“Use my picture if it will help” said the woman in this photograph. The babies are twins: the child with the bottle is a girl – she died the next day – but her brother was breastfed and is thriving. The mother was told that she wouldn’t have enough milk for both children, and so should bottle-feed the girl.
Sometimes I feel like we have to do the same activism over, and over, and over again. OK, a lot of the time.
Nestle and other infant formula companies been hooking poor mothers in to harmful, unaffordable artificial feeding for decades in a variety of countries all over the world, leading to one of the most widespread and longest-lasting boycott programmes in history. These companies have strenuously opposed all legal restrictions on their campaigns to reduce breastfeeding in the most vulnerable of populations.
Now, the Queensland government is reported to be favourably considering a plan to start handing out infant formula and bottles in local Aboriginal communities. The proposal, presented by pediatric surgeon Richard Heazlewood and general practitioner Lara Wieland, is suggested as an social-engineering alternative to the cash baby bonus. There has been an inexorable move toward conditional welfare for Indigenous women over the past year, and this is just one part of that.
ABC: “Qld doctors back Indigenous ‘baby packs'”
The Australian: “Packs to give indigenous infants a good start”
Australia pays lip service to the World Health Organisation infant feeding guidelines and Code for the marketing of breastmilk substitutes. Under the feeding guidelines and Code, infant formula and bottle samples must not under any circumstances be handed out indiscriminately to mothers. An key part of the Infant Feeding Guidelines (which is incorporated into the Australian Dietary Guidelines) is:
Health workers must always ensure that they encourage the initiation and maintenance of breastfeeding and avoid any role in the promotion of breastmilk substitutes.
The very first principle in the Dietary Guidelines for Children and Adolescents in Australia is “Encourage and support breastfeeding“. Free samples of infant formula have been proven again and again to reduce breastfeeding incidence and duration. (For references, see the Ban the Bags campaign.)
And yet, here we have two health workers proposing that we start handing out infant formula freebies.
IBFAN (the International Baby Food Action Network) lays out in detail the ways in which breastfeeding is undermined. “Promotion Using Free Supplies” is number one. This should be banned in all companies who are signatories to the Code.
Method 3 in Undermining Breastfeeding is “Using “humanitarian aid” to create markets“, which also applies to the Queensland situation.
Article 4.2 of the Code calls for the clear information on, “where needed, the proper use of infant formula; When such materials contain information about the use of infant formula they should include:
* the social and financial implications of its use.
* the health hazards of inappropriate foods or feeding methods.
* in particular, the health hazards of unnecessary or improper use of infant formula and other breastmilk substitutes.”
* Most importantly, “such materials should not use any pictures or text which may idealize the use of breastmilk substitutes.”
Will the Queensland Government be paying attention to these precautions?
The ONLY circumstances under which free formula may be safely provided are when:
(a) Breastfeeding, expressed mother’s milk, and donor milk are all unavailable (formula is the fourth choice);
(b) The providing organisation trains the parents appropriately and thoroughly in making its administration as safe as possible;
(c) There must be adequate facilities for cleanliness, and a safe water supply;
(d) Powdered formula must not be provided to any infant under four to six weeks of age, because of the risk of neonatal meningitis bacterium Enterobacter sakazakii, an emerging pathogen and common contaminant of infant formula. (more information at the CDC;
(e) The providing organisation is prepared to provide ALL of that infant’s artificial baby milk needs for a full year (article 6.7 of the Code); and
(f) all of the other criteria of the Code are fulfilled.
Enthusiastic, unconditional, informative & informed support for breastfeeding is absolutely essential in Australia’s most vulnerable populations. The support must take place at all levels of healthcare and community service. Indigenous infants have the highest risk for death from infectious disease of any group in Australia, and breastfeeding is by far the one cheapest and most effective intervention that could reduce that risk. Diarrhoeal and respiratory disease feature prominently, and these are the infections most increased by artificial feeding.
There are a variety of other risks of artificial feeding for both mothers and babies, including an increase in cancer risk, increase in diabetes risk, less optimal child spacing – read the whole list at promom.org, and see kellymom.com for more details.
Yet instead of providing professional breastfeeding support and maternal nutrition programmes in indigenous communities, instead of offering appropriate training to indigenous healthcare workers, instead of funding and fostering woman-to-woman support programmes: we want to throw formula at them.
If Australia is going to look seriously at improving nutrition and the availability of high-quality food in Aboriginal communities, we need to start from the beginning.
Anna Bligh’s office can be contacted at ThePremier@premiers.qld.gov.au .
Categories: education, ethics & philosophy, health, indigenous, medicine, social justice
Hoyden About Town 
I am always wary of any promotion in health or human services conducted with the backing of any large organisation, but especially Nestle with their track record.
At the same time, I’d be interested to find out the actual facts of the case of the mother in that picture.
I’ve also always been wary of any program that might make new mothers feel more exposed than they already do, and the guilt attached to not being able to breastfeed is enormous and not helped by the programs that tell a woman she might be killing her child if shes unable to breastfeed.
I guess it’s a split issue for me.
I think Keri makes some very good points.
There are a range of reasons why women don’t breastfeed (my mum bottle fed all eight of her kids – I suspect it was to do with attitudes that were dominate in her day and community). Some breastfeeding advocates do do a very good line in guilt. So while breast is best, it’s not always what the mum wants or can do.
Yes, we don’t know the actual facts behind the picture. I do think this is a good issue to raise, however.
“not helped by the programs that tell a woman she might be killing her child if shes unable to breastfeed.”
Yes, but in developing countries, or Aboriginal communities with five times the infant mortality of the rest of Australia, being formula fed may well contribute to a baby’s death.
Not that I’m suggesting women should be told they’re killing their babies if they can’t, but as Lauredhel points out, the WHO lists preferred infant feeding methods (in descending order) as (a) Breastfeeding, (b) expressed mother’s milk (c) donor milk and then (d) formula. Very few women actually can’t breastfeed IF they get the right support when they need it, and those women should have options for expressing milk or using donor milk, rather than being handed a pack of formula. Whatever way you look at it, this program is a stunningly stupid idea. I am about to write emails to the idiots who suggested it.
On a related note, there is a video here that shows how a baby attaches itself to its mother’s nipple by itself after birth, and the science that shows that letting this process happen naturally seems to prevent latch problems (among other things).
At a guess, she could not afford to feed the formula-fed baby full strength formula, and/or was unable to find a source of safe drinking water or unable to boil the water she had before making up the formula. This is a very common problem for mothers living in poverty who have been persuaded to formula-feed.
The Australian article mentions providing formula “where not breastfeeding”.
I’m still writing to Bligh though, because Lauredhel raises important points about the role of states & aid in creating markets over mother centered approaches.
Queensland has a shabby record on handling of both child welfare and Aboriginal affairs. That’s been permitted partly by the lack of public scrutiny of state governments negligence in these areas until scandals exposed them [remember that mishandled child rape trial?].
Writing to remind them that there is scrutiny, and not to slack on supporting community based programmes, needn’t involve any bottle feeding stigma.
This [http://www.antar.org.au/content/view/395/189/] AnTAR page about an Townsville based Mums & Babies service notes that a 3rd of the mums are making the trip from beyond Townsville because they appreciate a service with Aboriginal staff, support for mums on things like breastfeeding etc.
A lot of people confuse grief and anger with “guilt”, in this area. A lot of mothers have a lot of reasons to grieve and/or to feel angry about the way they have been treated when it comes to breastfeeding support, or about the ways their breastfeeding relationship hasn’t turned out as they wish; and, speaking from the inside (both for myself and working in breastfeeding support for those with severe difficulties), those feelings are intense, sometimes overwhelming. They are made worse by the fact that the feelings are not recognised for what they are by a formula-loving society, which relabels them “guilt”, with a side serve of “unnecessary” and “get over it”.
It is entirely possible, with enough societal support over enough time, for every single baby to receive human milk (except the much less than half a percent of babies who literally can’t tolerate it because of inborn errors of metabolism).
The experience in Scandinavia shows that 95-98% of nourished, supported mothers can breastfeed. In an environment where that was the case, it would be almost trivially easy to get donor milk or wet-nursing to those who can’t or don’t want to.
This is what we should be keeping in mind, and working towards as a long-term goal.
In the short term, we’re probably going to have to settle for not actively undermining breastfeeding, which is what this plan would do.
The “where not breastfeeding” disclaimer ends up, in practice, being a “Breast or bottle?” tick-a-box, with a bonus “If you pick ‘bottle’ now, we give you free stuff!” rider. Just casting the choice in that way is a problem, as it presents them as two equal, neutral choices. Thinking of and presenting bottle-feeding and formula-feeding as a medical and nutritional intervention is one way forward from there. I don’t see intervention and assistive feeding devices, for those who are unable to breastfeed, as really much different from any other assistive device for any bodily disability, nor do I think there should necessarily be any guilt attached to using assistive devices.
The experience of the “WIC” programme in the USA handing out formula freebies is instructive. (The USA is not a signatory to the WHO Code.) Despite the nominal breastfeeding support built in to some of the programmes, too often the mindset remains “Of course you should sign up for the free formula! It’s FREE!”, which is not at all surprising. Then the formula only fills around half the baby’s needs, and it’s all downhill from there financially as well as healthwise, as by the time the mother realises the fix she’s in, her supply is very low.
Relactation is possible, but it’s more difficult than just maintaining the supply in the first place, and it’s also not suggested or supported. The women I know who have asked their healthcare workers about relactation have generally met with a “Wha-? Is that even possible? Why would you want to do that?” response.
Note that in a society where breastfeeding women are truly supported in every way, the “don’t want to” numbers do end up being low. They’re low here and now, in fact – the vast majority of formula-feeding families, where a mother is present, are in the situation where the mother wanted to breastfeed, and believes or was told that she was “unable” to breastfeed or that “her milk dried up” or that she’s allowed no glasses of wine while she’s breastfeeding or that she can’t work and breastfeed or that by the time she was finished that course of penicillin that she “had” to pump ‘n’ dump for, the baby wasn’t interested any more. If you truly think that inability to breastfeed is biological fact for over 50% of women, your biology is way off.
This is patriarchy at its finest: convince half or more of the female population that their bodies are defective, so that you can sell them something very, very lucrative.
Racist attitudes to infant feeding aren’t new. In New Zealand in the first part of the 20th century, white mothers were encouraged to breastfeed, and Maori mothers weren’t. The basis for this seemed to be that Maori mothers were too stupid and/or lazy to breastfeed properly, so if they bottlefed there as an objective measure of how much the baby was getting – heaven forbid that the baby could let them know if it was getting enough! It proved really difficult to increase Maori breastfeeding rates in the 1970s – many Maori women had learned from the mothers and grandmothers that human milk wasn’t good enough for their babies. I suspect that Maori breastfeeding rates are still lower than Pakeha, although I have no figures for that.
Of course the man who in 1907 founded the primary organisation for baby care in New Zealand, the Plunket Society, was Sir Frederick Truby King, a eugenicist and social engineer of the worst kind.
Go Lauredhel!! Woot!
Breastfeeding is not a split issue for me. And as for “guilt” I wonder if we expect that female dominated occupations like nursing will to look after our emotional needs in a way we don’t expect male dominated ones to. Medical advice to increase your exercise and eat lower fat foods isn’t dismissed as oppressive or guilt inducing for people who are having trouble losing weight.
Plunket still has a formula company and WHO Code violator as a major sponsor. They are currently actually selling co-branded Plunket-Wattie’s breastmilk substitutes (baby food marked as being suitable from 4 months, an explicit Code violation). While there are some good individuals there, by all reports: they’re dirty to the core.
Yeah, when I heard about the baby packs on the news I thought they were an interesting idea, but as soon as they mentioned the word ‘formula’ my alarm bells started ringing hard.
Not by anyone except the FA movement, no, but it should be. I think you’re saying, Zoe, that the advice to breastfeed should be seen as neutral, objective and scientific in the same way that dieting advice is, and not dismissed as emotional because it comes from female practitioners?
Certainly, insofar as comparing the two sorts of advice goes, the health benefits of breastfeeding are far more supported by medical science than the benefits of dieting. But I think your analogy is flawed – both dieting advice and breastfeeding advice are subject to huge societal pressures, impact directly on someone’s bodily autonomy and come with often-conflicting messages with regard to their health benefits.
Lest it be confused, I am a huge supporter of breastfeeding. But I take issue with the idea that it should be as non-emotive and unquestioningly accepted as the advice to diet, specifically.
This issue gets me angry in 45 different ways. I had reason to read the WHO breastfeeding guidelines the other day (not over this issue) and came away thinking “They can shove their advice up their jumper” – or perhaps some slightly less PG version. It is condescending, proscriptive and insulting. It is probably also accurate. Although I think it is *really* important to discuss WHY formula contributes to infant mortality. It isn’t something inherent in the formula. It is the expense and the hygiene problems.
But then I hate formula being marketed irresponsibly, and I am utterly disgusted by this whole issue, and the formula recommendation is just a part of it.
And then again, I object to being told that giving anything other than breastmilk before 6 months is BAD. I think there is way too little evidence for that proclamation where good quality food is available.
OTOOH, where do they get off telling indigenous people they can’t be trusted with cash, while the rest of the population can?
So yeah, lots of anger sprouting in many directions. Although it all stems from treating people like idiots. Treat people with more respect and most of my complaints go away…
Arianes last blog post..Baby packs
Ariane, it’s a really common misconception that restrictions on infant formula promotions should only really apply in the “third world”, because it’s about hygiene, not artificial feeding. This isn’t borne out by the literature (the literature not cherry-picked by formula companies, that is!) The effect is magnified where hygiene is poor, but well-controlled studies done in the richest countries in the world still show increased infant mortality with artificial feeding. Have a read through all the refs at promom.org, and at kellymom health pages. and you’ll see what I mean. Chen and Rogan found about a doubling of mortality in the USA, after controlling for every factor they reasonably could. As the Enterobacter issue has shown, some formula comes ready-contaminated, and breastmilk supports the immune system in a variety of ways.
The problem is that people trying to support women and babies in this field are pushing shit uphill. They are absolutely overwhelmed by the push by big business to promote their products however they can, and the push occurs in all areas, at every level.
I have plenty of friends who have breastfed beyond early infancy, but they’re each one privileged in a wide variety of ways. This includes their own stubbornness and the ways in which they have faith in their own bodies, which has typically been attacked on all sides – by parents, relatives, friends, healthcare workers, and random strangers as well as by advertising. Women’s resistance to those influences only has to break down at one level for breastfeeding to be undermined, usually for good. I think we need to support that resistance every way we can.
I’ll be convinced that “breastfeeding promotion has gone too far” when it actually has. Kinda like how I’ll be postfeminist in the postpatriarchy – we’re nowhere near there yet.
Separating out structural, institutional change from individual blaming – that’s important, crucially important, as you identify. Confusing those two things, ignoring the first, trying to cast infant feeding as purely an uninfluenced, individualistic, free “personal choice” is exactly what the companies and their dupes do. This is what they want us to think, because it gives them free rein.
I’ll ask you to please have a read back through my other breastfeeding posts if you think I’m blaming individual mothers in my approach to anti-formula-company activism. Mother-blaming and the various mothering double binds are one of my particular pet peeves. As always, I blame the patriarchy.
Argh. Sorry about the essays. I’ve got more to say about “choice”… but I should probably take it to a real post!
Lauredhel, I understand what you are saying, and at the global level, I know what you are saying about pro-breastfeeding. I was unaware of the studies you mentioned, and that is interesting. I stand corrected on that. However, from what I could see of those studies, they didn’t control for people who have trouble breastfeeding.
I completely agree that if breastfeeding works (and by that I mean after the initial difficulties), there is absolutely no doubt it is superior. When there are problems, though, it is a lot less clear. I would be very interested in a study that showed the long term outcomes of borderline failure to thrive babies that continue breast feeding and those who switch to formula. Not to mention how personally angry I get about bonding. I remember one or two moments that felt like bonding, mostly it felt like martyrdom.
And whatever you do, don’t tell someone in the hospital you don’t want to breastfeed. At least in Sydney. There are pockets where pro-breastfeeding has gone too far, but clearly this is not a global situation.
But, I take your point that propaganda has excluded the option of human breast milk banks and other similar options, and that is despicable. I would definitely have gone that way rather than formula if it was an option.
Arrggg, it is so frustrating that we have a situation in which every body loses. As a person who couldn’t breastfeed for 12 months, I don’t feel supported. Clearly people who do breastfeed don’t feel supported. Wow, we’ve done well.
Arianes last blog post..Baby packs
Oh, and Lauredhel, I didn’t mention, I did not at all think that you are mother blaming. Not even slightly. The WHO recommendations definitely read that way, as does much of the medical data. That’s where my anger and frustration are directed, not at you. I’m sorry I didn’t make that clear.
Totally. And the worst thing we can do is all turn on each other, as women – which lets the actual culprits completely off the hook.
I suppose i’m coming from the point of view of someone who will be unable to breastfeed (as a result of burn scarring)
What’s the answer to this? I don’t know. I just think it’s a sensitive issue with no easy solution.
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keri, I’m sad to hear that you were so badly burnt. That must have been awful.
The science shows that your future offspring would do better with donor milk than with formula though, which is the major problem with the way the formula companies have attempted to pathologise breastfeeding – it makes donor milk hard to come by. As Lauredhel noted in #6, in countries where breastfeeding is fully accepted and supported, the rate of successfully nursing is 95-98% in mothers who are adequately nourished themselves. In such an environment donor milk would be readily available.
The formula companies have made an environment where even the well-educated amongst us rarely consider donor milk – I never did until Lauredhel first wrote about it. That’s reprehensible, and we would be doing indigenous mothers no favours by pushing their infants onto formula when we could do much better by supporting their mothers with better nutrition instead.
Never heard of the concept of donor milk.
The formula companies have obviously been pathologising breast feeding for a long time. Does anybody know whether there has been an increase in breast feeding in recent years?
I still think it’s a complicated issue and I still wouldn’t tell any woman that she shouldn’t bottle fed (my liberal feminist tendencies are showing).
Quite the opposite – there’s been a decrease in breastfeeding over the last few years.
It’s not about telling women they “should”, it’s about supporting women so that they can and do.
Darlene, the problem is that there’s a fair amount of telling women they ‘should’ and relatively little in the way of ‘how’. We don’t have the social structures that make breastfeeding destined to succeed most of the time, on the contrary, it’s tacked on to a society where breastfeeding is destined to fail. Then we nag mothers because that’s cheaper than changing the health system or workplaces. It’s like telling kids they should learn to read, giving them some books, but not reading to them, or sending them to school, or explaining how words and letters work, and telling them that watching a movie of the story is pretty much the same.
I like your analogy, kate! The only extension I’ll add is: “And taking those books away if they haven’t taught themselves to read within ten days.”
As a new mother who struggled to establish a breastfeeding relationship I think you’ve hit the nail on the head, kate!
I think it all comes back to that “male as default” model we’ve got going on in our society – so it’s ‘normal’ to have a working career uninterrupted by childbearing or parental caregiving, where it’s not excusable to have infants in the workplace, where it’s not amenable to go away and express breastmilk every two hours or so.
It made me so incredibly sad when every other woman in my mother’s group told of giving their 6 to 8 week olds at least one bottle of formula per week after leaving the hospital, “because I just needed a break”.
It frustrates me I don’t feel any real effort was ever made by the midwives or medical professionals through my pregnancy to convey to me just how much time, effort and sacrifice of myself breastfeeding can take, so I didn’t have realistic expectations. It seems to have been a mass experience from the new mothers and pregnant women I’ve asked. And alternatively, I’m mad as hell several of the nurses in the NICU were pressuring me to use formula instead, and gave me incorrect advice regarding breastfeeding!
I suspect the pressure will come from outside, but the changes will have to be made in the medical profession first and foremost.
This is part of why it feels so overwhelming, I think – the change needs to come from everywhere, from work structures, social expectations, healthcare, everything.
I just read a story of a mother who was told in disgust to cover up – while breastfeeding her baby in a NICU. By a NICU nurse. Sometimes it really is more tempting to despair.
Aphie, you make a really good point about expectations, although I don’t understand why the odd bottle of formula makes you sad. I didn’t think formula was so evil that a bottle here and there will cause problems.
But I suspect that there is a bit of a Catch 22 here. I can’t tell you how many times I have read “Breast feeding shouldn’t hurt.” The ABA shout it everywhere. That just isn’t universally true, but if you start out telling people how hard it can be, even without that sort of problem, you could lose a lot of people before they start.
My personal advertising campaign for breastfeeding is “It sucks for the first few weeks, then it gets better. Or even if it doesn’t, bottle feeding sucks more, at least until you have solid food happening.” At least then you don’t have to hear about bonding when feeding makes you want to throw the child through the window. Never underestimate the bonding potential of a feed without screaming boobs…
But bad advice, insane NICU nurses, and an all pervading attitude that if a child can be seen or heard while working, you are absolutely unprofessional are definitely massive road blocks to feeding for most people.
I’m in for a campaign that makes it clear that feeding is bloody hard work, that anyone and everyone should always lend a hand when appropriate and that the sound of a child is not anathema to working. That shouldn’t be hard should it?
Arianes last blog post..What the?
Ariane
For your information please read this pdf
http://www.health-e-learning.com/articles/JustOneBottle.pdf
There are plenty more reasons why just one bottle is “so bad” in the references you’ll find at the end of the pdf.
Jem, thanks for the reference. That doesn’t much change my position about the odd bottle (one or two a week) for a baby 6 weeks or more. Which is what I did with my last one.
In a family with a genetic history of allergies, there is a different story – not because early exposure causes allergies, the jury is still well out on that – but because an allergic reaction in a 4 month old baby is not something you want to see. Of course, breast milk is often the cause of the allergic reaction, so it isn’t a panacea.
I would much rather have used human milk for when I needed to use a bottle, but since that isn’t an option at the moment, alarmist stuff suggesting that one bottle is BAD doesn’t help. I am pretty sure guilt ridden parents pose a much greater risk to their kids in the long run than one bottle a week.
I’d rather see a campaign for availability of human milk than vilifying formula.
Sorry I just have to support ABA. I run Breastfeeding Education Classes as a counsellor with ABA and I always tell the mums-to-be that breastfeeding will make your nipples tender and even sore. I try to be positive but for most women tenderness and even pain will last 3 – 6 weeks. What we say is that once baby is attached and suckling the pain shouldn’t be as bad (or that it should be mostly pain free) as when they are first attaching. Write to Anna Bligh’s office and support breastfeeding in Aboriginal communities. Surely Aboriginal women are sick of being told what to do. They would be better supported with nutrition and healthcare for mothers and children and let babies get on with the business of being babies. Please note these are my personal views and not ABAs.
Katrina, I know what you are saying is true for most women, but for those of for whom it *hurts*, not just in the nipple area but the whole breast, for the whole time, for months on end, the ABA’s advice is frustrating, and makes us feel like we’re doing it wrong. If I hadn’t found a few people who told me that I wasn’t doing it wrong, I was just one of those people, I probably would have given up way sooner. Constantly trying to correct something that isn’t wrong is soul destroying.
I support breastfeeding, I just think that it more resembles pregnancy in that it can be anything from a wonderful, gratifying experience to pure hell – rather than a straightforward process with a few difficulties at the start. I think it is marketed wrong, not that it is a bad thing. And I support the majority of the work the ABA does too, although their approach and advice doesn’t work for me. I know it does great things for lots of people.
Arianes last blog post..What the?
Aphie, you make a really good point about expectations, although I don’t understand why the odd bottle of formula makes you sad.
The children were all between 6 and 8 weeks and had been receiving at least one bottle of formula per week from the moment they got out of hospital in some cases, Ariane.
And my sadness wasn’t so much for the bottles of formula – when I was in the ER doped up to my eyeballs for several hours and we ran out of EBM my partner got some formula for him and we were glad of the option – it was for the fact that these women expressed breastfeeding as something they “couldn’t cope” with doing.
I don’t think demonising formula is a good option, either – though I’m disquieted by the fact it’s not regulated by an impartial body – I really do feel that more support and understanding is the way forward, to promote healthier expectations and levels of knowledge about breastfeeding. Ditch Elmo telling kids “bottles are how babies eat”, add more practical information into childbirth classes regarding breastfeeding (including the admission it can hurt and/or be uncomfortable, even past the first week, and why it’s still good to continue and where to get support), develop businesses that do breastfeeding-mother meals home-delivered! It’s mind-boggling that we have affordable meal services direct to your door for those wanting to lose weight, but not similar schemes for overwrought new parents and carers.