No, Formula milk is not like cigarettes

Do I really have to write this post?

Apparently I do. Today, a children’s charity, in its wisdom, has declared that Formula milk should be plastered with “cigarette-style” warnings that “breast is best”. It must be true – it says so in the Daily Mail.

I cannot imagine how devastated I would have been to have seen such a thing when I was desperately trying to feed a hungry newborn and had no breast milk worth writing home about. And I’m sure all the anxious parents pacing the corridors of the Neonatal Intensive Care Units around the world would feel amazing too about seeing that being given to their tiny little ones as they clung to life.

And what form should these “warnings” take? The report is a little, um, vague. Are we talking photos? Of what? Take your pick – some people will have you believe Formula is responsible for every single ill imaginable.

Here’s Dr Sue Battersby, a retired midwife and lecturer, specifically on the subject of childhood diabetes, in my book (what do you mean you haven’t bought it yet? 😉 )

“We know that the number of young children getting diabetes has increased. Diabetes is an auto-immune disease and exposure to cow’s milk (on which most formulas are based) can contribute to the body getting auto-immune failure… but you need pre-disposition too. You can’t say being breastfed will stop you from getting it or being formula fed will give it to you.”

And here’s another quote, from an academic called Dr Joan B Wolf, also in my book:

“We know there are antibodies in (breast) milk, we know they line the baby’s gut and fight bacteria. But we don’t have any evidence that they go anywhere else in the body. Are they ultimately excreted along with everything else?”

According to Cancer Research UK, smoking is the cause of 86% of lung cancer deaths in the UK and 25% of cancer deaths over all. Did anyone think to check whether or not these poor people also had the so-called “misfortune” to be bottle fed? Ah but what if you were breastfed and your parents smoked? Or you were bottle-fed and you smoked but lived to be 102? Did you grow up in an urban or rural environment? Were you exposed to asbestos? What’s in your DNA? You see – there are a million and one factors that come into play when you start to think about it.

I hope it goes without saying by the way that I am not anti-breastfeeding. I am just fed up with the demonisation of mothers who, for whatever reason, opt out. I’d be interested to see some properly researched statistics on the number of babies who are admitted to hospital dehydrated and under-nourished (I know of dozens, anecdotally) because of the incredible pressure to breastfeed in cases when anybody with half a brain cell can see that it isn’t actually working.

And plastering disapproval all over the one product available to avoid all that is not, in my view, particularly helpful.

UPDATE: Thanks to mssres on Twitter for sending me this interesting breakdown of the headline figure in the report which is that “95 babies an hour” could be saved by colostrum (the very early milk).

Obviously as the report itself claims, newborn mortality varies from country to country. But check Fullfact.org’s final paragraph:

Even in terms of these neonatal deaths, data from the Office for National Statistics show that in the UK 85.9% in 2011 were related to events occurring before the actual birth like congenital anomalies, antepartum infections and immaturity related conditions. None of these could have been prevented by breastfeeding. 

Well said.

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7 thoughts on “No, Formula milk is not like cigarettes

  1. In answer to your question, the Save the Children report is calling for the existing warnings which are already on formula packaging to be made larger:

    ‘…while the International Code states
    that companies must include health warnings and
    details of the benefits of breastfeeding, in practice
    these warnings are usually small and unobtrusive.
    To strengthen the power of these warnings, national
    laws should specify that health warnings should
    cover one-third of any BMS packaging.’ (pdf page 12, Superfood for Babies viewable here: http://www.savethechildren.org.uk/sites/default/files/images/Superfood_for_Babies_UK_version.pdf)

    The International Code can be found in full in Appendix 4. So the report’s suggestion is nothing new on the content of the label warnings (which you will already see on breast milk substitutes in the UK), just the size of the text.

    The rest of the report focuses on the recommendation that babies should be fed colostrum in the first 24 hours. In some countries, there is a cultural taboo against colostrum. The Save the Children report estimates 830,000 children’s lives would be saved just from babies receiving colostrum. They put some explanation on how they worked out these figures at the back of the report.

    As well as examining the case for governments to support exclusive breastfeeding for six months, the report also examines the reasons why families aren’t continuing to breastfeed. It acknowledges that there are some times when women and babies need to use breast milk substitutes (I found two references to this point). It recommends an increase in paid maternity leave and other measures to allow women who return to work to continue to breastfeed. It suggests tighter regulation of some lobby groups made up of formula manufacturers. The report is looking at the global context. It doesn’t surprise me that a charity called ‘Save the Children’ is doing research on ways to reduce child mortality.

    I found no references in the report to cigarettes, cigarette packaging, or ‘cigarette-style’ health warnings. I also found no references or suggestion that individual families who had had problems feeding should be made to feel guilty about their individual circumstances. Rather, the report referenced some reasons why a combination of cultural pressure, government policy, availability of healthcare professionals and formula company marketing techniques may contribute to problems occurring (for some).

    There was no use of the term ‘breast is best’ which has been out of vogue for over a decade. Admittedly, the International Code does state that labels on formula products must ‘…state the superiority of breastmilk’. As far as I understand it, the current focus in infant feeding education is to speak of breastfeeding as being normal/standard (as is vaginal birth), with discussion of the risks of formula (just as you would if an individual needed a different intervention, such as caesarean birth). But that’s an aside.

    As another aside, the report also had a case study in Brazil where the fire brigade was involved in transporting donated breastmilk to families who were having problems breastfeeding using their own milk. How cool is that? I imagine that any cultural taboos in the UK about using someone else’s milk to support a feeding issue might well be broken down if people knew they’d get a visit from a nice firefighter to deliver it! 😉

    I’m not sure which pages of the report the Daily Mail was reading when it wrote its article. I’m writing this rather late, so I could have missed something… Hmm 😉

    Anyway, this ‘quick’ reply has almost turned into a blogpost of its own. In answer to your other question – yes, *of course* I’ve read your book 😀 xx

  2. Hello SparkyAnnC! thanks for commenting, I’m not sure who has declared that “breast is best” is no longer in vogue because it is certainly bandied about pretty freely to everyone i know who has been/is pregnant recently.

    Donor breast milk – now there’s a very personal issue. For me I think the intimacy would have felt too great and it might have added weight to my own feelings of failure as a mother but I appreciate that others would embrace it and I certainly think it would be cool to have it as an option.

    I am about to update this blog post with a fascinating analysis of the figures from the report that were sent to me via twitter – would be v interested to hear your thoughts x

  3. Hello!

    I can’t find a reference for the ‘breast is best’ thing, but my understanding is that it’s no longer used by UK government as a slogan. A bit like ‘Clunk Click Every Trip’ – it used to be a thing in govt campaigns and people still say it, but it’s not on any late-night adverts anymore (that I know of)!

    Anyway…the STC report is about the global context, and it focuses on the developing world. The sums may be a bit rough (my journalistic instincts are also roused by round numbers) but they’re saying ‘Lots of mothers are told not to feed the baby colostrum. We think that if they did, we could stop some babies dying unnecessarily’. They reference reports from Ghana and Nepal which state that over 40% of early baby deaths could be prevented by them receiving colostrum in the first 24 hours.

    Babies dying. Because of something preventable.

    I can’t see any reason why anyone would not support attempts to combat myths in some parts of the world about colostrum, in light of the findings of the studies mentioned.

    It’s not a report about the UK, although the reaction to the report’s publication over here has been somewhat parochial.

    The Guardian article is the best summary I’ve seen so far of what the report actually says: http://www.guardian.co.uk/commentisfree/2013/feb/19/breastfeeding-saves-lives-warnings-formula-milk

    I’m not quite sure if your blog post is about the findings of the STC report, or the coverage of it in the Daily Mail, or the coverage of it generally. Or is it the labeling element with which you disagree? How would you tackle the problem of misinformation and babies dying in the developing world because of myth? (I wish I could solve it, but I think it’s something we all have to do together – a timely reminder as the UN pushes for the fulfillment of the Millennium Development Goals by 2015.)

    PS On the milk banking thing, interestingly in the UK the main place this is really done is for babies in NICU/SCBU, as they are the ones that need BM even more than most. Just as the STC report highlights that cultural barriers are preventing some children from receiving colostrum in other countries, so here we have cultural barriers to milk sharing. So we’re really not that different in the global sisterhood of mothers trying to feed their babies, despite what everyone around them is telling them to do! x

    • It is a tough one. I am uncomfortable with anyone wanting to interfere with the cultural habits of others whether they approve or not – what gives them the right?

      Obviously I am not saying we should stand by and watch babies die and I agree with education but I don’t see that a big warning slapped onto the side of a box of formula is going to achieve that.

      Today I went to see my GP. She gave me a prescription and said “it says on the box you shouldn’t take this but just ignore that”. See what I mean?

      I would also be interested to see how those UK stats about death due to pre-birth factors plays oit around the world x

      • Definitely about informed choice and education rather than interference – I suppose it’s the difference between getting your information from a reliable source vs some friend of a friend via the internet and what her Granny once said was helpful. You may then choose to ignore the information or do something different with it (e.g. taking the tablets in x situation even though the packet says that most people shouldn’t). But at least you have the information. ‘Cos ‘choice’ without the facts really isn’t one. As with so many things in life!

        This is the second major report your blog has inspired me to read in full. Thanks for that (I think!) x

  4. Zoe, you had a horrible experience with poor maternity care, no doubt about it. But I don’t understand what would be ‘culturally interfering’ about explaining to mothers in settings with no clean water, no facilities to boil the water, and very little money to buy formula, that using formula instead of breastfeeding could pose a risk to their baby? What is cultural about babies dying??? The formula manufacturers with their marketing are the ones who have interfered with culture, by undermining breastfeeding for the sake of profit.

    • I had hoped it was obvious that I wasn’t condoning any unethical marketing activities by the formula companies. My point was that without understanding individual communities and their cultures it is difficult to assume all of their reasons for not breastfeeding. I do for example know of specific communities here in the UK and in Europe where it is not considered culturally acceptable. Now, that might not meet with the approval of the wider country/continent but for these people it is the way they live their lives. That was my point.

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