Guest post: Marsha Walker on "a new low in formula marketing."

Recently, thanks to a reader, I learned that a formula company was titling one of its webpages "the breast milk formula." 

I passed this along to Marsha Walker, Executive Director of the National Alliance for Breastfeeding Advocacy, and she in turn launched a campaign to get the company to change this slogan.  Below, Marsha discusses formula marketing in the U.S., and how you can work to challenge marketing that undermines breastfeeding.

Many of you have seen the recent webpage title appearing on a Mead Johnson website, which stated: ”The Breastmilk Formula-Enfamil.” Word of this hit many of the major breastfeeding listservs and a call by the National Alliance for Breastfeeding Advocacy (NABA) to report this deceptive advertising to the Federal Trade Commission (FTC) resulted in many complaints being sent to the agency responsible for monitoring false and misleading advertising. Several days later Mead Johnson removed the title tab and replaced it with “Enfamil Lipil-Lipil.”  Infant formula marketing rages almost unchecked, other than formula manufacturers suing each other or reporting unfavorable ads to the Better Business Bureau’s National Advertising Division for a ruling.

Formula companies spend millions of dollars in marketing efforts each year, resulting in a can of powdered formula costing $25 for approximately 25 cents worth of ingredients. The duty of a formula company is to its shareholders not to help breastfeeding mothers. US corporate law obligates that management of publicly held companies act primarily in the economic interest of the shareholders not put community interest above corporate interest. Companies work the system to make it easier to transact business and avoid criticism by:

Lobbying

• companies lobby Congress for favorable laws and befriend federal officials
• companies send public relations experts to government agencies for favorable regulations
• companies buy access and influence by contributing to political campaigns

Enticing the experts/disarming the critics

• academic experts are hired as consultants, spokespersons, and advisors and are funded to engage in research. This helps remove the threat that leaders in the field will speak against the product or company, but taints their objectivity
• companies routinely provide funds to researchers, universities, and professional associations. These funds support conferences, projects, publications, internet sites, and meetings. Formula companies do not give away money as a benevolent charity, but in the long term interests of increasing profits. Companies need respectability to buttress their political power and avoid regulatory attention
• manipulating the data is easier if the research is funded by the company that produces the product. Some studies on the addition of the long chain polyunsaturated fatty acids DHA/ARA into infant formula have a 20%-33% loss of the sample population because mothers switch their baby to a non-study formula. There is no explanation for the high attrition rates. Therefore, no side effects are reported to the public. Meta-analyses regarding the addition of DHA/ARA to infant formula shows that these formulas confer no advantage to the infants consuming them, even though the products cost as much as 15%-33% more than standard formulas
• inservices provided to physicians and nurses by formula salesmen in hospitals are carefully orchestrated to present data from company funded studies that show the benefits of the product while distorting the risk
• companies encourage adversarial relationships between health professionals. Potential areas of disagreement are exploited to “divide and conquer,” even at the highest levels of government and within the World Health Organization
• members of government advisory committees frequently have industry affiliations

Corporate Public Relations/Masters of Spin

• industry front groups are used to appear to the public as independent supporters of the formula agenda
• new public relations opportunities are seized upon immediately, such as pressuring UNICEF to accept donations of baby formula to feed infants of HIV positive mothers in Africa
• a technique called “crisis management” was activated when the Baby Friendly Hospital Initiative was introduced into the US in 1991. An expert work group was formed and funded by the Department of Health and Human Services without industry representation. One company met secretly with the conveners of the work group and threatened to engage in direct to consumer marketing of infant formula if they lost their access to market formula through hospitals. It also engaged in a slick marketing campaign to hospitals claiming the BFHI was punitive in nature.

Giving Gifts

The giving and receiving of gifts is a complex relationship with the expectation on the part of the giver that the recipient will engage in a reciprocal behavior. One nurse manager stated that all of the food and gifts were accepted as perks for the nurses to help retain them as employees! These gifts are not free. The mothers who purchase formula buy the trinkets, food, educational offerings, and lavish entertainment accepted by so many health care professionals. Formula salesmen have unlimited access to maternity units in many hospitals, violating the vendor policy of the institution. This constant, “helpful” presence allows the salesman to be perceived as a member of the health care team who in some instances actually determines what infants are fed in the hospital nursery. The purchasing of loyalty is a prime goal of the formula industry.

Voluntary Codes

The International Code of Marketing of Breastmilk Substitutes (the Code) is an important tool and the foundation for ethical practice, but it is voluntary on the part of industry. The Code was created in 1981 by the World Health Organization and UNICEF as an international guideline for manufacturers to follow. It aimed to curb the unethical marketing practices that were resulting in the illness and death of thousands of infants each year. The Code has not been legislated in the US which allows egregious marketing practices to continue unabated. Companies fear regulation above all else.

What Can Be Done?

Learn to work the system.

• Report all unethical marketing practices to NABA (email).
• Report offending advertising to the Federal Trade Commission
• Ask all birthing hospitals to eliminate distribution of commercial discharge bags supplied by infant formula manufacturers. See www.banthebags.org
• Request that clinics, obstetrical, and pediatric offices refrain from distributing gifts from formula manufacturers
• Support organizations like NABA and Best for Babes. Best for Babes placed a full page ad in the June 2009 issue of Fit Pregnancy magazine to help mainstream breastfeeding and offset formula marketing efforts. NABA has 2 publications available on the extent of formula marketing in the US.