The Motherwear Breastfeeding Blog

Breastfeeding Promotion Act gets reintroduced, with more to like.

You may already know that on June 11th, Representative Carolyn Maloney and Senator Jeff Merkley introduced the Breastfeeding Promotion Act of 2009 (HR2819 / S1244).

What you might not have noticed is that this version of the bill has a new provision which would make life far easier for mothers who want to pump in the workplace. 

This version requires employers with more than 50 employees to make reasonable efforts to provide a private space and unpaid break time for mothers to pump.  This mirrors laws in a number of states, California and New York among them, that require employers to make some simple and cost effective accommodations for nursing moms.

In addition, the bill would protect breastfeeding mothers under the protection of the 1964 Civil Rights Act, set standards for breast pump manufacture, provide tax incentives for employers that establish private lactation areas in the workplace, and provide tax credits for nursing mothers.

To express your support for the bill, you can sign petitions sponsored by the U.S. Breastfeeding Committee or Moms Rising.  There's also a Facebook group dedicated to promoting the legislation.  And you can see a silly interview with Rep. Maloney and Stephen Colbert. 

Thanks to Angela at Breastfeeding 1-2-3 for some of these links, and to Mama Seoul for the picture of a rally in support of this bill in 2007.

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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.

A little research update.

New research about breastfeeding has been in the news quite a bit in the last few weeks.  Here's a sampling:

Breastfeeding leads to better academic achievement in high school and an increased likelihood of attending college

Women with multiple sclerosis who breastfed exclusively for at least two months appear less likely to experience a relapse within a year after their baby's birth

Women who breastfed were less likely when they were older to have developed high blood pressure, diabetes, high cholesterol and cardiovascular disease

Breastfeeding cuts women's risk of metabolic syndrome.

Mothers who drink an excessive amount of fructose-sweetened beverages (as high fructose corn syrup) during pregnancy or breastfeeding may be likelier to have children—at least sons—who are more prone to becoming overweight and developing type 2 diabetes

Hand expression and breast massage combined with breast pumping did a better job of stimulating milk production than breast pumping alone.

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If "bad" mothers are now "good," where does that leave breastfeeding?

Have you heard?  Bad parenting is the new good.

According to CNN, the New York Times, and the Wall Street Journal, bad (meaning good?) moms admit to leaving their kids alone in the bathtub, spanking, yelling, and loving their spouses more than their kids.  It's a backlash against 'hyper parenting,' and some very class-bound (more on this in a post I've been meaning to write forever) notions of what's good for kids.  It can also be seen as a pressure release valve for parents feeling oppressed by the cult of the "perfect mother."     

My first reaction to this is to wonder why we have to keep having this debate about what a good (meaning bad?) mother is.  Apart from health and safety, how is it anyone else's business if you have a couple of beers, or let your dog mop the floor?  And the reality is, as Heather Cushman-Dowdee points out, so much more complicated and nuanced than it's typically portrayed.  It's also interesting to me that we still find this kind of confessional titillating.  Is it still really news that parenting is a mixed bag (containing lots of fluids)?

My next thought was to wonder what this means for breastfeeding.  Is it now good (meaning bad)? 

I guess that depends on whether or not you see it as ideology.  If you do, it might look like one more box to check on the 'good mom' (meaning bad mom?) to do list.  It's certainly a choice, but I tend to see it more in terms of biology - a logical extension of in utero nutrition that has evolved for specific nutritional, immunological, and emotional needs of our young.  In my mind, it's so normal that to attach it to a particular world view would be a little bit like calling cleaning up poop a lifestyle choice.  And you can only treat it as ideology if you ignore or discount the science, which is how The Case Against Breastfeeding got there. 

Because breastfeeding has had to battle back from the brink of extinction in this country, and in doing so has required justification along medical and political lines, it's seen as more of an ideological football than it really is.  I'm embarrassed to say that I used to think that breastfeeding was something that only left-leaning, anti-establishment moms did.  But the far broader appeal of breastfeeding was made clear to me the first time I searched Amazon for a Dr. Sears book and realized that he writes books on Christian parenting.  Wait a minute, I thought, they do it, too?  I had a lot to learn.

This is why I like Moms Rising and other organizations that shift the focus from judging each other to the real issues that parents face - often in common with families quite different from themselves - like sane family leave policies, health care for all, and fair pay.  Just think of what could be done with all those kilowatt hours we spend on angst and vitriol.

Even though the "good mom/bad mom" pendulum has been swinging back and forth for decades - periodically clocking moms in the head - I have hope that we'll see, sooner or later, that we're all in this together.

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"The Breast Milk Formula?"

Speaking of deceptive marketing:

Reader Anna emailed me to point out that the formula company Enfamil is marketing one of their formulas as "The Breast Milk Formula" in the title of their one of their webpages.

This is the most blatant form of unethical marketing I've ever seen from a formula company, and unfortunately there are many examples to chose from.  And of course it's a clear violation of the International Code of Marketing of Breast Milk Substitutes.

It's this kind of advertising which leads to a near doubling in the number of people who say that formula is as good as breastmilk.

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Beware the pregnant woman...

...who extols the virtues of BPA.

Remember Bisphenol-A, the component of some polycarbonate plastics linked to reproductive disorders, developmental toxicity, and cancer?  The one found, until recently, in nearly every brand of baby bottle?  The one still in infant formula containers and canned food containers?  The one banned from baby bottles in Canada, significantly reduced from products in Japan, and increasingly banned in the U.S.?

I don't usually think that toxins in plastic are funny, but I actually laughed out loud when I saw this Washington Post story last week about the plastic industry's strategy to counter the anti-BPA movement:

The notes [from an industry meeting on BPA] said the executives are particularly concerned about the views of young mothers, who often make purchasing decisions for households and who are most likely to be focused on health concerns.

The attendees estimated it would cost $500,000 to craft a message for a public relations campaign, according to the notes. "Their 'holy grail' spokesperson would be a 'pregnant young mother who would be willing to speak around the country about the benefits of BPA,' " the notes said. [emphasis added]*

Let's just remember for a moment that it was you - mothers, armed with information - who got out way ahead of the FDA, the industry, and the retailers, and voted with your feet.  By buying glass and BPA-free plastic bottles, you got every major manufacturer of baby bottles to produce a BPA-free product.  The FDA was in recent years more interested in the plastics industry's view than the science, though this seems poised to change with pressure from Congress and a newly appointed commissioner. 

So, they really think that you're going to fall for an ad campaign featuring a pregnant mom who loves to feed her kids endocrine-disrupting plastic?  They've got a lot to learn.

*For fun, feel free to suggest a slogan in the comments section!

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Normal.

In the last week or so there have been some great examples of what it would mean if breastfeeding were considered normal behavior in our culture.  They all happen to come from the U.K., but there have been similar stories here.

If breastfeeding were considered normal:

1)  A picture of a toddler nursing her doll (on a poster meant to 'normalize' breastfeeding, no less) would be considered cute, not obscene.

2)  A mother nursing her child at the pool wouldn't be ejected for violating the 'no food or drink' policy.

3)  Breastmilk would seem at least as normal as cow's milk, and a story of a cancer patient drinking it wouldn't make national freak-show news. (By the way, if you watch the video, listen to Dr. Lori Feldman-Winter, who is on the AAP Section on Breastfeeding, not the Good Morning America 'expert,' who doesn't appear to know much about this topic.)

Just this week several mothers told me that they're worried about getting harassed for nursing in public.  Again, if breastfeeding were considered normal behavior, there wouldn't be any worry about that.

So, how do we get some of that normal?

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Coming soon to a magazine stand near you...

I'm very excited that this ad, created by the Best for Babes Foundation, will appear in Fit Pregnancy magazine in their June/July issue.  It's one in a clever and attractive series - doesn't the style remind you of Sex and the City?  Best for Babes expects these ads to appear on billboards and buses in the near future.

The text at the bottom reads:

Breastfeeding boosts your bank account and your baby's immune system, saving you on hospital bills, doctors' visits, medicine, and missed days of work.  It could also save billions on health care costs.  Are your hospital, physician, employer, and insurer doing their part to help you succeed?  Let us help you find out at bestforbabes.org.

From Best for Babes' press release:

On May 25th, the Best for Babes Foundation will launch a clever and provocative new ad campaign designed to change the public perception of breastfeeding and expose the "booby traps" - the myriad cultural and institutional barriers that keep moms from succeeding.  ...The campaign has been endorsed by Dr. Joan Meek, Chair of the United States Breastfeeding Committee and celebrities Gabrielle Reece and Marilu Henner.

Best for Babes co-founder, Bettina Forbes, says:

"All women should be allowed to make and carry out the best decision for themselves and their families without being sabotaged.  When we remove the barriers, more moms will be able to reap the lifetime benefits of what can be a uniquely empowering and rewarding experience."

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Our breastfeeding coalition in the news.

Our breastfeeding coalition, which meets at Motherwear, has been making the local news a lot recently.  Here are some articles that showcase things we're doing:

Going Baby Friendly, Valley Advocate

A Victory for Nursing Moms and Babies, Valley Advocate

Breastfeeding Welcome, Pioneer Valley Parent

Milk Bank supplies 'the perfect food:' Breastfeeding task force brings critical resource to Pioneer Vallley, Valley Kids

There was also a great news segment about the breast cancer research project I'm working on.

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Donate breastmilk for breast cancer research.

Some of you probably remember posts I wrote last Fall about a research project I'm involved with at the University of Massachusetts.  (That project is ongoing, and if you are nursing and have had, or are expecting to have, a biopsy, please see the study website for information on how to participate.)

The same professor, Dr. Kathleen Arcaro (shown to the right at a visit to my breastfeeding group), is now recruiting for a separate, though related study. 

This study, funded by the Avon Foundation, involves research on the breastmilk of mothers who have nursed over time.  Dr. Arcaro is examining the DNA of these mothers' milk to identify changes in the functioning of genes in breast epithelial cells.  This will help to identify which genes' functions are being altered (or not altered) over time.  The future of cancer therapy is thought to lie in a field called "epigenetics," (great video about it here) which involves the restoration of normal DNA functioning, so understanding which genes are involved in the development of breast cancer is key.

This time, we're looking for mothers who:

• Are in our area (Western Massachusetts, but anywhere within reasonable driving distance to our area may be okay)
• Had and nursed a baby in your mid-20's
• Are now in your mid 30's or older, and are nursing or pumping
• Willing to provide a milk sample. 

Participants also fill out a questionnaire, and receive $25 in thanks.  If that sounds like you, please email me.  More information is available at Dr. Arcaro's website.

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