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 FearlessFormulaFeeder.com, 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.

Signed,

Concerned Members of the FearlessFormulaFeeder.com 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.

 

Support versus advocacy: how finding balance is like keeping a white carpet clean

I lost a few very dear followers over on the Facebook page recently (and I assume on the blog as well), and I’ve been obsessing over their departure. As too often happens on the FFF community page, we have been visited by a few breastfeeding advocates who have, at times, pushed their agenda to an uncomfortable (and sometimes quite emotionally triggering) point. Tempers flared, statistics and studies were tossed around like grenades, and my failure to wield the “ban stick” resulted in a loss of security for some members. They no longer felt safe around the FFF community; no longer felt like it was a positive and healthy place to heal their postpartum wounds and work through their feelings about infant feeding.

Yeah. Shitty.

What really burns me up about this is that in trying to stay open and neutral, I have singlehandedly sullied a place which I’d built to be the safe haven I personally craved. Even I have felt a pit in my stomach when I’ve gone over there lately, wincing in anticipation for the latest infiltration of misplaced “education” or not-so-thinly-veiled hatred (like a comment the other day that referred to me as the “Bitter Formula Feeder.”) When you don’t want to visit your own page, you know there’s a problem.

Some colleagues have suggested that I haven’t protected my community from the types of voices which have already caused so much hurt in their hearts. I fear this is true – people come to a page called “The Fearless Formula Feeder”, not knowing squat about my blog, and assuming that it will be a safe place to discuss bottle feeding and negative feelings about breastfeeding. Instead, they find acrimonious debates about the dangers of formula and critiques of the way that they are choosing to nourish their children. It ignites anger (quite justifiably) and people lash out, sometimes in the wrong direction. They expect me to come to their defense, and it takes every ounce of my being not to lunge like a bloodthirsty mama lioness, but I usually don’t.

What kind of fearless leader does this make me? Not a very good one, I fear. I completely sympathize with the people who feel betrayed by my allowance of dissenting voices, and encouragement of highly emotional debate. There was a time, not so long ago, that I would have felt the same way.

The problem is, I’m against hypocrisy more than I’m against anything (well, maybe not anything. I mean I’m probably more against human trafficking or the unethical treatment of animals or John Wayne Gacy… but you get the point). It would be agonizingly hypocritical of me to only allow those who agree with me to post on this blog, or on my Facebook page. Now, there’s a fine line between being outright obnoxious and posting things which challenge someone else’s beliefs. In the case of the former, I have no problem wielding my ban stick with a theatrical flourish. But with the latter? Well, I’ve had that happen to me on other anti-formula blogs, just because I politely dissented, and it sucks. I don’t want to be part of the very problem I rage against.

Unfortunately, it’s hard to know where to draw the line. Having someone come and throw the same studies we’ve discussed and (I believe quite fairly) critiqued on this blog in our faces every day can feel rather antagonizing and confrontational. Sometimes, I will attempt to express this – telling the person in question that we are well aware that WHO ranks formula feeding fourth in its hierarchy of feeding, and that breastfeeding contains live blood cells, and that studies have shown that formula feeding leads to SIDS, cancer, and the plague, and the slaughter of innocent lambs at the alter of Enfamil, and so forth. And sometimes they keep pushing. And sometimes it makes me want to stick my head in the oven.

When this happens – when the attempt at “education” or “correcting misinformation” becomes aggressive and contrary to the purpose of my page (which is outlined here, if you’re wondering), people begin to get bitterly angry. I understand this, because I feel the same anger. I have to fight against it, sometimes ranting to Fearless Husband for hours on end to get the rage out. But I have the advantage of having done this for nearly four years, and I’ve heard so much hate, passive aggressive “education”, pity, and condescension that it begins to blur into a nice, easy-to-ignore din. For many of you, the wounds are just too fresh, and these people are pouring salt into a wound, and then pouring on some vinegar for good measure even after you’ve asked them to stop the salt. It sucks, I get that.

At the same time, though, I also notice myself allowing people on “our side” to engage in name calling and, at times, unfair attacks. That’s because, on the most fundamental level, I think we are in the right. It is our territory – a place that is supposed to be free from drama, free from the usual critical voices. If someone wants to come into our house and visit for awhile, I’d appreciate they didn’t stomp around with muddy boots.

The thing is, sometimes the boots aren’t exactly caked in mud – sometimes these guests just have a bit of sand on the bottoms. We’re already so sick of vaccuuming up after rude guests, though, that the tiniest bit of sand is enough to turn us apoplectic. And that is where I get uncomfortable, because I don’t want to stoop to the level of other communities, where the slightest disagreement is treated like a federal offense. If it’s just a little sand, maybe it’s better to just kick it aside, and see if offering the guest a drink of water might just make them sit tight for a minute and stop tracking sand all over the floor.

I get that this can veer into uncomfortable interactions for some people, because hey, when you’ve been treated like freaking Cinderella and forced to clean up someone else’s shit while simultaneously ridiculed and insulted, a tiny bit of sand can be a huge pain in the ass. But I’ve seen the same people who initially came in tracking mud on the floor turn around and ask if they could help mop it up. Sometimes you just need to give someone a chance. Sometimes you catch more flies with honey than with vinegar (a nice reminder for those perpetuating the salt-and-vinegar torture I alluded to above).

I see Fearless Formula Feeder – the site, the Facebook page, and the persona- as standing for infant feeding freedom first and foremost. But FFF also stands for honesty, open-mindedness, respect, and fairness. We have to give people a chance to engage with us if we’re going to make any progress in ending this ridiculous breast vs bottle war. I know, I know – many of us feel like it’s only a war because the “other side” has made it so, and I think there is a lot of truth to that. And I know it feels really sucky to have to be the bigger person and treat others how you want to be treated, especially when they aren’t giving you the same respect.

Don’t get me wrong – this doesn’t mean you can’t fight fire with fire. I love the articulate, targeted way some of you choose to fight back. You fight science with science, studies with studies, anecdotes with anecdotes. That’s the way to do it. Stooping to calling someone a “lactonazi” or making blanket statements about breastfeeding mothers is only perpetuating the belief that all formula feeders are anti-breastfeeding, when I know most of us are the farthest thing from it. I don’t want to feel like a sanctimonious jerk by reminding the community about that. I also don’t want to seem like I am not jumping to the defense of those I care so deeply about defending.

I think the point of this rant is as follows: FFF serves a few purposes – it exists to support mothers who are bottle feeding in a practical manner, both emotionally and with research-based and peer-oriented advice on feeding logistics. It also exists as an advocacy site, to protect the rights of formula feeding, tube feeding, and combo feeding parents. It supports  women in their individual breastfeeding journeys (i.e., helping with encouragement for moms wanting to try again, or moms who are currently struggling but want to continue to breastfeed). And it promotes a conversation between infant feeding activists, mothers, physicians, researchers, and interested parties to try and make some progress so that things aren’t so crappy for future generations of mothers.

Therefore, the Facebook page is sometimes not going to be a safe haven. There are going to be times when someone might say something that hurts you deeply, and I invite you to express that hurt, and strike out in the most powerful way you can – by speaking your truth, being proud of your choices, and knowing that the power of the community is behind you. And my promise to you is that while I will gladly allow the sandy shoed folks to hang around and contribute, I will not stand for people tracking mud all over my living room. Or if they do, they better plan to stick around and Hoover the crap out of the place.

 

Formula feeding education, or lack thereof

Reading through my Google alerts, I almost squealed with excitement when I saw a link entitled “Health Tip: Preparing Baby Formula” from none other than U.S. News and World Report. A major news outlet! Formula feeding education! Squee!

Well, turns out the article was less “squee” and more “eh”.

According to the esteemed publication, the formula-related health tip that was so vital that it necessitated being “called out” (publishing world lingo for highlighting a fact or quote) was the following:

Wash Your Hands.

The rest of the tips have to do with general hygiene- cleaning surfaces, sterilizing bottles, etc. I’m probably being unnecessarily snarky, because this is important information; it is important to keep things as clean and sterile as possible when making up an infant’s bottle. They also throw in one useful tip about keeping boiled water covered while cooling (great advice). But most of this is certainly not new information, and in many ways, I think it’s a waste of newsprint.

Why? First, I expect most parents know they are supposed to wash their hands and clean their bottles. What they may not know is why. There is no mention of the risk of bacterial infection here, so it just comes of sounding like vague, somewhat stodgy advice, like something your mother-in-law tells you in that tone. (You know the one.) The kind of advice that gets filed in the “I know I should do it, but come on, what’s the harm” portion of your conscience, alongside “floss twice a day” and “never jaywalk” (unless you are in Los Angeles. Then you probably take the jaywalking thing seriously, as the LAPD will ticket your ass for crossing where you shouldn’t). I think an acknowledgement that these precautions will help you avoid potentially deadly bacterial infections would make the advice seem a tad more topical.

But also, this is standard food prep protocol. There are other intricacies to formula feeding that may not be as intuitive- safety precautions like mixing the proper amounts of water to formula; not diluting the formula; using the right type of water; discarding formula after specific amounts of time; opting for ready-to-feed for newborns. Or what about other tips which might help avoid other formula-related health problems? Like a run down of the different types of formulas so that parents can choose the right type for their babies. Advice for understanding hunger cues. A bit of education on growth spurts; what’s normal when it comes to formula-fed babies and spit-up and elimination (both pee and poop); a quick description of how to feed a baby holding the bottle at a good angle?

I get that this was merely a half-column filler, not an 800-word feature. I understand that U.S. News & World Report isn’t in the business of imparting feeding advice to parents (and in fact, the article in question was syndicated, from Health Day) . And I seriously do appreciate the effort to give a bit of valuable info to formula feeding parents. Yet, I can’t help but wish that this half-column was put to better use. A short paragraph on when (and just as importantly, why) formula should be discarded would have been infinitely more interesting and useful.

There are a few reasons why formula feeding education is as hard to come by as a good house under half a million in the greater Los Angeles area (I’m bitter about real estate at the moment). Many people think it’s unnecessary; formula feeding is seen as the “easy way out”, and assumed to be as simple as scoop and shake. Some breastfeeding advocates believe that prenatal formula education/preparation is counterproductive to breastfeeding promotion – the theory being that if you discuss it, it will be taken as an endorsement, when formula should only be used in an all-else-has-failed scenario. (The World Health Organization’s “WHO Code” basically forbids health workers from even uttering the words “infant formula” until it becomes clear that there is no other option.)

What is puzzling to me about this situation is that breastfeeding, while definitely a lost art in our bottle-heavy society, does have an intuitive aspect to it. Or at least it is portrayed that way – something so natural, so instinctual, shouldn’t require training. Assistance, yes. Support, most definitely. Protection, you bet your bottom dollar. But instruction/education? That seems rather – well, quite literally, counterintuitive.

Formula feeding, on the other hand, is something which has always been a man-made, lab created, medically-approved (at least up until recent events) form of infant feeding. It does require instruction; you don’t see our primate cousins giving birth and popping open a can of Similac (although I am quite sure they could be trained to do so, considering how smart they are. I’ve seen Rise of the Planet of the Apes. Scared the bejesus out of me). Yet parents leave their prenatal classes and hospital stays with plenty of info on birthing and baby care and breastfeeding, but little to no instruction on how to make a damn bottle.

The vast majority of babies will have some formula in their first year. Heck, by the time they are 6 months old, it’s a safe bet to assume most of them are partially, if not exclusively, formula fed. We can’t sell infant feeding as the number one predictor of infant health and development and simultaneously ignore the primary way our nation’s babies are being fed.  It’s bogus, and irresponsible.

This is not to imply that parents are putting their babies in dire jeopardy because they leave a bottle out too long, or forget to scrub their hands like Lady MacBeth before mixing formula. Heck, I committed almost every formula feeding sin and my kids are pretty normal. (Except for Fearlette’s suspicious fear of police helicopters, but I blame that on her past life.) But until we ensure that parents are properly educated on formula feeding – something that could be done with one quality, AAP-endorsed pamphlet, or a few minutes of discussion in a hospital baby care class – we can’t possibly get a clear idea of the real risks of formula feeding (I bet we’d see an even smaller difference in breastfed versus formula fed if all formula feeding parents were doing it correctly), or feel confident that all of our babies are getting the best version of whatever feeding method their parents have chosen.

For now, I’d suggest checking out Bottle Babies – a great non-profit organization run by some friends of mine. They’ve put together some excellent, research-based information on a myriad of bottle-related issues. Or feel free to click on the link to the FFF Quick-and-Dirty Guide. And I hate to say it, but for the moment, the formula companies are probably the best resource for formula feeding parents. At least they give a crap about their customer base, even if this is rooted in a desire for customer loyalty and a fear of litigation.

And, ya know, remember to wash your hands.

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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