family tools
choose a tool resource directory
find a practitioner parenting toolbox product safety media reviews family fun guide send an e-card family astrology

community features choose a feature birth stories find a Mothering friend live chat mothers' writing group teen voices

	a quiet place by peggy o'mara

The Dastardly Deeds Of The AAP
Issue 123

When the American ACADEMY of Pediatrics (AAP) issued its historic statement on breastfeeding in 1997, it identified public perception as one of the obstacles to breastfeeding. It encouraged breastfeeding to be promoted as a normal part of daily life and called on pediatricians to promote and support breastfeeding enthusiastically. Yet, tragically, the AAP as an organization undermines breastfeeding success.

In "Breastfeeding and the Use of Human Milk," the AAP Workgroup on Breastfeeding called for the elimination of hospital-discharge formula packs, as they have been shown to undermine breastfeeding. Not only has the AAP as a whole done little publicly to discourage this practice, the organization has sold thousands of copies of its breastfeeding book to be included in these formula packs. However, the AAP's recent obstruction of the National Breastfeeding Awareness Campaign has been the unkindest cut of all.

In October 2000 the surgeon general released a report entitled the "Health and Human Services Blueprint for Action on Breastfeeding." It represented the nation's first comprehensive framework on breastfeeding and was developed by a subcommittee of the Federal Interagency Working Group on Women's Health and the Environment.

This blueprint focuses attention on the importance and promotion of breastfeeding and recommends action steps for the healthcare system, families, the community, researchers, and the workplace. Specifically, the plan lays out a framework based on the recommendation that infants be exclusively breastfed for the first four to six months of life, preferably six months. Currently, the initiation rate for exclusive breastfeeding is 47 percent, and only 12 percent of new mothers are exclusively breastfeeding at six months.

The US Department of Health and Human Services (DHHS) Office on Women's Health (OWH) has been funded to carry out the recommendations of the HHS "Blueprint for Action on Breastfeeding" into a National Breastfeeding Awareness Campaign to promote breastfeeding among first-time parents who would not normally breastfeed. The overall goal of the campaign is to increase the proportion of mothers who breastfeed their babies in the early postpartum period to 75 percent and at six months postpartum to 50 percent by the year 2010, in keeping with the goals of Healthy People 2010.

The National Breastfeeding Awareness Campaign consists of 18 community-based demonstration projects throughout the US. These projects include breastfeeding coalitions, hospitals, universities, and other organizations funded to offer breastfeeding services, provide outreach in their communities, train healthcare providers on breastfeeding, implement the media aspects of the campaign, and track breastfeeding rates in their communities. On March 25, 2003, DHHS launched its Breastfeeding Helpline, 800-994-9662, developed with the help of La Leche League, and a website for breastfeeding mothers, www.4women.gov/breastfeeding.

To help address the disparities in breastfeeding rates among white and African American mothers, the OWH has formed a strategic educational partnership with the African American Breastfeeding Alliance.

The cornerstone of the National Breastfeeding Awareness Campaign, however, is a comprehensive three-year multimedia social marketing campaign worth, some say, $40 million in advertising. The campaign was selected for official sponsorship by the Advertising Council in 2002 and developed by McKinney and Silver of Raleigh, North Carolina.

The campaign, based on the goals, objectives, and recommendations of the HHS "Blueprint for Action on Breastfeeding," will primarily target first-time parents. It will employ state- of-the-art communication techniques through a variety of channels and strategies, such as, public-service announcements on television and radio, bus-stop posters, billboards, educational pamphlets, and articles in community newspapers, parenting and women's magazines, and websites.

In our November/December 2003 issue, we reported that this national campaign was scheduled to begin in the fall of 2003. In early November, however, at the AAP annual conference, representatives of infant formula companies lobbied the AAP to do something about the "negative messages" of the campaign. At that conference, on November 3, the same day he was installed as president of the AAP, Carden Johnston signed a letter to Tommy Thompson, secretary of DHHS, expressing misgivings about the tone of the National Breastfeeding Awareness Campaign. In his letter he said, in part, "We note that the focus will be on the risks incurred by not breastfeeding rather than to expound upon the benefits to be derived from breastfeeding. We have some concerns about this negative approach and how it will be received by the general public. . . . We must absolutely avoid making any claims that cannot be scientifically validated and thus undermine the credibility of the campaign."

In raising these concerns, Johnston was attacking the very elements that were designed to make the National Breastfeeding Awareness Campaign effective. In a letter to Tommy Thompson, Dr. Lawrence Gartner, previous chair of the Department of Pediatrics at the University of Chicago and present chair of the AAP Section on Breastfeeding, made the point that showing the risk of not breastfeeding is entirely the point of the awareness campaign. The public does not currently perceive that there is any negative consequence of not breastfeeding. (For both Thompson's and Gartner's letters see "Formula Companies Play Foul" at www.mothering.com/action-alerts/index.shtml.)

In his letter to Thompson, Gartner said, in part, "The Advertising Council and the Office on Women's Health, with assistance from many other organizations and from members of our own Section on Breastfeeding of the American Academy of Pediatrics, have very carefully researched the question of how the campaign should be oriented. Through the use of many focus groups that included participants from the target population and other data-collection points, they have come to the conclusion that for the advertising campaign to be effective, it is essential that the message point out the risks of not breastfeeding. The focus-group participants found this approach entirely acceptable. We agree that this is a very appropriate and necessary technique.

"We believe The Advertising Council's extensive experience in public service messages should be honored and followed. Many of their campaigns have had a major impact on improvement of health and social conditions for our citizens. Their PSA on Seat Belt Usage uses an approach similar to their plan for the Breastfeeding Campaign; they provide examples of what can happen when not wearing a seat belt.

"Dr. Johnston's warning about "making any claims that cannot be scientifically validated" is entirely valid. We agree. We know from those who have participated in the preparation of the Breastfeeding PSA materials that every word and claim made in these PSAs has been reviewed by multiple scientists and validated by published research from respected medical journals."

Dr. Joe Sanders, executive director of the AAP, admitted to Dr. Gartner that he and Johnston purposely did not consult with the AAP Section on Breastfeeding before writing the letter to DHHS and that he had been pressured by the formula industry to write the letter. Representatives of the formula industry also lobbied government health agencies, such as the National Institutes of Health (NIH), the National Women, Infants, and Children (WIC) Association (NWA), and the Centers for Disease Control and Prevention (CDC), to modify the campaign. They also pressured members of Congress responsible for healthcare policy and WIC reauthorization, as well as the Ad Council, which created the ad campaign.

It's unethical that the industry that stands to lose millions of dollars if the National Breastfeeding Awareness Campaign is successful has a say in the content of the campaign. It's tragic that, because no one makes money from breastfeeding, its advocacy can effectively be obstructed by special moneyed interests. Even the president of the AAP, Carden Johnston, dismisses breastfeeding advocates. In an interview with www.hipmama. com, Carden claims, "I rely on the breastfeeding experts to help me learn more about breastfeeding, but some of the science behind these breastfeeding claims is shaky. It's just not solid yet, and you know how some of these breastfeeding enthusiasts can lack objectivity."

Where has Dr. Johnston been? "Breastfeeding and the Use of Human Milk" contained more than 100 references and took the nation's top breastfeeding experts years to complete. In just the last four years, more than 1,000 breastfeeding studies have been done. Ear infections, asthma, allergies, respiratory illnesses, and obesity are considerably less in breastfed babies. They are smarter, and their moms have a 61 percent reduction in breast cancer.

The World Health Organization recommends breastfeeding for at least two years. It has been calculated that if we followed this recommendation in the US, we could save over $1 billion a year. But here's the rub. As Dr. Gartner said in his letter to his colleagues in the AAP, "There is every reason to believe that the infant formula companies are pulling out all the stops to get this ad campaign buried, or, at least, modified to be less effective. . . This entire affair is a very serious matter, which raises many questions about the leadership of the AAP and the influence of the formula industry on AAP activities."

Making artificial baby food is a $3-billion-a-year industry whose executives reap huge rewards. Jennifer Coburn reported in the July/August 2000 edition of Mothering that the CEO of Abbott Labs earned more than $4 million per year; his counterpart at Bristol- Myers Squibb earned nearly $13 million. Ironically, formula companies promote breastfeeding, fund breastfeeding research, and keep breastfeeding statistics. They also donate a lot of money to the AAP and the Ad Council.

In her article, Coburn reported that formula manufacturers donate $1 million annually to the American Academy of Pediatrics in the form of a renewable grant that had netted the AAP $8 million as of 2000. The industry contributed at least $3 million toward building the AAP headquarters. There are additonal ways it gives money to the AAP.

The major US formula manufacturers are Nestle, Mead Johnson, Abbott Labs, American Home Products, and Johnson and Johnson, and all but one are listed on the AAP website (www.aap.org/donate/fefhonorroll.htm) as donors who gave between $3,000 and $24,999.

Johnson and Johnson, a Champion for Children on the Ad Council site, also donates to the Ad Council. According to the article on www.hipmama.com, Ad Council insiders claim that Mead Johnson threatened to pull millions from the Ad CouncilÕs budget if specific risk numbers were not removed from the National Breastfeeding Awareness Campaign ads. The Ad Council has declined to comment on this claim.

What are we breastfeeding advocates to make of this cautionary tale? The yearly budgets of all of the breastfeeding advocacy organizations combined do not begin to compare to the budgets of lobbying organizations such as the International Formula Council. This trade group represents companies who give millions to government and industry every year to win favor and influence policy. We can no longer be naive about the special interests that oppose sound healthcare policy. Tragically, our gross domestic product runs on the engine of healthcare profits.

The mission statement of the AAP is "to attain optimal physical, mental and social health and well-being for all infants, children, adolescents and young adults." While I'm sure this is true of many well- intentioned and courageous members of the AAP, the organization as a whole has traded optimal health for infants for political position and financial gain. The group has done good work over the years, but ties to government and industry as well as constant funding needs inevitably compromise its mission.

Let us not be fooled again. Let us redouble our efforts, knowing full well that the fierce resistance to the National Breastfeeding Awareness Campaign is a sure sign of its eventual success. The recent attacks on breastfeeding mean that it is becoming assimilated into the culture. Contact Tommy Thompson at 877-696-6775, Carden Johnston at 205-939-6039, or call your elected representatives. Let them know that we will never give up on this one.