conference was convened to create the Innocenti Declaration,7 which could be considered the cornerstone of lactivism. Developed during a WHO/UNICEF policymakers’ meeting in the summer of 1990 (held at the appropriately named Spedale degli Innocenti in Florence, Italy), this declaration outlined the importance of global breastfeeding initiatives: “As a global goal for optimal maternal and child health and nutrition … all infants should be fed exclusively on breastmilk from birth to 4–6 months of age. … [T]his goal requires, in many countries, the reinforcement of a ‘breastfeeding culture’ and its vigorous defence against incursions of a ‘bottle-feeding culture’ … utilizing to the full the prestige and authority of acknowledged leaders of society in all walks of life.”8
The serious tone of the Innocenti conference reflected a belief—inspired by the Nestlé debacle—that formula feeding was legitimately dangerous. It didn’t really matter that what caused the deaths of so many third-world children was not the formula, specifically, but a slew of formula-handling-related problems (contaminated water, lack of resources); even in affluent Western cultures where these problems were practically nonexistent, people began viewing formula as a deadly substance. This mentality became more pervasive through the decades, gaining momentum through literature that frames risks in ways that the average person can easily misinterpret. For example, in her book The Politics of Breastfeeding, nutritionist and outspoken breastfeeding activist Gabrielle Palmer chastises the United States for its hypocrisy in claiming to defend the life and liberty of babies in a myriad of military conflicts, and then being unwilling to set “guidelines for the marketing of a product which could kill children.”9 The Los Angeles Breastfeeding Task Force website somberly states that “the practice of feeding babies infant formula … carries with it profound risks in modern, industrialized countries, as well as in developing countries. … [M]any are unaware of how the lack of breastmilk and the use of infant formula compromise the health and well being of children in the United States. These risks are well documented in the medical literature.”10
The United States has taken flak for being the only “major country”11 not to adopt the WHO Code. (Ronald Reagan’s administration held out on the grounds that it restricted free trade. Score one for capitalism.) However, years of lobbying from groups like the La Leche League, the United States Breast-feeding Committee, and the American Academy of Pediatrics’ Breastfeeding Section resulted in the United States adopting much of the Code in 1994. All this really meant was that the government informed formula companies about the Code and “encouraged” them to abide by the rules. Breastfeeding advocates attempt to police these rules, but it has admittedly been an uphill battle; formula advertisements are still seen prominently in parenting magazines and on television. But there have been many victories, as well—a substantial (and steadily growing) number of “breastfeeding-friendly” hospitals have ceased to hand out free formula samples, and formula manufacturers are required to print an advisory statement on their products explaining that breast is always best (but the formula you’ve just bought is an excellent substitute!). In other countries where the WHO Code is uniformly followed, formula companies are far more restricted—for example, they are not allowed to advertise at all. Breastfeeding advocacy groups like the National Alliance for Breastfeeding Advocacy (NABA) are working to encourage the United States to adopt similar policies. If this happens, formula will become part of a shameful club—the only other consumer goods in America that have these types of restrictions and laws governing their advertising and packaging are tobacco products and alcoholic beverages.
For those of us having babies in the twenty-first century, breastfeeding advocacy is becoming more like antiformula advocacy. Suggestions on raising breastfeeding rates focus on eliminating formula from our lives: What if we made formula available by prescription only? If hospitals went formula-free, only allowing parents to use it if deemed “medically necessary”? And this isn’t just from grassroots organizations. Even the CDC, on a webpage explaining its 2010 Breastfeeding Report Card project, emphasizes that in our country, “too few hospitals participate in the global program to recognize best practices in supporting breastfeeding mothers and babies, known as the Baby-Friendly Hospital Initiative,”12 an initiative that puts heavy controls on the use of formula in institutional settings—even if the parents have expressed no intention to breastfeed. But perhaps the biggest game-changer in the way breastfeeding advocacy is handled has been the concept of educating women on the risks of formula feeding rather than the benefits of breastfeeding. This has provoked a recent movement to trade in the old “breast is best” slogan for the new “breast is normal,” although the sentiment is nothing new. “The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same, nor superior, is therefore deficient, incomplete, and inferior,” Diane Wiessinger, an outspoken lactivist and international board-certified lactation consultant (IBCLC), wrote back in 1996 in an oft-cited article, “Watch Your Language.”13
In this context, the formula freebies I received take on a darker meaning. But even for those who don’t fear formula, and simply feel strongly that breastfeeding should be the default, these samples are troublesome. The belief is that samples are simply too tempting for women, that breastfeeding is difficult at first, and having formula in the home undermines a woman’s confidence in her own body. There have been studies bolstering the suggestion that outlawing the samples might increase breast-feeding rates; one small Canadian study found that women were 3.5 times more likely to be breastfeeding exclusively at two weeks postpartum if they hadn’t received formula samples.14
At least in my case, an unsolicited package from a formula company couldn’t undo all the subtle, subliminal pronursing messages I’d endured since joining the profitable ranks of expectant mothers. Every time I walked into a maternity store, I saw huge sections full of Medela nursing products; rows of nursing bras and fashions; special rooms for “nursing moms”; breast-milk “test kits” in case a modern, socially active mom had one too many cocktails and still wanted to give her baby the best nutrition; baby and pregnancy magazines that consistently had cover stories on how breast is even better than we thought before, and so on. Nursing was the norm, at least in my socioeconomic and cultural stratum.
Even for mothers immune to social pressure, the fact that respected medical authorities have come down so dramatically on the side of breastfeeding makes a strong statement. The American Academy of Pediatrics (AAP), American Medical Association (AMA), and American Dietetic Association (ADA) all recommend exclusive breastfeeding for at least the first six months of life, followed by at least another six months of partial breastfeeding. WHO takes it a step further, commanding us to nurse for two full years. Although the Office on Women’s Health, U.S. Department of Health and Human Services, argues that “the marketing of infant formula negatively affects breastfeeding … [and being] given [an] infant formula kit [is] strongly discouraging” to breastfeeding efforts,15 a stereotypically anxious mother would have a hard time ignoring these research-backed mandates in favor of Similac’s prettily packaged presentation of bottle-feeding bliss.
The same day the formula package arrived, I also got a coupon for a free six-piece Chicken McNuggets from McDonald’s. I don’t eat fast food; I didn’t run out to the drive-thru just because I could get something for free. I couldn’t really understand why the formula package was any different. I did see one problem inherent in the free gift I was sent, however, and that was the enclosed reading material. I was media-savvy enough to understand that the pro-breastfeeding pamphlet included in my Similac-sponsored gift was just lip service, but obviously they were sending mothers a mixed message by offering free formula samples along with a small booklet of advice to help with all the potential problems we might face if choosing to breastfeed: Breastfeeding is hard. Choose formula. Message received.
There are other messages, though, received indirectly but just as powerfully. Shortly after I received that Similac sample, I found myself wandering the hallowed halls of Babies ’R’ Us in a daze, agonizing over whether or not to register for bottles in case I wanted to pump somewhere down the line. I was afraid of what friends would think if they saw bottle paraphernalia on my registry; that I might be setting myself
