Weekend Movie: Formula for Disaster

Have you seen this short but potent documentary on formula marketing in the Phillipines? It's available on YouTube in its entirety in 5 short segments. A great illustration of the coercive power of marketing, and why the WHO Code is so incredibly important.

Simianlac: The Closest Yet to Mother's Milk

No, This Time We Mean it: Really Really REALLY Close to Mother's Milk

For some time now, breastfeeding advocates have noted that whenever formula companies release a new product, much of the marketing focuses on insinuating that this new recipe makes their variation closer than ever before to human milk, typically by featuring synthetic versions of various ingredients found naturally in mother's milk (i.e. the essential fatty acids DHA and ARA, vital for brain development, with particularly disastrous results in artificial form).

Other concerns aside from attempts to replicate specific components of human milk include the protein content of the formula, based in cow's milk. These proteins are significantly different than those found in human milk, due to the fact that they are designed for a large ruminant, the offspring of which will be walking almost immediately after birth, in contrast to the needs of the human infant. Dr. Nils Bergman groups mammals into four types with regard to the nutritional needs of their young: Cache mammals, follow mammals, nest mammals, and carry mammals.

That last category is us. In "Breastfeeding Made Simple", Bergman describes it like so:

Carry mammals: This group includes the apes and marsupials, such as the kangaroo. The carry animals are the most immature at birth, need the warmth of the mother's body, and are carried constantly. Their milk has low levels of fat and protein, and they are fed often around the clock. Humans are most definitely carry mammals. Human milk has the lowest fat and protein of all mammalian milks. That, and our immaturity at birth, means human infants need to feed often and are meant to be carried and held.

Breastfeeding advocates and many health professionals have long recognized that cow's milk, and thus cow's milk-based formula, is therefore not biologically appropriate for human infants. This manifests in a number of ways, including the way the proteins are broken down in the baby's stomach, forming tough, rubbery curds that are difficult to digest. Yet aside from turning to soy formula -which introduces a host of other issues - there seemed to be no other real alternative source for the times when breastfeeding is not possible. Chemically enhanced and artificially fortified cow's milk it was . . .

. . . until now.

Abbot Laboratories introduces an exciting new choice in infant formula. Their scientists have been paying attention to these breastfeeding advocates, and conceding their point in at least one argument. "The illogical practice of using milk from a completely different type of mammal with vastly different nutritional needs has been a concern of ours for some time," says Dr. Jane Fossey, a head researcher in Abbot product development. "We have finally found a way to deliver the closest approximation possible to human milk. Rather than using ruminant livestock, simply out of cultural habit and convenience, we decided to try turning instead to another member of the primate order."

Introducing Simianlac.


Simianlac, available in powder and ready-made varieties, is manufactured in the first chimpanzee dairy in North America. Dr. Fossey emphasizes that the chimps are free-range and fed an organic diet, being rounded up only every three hours to be milked. "We're also proud to announce our partnership with Medella, and use only the comfortable, convenient Pumping Style model on our chimps."

At long last, human babies in need of supplementation will have a product that really, truly, seriously, for real now, comes as close as possible to their own developmental needs. Simianlac will hit the market in April. Look for samples in your hospital bag!

Simianlac. Don't monkey around with your baby's milk.


No chimps were harmed in the making of this post. Nor were any real people or companies. There's no such thing as Simianlac. Pure April Fool's silliness.

OR IS IT???

Yes, it is.

FOR NOW.

A Paradigm Shift is Afoot: from "combination feeding" with formula to informed milk donation

There has been a rather seismic movement afoot (pun intended) in the online breastfeeding community, as it were, over the last few weeks. If you're not in the loop, the gist of the situation is that a breastfeeding advocate named Emma Kwasnica has galvanized a Facebook-centered milksharing network online: Eats on Feets. Such a thing isn't 100% new, as a site called MilkShare has been working at the same for a while now, and those in the know might be able to find donors on boards like Mothering.com (I've unloaded my freezer to several strangers on MDC myself). But this is taking flight like nothing has before, and I think it has everything to do with harnessing the power of Facebook and social networking in general, and how integral it has become to many of our lives.

Other bloggers have done a great job detailing the phenomenon that is Eats on Feets, such as The Motherwear Breastfeeding Blog and One of Those Women. There's much to discuss, including the (over)reaction of the Canadian government - and I won't try to reinvent the wheel here; check out their posts! But this awesome recent development ties into something I've been struggling to write about recently anyway, which is the matter of supplementation, which, in our current Western society, is set by default to formula.

Some refer to the choice to supplement (often electively, but sometimes out of necessity) as "combination feeding" or "mix feeding". It sounds innocuous enough, right? I've heard it referred to as "the best of both worlds", and despite the crystal-clear recommendation from both the AAP and the WHO to breastfeed exclusively for a minimum* of six months, the number of women who breastfeed at all are combination feeders. By a huge majority.

Initiation rates have gone up in most areas (though there's still room for improvement), and this is a positive thing. But after even a few weeks, the number of women exclusively breastfeeding drops dramatically. Check out the CDC's latest report card: By 3 months, the number of women exclusively breastfeeding is only 33%, and by 6 months . . . 13.3%. The numbers for continued non-exclusive breastfeeding are a little bit better, if only by comparison to those exclusively breastfeeding: by that same 6 month mark, 43% are breastfeeding in combination with formula.

Let's look again from the flipside: by 6 months, 86.7% of all American babies are consuming formula.

There has been a lot of great material written about why our numbers for breastfeeding are so low. Many advocates and authors of such pieces focus on the fact that real world support is still so deeply lacking. Our initiation rates are high - should be higher, again, but still, 75% is better than it used to be - and this tells us that the message that Breast is Best has definitely gotten out there. And then, when challenges arise, it is pretty much luck of the draw whether or not the support you get will be enough to allow you to continue. Were I living in a different area, and didn't have access to the excellent IBCLC that I did, I myself would not have been able to breastfeed. It's no hyperbole. I would have been another casualty of this booby-trapped system.

But as I said, wonderful articles and posts abound on this topic. I want to think more about combination feeding and why, and how, it is so acceptable, commonplace, and even encouraged - including encouragement by professionals, despite the unmistakable consensus of their own organizations on exclusive breastfeeding.

Here's my loose hypothesis: the prevalence of combination feeding is yet another result of the well-intentioned but deeply flawed "Breast is Best!" message backfiring. How so? It's tricky, but think about statements like "Every little bit counts - it's liquid gold, after all!" and "Any breast milk is better than none!" Such sentiments abound. Are they true? Well . . . yes. But I think there's a perception out there that breast milk is so powerful that even one feeding a day is enough to confer its benefits. Breastmilk, an omnipotent panacea of mythical, even supernatural proportions - surely it will cut through all the well-documented risks of commercial, artificial infant milk. Right?

IS some breast milk better than none? Well, I'd be hard-pressed to say no. Yes, it is. But saying "yes" is so far from saying that some breastfeeding is even close to the same as exclusive breastfeeding. The immunological benefits of breastmilk are some of its most powerful, the introduction of formula actually negates these very benefits. Look at this recent study from BMJ, examining the protective effect of exclusive breastfeeding on infections in infancy. It concluded that "Partial breastfeeding was not related to protective effect."

And here's another piece on a larger study released earlier this year:

"Significantly, the study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months . . . . None of the antibodies found in breast milk are able to be duplicated in manufactured formula, resulting in a significant lack of protection for formula-fed babies against infectious diseases. Formula is unable to match the complexity of breast milk, the consistency of which adapts over the first few months of a baby's life, changing to fit the baby's needs as he or she grows."

Allow me to repeat that - I apologize for belaboring the point, but I want to make sure it's not missed: "The study showed no health benefits for infants who received formula along with breast milk, even when partial breastfeeding extended a full six months."

Pretty far from "Every little bit of liquid gold counts!", isn't it? Why is this? If breast milk is so powerful - and it IS; believe me, I'm not saying it isn't the very definition of a vital substance - then how can the introduction of a little formula negate it? Much of this has to do with the effect it has on our intestinal, or 'gut' bacteria. This IS where our immune system is centered, and what takes place when foreign proteins are introduced is significant. If you have never read The Case for the Virgin Gut, I implore you to do so**. From the piece:

"When babies are born, they have sterile gastrointestinal tracts. If babies are exclusively breastfed, they develop a natural healthy gut flora. (When I speak of the gut, I mean Baby's insides where the food goes until it hits the diaper.) This means that the major flora in breastfed babies has reduced numbers of bad types of bacteria and increased numbers of good bacteria. Formula-fed babies have increased numbers of bad bacteria, leaving them at more risk for illness.

Having knowledge of the importance of what is normal for newborns inside may help some mothers in making a decision about whether or not to supplement their babies for convenience in the early weeks. Very few mothers know how totally different babies are on the inside when artificial food is added to their diets. Some mothers add the formula in the hopes that their babies will sleep longer at night. Knowing that only one bottle a day can totally change the protective environment of their baby's gastrointestinal tract may give them pause to reconsider before instituting this practice.

The case for the virgin gut is a valid one. There is much research to support avoiding supplementation if at all possible. A huge increase in diarrheal diseases occurs in babies who do not have optimal "intestinal fortitude," which is only possible with guts that have never been exposed to infant formula."

Yet again, something touted as the best of both worlds is revealed to not be the best of either, something I've blogged on before - it's practically a series.

Where does this leave us? Despite the overbearing harpy cliche, I'm coming to feel that breastfeeding advocates, including lactivists and educators as well as some medical professionals, ARE extremely sensitive about pressuring new moms, and want so badly to be reassuring and accepting and above all, non-judgmental . . . so much so that they/we end up understating the risks of formula feeding. Do what you can. Of course some breast milk is better than none. It's okay. You do what you can.

It's a conundrum. We DO need to be supportive. We DO need to be inclusive. We DO need to be non-judgmental. But we also need to make sure that mothers have all the relevant information, all the facts, in order to make empowered choices. Choice, yes, but informed choice. We need to not undermine parents right out of the gate by telling them that (as I witnessed from a professional firsthand) The breastfeeding bag they give you at the hospital has a bottle of formula in it, and that's there to tell you that hey! it's okay to do both! You don't have to choose!

As anyone reading this blog is likely aware, in addition to the risks for the infant, supplementation not done carefully leads to diminishing supply, and if the mother is not aware of how this works, mom's assumption is that something is wrong with her, that she "just couldn't make enough milk", and the slippery slope to total cessation of nursing has already begun. There has to be a way of being compassionate and inclusive without saying things like, as I have also heard with my very own ears from a pro, "If you want to nurse for 6 weeks and then start using formula, that's okay! Whatever works for you! If you want your husband to give a bottle of formula overnight so you can sleep, that's okay! Whatever works for you!"

But there ARE cases, as we know, where supplementation IS necessary. There is no denying that. We want to reduce these cases, but there absolutely are times when it is needed, such as moms with hypoplasia/IGT, or with some BFAR moms, for instance. And here's where the paradigm shift comes in.

It's time that donor milk becomes a real possibility for mothers.

Despite formula companies spending millions to convince you that their product is the "next best thing" to human milk, the WHO designates formula as fourth best - dead last, in other words. The first choice is simply mother breastfeeding her own child, and then pumped milk from the same mother to her own child. Then, third best, is donor milk from another mother, not formula. Yet when supplementation proves to be necessary (either temporarily or long-term), the default in our society is to go directly to formula. Then begins a cycle of figuring out which formula is less difficult for the baby's system. Do we try the "gentle" variety? What if milk is the problem - do we do soy? If that's not working, on to the hydrolyzed and painfully expensive kinds. What if donor milk was a viable option? What if it wasn't just a vague possibility - difficult to pull off in the short term and even harder to do over any substantial length of time - what if donor milk was, instead, the default?

Now, milk banking has been around for a while, and while I think it's basically a good thing (as in HMBANA), to say that it's prohibitively expensive for most families is an understatement, and can be difficult to impossible to get unless your child is ill. Doctors can prescribe it and SOME insurance companies are starting to cover it - but we're a long ways from this being the standard. There's always talk of making banked milk more plentiful and accessible (as the Canadian government stated in response to the growth of Eats on Feets), but that time has definitely not yet arrived.

Doesn't milk sharing and direct donor milk (as opposed to the pasteurized kind one can gets from banks) carry some risk, though? Yes it does. There are diseases that are communicable via breastmilk, and it's absolutely wise to vet the donor in whatever way both parties feel comfortable, wether there's a formal or an informal process in place. I've given milk directly to moms who knew me and trusted me, and have done a little bit of wet nursing, but to one mother who found me via MDC, I submitted a medical record of my most recent blood workup, which I thought was totally fair and the other mom seemed satisfied by this. It still involves some trust, but the risks taken in accepting donor milk must be weight against the risks of infant formula. PhD in Parenting has already done a bang-up job of doing just that (though of course every parent has to make this comparison on their own, as she illustrates).

As someone who participated in a nursing support group where milksharing was common, and donated literally gallons of my own milk to several babies, I am so pleased that since mothers are frustrated with the admirable but glacial progress of milk bank accessibility, they are making their own informed choices, taking this into their own hands - and feets.




*This is something that gets lost in translation, telephone game style. I have heard and read more than one mother claiming that the recommendation is to breastfeed for six months, period. They literally interpret the recommendation -whether second or third or fourthhand through peers, or not explained well enough by professionals, or misread in a book - as endorsing breast feeding for six months and no longer.

** Another helpful link on the subject: Just One Bottle Won't Hurt - Or Will It?

Breast is Best, Sponsored by Simfamil: Don Draper Explains It All For Us.

INT: STERLING COOPER DRAPER PRYCE, DON DRAPER's OFFICE. PEGGY OLSON and PETE CAMPBELL sit expectantly on the sofa, an easel bearing the Simfamil logo and a photo of a smiling baby next to them. A box with canisters of various brands of formula is on the floor.

Enter a typically taciturn DON. He glances at the easel and continues to the liquor cabinet without breaking stride, pours himself a scotch, then turns his attention to the pair on the sofa. DON remains standing.

DON

I'm not sure why this took 2 weeks. This should have come easily to you, Peggy.

PEGGY

Well, I've bee-

DON

Just tell me what you have.

PEGGY

(takes a moment to square her shoulders, then continues)

This has been trickier than you might think. We've been reviewing the latest improvements by Simfamil as well as the improvements to formula made by competing brands and -

DON

Competing brands don't matter.

PETE
(leans forward)

What? What do you mean?

DON

The other brands aren't the problem we have to worry about. That part's easy.

PETE
(huffily)

Listen Don, I've worked long and hard to get us this account. Simfamil is not going to want to hear that Enfilac isn't a threat that we take seriously. The market data shows that coupons and sampl-

DON

Enfilac, Simfamil, Nestle, their strategies have all been the same. Look at this.

(He grabs a one canister after another out of the box, reading their labels aloud, then tossing them aside.)

"More like mother's milk". "The closest thing to mother's milk." "Now with more of the same ingredients found in breast milk". They're all vying to make their product more like breast milk than any other brand. What's the problem with that, Peggy?

PEGGY
(thoughtfully)

Well, because there's just no comparison with breast milk. We've looked at all the research, and the brand never matters. Formula just can't measure up, no matter what brand. So . . . (she gestures at the discarded canisters) . . . how do we set Simfamil apart from them?

PETE
(enthusiastically)

A new package design? Some prettier, younger models as the mothers?

DON

We take on breastfeeding itself.

PEGGY

But you just sai . . . didn't we just say there's no comparison to breastmilk?

DON

There isn't. Formula can't compete with breast milk. We can't fight the research and mothers know this. Almost every mother in America wants to breastfeed. There's no suppressing the truth. Women know that breastfeeding is best. So we're not going to argue with that.

PEGGY and PETE look at each other silently. DON tosses back the rest of his drink and pours another.

PEGGY

I give up. You don't want to promote the new ingredients of Simfamil. Are you saying we should try to find research that makes it look like formula is better?

PETE

We've tried. It doesn't exist. (PEGGY nods.)

PEGGY

So what do we do?

DON

We promote breastfeeding.

PETE

What?

(He goes to the liquor cabinet and pours himself his own drink, gesticulating)

I can't believe you're not taking this seriously. This account is one of the biggest we've ever had a shot at! With everything I've gone through with my father-in-law and losing the -

DON

Breast . . . is best.

PEGGY looks incredulous, then seems to start thinking. DON walks over to the easel and rips down the poster with the logo and baby on it, and writes "Breast is best" on the blank sheet underneath.

DON
(continues)

The research says so, doctors say so, there's no arguing it. And if we attack breastfeeding itself, it backfires, because the facts are the facts, and that makes us not only the bad guys, but liars too. What does the word "Best" imply?

PEGGY listens intently, then starts to write.

DON

Best. Perfect. Ideal. They all have one thing in common. They're impossible. Unattainable. There is no such thing.

PEGGY
(catching on)

Women may dream of being perfect mothers, but they know it's just a dream. So if breastfeeding is perfect, we need to give them permission to be imperfect. Not just permission, but encourage them to be imperfect.

DON

Exactly. So how do we get them from understanding that breast is best to buying formula?

PEGGY

We hire our own experts.

PETE

AHA! Actors pretending to be breastfeeding experts who will say that formula is better! I get it.

PEGGY

No, no, not at all. We hire real experts. And we set up our own hotlines for women to call when things go wrong, and promote those hotlines. And we sponsor information that's given out by doctors themselves, too.

DON lights a Chesterfield. A confused PETE shakes his head and shrugs helplessly, sitting back on the couch.

PEGGY
(building momentum)

And we make up pamphlets and other resources that look like they're designed to help moms with all the problems that mothers are likely to encounter, emphasizing how many things can go wrong. We focus the whole campaign on helping women navigate the terrible, perilous, grim experience that breastfeeding is likely to be. We mention every single thing we can think of: Sleep deprivation, slow weight gain, cracked and bloody nipples, [PETE winces] how hard it is to nurse in public and how hard it is to have to stay home instead, and on and on. We're the good guys, we're just trying to help - it's not our fault that breastfeeding is so difficult and unpleasant. We look altruistic and supportive - we're not trying to get women not to breastfeed, we're just here to support them in case it doesn't work out.

PETE
(lightbulb finally going off, however dimly)

And then we make sure it doesn't work out. What about that part of it?

DON

The information we give. Do we give out accurate information?

PEGGY

Some of it is, and some of it isn't. Little things that undermine breastfeeding, subtle things, things that will jeopardize her supply. Like telling her to never nurse a newborn more than 15 minutes at a time, for example. and saying that frequent feedings for a newborn are 3 to 4 hours apart. The mom will be lucky if her supply ever comes in at all, and when it doesn't, she'll just think something was wrong with her. Because she's not perfect - and that's okay.

DON

And then we swoop in to save the day.

The three look satisfied. PETE and PEGGY stand.

DON

Come up with a new slogan by the time we meet with Simfamil tomorrow.

PEGGY

I'll have it by the end of the day, actually.

(She exits. PETE follows behind.)

PETE
(turning back for a last word, hand on the doorknob)

Bert Cooper is going to think you've gone off the deep end, you know.

DON

He's thought so before. He always gets used to it.

PETE raises his eyebrows, shakes his head and exits. DON goes behind his desk, puts out his cigarette, and reaches for the phone.

CUT TO: INT: JOAN HOLLOWAY's office. She picks up the ringing phone.

JOAN

Yes, Don? . . . Of course I have the best . . . Model them? . . . In your office? Now? . . . You're lucky I'm such a liberated woman, you know. I'll have your secretary hold your calls.

ZOOM IN to her cleavage, then FADE to black.

Background here, here, and to a lesser degree here. Bottom photo from Cracked.com, Top from Men's Fitness.

THE HORROR! How backhanded "breastfeeding support" from Similac works.

As alerted by Blacktating, Babble has not only been hosting Similac ads, but also breastfeeding support and advice pages . . . as hosted by? Similac.

To this, you're probably thinking one of three things. 1) Huh? I don't understand why Similac would do that. 2) Yup, up to their old tricks (if you're a jade- er, experienced lactivist).

Or maybe you're thinking 3) Well, what's so bad about that? That's awfully generous of a formula company, to provide supportive information for their competition - competition which happens to not charge a cent for their product. That's downright altruistic, really! See, they can't argue with the facts about breastfeeding - and look how nice they are, they're not even trying to argue! They're trying to HELP women!

In case you fall into reactions number 1 or 3, here's most of the introduction (and this is just the introduction):

Your body is still recovering from labor and delivery. You and your baby are struggling to learn the finer points of latching on, which are so essential to breastfeeding success. You're also adjusting to each other's nursing supply and demand. You're sleep deprived. Friends and relatives, in-laws and neighbors, everyone seems to have an opinion about what you should be doing and how you should be doing it. And you're just trying to learn as much as you can about who this tiny new person, all snuggled in next to you, is.

Add to that the breast soreness, nipple pain, the need to respond to middle of the night cries, and a body that feels like it belongs to someone else completely — perhaps even more than it did when you were pregnant — and you have a lot of factors challenging your preciously regarded pre-childbirth image of yourself, with baby at breast, in the happy still of the night, breastfeeding contentedly by the light of the moon, gently humming a lullaby to your satisfied infant.

True, there are probably some new mothers who do waltz right into that idyllic scene. But many new moms limp there, feeling engorged, massaging their way through blocked milk ducts, gritting their teeth through cracked, sore nipples, wondering if that broccoli they ate the dinner before is what's making their infant howl through the night. But either way, if you muddle through — past whatever common breastfeeding problems may await you — you may get to the promised land.

This is just the introduction and already it's a %$@#! TEXTBOOK example of how formula companies expertly undermine breastfeeding while trying to appear as if they're helping.

"Who, US? Undermine the ideal, pie-in-the-sky, vision of perfection, unrealistic promised land that is breastfeeding? Heavens no! We're just providing a backup plan in case breastfeeding is SO MISERABLE AND AWFUL AND HORRIBLE AND NIGHTMARISH AND PAINFUL AND FRUSTRATING AS IT IS FOR SOOOOOOO MANY WOMEN (PERSONAL CHOICE) BLEEDING NIPPLES PLUGGED DUCTS CRUELLY-RESTRICTED-DIETS-FOR-MOM THRUSH MASTITIS LOW SUPPLY (PERSONAL CHOICE) SLEEP DEPRIVATION BODYNEVERYOUROWNAGAIN (PERSONAL CHOICE) AND DID WE MENTION SORE CRACKED BLOODY RAW HAMBURGER NIPPLES that you need an alternative. Just in case.

But breast is best!"

The rest of that page is a freaking marketing masterpiece, laying out all the ways in which your life is liable to become one of pure misery if you breastfeed, one after another after another. I may pick it apart later, but I'm seriously too pissed off about the whole thing to do so right now. Feel free to have at it in the comments. It can be a game! Find the undermining techniques used in each of the problems they so helpfully cite. You'll be busy for hours.

For the record, of course I'm not denigrating any mom who experiences any one of these issues - I had some myself, as you probably know. So not the point of this. Babble, I like some of your bloggers and many of your articles, quite a lot, in fact, but wow, is this ever revolting to me.

[No, "The Scream" doesn't have anything to do with this directly, except (a) how I feel after reading that page, and (b) illustrating exactly, to a T, how Similac wants you to feel about breastfeeding. Ideal, best, painful, terrifying, practically impossible breastfeeding.]