In 2017, the U.S. birth rate sunk to the lowest percentage in 30 years, prompting concern from labor economists and other groups. This drop can be explained by better family planning, as more and more potential parents have come to accept an undeniable fact: Raising a child is really, really difficult.
New mothers face many difficult choices when deciding how to parent, one of the most important of which is determining how to feed their children. There is broad consensus among the medical community that breast milk provides the best nourishment for newborn infants. The use of infant formula, the most common alternative to breast milk, has been linked to higher rates of sudden infant death syndrome, asthma, autism, diabetes, obesity, lower IQ scores, worse respiratory health and a weaker parent-child bond. The American Academy of Pediatrics strongly urges new mothers to breastfeed as much as possible due to the “unequivocal evidence that breastfeeding protects against a variety of diseases and conditions.” However, infant formula companies need mothers to buy their products. In order to accomplish this, their political and advertising efforts have created a climate opposed to breastfeeding.
Health advocates have suggested that formula advertising be restricted, formula be regulated as a prescription drug, or free formula samples be banned from hospitals. Unfortunately, the political might of the formula industry has prevented any such reform. The three major breastfeeding companies, Abbott Laboratories, Nestle, and Reckitt Benckiser, have collectively spent over $60 million lobbying Congress over the past decade, and their spending has been successful.
Their most recent success was the well-covered battle against a WHO resolution supporting breastfeeding. The Trump administration, at the request of infant formula lobbyists, threatened economic retaliation against South and Central American countries who supported the resolution. In 2004, the Department of Health and Human Services announced a PSA campaign to promote breastfeeding, but the formula industry hired a former RNC chairman and a former regulatory official to lobby HHS. Unsurprisingly, the PSA campaign was diluted. These seemingly abstract political victories have played a significant role in minimizing the number of mothers who breastfeed their children.
The American College of Obstetricians and Gynecologists recommends that all new mothers (without a disqualifying medical condition) exclusively breastfeed their child for the first six months of the newborn’s’ life and use breast milk as the principle source of nutrition well into the child’s first year. A considerable portion of Americans don’t follow this advice. The CDC reports that an astounding 16.8% of new mothers never breastfeed their children and less than a quarter follow the recommended 6 months of solely breast milk.
This unwillingness to follow medical advice becomes understandable when one considers the barriers to breastfeeding. Many mothers never even learn that breastfeeding is preferable. The National Institute of Health reports, “education about breastfeeding is not always readily available to mothers nor easily understood by them.” Even when mothers have enough information to decide to breastfeed, they still face many challenges. Only 26.1% of live births occur in hospitals with the recommended level of support for lactating mothers, so many mothers are never taught how to properly breastfeed. Once mothers leave the hospital, it doesn’t get easier; only 49% of job sites provide lactation support programs, leaving many working mothers without the resources they need to breastfeed. Each of these barriers can be mitigated by governmental action, but the infant formula industry stands to profit when breastfeeding is a struggle, so it’s unsurprising that little has been done.
To complement their lobbying, infant formula companies engage in dubious marketing practices to maintain their $25 billion industry. The most egregious of these is the distribution of “free” formula samples in hospitals to new mothers. At first glance, this practice seems no different from supermarkets providing free samples to customers, but the effects of providing free formula can be massive. Mothers who receive bundles of free formula are significantly more likely to use infant formula as their principle feeding method. Once they’ve decided to use formula, mothers also view their free sample as the best product even though most major formula brands have identical products. Mothers thus purchase products that are up to 66% more expensive even when it provides no benefit to their children.
This practice is doubly problematic because even a single use of infant formula in the first few days of a newborn’s life can be immensely harmful. Because suckling from a bottle is so much easier than from a mother’s breast, infants generally prefer bottles and sometimes refuse to accept their mother’s milk. Moreover, infant formula interferes with the formation of bacterial colonies in an infant’s gut, and even one instance of formula feeding can increase the likelihood of gastrointestinal disease and dehydrating diarrhea. Though advocacy efforts have decreased the prevalence of free formula samples in hospitals, almost one-third of hospitals still provide samples to new mothers. The hospitals that do still provide these samples are disproportionately located in poor rural areas. When deciding between extra spending on feeding education and free samples, underfunded medical centers have little choice but to make the money-saving decision. Given that mothers in these poorer areas are less likely to be able to afford baby formula, the presence of enticing free samples in hospitals may be a primary culprit to the high level of baby formula use among lower-income groups.
The United States suffers from an informational vacuum about breastfeeding, and the infant formula industry has masterfully exploited it. The Surgeon General’s Call to Action to Support Breastfeeding illuminates just how little most mothers know about the food they give their newborns. Only a quarter of new mothers believe that formula feeding raises the risk of disease for newborns, even though it is an undisputed scientific fact. This polling contributes to the report’s conclusion that a significant number of mothers, and even some health professionals, incorrectly believe that “infant formula is equivalent in terms of its health benefits.”
Though an administrative failure to effectively disseminate information about breastfeeding is partially to blame, formula companies’ marketing campaigns also play a large role in contributing to this lack of information. The Changing Markets Foundation published a report on Nestle’s marketing strategies (Nestle’s American subsidiary Gerber Good Start is the leading producer of infant formula) found that messages on formula containers had little bearing to the nutritional value of the product. Moreover, the company actively changed their formula so that it could be marketed as “better quality” when such changes had no nutritional effect. The inclusion of certain probiotics, for example, has no measurable effect on infant health, but Nestle charges more for formula that advertises the useless ingredients.
American mothers receive information about breastfeeding from companies, governments and hospitals with a vested interest in the profitability of infant formula. It should be wholly unsurprising that so many Americans believe that formula and breast milk are equally nutritious. Only 10% of new mothers meet the breastfeeding goals they set for themselves before delivery; the United States needs to respond to reasons why these goals aren’t met. While any individual policy to promote breastfeeding would serve as a step in the right direction, the only long term solution to the overuse of infant formula is to examine its source: the companies that profit from its sales. It’s likely that reform will hurt infant formula companies’ bottom lines, but that shouldn’t matter. Being a new mother is incredibly difficult, and the government needs to do anything it can to help.
Photo: Lunch Time