This is taken from http://www.whale.to/b/thomas.html and was first seen in The Ecologist 01/04/2006

The human species has been
breastfeeding for nearly half a million years. It’s only in the last 60 years
that we have begun to give babies the highly processed convenience food called
‘formula’. The health consequences – twice the risk of dying in the first six
weeks of life, five times the risk of gastroenteritis, twice the risk of
developing eczema and diabetes and up to eight times the risk of developing
lymphatic cancer – are staggering. developing lymphatic cancer – are staggering.

Killing babies

So why aren’t women breastfeeding?

Medicalised birth

Professional failures

The influence of advertising

Funding research

Fighting back

Unfortunately . . .

Not good enough

BREASTMILK vs FORMULA: NO CONTEST

With UK formula manufacturers spending around £20 per baby
promoting this ‘baby junk food’, compared to the paltry 14 pence per baby
the government spends promoting breastfeeding, can we ever hope to reverse the
trend. Pat Thomas uncovers a world where predatory
baby milk manufacturers, negligent health professionals and an ignorant,
unsympathetic public all conspire to keep babies of the breast and on the
bottle.

All mammals produce milk for their young, and the human species has been
nurturing its babies at the breast for at least 400,000 years. For centuries,
when a woman could not feed her baby herself, another lactating woman, or ‘wet
nurse’, took over the job. It is only in the last 60 years or so that we have
largely abandoned our mammalian instincts and, instead, embraced a bottlefeeding
culture that not only encourages mothers to give their babies highly processed
infant formulas from birth, but also to believe that these breastmilk
substitutes are as good as, if not better than, the real thing.

Infant formulas were never intended to be consumed on the widespread basis that
they are today. They were conceived in the late 1800s as a means of providing
necessary sustenance for foundlings and orphans who would otherwise have
starved. In this narrow context – where no other food was available – formula
was a lifesaver.

However, as time went on, and the subject of human nutrition in general – and
infant nutrition, in particular – became more ‘scientific’, manufactured
breastmilk substitutes were sold to the general public as a technological
improvement on breastmilk.

‘If anybody were to ask ‘which formula should I use?’ or ‘which is nearest to
mother’s milk?’, the answer would be ‘nobody knows’ because there is not one
single objective source of that kind of
information provided by anybody,’ says Mary Smale, a breastfeeding counsellor
with the National Childbirth Trust (NCT) for 28 years. ‘Only the manufacturers
know what’s in their stuff, and they aren’t telling. They may advertise special
‘healthy’ ingredients like oligosaccharides, long-chain fatty acids or, a while
ago, beta-carotene, but they never actually tell you what the basic product is
made from or where the ingredients come from.’

The known constituents of breastmilk were and are used as a general reference
for scientists devising infant formulas. But, to this day, there is no actual
‘formula’ for formula. In fact, the process of producing infant formulas has,
since its earliest days, been one of trial and error.

Within reason, manufacturers can put anything they like into formula. In fact,
the recipe for one product can vary from batch to batch, according to the price
and availability of ingredients. While we assume that formula is heavily
regulated, no transparency is required of manufacturers: they do not, for
example, have to log the specific constituents of any batch or brand with any
authority.

Most commercial formulas are based on cow’s milk. But before a baby can
drink
cow’s milk in the form of infant formula, it needs to be severely modified. The
protein and mineral content must be reduced and the carbohydrate content
increased, usually by adding sugar. Milk fat, which is not easily absorbed by
the human body, particularly one with an immature digestive system, is removed
and substituted with vegetable, animal or mineral fats.

Vitamins and trace elements are added, but not always in their most easily
digestible form. (This means that the claims that formula is ‘nutritionally
complete’ are true, but only in the crudest sense of having had added the full
complement of vitamins and mineral to a nutritionally inferior product.)

Many formulas are also highly sweetened. While most infant formulas do not
contain sugar in the form of sucrose, they can contain high levels of
other types
of sugar such as lactose (milk sugar), fructose (fruit sugar), glucose (also
known as dextrose, a simple sugar found in plants) and maltodextrose (malt
sugar). Because of a loophole in the law, these can still be advertised as
‘sucrose free’.

Formula may also contain unintentional contaminants introduced during the
manufacturing process. Some may contain traces of genetically engineered soya
and corn.

The bacteria Salmonella and aflatoxins – potent toxic, carcinogenic, mutagenic,
immunosuppressive agents produced by species of the fungus Aspergillus – have
regularly been detected in commercial formulas, as has Enterobacter sakazakii, a
devastating food borne pathogen that can cause sepsis
(overwhelming bacterial infection in the bloodstream), meningitis (inflammation
of the lining of the brain) and necrotising enterocolitis (severe infection and
inflammation of the small intestine and colon) in newborn infants.

The packaging of infant formulas occasionally gives rise to contamination with
broken glass and fragments of metal as well as industrial chemicals such as
phthalates and bisphenol A (both carcinogens) and, most recently, the packaging
constituent isopropyl thioxanthone (ITX; another suspected carcinogen).

Infant formulas may also contain excessive levels of toxic or heavy metals,
including aluminium, manganese, cadmium and lead.

Soya formulas are of particular concern due to the very high levels of
plant-derived oestrogens (phytoestrogens) they contain. In fact, concentrations
of phytoestrogens detected in the blood of infants receiving soya formula can be
13,000 to 22,000 times greater than the concentrations of natural oestrogens.
Oestrogen in doses above those normally found in the body can cause cancer.

Killing babies

For years, it was believed that the risks of illness and death from bottlefeeding were largely confined to children in developing countries, where
the clean water necessary to make up formula is sometimes scarce
and where poverty-stricken mothers may feel obliged to dilute formula to
make it stretch further, thus risking waterborne illnesses such as diarrhoea and
cholera as well as malnutrition in their babies. But newer data from the West
clearly show that babies in otherwise affluent societies are also falling ill
and dying due to an early diet of infant convenience food. Because it is not
nutritionally complete, because it does not contain the immune-boosting
properties of breastmilk and because it is being consumed by growing babies with
vast, ever-changing nutritional needs – and not meeting those needs – the health
effects of sucking down formula day after day early in life can be devastating
in both the short and long term.

Compared to breastfed babies, bottlefed babies are twice as likely to die from
any cause in the first six weeks of life. In particular, bottlefeeding raises
the risk of SIDS (sudden infant death syndrome) by two to five times. Bottlefed
babies are also at a significantly higher risk of ending up in hospital with a
range of infections. They are, for instance, five times more likely to be
admitted to hospital suffering from gastroenteritis.

Even in developed countries, bottlefed babies have rates of diarrhoea twice as
high as breastfed ones. They are twice as likely (20 per cent vs 10 per cent) to
suffer from otitis media (inner-ear infection), twice as likely to develop
eczema or a wheeze if there is a family history of atopic disease, and five
times more likely to develop urinary tract infections.

In the first six months of life, bottlefed babies are six to 10 times more
likely to develop necrotising enterocolitis – a serious infection of the
intestine, with intestinal tissue death – a figure that increases to 30 times
the risk after that time.

Even more serious diseases are also linked with bottlefeeding. Compared
with infants who are fully breastfed even for only three to four months,
a baby drinking artificial milk is twice as likely to develop juvenile-onset
insulin-dependent (type 1) diabetes. There is also a five
to eightfold risk of
developing lymphomas in children under 15 who were formula fed, or breastfed for
less than six months.

In later life, studies have shown that bottlefed babies have a greater tendency
towards developing conditions such as childhood inflammatory bowel disease,
multiple sclerosis, dental malocclusion, coronary heart disease, diabetes,
hyperactivity, autoimmune thyroid disease and coeliac disease.

For all of these reasons, formula cannot be considered even ‘second best’
compared with breastmilk. Officially, the World Health Organization (WHO)
designates formula milk as the last choice in infant-feeding: Its first choice
is breastmilk from the mother; second choice is the mother’s own milk given via
cup or bottle; third choice is breastmilk from a milk bank or wet nurse and,
finally, in fourth place, formula milk.

And yet, breastfed babies are becoming an endangered species. In the UK, rates
are catastrophically low and have been that way for decades. Current figures
suggest that only 62 per cent of women in Britain even attempt to breastfeed
(usually while in hospital). At six weeks, just 42 per cent are breastfeeding.
By four months, only 29 per cent are still breastfeeding and, by six months,
this figure drops to 22 per cent.

These figures could come from almost any developed country in the world and, it
should be noted, do not necessarily reflect the ideal of ‘exclusive’
breastfeeding. Instead, many modern mothers practice mixed feeding – combining
breastfeeding with artificial baby milks and infant foods. Worldwide, the WHO
estimates that only 35 per cent of infants are getting any breastmilk at all by
age four months and, although no one can say for sure because research into
exclusive breastfeeding is both scarce and incomplete, it is estimated that only
1 per cent are exclusively breastfed at six months.

Younger women in particular are the least likely to breastfeed, with over 40 per
cent of mothers under 24 never even trying. The biggest gap, however, is a
socioeconomic one. Women who live in low-income households or who are poorly
educated are many times less likely to breastfeed, even though it can make an
enormous difference to a child’s health.

In children from socially disadvantaged families, exclusive breastfeeding in the
first six months of life can go a long way towards cancelling out the health
inequalities between being born into poverty and being born into affluence. In
essence, breastfeeding takes the infant out of poverty for those first crucial
months and gives it a decent start in life.

So why aren’t
women breastfeeding?

Before bottles became the norm, breastfeeding was an activity of daily living
based on mimicry, and learning within the family and community. Women became
their own experts through the trial and error of the experience itself. But
today, what should come more or less naturally has become
extraordinarily
complicated – the focus of global marketing strategies and politics, lawmaking,
lobbying support groups, activists and the interference of a well
intentioned,
but occasionally ineffective, cult of experts.

According to Mary Smale, it’s confidence and the expectation of support that
make the difference, particularly for socially disadvantaged women.

‘The concept of ‘self efficacy’ – in other words, whether you think you can do
something – is quite important. You can say to a woman that breastfeeding is
really a good idea, but she’s got to believe various things in order for it to
work. First of all, she has to think it’s a good idea – that it will be good for
her and her baby. Second, she has to think: ‘I’m the sort of person who can do
that’; third – and maybe the most important thing – is the belief that if she
does have problems, she’s the sort of person who, with help, will be able to
sort them out.

‘Studies show, for example, that women on low incomes often believe that
breastfeeding hurts, and they also tend to believe that formula is just as good.
So from the start, the motivation to breastfeed simply isn’t there. But really,
it’s the thought that if there were any problems, you couldn’t do anything about
them; that, for instance, if it hurts, it’s just the luck of the draw. This
mindset is very different from that of a middleclass mother who is used to
asking for help to solve things, who isn’t frightened of picking up the phone,
or saying to her midwife or health visitor, ‘I want you to help me with this’.’

Nearly all women – around 99 per cent – can breastfeed successfully and make
enough milk for their babies to not simply grow, but to thrive. With
encouragement, support and help, almost all women are willing to initiate
breastfeeding, but the drop-off rates are alarming: 90 per cent of women who
give up in the first six weeks say that they would like to have continued. And
it seems likely that long-term exclusive breastfeeding rates could be improved
if consistent support were available, and if approval within the family and the
wider community for breastfeeding, both at home and in public, were more obvious
and widespread.

Clearly, this social support isn’t there, and the bigger picture of
breastfeeding vs bottlefeeding suggests that there is, in addition, a confluence of complex factors – medical, socioeconomic, cultural and political – that
regularly undermine women’s confidence, while reinforcing the notion that
feeding their children artificially is about lifestyle rather than health, and
that the modern woman’s body is simply not up to the task of producing enough
milk for its offspring.

‘Breastfeeding is a natural negotiation between mother and baby and you
interfere with it at your peril,’ says Professor Mary Renfrew, Director of the
Mother and Infant Research Unit, University of York. “But, in the early years of
the last century, people were very busy interfering with it. In terms of the
ecology of breastfeeding, what you have is a natural habitat that has been
disturbed. But it’s not just the presence of one big predator – the invention of
artificial milk – that is important. It is the fact that the habitat was already
weakened by other forces that made it so vulnerable to disaster.

‘If you look at medical textbooks from the early part of the 20th century,
you’ll find many quotes about making breastfeeding scientific and exact, and
it’s out of these that you can see things beginning to fall apart.’ This falling
apart, says Renfrew, is largely due to the fear and mistrust that science had of
the natural process of breastfeeding.

In particular, the fact that a mother can put a baby on the breast and do
something else while breastfeeding, and have the baby naturally come off the
breast when it’s had enough, was seen as disorderly and inexact. The medical/
scientific model replaced this natural situation with precise measurements – for
instance, how many millilitres of milk a baby should ideally have at each
sitting – which skewed the natural balance between mother and baby, and
established bottlefeeding as a biological norm.

Breastfeeding rates also began to decline as a consequence of women’s changed
circumstances after World War I, as more women left their children behind to go
into the workplace as a consequence of women’s emancipation – and the loss of
men in the ‘killing fi elds’ – and to an even larger extent with the advent of
World War II, when even more women entered into employment outside of the home.

‘There was also the first wave of feminism,’ says Renfrew, ‘which stamped into
everyone’s consciousness in the 60s, and encouraged women get away from their
babies and start living their lives. So the one thing that might have helped –
women supporting each other – actually created a situation where even the
intellectual, engaged, consciously aware women who might have questioned this
got lost for a while. As a consequence, we ended up with a widespread and
declining confidence in breastfeeding, a declining understanding of its
importance and a declining ability of health professionals to support it. And,
of course, all this ran along the same timeline as the technological development
of artificial milk and the free availability of formula.’

Medicalised birth

Before World War II, pregnancy and birth – and, by extension, breastfeeding –
were part of the continuum of normal life. Women gave birth at home with the
assistance and support of trained midwives, who were themselves part of the
community, and afterwards they breastfed with the encouragement of family and
friends.

Taking birth out of the community and relocating it into hospitals gave rise to
the medicalisation of women’s reproductive lives. Life events were transformed
into medical problems, and traditional knowledge was replaced with scientific
and technological solutions. This medicalisation resulted in a cascade of
interventions that deeply undermined women’s confi dence in their abilities to
conceive and grow a healthy baby, give birth to it and then feed it.

The cascade falls something like this: Hospitals are institutions; they are
impersonal and, of necessity, must run on schedules and routines. For a hospital
to run smoothly, patients must ideally be sedate and immobile. For the woman
giving birth, this meant lying on her back in a bed, an unnatural position that
made labour slow, unproductive and very much more painful.

To ‘fix’ these iatrogenically dysfunctional labours, doctors developed a range
of drugs (usually synthetic hormones such as prostaglandins or syntocinon),
technologies (such as forceps and vacuum extraction) and procedures (such as
episiotomies) to speed the process up. Speeding up labour artificially made it
even more painful and this, in turn, led to the development of an array of
pain-relieving drugs. Many of these were so powerful that the mother was often
unconscious or deeply sedated at the moment of delivery and, thus, unable to
offer her breast to her newborn infant.

All pain-relieving drugs cross the placenta, so even if the mother were
conscious, her baby may not have been, or may have been so heavily drugged that
its natural rooting instincts (which help it find the nipple) and muscle
coordination (necessary to latch properly onto the breast) were severely
impaired.

While both mother and baby were recovering from the ordeal of a medicalised
birth, they were, until the1970s and 1980s, routinely separated. Often, the baby
wasn’t ‘allowed’ to breastfeed until it had a bottle first, in case there was
something wrong with its gastrointestinal tract. Breastfeeding, when it took
place at all, took place according to strict schedules. These feeding schedules
– usually on a three- or four hourly basis – were totally unnatural for
human
newborns, who need to feed 12 or more times in any 24-hour period. Babies who
were inevitably hungry between feeds were routinely given supplements of water
and/or formula.

‘There was lots of topping up,’ says Professor Renfrew. ‘The way this ‘scientific’ breastfeeding happened in hospital was that the baby would be given two
minutes on each breast on day one, then four minutes on each breast on day two,
seven minutes on each on day three, and so on. This created enormous anxiety
since the mother would then be watching the clock instead of the baby. The
babies would then get topped-up after every feed, then topped-up again
throughout the night rather than brought to their mothers to feed. So you had a
situation where the babies were crying in the nursery, and the mothers were
crying in the postnatal ward. That’s what we called ‘normal’ all throughout the
60s and 70s.’

Breastmilk is produced on a supply-and-demand basis, and these topping-up
routines, which assuaged infant hunger and lessened demand, also reduced the
mother’s milk supply. As a result, women at the mercy of institutionalised birth
experienced breastfeeding as a frustrating struggle that was often painful and
just as often unsuccessful.

When, under these impossible circumstances, breastfeeding ‘failed’, formula was
offered as a ‘nutritionally complete solution’ that was also more ‘modern’,
‘cleaner’ and more ‘socially acceptable’.

At least two generations of women have been subjected to these kinds of damaging
routines and, as a result, many of today’s mothers find the concept of
breastfeeding strange and unfamiliar, and very often framed as something that
can and frequently does not ‘take’, something they might ‘have a go’ at but,
equally, something that they shouldn’t feel too badly about if it doesn’t work
out.

Professional failures

The same young doctors, nurses and midwives who were pioneering this medical
model of reproduction are now running today’s health services. So, perhaps not
surprisingly, modern hospitals are, at heart, little different from their
predecessors. They may have TVs and CD players, and prettier wallpaper, and the
drugs may be more sophisticated, but the basic goals and principles of
medicalised birth have changed very little in the last 40 years – and the effect
on breastfeeding is still as devastating.

In many cases, the healthcare providers’ views on infant-feeding are based on
their own, highly personal experiences. Surveys show, for instance, that the
most important factor influencing the effectiveness and accuracy of a doctor’s
breastfeeding advice is whether the doctor herself, or the doctor’s wife, had
breastfed her children. Likewise, a midwife, nurse or health visitor formulafed
her own children is unlikely to be an effective advocate for breastfeeding.

More worrying, these professionals can end up perpetuating damaging myths about
breastfeeding that facilitate its failure. In some hospitals, women are still
advised to limit the amount of time, at first, that a baby sucks on each breast,
to ‘toughen up’ their nipples. Or they are told their babies get all the milk
they ‘need’ in the first 10 minutes and sucking after this time is unnecessary.
Some are still told to stick to four-hour feeding schedules. Figures from the
UK’s Office of National Statistics show that we are still topping babies up. In
2002, nearly 30 per cent of babies in UK hospitals were given supplemental
bottles by hospital staff, and nearly 20 per cent of all babies were separated
from their mothers at some point while in hospital.

Continued inappropriate advice from medical professionals is one reason why, in
1991, UNICEF started the Baby Friendly Hospital Initiative (BFHI) – a
certification system for hospitals meeting certain criteria known to promote
successful breastfeeding. These criteria include: training all healthcare staff
on how to facilitate breastfeeding; helping mothers start breastfeeding within
one hour of birth; giving newborn infants no food or drink other than breastmilk,
unless medically indicated; and the hospital not accepting free or heavily
discounted formula and supplies. In principle, it is an important step in the
promotion of breastfeeding, and studies show that women who give birth in Baby
Friendly hospitals do breastfeed for longer.

In Scotland, for example, where around 50 per cent of hospitals are rated Baby
Friendly, breastfeeding initiation rates have increased dramatically in recent
years. In Cuba, where 49 of the country’s 56 hospitals and maternity facilities
are Baby Friendly, the rate of exclusive breastfeeding at four months almost
tripled in six years – from 25 per cent in 1990 to 72 per cent in 1996. Similar
increases have been found in Bangladesh, Brazil and China.

Unfortunately, interest in obtaining BFHI status is not universal. In the UK,
only 43 hospitals (representing just 16 per cent of all UK hospitals) have
achieved full accreditation – and none are in London. Out of the approximately
16,000 hospitals worldwide that have qualified for the Baby Friendly
designation, only 32 are in the US. What’s more, while Baby Friendly hospitals
achieve a high initiation rate, they cannot guarantee continuation of
breastfeeding once the woman is back in the community. Even among women who give
birth in Baby Friendly hospitals, the number who exclusively breastfeed for six
months is unacceptably low.

The influence of
advertising

Baby Friendly hospitals face a daunting task in combating the laissez-faire
and general ignorance of health professionals, mothers and the public at large.
They are also fighting a difficult battle with an acquiescent media which,
through politically correct editorialising aimed at assuaging mothers’ guilt if
they bottlefeed and, more influentially, through advertising, has helped
redefine formula as an acceptable choice.

Although there are now stricter limitations on the advertising of infant
formula, for years, manufacturers were able, through advertising and promotion,
to define the issue of infant-feeding in both the scientific world (for
instance, by providing doctors with growth charts that established the growth
patterns of bottlefed babies as the norm) and in its wider social context,
reframing perceptions of what is appropriate and what is not.

As a result, in the absence of communities of women talking to each other about
pregnancy, birthing and mothering, women’s choices today are more directly
influenced by commercial leaflets, booklets and advertising than almost anything
else.

Baby-milk manufacturers spend countless millions devising marketing strategies
that keep their products at the forefront of public consciousness. In the UK,
formula companies spend at least £12 million per year on booklets, leaflets and
other promotions, often in the guise of ‘educational materials’. This works out
at approximately £20 per baby born. In contrast, the UK government spends about
14 pence per newborn each year to promote breastfeeding.

It’s a pattern of inequity that is repeated throughout the world – and not just
in the arena of infant-feeding. The food-industry’s global advertising budget is
$40 billion, a figure greater than the gross domestic product (GDP) of 70 per
cent of the world’s nations. For every $1 spent by the WHO on preventing the
diseases caused by Western diets, more than $500 is spent by the food industry
to promote such diets.

Since they can no longer advertise infant formulas directly to women (for
instance, in mother and baby magazines or through direct leafleting), or hand
out free samples in hospitals or clinics, manufacturers have started to exploit
other outlets, such as mother and baby clubs, and Internet sites that purport to
help busy mothers get all the information they need about infant-feeding. They
also occasionally rely on subterfuge.

Manufacturers are allowed to advertise follow-on milks, suitable for babies over
six months, to parents. But, sometimes, these ads feature a picture of a much
younger baby, implying the product’s suitability for infants.

The impact of these types of promotions should not be underestimated. A 2005 NCT/UNICEF
study in the UK determined that one third of British
mothers who admitted to seeing formula advertisements in the previous six months
believed that infant formula was as good or better than breastmilk. This
revelation is all the more surprising since advertising of infant formula to
mothers has been banned for many years in several countries, including the UK.

To get around restrictions that prevent direct advertising to parents,
manufacturers use a number of psychological strategies that focus on the natural
worries that new parents have about the health of their babies. Many of today’s
formulas, for instance, are conceived and sold as solutions to the ‘medical’
problems of infants such as lactose intolerance, incomplete digestion and being
‘too hungry’ – even though many of these problems can be caused by
inappropriately giving cow’s milk formula in the first place.

The socioeconomic divide among breastfeeding mothers is also exploited by
formula manufacturers, as targetting lowincome women (with advertising as well
as through welfare schemes) has proven

very profitable. When presented with the opportunity to provide their children
with the best that science has to offer, many low
income mothers are naturally tempted by formula. This is especially true if they
receive free samples, as is still the case in many developing countries.

But the supply-and-demand nature of breastmilk is such that, once a mother
accepts these free samples and starts her baby on formula, her own milk supply
will quickly dry up. Sadly, after these mothers run out
of formula samples and money-off coupons, they will find themselves
unable to produce breastmilk and have no option but to spend large sums of money
on continuing to feed their child with formula.

Even when manufacturers ‘promote’ breastfeeding, they plant what Mary Smale
calls ‘seeds of ‘conditionality’ that can lead to failure. ‘Several years ago,
manufacturers used to produce these amazing leaflets for women, encouraging
women to breastfeed and reassuring them that they only need a few extra calories
a day. You couldn’t fault them on the words, but the pictures which were of
things like Marks & Spencer yoghurt and whole fish with their heads on, and
wholemeal bread – but not the sort of wholemeal bread that you buy in the corner
shop, the sort of wholemeal bread you buy in specialist shops.

The underlying message was clear: a healthy pregnancy and a good supply of
breastmilk are the preserve of the middle classes, and that any women who
doesn’t belong to that group will have to rely on other resources to provide for
her baby.

A quick skim through any pregnancy magazine or the ‘Bounty’ pack – the glossy
information booklet with free product samples given to new mothers in the UK –
shows that these subtle visual messages, which include luxurious photos of whole
grains and pulses, artistically arranged bowls of muesli, artisan loaves of
bread and wedges of deli-style cheeses, exotic mangoes, grapes and kiwis, and
fresh vegetables artistically arranged as crudités, are still prevalent.

Funding research

Manufacturers also ply their influence through contact with health
professionals (to whom they can provide free samples for research and
‘educational purposes’) as middlemen. Free gifts, educational trips to exotic
locations and funding for research are just some of the ways in which the
medical profession becomes ‘educated’ about the benefits of formula.

According to Patti Rundall, OBE, policy director for the UK’s Baby Milk Action
group, which has been lobbying for responsible marketing of baby food for over
20 years, ‘Throughout the last two decades, the baby-feeding companies have
tried to establish a strong role for themselves with the medical profession,
knowing that health and education services represent a key marketing
opportunity. Companies are, for instance, keen to fund the infant-feeding
research on which health policies are based, and to pay for midwives, teachers,
education materials and community projects.’

They are also keen to fund ‘critical’ NGOs – that is, lay groups whose mandate
is to inform and support women. But this sort of funding is not allowed by the
International Code of Marketing of Breastmilk Substitutes (see below) because it
prejudices the ability of these organisations to provide mothers with
independent information about infantfeeding. Nevertheless, such practices remain
prevalent – if somewhat more discreet than in the past – and continue to weaken
health professionals’ advocacy for breastfeeding.

Fighting back

When it became clear that declining breastfeeding rates were affecting infant
health and that the advertising of infant formula had a direct effect on a
woman’s decision not to breastfeed, the International Code of Marketing of
Breastmilk Substitutes was drafted and eventually adopted by the World Health
Assembly (WHA) in 1981. The vote was near-unanimous, with 118 member nations
voting in favour, three abstaining and one – the US – voting against. (In 1994,
after years of opposition, the US eventually joined every other developed nation
in the world as a signatory to

the Code.)

The Code is a unique instrument that promotes safe and adequate nutrition for
infants on a global scale by trying to protect breastfeeding and ensuring the
appropriate marketing of breastmilk substitutes. It applies to all products
marketed as partial or total replacements for breastmilk, including infant
formula, follow-on formula, special formulas, cereals, juices, vegetable mixes
and baby teas, and also applies to feeding bottles and teats. In addition, it
maintains that no infant food may be marketed in ways that undermine
breastfeeding. Specifically, the Code:

• Bans all advertising or promotion of these products to the general
  public
• Bans samples and gifts to mothers and health workers
• Requires information materials to advocate for breastfeeding, to warn
  against bottlefeeding and to not contain pictures of babies or text that
  idealises the use of breastmilk substitutes
• Bans the use of the healthcare system to promote breastmilk substitutes
• Bans free or low-cost supplies of breastmilk substitutes
• Allows health professionals to receive samples, but only for research
  purposes
• Demands that product information be factual and scientific
• Bans sales incentives for breastmilk substitutes and direct contact with
  mothers
• Requires that labels inform fully on the correct use of infant formula
  and the risks of misuse
• Requires labels not to discourage breastfeeding.

This document probably couldn’t have been created today. Since the founding
of the World Trade Organization (WTO) and its ‘free trade’ ethos in 1995, the
increasing sophistication of corporate power strategies and aggressive lobbying
of health organisations has increased to the extent that the Code would have
been binned long before it reached the voting stage.

However, in 1981, member states, corporations and NGOs were on a somewhat more
equal footing. By preventing industry from advertising infant formula, giving
out free samples, promoting their products in healthcare facilities or by way of
mother-and-baby ‘goody bags’, and insisting on better labelling, the Code acts
to regulate an industry that would otherwise be given a free hand to pedal an
inferior food product to babies and infants.

Unfortunately . . .

Being a signatory to the Code does not mean that member countries are obliged
to adopt its recommendations wholesale. Many countries, the UK included, have
adopted only parts of it – for instance,

the basic principle that breastfeeding is a good thing – while ignoring the
nuts-andbolts strategies that limit advertising and corporate contact with
mothers. So, in the UK, infant formula for ‘healthy babies’ can be advertised to
mothers through hospitals and clinics, though not via the media.

What’s more, formula manufacturers for their part continue to argue that the
Code is too restrictive and that it stops them from fully exploiting their
target markets. Indeed, Helmut Maucher, a powerful corporate lobbyist and
honorary chairman of Nestlé – the company that claims 40 per cent of the global
baby-food market – has gone on record as saying: ‘Ethical decisions that injure
a firm’s ability to compete are actually immoral’.

And make no mistake, these markets are big. The UK babymilk market is worth £150
million per year and the US market around $2 billion. The worldwide market for
baby milks and foods is a staggering $17 billion and growing by 12 per cent each
year. From formula manufacturers’ point of view, the more women breastfeed, the
more profit is lost. It is estimated that, for every child exclusively breastfed
for six months, an average of $450 worth of infant food will not be bought. On a
global scale, that amounts to billions of dollars in lost profits.

What particularly worries manufacturers is that, if they accept the Code without
a fight, it could set a dangerous precedent for other areas of international
trade – for instance, the pharmaceutical, tobacco, food and agriculture
industries, and oil companies.

This is why the focus on infant-feeding has been diverted away from children’s
health and instead become a symbolic struggle for a free market.

While most manufacturers publicly agree to adhere to the Code, privately, they
deploy enormous resources in constructing ways to reinterpret or get round it.
In this endeavour, Nestlé has shown a defiance and tenacity that beggars belief.

In India, for example, Nestlé lobbied against the Code being entered into law
and when, after the law was passed, it faced criminal charges over its
labelling, it issued a writ petition against the Indian government rather than
accept the charges.

Years of aggressive actions like this, combined with unethical advertising and
marketing practices, has led to an ongoing campaign to boycott the company’s
products that stretches back to 1977.

The Achilles’ heel of the Code is that it does not provide for a monitoring
office. This concept was in the original draft, but was removed from subsequent
drafts. Instead, monitoring of the Code has been left to ‘governments acting
individually and collectively through the World Health Organization’.

But, over the last 25 years, corporate accountability has slipped lower down on
the UN agenda, far behind free trade, self-regulation and partnerships. Lack of
government monitoring means that small and comparatively poorly funded groups
like the International Baby Food Action Network (IBFAN), which has 200 member
groups working in over 100 countries, have taken on the job of monitoring Code
violations almost by default. But while these watchdog groups can monitor and
report Code violations to the health authorities, they cannot stop them.

In 2004, IBFAN’s bi-annual report Breaking the Rules, Stretching the Rules,
analysed the promotional practices of 16 international baby-food companies, and
14 bottle and teat companies, between January 2002 and April 2004. The
researchers found some 2,000 violations of the Code in 69 countries.

On a global scale, reinterpreting the Code to suit marketing strategies is rife,
and Nestlé continues to be the leader of the pack. According to IBFAN, Nestlé
believes that only one of its products – infant formula – comes within the scope
of the Code. The company also denies the universality of the Code, insisting
that it only applies to developing nations. Where Nestlé, and the Infant Food
Manufacturers Association that it dominates, leads, other companies have
followed, and when companies like Nestlé are caught breaking the Code, the
strategy is simple, but effective – initiate complex and boring discussions with
organisations at WHO or WHA level about how best to interpret the Code in the
hopes that these will offset any bad publicity and divert attention from the
harm caused by these continual infractions.

According to Patti Rundall, it’s important not to let such distractions divert
attention from the bottom line: ‘There can be no food more locally produced,
more sustainable or more environmentally friendly than a mother’s breastmilk,
the only food required by an infant for the fi rst six months of life. It is a
naturally renewable resource, which requires no packaging or transport, results
in no wastage and is free. Breastfeeding can also help reduce family poverty,
which is a major cause of malnutrition.’

So perhaps we should be further simplifying the debate by asking: Are the
companies who promote infant formula as the norm simply clever entrepreneurs
doing their jobs or human-rights violators of the worst kind?

Not good enough

After more than two decades, it is clear that a half-hearted advocacy of
breastfeeding benefits multinational formula manufacturers, not mothers and
babies, and that the baby-food industry has no intention of complying with UN
recommendations on infant-feeding or with the principles of the International
Code for Marketing of Breastmilk Substitutes – unless they are forced to do so
by law or consumer pressure or, more effectively, both.

Women do not fail to breastfeed. Health professionals, health agencies and
governments fail to educate and support women who want to breastfeed.

Without support, many women will give up when they encounter even small
difficulties. And yet, according to Mary Renfrew, ‘Giving up breastfeeding is
not something that women do lightly. They don’t just stop breastfeeding and walk
away from it. Many of them fight very hard to continue it and they fight with no
support. These women are fighting society – a society that is not just
bottle-friendly, but is deeply breastfeeding-unfriendly.’

To reverse this trend, governments all over the world must begin to take
seriously the responsibility of ensuring the good health of future generations.
To do this requires deep and profound social change. We must stop harassing
mothers with simplistic ‘breast is best’ messages and put time, energy and money
into reeducating health professionals and society at large.

We must also stop making compromises. Government health policies such as, say,
in the UK and US, which aim for 75 per cent of women to be breastfeeding on
hospital discharge, are little more than paying lip service to the importance of
breastfeeding.

Most of these women will stop breastfeeding within a few weeks, and such
policies benefit no one except the formula manufacturers, who will start making
money the moment breastfeeding stops.

To get all mothers breastfeeding, we must be prepared to:

• Ban all advertising of formula including follow-on milks
• Ban all free samples of formula, even those given for educational or
  study purposes
• Require truthful and prominent health warnings on all tins and cartons
  of infant formula
• Put substantial funding into promoting breastfeeding in every community,
  especially among the socially disadvantaged, with a view to achieving
  100-per-cent exclusive breastfeeding for the first six months of life
• Fund advertising and education campaigns that target fathers, mothersin-law,
  schoolchildren, doctors, midwives and the general public
• Give women who wish to breastfeed in public the necessary encouragement
  and approval
• Make provisions for all women who are in employment to take at least six
  months paid leave after birth, without fear of losing their jobs.

Such strategies have already proven their worth elsewhere. In 1970,
breastfeeding rates in Scandinavia were as low as those in Britain. Then, one by
one, the Scandinavian countries banned all advertising of artifi cial formula
milk, offered a year’s maternity leave with 80 per cent of pay and, on the
mother’s return to work, an hour’s breastfeeding break every day. Today, 98 per
cent of Scandinavian women initiate breastfeeding, and 94 per cent are still
breastfeeding at one month, 81 per cent at two months, 69 per cent at four
months and 42 per cent at six months. These rates, albeit still not optimal, are

nevertheless the highest in the world, and the result of a concerted,
multifaceted approach to promoting breastfeeding.

Given all that we know of the benefits of breastfeeding and the dangers of
formula milk, it is simply not acceptable that we have allowed breastfeeding
rates in the UK and elsewhere in the world to

decline so disastrously.

The goal is clear – 100 per cent of mothers should be exclusively breastfeeding
for at least the first six months of their babies’ lives.

BREASTMILK vs FORMULA: NO
CONTEST

Breastmilk is a ‘live’ food that contains living cells, hormones, active
enzymes, antibodies and at least 400 other unique components. It is a dynamic
substance, the composition of which changes from the beginning to the end of the
feed and according to the age and needs of the baby. Because it also provides
active immunity, every time a baby breastfeeds it also receives protection from
disease.

Compared to this miraculous substance, the artificial milk sold as infant
formula is little more than junk food. It is also the only manufactured food
that humans are encouraged to consume exclusively for a period of months, even
though we know that no human body can be expected to stay healthy and thrive on
a steady diet of processed food.

BREAST MILK	FORMULA	COMMENTS
FATS
Rich in brain-building omega-3s, namely,DHA and AA. Automatically adjusts toinfant’s needs; levels decline as babygets older. Rich in cholesterol; nearlycompletely absorbed. Contains the fat-digesting enzyme lipase	No DHA Doesn’t adjust to infant’s needs No cholesterol Not completely absorbed No lipase	The most important nutrient in breastmilk; the absence of cholesterol and DHA may predispose a child to adult heart and CNS diseases. Leftover, unabsorbed fat accounts for unpleasant smelling stools in formula-fed babies
PROTEIN
Soft, easily digestible whey. More completely absorbed; higher in the milk of mothers who deliver preterm. Lactoferrinfor intestinal health. Lysozyme, an antimicrobial. Rich in brain- and bodybuilding protein components. Rich in growth factors. Contains sleep-inducing proteins	Harder-to-digest casein curds Not completely absorbed, so more waste,harder on kidneys Little or no lactoferrin No lysozyme. Deficient or low in some brain and body-building proteins Deficient in growth factors Contains fewer sleep-inducing proteins	Infants aren’t allergic to human milk proteins
CARBOHYDRATES
Rich in oligosaccharides, which promote intestinal health	No lactose in some formulas Deficient in oligosaccharides	Lactose is important for brain development
IMMUNE-BOOSTERS
Millions of living white blood cells, in every feeding Rich in immunoglobulins No live white blood cells or any other cells. Has no immune benefit	No live white blood cells or any other cells. Has no immune benefit	Breastfeeding provides active and dynamic protection from infections of all kinds Breastmilk can be used to alleviate a range of external health problems such as nappy rash and conjunctivitis
VITAMINS & MINERALS
Better absorbed Iron is 50–75 per cent absorbed Contains more selenium (an antioxidant)	Not absorbed as well Iron is 5–10 per cent absorbed Contains less selenium (an antioxidant)	Nutrients in formula are poorly absorbed. To compensate, more nutrients are added to formula, making it harder to digest
ENZYMES & HORMONES
Rich in digestive enzymes such as lipase and amylase. Rich in many hormones such as thyroid, prolactin and oxytocin. Taste varies with mother’s diet, thus helping the child acclimatise to the cultural diet	Processing kills digestive enzymes Processing kills hormones, which are not human to begin with Always tastes the same	Digestive enzymes promote intestinal health; hormones contribute to the biochemical balance and wellbeing of the baby
COST
Around £350/year in extra food for mother if she was on a very poor diet to begin with	Around £650/ year. Up to £1300/year for hypoallergenic formulas. Cost for bottles and other supplies. Lost income when parents must stay home to care for a sick baby	In the UK, the NHS spends £35 million each year just treating gastroenteritis in bottlefed babies. In the US, insurance companies pay out $3.6 billion for treating diseases in bottlefed babies

Comments

Adrian Francis K Clarke-
03/06/2007 06:03:04

Many conventional doctors often prescribe Calcium to nursing mothers. They say
it is to fortify the milk. Homeopaths prescribe the same thing to dry milk up.
So conventional doctors are actually stopping the milk and causing the mothers
to be unable to breast feed – so they resort to formula, oftern with a broken
heart. That is thanks to the ignorance of conventional doctors……