A suggestion from Dr. Jennifer James, a midwifery lecturer at RMIT University, has been inflaming parenting message boards and blogs all over today. Dr. James has been quoted in the main stream media about her proposal to remove infant formula from supermarket shelves and make it a prescription-only product.
I’m at least sympathetic to the idea: I can certainly see potential benefits to breastfeeding rates. Perhaps, in principle it seems similar to proposals to put cigarettes in plain packaging as a way to stop companies from marketing their products to consumers.
Except, infant formula is not tobacco.
Parents choose to use formula for a myriad of reasons (some of which feel little like actual choices) and the overwhelming feeling amongst commenters on the article and parents on Twitter seems to be that this is a push to make formula use taboo. Some parents who formula feed already feel they are shamed for it, and this feeling can result in a backlash against organisations who promote breastfeeding, like the Australian Breastfeeding Association. This proposal would likely only make the guilt-shame-anger cycle worse.
On the other hand, parents who have clear medical reasons for not breastfeeding might well feel vindicated by a prescription – they are less likely to be shamed or questioned, perhaps, if others readily assume that there is a ‘good reason’ for them not to choose breastfeeding. But I don’t think that’s a sound argument for supporting James’ idea; in fact, I think it just raises more questions.
What constitutes a ‘good reason’ to stop breastfeeding or supplement with formula? Who decides that? Why should it be any one’s but the breastfeeding parent’s right to decide what kind of reasons are ‘good enough’? What happens if an individual parent’s reasons are not good enough for a given health professional? Does that amount to forcing someone to breastfeed, or forcing them to find other (potentially less safe) ways to feed their baby? What happens if someone who is wanting help to persist with breastfeeding is issued a formula prescription by a health professional? Would that appear to amount to a directive to use formula? Would formula companies respond by marketing even more aggressively to health professionals, many of whom already know little about breastfeeding and how to support it? What would removing supermarket competition do to the cost of formula and how would that impact on low-income families, who are disproportionately dependent on commercial baby milk? How would it affect the availability of alternative feeding methods for parents who face literacy or language barriers or who have economic or other reasons for not seeing health professionals? How many babies would be fed cows’ milk as a stop-gap measure? I think that constitutes too many unanswered questions for this proposal to be something I could get behind.
I agree that the marketing of formula, including (especially) toddler milk, is not nearly well enough controlled and I believe that is to the detriment of breastfeeding rates. I think that the ready availability of formula and easy brand recognition combined with poor support for, and education about, breastfeeding contribute to lowering breastfeeding rates. The WHO code, which should be the minimum standard for regulating formula marketing, isn’t enforced in Australia, nor in much of the world. (Both links PDFs) And as a feminist I have a problem with that: women are being marketed to in the name of ‘choice’ to the potential detriment of our health and that of our children. As a lactivist I obviously have a problem with the marketing of infant formula and any implication that it is as good as, or better than, breast milk. But as a human being I also know that people are hurt, seriously hurt, when they feel judged and shamed and when they are exhaustedly holding a hungry, crying, baby at 2:30 am and it feels like no one can help them.
Removing systemic barriers to breastfeeding certainly may require improved measures to reduce the popularity of formula – popularity which can be attributed to decades of marketing not only to the public but to health professionals. A big part of that marketing is about convenience: huge displays in chemist shops and regular sales at the supermarket of products in familiar-looking tins add to the impression of ease of use and the normalisation of artificial feeding. But whether we like it or not, formula and its ready availability is important to many families. Removing that now feels like a stick where a carrot should be.
Give parents the tools to make sound decisions that benefit them and their babies. Give parents not only choices, but supported, realistic choices. Don’t tell a woman who has to go out of the home to work, or who has other children to look after and little support, that the choice to dedicate perhaps days to increasing her milk supply through frequent feeding and skin-skin contact to avoid supplementing with formula is an easy one: it clearly is not. Education and information are hugely important but they are only part of the picture when practical barriers still so often interfere with breastfeeding relationships.
Adding practical barriers to formula use, as I think this proposal would, isn’t a particularly kind way to help parents. Being caught between a rock and a hard place doesn’t make the rock seem any easier to budge: it just makes it hurt more to be stuck there.
Edit: The Herald Sun article I linked to (and some discussion I’ve seen elsewhere) implies that the Australian Breastfeeding Association is supportive of the proposal to make formula prescription-only. That’s misleading: the Association’s statement to the media on the comments by Dr James was:
The idea of obtaining formula on prescription is worth serious discussion although the Australian Breastfeeding Association is not currently advocating this. Research shows formula fed infants are more likely to become ill so being in contact with a health professional could be very beneficial. A health professional could counsel the mother, address any breastfeeding problems and help the mother make an informed decision. Many of the calls to the Australian Breastfeeding Association 24 hour helpline are about reassuring mothers about their milk supply, feed frequency and normal baby behaviour. For example mothers often think they have an inadequate milk supply when baby cluster feeds in the evening however this is normal baby behaviour. Sore nipples, mastitis and attaching the baby to the breast are also very common calls. Over 90% of mothers start out breastfeeding by 6 months only 50% are partially or fully breastfeeding, many more would continue with better support and information.
Australian Breastfeeding Association supports a ban on marketing of Infant formula in line with the WHO Code as this is proven to affect breastfeeding rates. From ABA Facebook page