in 2007,9 and, as of August 2014, all of Philadelphia’s birthing hospitals agreed10 to “ban the bags”11—the name for the national campaign to stop mothers’ receiving free infant formula at the hospital.
Why the fuss about freebie formula? “What companies have done is co-opted health-care providers into doing their marketing for them,” explains Marsha Walker,12 who is executive director of the National Alliance for Breastfeeding Advocacy. Removing free formula, therefore, means that moms are supposedly only now able to make an unbiased choice between breast and bottle. “It is still the choice of the mom if she breastfeeds or not,” but now she is making the decision free of marketing influence, said Katja Pigur, who led the Philadelphia ban-the-bag campaign for the Maternity Care Coalition.13
The argument against free formula is that mothers who might otherwise commit to breastfeeding may become “discouraged” or “break down” and give their babies some too-readily-available formula if they are having any complication with nursing, and that in turn will discourage keeping to exclusive breastfeeding going forward. What breastfeeding advocates want to prevent is mothers feeding their kids formula at all, so they want to make getting your hands on it as difficult as possible.
These zealots do have a point about the work required to breastfeed. Mothers’ milk does take time to come in after birth, and getting used to breastfeeding and generating an adequate milk supply does require a level of time, energy, and commitment that isn’t required when mixing formula. Powdered infant formula gets mixed with water and can then immediately be given to baby. Also, breastfeeding advocates worry aloud about “nipple confusion” if infants are given the breast and then a bottle before they’ve become accustomed to the harder work of nursing. In addition, the flow through a bottle nipple is quicker than a woman’s breast, which critics of bottle feeding say is another reason to stick with exclusive breastfeeding, though it is important to note that even the most ardent breastfeeding advocate will urge mothers to supplement with formula when medically required.
The question is how hard hospitals will make the rational decision to feed babies with formula. Will it be an easily accessible choice, or will new moms have to send their husbands, mothers, grandfathers, friends, or a friendly nurse to Costco or the nearest supermarket to get a can of formula while they are still in the hospital recovering? As new mothers may not be directly aware but can no doubt sense, there is a web of organizations at the global and local levels that have made it their agenda to demonize formula and promote breastfeeding as the only acceptable method of nourishing infants.
PUMPING UP BREASTFEEDING: 1. GLOBAL
The World Health Organization (WHO), which is pushing its Baby-Friendly Hospital Initiative (BFHI) in the United States and across the globe, would love for formula to be as difficult to get as possible. “Launched in 1991, [BFHI] is an effort by UNICEF and the World Health Organization to ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support,” the UNICEF website declares. And according to their “About Us” statement, breast milk is really the only correct choice.
Human milk fed through the mother’s own breast is the normal way for human infants to be nourished. . . . Breastfeeding is the natural biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant. With the correct information and the right supports in place, under normal circumstances, most women who choose to breastfeed are able to successfully achieve their goal.
There is no qualification here. The “normal” and “correct” choice is mother’s milk, and if every mom would just try hard enough and get enough encouragement from the institution where she gives birth, the goal of exclusive breastfeeding can be realized. Of course, the Baby-Friendly designation comes with strict rules for the institutions that choose to sign up for certification. These rules include the means for getting most everyone to breastfeed and include an anti-formula perspective. For instance, supplementing baby’s food at all is discouraged. “Give infants no food or drink other than breast-milk, unless medically indicated,” WHO says. Also, since they want staff to “encourage breastfeeding on demand,” to be baby-friendly means practicing “rooming in—allow[ing] mothers and infants to remain together 24 hours a day.” This is nice in theory but hard on mom in practice. Having just given birth, most moms are in need of rest; but since the breastfeeding police want you to jump at every opportunity to breastfeed, mom is going to spend most of her time listening for baby rather than sleeping. Finally, WHO doesn’t want anyone to offer baby pacifiers or “artificial nipples to breastfeeding infants,” lest baby develop any attachment other than to mama’s milk supply.14 The fact that babies suck for comfort as well as for food seems to be of no concern to the “experts” at WHO.
Each hospital and maternity ward could and does come up with their own policies about infant feeding, but as one former hospital administrator explained to me, many institutions will take every opportunity to market themselves as the “best” place to give birth. If a globally recognized organization is telling them to institute a few rules to receive a stamp of approval—like baby-friendly—so much the better. Here the standards have been developed and corresponding educational materials created for the sole purpose of getting staff to institute “baby-friendly” procedures. And the whole process is free, almost. There was a study done for the University of Texas’ Health Sciences Center to gauge the price of BFHI, but even though results showed that “first year marginal costs will approximate $110 per delivery (birth)” and that “BF hospitals have around a 2% higher cost structure than non-baby-friendly facilities,” the researchers believe it is worth it.15 As my hospital administrator friend put it, “the hospital is thinking of marketing itself to the whole family, not just the baby.” She added that when a hospital is focused on gaining the business of every family member and not just performing a single service, like a delivery, then anything that gives them a way to signal they are a leader in quality services, like being baby-friendly, will be deemed worthy.
PUMPING UP BREASTFEEDING: 2. STATE
The hospitals working to earn the World Health Organization–defined label “baby friendly” for banning formula giveaways and the entire cities riding the breast-is-best bandwagon aren’t alone in their zeal to promote exclusive breastfeeding.
Five states—California, Illinois, Minnesota, Missouri, and Vermont—and Puerto Rico “have implemented or encouraged the development of a breastfeeding awareness education campaign,” reports the National Conference of State Legislators. Twenty-seven states, the District of Columbia, and Puerto Rico have laws related to breastfeeding in the workplace.16
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