If you spend time online, you’ll know the ‘breast milk versus formula’ discussions can quickly turn into emotionally charged debates.
Many women enter motherhood with plans to breastfeed.
In fact, over 90% of Australian mothers initiate breastfeeding.
But by four months, fewer than 50% of Australian babies are exclusively breastfed.
For many of us in well developed countries, the decision to breastfeed or formula feed feels like a personal preference.
In fact, breastfeeding is our biological norm, and breast milk provides the most appropriate nutrition for a growing human infant.
If, however, because of choice or circumstance, we ended up in a situation where formula feeding were necessary, few of us would be overly concerned about disease, malnutrition and cognitive development.
Formula feeding increases the risk of illness, digestive health and other problems, but because we have access to clean water and medical care, these risks seem foreign to us.
Formula Milk Companies Target Mothers Who Can’t Afford It – When Breastfeeding Is Life Or Death
Chances are, you’ve never met a formula fed infant who was suffering from malnutrition.
It’s highly unlikely you’ve met a baby who experienced such severe diarrhoea he died of it. It can happen in well developed countries, but it’s quite rare.
For this reason, it’s hard to imagine why the formula debate is such a big deal.
Who cares if formula companies advertise? Is it really a big problem if they target pregnant mothers?
When Not Breastfeeding Can Be Life Or Death
In developing countries, the decision not to breastfeed can have lifelong consequences for children. It can even be a fatal decision.
For this reason, the World Health Organization (WHO) came up with The International Code of Marketing of Breast-Milk Substitutes. The purpose of the code is outlined by the WHO:
“The International Code of Marketing of Breast-milk Substitutes is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to contribute ‘to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution’ ”.
Many countries have implemented this code or developed similar ones of their own, in the interest of public health.
In 2013, just 16% of Filipino babies were exclusively breastfeeding. Despite the Philippine Milk Code (E.O. 51 Milk Code), few pharmaceutical milk companies and healthcare providers follow the code. Marketing of formula is rampant in the Philippines.
Why is this a problem? Because many parents don’t have access to clean water, medical resources are limited, and they can’t afford to purchase the amount of formula a growing infant needs. In these places, undermining women, and discouraging them from breastfeeding leads to malnutrition, disease, and death
UNICEF has interests in ensuring the health and wellness of children all over the world. Formula companies have interests in making a profit. They make their profit, however, by convincing parents they have health and wellness as a priority.
UNICEF Documentary: Formula For Disaster
In the interest of raising awareness about the importance of breastfeeding, especially in developed countries, UNICEF created a documentary looking at the predatory marketing practices in the Philippines.
As a parent, you want to believe people are interested in your children’s health and wellbeing. When a doctor, nurse or professional expert tells you something, you want to believe it’s true.
It is a sad reality, but pharmaceutical milk company reps ‘educate’ doctors, midwives and health workers with false ‘facts’ about the benefits of breast milk substitutes.
Advertising campaigns on billboards line the streets. Posters in the halls of hospitals and health centres tout the supposed benefits of formula. On TV screens, commercials constantly tell parents their children will become geniuses if they choose a particular brand of formula.
The campaigns are so pervasive, many Filipino parents continue to believe formula is best.
In reality, when mothers choose formula, and their milk supply diminishes, many infants are left undernourished and at risk of illness because their parents can’t afford enough formula and don’t have access to clean water.
While the documentary is long, I highly recommend you watch it, to have a real understanding of just how predatory formula companies can be, in their quest to make more money.
Despite being part of a billion dollar industry, many companies will stop at nothing to make increasing amounts of money, even when it means increasing risks of death for our most innocent human beings.
Shocking Facts About Formula Companies
As a parent, doula, and parent educator, I will never judge a mother based on the way she feeds her baby. I don’t believe formula to be a horrible product; neither is choosing it a reflection on a parent’s worth.
However, many formula companies value money over humanity, while convincing parents they care. The extent to which many companies will go to make money is nothing short of repulsive.
That is why there are lactation activists. That is why there are people who consider themselves ‘anti-formula’. And why some people have been boycotting the Nestle company for decades.
It isn’t because the world is filled with ‘sanctimommies’ (although some exist) who think breastfeeding makes them superior. It’s because they’re aware of how much companies invest in convincing women breastfeeding is subpar, and they should spend money on their milk substitute products instead.
The documentary was filmed in Quezon City, Mandaue City and Tagbilaran City, in the Philippines. Some of the neighbourhoods the crew visited were crowded, with little to no clean water and very limited economic resources. For mothers who formula feed, these are extremely dangerous conditions.
Parents who can barely afford to feed their families are convinced to spend their limited income on formula. They are given promises of better health and intelligence for their children. TV commercials show children playing the piano and violin, and participating in athletics, as if to tell parents formula is the way to help their children achieve these things.
Although the code prohibits health centres, hospitals and public health workers from accepting incentives from milk company reps, in many areas the code is rarely enforced.
In the documentary, many reveal how health professionals receive air conditioners, food, money, and even extravagant all expenses paid trips, in exchange for promoting a particular brand of formula.
Public hospitals with limited means are given promotional items. New mothers are sent home with formula samples, which interferes with their breast milk supply, and often leads to a reliance on formula they simply can’t afford.
Pharmaceutical milk companies in the Philippines make around 21 billion pesos ($403 million USD) in profits each year. And they continue to market aggressively, to make more profits, despite the serious health risks.
Shocking Interview With A Milk Rep
Although I grew up learning about formula marketing scandals associated with Nestle, I still struggle to believe such greed exists in the world. However, interviews with milk reps, like this one from the documentary, are eye opening.
Milk Rep: “More often than not, we target the private doctors because they prescribe the high end products. In the health centers, you’re only able to push the low end milk. For premium brands it’s the private doctors. We try to put up scientific evidence for the doctors. We sponsor the doctor with plane fares and accommodations…after the seminar, that’s the time you harp on the benefits of your milk product.
Q: Is it true that milk companies sponsor the milk in the nursery and the milk is given out?
Milk Rep: “Yes, it has happened before. You can also sponsor non-medical related activities such as outings, Christmas parties, etc.”
Q: Who do you cover?
Milk Rep: “Basically doctors, nurses and midwives. Midwives in health centers do most of the deliveries, so they can influence mothers to breastfeed or not”.
Targeting healthcare workers to convince mothers they need formula is a violation of the Filipino milk code, the WHO milk code, and ethics in general. Unfortunately, this happens all over the world, but when it happens in the Philippines it can mean serious health risks.
What’s Being Done To Protect Mothers And Babies From Predatory Marketing?
Most healthcare workers have limited resources and income. Incentives like money, products, food and even trips can cause health workers to abandon the code.
However, Rosemarie Flores, a midwife and breastfeeding advocate, who runs a feeding clinic for malnourished children in Mandaue City, fights against milk reps. They try very hard to win her over, but she knows families can’t afford formula, which makes breastfeeding vital for babies’ survival.
“I had just given birth last year when the Alacta Medrep got mad at me because my baby was wearing a shirt from Wyeth. Alacta are so strongly convincing, so their sales can go up because their sales are much lower than Wyeth and Nestle. They’re really trying to convince us midwives to endorse their product. I refused their offer to go to Manila, Davao, Baguio, with them paying for everything. They’re really trying to convince me, but I refuse. Those things are really not that important to me”, Flores said.
One entire Filipino city is fighting back against formula companies and following the Filipino milk code. However, it isn’t easy.
In Tagbilaran City Bohol, the code is taken very seriously. Midwife Hannah Pacamiso said, “I don’t advertise infant formula, even if med reps come from Wyeth and Nestles. We don’t want to be rude, so we have to entertain them, but then we send them away. I keep recommending breastmilk”.
Unlike those in some cities, health workers in Tagbilaran City actively enforce the code, even when it means addressing their own colleagues.
Gloria Catipang, a milk code taskforce public health nurse, said, “We work hard to enforce the code. But for us who are members of the taskforce in the city, we find it difficult, because when we catch colleagues accepting giveaways from milk companies, they get mad at us for being strict. They get mad at us when, in fact, we’re just doing our jobs. It’s very hard and very painful for us. That’s the real story”.
Healthcare workers aren’t well paid, making them vulnerable to incentives from the billion dollar formula industry. With the government’s implementation of an updated code, and the dedication of some healthworkers, there’s hope breastfeeding can once again be the norm in the Philippines.
What Does This Information Mean For Me?
Perhaps you’re wondering how this relates to you. After all, if you choose, or need, to utilise a breast milk substitute you probably have the means to purchase it, and access to clean water.
Predatory marketing, however, isn’t unique to the Philippines. The prenatal vitamin samples from your doctor’s office is an early attempt to create brand loyalty. It’s a first attempt to make you question whether you’ll be able to provide enough vitamins in your milk, without using the company’s products.
The formula samples and coupons that show up at your door, after you’ve registered for breast milk pads at your local store, aren’t provided out of generosity.
Those breastfeeding ‘helplines’ run by formula companies aren’t intended to help you breastfeed.
The hours of ‘continuing education’ your paediatrician receives, while enjoying a nice dinner, represent an opportunity to provide ‘nutrition’ education.
Formula feeding increases a baby’s risk, and the severity, of diarrhoea, respiratory infections, ear infections, and a host of other things.
For most of us, ‘breastfeeding versus formula feeding’ isn’t a life-threatening choice. Should complications arise, we have the medical tools to address them.
However, as parents, don’t we have the right to make truly informed decisions, free of predatory marketing?