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.

 

 

Ready-to-feed formula may prevent Cronobacter infection in babies

I love when I’m right. I mean, it happens so infrequently (at least according to Fearless Husband).

Even before the Cronobacter scare of 2011, I’d dramatically changed my tune about formula preparation and safety. The research I read surrounding bacterial infection in babies due to formula or bottle use made me see just how piss poor our education on bottle feeding truly is; this is what spurred my interest in starting some sort of pre or post-natal educational workshop/literature for bottle feeders, and also made me suspect that there was an astonishingly simple – albeit prohibitively expensive – solution to the bacteria problem.

Safety, thy name is Ready-To-Feed.

Until now I’ve merely been able to suggest that my personal belief is that ready-to-feed nursettes are the safest bet for newborns, and especially for late pre-term babies or those with any sort of compromised immune system. Now, a study published in Pediatrics gives scientific credit to my completely unscientific gut feeling.

I’d say squeeeand do a little dance of egotistical joy,

but unfortunately I can’t. Because we are talking about infant safety here, and the solution which this study is suggesting is not going to be feasible for many parents due to the cost involved. This is turning my happy ego dance into a sad waltz. Which sucks, because who doesn’t enjoy a good happy ego dance?

The study, Prevention of Invasive Cronobacter Infection in Young Infants Fed Powdered  Infant Formulas, looked at the records of 68 babies infected with invasive cronobacter between 1958-2003, and 30 babies between 2004-2010. A couple of things to note before we get into the nitty-gritty of the study:

1. Invasive Cronobacter infection is extremely rare, and usually affects pre-term babies and very young neonates (all of the infants reflected in these records were under two months old).

2. This study had some significant limitations, considering that it was conducted using records from a variety of international organizations (CDC, USDA, WHO, as well as “personal communications” and “publications”. Definitions might have varied, as well as the quality of the information. This might explain the shocking disparity between the cases reported in the older batch (1958-2003) and the newer batch (2004-2010).

Now that the caveats are out of the way, let’s continue. The study found very different statistics in the two chronological batches. In the older batch, only 24% of the babies were full term; out of the more recent cases, 58% were full term. That’s a radical leap. Plus, while in the 1958-2003 group only 21% became symptomatic at home, that percentage jumped to 52% between 2004-2010. This may have something to do with the fact that there were half the number of cases in the more modern group versus the older one; if bacterial contamination was becoming more rare, then perhaps we’re dealing with a newer or more virulent strain in the new millennium. But I also wonder if part of the disparity between the characteristics of the cases has to do with the lack of formula feeding guidance. The resurgence of breastfeeding since 2000 has led to many fantastic outcomes, but the downside, as we’ve discussed before, is a refusal to address the needs of formula feeding parents. Historically, concerns about bacterial infection were focused on NICUs; the tubing used to deliver food to the tiniest babies could easily become contaminated if the utmost care wasn’t taken, and given the fragile systems of premature or sick infants… well, it wasn’t a great combination of risk factors. But looking at the statistics used in this study, it seems that in the past 12 years, full-term babies in their parent’s care – at home – were equally at risk. I think it merits further reflection, at least, to consider if these cases might have been due to parents being given no guidance or support with formula feeding. We know from our numerous conversations here, and on the FFF Facebook page, that most of us were given ample education on breastfeeding (even if we didn’t get much practical support); very few of us were instructed on how to formula feed safely, sometimes with the excuse from more intolerant healthcare professionals that there was no “safe” way to formula feed.

Regardless, even if we were given better instruction on safe bottle feeding practices, very young infants fed powdered formula are at significantly higher risk of becoming ill from invasive cronobacter. The Pediatrics study found that out of all infected infants studied, 26% had received breastmilk, 23% had received RTF, and 90% had received either powdered infant formula or human milk fortifier (which is another caveat I forgot to mention – powdered human milk also posed a significant risk, not just powdered formula. Apparently Cronobacter loves powder of any sort).

Okay- just so we are crystal clear here – the lowest percentage of infected babies came in the group fed ready-to-feed formula only. It even beat breastmilk (not by much, but I think it should be mentioned, since it would be if it were the opposite). So it’s a no-brainer that the study’s author then recommends the following:

Invasive Cronobacter infection is extremely unusual in infants not fed powdered infant formula/Human Milk Fortifier. RTFs are commercially sterile, require minimal preparation, and are competitively priced. The exclusive use of breastmilk and/or RTF for infants <2 months old should be encouraged.

I’ve been advising that newborns use RTF whenever possible for awhile now, but every time I do I feel like a classist a-hole. Because let’s be honest – the stuff is expensive. Even if you buy the 32-oz containers rather than the more costly (but sterile) nursettes, you’re still talking a major difference in cost for the recommended two months of use. And those first 2 months, there is a lot of wasted formula – babies are erratic, not on a schedule, parents are still figuring out hunger cues… it takes a few months before you know Junior will take exactly 4 oz every 4 hours. Powdered formula is significantly cheaper. And god help you if your baby ends up on a hypoallergenic – buying the RTF version of that stuff will seriously kill your bank account.

The big elephant in the room, of course, is that the formula typically given away in those controversial hospital swag bags is ready to feed – often in the form of sterile nursettes. Not that the amount in the bags would feed a baby for the entire two month window of risk, but the bags I received – generously “supplemented” by the maternity ward nurses since our breastfeeding-friendly hospital didn’t have many formula feeding mothers and there were plenty of leftover bags – gave me enough formula to get us through the first few weeks. Every little bit counts.

Now, I’m not naive enough to believe that the formula companies are giving away RTF out of the kindness of their hearts. But considering that the Ban the Bags movement has grown in popularity, and hospitals are going Baby-Friendly right and left – they are going to need an alternative way to market their products. Why couldn’t we set up a program which would give parents that have chosen to formula feed (or supplement) before leaving the maternity ward to request a “gift” of ready to feed formula? Formula companies could still reap the rewards of brand loyalty, and look somewhat altruistic in the meantime. The parents who receive these samples could be the same ones who already were forced to sign documentation which labeled them as formula feeders, so what would be the harm?

There needs to be a way to provide supplementing and exclusively formula-feeding parents with the safest breastfeeding substitutes possible. In the first two months of life, ready-to-feed formula is the safest commercial alternative. If the formula companies would be wiling to provide at least a few weeks of RTF to take the financial edge off, it might help parents afford RTF for the subsequent 6-7 weeks.

Seems like a no-brainer to me, but then again… you know what Fearless Husband says. I’m hardly ever right.

 

 

Public Citizen Jumps on the Ban–the-Bags Bandwagon: Advocacy group forms petition to rid hospitals of formula samples

One time, this potato bug terrorized our stairs for three days straight. Being the anti-violence-against-all-creatures vegetarian I am, I urged it to move on by gently prodding it with a stick. It wouldn’t budge. I finally gave up and decided it was it or me, so I ended up spraying it with all-purpose cleaner. It survived the assault. (All we had was organic cleaner in the house, so for all I know the stuff I used made the bug grow bigger and stronger.) Finally, I had to be all lame and stereotypically female and call my husband to take care of the situation – and he had to stomp on it seven times before it expired.

He was too ugly to live. Forgive me. 

I feel like a broken record, talking about the movement to outlaw formula goodie bags from hospitals, once again… but just like our friend the potato bug, the damn issue just won’t die.

The newest incarnation of the old debate comes from the advocacy group Public Citizen. They have put forth a petition on their website, and have submitted a letter to hospitals that continue to hand out formula samples. According to the letter,

There is overwhelming consensus among all major health professional organizations regarding the health benefits of breastfeeding for mothers and babies and the importance of exclusive breastfeeding for the first six months of life.[1]  Hospital promotion of infant formula through dissemination of these discharge bags contravenes this consensus, needlessly and inexcusably harming babies and families. Moreover, formula feeding imposes a significant burden on the nation’s economy. Breastfeeding saves families and the economy countless dollars….
 When hospitals distribute formula samples…they imply that these products are medically approved and recommended. Yet, there is ample evidence that formula samples reduce breastfeeding duration and exclusivity. Multiple studies have shown that women who receive commercial hospital discharge packs stop breastfeeding sooner than those who do not.[2] Hospitals expend resources to support mothers to breastfeed, but reduce the impact of these efforts by distributing formula samples.  Research shows that bag distribution sends a message more powerful than any verbal messages.[3] New mothers who at first experience difficulty breastfeeding are apt to choose to use free formula samples given to them in discharge bags instead of seeking out assistance with breastfeeding. Aware of these dangers, in 1981 the WHO established the International Code of Marketing of Breast-milk Substitutes.[4] The Code states that healthcare facilities are not to be used for the marketing of infant formula. Hospitals in the U.S. that continue to distribute formula samples are in violation of the WHO Code.

I’m not going to rehash my feelings about formula samples (if you’re interested in what I think – and trust me, it’s not all that interesting or revolutionary – you can check out this previous post or this one on the same topic) or drone on about WHO Code (like I did here). I simply want to address some of the inaccuracies and (what I feel are) harmful statements in this letter, which is making the rounds in the media and blogosphere.
1. The authors do not give a citation for the statement that “formula feeding imposes a significant burden on the nation’s economy”, but I’ll give them the benefit of the doubt that they meant to cite the Bartick/Reinhold study which claimed that “suboptimal” breastfeeding costs the United States 911 lives and 13 billion dollars per year. Please look to Momma Data’s Polly Palumbo for an astute analysis of this study and form your own opinions about the truth of this statement. I’d also submit that even if you believe Bartick and Reinhold were 100% correct, these results were basically a hypothesis; the study did not give sufficient information to start making such dramatic claims as if it were fact. 

2.  They state that “when hospitals distribute formula samples…they imply that these products are medically approved and recommended.” Well, um…that’s because they are. They are not recommended over breastfeeding (except in some cases) but they are indeed medically approved and recommended as breastmilk substitutes. Like it or not, formula has been deemed a safe alternative to breastmilk by medical authorities. A more accurate statement would have been “when hospitals distribute formula samples, they imply that they are advocating the use of formula over breastmilk.” Now that’s a train upon which I could climb on board. Hell, I’d even be the conductor. I agree that handing parents a bag of formula without asking if they are planning on formula feeding is utter and complete crap. It’s contradictory to the “breast is best/breast is normal” message and very confusing, especially coupled with the typically sub-par, hospital-grade breastfeeding support. (Don’t get excited – I’m not advocating that they do away with these sample bags. I think they should offer two versions – a breastfeeding one and a formula feeding one. Breastfeeding one could be provided by the state, since they are pushing so hard for the citizens to nurse their young. Formula one could be provided by the formula companies, because no one else is going to do it. And while we’re at it, it’s pretty depressing that the literature which comes in these bags is often the only education most parents get on how to safely bottle feed.)

3. Invoking WHO Code is pointless. The United States is notorious for being the only “major” country that doesn’t enforce the WHO Code; in this country, it is not a “law”, but rather a moral code which formula companies are “asked” to respect. It doesn’t matter that distributing these bags is violating the Code; until the government makes it illegal to pass out formula samples, hospitals have a right to do so.

Speaking of making formula bags illegal, the Ban the Bags movement was in the news for a different reason this week, as well.

(Ahem. Before I “go there”, I’m going to ask that we pretty please with a ginormous cherry on top do not let this veer off course into a political argument. This is not about the candidate in question or his political party, but merely some statements made by his camp many years back.)

One of the skeleton’s dragged out of Republican presidential contender Mitt Romney’s closet was his clash with breastfeeding advocates back in 2006. As Governor of my former home state, Massachusetts, he fought against an initiative to legally ban formula sample bags in hospitals.  According to BuzzFeed.com,


Romney’s spokesmen at the time and current campaign advisor Eric Fehrnstrom said the decision was about freedom of choice. “We’re not disputing the health benefits of breast-feeding, but we think that new mothers should make that choice,” Eric Fehrnstrom said. “If they choose to bottle-feed, they should be supported in that decision.”… Romney attacked the decision by the Department of Public Health as an intrusion of big government saying “I’m not enthusiastic about the heavy arm of government coming in and saying, ‘We think we know better than the mothers and we are going to decide that they can’t get free formula when it comes as a welcome home kit from the suppliers of formula with Q-tips, baby lotion and so forth. Let’s let the moms decide.”

Regardless of your political views, I do think it’s interesting that this story came out in the exact same week that Public Citizen released its letter and petition. If I were prone to conspiracy theories, I might say that Big Formula isn’t the only group that can orchestrate clever marketing campaigns. But I’m not prone to conspiracy theories, so I’ll just say this: Romney may or may not have been in cahoots with the formula companies (as was the accusation at the time, obviously), but that doesn’t make what he or his spokesperson said any less true. Let the moms decide.

So: if you really believe that receiving a sample bag hurt your breastfeeding efforts, let your voices be heard. Sign the petition. But please, don’t let this ridiculous battle overshadow the realities of the infant feeding discourse. Fighting for better support, longer paid maternity and paternity leaves, etc., would do far more for actually helping women to meet breastfeeding goals.

Lastly, using coercive tactics to convince the public about the superiority of your product is never okay.
And I’m not just talking to the formula companies.

Letter to the Editor of The Providence Journal: “Ban the Bags” Announcement Shames Women, Ignores Lived Realities

To the Editor:

Several days ago, Rhode Island became the first state to officially ban formula sample bags from hospitals. This decision was lauded by the state’s First Lady as a way for Rhode Island to “have healthier children, healthier mothers, and a healthier population as a whole.” AP reported that “formula will still be available to new mothers who experience difficulties with breastfeeding”, and a lactation consultant/nurse interviewed for the story assured the public that the “new policy isn’t intended to force women into nursing their children, “ but was rather designed to “(help) mothers decide what’s best for their child.”

As a mother who faced numerous challenges attempting to breastfeed her first child, and an author/blogger who has immersed herself in the breast/bottle debate for the past three years, I’m worried about the impact of this announcement. My problem is not that hospitals are opting to cease giving away commercial goody bags; as Marsha Walker, RN, commented in the AP story on the ban, “hospitals should be marketing health and nothing else”. My problem lies in the gleeful rhetoric used by a government spokesperson to announce this ban, and the growing anti-formula sentiment the ban represents.

While the AAP, WHO, and other major health associations have come out strongly in favor of breastfeeding – and well they should, considering it is a truly amazing gift a mother can give her child – the fact remains that the decision to breastfeed is not made in a vacuum. According to a 2009 article in US News and World Report, only 8% of American companies offer paid maternity leave; the average woman takes 6.6 weeks of unpaid maternity leave. Many breastfeeding experts agree that there is a learning curve for breastfeeding; that breastfeeding is a lost, and learned, art; something that does not come naturally to many women in our society. Some feel that it takes up to 6 weeks for breastfeeding to be established; this is 2-3 weeks longer than some women have off of work, altogether. And when they do return to work, they will have to pump at regular intervals to maintain exclusive breastfeeding – a feat which remains difficult for women in waged labor positions, despite Obama’s recent passage of a new workplace lactation policy. This new policy only applies to women working in companies with more than 50 employees, and disregards the inherent difficulties of expressing/storing milk while working as, say, a barista or factory worker. Not all working women are white-collar workers in female-friendly environments.

Additionally, many women have physical or emotional barriers to breastfeeding that have nothing to do with “predatory” marketing by formula companies. The phrasing used by the lactation consultant quoted in the AP piece, that banning free formula is “helping mothers decide what’s best for their child,” implies that what is best is breastfeeding, full stop. This is not always the case. What about mothers who must choose between contraindicated psychopharmaceuticals and nursing? What is better for that child – a healthy, sane mother, or a mother who is breastfeeding? What about a mother who is a survivor of sexual trauma, for whom feeding an infant from her breast brings back devastating flashbacks of abuse? Or what about a single mother with older children at home, who has a rough start breastfeeding, and who does not have the time, energy or resources to attend breastfeeding support groups or obtain in-home visits from lactation consultants? Or the mother who belongs to the supposed 1-5% of women (I personally believe it is a far greater number) who are physically incapable of producing enough milk?

These are all problems which may not be noticed by those working in maternity wards, or acknowledged as “medical reasons” for “needing” formula in the first few days postpartum. Yet they are real problems that real women face. These women come to my blog in states of despair: some feeling like negligent mothers for their failure to provide “the best”; some having watched their newborn babies lose precious weight while well-meaning lactation professionals have warned them against supplementation. And while taking away their opportunity to bring home free samples of formula may not be a big deal on the surface, taking away their opportunity to make a choice which is right for them, and right for their families, without being made to feel they are acting against medical orders, is a big deal.

Promoting breastfeeding does not have to mean clucking our tongues at the choice to use formula. There are numerous other risk factors which affect a child’s health and well being: having parents over the age of 40; going to daycare; living in the city versus the country; living in poverty versus wealth; being born anything other than white and middle to upper class. Just like with breastfeeding, these factors influence statistics about child health, any yet we don’t have government campaigns suggesting that all good mothers have babies in their prime childbearing years, or move to rural Ohio after giving birth. (Imagine posters announcing “Having a baby at the age of 21 reduces the risk of birth defects! Reproduce before college!” or, “Babies born to mothers living in high traffic areas have increased risk of low birth weight, prematurity, and respiratory problems. Country Living is Best for Babies!”) We all do the best we can with the circumstances we are given. While breastfeeding advocates insist that formula’s prevalence in our society is harming breastfeeding rates, I’d submit that a lack of public health care, paid maternity leave, individual circumstance, maternal health, and personal preference have just as much impact, if not more.

Take away the formula bags, if you must (although I’d still like someone to tell me why we can’t simply have them available upon request, if the formula companies are willing to provide them), but it’s time we started speaking up for the women who cannot, or choose not, to breastfeed. Anyone with an internet connection has gotten the message loud and clear: science has proven that breast is best. Now it’s time to let us take that information for what it is worth, perform our own risk/benefit assessment, and feed our children in the way we deem appropriate. Removing the temptation of formula freebies is not going to stop women from formula feeding, but it certainly will make women think that formula feeding is something to feel ashamed about. If that is the goal, then well done, Rhode Island.

Suzanne Barston

The FearlessFormulaFeeder.com

The real travesty about formula samples: How adoptive parents get the shaft

Just like breastfeeding doesn’t define a mother, neither does giving birth. If anything, I’d venture that adoption is likely correlated with better parenting, because most adoptive parents do not come to parenthood by accident, default, or because of the pressure to fulfill social norms. They must go through piles of paperwork, endure immense amounts of heartbreak, and pay bank-breaking fees in order to obtain what their hearts desire most: a child to love. And not because that child is their genetic copy, but because they simply want to love and nurture a child.

I worry – quite a lot, actually – about how the formula/breastfeeding debate affects adoptive mothers. It’s hard enough to swallow lines like “breastfeeding is the most important thing a mother can do for her baby” or “babies are born to be breastfed” when you’re the bio-mom; I imagine that these things would make you outright choke if you were also dealing with society’s ignorance about adoptive parenting (case in point: FFF Sarah was recently informed that she wasn’t a “real mother” by a nurse at her OB/GYN’s office). If we are essentializing motherhood down to biological functions, then adoptive moms are being blatantly dismissed. And while I think it’s wonderful for those who want to breastfeed to induce lactation, I am concerned that some adoptive moms may feel emotionally coerced into doing this thanks to this misguided belief that biology is the be-all, end-all of good parenting. (Incidentally, something very similar to postpartum depression – called “post-adoption depression, or PAD – strikes adoptive parents. I imagine all of these stresses, piled on top of the usual newborn crap, could easily put someone at risk for depressive disorders or anxiety.)

These are complex issues, and while I hope the things that FFF is trying to achieve will ultimately help mitigate these beliefs and change how society thinks about and treats both adoptive and biological mothers, I’m not sure what else I can do about them at this point. But there is one travesty going on in regards to adoptive parents that I hope I CAN do something about, and that is the way they are left out of receiving formula samples.

According to Sarah, both the hospital her birth mom delivered at and her own OB/GYN office refused to give her formula freebies (hence that lovely “real mothers” dig). She called Enfamil, who told her that they can’t give free samples directly; they distribute them to hospitals and OB offices. Touche, right?

This strikes me as pure idiocy, on many levels. First of all, most adoptive mothers are not able to induce lactation to the extent that they can exclusively breastfeed from day one onward. It’s a pretty safe bet that an impressive percentage of adoptive families are going to use formula at some point. Formula companies have a real opportunity here to secure a loyal customer who is not going to scream “BOOBY TRAP!!!” in their corporate face when approached with marketing material. Hospitals have the right to give formula samples to whoever they choose (unless they are Baby-Friendly, which I’ll talk about momentarily), so if they don’t give it to adoptive moms, that is just plain RUDE. I suppose there could be some dark-alley collusion between hospitals and Big Formula forcing nurses to only give samples to breastfeeding moms in order to sabotage their efforts, but somehow, I think the PR magic they’d reap by handing freebies out to adoptive parents would justify the momentary lapse of evil genius.

Now, if a bio-mom is giving birth in a Baby-Friendly hospital, this whole situation wouldn’t even be an issue, because NOBODY would be getting samples. So, fine. (You know how I feel about the Baby Friendly Initiative, but I honestly don’t care all that much if they get rid of the samples themselves. It’s nice to get them, but whatever; we’re only talking a few weeks of formula and an extra diaper bag, here.) The other way that people receive samples is from signing up on mailing lists at doctor’s offices or maternity stores. These are things pregnant women do, not adopting parents. The promotional items sent via these lists are different than what is sent when you sign up on the formula companies’ websites – the websites usually send one sample can of formula and a few coupons every now and then. Helpful, to be sure, but nothing like the bounty of free 4-0z nurser bottles which are total life-savers in the first few weeks.

I am not saying that the formula companies “owe” anyone free samples. In some ways, I think it would be better if they stopped handing them out altogether, because it just gives people a reason to target them as the “real” cause of lactation issues rather than focusing on legitimate issues like lack of not only maternity but also paternity leave (yes, I said paternity leave. YOU try going through latching or supply problems at 3 days post-partum with no family, friends, or spouse home to help you. It ain’t pretty, darlin’) or IGT or oral deformities or stress or sexual trauma. But if they are going to keep giving the proverbial cow away for free, don’t make adoptive moms buy the (formula) milk. It’s not fair, and it’s bad business.

Why not have a hospital policy that samples go, first and foremost, to any mother who REQUESTS formula on a pre-admission form, as well as any adoptive parent who enters the maternity ward unless they specify otherwise? That way, hospitals would not be accused of intentionally tempting women in the throes of early-breastfeeding hell. And mothers who needed formula would get it, and perhaps drum up some brand loyalty in the process?

Why not start having pre-baby-arrival visits for adoptive mothers at pediatric offices, giving them the same information and yes, marketing samples, that any pregnant woman can get at the maternity store or OB office? Help them out with inducing lactation if that is what they want, or counsel them about good formula practices (and let them sign up for some of those mailing lists while they’re at it)?

Why not have a separate section on formula websites for adoptive parents, which uses more sensitive language, or offers articles/tips catered to this audience? In this section, adoptive parents could sign up for samples, and perhaps the companies could be a tad more generous knowing that these parents won’t receive samples in the hospital.

Why not? Well, most likely it’s because formula companies are big corporations which concern themselves with the bottom line. Statistically, adoptive parents are only a small percentage of their potential customer base. But I think formula companies should start thinking outside the box. What they are doing now is gaining them such bad press, that is entirely possible that they will be banned from handing out samples altogether in short order. Look what happened when fast food was blamed for the obesity epidemic – now, we all need to have our guilty pleasures ruined by conspicuous calorie counts listed on every menu. (Speaking of which – did you know that those soft pretzels were so damn bad for you? It’s a tragedy.)

Take heed, Big Formula. Stop making dumb-ass moves like offering “breastfeeding help lines” in order to look high and mighty and do something that makes you look like any other big corporation (i.e., just slightly immoral). Do something nice for adoptive parents, because god knows they have been through enough, and deserve to have something come easily. Even if it is just a few cans of powder.

**Note**
I am planning on sending a letter to both Enfamil and Similac suggesting what I have outlined in this post. If anyone is interested in joining me in sending them some friendly advice, here are their addresses:

For Enfamil:

Mead Johnson Global Headquarters

2701 Patriot Blvd., Fourth Floor

Glenview, IL 60026 USA

Attn: Consumer Relations Dept.

For Similac:

Nutritional and Pharmaceutical Products
Abbott Nutrition Consumer Relations
625 Cleveland Avenue
Columbus, Ohio 43215-1724
(800) 227-5767

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