Dear Mayor Bloomberg: Please stop the smoke and mirrors

Dear Mayor Bloomberg,

I’m sure you’re sick to death of hearing about the Latch On NYC initiative. There’s been so many blog posts, opinion pieces, counter-opinion pieces, etc., inspired by the announcement of this policy… I felt it was redundant to add more fuel to the fire, after I said my piece the week the policy was made public. I was hoping to avoid making this personal, as we’re both from the same town (in fact, my mom and you were neighbors growing up) and I always had a soft spot in my heart for the local boy made good.

But unfortunately, your camp has made that an impossibility. Not necessarily because of the policy itself (although I do have many problems with it), but because they have pulled the most transparent, juvenile stunt that essentially begs for caustic commentary.

Back to the policy for a minute: I’m sure you’re aware that it has changed dramatically. So much so that everything I talked about in my prior post now sounds like the rantings of a paranoid moron, with a fondness for extrapolation. And it’s not just me – smart, rational women like Katherine Stone are enduring an onslaught of patronizing op/eds which reduce their concerns over personal autonomy and women’s rights to a “misunderstanding” of the policy.

I have serious concerns about the capabilities of our country’s journalists for not pointing out the giant, defecating elephant in the room: the reason there is a disconnect between what those of us who have raged against the policy wrote, and what is now being written by people sounding far more rational and balanced, is that the literature that was initially published online by your Dept of Health has been erased from existence. In its stead lies a “Myths and Facts” document, a step-by-step dismantling of the concerns brought forth by the initiative’s critics.

The outlining of the plan which made me so hysterical? They literally made it disappear. As in, whoosh, the hat became a rabbit. No public announcement admitting that your administration had overstepped or misjudged; not even an acknowledgment that the policy had been altered or revised. Just one day there, next day not.

Let’s walk through the new “Myths and Facts” document which took the place of the old “FAQ”. Unfortunately, I did not take screen shots of the original – I wish to god I did, but I naively never thought your office would condone such a blatantly disrespectful, Orwellian action. Luckily, a fantastic blogger at a site called Breastfeeding Without BS copied the sections I found most troubling verbatim on her post about the initiative, so we still have access to the text as it originally appeared.

What the new document says:

Myth: The city is requiring hospitals to put formula under lock and key.

Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

What the old document said:

What does it mean to restrict access to formula?

Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:

…Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit……Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system. 

 

Mayor, I’m confused. How is keeping formula in a “locked location”, available to only a “limited number of hospital staff” who should use a “log book, code or a key system”, making formula “fully available to any mother who chooses to feed her baby with formula”? I don’t recall if the original document explicitly stated that hospitals must keep formula locked up or if it was merely suggested, but in either case, I don’t think it’s a stretch to see why this particular “myth” seemed like a scary truth to many of us.

 

What the new document says:

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.

Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Myth: Mothers requesting formula will be subject to a lecture from the nurse.

Fact: The City’s new initiative does not set a requirement that mothers asking for formula receive a lecture or mandated talk. For the last three years, New York State Law under the Breastfeeding Bill of Rights, has required that mothers simply be provided accurate information on the benefits of breastfeeding. This requirement has not changed under the City’s new initiative.

What the original document said:

What do we tell our staff to do when mothers (families) request infant formula? 

While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s infant feeding choice. Educating mothers and families about breastfeeding and providing encouragement and support, both prenatally and after birth, is the best way to ensure breastfeeding success in your hospital.

While in the hospital your staff can:
Assess if breastfeeding is going well and encourage the mother to keep trying.
Provide education and support to mothers who are experiencing difficulties.
If the mother still insists on receiving formula, document it in the chart along with the  reason and distribute only the amount of formula needed for the feeding.
Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new mothers at all times regardless of day, night or weekends.

 

Notice the difference in language and tone here. “Mothers can and always will be able to simply ask for formula…no medical reason or written consent needed….” versus ‘Assess if breastfeeding is going well and encourage the mother to keep trying…if the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding.” We’re talking semantics here, but policy is all about semantics – and the “myth” sounds an awful lot like what was written in their initial, official FAQ literature. Obviously it does not state simplistically that moms will have to “convince a nurse” that there is a medical reason, or be “subject to a lecture”, but I don’t think it’s much of a stretch to imagine that this will be what ends up happening when the policy enlists health care providers to “encourage” a mom who has already made a decision – for whatever personal reason – that she wants to supplement; I don’t think it’s overreacting to take umbrage at the terminology “if the mother still insists” or the fact that nurses are told to only give the amount of formula needed for that feeding. As BF without BS so eloquently put it:

But what does “Assess if breastfeeding is going well and encourage the mother to keep trying” actually mean in practice? If the mother says clearly “I don’t want to do this any more,” is the nurse required to keep urging her to continue? Where do you draw the line between support and nagging? The initiative gives us no clear answers. Certainly, the use of the word “insist” here is deeply problematic. My understanding is that a person only “insists” on doing something when they continue to state their need after having experienced a considerable amount of pressure to do the opposite.

 

What the new document says:

Myth: Latch on NYC is taking away and/or jeopardizing a woman’s right to choose how to feed her baby.

Fact: The initiative is designed to support mothers who decide to breastfeed. For those women, the program asks hospital staff to respect the mother’s wishes and refrain from supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind). It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it.

Myth: Formula will be forbidden in some fashion.

Fact: If a mother decides she wants to use formula (or a combination of formula and breastmilk), she will be supported in her decision and her baby will be given formula during the hospital stay. If a breastfeeding mother changes her mind or requests formula at any time, her baby will be given formula.

 

In the original document, considering there is no further instruction given on subsequent requests, I think it was fair fair to assume – or at least to fear – that a lecture and limited formula will be the protocol for each and every feeding. It would have been easy enough for the authors of this document to add “Once it has been established that the mother has made an informed decision to formula feed, she should be given formula without further questioning, upon request” or even better, “a supply of ready-to-feed, pre-sterilized bottles and nipples should be left in her room for feedings.” As a formula feeding mother, that is what  “not restrict(ing) the mother’s nursing options in any way “ and not “restrict(ing) access to formula for those who want it” means.

 

What the new document says:

Myth: Positive benefits from breastfeeding are being overblown or aren’t true.

Fact: There is overwhelming evidence, supported by national and international health organizations, showing that breastfeeding produces better health outcomes for babies and mothers than formula. For mothers, breastfeeding reduces the risk of breast and ovarian cancers. Babies that are breastfed have a lower risk of ear, respiratory and gastrointestinal infections, as well as childhood asthma, than babies who are formula fed.

The American Academy of Pediatrics just published new guidance to pediatricians in February 2012, reaffirming the evidence that the health benefits of breastfeeding over formula are clear: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

What the “Initiative Description” (which is still available – for now – here) says:

Formula feeding markedly increases serious health risks for infants, including:

o 257% excess risk of hospitalization for lower respiratory infection

o 178% excess risk of diarrhea and vomiting o 100% excess risk of acute ear infections

o 67% excess risk of asthma for infants with a family history of asthma (35% for infants with no family history of asthma)

 

Again, the language here is markedly different. The spin doctors who have performed surgery on this document are skilled; I’ll give them that. I don’t think most of us would argue that there have been “better health outcomes” reported for breastfed babies; it’s the inflated representation of the statistics that we found misleading – a “100% excess risk of acute ear infections” sounds like formula fed babies have a 100% greater chance of getting ear infections to the untrained ear, and most of the NY public probably doesn’t have an advanced understanding of statistics.  But that’s almost irrelevant. The more important point here is that neither of these passages addresses the concerns that scholars like Joan Wolf have brought up, or the writers who have used her work to illustrate their essays: concerns like the confusion of correlation and causation, and the inherent flaws in breastfeeding studies, which make these statistics (even in their non-puffed-up form) questionable. Where’s the acknowledgment that even the literature used to support these claims has a clear warning that these very issues need to be addressed?

As I stated in my original post on Latch On NYC, I think it is a positive thing to support breastfeeding by not shoving formula in a mother’s face at the first sign of breastfeeding challenges. I think it’s wonderful to offer more lactation support, and to encourage rooming in, and not insist on formula supplementation unless it is medically indicated.  But this is not  all that Latch On NYC, as initially put forth to the public, is doing. Notice that there has not been the sort of outrage we’ve seen regarding this initiative towards any other Baby Friendly Hospital Initiative in the country. This outrage has come from breastfeeding moms and formula feeding moms alike. It has come from Democrats and Republicans and Independents. It has come from people who don’t even have children, nor plan to. There was a reason for this outrage, and I think it is unspeakably rotten for the mayor’s office to perform this rather amateur feat of smoke and mirrors to make it look like the vast majority that disapprove of this act are either anti-breastfeeding or ignorant.

Mayor Bloomberg, I hope that the scarier aspects of this initiative have been erased along with the document that outlined them. I’d much rather have the expectant mother of NYC be spared from injustices than be “right” about what I feared regarding this policy. But I would implore you to come clean about how this all went down; to allow this initiative to start out on the right foot. It will not help raise breastfeeding rates to have women going into    NYC labor and delivery suites with their cockles up, ready for battle. There are elements of this plan which should be rightly celebrated, and you have essentially rendered that impossible by allowing for such dirty warfare. Those of us who raged against the original plan are not a bunch of uneducated militants who work for the formula companies. We are mothers, daughters, and concerned sisters, some of whom have experienced the sting of breastfeeding “failure” on a personal level, and others who have studied this discourse and its historical relevance at length, and simply feel that there are better ways to support breastfeeding than to frame formula as the enemy. I beg you to sit down with some of us and listen to what we have to say, and at the very least, make the original FAQ PDF reappear. It won’t require magic, just the small bit of courage it takes to admit you were wrong and promise to try better next time. We are all trying to win the same war (better support for new moms, and healthier babies for NYC and the country at large), so let’s not get ourselves caught up in friendly fire…okay?

Best,

Suzanne Barston, FearlessFormulaFeeder.com

 

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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14 thoughts on “Dear Mayor Bloomberg: Please stop the smoke and mirrors

  1. I suspect, or at least hope, that the differences between the initial information and the edited information is due to poor communications protocols. I think the city perhaps underestimated initially the importance of being specific and careful in terms of the implementation and communication of the policy. I hope they’ve learned their lesson and that future communications about infant feeding or any other public health policies will involve a careful review of what is being said to ensure that it is appropriate, specific, and not open to misinterpretation.

    If the city did in fact plan to shame formula feeding moms and is now backtracking on that, shame on them.

  2. I’m really not seeing major differences in the before and after language. I think the myths vs. facts approach is nicely done and clarifies things for mothers which should be the goal. Public health communication is supposed to deliver a message to the general public, not just the blogosphere so I’m not sure what the gripe still is at this point. Nothing about the initiative itself has changed. Sure NY is a higher profile city but do Health Departments generally make a point of releasing statements about the rationale behind tweaks to their public health outreach and messaging? If the point is to advocate for mothers then mission accomplished; feedback resulted in better communication. There’s no smoke and mirrors in that. That’s how feedback is supposed to work. A woman giving birth in a NY hospital with questions about the initiative should be getting their information directly from the NYC Health Department website anyway not info that has been repackaged and interpreted by blogs (either pro-breastfeeding or pro-formula). It seems like so much ego is wrapped up in these discussions.

    • Shikki, I can’t promise that there isn’t some degree of egomania inherent in this particular post. I really don’t like being told that I have overreacted when someone has pulled the info I was responding to down from public view. I absolutely agree that the public should be getting their info from the NY Health Dept rather than blogs – that is the entire point of this post. I’m confused (and concerned) that you missed this. Yes, the initiative HAS changed, if this “Myths and Facts” doc is to be believed. The initial doc we were all responding to was directed towards the hospital admins, and not to the public. It was abundantly clear and left little to interpretation. You honestly are telling me you don’t see a difference between stating that formula should be locked away, with access given only to a few select staff member, and stating that “Formula will be fully available to any mother who chooses to feed her baby with formula?” Seriously?

      If they have tweaked the policy, that is wonderful. I also said that quite clearly in the post above – I’d rather have this be true than to be “right”. But considering the initiative literature has been taken down and this completely dumbed-down and over-simplified (and patronizing, IMO) document in its stead, I’m not convinced that the NYC city govt is treating its citizens with respect. Perhaps that is typical of city governments. It may well be. But that doesn’t mean we, as citizens, have to stand for it.

      Also, the “blogosphere” was hardly the only place that heard an uproar over these events. I’m seeing articles and news stories in major media outlets on a daily basis about this initiative and the damn thing was announced a months ago. A recent poll showed that the majority of New Yorkers are against this initiative. Maybe that’s because they are getting their information from “overreacting” blogs rather then the Health Dept, but that is the Health Dept.’s fault. If you announce something in a scandalous way, and then fail to back it up with intelligent discussion but rather hide behind innocuous and vague statements, it makes the public have major trust issues.

      • All hospital supplies are locked away if you will so I never took issue with that language to begin with. I thought the negative connotations people attached to that piece of verbiage were completely unreasonable. The problem with the internet is that people tend to use the internet as a place to reinforce their beliefs (and fears) as opposed to a place to get info and so there was a great deal of people projecting a lot of their unresolved baggage about their own feeding experience into this discussion as though Mayor Bloomberg was going to secure a time machine, go back in time and make women feel horrible about their feeding choices all over again. This initiative for the most part is only relevant to women who will be delivering in NYC hospitals in the future. The language has been clarified and so the concern over how you may be perceived as having overreacted does seem to be an ego based response. Shouldn’t the goal simply be for mothers to be treated with dignity regardless of their feeding choice? What are your concerns with the initiative as it currently stands? If there are still concerns about unintended consequences that’s fair but it’s almost as though you still believe that the Mayors intentions with this initiative are dubious and just now more cleverly hidden behind nicer language. Is it that you still distrust the initiative itself or that you’re basically just upset that the updated myths vs. facts language makes your original response to the issue seem unreasonable?

        • “All hospital supplies are locked away if you will so I never took issue with that language to begin with.”

          Do you work in a hospital? Because I have, and all hospital supplies are not “locked away.” Furthermore, not all hospital supplies require the nurse or admin to complete a log or use a key code in order to retrieve the supplies. You know what kind of supplies require that level of management? Drugs. Additionally, most hospital supplies are maintained in the ward or unit in which they are to be used. That way, hospital staff don’t waste a lot of time running around to retrieve the supplies. Under the old FAQ, hospitals were instructed to keep formula somewhere outside the maternity ward. Gee. I wonder why that’s the case? So hospital staff, who didn’t want to jump through hoops in order to get the formula, or get a black mark on their record for distributing it would further “encourage” women who requested formula to breastfeed?

          Here’s what happened:

          Latch On NYC showed its ass in public.

          Intelligent people (primarily women) called them on their ass-showing.

          Instead of saying, “Hmm. I think you’re right, we’re going to alter the initiative to say, ‘X, Y, and Z instead. Thanks for your feedback,'” Latch On NYC covertly removed documents from its site, used the news articles and feedback it received on the original documents to create a “MYTHS AND OTHER SCARY THINGS YOU SHOULD NOT BELIEVE” FAQ, and then shrugged its shoulders and said, “I don’t know what all those hysterical women are going on and on about – see your MYTHS AND OTHER SCARY THINGS YOU SHOULD NOT BELIEVE FAQ!”

          If that’s not insulting, misogynistic shenanigans, I don’t know what is.

          • Ithinkthatinterpretationisunecessarilyextreme.Iguesshavingworkedforahealthdepartment(environmentalhealth)Ijustdidn’tknowpublichealthworkersthiscalculating.FactIcangetbehindbutalltheseconspiraciesarejustnotinlinewithmyexperiencewiththoseinthefield.theyaretheonesreallydoingtheworkonthis.themayorjustgetsthecredit

          • Sorry, this site is not very compatible with posting from a mobile device.
            That should have read I think that interpretation is unnecessarily extreme. I guess having worked for a health department (environmental health) I just didn’t know public health workers this calculating. Facts I can get behind, but these conspiracy theories are just not in line with my experience with those in the field. They are the ones actually doing the work on this. The mayor just gets the credit. That is not to say that he doesn’t want to increase the rates of breastfeeding in NY hospitals but he certainly did not create the language himself. As for the myths vs. facts language, again the initiative still looks pretty much exactly the same. The original language was more of a how to guide for implementation with the audience being the hospital staff. It would probably have been more appropriate for that to be an internal document as opposed to outwardly facing. The new language has simply been updated for the audience to be the public.

  3. Also as for what you call patronizing language, most public health messaging is written at a 4th -7th grade reading level. What you consider patronizing really is just language that is accessible to more people, but sadly still not enough. In a city as culturally diverse at NY I think that the language could still be simplified further. The tone is patronizing to you because you are a formally educated person but to many it is not.

  4. I agree with you. I breastfed all three of my children, but that was my choice. Breastfeeding is not for everyone. For one it can be very frustrating to the new mom and if it doesn’t work she can feel like a failure. I feel that bottle feeding your baby is not bad for people who have running water. I don’t believe in bringing formula into 3rd world countries because they have no way to prepare formula, breastfeeding is best for them! I work in an OB department in a small hospital in upper Michigan. Our hospital wants to move towards the Baby Friendly Initiative this year. I dont think it will work but I guess I will have to see!

    • ‘I don’t believe in bringing formula into 3rd world countries because they have no way to prepare formula, breastfeeding is best for them!” A few points on this: a) many third world countries do have access to clean water in urban areas particularly; b) women with low supply or challenges that stop them from BFing exist in these countries too; c) in very traditional joint-family settings, there may be another lactating women to help out such women, but if there’s no-one, the babies may get diluted cow’s milk, rice water or sugar water, which is worse; d) shouldn’t we be trying to help all women have access to safe and nutritious choices for their children instead of making blanket statements about not “bringing” formula to the ignorant unwashed?

      • Agreed, Perfesser.

        I just heard a story about formula feeding in a 3rd world country on Sunday. A missionary couple to Guatemala was speaking. They help run a home for families whose children are patients at the children’s hospital, kind of like a Ronald MacDonald House. They also sometimes purchase supplies not covered by the socialized medical system.

        Anyway, the story was about a mother and her premature twins. The babies were not thriving, because their mother, who was breastfeeding, could not supply enough milk. “What do we do?” the parents asked. The doctors recommended formula. Formula is cost-prohibitive for many Guatemalans, as it was for this family. (So the parents were basically left asking the same question– “What do we do?”) The ministry was able to buy them two weeks’ worth of formula, and another missions group supplied the rest. The little twins are now doing much better. :-)

        So breastfeeding is not always successful, even in 3rd world countries. Also, breastfeeding is the norm among the very poor. Notice it didn’t even occur to the above parents to use formula. Because they couldn’t afford it, and they knew it.

        And as Perfesser pointed out, not all people in the 3rd world are too poor to afford formula and/ or lack access to safe, clean water. Why shouldn’t they formula feed if they need/ want to?

        To be frank, I find it paternalistic to say formula shouldn’t be on the market in certain nations just because it’s not a viable option for everyone. There are all sorts of products I can’t afford sold in the U.S. But I don’t think they should be banned from the country. I’m an adult and competent to make spending decisions. I logistically couldn’t take good care of a dog. Does that mean they shouldn’t be available to any Americans?

        • Oh, and sometimes people need stuff they can’t afford. *Cue discussions about poverty, hunger and costs of health care that I won’t get into right now.*

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