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Formula for Profit : How Marketing Breastmilk Substitutes Undermines the Health of Babies
Because of the strident societal and economic impact wielded by the formula industry, bottle-feeding has today become the social norm in the US. Fewer than half of all US babies are exclusively breastfed during their first day or two in the hospital.[1] By the time they are six months old, only 19 percent of US babies receive any breastmilk,[2] and only 2 percent of one year olds. Contrast this with the average age of weaning worldwide, which is 4.2 years. This country's societal hostility towards breastfeeding is such that many states have had to pass laws protecting a mother's right to breastfeed her child anywhere that she is otherwise permitted to be.
The very need for such legislation is a sad commentary on the lack of appreciation for the broad range of health, social, and environmental benefits of breastfeeding. Nevertheless, the slogan "breast is best" is no exaggeration. Breastmilk contains 400 nutrients that cannot be recreated in a laboratory, and several studies suggest that breastfeeding reduces the risk of sudden infant death syndrome.[3, 4, 5] An absence of breastfeeding has been linked to an increased risk of hospitalization,[6] childhood cancer,[7, 8, 9] diarrheal diseases,[10, 11, 12] lower respiratory illness,[13] ear infections,[14] bacterial infections,15 diabetes,16 infant botulism,[17 Crohn's disease,[18] ulcerative colitis,[19] and even cavities.[20] In Milk, Money and Madness: The Culture and Politics of Breastfeeding, Naomi Baumslag, MD, MPH, asserts that breastfed babies also have lower incidence of allergies, urinary tract infections, obesity, learning, behavioral and psychological problems, later-life heart disease, pneumonia, neonatal sepis, and giardia infection.[21]
Children are not the only ones who benefit from breastfeeding. Nursing mothers enjoy a reduced risk of premenopausal breast cancer,[22] ovarian cancer,[23] and osteoperosis.[24] Breastfeeding is advantageous for people who are outside the mother-baby unit, when you consider healthier babies mean lower health insurance premiums for everyone, and lower absenteeism among working parents. The production of formula, bottles, plastic nipples, and formula cans, not to mention cleaning artificial feeding supplies--all create pollution and in some cases hazardous waste. Finally, breastmilk is also free and convenient, considerations that should give pause to families faced with an average yearly cost of $800 per baby if they choose to formula feed.
The economic implications of formula are certainly significant. The industry generates $5 to $6 billion in sales each year,[25] and its executives reap huge profits--the CEO of Abbott Labs earns more than $4 million per year; his counterpart at Bristol-Myers Squibb (makers of Enfamil), nearly $13 million. Part of the reason the industry is so profitable is the fact that every dollar formula makers charge their retail distributions outlets costs them a mere 16 cents on production and delivery.[26] Formula is, in short, big business--the result of a complex social marketing campaign that began half a century ago, one that has speciously managed to define artificial feeding as a convenient, liberating, and "modern" way of feeding one's infant.
Science Crushes Nature
"At the beginning of the 20th century, basically women breastfed, had a wet nurse or their babies died," says Mary Lofton, spokesperson for La Leche League International (LLLI). Insofar as artificial baby milk became available as a life-saving alternative to breastmilk, it was deemed a blessing. "The crucial social phenomenon," Lofton adds, "was the shift from home to hospital in childbirth.... Women were given anesthesia, babies were taken away, schedules were rigid, and all those interferences led to problems with breastfeeding."
Considering formula to be nutritionally equal to breastfeeding, doctors began recommending it to patients. Tangentially our society experienced a burgeoning captivation with science and technology, and became increasingly enamored with an efficiency-model of infant feeding and care. The advent of World War II encouraged women to work outside the home, which only furthered the reliance on artificial feeding. By the 1950s, infant formula gained the widespread endorsement of the pediatric community, and artificial feeding increasingly became seen as equal--if not superior--to nursing.
Marian Tompson, one of the founding mothers of LLLI, thinks the 1950s doctor acted out of ignorance. "I think anyone with half a brain would realize that human milk is species-specific," she says. "No one ever suggests that I feed my kittens with milk from the cocker spaniel next door." Nevertheless, with its decidedly scientific-sounding name, formula fit right into the landscape of an America mesmerized by the march of modernity, leisure, and ease. Measuring formula, sterilizing bottles, the modern mom became a domestic chemist. Bottle-feeding became a symbol of modern living, prosperity, and progress--indeed, healthful living! In contrast, breastfeeding took on the aspect of a primitive, retrograde thing to do.
The Role of the Medical Establishment
The campaign to normalize artificial feeding gains a great deal of its effectiveness from an unholy alliance between the pharmaceutical industry and the medical establishment. To promote artificial feeding, formula manufacturers spend millions of dollars securing exclusive distribution deals for formula samples, at a yearly average of $6,000 to $8,000 per doctor. They donate $1 million annually to the American Academy of Pediatrics in the form of a renewable grant that has already netted the AAP $8 million. The formula industry also contributed at least $3 million toward the building costs of the AAP headquarters.[27]
The American College of Obstetrics and Gynecology received $548,000 from two of the four major formula makers in 1993. The American Medical Association television program is sponsored by the makers of Similac. Moreover, the American Dietetic Association, the National Association of Neonatal Nurses, and the Association of Women's Health, Obstetric and Neonatal Nurses all receive generous funding from the formula industry.[28] A 1994 study that was published in the Journal of the American Medical Association exposes the influence the formula industry wields over the medical establishment. "By giving physicians money," the authors found, "the [formula] companies are successful in influencing doctors to recommend their product."[29]
Formula manufacturers play hardball to get hospital business. Take the example of Canada, where Mead Johnson secured an exclusive contract with Toronto's Women's College Hospital that pays the hospital $1 million the first year and $350,000 per subsequent year for a decade. Abbott Labs and Bristol-Myers Squibb got into a bidding war over the right to promote formula through Grace Hospital in Vancouver, Canada's largest birthing facility. Ross Labs offered to pay the Doctor's Hospital in Canada $1 million for a contract which would require that the hospital would give their product to all mothers in take home packages, supply breastfeeding mothers with Ross's instructions on nursing, and make sure mothers had "access" to Ross architectural services for nurseries.[30]
Jack Newman, MD, author of Dr. Jack Newman's Guide to Breastfeeding, a book on the politics of formula use, characterizes the relationship between the pharmaceutical industry and medical establishment as bribery. From large donations to the "myriad of other little 'useful' items" such as pens, paper pads, measuring tape, growth charts, and coffee cups (all of which feature formula advertising), Newman considers these contributions wholly unethical.
Physical separation of hospital nurseries and maternity wards begin to erode the breastfeeding relationship right from the start. James McKenna, PhD, director of University of Notre Dame Mother-Infant Behavioral Sleep Laboratory, told me "Our studies of breastfeeding mother-baby pairs, where infants were about four months, reveal that proximity to mother, particularly the types of intimate contact that occur during bedsharing that permit the infant to smell its mother's milk, doubles the amount of breastfeeding episodes, and triples the amount of nightly breastfeeding time."
Perhaps the most coveted payoff for formula makers, however, is the opportunity to exclusively distribute their products through hospital maternity wards. When a mother is released from a hospital or birthing center, she is often given a discharge gift basket that includes free formula. Research shows this tacit endorsement on the hospital's part is so effective in establishing brand loyalty that 93 percent of mothers who artificially feed continue using the brand of formula given to them by the hospital.[31] Research suggests that exposure to formula advertising during pregnancy seriously undermines a future breastfeeding relationship.[32]