My honest reaction to The Honest Company’s new formula

So there’s a new formula on the market.


This should be good news, right? Especially as this particular formula brand (The Honest Company) is trying to corner the organic, natural-minded formula feeder market, which is steadily growing. I’ve heard from many FFFs who import a British organic formula because it’s the only one that suits their needs; this is certainly not cost-effective or efficient, and it’s spectacular that these parents now have a Stateside option.

Unfortunately, most of the formula feeding community (including me) learned of this new product via an article on PopSugar which only served to infuriate a good deal of its target audience.

“When you’re trying to feed your baby, you’re riddled with emotion, shame, judgement . . . all these extra layers,” Christopher Gavigan, the company’s cofounder and the creator of the formula, told us. “We acknowledge that breast milk is the most nutritious form of food on Earth, but if you look at the research, the majority of moms will end up doing some combination of feeding, whether it’s a choice or because they have to. It’s a growing reality around the world. And in that reality, parents have to be able to choose something.”

Um, I’m no marketing genius, but since when has “well, we know you feel really shitty about using this – and you SHOULD – but since you have to do it, you may as well choose us” been an effective marketing strategy?

One could argue that for moms who just need to supplement a little, or who are still feeling awful about their “failure” to breastfeed, this self-flagellating attitude might be welcomed. But that doesn’t mean it’s helpful. I wonder about the impact of this language on moms who already worry enough about nutrition to shell out $30/can for formula.

This product launch is also causing drama because Gavigan implies that other widely-used commercial formulas are sub-par:

What he came up with was a formula carefully modeled after breast milk, nutritionally complete, easy to digest, and meticulously blended using ingredients sourced from trusted organic farms. It’s free of gluten, GMOs, flavorings, steroids, growth hormones, and pesticides. And it’s the only formula on the market that has chosen to leave out hexane-extracted DHA (while the fatty acid is known to help with baby’s brain development, the synthetic forms don’t meet safety standards).

While there are many who don’t feel comfortable with hexane-extracted DHA (and I’m thrilled they have a new option, because all parents deserve to feel comfortable with what they are feeding their babies), it’s patently false that the forms used in other formulas don’t meet safety standards. They may not meet Gavigan’s safety standards, or the Cornucopia Institute’s standards, or European standards, or YOUR safety standards, but they do meet the safety standards formula companies must adhere to. Speaking of which, I highly doubt this formula’s ingredients closely resemble breastmilk any more so than Good Start’s. Every formula company wants to get as close to breastmilk as possible. That’s sort of the end-goal. If Honest Company has cracked the code, I think we’d be seeing articles in the Wall Street Journal, not PopSugar.  (Also, for the record, Baby’s Only also has a hexane-free option, although they market it as a “toddler formula” because they believe babies should be primarily breastfed for the first year. But it really is an infant formula. Which is weird. But whatever.)

That said, it is plausible that they have sourced all their ingredients from trusted organic farms. That’s probably where the hefty price tag comes from.

Yet, while Gavigan’s quotes in the Pop Sugar article left a lot to be desired, whoever designed the company’s website is a genius. In the introduction to their feeding section, they state:

No breast versus bottle, no right or wrong: We believe how parents choose to feed their babies is a personal process based on the needs of their families. We know it can be quite an emotional decision. That’s why we’re here not to judge, but rather to support parents with a range of researched information and safe, premium products that empower every family to make the best choices given their unique circumstances.
We’re aware that breast is best, but we also understand that families may choose or require other options. No parent should have to feel guilty for choosing to feed her or his baby one way or another. Parents have been nourishing their children in all kinds of ways since the beginning of time as we know it. With Honest Feeding, The Honest Company hopes to represent the next step in the evolution of nourishment as we help you lay the foundation for a safe, healthy and happy future.


Freaking amazing, isn’t it? And even better, they have a section called “Transparency” where they take you through the ingredients in their formula, where they are sourced, etc. The old guard formula companies could learn a lot from this approach. It’s beautiful.

Problem is, I don’t know if what’s on the site is merely lip service, and the “persona” of Honest as a formula company will be closer to the PopSugar representation. I really, really hope that Gavigan was just misquoted.

Regardless, when I posted about this new formula on the FFF Facebook page, all hell broke loose. Some echoed Gavigan’s feelings about currently available commercial formulas, saying that what was available was “garbage”. Others understandably balked at this suggestion. Feelings were hurt, insults were hurled, and I ended up turning off the computer and watching Law & Order SVU because it was less frightening.

(**This is what we’ve come to. We’re so reactive, because we’ve been forced to live in fear, under this heavy, smelly cloud of judgment. It puts us in bad moods, makes us jumpy and defensive, and who can blame us? You spend too much time under a smelly cloud, and you start to kind of stink, too. I know I do.** )

So where do I stand on this new product? First, it doesn’t matter what I think. It’s not my baby. It’s yours. And what mattered to me when I was choosing formula doesn’t have anything to do with what matters to you. My kids couldn’t tolerate anything but expensive hypoallergenics, and I was so relieved to have a way to feed them that allowed them not to starve or bleed from their GI tract that I wouldn’t have cared if the ingredients came from the seventh layer of hell. If organic, hexane-free formula is important to parents, then I damn well want to see organic, hexane-free formulas on the market. We should have more options, overall. That doesn’t mean formulas differ in how they will nourish your baby – they all meet the same nutritional standards and your baby will grow well on all of them, unless s/he has a special need/allergy/intolerance that necessitates a specialty formula. But there’s enough “noise” out there when it comes to our food (not that I condone or agree with this noise, but that’s not really here nor there) to make any new parent anxious, and when you’re already feeling anxious about not breastfeeding, the last thing you need is more anxiety.

One more thing I want to address, in this convoluted post: On Twitter, a lot of pediatricians I respect and who have fair, balanced perspective on formula use, surprised me with their reaction to this new formula. I share their skepticism on the marketing claims, but I worry about this attitude of “no formula will ever match breastmilk, so why even try?” That’s fatalist and scientifically pessimistic. There is always room for improvement. This may mean more options, better safety protocols, more transparency from the formula companies  And yeah, someday, it might mean making a formula that is even closer to breastmilk, at least in terms of certain specific aspects of human milk that we could potentially recreate in a lab. It’s not outside the realm of possibility.

Sometimes, I think that our desire to promote breastfeeding denies us the opportunity to do better for our population as a whole. As Gavigan rightly points out, many parents use formula. That will not change, at least not in our lifetimes. Throughout history, babies have been fed with drinks and foods other than breastmilk, much earlier than the currently advised 6-month mark. Providing the healthiest alternative possible should be a major goal. Dismissing formulas as “all the same” translates to “all junk” in the hyper-alert minds of loving parents. That’s not the message we should be sending, and more importantly, it’s not true.

Here is what it comes down to: No formula is “better” than another, nor is any parent “better” than another. We make choices; sometimes those choices are made for us, for financial or health reasons. The beauty of having options is that we feel we can exert some control over our babies’ health. The downside of having options is that we feel pressured to make choices that can exert control over our babies’ health.  And it gets even more complicated, because no one can agree on what is “healthy” half the time. Depending on whether you read Food Babe or Grounded Parents, your definition will vary.

But here’s what it also comes down to: We can’t confuse innovation, marketing and development within an industry with the politics of infant feeding at large. It’s the difference between arguing whether parabens should be in skin care products, and proclaiming that no one should be using anything but water and olive oil to clean their faces in the first place. It’s telling a car company that they shouldn’t be talking about their safety ratings, but rather encouraging people to walk.

It’s good to talk about these things. And no one should feel they have to sugarcoat or keep mum about issues that concern them. But if we could all just be realistic, be wary, and be kind, it would make for a much more palatable and productive discussion.

Honestly. It’s that easy.

All new parents deserve a place at the consumer protection table, not just breastfeeding ones: A response to the “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities”

Public Citizen is known for its advocacy for ordinary citizens who have been harmed by large entities–and rightly so.  Much good has been done by this organization in the name of everyday citizens who otherwise have little power to lobby our government for stronger laws and regulations to protect our society.  However, Public Citizen’s recent event, “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities,” does not accomplish the goal of protecting consumers.  A consumer protection advocacy organization has an obligation to women to support their right to bodily autonomy, as well as support their and their children’s health care needs—issues that are sometimes incompatible with breastfeeding and do not currently receive sufficient support in our breastfeeding-centric post-partum health care model.

The Day of Action fails to address many of the true issues that affect women’s and children’s ability to breastfeed.  A complete lack of formula advertising is not going to enable women with insufficient glandular tissue (IGT) to make sufficient milk, or change the fact that many women have to take necessary medications that are incompatible with breastfeeding.  It is not going to prevent complicated births or medical conditions in babies that sometimes make it exceedingly difficult – or impossible –for moms to breastfeed.  It does not reduce adoptive or foster families’ need for formula.  And a lack of advertising is not going to change the fact that some women do not want to breastfeed, and have a right to their bodily autonomy.  While we agree that it would be best for parents to receive information about formula from a non-profit source, currently, there is no such source that provides accurate, unbiased formula information, even to families for whom breastfeeding is not an option at all.

The Day of Action implies that information about formula is plentiful and accurate.  Nothing could be further from the truth.  Information about formula is typically riddled with fear mongering about not breastfeeding and uses value-laden language that assumes women who use formula lack perseverance or are selfish, lazy, uneducated, immoral, or ambivalent about their children’s health, despite ample evidence to the contrary. Formula supplies in hospitals are hidden in drawers or even locked up.  Lactation consultants are held to the WHO Code and urged not to discuss formula unless under special circumstances (lest it send a message that formula is “just as good as breastfeeding,” even though it is a medically appropriate option, and sometimes the only option).  Doctors are not taught about formula preparation and are frequently scared off of even talking about formula for fear of being labeled anti-breastfeeding.  Where are formula-feeding families supposed to get the accurate, unbiased, judgment-free information they need?

Perhaps Public Citizen is unaware of the extent to which breastfeeding marketing relies on shaky claims.  Maternity wards are typically papered over with literature that claims breastfeeding improving babies’ IQ and helps new moms lose weight—claims that some assert are based on poorly-done research that frequently confuses correlation with causation, and that have not been borne out in more powerful, well-designed studies.  Recent research on breastfed and formula fed siblings (three well-regarded published studies[1]) showed little to no long-term effect of breastfeeding for a number of oft-mentioned issues.  These studies are powerful because, unlike many other studies on breastfeeding, variables such as parental IQ, educational status, and socio-economic status are much better controlled.  Several large metastudies (including those conducted by WHO[2] itself and the United States’ Agency for Healthcare Research and Quality[3]) have found that the evidence in favor of breastfeeding is marred by confounding factors.

A consumer protection advocacy organization has the responsibility to ensure that advertising claims are based on sound science, but the “absolutes” plastered on maternity ward walls, city buses, and doctor’s offices (“Breastfeeding prevents asthma[4]”, “breastfeeding makes babies smarter[5]”, “Breastfed babies grow up stronger, healthier and smarter[6]”) and liberally sprinkled in literature distributed to new parents do not fulfill this criteria. Public service messages cannot be immune to the regulations that restrict other advertising.

Further, perhaps Public Citizen is unaware of how much of the advertising for breastfeeding actually benefits corporate entities.  New moms in hospitals are given sample tubes of Lansinoh nipple cream, Medela breast pads, and coupons or ads for local boutiques that sell breastfeeding products such as Boppy nursing pillows and covers.  It is common for new mothers to receive sample magazines, which exist both to promote themselves as well as the advertisers within. It seems counter to Public Citizen’s goals to protest one form of advertising and not others.

Women deserve to know the full range of medically viable options for feeding their children, in an unbiased, accurate, and judgment-free manner, and we feel a consumer protection organization should be at the forefront of that fight.  Formula feeding parents need help, advice, and support just as much as breastfeeding parents. Unless Public Citizen is willing to help establish a non-profit center to train “infant feeding consultants”, not just “lactation consultants,” whose job is to support all medically viable methods of feeding a baby, this Day of Action seems just another way to deny formula-feeding families what little information they can still get about their health care options for their children.  It seems to contradict the stated goals of Public Citizen to protect consumers.

We encourage Public Citizen to speak with actual formula feeding parents, many of who feel marginalized in our healthcare system for the choice or necessity of formula.  Breastfeeding—and products and service providers who support it—is so heavily promoted in hospitals that formula feeding families are left without the kind of education or support that breastfeeding families receive. As there are no non-profit sources of education for formula, other than a few websites run by mothers who have taken up the charge, companies are the only remaining source. This is not ideal, but it is currently all we have. We encourage Public Citizen and all who support this Day of Action to read the stories of actual formula-feeding parents, the vast majority of whom report seeing no advertising prior to using formula, at, and consider how they may equitably represent the needs of pregnant, birthing, and post-partum mothers and their babies at the consumer protection advocacy table.


Concerned Members of the Community



[1] Evenhouse, Eirick and Reilly, Siobhan. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res. Dec 2005; 40(6 Pt 1): 1781–1802; Geoff Der, G David Batty and Ian J Deary. Effect of breast feeding on intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis. BMJ 2006;333;945-; originally published online 4 Oct 2006; Colen, Cynthia G. and Ramey, David M. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, Volume 109, May 2014, Pages 55–65.


[2] Horta, BL and Victora, CG Long-term effects of breastfeeding: A systematic review. World Health Organization, 2013.

[3] NIH Agency for Healthcare Research and Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/Technology Assessments, No. 153, April 2007.



Getting a grip on the Strong Mom Empowerment Pledge Controversy

The latest outrage in the breastfeeding advocacy world doesn’t have to do with dying children in resource poor nations, or bogus “breastfeeding advice” hotlines run with the nefarious goal of undermining a mother’s goals. It’s not even about someone questioning the benefits of breastfeeding, or urging the government to rethink some of its public health messaging.

No, this week’s rage-fest is over a campaign asking women to pledge not to bully one another based on their parenting choices.

Sound silly? Well, according to a handful of well-respected bloggers, it’s about as silly as a car wreck. This is because the campaign is sponsored by Similac, a formula company, which has everything to gain by women feeling “empowered” to use their second-best (or fourth best, if we’re going by the WHO hierarchy) product in a world made less judgmental by a pledge such as this.

On a purely anti-capitalist, anti-marketing level , I understand why some may feel a little queasy about this campaign. I’ve seen some backlash against the Dove Real Beauty ads for the same reason – the message is great, but the fact that it was created by a group of advertising executives rather than a non-profit, purely altruistic group, sullies it. There’s an ad term for what Dove and Similac are doing – the “halo effect” – meaning that when you use the product, you’ll have positive, do-gooder type feelings about it. Coke’s done it, too. (Remember that catchy “I’d like to teach the world to sing” jingle? Halo effect, right there.)

I assume this is what was behind tweets I came across today suggesting that formula companies have no place talking about parenting issues. My counter argument to this is that many of us formula feeders feel abandoned by the parenting gurus (paging Dr. Sears) and in some cases, even our own pediatricians – the message we receive is that if we’re formula feeding, we’re pretty much a lost cause. So while I can’t say I’m thrilled that a formula company stepped up to fill this gap, I think we need to think a little more critically about why the gap was there in the first place.

For the record, with this particular campaign, Similac isn’t giving parenting advice, but rather advocating for an end to mother-to-mother judgment. More of an anti-bullying campaign than anything about parenting issues. Which is probably why they have Michele Borba as one of the spokespeople – she’s a well-known expert on bullying as well as parenting issues, but she barely deals with the infant/toddler set. For that matter, I don’t think babies are mentioned at all in the campaign literature –most of it has to do with embracing your parenting choices and not allowing other people to make you feel less-than.

But I’m not even all that interested in discussing the campaign itself – I’m more concerned with the response to it. Comments I’ve seen; articles I’ve read from some folks I have utmost respect for, but whom I feel really missed the mark on this one. Some of these arguments include: Similac has no right to talk about mommy judgment because formula feeding shouldn’t be a lifestyle choice; the bloggers who came on board to support the campaign are sell-outs or shills for Big Forma; and that the campaign is one big booby trap.

In a thought-provoking and controversial NY Times Motherlode column, KJ Dell’Antonia quotes Kimberly Sears Allers, who maintains that the Strong Moms Empowerment campaign is faulty because formula feeding is a public health issue, not a personal choice:

One centimeter beneath the surface of Similac’s “Strong Moms” Summit and online campaign you will find that framing of infant formula use as a “lifestyle choice” that is not to be judged has been its primary marketing strategy for decades. … And since choices are individual, they have no social consequences; women are therefore relieved of responsibility of considering the broader implications of their decisions. And once I make my choice, no one is to challenge me. We can’t talk about it. And if you do, you are judging me.

Admittedly, I’m taking major poetic license here, but my take-away from Allers’ post was that we can’t not judge other moms for doing something which puts babies at risk. KJ’s own argument is more nuanced and balanced; she suggests that this whole conversation has become too personal, and the “judgment” rhetoric just dilutes the real issues.

I agree with KJ, actually – it’s a point I’ve made myself, in my own somewhat pissy rants about how the only anti-breastfeeding-promotion opinions we hear come in the form of personal stories (which are important in their own right – don’t get me wrong – but hardly a match against scientific studies and “fact”-driven articles). But making things “less personal” doesn’t just mean that every blog post discussing breastfeeding must stop devolving into a who-had-it-harder string of comments. The onus can’t purely be on those whose choices are being questioned to buck up and be “strong”. If we’re going to make it less personal, than breastfeeding advocates cannot be in charge of conducting research on infant feeding. We need to ensure that voices from both sides are heard, so that formula feeding mothers don’t need to sit in awkward, shameful silence while the food that so beautifully nourishes their infants is compared to tobacco, lest they be accused of “taking things so personally”.  And outlets like the New York Times need to post intellectually-driven or research-based pieces from the “other” perspective, rather than just personal stories of breastfeeding failure, so that the conversation isn’t so one-sided.

But I think, in some ways, KJ’s point gets convoluted by Allers’ quote. It can’t not be personal, when a woman’s decision to formula feed is being equated to a public health issue. This is where the misinterpretation of risk within the breastfeeding canon is problematic; it is where people like Joan Wolf are so vitally important. And yet, Joan Wolf can’t participate in the conversation because it has become so personal: her assessment of the literature is brushed off as anti-breastfeeding, lost in the fervor of those who fear that discussing breastmilk as anything less than a miraculous and perfect substance, and breastfeeding as anything less than a moral imperative, will negate their admirable efforts to normalize what should be a human right.

The other common refrain in the past few days is that formula feeding mothers should be offended by this campaign. I’m crying foul. First of all, I take issue with breastfeeding advocates speaking for me – someone who felt completely ousted, chastised, and disenfranchised from their community, and their ideal of good mothering. Just like I will never know the hot rage felt by a nursing mom who is asked to leave a restaurant, someone who has a fundamental belief that breast is best will never know what it feels like to be told that your maternal instinct is faulty, due to susceptibility to marketing, stupidity, selfishness, or some combination of the three.  To hear a company which created a product that nurtured my babies echoing the same sentiments I’ve been preaching for years – that the judgment must stop; that moms need to stop fighting each other and work together for better parenting rights; that women need to stop engaging in sorority-level hazing in order to wear the label of “Good Mommy/Good Radical Feminist/Strong Woman – makes me happy. I don’t feel preyed upon; I am well aware that they are hoping to sell more formula, and you know what? If I had to decide between a brand that is marketing to breastfeeding moms and one that is finally trying to appeal to its actual audience, I’d probably choose the latter.

Someone commented on the NYT article that it would’ve been nice if this campaign came from an individual or group without profit-driven motives. Spoiler alert: that would be me. That would be Bottle Babies. We’re out there, doing this. But most people aren’t aware of us – we each top out at about 3k Facebook followers, opposed to the popular breastfeeding blogger-activists, who are all in the 200k range or higher (some of whom, incidentally, could benefit from a pledge not to bully other moms. Just sayin’.)  We have nothing behind us – no advertising, no sponsors. No money. It’s slow going, trying to make a dent, attempting to create change in a positive and real and measured way. We waste a lot of time defending ourselves against accusations of working for the formula companies; of being anti-breastfeeding; of being uninformed and defensive.  And trying to run our ad-free websites and blogs and attend conference on our own dime and BE HEARD when there are so many more powerful, louder people out there. I realize this sounds like a whiny me-me-me rant, but I’m trying to paint a picture here – because it helps explains why I’m okay with the Similac campaign. Until the indie, unsponsored voices are able to reach the masses, I’m just happy that someone can. I’m happy that women who are feeling judged and guilty and embarrassed about their choices, who are forced to read “Breast is Best” every time they see a formula ad, or open a can of food for their baby, can finally have an opportunity to feel good about the product they are using. That for once, we can feel like part of the sorority – part of the “empowered” group – even if it’s all manufactured and for profit, even if it’s bullshit.  It’s not even about the cheesy “empowerment” pledge – it’s about seeing a formula company treat formula feeding as something matter-a-fact, rather than constantly comparing itself to breastmilk, and in a more subtle and unintentional way, comparing formula feeding mothers to breastfeeding mothers. It’s about being able to feel okay about the way a formula company is operating, rather than cringing at how they are sending free samples to moms intending on breastfeeding (rather than those of us who’ve filled out the damn internet form 300 times and never received a single coupon, but I digress) or marketing some asinine product (like the company in question, with its new “formula for supplementation”. Jesus, Similac. I’m wasting time defending you and then you pull something like this? For real?)

Yes, it’s not perfect. But it’s a start. And if you think it’s sad that we are so desperate for acceptance and celebration that we are willing to get into bed with a formula company that thinks of us like an easy booty call, I’d recommend taking a long, hard look at yourself: at the comments you make; the Facebook posts you share; the policies you write; the initiatives you implement; the articles you publish.

Because yes, it is sad. It is sad that Similac has been able to capitalize on this need. It is sad that there is the need to capitalize on. And it’s sad that those who have created that need are refusing to see how implicit they are in the development of such a sad situation.

It’s just sad.


A slightly curmudgeonly rant about the drama over Save the Children’s “Superfood for Babies” campaign

The problem with writing a post which criticizes an organization which strives to help starving kids is that it makes you feel like the Grinch. Or Gargamel. I feel like I should be stroking an acrimonious cat and arching a pair of overgrown eyebrows inward.

Save the Children does a lot of wonderful things for children in dire straits, and I don’t want to come down on them too hard. And in many respects, I applaud their recently announced “Superfood for Babies” initiative. I do believe that breastfeeding is a hugely important part of improving childhood mortality in resource-poor nations, and the report supporting the program offers some excellent perspective on the challenges of raising exclusive breastfeeding rates in these areas.

In public health circles, there’s a lot of discussion on messaging – how to make PSAs culturally appropriate, sensitive, and effective. The thing is, this doesn’t only hold true for at-risk groups – it also applies to the middle-class factions of western nations. It’s just as ineffective (and inappropriate) to try and graft a message addressed to people living in tribal societies with problematic water sources onto a secretary in suburban Iowa as it would be to do the opposite. Yet, this is what happens – repeatedly – in our international discussions of breastfeeding. (Incidentally, this is at the root of my beef with Unicef and WHO, and why I feel it’s necessary to amend the Baby Friendly Hospital Initiative set forth by those organizations to be more culturally appropriate to developed, Western societies.)

This brings us to my scroogey analysis of the “Superfood for Babies” campaign.  I would encourage everyone to read the literature – it offers some truly excellent insight into the specific issues at play in a variety of developing nations, and makes it clear (whether or not it intends to) that formula is not the only barrier to encouraging exclusive breastfeeding. In some cultures, there are beliefs that breastfeeding for the first few days of a babies life is detrimental; in others, women feel pressured to produce as many babies as possible, thus making the fertility-restricting nature of breastfeeding a downside; and in others, it’s not formula which is used as a supplement but raw animal milks or concoctions of grains.

Save the Children (STC) did a lot right with this report. They addressed the need for social change; advised that governments subsidize breastfeeding women so that those in unstructured agricultural jobs (which don’t exactly come with a 401k or paid maternity leave) don’t need to return to work immediately, and have to choose between making a living and feeding their babies; and they press for better education and involvement from medical workers and midwives. I think their motives were great, and they did their homework.

Unfortunately, in their excitement, they lost perspective in three key areas…

1. They were (intentionally or unintentionally) vague about the research

Look, I would never argue that breastfeeding isn’t the best choice – by far – for babies in places where food is scarce, infection and disease runs rampant, medical care and antibiotics are severely limited, and the water source is questionable. Formula feeding is dangerous in these settings. But since breastfeeding advocates and orgs like WHO have made breastfeeding a global issue, we have a responsibility to be honest about what our body of research actually says. There are numerous instances in the STC report where claims are simply not held up by their citations. For example, this quote, on page vii of the report’s introduction:

It is not only through the ‘power of the first hour’ that breastfeeding is beneficial. If an infant is fed only breast milk for the first six months they are protected against major childhood diseases. A child who is not breastfed is 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhoea[2]. Around one in eight of the young lives lost each year could be prevented through breastfeeding,[3] making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths[4].

Let’s take a closer look at the citations. The first one, #2, is from a UNICEF report on diarrhea and pneumonia- not a study, but a report. So it took a bit of digging to see exactly where they were getting their data from. I *think* this figure comes from a table attributed to a Lancet piece, which “estimated”  that “Suboptimum breastfeeding was… responsible for 1·4 million child deaths and 44 million disability-adjusted life years”. I couldn’t get the full study on this one, but again – it was an estimate, most likely based on other studies – not hard data.

Citation #4 is the one that’s bothersome, however (#3 is just a footnote with the definition of “exclusive breastfeeding”). The sentence “making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths” is most likely read as “breastfeeding is the most effective way to prevent child death”. That’s quite emotive. The citation leads you to a Lancet paper on child survival, which does have some dramatic data and charts regarding the interventions which would most reduce infant mortality in the developing world. Breastfeeding is shown to offer the most dramatic reduction in risk- but there’s one important point to consider: while this report focuses on death in children ages 0-5, the majority of these deaths occur in the first few months of life. Exclusive breastfeeding, as opposed to mixed feeding or exclusive feeding of substitutes including goat or buffalo milk, paps, or formula (important to note that in many of the countries STC is concerned about, traditions include feeding neonates animal milks or solids within hours of birth – so I think it’s arguable that the issue here is the risk of giving a baby anything but breastmilk via the breast, rather than breastfeeding being the “magic bullet” the report dubs it to be. Otherwise, we probably wouldn’t see consistently poor outcomes in mixed-fed kids, as a “magical” substance would compensate) is going to reduce the risk of infections that cause death in very young babies. In other words – if the most deaths are in newborns, and breastfeeding saves newborns more than any other interventions like vaccines, clean water, etc – then there will be a disproportionate representation of “babies saved by breastmilk” in the results. This is not to say that breastfeeding isn’t an incredibly worthwhile and effective solution to reduce infant mortality, but it’s a bit of a stretch to suggest that breastfeeding alone will be the most effective intervention for ALL childhood deaths, which is exactly what the STC report does.

2. They didn’t consider the societal implications of their recommendations, beyond the scope of infant health

I was taking notes as I read the STC report, and my heading for the section which included this quote was “OMGOMGOMG”:

Many women are not free to make their own decisions about whether they will breastfeed, or for how long. In Pakistan, a Save the Children survey revealed that only 44% of mothers considered themselves the prime decision-maker over how their children were fed. Instead it is often husbands or mothers-in-law who decide….


….To overcome harmful practices and tackle breastfeeding taboos, developing country governments must fund projects that focus on changing the power and gender dynamics in the community to empower young women to make their own decisions.

Changing the power and gender dynamics sounds like a fantastic idea, and I would support any program that attempted to do this. But STC has to realize that “empower(ing) young women (in developing countries) to make their own decisions is a complex and uphill battle that extends far beyond infant feeding. I fear that by placing an emphasis on UNICEF-lauded solutions like warning labels on formula cans/making formula prescription-only, and on educating fathers/elders on the importance of breastfeeding using the current overzealous and often misleading messages, in these countries – places where, all too often, females are already considered “property” and subjected to any manner of injustices – it will create an atmosphere where women who are physically unable to breastfeed will be ostracized, shamed, or penalized. I agree that we need to empower women, but I think that we also need to be verrrry careful about presenting “suboptimal breastfeeding” as a risky behavior in certain cultures.

In another section, the authors report that breastfeeding rates have gone up in Malawai despite poor legislation on maternity leave, breastfeeding rights, etc. – that these improvements are based solely on strict implementation of WHO Code. I’d like to be reassured that as women are being given no option other than breastfeeding without any of the protections which would make EBF feasible while working, this isn’t having a deleterious effect on their lives. It’s wonderful that breastfeeding rates are up, but what about correlating rates of employment, poverty, and maternal health?

3. They failed to differentiate between resource poor and resource rich countries

I’ve seen a wide range of opinions on the STC program online in the past few days. Most of the drama is over British media reports which mention putting large warning labels on all formula tins – not just the ones going to resource-poor countries. Some feel that these labels will cause unnecessary upset in the West; others argue that when it comes to saving starving/sick third-world babies, privileged mommy pundits should STFU. And others keep insisting that the STC report was misrepresented, and that the labeling stuff was a minor part of the larger plan and shouldn’t be harped on.

All of these arguments are valid, and yet all are missing the nuance necessary to have a productive conversation. We need to realize that not breastfeeding has quite different implications in certain parts of the world. We also need to acknowledge that a woman’s rights are important no matter how much money she has or where she lives, and that we all have a right to stand up for what we believe – it’s rather useless to play the “eat your dinner because children are starving in Africa” game, and rather un-PC as well.

But STC also needs to take responsibility, here. The fact is that the report does not really differentiate between resource-poor and resource-rich countries when it is discussing WHO Code and formula marketing.  For example, this passage on p. 45 describes laws which STC wants implemented worldwide:

Breast-milk substitute companies should adopt and implement a business code of conduct regarding their engagement with governments in relation to breast-milk substitutes legislation. Companies should include a public register on their website that outlines their membership of national or regional industry bodies or associations, any meetings where the WHO Code or breastfeeding is discussed, and details of any public affairs or public relations companies they have hired, alongside the nature of this work… Any associations (such as nutrition associations or working mothers’ associations) that receive funding from infant formula companies should be required to declare it publicly. In addition to this information being made publicly available on the websites of individual companies, the International Association of Infant Food Manufacturers should publish a consolidated record of this information, updated on a quarterly basis.

Personally, I think the money spent on a “governing association” in order to police this policy would be better spent on funding literacy programs to help parents read the labels we’re arguing about. Some of these countries have literacy rates of like 30% – which makes me wonder exactly who the labels are geared to, if not the Westerners for whom formula feeding is far, far less of a risky endeavor.

Don’t mistake me – the evidence given in this report about the shady practices of formula co’s is alarming. There needs to be something done about unethical marketing practices in parts of the world where information is limited, education is a true privilege, and options are a joke. Yet, in the STC report, there is ample (and quite good) evidence that the unethical efforts of formula companies are only one slice of a thick-crust, Chicago-style pizza. There’s a lot of gooey, barely distinguishable elements which all combine to make a rather heavy problem, and focusing so much on one of them will leave you with the policy equivalent of Domino’s.

Further, the situation with breastfeeding in the developing world is markedly different from what’s going on in Great Britain, the US, Canada, and so forth. The online arguments are proof of this. I’ve seen the same people who argue that breastfeeding is a global issue turn around and tell concerned Americans and Brits that they have no idea what’s appropriate in Peru or Ghana. This may be true, but so is the reverse. International groups like STC have to remember that when they release papers making global recommendations about infant feeding, that they are inviting commentary from a global audience. That’s why we can’t make blanket statements about infant feeding and child health, or try and implement the same rules in order to get the same results. We wouldn’t go into a rural village where families share a 300-square foot hut and start lecturing them about the dangers of co-sleeping, and yet we assume that the same one-size-fits-all public health messaging is fair game when it comes to infant feeding. Breastfeeding might indeed be a global issue, but the type of issue it is varies greatly depending on what part of the globe you’re on.


Nothing changes…

Lately I’ve been frustrated. Like, mind-numbingly frustrated. It seems that every week there’s a new article on the infant feeding wars, rehashing the same points over and over, with the same battle being waged in the comments section: You’re judgmental. Yeah, well, you’re anti-breastfeeding! No I’m not, and I’m a better parent than you! Oh, really, well, I’m am MD/RN/LC/PhD and I KNOW I’m right, so shut up! You’re a lactofanatic! You’re selfish and misinformed and a threat to breastfeeding moms everywhere! Bloomberg! Hannah Rosin! Bottle! Breast! Bottle! Breast!

Shall I go on?

I’ve been blogging for nearly 3.5 years now, and I’m so damn tired. I’m incredibly grateful and proud of the community which has formed around FFF, but I don’t see anything changing. I want to do more than whine about how unfair the current atmosphere is; I want to change it. I want to make this blog unnecessary, because I’m truly sick of talking this subject to death. And I’m sure you guys are sick of hearing about it. How many times can I pick apart studies which fail to thoroughly consider the most basic notions of correlation and causation? How many ranty essays can I vomit out about the pressure to breastfeed? None of it seems to matter, because nothing changes.

I mean, nothing changes.

I wrote a book, one that took nearly three years of heavy research, interviews, and soul-sucking rewrites, hoping that it would help me reach a larger audience, and get people talking on a more nuanced level about this debate. But no one wants nuance.

And nothing changes.

I sit here at my computer, hiding behind the safety of our little community, preaching to the choir, holding myself up as fearless while I wallow in fear; the fear that people will judge me, criticize me; the fear that I will disappoint you.

And nothing changes.

Recently, an opportunity came up that might allow me to effect change in one tiny arena of this circus of insanity. It would allow me to meet with some other people who are uneasy with the way formula is being vilified. It would give me the ability to spread the message that we need better education and guidance for bottle-feeders. It might give me access to people willing to listen to ideas about tempering the Baby Friendly Hospital Initiative to be a little more palatable to those of us who must, or choose to, formula feed.

The problem is that this opportunity necessitates my associating with a formula company. They are the ones with the means to bring me to the table, to have these conversations. It makes sense that they contacted me; they have a vested interest in protecting infant feeding “choice”, and so do I. But theirs is financial, and mine is personal. I’m not naive; I know they aren’t doing this out of the kindness of their hearts.

Formula companies- like all major corporations- are out to make money. Some of the ways they go about this do not bother me – for example, I see no harm in them advertising their product. I view formula as a healthy substitute for breastmilk – certainly not perfect, not without room for improvement (because I always suspect manufactured substances always have room for improvement – that’s just the capitalist in me), and as I explain in Bottled Up, not a competitor to breastmilk. Just another option. Considering the only industry that has major restrictions on advertising is Big Tobacco, to say formula companies shouldn’t be allowed to advertise is to compare them with the manufacturers of cigarettes- a completely unfounded, ridiculous, and irresponsible comparison, in my opinion. I don’t like when they bring breastmilk into the marketing message – lines like “closest to breastmilk” should be left on the cutting room floor- but at the same time, how can we really blame them? If we are spending so much time and effort convincing society that breastmilk is the gold standard, why wouldn’t specific formulas want to be seen as coming closer to matching this liquid gold than their competitors?

But there are other ways that formula companies handle themselves that provoke a disturbing, fundamental mistrust in my gut. They want to increase their sales; therefore, it’s in their best interest if women do not breastfeed. This is a fact that’s impossible to ignore, when we see them sponsoring breastfeeding “help” hotlines and guides. I can’t help siding with breastfeeding advocates on this one: the LAST people who should be giving breastfeeding advice are the folks with a vested interest in having women turn to the alternative.

This is the point in my ongoing internal debate where I start getting all angst-ridden. Formula marketing execs need to take a long, hard look at how they are handling their accounts. They have an incredibly smart, media-savvy audience in this country-not all moms are Little Red Riding Hoods; many of us know there’s a wolf hiding behind that grandmotherly lactation consultant. Even if the breastfeeding information they are doling out is 100% useful, encouraging, and evidence-based, it is not going to be received as such.

What I find so frustrating is that formula companies are so busy trying to market to breastfeeding moms, when they have a willing and ready market base just sitting here, waving our arms to get their attention. Ban The Bags doesn’t want them hawking their wares to mothers attempting to breastfeed? Fine. More for us. Why not urge hospitals to keep the bags on hand, to be distributed only to parents who request them? Or even better, give parents the option of signing up on a website to receive the samples in the mail. Seems like a no-brainer that most moderate people could accept as a compromise.

Likewise, why should formula companies distribute pamphlets on breastfeeding when formula advice is so needed? If you’re going to spend money sending formula samples in the mail, the literature accompanying it should be about formula feeding. Not breastfeeding. Leave that to Medela or Lansinoh.

I have plenty of ideas on how formula companies could better serve us, their true customer base, and perhaps shift the cultural opinion of formula feeding away from a “competitor” to breastmilk and towards a more moderate point of view, where it is merely seen as an option for women who cannot or choose not to breastfeed. Tough distinction, but worth making. And there’s a hopeful part of me which thinks that maybe, just maybe, the formula companies also want to protect their customer base – even if it is for entirely selfish reasons.The formula companies don’t want their customers feeling ashamed to buy their products; they want us to be proudly bragging about how great our kids did on Enfasimistart. They don’t want us improperly using the stuff and then suing them later.

If I’ve learned anything in the past few years, it’s this: breastfeeding moms have a tough time in this world. But they also have a lot of respected, smart, noble individuals fighting their fight. No one believes that formula feeders need defending, so we are left to our own devices. The only folks who have a vested interested in our well-being is the formula companies, and they haven’t really done us many favors.

I’ve been thinking that maybe I can change that, though. If I can’t make headway with the breastfeeding organizations, maybe I can at least provoke some change in the companies who are making and marketing the products that feed our babies. Maybe if they hear from us – their customers – they can put some of their considerable resources and influences to good use, rather than simply pissing off breastfeeding advocates and giving them more fodder to hate on formula, formula makers, and by association, formula feeders.

This is something I want to do; something that I think could actually provoke change in a positive way for both formula feeding parents and breastfeeding moms – because we don’t have to be at cross purposes. I support infant feeding choice – that means ensuring that breastfeeding and formula feeding are equally protected, and parents are appropriately educated about whatever feeding method is right for them. I don’t see any education or protection for formula feeding parents, and no one is willing to change this. It would be great if UNICEF or the Academy of Breastfeeding Medicine wanted to listen to what I have to say, but I’m not waiting by the phone for them to call. I don’t get the impression they’re very interested in what I have to say.

While all of this sounds good in my head, these thoughts are giving me a migraine. I’m well aware that associating with the formula companies opens me up to major criticism. And yet I can’t help think that there is a major difference between being influenced by a formula company, and influencing a formula company. Being influenced by a formula company would mean having them sponsor this blog, or pay me a salary, because then my content would be soiled by bias- whether it be of the financial or subliminal persuasion. We’ve all seen how having ads or sponsors can soil the editorial style of some of our favorite bloggers; I certainly don’t blame them for it, since this blogging thing takes time and a girl’s got to eat. In my case, though, if I don’t have my neutrality, I don’t have sh-t.

But I’m not talking about being influenced – I’m talking about influencing. I’m talking about having them interface with me on MY terms, helping them move in a better direction, and walking away if I feel things are shady. I’m not sure how this is more suspect than a representative of Planned Parenthood meeting with Trojan. The former wants to advocate for safer sex, and knows abstinence is unrealistic; the latter makes condoms; if Trojan can help promote safer sex and sell more condoms due to a halo effect, it’s a win-win for both parties.

I’m opening this up to the community, because your opinions are the only ones I care about. People have been accusing me of being in the pockets of the formula industry since day one; I don’t know if it even matters to them whether I throw molotov cocktails into the lobby of Nestle headquarters, or bathe naked in a vat of Good Start. But I take my responsibility to this community very seriously, and I wouldn’t make a decision like this without your input.  Please think about this, and let me know: is it okay to associate with the formula companies on an advocacy level? Or will this destroy my neutrality, even if I vow not to let it?

Because seriously…. something has to change.

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