Formula can kill. I know that's harsh, but it's true. Like medications, formula can have side effects, namely a sick child, and sometimes a seriously sick child. An international code barring the advertising of formula exists for just that reason, yet formula companies around the world continue to actively convince parents to buy and use their products.
Baby formula does have a role of course. Not every woman can or is ready to breastfeed; milk banks and milk sharing are often not available or are not a comfortable choice. But helping women breastfeed while formula companies are helping them not to is as frustrating as helping people eat better in this junk food world, or helping them exercise in this age of the car.
The goal is not to judge women and their choices around breastfeeding, but to judge those who make breastfeeding more difficult: the workplaces and public spaces that are not breastfeeding-friendly, the hospitals and health care providers that subtly or not so subtly discourage breastfeeding, the companies who try to increase sales regardless of the public health consequences.
Prenatal information packages are famous for advertising disguised as education but I was still surprised to find formula ads in the one that came with my wife's recent pregnancy. Her family doctor knew nothing about them, turns out, they got in through other clinic staff, and they were promptly removed.
At my own clinic, the Nestle sales representative gave us her personal story of needing to supplement with formula so she could sleep better at night. Perfect sales technique, I must say. With no mention, of course, that according to the evidence women who do so are more likely to stop breastfeeding earlier.
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Direct-to-parents advertising continues as well, our friend the Internet has made that extra easy. Ads for the for the ever-so-fun-sounding Similac Club attach to many of my web searches. Membership in the Similac Club can get you a free formula can and a few coupons for more (but after that you are so on your own).
Research suggests that, unfortunately, these kinds of advertising work. In countries like Canada, they impact how long women breastfeed more than whether they start. Breastfeeding on day one has become normal here (over 90 per cent), thanks to rooming in with mom, year-long maternity benefits, better education. But still, by six months, just over half of babies are still breastfed, and most of that is supplemented with formula.
Baby formula is a big killer in less developed countries, but even where access to health care is good, not breastfeeding increases illness and death. A U.S. government agency review of the 400 or so best studies found that breastfed babies were less likely to be overweight, get diabetes, have ear infections, or suffer from diarrhea or asthma when they were older. They were less likely to get childhood leukemia, to die from sudden infant death syndrome (SIDS), or to get necrotizing enterocolitis (which is as bad as it sounds).
And the costs, oh the costs. An analysis in the journal Pediatrics, based on 2007 data, estimated that if 90 per cent of U.S. families used breast milk alone till only the age of six months, then each year over 900 fewer American children would die and $13-billion in health care costs would be saved.
Yet companies are still allowed to use advertising to convince parents to use their products. Some argue that manufacturers only advertise to convince those already about to use formula to use their brand, which is part of what they are doing of course. But if you know anything about advertising you know that creating demand, expanding the market, is not just a bonus, it is key to the game itself.
Others make the funny argument that companies have the right to educate consumers about formula. Please. Those looking to make a buck from the product have no business "educating" about it. We wouldn't trust Universal Studios to recommend movies, or Ronald McDonald to teach us healthy eating. Why would we trust what formula companies have to say about their own products?
But let's say you were to convince me that formula advertising has a role. We would want the ads to be truthful, no? How about the ads having to say: "warning: using formula instead of breast milk may cause asthma, ear infections, obesity, diabetes, leukemia or necrotizing enterocolitis" in nice bold print? Put that in your ad budget.
But then a group of important looking and sounding people, namely the world's health ministers, already decided in 1981 that formula advertising must stop. As part of the World Health Assembly they passed the International Code of Marketing of Breast-milk Substitutes calling on companies not to advertise their baby formula or baby bottles, neither publicly nor through hospitals and health care providers.
According to UNICEF, over a hundred countries have put at least part of the code into law, the United States being a glaring exception. In Canada, formula companies have to follow nutrition and health claim regulations on formula packages. They have also been asked nicely to pretty please follow the rest of the international code.
But we all know how well nicely and pretty please work. Manufacturers tend to follow the law not a code. Not a surprise given there are no consequences for ignoring the code. Which is why Canada needs a law, and one that is enforced.
We need to do everything we can to make sustained breastfeeding easier for women to choose. Our children will be healthier for it. Our health care budgets as well. It should be an easy decision. But nothing is easy when it affects profits.