A Quiet Place Issue 144 - September/October 2007

By Peggy O'Mara

Seventeen years later, in 1974, when I breastfed my first child, the breastfeeding initiation rate in the US was at 32.2 percent. In the ten years from 1970 to 1980, however, the breastfeeding initiation rate had more than doubled, from 26.5 percent to 55.3 percent. The rate continued to climb into the 1980s, and reached a high of 61.9 percent in 1982. Those of us who were breastfeeding advocates at the time thought we had won the war.

Then, the impossible happened. The breastfeeding initiation rate began to drop, and continued to drop for 14 years. By 1990, the rate was 51.5 percent-10 percent lower than the high of 1982. What had happened?

It is no coincidence that Nestlé began advertising formula directly to consumers on television and in magazines in 1989, in violation of a long-standing, informal agreement among formula manufacturers and several national health organizations. Bristol-Myers, in partnership with Gerber, quickly followed suit.

These campaigns were a big success. Both Nestlé and Gerber increased market share by nearly 3 percent each in one year. It came as a surprise to us naive breastfeeding advocates of the 1980s that corporate profits could trump good health.

In the late 1980s and the 1990s, breastfeeding advocates became more sophisticated, forming professional organizations and joining international efforts to promote breastfeeding. In 1997, the breastfeeding initiation rate surpassed the 1982 high and reached 62.4 percent. The rate grew three percentage points from 1996 to 1997 alone. In 2002, the breastfeeding initiation rate in the US reached an all-time high of 70.1 percent. The bad news, however, is that in 2003 the rate dropped four percentage points, to 66 percent-the first drop in eight years, and only four points higher than the 1982 rate. Do these 2003 numbers signal another decline?

Even without a decline, these numbers tend to make it appear as if there is more breastfeeding going on than there actually is. The US Women, Infants, and Children program's definition of initiation is one breastfeeding in one day. A formula company, Abbott-Ross, publishes the only available numbers on breastfeeding initiation, and includes in its count mothers who have breastfed for just one month.

What this means is that the rate of breastfeeding initiation is not a measure of who is breastfeeding, but only of who has tried breastfeeding. It is a measure of mixed feeding, not of the exclusive breastfeeding that the American Academy of Pediatrics and the World Health Organization recommend for at least a child's first six months. The US rate of exclusive breastfeeding is not increasing. It has been at 46 percent for the last several years, and only 10 percent of US babies are still being exclusively breastfed at six months.

Most other countries are doing much more breastfeeding than we are in the US. I looked at 2003 Breastfeeding Statistics compiled by Carol Huotari of the LLL Center for Breastfeeding Information (www.laleche league.org/cbi/bfstats03.html). With 86 countries reporting, the US is among only seven countries with breastfeeding initiation rates lower than 85 percent. Seventy of the 86 countries have breastfeeding initiation rates of over 90 percent.

Certainly, US women are deterred from breastfeeding beyond a few weeks because our country offers no paid maternity leave, and because the six weeks of unpaid leave that we do get-if we can afford to take it-barely give us enough time to establish breastfeeding, much less figure out how to combine it with working. In addition, white-collar workers have greater access to lactation support in the workplace than do blue-collar workers. We need laws that protect every woman's right to breastfeed or pump in the workplace, and provide training for employers about breastfeeding's advantages. Numerous studies have shown that the many benefits include lower health care costs, less absenteeism, improved staff productivity, and lower employee turnover.

In addition to obstacles in the workplace, there can be no doubt that our country's soaring cesarean rate adversely affects breastfeeding, as it did in the 1980s. A 2005 study in Greece showed that cesarean section and information disseminated through the mass media have a negative impact on exclusive breastfeeding. (Fani Pechlivani, "Prevalence and Determinants of Exclusive Breastfeeding During Hospital Stay in the Area of Athens, Greece," Acta Paediatrica 94, no. 7 [2005]: 928-934.) In the US, mainstream media coverage of breastfeeding, particularly on ABC, is sensational, provocative, and undermines breastfeeding success. On July 15, 2007, Good Morning America aired a segment titled "Breast-Feeding Battle." The host quoted a study showing that the majority of Americans disapproved of breastfeeding in public when, in fact, ABC's own online poll, "Public Breastfeeding: Tacky or Tactful," shows that 75 percent of respondents find breastfeeding in public totally acceptable.

According to a survey conducted by the National Breastfeeding Awareness Campaign, 69 percent of men are comfortable seeing a baby being breastfed in public. Even a poll on Dr. Phil's website showed that 61 percent of respondents were fine with breastfeeding, "anytime, anywhere." The online video clip of "Breast-Feeding Battle" appeared on the same Web page as an article about how to show off your cleavage at work. The segment spokesperson for breastfeeding was Susan Kane, editor of babytalk magazine, who recommended that women wear button-up shirts to breastfeed, and cover up while doing so.

Breastfeeding advocates do not recommend button-up shirts, as they expose the midriff when unbuttoned. Instead, a mother might wear a pullover top that can be hiked up from the bottom. This way, she can easily nurse discreetly. A breastfeeding mother doesn't need to cover up while breastfeeding in public, or ask permission to breastfeed, or buy new products in order to do so. Breastfeeding is a civil right; those who are prejudiced against it practice sexual discrimination.

Susan Kane falsely claims to have published the first national magazine cover of breastfeeding, in 2006. In fact, Mothering has published six covers of breastfeeding, the first in 1978, and the most recent in 2006. In the 1980s and 1990s, when the media supported public health goals, a La Leche League representative would always have been chosen to address breastfeeding questions on camera. Asking the editor of a magazine that advertises formula for advice on breastfeeding is a sign of the corruption of our times.

In addition to the inaccurate information on breastfeeding provided by the mainstream media, the unethical marketing practices of the formula companies continue to undermine breastfeeding. Author Margaret Kenda recently told me about several "stealth" breastfeeding websites that appear to be grassroots advocacy sites, but are actually mouthpieces for the formula industry. One such website, www.momsfeedingfreedom.com, is registered to eNilsson, an international Web consulting firm whose clients include Romney for President. Republican candidate Mitt Romney, as governor of Massachusetts, pressured his state's Public Health Council to rescind a ban on the bags of free formula given by hospitals to new mothers and paid for by formula companies. The website states that "the opinions and views expressed on this website are of Kate Kahn," a corporate communications strategist based in Boston. A sister site, www.babyfeedingchoice.org, is licensed to Kellen Communications, a public relations firm whose clients include the International Formula Council.

In December 2005, Massachusetts became the first state to prohibit formula sample bags in hospitals, as part of an update of the state's Department of Public Health regulations. Both the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) have called for an end to this practice (www.massbfc.org/news). Governor Romney pressured the Public Health Council to rescind the ban, but the council successfully resisted his pressure, until he fired and replaced three members just prior to a vote on it; the ban was rescinded in May 2006. Less than two weeks later, Romney announced a deal with Bristol-Myers Squibb, the world's largest formula manufacturer, to build a $66 million pharmaceutical plant in Devens, Massachusetts.

In June, Massachusetts state representative Helen Stanley (D-Second Essex) introduced House Bill 2257, which would protect a new mother's right to receive formula sample bags in the hospital; the bill is still pending. Momsfeedingfreedom.com hosts a petition in support of this bill. In response to such dirty politics, the Massachusetts Breastfeeding Coalition launched Ban the Bags, a national campaign to rid all US maternity wards of formula sample bags. In Massachusetts, 11 of the state's 50 maternity units are now bag-free, even without a state mandate. (See www.banthebags.org.)

The formula industry uses the same tactics in the US that it has used for years to undermine breastfeeding in developing countries, which now have the lowest breastfeeding-initiation rates in the world. Sub-Saharan Africa has a rate of 32 percent; Asia, overall, 35 percent; Indonesia, 39 percent. In Vietnam, only 19 percent breastfeed, and in Thailand, only 5 percent.

According to Alexander Padilla, under-secretary of health of the Philippines, breastfeeding has steeply declined in his country in tandem with the growth of infant-formula sales there, which now top $450 million annually. In 2006, the breastmilk-substitute industry spent $100 million advertising formula in the Philippines, an amount equal to nearly half of the Philippine Health Department's annual budget of $239 million.

Because only 16 percent of Filipinas exclusively breastfeed their babies for the first six months of life, the Philippine Health Department expanded regulations to prevent formula companies from targeting children under two with advertising. The new rules, which call for stricter labeling, more accurate health claims, and sanctions for failure to comply, were to become effective in July 2006. Representing the US formula companies Abbott-Ross, Mead Johnson, Wyeth, and Gerber, the Pharmaceutical and Healthcare Association of the Philippines (PHAP) sued the Philippine Health Department to prevent the new rules from being enacted.

In July 2006, the Philippine Supreme Court denied the formula companies a restraining order, but on August 15 it overturned its earlier decision and granted the restraining order to PHAP. This action was taken just four days after Thomas Donohue, president of the US Chamber of Commerce, wrote a letter to President Gloria Arroyo in which he threatened the Philippines with loss of international investment (www.babymilkaction.org). The actions of the formula industry, in both Massachusetts and the Philippines, are cautionary tales. The US accounts for half of the world's $8 billion annual sales of infant formula. US formula companies increasingly use free-trade arguments to challenge public-health initiatives here and in other countries. They prey on the legitimate fears and vulnerabilities of new mothers by framing breastfeeding as an issue of choice. And they confuse the public about the superiority of breastmilk by adding essential fatty acids such as DHA, and organic milk to artificial baby formula. Worldwide, 5,000 babies a day die from lack of breastfeeding. Today, perhaps more than at any other time in history, breastfeeding is at once both deeply personal and profoundly political.

Mothering subscribers who:
breastfeed 96%
breastfeed 1-2 years 40%
breastfeed 3-4 years 32%
breastfeed 4+ years 8%
Source: Lewis and Clark 2006 Mothering Readers' Survey

Breastfeeding reduces an infant's risk of:
Respiratory-tract infections 72%
Ear infections 50%
Eczema 42%
Asthma 27-40%
Type 1 diabetes 20%
Type 2 diabetes 39%
Source: See below.

Breastfeeding reduces a mother's risk of:
Type 2 diabetes 12%
Ovarian cancer 21%
Breast cancer 28%
Source: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Structured Abstract. Agency for Healthcare Research and Quality, Rockville, MD (April 2007): www.ahrq.gov/clinic/tp/brfouttp.htm.