- - - - - - - - - - - -
By Katie Allison Granju

July 20, 1999 | Parents may reasonably ask why, with research demonstrating the many and serious potential health hazards of routine bottle-feeding, do so many otherwise competent doctors continue to take a neutral or even pro-formula stance with their patients? As pediatrician and author Dr. Jay Gordon noted in the book "So That's What They're For: Breastfeeding Basics," by Janet Tamaro-Natt: "This [infant feeding] seems to be the one area where you can practice medicine in the 1990s -- with 1960s know-how -- and not get sued."

The failure of many medical professionals to fully inform their patients of the impact of infant feeding choices is due in large part to their own ignorance of the facts. Most obstetricians, pediatricians and nurses graduate from their professional training having had little or no exposure to the most up-to-date literature or clinical practice in this area. In fact, a recent AAP survey revealed that 45 percent of pediatrician respondents stated that they see formula-feeding and breast-feeding as equally acceptable methods for feeding an infant. The survey further noted that "nearly equal proportions of pediatricians agree and disagree as to whether formula-fed babies are just as healthy in the long run as breast-fed babies (34 percent vs. 38 percent); 27 percent are undecided." These statistics reveal a shocking unfamiliarity with the large and growing body of current research on this topic.

In many cases, health care providers' views on infant feeding are based on their own, highly personal experiences. A nurse who chose to formula-feed her own children or a doctor whose wife weaned her baby at three weeks is unlikely to be an effective advocate for breast-feeding. A large-scale study of physicians' knowledge of human lactation in a 1995 issue of the Journal of the American Medical Association reported that the most important factor influencing the effectiveness and accuracy of a doctor's breast-feeding advice to patients was whether the doctor herself, or the doctor's wife, had breast-fed her children. In a March 1999 report on breast-feeding promotion efforts by American doctors, Pediatrics magazine concluded, "A majority of pediatricians believe that breast-feeding and formula-feeding are equally acceptable methods for feeding infants. Furthermore, reasons given for not recommending breast-feeding include medical conditions such as mastitis, nipple problems, low milk supply, jaundice, and low weight gain, which have recognized therapeutic approaches that generally do not preclude breast-feeding."

"Doctors need to do better in giving their patients good information and support regarding infant feeding," says Dr. Gartner, who has traveled the country offering lactation training to physicians and hospitals. "But it takes a great deal more education to do this. It's easy to explain to parents why they should put their baby in a car seat, but human lactation is much more complex. Many, if not most doctors are carrying around a lot of wrong information about breast-feeding versus bottle-feeding. In order to be effective, they have to unlearn those misconceptions."

Infant formula companies have traditionally targeted health-care professionals as the quickest route to convincing mothers that formula-feeding represents a safe, nourishing option for their babies. Physicians and nurses in the U.S. routinely receive gifts, office supplies, meals, a year's supply of free infant formula for themselves or a relative and even pricey vacations from the infant-formula marketing representatives who haunt their offices. According to Dr. Dettwyler, some pediatric residency programs are largely underwritten by infant-formula manufacturers, an allegation verified by the National Association of Breastfeeding Advocacy and the International Lactation Consultants Association. Not surprisingly, more than 70 percent of surveyed pediatricians recently reported to the AAP that they recommend a particular brand of infant formula to their patients. (In contrast, Pediatrics reported that only 65 percent of pediatricians surveyed recommend exclusive breastfeeding for the first month after birth; only 37 percent recommend breastfeeding for the first year, as recommended last year by the AAP.)

The 1996 annual report from Abbott Laboratories, makers of Similac infant formula, took note of this cozy tie between the medical community and infant-formula manufacturers, stating that, "Abbott's close relationship with pediatricians and other health-care providers serves as the foundation for the company's solid market position in the United States. Pediatricians are also key to the success of the consumer education programs, such as the Welcome Addition Club ... a program that provides new and expectant parents with a broad range of information, from nutrition and breast-feeding tips to basic parenting skills."

In 1994, after years of stalling by Republican administrations that opposed it, the United States joined every other developed nation in the world as a signatory to the "WHO Code," an international agreement that, among other things, calls for an end to formula promotion and giveaways through the health-care system and includes a clause stating that "no financial or material inducements should be offered by [infant formula] manufacturers or distributors to health workers, or members of their families, nor should these be accepted." Despite the WHO Code, virtually all hospitals in the United States offering maternity services -- as well as the majority of individual obstetricians and pediatricians -- continue to provide massive free advertising from the huge pharmaceutical companies that produce and market formula in the United States. Such promotional material comes in the form of formula giveaways, patient "educational literature" produced by the formula companies and even free baby equipment such as diaper bags.

Obviously, marketing and product giveaways on this scale cost infant-formula companies millions and millions of dollars each year. But it pays off. Their own market research, as well as medical literature and anecdotal observations by lactation professionals, have demonstrated that these tactics make it statistically less likely that a women will breast-feed without supplementation or breast-feed at all. And once a woman stops nursing and begins feeding infant formula, these companies know that they likely have her "hooked" on their product, since even a brief interruption in the nursing relationship can cause a woman's own milk supply to dwindle or the baby to begin refusing breast in favor of bottle.

American hospitals have largely shrugged off the idea that accepting free formula and large cash "donations" in return for a particular formula company's right to market directly to its patients represents an ethical problem. Around the world, thousands of hospitals have become certified by the World Health Organization as "Baby-Friendly" by agreeing to aggressively and accurately promote breast-feeding and to end the practice of allowing infant-formula companies to offer freebies to personnel or patients. In the United States, however, fewer than 20 hospitals and birthing centers have received the Baby-Friendly designation.

"Hospitals should not be accepting free infant formula from these companies. They know that if they didn't accept it, they would have a reduced sense of obligation to promote formula. Their continued acceptance of this practice says something important," notes Dr. Cunningham.

Because the WHO Code hasn't been incorporated into federal law in the United States as it has in some other countries, it is impossible to enforce. And although American infant formula companies claim to voluntarily adhere to the code's provisions, including no direct marketing of infant formula to consumers, they openly flout the code and their own assurances of compliance. This can be made clear by flipping through any popular parenting magazine or watching any television program geared toward women in which appealing ads for infant formula are abundant. Nestlé, the notorious maker of Carnation brand formulas, is perhaps most disingenuous when it comes to adherence to the WHO Code. On its Carnation Baby Web site, parents who live in other countries are asked to read a statement in which Nestlé makes a feeble attempt to comply with the code by warning against bottle-feeding. American parents entering the site receive no such statement from Nestlé.

Next page | Product placement on "Chicago Hope"