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.
Supportive Workplace Policies Critical for Nursing Mothers
www.nationalpartnership.org/site/…Mothers_Fact…/574216797?…
What Moms Need for Successful Breastfeeding After Returning to …
www.med.umich.edu/whp/…/breast-feeding–return-to-work.htm
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!
Maternity Ward Swag – NYTimes.com
www.nytimes.com/2012/05/11/opinion/maternity–ward–swag.html
Community-based strategies for breastfeeding promotion and support in developing countries: World Health Organization
http://www.who.int/maternal_child_adolescent/d s/9ocument241591218/en/
Nutrition – Protecting, promoting and supporting breastfeeding
www.unicef.org/nutrition/index_breastfeeding.html
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
privatelifeinpublichealth 
May 23, 2012 @ 15:18:55
This is, of course, such a tricky subject. I totally agree with the overall that women need more support to nurse, or to pump after returning to work. Since I own my own business I was fortunate enough to bring both my kids with me to the office until they were six months old and then pumped another 4 or 5 months after that, so I could continue night and morning feedings, etc. I think all working mothers should be granted that option. And definitely mothers in impoverished areas around the world without access to clean water should be educated to know that breast feeding is their best option, by far. The Nestle scandal of the 70s still rips at me, every time I find their chocolate milk in my fridge.
However, I also have had friends who physically could not breastfeed and sometimes in our struggle to fight the good fight for “breast is best” we accidentally disempower the women in our lives who cannot or could not breast feed. Just as in my fight for natural birth, or home birth, I always fear insulting my friends who have had C-sections or epidurals, and that is never my intention.
I think the formula samples distributed at the hospitals is a fair exchange if the hospitals are truly getting lots of donated stuff to support their neo-natal care units. Honestly the formula I got sent home with after having my first in the hospital, along with the many formula samples I received in the mail, altogether would not get you through more than a day or so. And many women supplement anyway. So it’s not necessarily an all or nothing thing. And formula IS so incredibly expensive. In my case, I just stashed all those free samples away until my babies were 4 or 6 months old and I had started supplementing. And then I was happy to have a little freebie in the cabinet next to flour so I didn’t have to run to Target in my nightgown with two small kids!
I think the best way we can help our moms and babies, those who work in the home, and those who work out of the home, is by talking and listening and providing support in all the forms it takes, be it a quiet room to pump in, or gifting stylish nursing shirts (yes, they exist!) and also recognizing that formula is not poison and supporting our friends who don’t or can’t breastfeed so they don’t feel like they have somehow short-changed their children. I think there has been a great movement lately back to breast feeding and I feel blessed to have gotten to have my children during this time, rather than my grandmother’s time. Her doctor actually chastised her for breast-feeding. So we have come a long way baby. But surely we have further to go. Initiating the dialogue is a great step in that direction. Thanks, Mom!
May 24, 2012 @ 08:07:14
Wow, what a heartbreaking story about Nestlé. Disgusts me and I feel bad for those African mothers. I’ve heard if the term “bad milk” in Haitian (?) culture and that the babies were fed watered down 7-Up 😦
I am constantly championing for BREAST by feeding my child, whenever and wherever to let people know that it’s normal.
May 28, 2012 @ 13:57:20
I gave birth at 39 and breastfed for 18 months. After my 3-month maternity leave, I pumped twice a day at work, and when my daughter began sleeping through the night, I pumped late at night. It all was frozen and given to my daughter by the babysitter or my husband while I was at work. The La Leche League http://www.llli.org/ strongly supports breastfeeding, as well as local maternity centers. Friends and I learned and shared solutions for sore breasts.