feed are more likely to come from lower-economic, uneducated, disadvantaged groups (The Guardian), the increase in closely spaced reproduction perpetuates a cycle of poverty. Any contraceptive choice that is removed from a woman reduces her economic choices. This creates more kinds of headache for the taxpayer. For instance, it can cost the taxpayer over £154,000 to support a single mother over a decade (The BBC).

12. Formula fed babies clog up hospital and doctor waiting lists

Formula fed children clog up waiting rooms in both hospitals and GPs surgeries. Since they are statistically less healthy, formula fed babies see the doctor more often (McConnachie.A). They have a higher risk of infection, and are more likely to spend time in hospital during their first year (Shiva.F and Ghotbi.F; Hengstermann.S; Galton Bachrach. VR et al; Quigley.MA). This difference does not depend on the social or economic status of the baby's family.

One comparative study in the US and UK, focusing on just three medical complaints - lower respiratory tract illnesses, otitis media, and gastrointestinal illness - found that in the first year of life, after adjusting for confounders, there were 2033 excess doctor visits, 212 excess days of hospitalization, and 609 excess prescriptions for per 1000 formula fed infants compared with 1000 infants exclusively breastfed for at least 3 months (Ball. T and Wright. A). These excess visits would be preventable by breastfeeding, thus freeing up doctors to tend to needy patients with unpreventable illness.

13. Formula culture is anti-breastfeeding

Formula feeding is viewed by many as the “normal” way to feed infants. This formula culture makes life difficult for current and future breastfeeding mothers. It perpetuates a vicious circle: less women breastfeed - breastfeeding seen as subnormal – hostility towards breastfeeding mums - less women breastfeed.

Until more women breastfeed the “boobie-traps” of our formula culture will continue to make life unnecessarily difficult for nursing mothers. By boobie traps I’m talking about such things as aggressive formula marketing; lack of support from family and friends; insufficient knowledge among medical professionals about breastfeeding techniques and challenges; misinformed postnatal hospital practices; and cultural attitudes (Read more about boobie traps here).

Taking aggressive formula marketing for example, formula companies invest millions of pounds in marketing material that undermines breastfeeding (see how it is done here). One of their strategies is to plant seeds of doubt in the mind of the breastfeeding mother where there were none before. For instance, many commercials for follow-on milk cite that “when you decide to move on from breastfeeding, use our formula”; note that the commercial says "when" not "if". The assumption is that all breastfeeding mothers must move onto formula at some stage, presumably at 6 months. Unfortunately this untruth has been absorbed by health professionals and then regurgitated to parents as the common misconception that “there is no nutritional value in breastmilk after 6 months”.

Another example of formula companies erecting unnecessary hurdles in the way of breastfeeding mothers can be seen via their company ‘carelines’. Many of these hotlines and their associated website content maintain that in order to successfully breastfeed a mother must consume a specialist diet, which is nonsense (read more about the strategies of formula company carelines here). The more people that buy formula, the more money formula companies have to perpetrate such inaccurate and misleading marketing, thus distorting choice for all women.

Likewise, the more people that buy formula, the more money formula companies have to manipulate health care professionals (see how it is done here) which not only makes breastfeeding mother’s lives harder (click here to see how health visitors in particular do this), it also stalls medical progress. Accurate information on formula, its ingredients, its safe preparation, and its risks are obscured by heavy marketing campaigns and the pseudo-science they contain. Many of these campaigns are aimed at health care professionals, who assimilate the information and then relay it back to parents.

14. Draining the public purse

A sizeable proportion of my household income goes to the Government in the form of taxes. This is money taken from my purse that could have been used to feed and clothe my children, so naturally I have an interest in what it is spent on.

Firstly, the UK tax-payer supplements the formula-use of low income families (HM Revenue and Customs). The same goes for US tax-payers; at least one-third of the US infant formula market receives support from government programs. Those programs include both food stamps as well as the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC). Tax payers also supplement formula used by the general population as there is no tax (VAT) on formula. Curiously there is still tax on nursing bras, breast pumps, breastpads, nipple cream, etc. Thus breastfeeding mothers pay tax on their paraphernalia, yet formula feeding mothers do not. The tax lost from formula is supplemented by the public purse. Is this fair in light of the fact that breastfeeding mothers and their healthier babies cost the Government less?

Secondly and perhaps more importantly, the additional number of illnesses needlessly suffered by formula-fed babies translates into staggering medical costs. UK taxpayers would save £360 million for every year of higher breastfeeding rates. This would be made up of annual savings in treatment costs and lifetime contribution to the economy from infants who would otherwise have died prematurely.  In 1991, in an English town, the costs of treating just 150 formula fed babies hospitalised for diarrhoea was estimated to be £225,000. Hospitalisation for diarrhoea is almost unknown for exclusively breastfed babies (Palmer. G).

Breastfeeding an infant saves £305 on medical costs alone during just the first 6 months of a baby’s life. When you consider that there are 605,634 babies born annually in the UK, if they were all breastfed for 6 months that would be a hell of a lot of taxpayers money saved. £305 x 605,634 = £184,718,370. Think about how many new homes, hospitals and schools could be built annually with that!

If there was just a 10% improvement in breastfeeding that would mean that 60,563 additional babies would be breastfed. UK taxpayers savings for just three illnesses and the formula, bottles and teats, would therefore be: 27

•  about 17,000 cases of otitis media avoided at a saving of £509,000.
•  almost 3900 cases of gastroenteritis being avoided, at a saving of £2.6 million
•  over 1500 cases of asthma being avoided, at a saving of £2.6 million.
•  a reduction in the cost of teats and formula of £102,000

(Source: Baby Milk Action. To see the cost of formula v breastfeeding in other countries, read this).

In the US a minimum of $3.6 billion would be saved annually if breastfeeding rates were increased. This figure is likely to be an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis.

Furthermore, formula feeding is subsidized by American taxpayers through WIC programs (supplemental nutrition programs for poor families), which spend over $578 million dollars on infant formula annually. WIC is the largest purchaser of infant formula, buying approximately 40 percent of all formula sold in the United States.

Thus the conclusions are unanimous: It is more expensive to provide formula than to breastfeed, and formula-feeding results in excess illness, which increases the cost of health care. Treating the ill-effects of formula feeding drives a significant amount of money away from the treatment of conditions such as Parkinson’s disease, motor neurone diseases, diabetes, cerebral palsy, heart disease, muscular dystrophy, and from cancer research. People unfortunate enough to be affected by non-preventable diseases through no fault of their own are being significantly disadvantaged by the preventable increase of ill health caused by formula feeding. Therefore whilst formula feeding parents contribute to the prosperity of formula companies, they are also contributing to the state of inadequacy found in NHS care for terminally ill patients.

The salt in the wound is the fact that formula companies are not paying for the social and financial debt they continuously bring about. In the UK, HM Revenue and Customs estimate that companies avoid £13.7 billion worth of taxes by using ‘tax havens’. Consequently, the bulk of tax is paid by the mass of ordinary middle or low paid people like you and I. Is it any wonder that so many breastfeeders feel contempt towards their formula feeding peers? (An issue discussed in great length in my book 'Breast Intentions').

In conclusion...

Just to clarify, I fully defend a woman’s right to chose how she feeds her baby IF that choice is fully informed, free from bias and backed up with adequate support; yet as I pointed out in Top 10 Breastfeeding Boobie Traps and 15 Formula Company Tricks the choice of whether to breastfeed or formula feed is far from fully informed and support is patchy. The consequence of manipulation from formula companies is the production and maintenance of a society where shareholders bonuses are valued above infant health, babies are dying and women have warped cynical views of their bodies. By giving their cash to formula companies, parents are fuelling this cycle, providing a bleak outlook for future generations. Research has shown that formula-use is environmentally inherited. In other words, if you formula feed, your children are more likely to formula feed when they become parents. Thus, one formula feeding parent can equate to generations of formula feeding. The problems mentioned above (strained healthcare services, deteriorating environment, delayed women’s liberation, etc) are prolonged for decades.

So next time you feel the urge to tell a lactivist (or anyone else for that matter) to mind their own business, bear in mind that our choices are not made in isolation, they often have widespread implications for other people and society as a whole.

Friday, 7 October 2011

15 Tricks of Formula Companies

Infant formulas were originally designed to be a medical nutritional tool for babies who are unable to breastfeed due to unfortunate circumstances such as maternal death or illness. Nowadays the formula industry accounts for US$20.2 billion (data for 2010). It doesn’t take Einstein to figure out that formula is now being used by more than the 2% of women who physically can’t breastfeed. What went wrong? Formula companies got greedy and laws didn’t keep up, that’s what. The greedier the company, the more strategic and underhanded their marketing becomes. This article exposes 15 tricks of the most popular formula companies, illustrating how greed is more powerful than concern for infant welfare.

Trick #1: Get your logo everywhere

FACT: Exposure to formula promotion increases significantly breastfeeding cessation in the first 2 weeks. Also, among women with uncertain goals or breastfeeding goals of 12 weeks or less, exposure to formula promotion results in exclusive, full, and overall breastfeeding duration being shortened (Howard C et al. Obstetrics and Gynaecology Vol 5, No 2, Feb 2000 p296-303).

This is bad news for babies, but great news for formula companies. The less women who breastfeed – the more formula is purchased. This means lots of wonga for the shareholders. To put this scenario in context, check out the following stats:

The advertising spend for formula companies in 2006/07 was £7,626,847, an increase of 36.6% on the previous year.

The UK Government budget for promoting breastfeeding was £729,011 in 2006/07, a decrease on the 2004/05 figure of £747,000.
(Figures published by Save the Children).

The key to successful product marketing is to get as much exposure as possible, and the formula companies have got this down to a tee. They’ve been churning out hard sell marketing for decades. Here’s a Cow & Gate advertisement published widely in 1940s and 1950s UK:

“The best possible start in life”? Looks like formula companies’ lack of accuracy is nothing new. Nowadays they just find more covert and underhanded ways to mislead parents. They advertise in parenting magazines and, more recently, fashion and celebrity magazines. Here is an advertisement from Aptamil (right) featured in Pregnancy Magazine April 2008. It is a stitched insert so that the magazine naturally falls open at that page. I’ll talk more about advertising to pregnant women bellow.

With so many formula companies paying vast amounts of money to parenting magazines, is it any wonder the deputy editor of Mother and Baby magazine wrote an article describing breastfeeding as “creepy” (The Guardian).

Along with magazines, formula companies also place their advertisements on third-party websites, forums and blogs, promoting their infant formula brand name and encouraging mothers to visit their company website. One of the reasons I am reluctant to activate advertising on this blog is the inevitability that a formula company will detect the parenting content and submit their advertisements to the server. Formula companies know that online presence leads to increased sales. They know that the internet is where new mothers go for advice when they are feeling fragile; some of the biggest formula companies have commissioned research into it (Made For Mums).

Not content with bombarding your computer when you’re online, formula companies want dibs on it offline too. The idea is that every time you switch on your PC or laptop you’ll see their brand. Here’s Aptamil’s free desktop calendar:

You’ll also be targeted in supermarkets, where Cow & Gate branded gifts such as dummies and growth charts are distributed. This photo was taken in Sainsbury’s, September 2007:

And here they are at it again in Tesco, August 2011:

Aside from these examples, there’s also leaflets in health centres, email spam, snail-mail spam, supermarket ‘shelf talkers’ (plastic signs that flop out at you), pamphlets in Bounty packs, billboards, posters on public transport, internet pop-ups, TV commercials, radio advertisements, text messages, newspaper ads, social network advertising, YouTube video advertising, and several other gems I shall reveal bellow. Formula companies have an array of arsenal in their fight to line your baby’s gut, and more importantly, their pockets. The more cash they make, the more surplus funds they have to pump into their marketing arsenal. At this point you may wish to ponder what arsenal the breastfeeding movement has, and whose interests it serves.

Trick #2: Exploit the lazy

The rise of the bottle-feeding culture has fundamentally distorted our perception of the normal biology and psychology of new motherhood. It has produced a growing number of women who do not want babies’ feeds to dictate their lives. They cannot cope with the frequency of feeds required to maintain a good milk supply; that is, they cannot content themselves to sit and feed.

Why do a significant proportion of women now find that they 'can't cope' with something that's a biologically normal part of parenting? Women coped sufficiently well until formula marketing kicked off in the late 19th and early 20th centuries. They also coped during the Second World War when formula was unavailable.

By claiming convenience, formula companies tap into the psyche of the lazy parent. However as I described in my article “10 (Selfish) Things I Love About Breastfeeding”, formula feeding is anything but convenient and in many cases it’s tantamount to a pain in the arse.

No time is formula feeding more of a pain than during the night. Kettles to boil, powder to mix, milk to cool - it’s enough to wake the neighbours; so formula companies have produced ‘Goodnight Milk’. The name itself is an idealizing claim, as it suggests the milk is necessary for babies to sleep through the night. The suggestion itself is concerning, as sleeping deeper puts babies at higher risk of cot death. UNICEF has maintained that “Goodnight Milk is not necessary for any baby and there is no independent evidence to support the claim that they help babies settle or that they are easy to digest.” (UNICEF 2010).

Goodnight milks are thickened with cereals to make them harder to digest. Aside from the risk that they will be used to replace a night time breastfeed, another worry is that the products could encourage parents to put their baby to bed immediately after bottle-feeding which would rot a baby's developing teeth.

As with goodnight milk, the following SMA television advertisement plays on mothers’ insecurities and concerns about night feeding. It features a voice over from a man promising not to pretend to be asleep when his young baby wakes up and promising to do his share of night feeding. A scene from the ad shows a dad falling asleep next to a boiling kettle and a tin of SMA Progress in the middle of the night:

I’m sorry to burst SMA’s bubble but as Gabrielle Palmer (The Politics of Breastfeeding, 2009) has pointed out, “The reality is that few fathers actually do take the whole responsibility of infant care and most artificial feeding is still done by mothers”. Pauline Lim, author of the very useful book Teach Yourself Successful Breastfeeding, concurs that:

"In reality few partners actually share the night feeds, so don't be tempted to stop breastfeeding for this reason. There might be an odd occasion when this happens but the novelty wears off very quickly, leaving you firmly back in charge of the night-feed. This is particularly true when your partner has to get up for work".

Trick #3: Evade the law

(Warning: this section contains boring yet necessary legal content - I knew my law degree would come in handy one day). Twenty-six years ago, in recognition of the damage to infant health caused by the promotion of formula, the world’s highest health policy setting body – the World Health Assembly (WHA) -  adopted a set of rules called the International Code of Marketing of Breastmilk Substitutes (click here to view). It was intended “as a minimum requirement” to be “implemented in its entirety” by “all countries.” The aim of the Code is to protect all parents from commercial exploitation and to outlaw biased and inappropriate information. The Code was implemented into UK law in 1995 by the Infant Formula and Follow-on Formula Regulations (click here to view). They specify claims that companies are allowed to make about formula. Only claims specified in the law are permitted.

Obviously this Fairy Story didn’t end Happily Ever After. The Code’s implementation into UK law was piecemeal and littered with loopholes. This unfortunate state of affairs was no accident. It was an attempt by the UK Government to pacify the formula companies and prevent their business fleeing the UK. One example (and the biggest obstacle to change) is the Better Regulation Executive which forms part of the UK Department for Business, Innovation and Skills. It serves to block any rule that might interfere with a company's ability to make money. It gives businesses direct influence on how regulations that affect them are devised and delivered. It makes it easier to change or remove regulations, where this would be beneficial for the business. It also aims to reduce existing regulatory burdens affecting businesses. In the realm of baby milk, it places corporate profits above the health and welfare of babies.

Furthermore, Trading Standards Officers do not take action against formula companies anywhere near as often as they should because such action is expensive. Formula companies have much more disposable cash to pay lawyers than the Government can glean from the public purse.

Therefore currently we are stuck with a rather impotent law, yet it is still law nonetheless. Sometimes the formula companies’ evasion of the law is subtle using manipulation and strained interpretation, and sometimes the evasion is blatant criminality. On the face of it, the latter strategy seems more risky for the formula companies, however with laws so weakly drafted and with the risk of legal action being so sparse, law breaking is a profitable gamble for the formula companies.

One of the most prolific and blatant evasions of the law occurred when formula companies created so-called “follow-on” milk (formulated for babies aged 6 months plus). UNICEF have commented that “It is not necessary to move your baby on to these milks” (UNICEF 2010). In fact they have less nutritional value than first milks. Follow-on milks did not exist as a separate classification of product when the International Code of Marketing of Breastmilk Substitutes was adopted. They were introduced in an attempt to escape the provisions of the Code (which prohibits advertising formula for babies less than 6 months). Likewise, they were not invented because health professionals begged formula companies to produce a less-modified milk for older babies. They created these products as a means of promoting their entire formula range.

Take this magazine on the right for example. Although entitled Pregnancy and Birth, it contains 8 full pages of advertisements for follow-on formulae, formula brand names and Baby Clubs, as well as bottles, bottle warmers, and also baby foods advertised “from 4 months”.

A lot of the time, when parents see adverts for follow-on formula they think they are seeing adverts for infant formula; and this of course, is the intention of formula companies. The tins of infant and follow-on milk sit next to each other on the supermarket shelf; thus completely ignoring the requirement in the Code’s Guidance Notes that infant formula and follow-on formula should be placed in separate areas in retail outlets. Also as you can see from the photo bellow, the formula companies use almost identical packaging to make the formulas cross-promotional. Thus, advertising for one product is likely to encourage sales of the other. This has proven to be an effective, if underhanded, way to exploit the fact that follow-on formula advertising is permitted.

The effectiveness of this cross-labelling strategy was highlighted in a 2007 study (available from Baby Milk Action). Amongst a nationally representative sample of women of childbearing age, there was a high recognition of formula manufacturer’s logos and a very high association between the logo and formula for babies less than 6 months. Taking SMA’s logo for example, 89% of women linked the logo to formula for very young babies. Formula companies have strengthened this effect by making their logos (SMA, Cow&Gate, Aptamil, etc) more prominent on their advertising and packaging than the actual product name (Gold, Follow-on, Progress, etc).

Campaigners have pointed to some adverts that don't make it clear which of the two products they are promoting. When Baby Milk Action complained to the Advertising Standards Authority, it was told that the authority would not investigate unless the adverts specifically mention infant formula. Thus token reference to follow-on milk (usually in miniscule small print) seems to be sufficient to dissuade Trading Standards and the ASA from acting.

The Consumer Committee of the EU Parliament questioned the scientific basis for follow-on milks back in 1985, calling them “extremely dubious”. More recently, the UK Government’s Scientific Advisory Committee on Nutrition (SACN) has maintained that follow-on formula is an unnecessary product. They maintain that: “There is no case for allowing the advertising of follow-on formula... there is no scientific evidence demonstrating nutritional advantage of this product over infant formula...[both these] are breast milk substitutes as defined by the Code (which sets no upper infant age limit on this term)...We find the case for labelling infant formula or follow on formula with health or nutrition claims entirely unsupportable”.

The fact that follow-on formula is unnecessary and was created purely to circumvent law is illuminated in Scandinavia. The follow-on formulas marketed in the UK would not appear in Scandinavian countries because they do not have a culture of using follow-on milks. Instead the culture in Scandinavia is for those who wish to bottle-feed to use the same formula from birth to one year of age. If follow-on formula was necessary to a baby’s diet there would be a demand in Scandinavian countries. In fact, the UK Department of Health in their “Birth to 5” manual recommends that if a mother is not breastfeeding, she should continue using ordinary infant formula for the first year of her babies life. There is no mention of follow-on milk.

Trick #4: Get them while they’re young (very young)

As I outlined above, advertising infant formula (milk for babies under 6 months) has been illegal in the UK since 1995. The main reasoning behind this ban was to prevent the undermining of breastfeeding. In turn, it was hoped that this would enhance the health of the nation, as breastfed babies have greater immune health, fewer infections, reduced risk of sudden infant death syndrome, less diabetes, less childhood obesity and less tendency to develop allergic diseases, to name a fraction of the benefits. An honourable goal. Needless to say, it’s not one the formula companies aspire to. In fact, they became rather agitated by the law’s attempt to put a lid on their profits. If they cannot advertise their products for young babies, how can they convince mothers to choose bottle over breast, and more importantly, to choose their brand over other formulas? One strategy they developed to overcome this legal roadblock was to target pregnant women.

There’s a snag though, seeking direct or indirect contact with pregnant women is prohibited by the Code. However, formula companies, knowing that they have bigger penises than the law, roll their eyes at this minor inconvenience and proceed with their antenatal marketing anyway. Before your baby has even taken its first breath, she is already earmarked by the formula companies as a valuable source of revenue. This takes “cradle to grave” marketing to a whole new level.

For instance, in 2008 Cow & Gate attached a postcard to one of its magazine advertisements (featured in Prima Baby and many other magazines) and invited pregnant women to return it (see left). The postcard featured a tick box for receiving information on infant milks. The pregnant women are offered £90 of vouchers as an inducement for signing up.  Offering gift incentives is specifically mentioned as unacceptable in the Regulations 23(2) and Guidance 73.
Here is a similar strategy by Aptamil (right). They advertised in Prima Baby and Pregnancy in December 2008, encouraging pregnant mothers to join the Aptamil Baby Club to receive information and gifts, to visit the company website (where all Aptamil formulas are promoted) and to call the Aptamil telephone ‘careline’. It’s no coincidence that the term ‘healthy start’ is used - the name for a National Health Service scheme.

Similarly, this SMA advertisement appeared in the celebrity magazine Closer (31 Jan - 6 Feb 2009). It targets pregnant women with the headline: “Our free DVD will get you through the first 48 hours.” It directs people to the site where the full range of formulas are promoted. As it targets pregnant women, its target audience would look to the infant formula, making this, in effect, an infant formula advertisement.

Not wanting to miss out on this antenatal free-for-all, Hipp produced a pregnancy record book which it gave to pregnant women for free. How kind. Shame it’s littered with their crap.

Trick #5: Fabricate similarities to breastmilk.

Just to point out the obvious, formula milk is an entirely different substance from human milk, containing no living cells and not adapting to each baby’s individual changing needs. In fact, cow’s milk is the commonest basis of formula, not because it is the most appropriate breastmilk substitute - “chimpanzees’ or horses’ milk might be better” (Palmer 2009) - but because it is the cheapest and most readily available and therefore most used.

Some may praise formula companies for quoting the superiority of breastfeeding on their packaging: “breastfeeding is best for your baby” they cite. They do this, not merely because they are required to do so by law, but because it also affords them various benefits. By citing 'breast is best' the formula company is making a purely token concession, referring to one of the weaker arguments on the side of breastfeeding (even lactivists have criticize the slogan 'breast is best' for being misleading and counter-productive). This concession polishes the formula company's own image by adding to it the gloss of apparent objectivity.

It was not long before the formula companies discovered that they could go even further and change the ‘breast is best’ required notice into an endorsement by suggesting their product is close to or inspired by breastmilk. The term “closer than ever to breastmilk” is not compliant with UK Regulations. However in 2007 the front of Cow & Gate's tin read “Closer than ever to breastmilk”. SMA Gold read “now even closer to breastmilk”, while Aptamil read “the closest to breastmilk”. It is depressing yet predictable that a poll by Mori for the National Childbirth Trust found that a third of women believe that infant formula was “as good as” or “better than” breastmilk. For a mother who is struggling with breastfeeding (and most do, in the initial weeks), who is worried about her milk supply, the packaging of formula appears to offer reassurance: “Closer than ever to breastmilk” might sound close enough. It is unsurprising that most women switch from breast to formula at this stage.

When the law requested a change to formula packaging to reflect the fact that the term “closer than ever to breastmilk” was false and misleading, a spokesman for SMA, said: “We are changing our packaging in April. We would say the claims are fair and accurate, however the FSA has asked for a change and we will comply.”

So they changed their logo from this:

To this:

Notice how the new logo replicates a stylised image of a breastfeeding mother. *headdesk*

Furthermore, an email sent to parents from SMA claimed that, for mothers who don’t breastfeed: “They can still provide all the necessary goodness by choosing infant milk with a balance of nutrients as close to breast milk as possible, like SMA Gold.” The claim “close to breastmilk” is purposely vague. Closer to breastmilk than what? If you compare formula to say, petrol, then yes I guess it is closer to breastmilk. But how many parents would consider giving their beloved offspring a refreshing sippy cup of petrol?

Cow & Gate claimed that their milk supports the immune system, similarly to breastmilk (left). In truth babies fed on the formula are more likely to become sick and to be hospitalized than babies who are breastfed. The advertisement is now banned in the UK (Read about it in The Guardian: Cow & Gate case;  Aptamil Case; and in The BBC).
Aptamil also jumped on the bandwagon with these gems:

This advertisement for Aptamil appeared in The Independent newspaper during National Breastfeeding Awareness Week in May 2005. It draws equivalence between Aptamil and breastmilk.

A recent television and internet advertisement for Aptamil follow-on formula touts that the formula is “inspired by breastmilk.” Check out the Readybrek style blue glow around the breastfed baby. It’s supposed to signify protection. In the next shot there is a baby being bottle-fed with the same blue protective 'glow' implying equivalence with breastmilk.

Here’s an advertisement from a parenting magazine in Germany. It shows Aptamil (surprise, surprise) follow-on formulas with an obvious link to breastfeeding:

In 2006 Heinz promoted its formula on the back of the UK Government’s Healthy Start scheme claiming its formula was closest to breastmilk.

In 2010 Hipp (bellow) claimed that their formula contains “the key nutrients found in breastmilk but with an added bonus: they’re organic”. Bizarre. What is breastmilk if not organic? In fact, breastmilk is more organic than any formula could ever be. And as for their claim: “doesn't it go without saying that after the breast you want to give the very best”; Firstly, the breast is the very best; and secondly, the advertisement implies that every mother should switch to formula after breastfeeding which is absurd.

Amongst this frenzy of promoting new ingredients as equivalent to breastmilk, the subject the formula companies like to avoid is ‘nutrient bioavailability’ (i.e. how much is actually taken up by the body). The nutrients in breastmilk are so well-absorbed that there is very little waste. Compare the nappies of breastfed and formula fed babies (if you’re that way inclined) and you’ll see the contrast.

Trick #6: Throw in some pseudo-science

What do the following sentences have in common?

  • 'Prebiotics support natural defences'.
  •  'Beta carotene... to help maintain a healthy immune system'.
  •  'Nucleotides help growth and the immune system'.
  •  'Omega 3 long-chain polyunsaturated fatty acids (LCPUFAs) - for development'.
  • ‘Now with “Immunofortis”.
  • “Alphan lactalbumin, new betapol, LCP and betapol improve calcium absorption.

They’re all banned in UK advertising because they are not compliant with the Regulations. Despite this fact, Trading Standards have allowed them to work through the distribution system, which means that they’ve been on the supermarket shelves for a year or more.

These smart-arse sounding ingredients are a form of pseudo-science. In other words, they are exaggerated or made up names for made up ingredients with no proven benefits. Pseudo-science specializes in the use of technical jargon to deceive parents into supposing that claims of a scientific nature are being made, and that objective experimental evidence supports them. The white coat of technical jargon is so dazzingly clean (never having been tainted by any real scientific work) that it blinds parents to the true merits of what is being claimed. Just as loaded words try to manipulate parents emotionally, so does pseudo-scientific jargon try to induce an unearned respect for what is said.

The European Commission's scientific advisory body has maintained that formula companies should remove all nutrition claims from their advertising and packaging except 'lactose free'. However this is merely a recommendation rather than solid law. You don’t need to be Mystic Meg to have foreseen that formula companies chose to turn a blind eye to this request, instead opting to continue making statements for which scientists say there is no evidence.

Take for example LCPUFAs, they are a poor imitation of the LPCAs found in breastmilk. Formula companies make them from laboratory-grown fermented algae and fungus. Scientific studies have found that artificial LCPUFAs do not enhance infant health or development in any way (Simmer K. Longchain polyunsaturated fatty acid supplementation in infants born at term. The Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD000376). More worryingly, some studies have reported unexpected deaths among infants who consumed formula supplemented with LCPUFAs (Palmer. G 2009). You won’t see that information on the can.

The claim that “prebiotics support a baby's natural defences” is also not compliant with UK Regulations. Yet one particular formula company has bent over backwards to tell you that “babies thrive when their natural immune system is supported, so Cow & Gate milks are developed with special nutrients, such as prebiotics, that can do this. It's our way of helping you to protect your baby.” Aptamil packaging claims that “prebiotics ... support your baby's natural immune system”. It also made claims, about fatty acids, nucleotides and betacarotene which contravene the Regulations.

It would seem that the formula companies like to compete with each other to see who can create the most scientific-sounding, longest, hardest to pronounce fictional proteins. Indeed, the first rule in pseudo-science is to never use a four letter word, especially if you can think of a 24 letter word to take its place. Remember, the basic function of pseudo-scientific words is to prevent communication. Their real task is to transform what is banal, trivial and easily refuted into something profound, impressive and hard to deny. Check out this whopper from Cow&Gate: “Oligosaccharides”. They’re pulling out the big guns here. Unsurprisingly, this made-up term is not permitted by the Regulations.

In the rare occasion that a formula advertisement features references as evidence for its claims, in most cases there are substantial conflicts of interest. The formula company has often donated the formula used in the study, part-fund the study and provided the randomization schedule of study participants to the researchers, who work for a foundation receiving financial support from the formula company. Sleazy business. This kind of behaviour makes politicians appear positively angelic.

In amongst the flaunts of pseudo science there is no mention that a child fed on formula is more likely to suffer from gastro-enteritis, respiratory infections and other illnesses than a breastfed child, no matter how hygienic the feed preparation. How convenient that they forgot to enter that information on the labelling.

Another formula company strategy is to attempt to medicalise normal feeding conditions such as possetting and “hungrier babies”, and then suggesting they need specialised formulas. UNICEF have maintained that “There is no evidence that babies settle better or sleep longer if given these milks. They are based on the curd of cow’s milk and take your baby longer to digest than first milks" (UNICEF 2010). In the UK Mead Johnson and Nestle conduct their entire business around specialised formulas, an indication of the cash to be made from this growing niche. They both promote ‘hypoallergenic’ formula, a health claim which is prohibited in the US after infants fed on it suffered allergic reaction (New Scientist).

What's more, parents are encouraged to self-diagnose and ask doctors to prescribe products such as Wysoy soya formula (from the same corporation that produces SMA). Soya beans are used as the basis for such formula, not because they are best for babies, but because the soya industry sought profitable outlets. The Food Standards Agency’s advice on soya formula and milk intolerance is “the use of soya formulas should be discouraged through professional and parental education as more suitable alternatives are available.” Soy formulas contains substances which inhibit nutrient-absorption and a high phytoestrogen content, which could pose a risk to the long-term reproductive health of infants (for more information see research by the National Toxicology Program; the American Medical Association; the Journal of Human Reproduction; the British Dietetic Association; UNICEF; and The Guardian).

Trick #7: Lure mothers with gifts

Any gift makes us feel cherished and loved by the giver. A mum or indeed, a health worker, can feel obliged, even affectionate, towards the salesperson who have given an attractive or much-needed pen, notepad and diary, and of course this is why it is done. “The recipient’s bias towards the gift-giver is unconscious and unintentional” (Palmer. G 2009).

With this in mind, dare you enter my Aladdin’s Cave of formula tat? It showcases a range of formula company freebies aimed at ensuring that you and your baby become walking billboards. Click on the image below to enter:

And the award for worst formula marketing freebie goes to...

Aptamil: breast pads and breast pad cover embossed with their careline number.

A mother is more likely to need breast pads during her baby’s first few months as her breasts learn to regulate milk production. It also happens to be the period which the majority of mothers find challenging and are most likely to quit breastfeeding. Here we see Aptamil making sure they’re on hand to salvage the spoils of breastfeeding failure.

Trick #8: Get mothers’ personal details

Formula companies go to great lengths to get mothers onto their databases. Most of the large formula companies target pregnant mothers in clinics to gather contact details. Then the company bombards them with advertising in the form of leaflets, emails, website endorsements, and so on. Recently an Alpha Parent reader emailed me about a ton of formula samples she had just received:

"I'm 36 weeks pregnant with my second, nursed my first for 21 mos with no formula and I have every intention of doing the same (or longer!) with this baby.

So imagine my surprise when I came home yesterday and found a Similac package on my doorstep. It's addressed to me, although my first name is spelled incorrectly. Inside is a 1.45 lb tub of Similac Advance, a bottle and a 12.6 oz tub of Similac sensitive. Not to mention coupons and other paperwork, including The Art of Feeding, a pamphlet that has such gems as "reasons for bottling your breastmilk," and "if you'll be gone for an extended period during the day on a regular basis, you'll want to switch to formula a few weeks ahead of time so that your body will gradually decrease your milk supply."

This is not an isolated example. Once the child is born, email and postal mailshots intensify. Companies continue to try to get mothers to sign up to their lists, with leaflets in clinics, advertising, materials in bounty packs and free gifts.

In 2007 Registry offices were recruited by Hipp in some cities to distribute a sticker booklet on ‘Baby’s first year’ - which promotes its formula brand, website and careline telephone number.
What’s more, in many countries, health professionals and hospitals sell the names and addresses of clients to promotional agencies to facilitate direct mailing to new mothers.

Let’s not forget the dads! (see right for a Cow&Gate website ad). If your partner forms an affinity with a certain formula company, then he is more likely to suggest formula (and in particular, that brand) when you encounter your first breastfeeding problem. Formula companies, of course, know this. Which leads us to the next formula company trick...

Trick #9: Undermine breastfeeding

The sad fact is that formula companies must lure a great mass of women away from breastfeeding to keep their products profitable. Here is a genuine Cow & Gate advert on a mailshot pamphlet:

It says: “I’m thinking of getting a t-shirt made – ‘Danger! Sore boobs!” Inside it encourages mothers to go to the Cow & Gate website, which promotes all their formulas, and to telephone the Cow & Gate careline. Baby Milk Action have commented on the advert saying, “Ostensibly offering to support mothers, it preys on a mother's concerns and pain she may be experiencing to promote its formula brand name on the card and specific products on the site. Some mothers do experience pain as they and their child get used to breastfeeding. But if a mother experiences problems she needs help from reputable health care professionals and mother support groups, not a mailshot dropping through the letter box promoting Cow & Gate”. The mailshot was timed for when the recipient mother was most vulnerable. It was sent out when her baby was 3-4 weeks old.

In 2008 Heinz placed the following claim on their label for newborn formula: “Giving your newborn Heinz Nurture Newborn infant milk will give you the reassurance that your baby is getting total nutrition”. This claim undermines the status of breastfeeding and is 100% false. It is impossible for formula to contain ‘total nutrition’ when it does not contain many of the components found in breastmilk (Click here to see an illuminating list of the contents of breastmilk and formula).

The Baby Feeding Law Group has highlighted another formula company strategy for undermining breastfeeding, namely idealising bottle use: “The information on the Aptamil ‘experts in infant nutrition’ website about bottle feeding undermines breastfeeding by highlighting how others can feed and ‘bond’ with the baby. It suggests that bottle feeding will become essential for working mothers and undermines breastfeeding again by suggesting that mothers who express milk feed this in a bottle, which is not recommended due to the different sucking reflexes that can lead to lactation being compromised (cup feeding is recommended)”.

It seems that Aptamil and friends have a lot to ‘advise’ parents about; because parents are incompetent right? They need corporations to tell them how to do what their ancestors have been doing naturally for thousands of years. Which leads us to...

Trick #10: Claim to be ‘experts’ on nutrition and childcare

Formula companies want to be seen as the source of information on infant care - then they promote the company’s brands and health claims for formula. The SMA tagline is “for infant nutrition trust the experts - we know”; Because the best person to tell you about your baby, nutrition and formula, is the company making a profit from selling it to you. Obviously.

This strategy was brought to the world’s attention by the infamous Nestle 1970s lawsuit involving their “milk nurses”. Nestlé employed sales reps dressed as nurses who promoted Nestle formula to new mums in developing countries. They were paid on commission and their uniform carried the prestige of the health worker and inspired trust.

The lawsuit lost Nestle a lot of consumer support and inspired the popular “Boycott Nestle” campaign. Consequently Nestle lay low for a few years until the dust settled, then in China in 2005 Nestle positioned doctors in ‘Nutrition Corners’ in supermarkets to promote formula products to pregnant and breastfeeding women. It seems this leopard has its spots permanently tattooed on.

Nestle are not alone in employing the “disguise yourself as experts” strategy. All the major formula companies have created telephone ‘carelines’ to idealize their products and undermine independent advice from health workers. There appears to be scant regulation of the content of company advice provided via these carelines. Needless to say, the ‘information’ (read: marketing) is not objective. Not only does advertising for formula company carelines direct parents away for reputable helplines such as NHS direct, the information given is at times misleading and dangerous.

At this point it is worth highlighting that the primary purpose of formula companies is not to do good or even provide useful products. Rather the companies have a statutory duty to put the needs of their shareholders first, which means generating as much profit as possible. The ‘caring’ image is simply part of marketing and has nothing to do with the realities of business. This fact was illuminated in one particular study. Baby Milk Action called the carelines in the role of a confused parent wanting to know the difference between the formulas on the market and the particular health claims made about the company’s product.

When asked about the ingredient ‘immunofortis - inspired by breastmilk’ promoted on labels, the Aptamil advisor said it is: “Soluble fibres found in breastmilk” which “liaise with the immune system.”
Next, a Cow & Gate advisor was asked about the claim that its formulas contain prebiotics and said that prebiotics are present in breastmilk, support the natural immune system and provide food for friendly bacteria. Asked if they are the same as in breastmilk “Yes, prebiotics are in breastmilk”.

SMA advertised their careline in Prima Baby magazine. As an inducement to call the careline, the first 200 callers in August and September 2008 were offered an SMA-branded baby towel (seen in my Aladdin's Cave above). Article 23 (2) of the Regulations is clear that branded gifts such as this are not permitted. When phoned, the SMA’s careline advisor was asked about its ‘new protein balance’, promoted on labels. She said: “It makes it closer to the protein found in breastmilk.” She was asked how SMA could be the closest to breastmilk when the Aptamil label and advertising says it is the closest and replied: “Ours is balanced. It is closest.”

Not content with just their staff regurgitating their scripted content on their carelines, formula companies have even paid celebrities to do the dirty deed. Cow & Gate employed Celebrity mum Sheree Murphy (star of Emmerdale, I'm A Celebrity...Get Me Out Of Here) to promote their careline.

I strongly believe that every mother should be empowered to make the best decision for herself and her child based on accurate and independent information. Would it be wise to trust a company for breastfeeding support when that company has a vested interest in making as much money as possible from a mother’s *failure* to breastfeed? Would you expect impartial advice on washing machines from Hotpoint? Baby care and feeding advice should not come from corporate carelines, and certainly not from a z-list soap star! Instead, a lot of people would advise that mothers go to health care professionals; however read on to discover how that route is equally troublesome ...

Trick #11: Manipulate the professionals

“Accurate, independent information on new ingredients and products should be prepared for communication to health workers by the Food Standards Agency, or other authority to equip them to advise parents rather than formula companies delivering this information” (Baby Milk Action).

Back on planet earth... midwives, health visitors and GPs are persistently subject to very clever and insidious marketing from formula companies via advertising, gifts, conferences and ‘training days’. Many health workers are so used to being bombarded with covert formula marketing that they do not perceive its function. In the absence of good knowledge about how to recognise when breastfeeding needs fixing and how to do it, health professionals fill the gap with biased instruction from formula companies. How many times have you heard a health visitor recommend topping up with formula at the first sign of a breastfeeding issue? Wonder where they got that idea.

Aptamil love this lark. Here is one of their advertisements, the second page of double page spread, featured in the British Journal of Midwifery, March 2008, April 2008. Here Aptamil tell professionals to “count on Aptamil First” (a deliberate play on words):

Here is another advertisement in the British Journal of Midwifery, April, May, June 2008:

Here’s an advertorial that Aptamil placed in Community Practitioner February 2009. Here they spoon-feed practitioners on how to reply to parents’ queries:

In November 2008 the British Journal of Midwifery included a calendar branded on every page with the Aptamil formula name and claims about the infant formula (see right). Being a functional item, it was no doubt hoped that health professionals would place the calendar in their offices in view of their clients, or at the very least, consult it. Other gifts given to health professionals include pens, keyrings and post-it notes. All functional items designed for public use. Health professionals’ perception of such gifts as innocent and inconsequential has proven hard to change, because the commercial links have become such an intrinsic part of their lives.

Heinz cottoned on to the value in getting midwives and health visitors under their wing, so they littered professional periodicals with their advertisements. This classic piece of pseudo-science seen here on the left was featured in Community Practitioner, June 08. The advertisement makes multiple claims that are not permitted under the Directive, e.g. Constipation relief, including the name ‘Nurture’ (used to be ‘Farley’s’) which is idealising and therefore contrary to Regulation 21, applying Reg 17(3). It conveys a false sense of trust, security and motherliness.

idealize (also idealise) : verb regard or represent as perfect or
better than in reality.                               Oxford dictionary

SMA placed this advertisement (right) in the Journal of Family Health Care Vol19 No1 2009.

Now we come to the beast they call Nestle. Despite claiming they would not enter the UK infant formula market Nestle launched a video at a Royal College of Midwives Conference in 2008. They failed to obtain the necessary approval to do this from the Secretary of States as required by the Regulations, but went ahead and launched the video anyway. Those whom viewed the video found that it undermined breastfeeding by highlighting difficulties in an exaggerated and needless fashion. The RCM has since announced that it will no longer take advertisements from formula companies (Babyfeeding Law Group 2009).
Here come Cow & Gate to join the party. In 2010 Cow and Gate started a campaign, called "In Practice", to target newly qualified midwives, to 'help' them in their day to day practice.

The site (click here to access it if you must) offers leaflets, study days and training days. It includes downloadable patient podcasts, information sheets, on such things as the benefits of all that chemical junk they put in formula.

At one ‘training event’ health workers were given a branded bag of promotional materials and gifts, refreshments from Starbucks and a £10 food voucher, encouraging them to walk to the food hall with the bags:

Midwives don’t have the time to probe each advertisement and may believe that what they read is science because of the charts and language. Here’s another example from Cow&Gate:

There is currently no legal obligation for formula companies to supply evidence of their claims to health workers. A frustrating consequence of this is that health workers have no access to accurate information about formula products. They only have the marketing information produced by the formula companies from which to advise parents.

As a side note, if you’re a midwife fond of magazines consider buying Practicing Midwife instead of The British Journal of Midwifery - no formula ads.

Magazines are not the only stream through which formula companies influence health care professionals. These cards (bellow) were sent to health workers from Cow & Gate in the hope that they would be distributed to mothers, thus giving the impression that the health worker endorses Cow & Gate. They carry the formula brand name on the back. As an inducement to promote the careline, health workers could win £250 in Marks and Spencer vouchers by calling the line themselves.

However it must be said that health care professionals are not entirely blame-free reluctant sheep, led naively astray by formula companies. There is a significant degree of mutual benefit involved in this collusion. As formula fed babies are more prone to illness, this means that doctors, nurses and health visitors are becoming increasingly important fixtures in infant life. So there are more jobs, more careers, and more sales of drugs in health care.

Furthermore, aside from the small freebies which formula companies bestow on health workers, large gift incentives are also given. An important proportion of medical and nutritional research is financed by formula companies. Also, professional health bodies frequently receive funding for salaries, grants and conferences from formula companies. In America for example, formula companies donate $1 million annually to the American Academy of Paediatrics in the form of a renewable grant that has already netted the AAP $8 million. The formula industry also contributed at least $3 million toward the building costs of the AAP headquarters. The American College of Obstetrics and Gynaecology received $548,000 from two of the four major formula makers in 1993. The American Medical Association television program is sponsored by the makers of the infant formula: Similac. Moreover, the American Dietetic Association, the National Association of Neonatal Nurses, and the Association of Women's Health, Obstetric and Neonatal Nurses all receive generous funding from the formula industry. In the Philippines health care professionals earn 500 pesos for every 10 infants they convert to using a particular formula brand.

Trick #12: Obscure the health risks of formula

The mantra "Breast is Best" implies that formula is normal and safe, and that breastfeeding is a bonus. The reality is far from that...

Click here to view the NHS instructions for preparing formula. These instructions were updated via information from the Food Standards Agency following deaths of infants in Belgium and France linked to Enterobacter Sakazakii contamination. The FSA warned that powdered formula is not sterile and that steps can be taken to reduce the risks, such as ensuring that water used to mix up formula is at least 70oC. No company has given this information to parents as set out by the NHS, and some directly contradict it. After all, it’s not their problem, “ignorance is a mother’s crime” (Palmer. G 2009).

Incorrectly prepared formula is a major cause of malnutrition and illness. It can result in feeding difficulty and specific health problems like malnourishment, dehydration, and gastrointestinal inflammation. In some cases it can even result in death. The World Health Organisation has recommend that all parents should be informed through an explicit warning on the packaging that powdered infant formula may contain pathogenic microorganisms. Yet only one company has included the information that powdered infant formula is not sterile on its new labels (Hipp), and sadly it instructs parents to use water at 50-60oC. WHO experts say that mixing formula with water at the correct temperature of 70oC is the single most effective decontamination step which could reduce the risk 10,000-fold (WHO Guidance can be found here).

More worrying than the lack of information on safe preparation is the presentation of inaccurate information. When Baby Milk Action phoned the Aptamil careline in the role of confused parent enquiring about sterility and the need to use hot water, the Aptamil advisor said it wasn’t necessary: “The reason we say 30 minutes is that is the optimum time. It is a health and safety issue, we don’t want people scalding their hands. People can make it at room temperature”.

The Cow & Gate careline recommended using cold water(!) When asked whether Cow & Gate formula was sterile, the advisor said “No formula is sterile.”Asked if that was a problem, she said: “Makes no difference.” She advised: “Prepare bottles of sterile water in advance. That stays fresh without refrigeration for 24 hours. Take from the bottle and mix.”

When the Heinz careline were asked about the need to use hot water as powdered formula is not sterile, the advisor’s advice was: “Heat the water and let it cool. I don’t know if it gives the temperature. It says 30 minutes.” The NHS guidance says no more than 30 minutes. Asked if using hot water was important, she said: “It mixes better” and had nothing to do with sterility.

When the SMA careline were asked about sterility, their advisor said: “No formula is sterile if it is exposed to the air.” A bizarre statement, as formula powder is not sterile even when sealed in the tin.

Hipp were arguably the scariest. Their Careline advisor did not have an answer to questions on sterility, so the nutritionist phoned back. She said Hipp did not follow the NHS guidance for parents of using water above 70oC because “you kill the protein and it would be dangerous to hold it.” When asked about the NHS guidance, she said water at 70oC would cool when it was mixed with the powder so “the temperature would be lowered anyway.” She claimed “no-one does it at 70.C”.

Aside from the improper preparation of formula carrying substantial health risks, the ingredients in the formula themselves have also proven to be dangerous. Formula companies regularly add new ingredients - before their safety has been properly evaluated - simply to gain competitive advantage. This is equivalent to a mass uncontrolled trial on babies. Surprisingly there is currently no legal requirement that the ingredients are evaluated by an independent scientific body prior to introduction onto the market. Baby Milk Action has commented that:

“Formula can be the sole source of nutrition during a critical period of rapid growth and development. Minor modifications can have major effects on infant health. The Report of the Scientific Committee on Food, 2003, identifies problems that have occurred with the introduction of modified infant formulae. Examples include reduced protein availability with impairment of growth; trace element deficiency with severe clinical disease; chloride deficiency with long-term neurological damage and thiamine deficiency with severe clinical disease, including neurological damage and several cases of infant death.”

I must point out (because the formula companies won’t) that children who are formula fed are more likely to suffer from:

  1. Diarrhoea
  2. Meningitis
  3. Ear infections
  4. Blood infections
  5. Sudden Infant Death Syndrome (cot death)
  6. Diabetes
  7. Childhood cancers
  8. Obesity
  9. High blood cholesterol
  10. Asthma
  11. Reduced effectiveness of vaccinations
  12. Reduced effectiveness of organ transplants
  13. Candidiasis
  14. Enteroviruses
  15. Gastroenteritis
  16. Giardia
  17. Haemophilus Influenza
  18. Necrotizing Enterocolitis
  19. Pneumococcal Disease
  20. Respiratory Infections (general)
  21. Respiratory Infections (protective effect against exposure to tobacco smoke)
  22. Respiratory Syncytial Virus
  23. Salmonellosis
  24. Sepsis in Preterm Infants
  25. Urinary Tract Infections
  26. Anemia and Iron Deficiency
  27. Autoimmune Thyroid Disease
  28. Constipation and Anal Fissures
  29. Cryptorchidism (undescended testicle)
  30. Gastroesophageal Reflex
  31. Inguinal Hernia
  32. Lactose Malabsorption
  33. Morbidity and Mortality
  34. Plagiocephaly
  35. Pyloric Stenosis
  36. Wheezing and Asthma
  37. More pain during medical procedures
  38. Impaired jaw and teeth development
  39. Allergies
  40. Eczema
  41. Reduced Development and Intelligence
  42. Bedwetting
  43. Reduced Brainstem, Cognitive, and Motor Development
  44. Reduced IQ
  45. Reduced Gastrointestinal and Immune Development
  46. Hormone imbalance
  47. Reduced Neurological, Psychomotor and Social Development
  48. Disturbed Sleep Cycles and Arousal
  49. Reduced Speech and Language Development
  50. Reduced Thymus Development
  51. Autism
  52. Appendicitis
  53. Poor Bone mass
  54. Cardiovascular Disease (Atherosclerosis, Cholesterol Concentration)
  55. Celiac Disease
  56. Diabetes Mellitus
  57. Helicobacter pylori infection
  58. Haemophilus Influenzae Meningitis
  59. Inflammatory Bowel Disease (Crohn's Disease, Ulcerative Colitis)
  60. Juvenile Rheumatoid Arthritis (JRA)
  61. Poor Mental Health
  62. Menopause (timing of) – I’m not joking
  63. Multiple Sclerosis
  64. Reduced Oral and Dental Health
  65. Reduced Protection against toxins (environmental contaminants, chemicals, heavy metals)
  66. Schizophrenia
  67. Reduced Stress Resilience
  68. Tonsillitis

(Read about each of these conditions and their links to formula feeding here).

I hope the points I have raised above put to rest the popular yet ignorant argument that “formula is only dangerous in developing countries where they have poor sanitation”.

Trick #13: Manipulate the scales

Formula companies often provide free weight charts to health care professionals that are only relevant to formula fed babies. Cows’ milk is the main basis of formula. I’m sorry to state the obvious, but cows’ milk is designed for baby cows - they have four stomachs, double their weight in 47 days, and weigh 800 pounds within a year. As Professor Michael Crawford, head of brain metabolism and nutrition at the Institute of Brain Chemistry and Human Nutrition in London, pointed out, “Cows' milk is designed to rapidly grow an animal with a large body and a small brain whereas human milk is designed to grow a small body but a large and rapidly developing brain” (The Independent). Weight charts based on cow’s milk are not in babies’ best interests.

Here’s a weight conversion wheel (right), the type you’ve probably seen your midwife use. It’s made by Cow&Gate and given free to health professionals in the hope that they will use it in front of parents, thereby giving the illusion that the healthcare professional endorses Cow & Gate. It is based on the growth of formula fed babies.

Trick #14: Get emotional

Pregnant women and new mums are a hormonal bunch. Perfect fresh meat.

This advert (bellow) plays on parents’ emotions; it talks about giving up career, social life and figure. These sacrifices are arguably more relevant in the first six months of a baby's life; readers will not differentiate this from infant formula milk; the words 'follow-on milk' or 'not before 6 months' are not clearly visible and not in the same size text as the logo.

Mike Brady, coordinator of the Baby Feeding Law Group's monitoring project has said: “If the Advertising Standards Authority really believes that parents should be basing their decisions on how to feed a child during the most important phase of its development outside the womb on the heart-tugging, greeting-card sentiments of SMA’s advertisement then they have seriously failed in their responsibility to protect the public” (Baby Milk Action Press Release).

While the small print on the advert states that the product is not intended to replace breastfeeding it also states: “When used in conjunction with solid feeding, it provides the nourishment essential to a baby’s healthy and sustained growth.” Needless to say, this is contradictory to the UK Department of Health and World Health Organisation recommendation of continued breastfeeding. It also implies a false equality between the formula product and breastmilk.

Sometimes the most simple emotional hooks are the most effective. Polar bears, cuddly cows and fuzzy ducks are all used on formula packaging and in advertising. They convey no information and exist for the sole purpose of eliciting a positive emotional response to the product. Should parents be encouraged to use a polar bear as a good basis for selecting what is to be the sole nutrition for their child’s tender months? Naturally, the WHO Code thinks not. It requests that “Labels should not feature words or pictures idealising artificial feeding”.

Trick #15: Exploit New Media

Any marketing bod will tell you that the best way to suck in customers – and keep them - is to interact with them on a regular basis. Aside from their carelines, formula companies have other techniques aimed at keeping mothers coming back.

In 2008 Hipp launched a blogging network encouraging mothers to blog on its site (right). They point out that their blogs are FREE. Yeah, and so are all the other non-formula-advertised blogging hosts (Blogger, Wordpress, Livejournal).

Cow & Gate encourage mothers to send in videos of their babies (here) so that one of the little dears can rival that ugly fucker they put at the end of their adverts. You know the one.

And while you’re at it, they want you to send in photos too (here).

The company's most recent exploitation of new media is the launch of their iPhone app, plastered from top to toe with their logo and marketing. The application sucks parents in by offering the ability to add Cow&Gate branded frames and captions to their baby's photos. Then the app encourages parents to share the photos with family and friends (i.e. do the company's marketing for them). Other features of the app include: "discover some extraordinary facts about your toddler’s development" and: "contact our careline for any other toddler questions". The company are so eager for you to contact their careline that they can connect you directly from the app; no need to actually type in the number. Read more about the app here.

A few weeks later Cow&Gate launched another app, this time targeted squarely at pregnant women. The app encourages expectant mothers to monitor their diets during pregnancy. "Our unique Pregnancy Diet Calculator will help you check you're eating enough of the right foods to give your baby the best start in life" touts the company (website here). It's disappointing that Cow&Gate's encouraging mothers to give their babies "the best start in life" does not extent to life outside the womb.

In Conclusion

Above I have outlined just some of the tricks used by formula companies to generate cash from parents and in the process, diminish the health of mothers and babies worldwide.

Feeling angry? You can sign up to the Breastfeeding Manifesto campaign, send a message to your Member of Parliament and find out full details at:

Also, if you have any formula tat to feature in my Aladdin’s Cave, do email me a photo.