(1) Baby-Unfriendly Maternity Hospital Practices
Maternity hospital practices
contribute to widespread breastfeeding failure. The routine use
of drugs during labor and delivery often results in babies arriving
in this world in a drugged state, unable to bond their mothers or
latch onto the breast. The immediate separation of mother and baby
so that the baby can undergo routine tests and procedures (all of
which could be delayed without any harm to the baby), also interferes
with the baby's ability to initiate breastfeeding during the crucial
first hour after birth, when most babies are in a relaxed, alert
and receptive state. Unnecessarily aggressive suctioning of the
airway immediately after birth traumatizes some babies so much that
they shy away from all oral stimuli -- including bottles -- for
days after birth. Many babies are routinely given bottles of formula
or glucose water in the hospital nursery, even when their mothers
have requested that no bottles be given and that their babies be
brought to them to nurse. Since formula is easier to get out of
a bottle than human milk is from the breast, even one bottle feeding
can cause some babies to form an irreversible preference (sometimes
known as "nipple confusion") for the bottle nipple; those
babies may never be able to breastfeed normally.
(2) Formula Company Marketing Practices
targets women. New mothers are given free samples of formula, babies
are given bottles in hospitals, coupons or food samples arrive in
the mail, or booklets and videotapes are distributed on breastfeeding
and weaning. The World
Health Organization's Code for the Marketing of Breastmilk Substitutes
prohibits marketing of these products in these ways. It covers formula,
other milk products, cereals, teas and juices, as well as bottles
The Code has 10 important provisions.
- NO advertising of any of these products to the public
- NO free samples to mothers
- NO promotion of products in health care facilities, including
the distribution of free or low- cost supplies
- NO company sales representatives to advise mothers
- NO gifts or personal samples to health workers
- NO words or pictures idealising artificial feeding, or pictures
of infants on labels of infant milk containers
- Information to health workers should be scientific and factual
- ALL information on artificial infant feeding, including that
on labels, should explain the benefits of breastfeeding and the
costs and hazards associated with artificial feeding
- Unsuitable products, such as sweetened condensed milk, should
not be promoted for babies
- Manufacturers and distributors should comply with the Code's
provisions even if countries have not adopted laws or other measures.
The Code was endorsed by the United States in May, 1994. Nothing
has been done so far to implement the Code in the United States.
Here are a few examples of the formula companies' continued use
of the prohibited unethical means to market their products:
Many hospitals have arrangements with formula companies in which
the hospital receives hundreds of thousands of dollars annually
from the formula company. The hospital then promises to give every
post-partum woman a discharge package designed by the formula company.
Not surprisingly, these "gifts" are covered with the logo
and advertising slogans of the formula company, and contain free
formula samples, coupons for more formula, and pamphlets full of
misinformation about the hazards of formula feeding. When the new
parents get home with their baby and their "gift," the
result is often the following scenario:
Three days after baby is born. 3 a.m.
The baby has been crying for the last two hours. Mother's breasts
are engorged and sore; baby is not latching on and sucking effectively.
Parents don't know what to do because their knowledge of breastfeeding
comes entirely from formula company sources. They are worried about
baby being hungry. They are exhausted and do not know whom to ask
for help. The bottle of premixed formula from the hospital discharge
pack is sitting on the table next to the crib. They feed the formula
to the baby, and s/he quiets down and sleeps for several hours because
formula is more sedating and takes longer to digest than human milk.
Mother's milk supply is reduced because the milk in her breasts
wasn't removed by her baby. In the following days, baby needs more
and more formula. Mother's milk supply quickly dries up and baby
The result of this marketing strategy is to ensure that every new
mother is given misleading information about infant feeding, as
well as the means to undermine any efforts she may make to breastfeed
Doctors and nurses charged with the care of post-partum women
and their newborns are showered with gifts, including a full
year's supply of free formula to any nurse or doctor with a
new baby. This is a particularly brilliant marketing gimmick, since
this greatly increases the chances that the nurses' and doctors'
children will be formula-fed and a health care professional who
has formula-fed his or her own children is hardly going to be able
educate his or her patients about the dangers of artificial feeding.
Another gimmick is a contest with valuable prizes -- run by a
formula company -- to see which of the nurses in the post-partum
ward can collect the most formula can tops. Obviously, this puts
the nurses' interest (to win the contest, she must have more patients
who feed formula and do not breastfeed) directly in conflict with
the health interests of his or her patients.
Formula advertising directed to parents is rampant in hospitals
and doctors' offices on prescription pads, pens, growth charts,
pamphlets and posters. Doctors and hospitals routinely send personal
information about pregnant women to the formula companies so that
direct mail advertisements can be directed to them. This can have
tragic results. as the mothers of stillborn babies continue to receive
cases of formula in the mail for months after they have buried their
children. Those formula companies that have been unable to penetrate
the medical community as effectively, such as Nestle-Carnation and
Gerber, advertise their products directly to the public on TV shows
directed at new parents and in parenting magazines such as "Parents,"
"Child," "American Baby," and "Parenting,"
again, all in violation of the WHO Code.
Imagine what it would be like
if breastfeeding were advertised competitively with formula!
(3) Medical Professionals' Ignorance of Breastfeeding
Another related reason for low breastfeeding rates is the almost
complete absence of breastfeeding curricula in medical schools.
A study published in the Journal of the American Medical Association
shows that most doctors know little about breastfeeding. Freed GL
et al. National assessment of physicians' breast-feeding knowledge,
attitudes, training, and experience. JAMA 1995;273:472-476. The
study looked at doctors' knowledge of the clinical aspects of breastfeeding.
It revealed disturbingly high rates of ignorance about why breastfeeding
is important and how to handle breastfeeding difficulties. The
authors of this study surveyed more than 3,000 residents and nearly
2,000 physicians practicing obstetrics, pediatrics and family medicine
and found that few of them knew the basics of breastfeeding such
as how to teach a new mother how to use a breast pump or what to
do about low milk supply. Many doctors who are not educated about
breastfeeding advise supplementing with formula when any problem
arises with breastfeeding. The result: the baby is quickly weaned
from the breast to the bottle because the mother's milk supply diminishes
immediately in response to her baby's diminishing demand for her
Interestingly, the study found that most important factor influencing
whether a physician was knowledgeable about breastfeeding was whether
the doctor herself, or the doctor's wife, had breastfed children.
This is apparently not news to the formula companies, who make
sure that every physician who treats pregnant and post-partum women
and is expecting a baby is offered a full years' supply of formula
In addition, obstetricians generally decline to advocate breastfeeding
to their pregnant patients on the grounds that "it might make
the mothers who choose formula feel guilty." Of course, the
doctors have no such qualms about advising pregnant patients to
eat a healthy diet, or to quit smoking and drinking, because that
might make the mothers who ignore their advice feel guilty. Formula
appears to be the only health hazard that doctors fear to warn of
because of fear of inducing guilt.
(4) The Bottle-Feeding Culture
Another big reason for the low breastfeeding rates is the bottle-feeding
culture that has developed as a result of formula promotion and
medical ignorance of breastfeeding. Babies are associated closely
with bottles, not breasts. Go to any toy store. It is difficult
to find a baby doll that doesn't come with a bottle. Look
around you where mothers with babies can be found. Most of the babies
are fed with bottles. The sight of a woman breastfeeding her child
in public is so rare as to be remarkable.
The result is that the chain of cultural breastfeeding knowledge
has been broken. Where breastfeeding is the norm, girls grow up
seeing their mothers breastfeeding their younger siblings, their
aunts breastfeeding their cousins, their older sisters breastfeeding
their nieces and nephews, their neighbors breastfeeding their children,
etc. Breastfeeding is a normal part of everyday life, and a girl
inherits the accumulated knowledge of previous generations about
such things as how to position the baby at the breast, how to tell
if you have a let-down of the milk, and how to tell if the baby
is properly latched on and is getting milk.
New mothers in a bottle-feeding culture need expert medical advice
to take the place of the lost cultural knowledge of breastfeeding.
As the study cited above makes clear, such advice is unlikely to
come from your doctor. Someone with specific training in human
lactation, such as a board certified lactation
consultant. or a leader from a mother-to-mother support group,
such as La Leche League
International, is much more likely to be able to help you with
breastfeeding problems than your doctor.
(5) Maternal employment
The belief that breastfeeding cannot continue when the mother
works is an unfortunate misconception. Maternal employment is only
a complete obstacle to breastfeeding if the mother must be separated
from her baby for weeks. Otherwise, an employer need only make minor
accomodations to allow employees to breastfeed their babies.
With a clean, private place and about 20 minutes every 4 hours,
a mother can express her milk for later use by her baby. With on-site
or nearby daycare, a mother can breastfeed her baby directly during
brief breaks. Even a mother who cannot pump or breastfeed during
the workday can breastfeed her baby when they are together and supplement
with formula at other times.
Formerly part of
If breastfeeding is so great,
why are the rates so low?