Babies Were Born To Be Breastfed

by Amy Spangler
August 31, 2007

Washington Post staff writers Marc Kauffman and Christopher Lee report that the National Breastfeeding Awareness Campaign may have fallen victim to political pressure by the formula industry.

According to the report, “In an effort to tone down blunt ads, the formula industry hired a former chairman of the Republican National Committee and a former regulatory official to lobby the Health and Human Services Department (HHS). Not long afterward, department political appointees toned down the campaign.”

The formula industry’s intervention is being scrutinized in light of testimony by former Surgeon General Richard H. Carmona that the Bush administration repeatedly allowed political considerations to interfere with his efforts to promote public health.

Kauffman and Lee report that, “The Congressional Committee on Oversight and Government Reform is investigating allegations from former officials that Carmona was blocked from participating in the breastfeeding advocacy effort and that those designing the ad campaign were overruled by superiors at the formula industry’s insistence.”

It is clear that the campaign ads were modified at the request of HHS, but only after scientists from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Centers for Disease Control and Prevention (CDC) had an opportunity to review the scientific data. The extent to which Dr. Carmona was blocked from participating in the campaign remains to be elucidated.

I had the opportunity to serve as Chair of the U.S. Breastfeeding Committee during the development and launch of the campaign, and to see first hand, genuine efforts by HHS Assistant Secretary Kevin Keane and representatives of the Ad Council to formulate ads that were both scientifically credible and emotionally compelling.

For me the greater disappointment was that the message of the campaign—Babies were both to be breastfed—was overshadowed by the controversy surrounding the campaign. Controversy that neither HHS nor the Ad Council anticipated, controversy generated by deep-seated animosity between the formula industry and the breastfeeding community, controversy over wealth or health.

Health risk messages by their nature are controversial. When fear is used as a mechanism for behavior change, there better be strategies in place to support that behavior change. In other words, if we tell mothers and fathers that babies exclusively breastfed for six months have less risk for ear infections, pneumonia, asthma, obesity, and a myriad of other acute and chronic diseases, and they subsequently decide to breastfeed exclusively for six months, we better have the resources in place to support that decision—including skilled lactation care and services; extended, paid maternity leave; worksite-based child care; flexible work schedules; and time and space at school or work to breastfeed or express milk.

Joan Wolf, author of Is Breast Really Best? Risk and Total Motherhood in the National Breastfeeding Awareness Campaign, is a wonderful example of what happens when misinformed individuals with misguided agendas attempt to influence public health policy.

Breastfeeding promotion presents a unique challenge because it defies comparisons. Wolf was critical of the comparison made by myself and others between breastfeeding and smoking—and perhaps rightfully so. There is no level of nicotine intake that is ever recommended or required, but there are situations when infant formula may be needed.

Perhaps cesarean birth would be a more plausible comparison.

Vaginal birth is normal. When normal is not possible, a solution must be implemented. Cesarean birth is a solution. As a solution, cesarean birth should not be promoted as “better than,” “equal to,” or “nearly like,” normal (i.e. vaginal) birth. There are situations when cesarean birth is needed, and the associated risks are then viewed as acceptable. Conversely, unnecessary cesareans births carry unacceptable risks.

What about breastfeeding and formula-feeding?

Breastfeeding is normal. Formula-feeding is a solution that is implemented when a problem precludes normal. When the promotion of a solution alters society’s perception of normal and negatively impacts public health, the promotion needs to be curtailed.

There is a reason why we have an International Code of Marketing of Breast-Milk Substitutes.

There is a reason why we have a Congressional Committee on Oversight and Government Reform.

The fact remains, babies were born to be breastfed.