I know -- as a parent first of all, then as a physician, and finally as a public health practitioner -- that "breast is best." Breast milk, absent some very compelling contraindication such as a transmissible infection, is the ideal food for a newborn. Nothing else we've got confers the many unique benefits of breast milk.
These benefits, very well chronicled in the scientific literature, are stunningly comprehensive. They range from the psychological effects of such close bonding between mother and baby, to enhancements to both skeletal and cognitive development, to the transmission of protective maternal antibodies as the newborn immune system and GI tract slowly mature, to an apparently lifelong defense against obesity we don't even fully understand.
While in general we really can't say for sure which specific diet is best for older kids and adults, the first year of life is a clear exception. Breast is unequivocally, unambiguously, and altogether conclusively best.
And so, the promotion of breastfeeding is a World Health Organization priority, and breastfeeding figures among the objectives for Healthy People 2020. Objectives, by the way, we are still a long way from meeting.
None of the above was surprising to me, and I bet nothing so far has been terribly surprising to you. So here's the surprise: One of the reasons we are so far from national objectives for routine reliance on breast milk as the safest, cheapest, healthiest, and just plain best way to feed a newborn is... food marketing. Yep: food marketing to neonates.
I am among those who feel that food marketing to children is a serious problem, in need of substantial reform through voluntary restraint (I advise against holding your breath!) or regulation. Foods marketed most aggressively are unfailingly -- as innumerable studies show -- of fairly poor nutritional quality. The foods kids are coaxed into loving, in other words, are the least likely to love them back -- and will instead accelerate their progress toward obesity, and even diabetes. And the contest between a 6-year-old and a highly-paid advertising executive is unfair by any standard.
But despite my devotion to this topic, I had no idea that even neonates were in the crosshairs of food marketers.
They are. According to Elizabeth Ben-Ishai, Ph.D., the campaign coordinator for Public Citizen's Commercial Alert Project, roughly two-thirds of ALL HOSPITALS nationwide allow food and pharmaceutical companies access to their maternity wards. The companies use this hallowed real estate to hand out "discharge bags" of free infant formula to new moms. The bags are, of course, decorated with company insignia and formula names -- and are accompanied by discount coupons for subsequent purchases of the same formula.
My friend and colleague Karla Shepard Rubinger, executive director of the Academy of Breastfeeding Medicine, had this to say:
Although the formula companies all give lip service to "breast is best," their aggressive advertising and marketing do everything to undermine it. And there is a significant amount of research to show that where formula is provided at no cost, breastfeeding rates are lowest. Our goal is to better educate physicians, hospitals, and other healthcare providers to understand why breastfeeding is so very important: It is universally available, free, evidence-based, supported in all cultures throughout time, shows documented benefits for mother and baby, and is "green" into the bargain.
What she said!
I spoke with Dr. Ben-Ishai, who confirmed that simply distributing formula and coupons substantially reduces breastfeeding rates. She noted that the practice extends at times from the hospital to the offices of both gynecologists and pediatricians.
Public Citizen is sponsoring a petition to end food marketing to neonates. Dr. Ben-Ishai noted, "This is not about setting any limits on mothers' choices; it's about opportunistic marketing by the formula companies, and the ethics of the hospitals that allow this marketing to take place on their turf." A formula industry valued at well over $3.5 billion and an exhausted new mother with a newborn in her arms looking to a ward full of health professionals for guidance seems a very unfair match-up indeed. By distributing their goodies on maternity wards, the formula companies are getting a "halo effect" -- making it seem as if the hospitals and health professionals are recommending formula.
And for that reason, the marketing works -- even when lactation counselors encourage breastfeeding, according to Dr. Ben-Ishai. The counselors do provide a first line of defense, but it's not enough against a marketing campaign valued at many, many millions of dollars.
If we want more children to get the benefits of breastfeeding -- and anyone with any reason to care about any child, should -- we need to un-muddle the message being delivered on the rarefied terrain of the nation's maternity wards. "Breast is best" needs to be uncoupled from "but here's a free bag of formula and some swell coupons!" And the fact that no one gets paid when a mother provides her baby the best nutrition there is? Too bad! We all profit in the ways that matter most if healthier babies abound.
I remain hopeful about curtailing food marketing to kids in general. But for now, let's at least end exploitative food marketing to neonates. Mothers who truly prefer or need formula should get it. Mothers who don't should not be talked into it.
Ideally, formula companies should simply abandon the practice. If they don't, hospitals should defend their turf against it.
The best possible start in life is every baby's birthright. For the vast majority of babies, breastfeeding is an important part of THAT formula. The marketing of other formulas to neonates as an alternative to breast milk... most certainly is not!
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