Are Formula Companies “Baby-Friendly?”

Public health authorities have proclaimed for years that “breast is best,” but this simple declaration does not provide the support parents need to breastfeed. About 60% of new parents stop breastfeeding sooner than they planned, and about 15% of infants never breastfeed. Out of 19 high-income countries, the U.S. has the third lowest breastfeeding rates. Two-thirds of American babies rely on formula for at least part of their nutrition in their first six months. In May 2022, a baby formula shortage and subsequent infant hospitalizations added new urgency to the country’s relatively low breastfeeding levels.

A research team led by Jennifer Pomeranz analyzed content on infant formula manufacturer websites that collectively represent 98% of the U.S. formula market. They found the websites were 44% more likely to mention the benefits of formula over the benefits of breastmilk and 40% of breastfeeding content was dedicated to breastfeeding problems.

The authors suggest the U.S. government should require formula manufacturers to align their marketing with the WHO’s Code of Marketing on Breastmilk Substitutes, which regulates predatory marketing efforts by the formula industry. The U.S. is one of few countries that has not adopted any portion of the code into law. Meanwhile, baby food companies doubled their U.S. sales from 2005-2019.

When asked about the influence of formula companies’ marketing strategies, Eileen Amy, RN and lactation consultant, answered “education.” Amy is an international board-certified lactation consultant (IBCLC) with 21 years’ experience teaching prenatal classes at Boston’s Brigham and Women’s Hospital. In her educator role, she would teach parents about breastfeeding basics: baby’s feeding needs, a parent’s natural capabilities and highlighting that lactation support is covered by most health insurances: “If you don’t give people that chance, they’re not going to have the idea that it (breastfeeding) is even going to work.”

The birth experience and the following weeks are critical times to offer breastfeeding support to parents who want it, according to Amy. She was part of the Brigham’s work towards “Baby-Friendly Hospital” status. Nurses, midwives, lactation consultants, obstetricians and pediatricians worked closely to implement policies that improve breastfeeding success, such as rooming babies with their parents, fostering skin-to-skin contact, and limiting pacifier use. These measures have been associated with significantly higher exclusive breastfeeding rates during post-pregnancy hospital stays.

With or without paid leave, Amy says one home visit from a lactation consultant can make a big difference for parents who wish to breastfeed.

As part of the baby-friendly designation, hospitals must adhere to WHO’s Code of Marketing on Breastfeeding Substitutes. This includes rejecting free samples and discounts offered by formula companies during hospital stays. According to Amy, “Formula companies would give out these freebies, these bags, that the patients loved to get. They’d give you a can of powdered formula and a few diapers, bottles. Pulling out the gift bags was a big deal.” These gifts encourage brand loyalty to formula companies, decrease duration of breastfeeding, and undermine parents’ confidence in their breastfeeding success.

After leaving the hospital, parents often experience additional feeding challenges. Paid leave is a key determinant of breastfeeding, and the U.S. is the only high-income country without federally mandated paid leave. With or without paid leave, Amy says one home visit from a lactation consultant can make a big difference for parents who wish to breastfeed. Health insurance plans are required to cover these services under the Affordable Care Act. She recommends that families look for an international board-certified lactation consultant, because their ethical code forbids the promotion of any particular products while helping parents meet their feeding goals.

On a systemic level, much can be done to support parents who may want to breastfeed. But without widespread adoption of these practices, infant formula companies continue to maintain a strong hold on new parents. As Amy says, “There are a lot of parents who figured it (breastfeeding) would either work or wouldn’t work, when really there is a trajectory of things that can help it work better. And some of those people are down that formula route before they even knew what happened.”

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