There was an op-ed article in the New York Times last week that seemed like deja vu all over again. Titled Maternity Swag, the author noted the current practice of infant formula companies providing samples of formula to hospitals for distribution to mothers as gifts to take home with them. The justification of hospitals is that they benefit from providing this free advertising by receiving support from the companies for their neonatal intensive care units, nurseries and lots of gratis equipment. Hospitals claim they are giving the samples to women because so many women are having to return to their jobs shortly after giving birth, and they need the formula to feed their babies while they are away from them at work.
I actually became aware of a global tragedy due to the very unethical business practices of formula companies in the early 1970’s as I was about to have my first baby. Researching the benefits of breastfeeding, I came across information about the Nestle infant formula campaign in developing countries. With a decrease in infant formula sales in the United States and countries in Europe as more women chose to breastfeed their babies, Nestle stepped up their marketing of “breast milk substitute” in Africa. The marketing strategy included sending company salespersons wearing white uniforms into local hospitals in Africa and giving women samples of about a month’s worth of powdered formula….enough so that by the time they ran out of the sample they had also lost their breast milk and had to buy the formula. But the formula, the mothers soon learned, was very expensive, a month’s worth often costing more than the family income for a month. And so the formula that was purchased was watered down and often with unclean water. The number of babies who died cannot be calculated, but the World Health Organization had to spend million of dollars to try to rescue babies and a generation of sick children. It was perhaps my first small public health effort to demonstrate against Nestle in my local grocery stores to raise awareness of what the company that made chocolate milk for our kids was doing to mothers and babies in Africa. Back in those days before computer generated labels, I had little handwritten notes that I stuffed in the shelves of chocolate bars and cocoa that read, “Nestle Kills Babies.” Today I guess I could provide websites and blogs and links to research, but back then the message was simple.
That was 40 years ago but UNICEF still estimates that a non-breastfed child living in disease-ridden and unhygienic conditions is between 6 and 25 times more likely to die of diarhhea and 4 times more likely to die of pneumonia than a breastfed child. I suggest that any maternal and child health advocate take a look at this issue on the internet. Maybe we still have to be in grocery stores protesting and questioning the business practices and marketing strategies that put our babies and children at risk of death and disease. But maybe we need a more complex solution and protest. Now as back then the issue is not just one of formula companies marketing their products. The companies are just capitalizing on the political issues and governmental prorities that contribute to women being unable to breastfeed their babies for as long as they choose. For example in the US there is simply the issue that many mothers do not work in “breastfeeding-friendly” workplaces as in the article below:
Every year roughly four million women give birth in the United States, and more than 75 percent of them choose to breastfeed. But with two-thirds of today’s working women returning to work within three months of giving birth, a lack of supportive workplace policies and laws is forcing too many nursing mothers to quit breastfeeding (or never start). Study after study has shown the value of breastfeeding in protecting both mothers and children from a number of acute and chronic diseases and conditions. It is time for our nation’s workplace policies—and our laws—to eliminate the barriers that keep many working mothers from breastfeeding.
In developing countries as well, some women need to go back to work, care for other children, and leave their babies for periods of time with other caregivers. They may tragically be too sick and malnourished to feed their babies. And there is the lure away from breastfeeding that still comes from providers of infant formula supported by hospitals and health care providers who all profit from the sale of the formula and promote it as the way women can best feed their babies and be modern. These are all opportunities for the formula companies to successfully market their products, but in farness to them they didn’t create the poverty that results in women not being healthy enough to breastfeed their babies or the other demands and stressors in women’s lives.
When I was 39 years old and gave birth to my youngest daughter, I breastfed her from birth during my maternity leave from my job. She was born on Memorial Day and I was due to go back to work right after Labor Day, the day that celebrates workers rights and of course ironically is the same word as giving birth. During the summer I actually had to go into my office in the Bronx to handle some contract budgets and also wanted my staff to meet my lovely baby, but I also took her with me so I could feed her. I sat at my desk and breastfed her with the door closed. Staff were respectful but also embarrassed that I, the boss, was “exposed.” Our family traveled to Barbados for an end of summer vacation and I still remember clearly sitting in a chair looking out at the sea contentedly rocking and feeding my sweet baby girl. It was bitter sweet though because I knew that in a couple of weeks I was going to be spending 9 to 10 hours a day out of the house at my office away from her. Yes, I look back now and think I could have pumped during the day at work, I could have frozen milk, I could have continued to breastfeed her at night with the baby sitter giving her my milk during the day. But there was no “lactation room” where I worked. I often had to be out of the office at meetings at other sites in the Bronx or in Manhattan…and mostly I felt I had to convince the people I worked for and worked with that having a baby had not in any way impaired my ability to be productive. A few days after I went back to work Alex and I rocked together in her white wicker rocking chair and that was the last of our breastfeeding relationship. I don’t think it in any way has impeded her health or our wonderful mother/daughter relationship and I had been able to breastfeed for about 3 months, but especially when I do this research about the benefits of breastfeeding I regret that it did not go on for longer. I was 39 and working and my maternity leave was over.
The formula companies continue to claim that their distribution of free samples to women around the world is about empowering women so they can chose which feeding method or combination is best for them and their babies, but as the author of the NYT article states, “it drives up sales.” Companies and organizations require that their employees to come back to work and there is little compensation in the United States during a Family Leave if one chooses to stay out longer. Governments have other priorities besides ending poverty and gender inequity and lack of education for women and girls. The formula companies will go on driving up their sales as long as women are not truly empowered to make the best health choices for themselves and their children.
So let’s join together and battle for the breast!
Community-based strategies for breastfeeding promotion and support in developing countries: World Health Organization
Footnote or perhaps better called a breast note:
The May 21, 2012, cover of Time magazine featured a photo of a woman breastfeeding her three year old son. This has caused quite a controversy about how long breastfeeding should last. Join the discussion. Send a comment to this blog!
Commentaries on the Time magazine cover