Will it take a new Surgeon General’s report to finally debunk the belief that breast is best?

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Everyone knew it was the gold standard for both health and sophistication.

Doctors recommended it and were sure to do it themselves. This despite the fact that for hundreds of years there had been obvious casualties.

It’s wasn’t until the Surgeon General’s Report of 1964, that the truth was finally presented for all to see. Tobacco wasn’t safe and had never been safe. It caused cancer, heart disease and lung disease. Thousands of people had been dying each year for decades, so why hadn’t anyone noticed?

Formula, not breastmilk, is the gold standard in infant nutrition.

Marketing!

Breastfeeding is currently the gold standard for health and nutrition of infants.

Doctors recommend it and are sure to do it themselves. This despite the fact that for thousands of years there had been obvious casualties.

Aggressive breastfeeding promotion leads to tens of thousands of neonatal hospital readmissions each year in the US alone at a cost of hundreds of millions of dollars each year. Aggressive breastfeeding promotion causes neonatal brain injuries and deaths from dehydration, severe jaundice, low blood sugar and infants falling from or smothering in their mothers’ hospital beds. A single case of infant brain injury can cost millions in liability payments, not to mention the destruction of potential and the anguish of families.

So why hasn’t anyone noticed? Marketing!

As I explained yesterday, La Leche League, originally created by a group of traditionalist Catholic women in order to convince mothers of small children not to work, exploited the Nestle African tragedy to partner with the World Health Organization in promoting breastfeeding. Never mind that it was not infant formula that harmed babies, but the contaminated water used to make it. Never mind that children continued to die in their hundreds of thousands because they bathed in and ultimately drank that same contaminated water. This was the perfect opportunity to market breastfeeding and they took it.

They took it because it dovetailed neatly with their financial plans to profit from breastfeeding. At the same time that they partnered with the WHO to promote breastfeeding, they began to monetize it by creating the lactation consultant credential and lobbying heavily to install lactation consultants (themselves) in hospitals and doctors’ offices.

The heart of the marketing campaign was to convince everyone that “breast is best” and that breastmilk is “the perfect food.” Neither of those things were ever true (just as tobacco was never healthy) but after 30 years of marketing the average person “knows” that breastfeeding is the gold standard just like the average person in 1959 “knew” that smoking was healthy, or at a minimum, safe.

Don’t get me wrong: breastfeeding is not dangerous in the way that tobacco is dangerous. There is no safe way to use tobacco while millions of babies can be fully nourished with breastfeeding. But breastmilk is hardly the gold standard.

What would it take for something to be the perfect infant nutrition?

  • It should contain all the nutrients and other factors that an infant needs.
  • It must be available in sufficient quantity to promote vigorous growth of the infant.
  • The infant must be able to access it easily.

Breastfeeding fails on all three counts. Breastmilk lacks sufficient iron and vitamin D; exclusively breastfed infants need vitamin supplements. As many as 15% of first time mothers cannot produce enough breastmilk to fully nourish an infant especially in the early days after birth. Moreover, a significant minority of infants cannot access milk from the breast. It has become fashionable to diagnose those babies as “broken” due to tongue tie and subject them to painful surgery though the scientific evidence provides no support for that treatment in the vast majority of cases.

You know what DOES meet the definition of the perfect infant nutrition? Formula!

It contains more nutrients than breastmilk. It is available in endless quantities. All infants can easily access it through bottles or feeding tubes.

In addition, it dramatically reduces the risk of neonatal hospital readmission, reduces the risk of dehydration, severe jaundice and low blood sugar, saving hundreds of millions of healthcare dollars and liability payments.

But, but, but breastfeeding is natural and formula is not. So what? Contaminated ground water is natural and filtered tap water is not. Living in caves is natural and central heating is not. Unvaccinated is natural and vaccines are not. In all three cases it is the “unnatural” that is far safer.

Wait, what? Formula doesn’t have maternal antibodies? That’s true, but the vast majority of antibodies a baby receives from its mother are transmitted across the placenta. Most antibodies in breastmilk can’t be absorbed through the infant gut; only the smallest antibodies, IgA, are biologically active within the infant. That accounts for the slight reduction in colds and diarrheal illnesses across the entire population of infants in the first year.

What about all those other benefits claimed for breastfeeding? Nearly all have been thoroughly debunked by careful studies that revealed that it is the higher maternal socio-economic status of breastfeeding mothers that accounts for benefits of breastfeeding, not breastfeeding itself.

I’m hardly the only person to point this out. Joan Wolf wrote in yesterday’s New York Daily News:

But, the WHO and myriad pro-breastfeeding groups will claim, the science on infant feeding is virtually unanimous. Breastfed babies are healthier, smarter and more socially successful than those who were formula fed throughout the life course, and formula feeding is dangerous. So they say.

The problem, as I have demonstrated in “Is Breast Best: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood,” is that this research is poorly designed, executed and interpreted — and then grossly misrepresented among scientists and between researchers and the public.

Courtney Jung pointed the same thing out in her book Lactivism and an her op-ed in The NYTimes Overselling Breastfeeding:

Oddly, the fervor of breast-feeding advocacy has ramped up even as medical research — published in The Journal of the American Medical Association, BMJ in Britain and The American Journal of Clinical Nutrition — has begun to report that the effects of breast-feeding are probably “modest.”

Some sobering results have come from Dr. Michael Kramer’s Probit trial, which has studied a wide range of outcomes among about 14,000 mother-infant pairs for 16 years… While Probit found that breast-feeding had some benefits, including for cognitive development, it did not reduce the risk of obesity, asthma, allergies, dental cavities or attention-deficit hyperactivity disorder.

The benefits associated with breast-feeding just don’t seem to warrant the scrutiny and interventions surrounding American infant feeding practices… [A] meta-analysis of the research on breast-feeding done by the United States Agency for Healthcare Research and Quality in 2007 concludes that much of that research is weak: Some studies are too small, or they fail to control for confounding variables. The findings themselves are often inconclusive. One study will find evidence of an effect and another won’t — so we just don’t know which results to trust.

So why do we believe that breast is best? For the exact same reason we believed that tobacco was safe: marketing!

A new Surgeon General’s report might finally convince people that they’ve been duped by excellent marketing and that breast is NOT best for every mother and every baby.

I don’t see that on the horizon since most doctors of the early 21st Century are as enthralled by breastfeeding as the doctors of the early 20th Century were by smoking. I suspect that it will be insurance companies that will lead the way on this issue. Health insurers will realize how much they are spending on infant hospital readmission and will stop paying for it; as a result hospitals will revert to common sense in formula supplementation instead of aiming for lactivist ideological purity. Furthermore, malpractice insurers will look at the millions they are spending on babies falling from and smothering in their mothers’ hospital beds and pressure hospitals to bring back well baby nurseries instead of knuckling under to lactivist insistence on mandatory rooming in.

No matter how desperately lactation professionals continue to exaggerate the benefits of breastfeeding (the microbiome! epigenetics!) it simply costs too much in infant illness and death, maternal anguish and money to maintain the fiction — breast is best — that has been created through marketing.

 

Don’t believe me? I’d be happy to publicly debate (in print or in person) any well known lactation professional on this issue. Don’t hold your breath waiting for that to happen, though. No lactation professionals would dare subject their claims to a public debate; they know they would lose.

  • Robin

    Can someone link me to the original paper(s) that found the 5-15% breastfeeding failure rate?

  • Megan

    Totally OT but today was my baby’s first round of vaccines. I love vax day! He’ll finally have some disease protection and if he’s anything like my older kids, he’ll sleep well tonight as a bonus!

    • maidmarian555

      It’s such a good feeling, isn’t it? We are now on countdown for my daughter’s MMR. She’s almost ten months old now so not long to wait at all. Hooray!

  • yentavegan

    I wish I knew how to link photographs from the web to this comment section. I am eager to discuss the photo of the woman with one thriving infant ( the nursed one) and the twin starving to death with a bottle in her mouth. The photo has been used to malign formula. I see something different… any body care to discuss?

    • Sarah

      I think I’ve seen someone here before suggest hypoplasia?

    • swbarnes2

      I would think the simpler explanation for that would be a Sophie’s Choice situation.

      • yentavegan

        Or perhaps the formula fed twin was actually suffering from a heart defect? and no amount of breastmilk/formula could cure what surgery would have? It makes no sense, that if the mother could have latched/suckled /nursed the twin daughter, she would have. Or was the introduction of tainted water/mixed with formula lethal enough to cause fatal diarrhea?

  • MaineJen
    • Daleth

      OMG WHAT A SURPRISE

    • You beat me to it. If the woman retains a decent lawyer, I doubt she’ll get too harsh a sentence; “Breast is best” gets hammered into everyone.

    • Heidi

      That is so sad, and I do place blame squarely on those who promote the idea that anything is better than forgoing breastfeeding. This understating and outright denying the risks associated with drugs and breastfeeding, alcohol and breastfeeding, HIV and breastfeeding, etc. is scary. I mostly didn’t breastfeed and my toddler is a toddler, like all other toddlers. The way they state these things you’d think it was a super important matter that surely we’d all recognize the difference between breastfed and formula fed. Of course, there was a tragic difference here.

    • Heidi

      It also scares me that women on drugs may sell their breast milk for money believing it’s really not a big deal, and even if the buyer is aware the woman is an addict, maybe they don’t think it’s a big deal either. Meth milk is totes better than ebil foooormuuuula!

      • MaineJen

        That’s why I had to kind of chuckle at the notion of women selling their breast milk, in the discussion below, especially selling it under the table or on craig’s list. NO THANK YOU

  • yentavegan

    Women in the first world can sometimes find breastfeeding and breastmilk production unachievable for a variety of reasons. Women in the third world can also be unable to breastfeed/produce breastmilk. Lactation educators advance the idea that donated breastmilk can answer the needs of first world and third world communities. Formula is a last resort rather than an ideal substitute for the mother’s own breastmilk. The lacation industry foresees the day when a lactating mother can monetize her breastmilk production in order to help feed another baby while earning money for her own family. It is a win-win.

    • demodocus

      if it can be organized enough, maybe. How common is overproduction, anyway?

      • yentavegan

        Lactation educators advance the idea that many of the mothers who experience bountiful breastmilk production can express to feed another baby if they desire to do so. In my own experience ( 30 plus tears) of volunteer mother to mother breastfeeding support , I have seen this happen. It is not overproduction of breastmilk, it is supply and demand.

      • Gæst

        Well, when lactation consultants pressure you to keep pumping no matter what….more common than it would be without breast pumps, I’d wager.

    • Who?

      My question is this: overlooking the deficiencies in breastmilk-specifically iron and vitamin D, isn’t it the case that one of the reasons for preferring it (according to those who do) is that it is perfect for your baby?

      If that is so, why is my breastmilk (which shares the deficiencies of all breastmilk, and is perfect for my baby) better for someone else’s baby than formula?

      • Vitamin D deficiency is not inherently a nutrition issue, but rather a lack of sunlight issue. Mothers who get enough sunlight do not have breastmilk deficient in vitamin d. Still, even mothers who aren’t getting enough sunlight can pass on enough vitamin D to their breastfed babies if they supplement their own diet adequately:

        https://www.sciencedaily.com/releases/2014/06/140606184845.htm

        Of course, there’s nothing wrong with giving your baby supplements, but many mothers would be more comfortable supplementing themselves rather than their baby. Also, even a formula-fed baby would need to go on vitamin d supplementation once they are weaned off formula if the sunlight issue is not addressed, as many solid food diets are inadequate in providing enough vitamin d in and of themselves.

        • Who?

          Interesting, but not an answer to my question, which was:

          If my breastmilk (absent the nutritional deficiencies all breastmilk shares) is ‘perfect’ for my baby why is it better for a baby other than mine than formula would be? Particularly since formula addresses the nutritional deficiencies.

          • Potentially antibodies and micro-nutrients that cannot be replicated by lab produced formulas. Easier to digest as well. However, the degree to which that matters is debatable and would be difficult to prove in either direction. Whether or not you believe that is a legitimate answer is up to you, I don’t consider it rock solid.

          • Who?

            And we’re assuming these ‘potential’ antibodies and micronutrients are all positive to the donee baby?

            Thankyou for affording me the courtesy of acknowledging it is up to me to make up my own mind about your answer. In an effort to discharge what I consider to be my responsibilty to be courteous, I will exercise my right to express no view.

        • demodocus

          Living this close to a Great Lake with lake effect clouds for much of the winter, getting enough sun can be tricky, even for those of us with North European skins.

      • yentavegan

        I can share my experience…I did not give my exclusively breastfed children vitamins. They are all now strappingly healthy adults.

        • Who?

          Me too. But my question was why is donated breastmilk better for another baby than formula would be?

          I ask this whenever someone raises the value of donor milk for healthy full term babies, but no one ever answers.

      • The Bofa on the Sofa

        You don’t understand, that is the magic of breastmilk. Even donated breastmilk changes to accommodate the needs of your baby!

        • Who?

          Gaah my bad why didn’t I see that!

          • The Bofa on the Sofa

            See, when they call it “liquid gold” it’s more from an alchemical perspective

    • Merrie

      I was an overproducer with my first two kids and this sounds pretty unpleasant. And potentially rife with abuses.

    • Daleth

      There is no way I’m putting someone else’s bodily fluids in my child’s mouth. Formula is at least vetted, pasteurized and clean.

      • yentavegan

        If there was no other alternative, if the world and civilization descended into chaos and your infant would otherwise starve you would.

        • Who?

          Really? I’m not sure I wouldn’t take the baby and whoever I was responsible for and bale out on my own terms in that situation.

          • guest

            Agree. My husband and I watch “Walking Dead” and I told him after the first episode, I would kill myself and my family before living through that. That opinion has only gotten stronger the farther we’ve gotten in the series. He, on the other hand, thinks we could all survive just fine and doesn’t understand my view. I think people like to think they’d be in the group of “survivors” but most likely they will end up eaten by a zombie and probably pretty quickly. And if they did happen to not get eaten, is the world really worth living in at that point??

          • MaineJen

            Remember the episode where they had to do a c section with no anesthesia because the labor was obstructed and the zombies were trying to break down the door? Yeeeeeah

          • guest

            Yeah that was horrifying. No way you could convince me to get pregnant and have a baby in that environment.

          • Who?

            I’m with you. It’s like when I read Victorian novels and imagine living in those stories, I used to assume I would be among the aristocrats or industrialists, not the maids, house servants or peasants, let alone the folk working in the factories. In real life though, the latter groups were huge and the former tiny.

            Do the numbers, people!

        • Daleth

          Well sure, but in such a situation I’m sure the “vegan” part of your handle would go out the window, and for that matter I would probably be willing to eat YOU. But short of apocalyptic Mad Max scenarios, I trust you would remain a vegan and I would remain a non-cannibal. (It’s not just vegans I won’t eat, it’s everyone).

          • MaineJen

            Why do these arguments always end up here? “Well sure, c sections and formula are fine for NOW, but what are you going to do when the apocalypse comes??” Uhhhhh, probably die along with everyone else, sadly. Feeding the baby and reproduction are going to be way down on my list of priorities, unless I happen to be pregnant or have a baby in the family when the apocalypse happens.

            What a weird outlook…I don’t think we should be living as if the apocalypse is imminent (although with the state of current politics, I might be more inclined in that direction than I would have been 2 years ago).

          • Heidi

            “Well, sure as planets come, I know that they end
            And if I’m here when that happens
            Will you promise me this my friend?

            Please bury me with it!
            I just don’t need none of that Mad Max bullshit”

            I feel like Modest Mouse lyrics apply here.

          • MaineJen

            I love Modest Mouse 🙂

    • Madtowngirl

      I’m not so sure it’s this straightforward though. Back when I believed I would still be able to produce, I looked into the option of selling extra breastmilk, and there is a lot of arguing about whether it is ethical to do so. Many lactation educators believe you should never profit off of breastmilk, and that it should be donation-only.

      • E.C.

        In some places, gestational surrogacy can only be unpaid. The idea that a woman’s time and work should be priceless keeps it from being assigned a market value, and actually thus keeps it worthless.

        In the northeast, a woman can earn about $30,000 for gestational surrogacy. Some states have banned it, though it’s less dangerous than a man going into a mine for coal or onto an oil rig.

        • Madtowngirl

          “The idea that a woman’s time and work should be priceless keeps it from being assigned a market value, and actually thus keeps it worthless.”

          I think this is the heart of why those arguments about “don’t sell your breastmilk” really got to me. The unspoken motivator seems to be to keep women from monetizing something that could be profitable.

          • Chi

            I have several concerns over selling breastmilk;

            1) How well will it be screened for infectious diseases/dangerous medications etc?

            2) How much will screening it drive up the cost to buy it?

            3) If it winds up being sold for ridiculous amounts, aren’t the mothers who buy it MORE likely to dilute or adulterate it in order to make it stretch farther? In other words, won’t they start doing what those against formula claim happens ALL the time, where people deliberately make up formula improperly in order to make a can of the powdered stuff go further?

            4) How the HELL can they say that sold breastmilk (which will likely wind up FAR more expensive than formula) be a BETTER option than just going to formula in the first place??

          • Who?

            Exactly.

            And just what will the black market in it (there’s always a black market in substances that are at all controlled) look like? Auntie giving hers to niece for great-nephew, at a family discount, never mind auntie’s secret substance abuse/unknown disease etc.

            Nothing good, and for no sensible reason.

          • Sarah

            These are also reasons why making formula prescription only is such a stupid idea, and we’ve heard that one before too.

            The issue of selling breastmilk does raise an interesting theoretical exercise though. We know that money makes a big difference to a child’s life chances. We also know that breastmilk can be sold, and that it leads to fewer colds and bugs in infants on a population level, in developed countries. A newly delivered woman in, say, the US or UK who is able to pump a lot theoretically has the option of flogging it all instead.

            I wonder if it would be possible to cost up how much a woman could sell a year’s worth of breastmilk for, deduct the costs of formula and then hypothesise how much impact this money could have on the child if then either spent on them or invested for them. Would be an interesting one!

          • Who?

            I think maidmarian’s comment above might respond to your thought about costing up a supply of breastmilk.

          • maidmarian555

            There’s already been an attempt by an American company to commodify breastmilk in this way. Ambrosia Labs worked out that paying American mothers a compensation they’d accept was too expensive so they went to Cambodia, where they were paying mums around $10 dollars a day for milk they were then selling in the USA for $20 for 5oz. Cambodia banned the practice but I wouldn’t be surprised to see this sort of operation popping up again somewhere else.

            https://www.theguardian.com/world/2017/mar/28/cambodia-breast-milk-us-export-ambrosia-labs

            I think whichever way you look at it, there’s no way you can properly compensate mums for their time and energy, ensure that their own children are being fed, thoroughly test and process the milk and then sell it for a price that would make it even remotely competitive with formula. Never mind the potential for exploitation. We’re pretty comfortable financially but $20 for 5oz would be well out of our price range. My daughter is 10 months and eating plenty of solids but still has around 20oz over 3 feeds every day. That’s $80 A DAY. I don’t spend that a month on formula.

          • Sarah

            I don’t think you could either! That’s not going to happen. I was thinking more that one could make quite a bit more than the costs of formula from selling breastmilk, especially if a prolific pumper, then invest it. One way to get a house deposit…

          • maidmarian555

            Yeah there’s clearly the potential for some serious money to be made, although I strongly suspect that for that money to land squarely in the mother’s pocket, she’d need to be selling it untested on the internet. For a prolific pumper, arguably she’d be even better off selling *all* of her breastmilk and giving her own child formula. Although, I don’t think this is quite what the ‘EveRYoNE sHOuld HAvE ACceSs to DonOR mILk’ people quite had in mind…..

          • Sarah

            I had similar thoughts…

          • Madtowngirl

            in places where breastmilk is available for purchase, women have reported it being significantly more expensive than formula. I completely agree with your concern, especially now that I’m no longer in that mindset.

        • Daleth

          The idea that a woman’s time and work should be priceless keeps it from
          being assigned a market value, and actually thus keeps it worthless.

          Yup. And that’s actually an outgrowth of the nasty old idea that women’s realm is the home, not the brutish outside world–in other words, our realm is love and caring, not money. We’re supposed to provide services to others through unselfish love and caring, not in exchange for money. Which is awfully convenient to the people we’re serving…

          • I’ve actually been told that nurses ought not to get a salary because what we do is a “mitzvah”.

          • Gæst

            That’s some bullshit right there.

          • demodocus

            Snort.

          • Daleth

            Omfg. Just shoot that comment right back at whoever says it: “Oh, it’s such a mitzvah to be a landlord, providing housing to families! You shouldn’t get paid money for that!”

          • yentavegan

            People say the cruelest things to women! Would we say something so demeaning to a male teaching Torah? We expect him to be paid, even though it is a mitzvah.

          • It derives from the original “nursing sisters” who were in fact nuns, and were not paid salaries. Indeed, the term “sister” is still a synonym for “nurse” in a number of languages [including Hebrew!]

            Florence Nightingale spent some time with the Protestant Deaconesses in Germany before going to the Crimea. At the time they were the only nurses not in religious vows with any sort of training. She was fairly critical of them. Later, when she was setting up the first professional school of nursing at St. Thomas’ Hospital in London, she got tons of unsolicited advice, and, never one to suffer fools gladly, commented to a friend in a letter, about those who thought that only “religious gentlewomen of independent means” should be accepted as students, “I WOULD FAR RATHER ESTABLISH A PROFESSION HIGHLY PAID THAN A RELIGIOUS ORDER”. [caps are in the original, and underlined]

        • Gæst

          There are even ethical concerns about paying for donor sperm, actually. The idea being that mostly young men do it without realizing the full extent of the consequences, so that it’s a form of exploitation.

          • Junior doctors, during my years in NYC, would often donate sperm to make a little pocket money. At least the OB/GYN could claim that he could vouch for the health of the “anonymous” source.

          • Gæst

            The donor I chose was a computer science guy, although that had nothing to do with why I picked him – if it had been an option after other more important criteria were met, I’d’ve chosen someone in the humanities.

          • This is a true story. One day a doctor we knew well in L&D in my NYC hospital came to work looking rather stunned, and when we asked why, he told us that he’d had an ultra-Orthodox patient who needed donor sperm to conceive via artificial insemination. “I know, Doctor”, she’d told him, “that you can’t tell me anything about the donor, but if it’s possible, could you find a donor of Italian background?” When he asked her why this was important to her, she replied “Because I want my child to look Jewish”.

          • yentavegan

            Well it is common practice to find a donor that resembles the father, no?

          • Gæst

            Yeah, I don’t get the joke/point here. Many sperm banks offer photo matching, and all of the ones I know of provide some basic information to families about donors that includes medical history, hair color, eye color, height, race, and ethnic roots. Often it includes far more than that – audio recordings, staff impressions of the donor, favorite color, etc. And all of it is available directly to the families seeking to use donor sperm today – doctors do not choose the donor.

          • Maybe now; this was a long time ago, almost half a century ago.

          • Daleth

            Maybe now; this was a long time ago, almost half a century ago.

            Oh, these days the amount of info on sperm and egg donors in the US is huge. I’ve seen everything up to multiple childhood and adult photos, family photos, info on donor and family health issues going back two generations, info on donor and family educational background and career, favorite movies/books/etc., videos, up to and including potentially meeting the donor.

            On the other hand, in Europe–or I should say, the European countries that people travel to for sperm and/or egg donation (due to legal or availability reasons, a lot of people in Europe go to Spain and the Czech Republic, and for cost reasons people travel there from the US too)–the doctors do choose the donors and they’re legally required to choose ones who have a similar “phenotype” to the parents. IOW if a slim blonde woman with green eyes needs an egg donor, they’ll find a slim, blonde, green-eyed egg donor. Recipients can never see photos and don’t get more than basic info (age, education maybe, health and fertility background maybe).

          • Gæst

            I find that rule pretty icky. A blond woman must have a blond donor? Ug. I have also seen weird fetishization on message boards where white women want black sperm because they think biracial babies are just so cute, but forbidding it doesn’t seem right either. And what if you have something rare, like red hair and blue eyes? You just have to wait around until the right match comes up?

          • Who?

            And really who can say what colour hair or eyes someone really has? A quick trip to the hairdresser, pair of coloured contact lenses and a white lie or two on a form and you become your own ‘ideal’.

          • Gæst

            Of course, but this isn’t about that. It’s about genetic resemblance.

          • Daleth

            Well, bear in mind that in the US, where no rules exist to dictate what donor you can pick, women almost always want one who looks like them. A blond woman wants a blonde donor, a Korean woman wants a Korean donor or bare minimum an Asian one, an African-American woman wants an African-American donor with a similar complexion to herself, etc. Tall, tall. Musical, musical. Scientist, scientist. Nurse, nurse.

            This isn’t sperm donation we’re talking about; you’re literally looking for someone whose eggs can replace yours. It’s very normal to want someone as similar to yourself as possible. And on top of that, with all the trauma already imposed by infertility, for the sake of both themselves and the eventual kids, most people would rather not add to it by having kids who look different enough for every nosy armchair geneticist on the face of the earth to interrogate you at the bus stop or make jokes about how those must be the postman’s kids. Even innocent questions like “Wow, so who in the family is blond?” get old after about the 50th time.

            The rules that exist in Spain and the Czech Republic about phenotypically matching donors exist mainly for that last reason–to protect the privacy of the kids and parents involved. And because those two countries are among the very few European countries where egg donors are paid, it’s actually not hard to find less common, uh, phenotypes. I know a green-eyed blonde woman who went to Spain for IVF and with no apparent difficulty was given a green-eyed blonde donor, despite that combo being much less common in Spain than it is here. They also have racial/ethnic minority women who donate. It’s not that hard.

          • Gæst

            It may be normal for *many* women to choose a donor who resembles them, but what I find objectionable is forcing it – purity of the races, much? I know a lot of SMCs, and in our choices for sperm and egg donors, “looks like us” is rarely the top priority. That attitude is from a different era, when ART (and even adoption) was something you kept secret from your child and the world. SMCs are usually completely open about the fact that they have used an anonymous donor, with their kids as well as anyone else – and this is healthy for the children that result. There’s a big push away from keeping egg and sperm donation secret from children, as well as a push away from anonymous donation. But by allowing choice, those who which a phenotypical donor can still have it for whatever reason they want it.

            In the US, donation is for money, and sperm banks are a business. If a particular type of donor is not very desirable among their customers, they don’t stock them. This includes the obvious, like serious genetic disorders, but also phenotypes – red haired donors supposedly don’t sell as well, even though one would have been my preference.

            But back to the original point, with the easy availability of genetic testing now, anonymity is likely a thing of the past. I already know SMCs using these tests to try and identify their anonymous donors, as well as half-siblings. I don’t agree with their actions, since the donation was made on the basis of anonymity, but it is happening. I used an Open ID donor myself to avoid that issue.

          • Daleth

            I know a lot of SMCs, and in our choices for sperm and egg donors, “looks like us” is rarely the top priority

            Top priority? No, but in the EU countries where these laws exist, they already select for the actual top priorities, namely personal and family health (which parents care about because everyone wants their kids to have a great chance of being healthy) and fertility (which parents care about because without that, you don’t get a baby in the first place).

            Those characteristics are a given. The donor’s looks are how you choose between multiple donors who are all healthy and fertile. So nobody is saying that looks are the top priority.

            As for the SMC’s you know, a single woman using donor sperm is in a totally different situation than a woman, single or not, using donor eggs. The donor-sperm woman is using her own eggs. The child already has a strong chance of resembling her because of that. A woman choosing a sperm donor isn’t even remotely trying to replace herself, so why would she care whether he looked like her?

            Side note: I think you’ll find, if you ask, that when heterosexual couples use sperm donors due to male infertility, they usually want donors who look like the husband. Basic principle: people who are using a donor to replace the gametes of one of the parents usually want a donor who looks at least somewhat like that parent.

            And in my experience/among those I know, that’s not because they’re planning on keeping donation secret from the kids. Most parents who use gamete these days are “open,” i.e. they tell their kids. They still want a donor who resembles the parent whose gamete is being replaced, though. It’s probably partly for the “what if” factor (what if we had been able to have a kid together–this is what our own genetic kid might have looked like) and partly to avoid nosy strangers bothering themselves and/or the kids.

            Whether that promotes “racial purity,” as you suggested, depends on whether it’s a mixed-race couple or not. And as for single women, in the Czech Republic at least that’s a moot point because only married women are allowed to do IVF with egg donation.

          • Gæst

            Why so condescending? I’m hearing what you say about sperm and egg donation in Europe, but you keep talking down to me when I describe how it works in the US. No, looks are NOT how most SMCs choose after health and fertility – you think that I don’t know those are a given? Of course they are. But those requirements are mostly managed by the sperm banks – potential donors who don’t meet them aren’t allowed to donate. I also know quite a few couples who have used donated sperm or eggs, though I am more familiar with the SMCs, and though I cannot give specific examples for privacy reasons, “looks like me/my partner” are not the most commonly cited reasons for choosing a particular donor among that group, either.

            Good job dodging the main point of my comments, though, which is that allowing people to *decide for themselves* whether phenotype is important to them or not is a better policy.

          • Daleth

            I totally agree that people should be able to choose for themselves. I’m not saying the Czech and Spanish laws are awesome and we should have them here. BTW I know, in great detail, how it works in the US. It’s one of the fields I practice in as a lawyer.

            I’m just saying that those Czech and Spanish laws don’t have all the baggage that you’ve been trying to put on them, and that in a situation where you’re not allowed to choose your donor anyway (which is the situation throughout the EU), most people are fine having doctors select for health, fertility, and (in third place) resemblance to the patient.

            And of course my other point is just that when it comes to a donor’s physical appearance, the priorities of SMCs choosing sperm donors are not the same as the priorities of women choosing egg donors.

          • Gæst

            I disagree that those laws don’t have the baggage of eugenics and racism.

            And you are still assuming that a) SMCs never make use of egg donors, and b) that I didn’t know that couples may have a different approach to choose a donor, whether egg or sperm. The reason I mentioned being most familiar with SMCs was to make clear that I AM aware of that. I don’t enjoy a conversation where the other person assumes I am not informed.

          • Daleth

            I disagree that those laws don’t have the baggage of eugenics and racism.

            Then let’s agree to disagree. The vast majority of egg donation recipients in Europe are white, and I don’t see racism or eugenics in the practice of giving the eggs of green-eyed donors to green-eyed women, brown-haired donors to brown-haired women, tall donors to tall women, red-haired donors to red-haired women, etc.

            And you are still assuming that a) SMCs never make use of egg donors

            I’m not assuming that, I’m just not talking about that situation. My only point is that a woman choosing a sperm donor to fertilize her own eggs is not comparable to a woman choosing an egg donor to have babies with [insert man here: her husband, a sperm donor, etc.].

            Psychologically those are fundamentally different things: in one situation you’re looking for someone to replace yourself, and in the other, you’re not. So the fact that women choosing sperm donors don’t tend to care whether he looks like them has no bearing on whether women choosing egg donors do care or should care.

          • Daleth

            But back to the original point, with the easy availability of genetic testing now, anonymity is likely a thing of the past.

            Yes, definitely. A random second cousin of mine found me on Ancestry.com after we DNA matched. He’s the grandson of my grandma’s brother from a marriage I’d never heard about, in said brother’s native country!

          • Not always. Depends on the situation and the availability.

          • Daleth

            The idea being that mostly young men do it without realizing the full extent of the consequences, so that it’s a form of exploitation

            If that’s the definition, EVERYTHING is exploitation. Since when do young people “realize the full extent of the consequences” of any of their choices? Since when does anyone?! Did you realize the full extent of the consequences of deciding to have or not have children yourself, or deciding what college to go to or what to major in, or deciding on your career, back when you made those decisions?

            They don’t need to “realize the full extent” of consequences. They just need to realize the consequences well enough.

            Or as a California appeals court put it in an early (1993) case about surrogacy:

            “Although common sense suggests that women of lesser means serve as surrogate mothers more often than do wealthy women, there has been no proof that surrogacy contracts exploit poor women to any greater degree than economic necessity in general exploits them by inducing them to accept lower-paid or otherwise undesirable employment.”

            Johnson v. Calvert, 851 P.2d 776, 785 (Cal. App. 1993).

            https://www.courtlistener.com/opinion/1313999/johnson-v-calvert/

          • Gæst

            No one is proposing those exact words as a definition for exploitation. I’m just pointing out that there are concerns that anonymous, paid sperm donation may be exploitative of young men strapped for cash. It also involves practices by the sperm banks – are they given enough information to make informed consent? Does the recent popularity of home DNA testing mean an end to anonymous genetic material donation? (Probably.) The argument for their exploitation is basically the same as it is for women selling breast milk or eggs – that economic necessity might drive them to do something they wouldn’t otherwise.

          • Gæst

            And I’m not asserting a position either way on whether it is or isn’t exploitation – my intent was just to share that it doesn’t exclusively apply to restricting women’s options.

      • The situation is way beyond ethics. Where is the donated milk coming from, how is it packaged, sterilized [which generally kills all those good antibodies], transported under what conditions — in short, unless it’s from your best friend next door, it is a totally unregulated and undependable source of milk.

        • FormerPhysicist

          And nobody’s ever been blind-sided by health or lifestyle news from their best friend. /sarcasm

    • FormerPhysicist

      No way. I’m NOT trusting my infant’s health to some unknown woman’s health status. I WAY prefer formula. easy, cheaper, less likely to be contaminated.

    • Heidi

      That’s the major problem, that the lactation community thinks they can decide for me what should be a “last resort” and what’s less than ideal. This isn’t based on science. This is based on a heaping pile of sexism. I don’t want to feed my child another woman’s breast milk PERIOD. And in an apocalyptic situation where pregnancy termination isn’t available, I believe I would kill my pregnant self if the other option was to attempt to raise a child in the apocalypse. If somehow I had no warning that the apocalypse was going to happen and find myself with a baby too young to drink something other than breast milk or formula, I’m not sure how I’m going to find a nursing woman who can provide extra milk in the apocalypse. She is probably barely able to feed her own child because I’m sure her own food resources are limited. I might put my child and I both out of our misery.

      If a woman enjoys hooking herself up and pumping and selling that milk, whatever, go for it. But foreseeing a world where women are expected to do this…that’s some creepy shit.

    • Heidi

      I’ve already commented on this, but to me, this proves LLL original beliefs from the 50s or 60s are still present, and I will continue to be very suspicious of them. Keep women home! A woman must fulfill her biological role and nothing more or less. I mean, sure men can donate their sperm (although sitting around masturbating sounds a lot more pleasant and quick than being hooked to a breast pump for HOURS), but it’s not expected of them, and I don’t think it ever will be. Given that about 15% of women can’t produce enough milk, that means probably at least 30% of breastfeeding women will have to pump for other women. I think you’d want more than that because you wouldn’t want there to be just enough breast milk. Is there a world where that many women really want to pump for a few dollars? There’s no way pumping is going to pay as well as a job outside of the home. And there’s no way it’s going to be as cheap as formula. So sounds like a whole lot of effed up. Women make measly money and other women have to pay A LOT for breast milk.

      And maybe I’m overstepping here, but you support this as a vegan? You don’t think cows should be hooked up and enslaved but you want this for human women? As a person who avoids dairy out of ethical concerns, I really don’t see how making human women dairy cows is ethical.

      • maidmarian555

        You’ve articulated exactly what I’ve been thinking. TBH I think the only way you’d get enough women pumping enough milk at consistent levels that we could get rid of formula altogether is if it was made a legal requirement. You know like how they’ve made it the law in that bastion of female empowerment, Saudi Arabia, that all mothers must breastfeed for two years minimum? I mean it’s not such a leap from there to demand that all mothers must supply a certain amount of pumped milk during that time to the milk bank. That is not any sort of ‘win’ for women at all (regardless of whether you chuck them a few quid for their troubles).

      • yentavegan

        I do not in any way support women selling their breastmilk. I do, however, support sisters, aunts, cousins cross nursing if they so choose to do so. I have , when asked, if I think donating human milk to a non-profit human milk bank is a good use of extra milk, I so support that. I agree with your assessment that LLL in our original true to mission philosophy , do encourage hands on within arms reach , mothering during the early years of a child’s life. As new more feminist minded women/parents join LLL, that part of our mission statement is under scrutiny. Furthermore I proudly separate my work as a volunteer from the Lactation Industry.

        • Heidi

          “The lacation industry foresees the day when a lactating mother can monetize her breastmilk production in order to help feed another baby while earning money for her own family. It is a win-win.”

          I assumed the “win-win” was your own assessment and opinion.

          • yentavegan

            My snark voice …sorry if I wasn’t clear

          • Heidi

            🙂

        • Megan

          You know, I actually did this with my first child. I was so enamored with breastfeeding ideology that when I couldn’t produce breastmilk I got it from a friend and a woman referred by my LC. I saw both of their prenatal lab results but there are some things you can’t test for. I later found out that my friends husband was cheating on her while continuing to have sex with my friend. She could’ve contracted HIV or hepatitis at any time and I and she wouldn’t have known. Fortunatey, after she found out she got tested again and it was fine. I have no further contact with the lady my LC referred me to for breastmilk and there’s no reason the same thing couldn’t happen to her. It is irresponsible of an LC to promote milk sharing without at least acknowledging these risks and I personally think they shouldn’t be referring for donor milk at all unless they are affiliated with a milk bank. My daughter is fine but I would never do that again. I am ashamed I did it at all as a physician who should know better. But you really do get caught up in the fervor as a postpartum, sleep deprived, first time mom and do stupid things. I vowed I would never do it again and I am thankful I have formula and clean water to feed my children.

          Also, all the points made about donor milk for all babies not being feminist are totally true IMO. You’d never have enough milk for everyone unless it was mandated to turn women into dairy cows. Don give the GOP any ideas.

  • Trees

    Even before I began reading your blog, I wondered why exclusive breastfeeding required supplementation with vitamin D (and other nutrients when moms were deficient) if it was the safest and most complete food. Meanwhile, formula-fed babies needed nothing else until they were old enough for solid food.

    • Daleth

      Yep! Breastfeeding obsessives like to overlook that fact.

      • PeggySue

        I remember a blog writer who was pretty proud of the fact that she exclusively breastfed her children. That was part of her bio actually. She was stunned when her kids were diagnosed with iron deficiency anemia sufficient that the pediatrician recommended supplemental iron. She could not fathom how such a thing could have happened. Apparently whoever “supported” her breastfeeding never mentioned this.

  • “I have worked in over 50 countries, and I have not seen so much opposition to BF [breastfeeding] as in the USA,” Victora [an epidemiologist at the Federal University of Pelotas in Brazil] wrote. “Is it because many women feel wrongly guilty for not breastfeeding in a society that does everything it can to prevent mothers from BF (no paid maternity leave, free formula samples in hospitals, no BF in public, etc)? Are there other explanations?”

    • Amy Tuteur, MD

      That’s the same type of argument the anti-choice crowd makes when opposing abortion: if only women were better educated and received more support they would never terminate pregnancies; they are suffering from false consciousness at best and ignorance at worst. But they aren’t! Similarly, women who can’t or don’t wish to breastfeed aren’t suffering from false consciousness, either. HER baby, HER body, HER breasts, HER choice. Why is that so difficult to accept?

      • He didn’t make any argument about women being educated at all. You just made that part up.

        I do certainly believe that maternal support is poor in the USA and there should be more. Paternal support is poor too.

        But I am beginning to understand where you’re coming from now and why are are so passionate about pushing this side of the argument.

        I’m not aware of anyone who has attempted to take the choice to breastfeed or not away from the mother. If that position exists, it is a fringe one and doesn’t concern the actual people in this discussion. If you’re worried about promotion, then don’t worry – funds to promote infant formula will always vastly outweigh funds to promote breastfeeding. But the only thing significantly preventing formula access is poverty, not public health advocates.

        • Amy Tuteur, MD

          Then you are not aware of the aggressive breastfeeding promotion efforts embodied within the Baby Friendly Hospital Initiative. That’s a big lapse for someone making accusations about why women don’t breastfeed.

          • You’re going to have to make a more specific claim to show how the BFHI disproves any of the points I made.

            And how do you think all the insults will convince me?

            Imagine for a moment that there was a neutral observer looking at what you just said. Do you believe that degree of constant snark is what will convince them to your side of the argument, or do you just do it for entertainment? It adds an additional extremely tiring element to the conversation.

          • space_upstairs

            Longtime lurker pitching in here…not exactly a neutral observer as my own hesitance to follow the popular “natural parenting” mandates if I did reproduce led me here long before I got married and 3 months pregnant, but following this debate has led to sorting out a lot of thoughts on the matter and gaining more confidence in my own stance (leaning towards formula feeding for practical and feminist reasons, and with the resources to do it right, but pumping would be preferred in the case of a very premature baby whose intestines might need the most scientifically robust benefits of breastmilk).

            From what I understand from reading a lot about the matter, the BFHI tends to promote some rather draconian restrictions that can cause demonstrable harm – largely in first-world hospitals where bottle-feeding is much safer than in the communities in which your activism is based – in order to try to promote breastfeeding. These include making formula only available by prescription in the hospital, discouraging pacifier use (with much better scientific evidence suggesting that pacifiers reduce infant suffocation than that they reduce latch or will to feed during breastfeeding sessions), and pushing exhausted post-partum mothers to hold their babies in order to promote breastfeeding, which can lead to unsafe sleep positions and thus falls and suffocation risks. Of course, this is a separate issue from the marketing of formula to very poor families and their doctors and midwives, but it is an issue nonetheless, and the WHO standards were the supposed inspiration for these restrictions.

            As for snark and condescension, believe it or not, there are people who try to look past those matters and to the question of what is being said and whether it makes sense. Here’s what both sides of the argument look like from here, taking out all snark and condescension:

            Yours: Breast is best according to the largest number of studies and organizations, and especially in very poor parts of the world where families cannot afford adequate formula or good water to make it or refrigeration to keep extra formula fresh. That’s as true now as it was during the Nestlé fiasco 45 years ago. It is therefore the most practical policy on a worldwide scale to continue to promote breastfeeding and discourage formula marketing at least until everyone can get clean water and cheap formula. It is potentially dangerous to third-world infants to suggest that opposing these efforts may be beneficial. Also, marketing influences many minds to possibly make bad decisions.

            Amy’s: In the first world, and when looking at the studies that make the best effort to control for confounding factors like the wealth of breast-feeding vs. formula-feeding families, it’s not always clear that breast is best. In fact, heavy-handed attempts to promote breastfeeding in the first world specifically – a separate issue from the third-world stuff – seem to have been causing more harm than good, ranging from a culture of guilt and shame that leads many first-world mothers to seek out alternative voices such as this blog, to the Baby Friendly Hospital Initiative and the suffocation and near-starvation/dehydration that can result from its crude implementation and other efforts to try too hard to breastfeed in places where formula feeding is quite safe. Therefore, one size does not fit all when it comes to infant feeding policy, and controversial measures to soften breastfeeding promotion may in fact help more first-world babies, especially, than one might think (and perhaps harm fewer third-world babies than one might think, according to a new study mentioned in another post). Also, marketing is not the only thing that influences families’ decisions.

            What I take away from it: in the end, one size does not fit all. Breastfeeding promotion should probably be done differently in areas with different average wealth and infrastructure, and overzealousness on either side is probably not going to help anyone’s cause.

          • The Bofa on the Sofa

            Here’s the view that accommodates both perspectives:

            All else equal, breast is best. However, all else is never equal.

          • space_upstairs

            Yeah, sounds about right for a short, general version of it. My tl;dr came to the conclusion that one of the biggest things that’s never equal is the set of socioeconomic and cultural conditions. Hence both sides can be right for the specific conditions that they primarily focus on.

          • Sue

            Bofa’s Rule is very useful – I have quoted it multiple times.

          • seenthelight

            You are the tiring element, by this outsider’s view. If you look at her blog posts, there are many about the negative effects of the BFHI and social pressure to breastfeed. No one’s going to sit here and copy and paste all of them for you. Just poke around the site for a bit. You’ll quickly find out what you didn’t know coming into this conversation.

          • “Many of these deaths could have been avoided if more mothers had breastfed. There are a number of effective antenatal and postnatal behavioral change interventions that improve breastfeeding practices and thereby reduce infant formula use (35). Examples include education and counseling during the prenatal period as well as hospital and homebased support in the postpartum period (36, 37), and effects of which can be enhanced by including fathers (38). A very effective program is the Baby Friendly Hospital Initiative, which bans promotion of bottle feeding infants post-partum and supports breastfeeding immediately after birth and throughout the crucial first few days (38).”

            That’s a paragraph pulled directly from the study that Amy quoted positively earlier this week. Of course, she didn’t quote that paragraph because she is cherry-picking only the aspects of studies which agree with her narrative.

            I read all the half-dozen posts made on the topic this week as well as all of the comments, and much of the supporting literature linked in them. I assumed that the most recent arguments would have been the best and most complete ones. If there is something missing that would be relevant here, then feel free to copy and paste it, but I haven’t seen anything so far that would make me think that it would be worth additional effort.

  • sdsures

    It will take enough babies dying of starvation and dehydration. Babies who are the children of important, politically-influential people. :'(

  • Cestrum Nocturnum
    • Montserrat Blanco

      This is what happens with any other mass produced food (or water). We have had cases of soya sprouts contaminated with E. coli in Germany, water in Flint in the USA, cooked chicken in Spain, etc. Safety food standards are very high, and infections due to mass produced food remain thankfully low. The alternative is getting food borne diseases out of your personally produced food, with no quality control and no regulations. Some friends of mine did their tomato sauce preserve not exactly right and 4 people in the family got botulism and that is hardly the only case I know personally. Formula with Salmonella makes headlines as the soya sprouts did, and I am all up for higher regulation and better standards and of course ensuring safety is of outmost importance. Statistically if you want the higher safety, eating at MacDonalds is better (for food borne diseases) than at your local vegan bistro.

      15% of first time mothers do not make enough milk at the beginning. Malnourishment is an immediate risk for babies survival. It of course outweighs the minuscule risk of food borne infections.

      For the record, my son was combo fed in Spain, one of the affected countries during that period,

  • Gæst

    Is there any evidence that Nestlé or any other formula company continues to send representatives out to underdeveloped areas to get women to try formula so their milk will dry up and then they’ll have to keep buying it? Or anything like that? Because I keep running into people who believe this is still going on. It was a horrible thing to do, but are they still doing it?

    • Montserrat Blanco

      No, they are not. It happened 40-50 years ago and we are still hearing it as happening today and as it still is a thing.

    • Cestrum Nocturnum

      The Nestle corporation has moved on to making safe drinking water expensive instead of crappy baby formula.

      https://www.bloomberg.com/news/features/2017-09-21/nestl-makes-billions-bottling-water-it-pays-nearly-nothing-for

    • Yes, it continues to be a massive issue, because the infant formula industry has hundreds of times more money available for such purposes than any pro-breastfeeding group:

      “Formula milk companies are continuing to use aggressive, clandestine and often illegal methods to target mothers in the poorest parts of the world to encourage them to choose powdered milk over breastfeeding, a new investigation shows.

      A Guardian/Save the Children investigation in some of the most deprived areas of the Philippines found that Nestlé and three other companies were offering doctors, midwives and local health workers free trips to lavish conferences, meals, tickets to shows and the cinema and even gambling chips, earning their loyalty. This is a clear violation of Philippine law.

      Representatives from Nestlé, Abbott, Mead Johnson and Wyeth (now owned by Nestlé) were described as a constant presence in hospitals in the Philippines, where only 34% of mothers exclusively breastfeed in the first six months. Here, they reportedly hand out “infant nutrition” pamphlets to mothers, which appear to be medical advice but in fact recommend specific formula brands and sometimes have money-off coupons.

      Hospital staff were also found to be recommending specific formula brands in lists of “essential purchases” handed to new mothers. Targeted advertising on Facebook and partnerships with influential “mummy bloggers” means mothers are being exposed to more unregulated formula promotion than ever before.”

      https://www.theguardian.com/lifeandstyle/2018/feb/27/formula-milk-companies-target-poor-mothers-breastfeeding

      • Amy Tuteur, MD

        Has it ever occurred to you that accusing women who disagree with you of being corporate dupes is rather ugly? https://uploads.disquscdn.com/images/b72860854e59766dca53ae8a34619fbec9331f5e9272051a173e510ad173ef7f.jpg

        • What are you talking about? I did no such thing.

          Nor have I ever mentioned Nestle’s immoral formula promotion in the 1970s.

          What I have accused you of is using disingenuous argument tactics that don’t address the actual issues I’m raising. Which you have again demonstrated.

          • Amy Tuteur, MD

            If you are claiming that formula marketing is responsible for the popularity of formula then you are assuming that women who choose formula are corporate dupes.

          • Advertising is a $600 billion industry for a reason. They wouldn’t do it if it didn’t work.

            To suggest that corporations like Nestle are wining and dining medical professionals in third-world countries for no effect would be ridiculous.

            In fact, you believe the exact same thing, otherwise you wouldn’t be complaining so much about breastfeeding promotion.

            And you said, “accusing women who disagree with you of being corporate dupes.” Now you’ve switched the accusation to something else entirely. But I do see what you’re going for, considering what you admitted above regarding your ideological basis for your position

          • Amy Tuteur, MD

            Formula use is widespread in industrialized countries. They don’t advertise to promote formula; they advertise to promote brand awareness so women will choose one brand over another.

            Claiming that formula companies advertise to convince women to use formula is like claiming Crest advertises to convince people to use toothpaste.

          • Both certainly occur. They are trying to increase their share of the pie as well as the size of the pie simultaneously.

            I thought you already admitted that when you said at the beginning that the Trump Administration made their recent move at the bequest of formula companies. They wouldn’t care about what breastfeeding promotion was going on unless they were still fighting for more women to use formula overall. Formula companies have seen sales stall in industrialized countries, and now chase industry growth in developing nations.

          • maidmarian555

            Ok, ok. So, question for you. Obviously formula companies do shitty things in order to increase market share and make money. Why do none of the big health organisations or any governments make their own formula and cut them out of the loop? There are always going to be mums who can’t/don’t want to breastfeed no matter how much Breast Is Best propaganda we bash them over the head with so why is there no desire to take control over the only safe alternative way to feed their babies? Why is all the responsibility being dumped in the laps of individual mothers to try harder or breastfeed more even if they can’t or don’t want to? Is it really ethical to blame these individuals when there is zero collective will to provide an alternative feeding method that would nullify the power and control Nestle, Danone etc etc have over the current market?

          • Do you know for certain they do not? I don’t know that no one produces nonprofit infant formula.

            But as a general rule, industrial production on that scale is quite a logistic endeavor and international bodies like the World Bank have pushed developing countries heavily towards privatization of production.

            I don’t think any blame should be directed towards the individual mothers, and I haven’t seen anyone trying to do that here. On the ground, of course, the bedside manner of many medical professionals leaves a lot to be desired.

          • maidmarian555

            The policies of the WHO right now in and of themselves place the responsibility to breastfeed at the feet of individual mothers. That’s why, for example, Doctors Without Frontiers have had to make statements about how current policy is causing problems in the frontline. Saying that nobody should have formula without a prescription means in practice that babies have to present with severe symptoms of malnutrition before being ‘allowed’ formula. It means that here in the U.K.,food banks won’t accept formula because by some twist of logic if they did, it would somehow disencourage mothers from breastfeeding. The policy places that blame and pressure on individual mothers. That’s the whole point of it. It absolves health organisations of any responsibility for ensuring all babies are properly fed- even those for whom BF is not a viable option.

          • That’s the second time that Doctors Without Borders has been brought up, and I’ll point out again that they specifically praised WHO’s recommendations and said they were good ones, but that better allowances needed to be made for war zones. Which is something I would certainly cosign.

            I’m fairly certain that none of WHO’s recommendations state that only babies presenting severe symptoms of malnutrition can get formula, and I know of no nation where that is true on a meaningful scale for any reason other than poverty and the cost of formula distribution.

            If mothers have to rely on food banks to get their formula than that’s a sign of other problems in the system. Personally I don’t think that formula access within food banks would really move the needle either way.

          • maidmarian555

            So why restrict it then? It doesn’t move the needle either way bc mums who were previously feeding their babies formula and now have no money to get it feed those infants other things. If they can’t afford formula and can’t get it from the food bank, they certainly aren’t giving those infants breastmilk, are they? And yes, it’s indicative of other issues within the system. The existence of food banks tells us that there are real problems with poverty even within a country as wealthy as the UK. The policies of the WHO in particular are used as an excuse to do nothing in these situations (whether that’s fair or not is moot. That’s what’s happening in practice- and the WHO know it).

            And yes, BFHI policy and WHO policy is interpreted as meaning that any baby that isn’t presenting with signs of malnutrition is not given formula. That’s exactly what MSF complained about *specifically*. They have to wait for said babies to literally collapse before they can help. Syria wasn’t some backwater before the war, there will have been plenty of mothers who chose/had to use formula before the war and when the war happened, the option to BF was already long past. Those parents are not entitled to formula *until* their babies get sick bc they’re starving. That’s the policy everyone is complaining about.

          • Personally, I wouldn’t restrict formula from food banks, no. But as I said, it isn’t really important either way.

            I don’t have any experience with UK foodbanks, but in the USA foodbanks are purely low-level supplemental and don’t provide the bulk of anyone’s food requirements. It’s pretty much expected that you get what you can from the food bank and find other means to get the rest of what you need, so any particular item not being available makes little difference because that just makes it the one you buy.

            “any baby that isn’t presenting with signs of malnutrition is not given formula” – which country is that occurring in? I haven’t seen documentation for that particular policy.

            I am under the impression that MSF can give formula to whoever they wish, and that formula can be bought by whoever wants it, but that MSF complained that WHO was only distributing their free formula by prescription. I agree with what you appear to be saying, that in conflict zones where emergency supplies are needed that infant formula should be provided without barriers to those who need it.

          • maidmarian555

            So here in the UK, food banks plug the gap when you don’t have any money for food. For example, when you apply for benefits, there’s a minimum of a five-week wait for money. During that five weeks, food banks are now (sadly) normally where ppl go to get food. A can of formula is around £10. Where are people who can’t afford a 40p bag of pasta going to find that money from? There are vouchers you can get that will cover about half the cost of that can but you have to apply for them. And still find the other £5. When you say ‘this isn’t important either way’ it *is* important to this specific demographic. It *is* important to these families and it *is* important to these babies.

            As for Doctors Without Borders and WHO policy regarding only giving infants formula via prescription, see here:
            https://www.doctorswithoutborders.org/what-we-do/news-stories/story/iraq-babies-suffering-severe-malnutrition-mosul-region

            Yes they can sort of get around policy but it creates barriers. That don’t need to be there and could be removed by the WHO if the political will was there. I don’t think we disagree on this specific point. It should be official policy in conflict zones that those working within them can supply formula to infants that need it. It’s, frankly, bizarre that this is not already the case.

          • Yeah, when I worked in food banks in the USA nearly all of the customers were long-term and typically already on benefits so it was a bit of a different situation. (Also, I don’t think I’ve mentioned this but we certainly did give out formula to families with babies under one, at least we did in the 2006-2010 period when I was around them. It never even occurred to me to ask mothers about breastfeeding, it was just automatic.)

            On the WHO policy, I wasn’t questioning that they only give infants formula via prescription, I was asking about the claim that they only give such prescriptions to malnourished infants who are “sick because they’re starving.”

            I agree with you – I don’t think we actually disagree on these points around the edges of the main thing.

          • maidmarian555

            In the U.K. during the 2006-2010 period we had a Labour government, a reasonable welfare system and food banks existed but, as you say, we’re predominantly used occasionally by long-term claimants. I worked on a rough estate from 2007-2009 with unemployed people. We were a referral agent for the food bank (you used to need to be properly referred by another agency) and during that time we maybe referred a handful of people. In 2010, the Conservatives took over and they’ve been systematically decimating welfare ever since. The benefits system is now an Orwellian nightmare and the Jobcentre will ‘sanction’ claimants for doing terrible things like being five minutes late for an appointment (which has been made more likely after they closed so many offices that it’s not uncommon for people to have to travel miles to get to their ‘local’ office via a public transport system that has also been decimated by government cuts). By ‘sanction’ I mean stop their money. Sometimes for weeks at a time. And these are people who are already living hand-to-mouth.

            It’s not just that though, there are people working full-time who can’t afford to feed their families and because they’re working, aren’t able to access much in the way of help. The cost of living has rocketed and wages haven’t caught up. There’s an awful lot of families who are literally just one redundancy or one broken-down car away from complete financial disaster.

            Well over a million food parcels were given out last year. There will have been people in amongst that who desperately needed formula but were unable to get it. And who may well not have any other available resources in order to feed their infants.

          • That’s terrible. I hadn’t known about UK systems degrading to that degree, but it’s really rough to hear.

            The most pathetic thing is that there are countries which are doing a better job, a demonstrably better job, yet the countries with poor systems don’t have the political will to look at the more successful nations and replicate them. The English-speaking nations, for whatever historical/cultural reasons, seem to be particularly poor in this regard.

          • Sarah

            Of course there are other problems in the system, hence the food bank in the first place. However, as for better or for worse there are people in the UK who need to use foodbanks, and some of them have babies who need formula, foodbanks refusing or not being allowed to provide formula is a problem in itself. And one that can quite easily be avoided.

      • BeatriceC

        I see an awful lot of accusations both in your comment and in the article, but no actual proof that any of this is true.

        • The article from The Guardian cited their own in-depth investigation and quoted a doctor, a midwife, a mother, and industry representatives. it was in fact an industry representative who provided the exact answer to the original question.

          What would you consider “proof”?

          “Julianne Bores, a GlaxoSmithKline representative who worked alongside formula representatives in hospitals since 2009, described a culture of financial dependency, where if doctors want to go to expensive medical conferences – held mostly in lavish hotels or abroad – they would always ask the milk companies for sponsorship, and were occasionally allowed to bring their spouses. Formula representatives would also pay for “rest and recreation activities” for doctors and their families, such as tickets to Cirque du Soleil, and meals at popular restaurants.

          Bores was also an observer of the “parenting” and “nutrition” forums for parents held in the hospital canteens by the formula representatives, where samples or branded freebies like umbrellas and feeding bottles would be distributed. All these practices are a violation of Philippine law.”

      • Montserrat Blanco

        I kindly suggest you read Gaest post and the article you link in The Guardian. Gaest asked if formula companies are still marketing directly to women offering samples so their milk dry up. Your article describes marketing directed to doctors and midwives. Two different things. We can discuss the Guardian piece and how it clearly states that the woman for the “case study” had important difficulties breastfeeding. Formula was expensive for her but probably she had to make a choice between letting the baby starve or starve herself to feed her formula. In this case, in my opinion the solution would have been cheap, or better, free formula instead of breastfeeding.

        To put things in perspective pharmaceutical companies use marketing to doctors routinely, with the same approach described in The Guardian piece, and it depends on the country the level of regulation about it. Next time you get any prescription, know that this is what happens behind the scenes providing your government allows it.

        • You really think there’s a substantial difference between marketing to women and marketing to doctors so that they will market to women?

          Even by your distinction though, you’re wrong. Right out of the article:

          “Here, they reportedly hand out “infant nutrition” pamphlets to mothers, which appear to be medical advice but in fact recommend specific formula brands and sometimes have money-off coupons.”

          “Targeted advertising on Facebook and partnerships with influential “mummy bloggers” means mothers are being exposed to more unregulated formula promotion than ever before.”

          I completely agree with you that for women who cannot breastfeed, cheap or free formula is the best option, and we should do a better job of diagnosing that and subsidizing it for women in need.

          I also agree that pharmaceutical companies do this sort of thing regularly, and I believe it is problematic across the board. One of the main points of The Guardian piece is that even where regulations exist, the companies are flaunting them.

          • Gæst

            You make it sound like women are stupid, not understanding that coupon prices are different from regular prices, etc.

          • No, I don’t believe women are stupid. However, in many nations (including the one I live in) there are profound power differentials between people in society and marketers often take advantage of that in order to manipulate customers to their own ends. Both medical professionals and those who portray themselves as “professional experts” can be abusive in that respect. (Even a completely uneducated non-expert, like an MLM salesperson, will use this dynamic for their own ends.)

          • Gæst

            So, again, you think women are stupid.

          • Nope, not in the least. And since the entire conversation history is right here anyone can see straight through your tactics – it does not reflect well on you, and it does help a single woman or a single baby anywhere in the world.

            This discussion started with you asking a question. I answered it with a clear, linked citation. Someone else gave the opposite answer with no evidence at all. You have chosen to believe the unsourced answer over the cited answer and then proceeded to attack me with baseless insults. I really don’t feel this is an honest discussion.

          • Gæst

            I read your article, but it doesn’t contain much evidence – especially since I’ve seen the misinformation being spread by hospitals in the Philippines about breastfeeding. I have no “tactics” here, but a good sense of when someone is mansplaining vs. when they are presenting well-researched facts.

          • The article in The Guardian cited their own in-depth investigation with detailed explanations of what they found, and even directly cited “Julianne Bores, a GlaxoSmithKline representative who worked alongside formula representatives in hospitals since 2009”, in sourcing the exact claim from my answer. They also quoted a doctor, and a midwife, and a mother whose personally described the exact difficulties that women in her situation face.

            If you don’t believe investigations by The Guardian, with cited witnesses including the key one from the industry itself, what would you consider “evidence”?

            And why did you dismiss such evidence yet accept the opposite claim from Montserrat without any explanation or evidence at all, and even suggest that such a simple “no, it’s not” explanation was enough for you to go out and repeat it to others elsewhere?

            And what is “mansplaining”?

          • Gæst

            Oh please. You’re not even trying now.

          • Who?

            I’d say he’s a little trying.

            The ducking and weaving is tedious-right out of the MRA playbook.

          • I googled MRA, and since I’m pretty sure you’re not talking about Magnetic Resonance Angiography I kept scrolling down and…

            No. You have to be trolling at this point. Where do you get the idea that making such ridiculous accusations gets you anywhere with anyone? You can’t name ONE thing that I’ve said, anywhere, that puts me on the same page as those fools.

          • Who?

            It’s the style, not the content. ‘Oh, I said X but I meant Y, you should have realised that’. Now you can go ahead and say that’s not at all what you’ve been doing. This is the oldest story on the internet.

            You following me around and complaining about what I’m saying doesn’t make me a troll.

          • I don’t now how they style their talking. But I didn’t say, “I said X but I meant Y, you should have realized that” anywhere. What are you basing that claim on?

            I haven’t been “following you around.” Looking back I can only see one instance in my history where I replied to you when you weren’t already talking to me or about me, and that was a simple answer to an open question you had posed.

            I suggested you were a troll because you accused me of doing things “right out of the MRA playbook”, which seemed especially silly since as far as I can tell I haven’t made a single statement anywhere that aligns with MRA values in any way. I can’t speak to their “style” because I have no idea what their style is, but I can definitely say that I didn’t do what you say I did.

          • Who?

            Not stupid, just too gullible to see through marketing tactics and decide what is best for their family.

          • Montserrat Blanco

            Yes, I do believe there is a fundamental difference between marketing yo patients vs. marketing to doctors. In any case: handing leaflets and coupons is not exactly the same as giving formula samples so their milk dry up. They want to sell formula. Fine. The same as say GAP wants to sell clothes. Nobody thinks GAP is evil when they give you a leaflet with a coupon. Even more, nobody criticizes Di Giorno for giving you coupons for free with the Sunday newspaper so that you buy that unhealthy pizza!

          • You’re ignoring that I quoted the article doing the exact thing you claimed it didn’t have.

            You said:

            “I kindly suggest you read Gaest post and the article you link in The Guardian. Gaest asked if formula companies are still marketing directly to women offering samples so their milk dry up. Your article describes marketing directed to doctors and midwives. Two different things.”

            I quoted, among other examples:

            “Bores was also an observer of the “parenting” and “nutrition” forums for parents held in the hospital canteens by the formula representatives, where samples or branded freebies like umbrellas and feeding bottles would be distributed. All these practices are a violation of Philippine law.”

            You not only gave the wrong answer to Gaest, but made false accusations about myself and others in the process and even made a false claim about the exact reference I gave to show that you were wrong.

          • Montserrat Blanco

            Read this piece about what they did in the 1970s and compare it to the piece you cite.

            http://www.businessinsider.com/nestles-infant-formula-scandal-2012-6?IR=T

            In my opinion it is clearly not the same.

            In any case, what your article describes is leaflets, freebies, coupons and meetings.

            I did not have any of those and still combo fed my son. I did have a lactation consultant, double pump, power pumped for a very miserable weekend, youname it. Still did not have enough milk. So I chose to feed my son.

            The fact that the piece you so religiously cite only found a mother that, in their own words, did not have enough milk to feed her daughter speaks for itself. She is poor. She should have free access to formula. But she is not stupid. She chose to feed her daughter and starve herself. She did not chose to starve while denying her daughter something that was free and easily available. She chose to starve because she did not have any other way to keep her daughter alive. As a mother I completely understand her choice. She is not gullible, she chose her daughter benefit over her own.

          • The article described leaflets, freebies, coupons, and meetings, but also the illegal bribing of health workers and medical professionals, straight lies in advertising, commercial advertising disguised as hospital recommendations, actual hospital recommendation lists with branded products listed as “essential” items, and targeted clandestine advertising via social media networks which is disguised to appear as honest peer advice. And all while paying lobbyists to fight against government regulations which hold them back to some degree.

            I certainly don’t mean to imply that no progress has been made since the 1970s. Yes, progress has definitely been made, in large part because of the WHO as well as the very people that Amy and others are referring to as “lactivists.” The worst sins of Nestle are no longer practiced the same way, not because they had a magical change of heart, but because they were forced to change.

            However, Nestlé and other formula companies still definitely continue to send representatives out to underdeveloped areas to get women to try formula and become dependent on that rather than on their own breastmik, in some cases by skirting around laws that have been set up to stop them and in other cases by openly defying them. The existence of progress does not mean that the problem is over.

            And yes, I absolutely refute any suggestion that the women involved are “stupid” or “gullible” and have said no such thing. If brilliant doctors of every nation and education are susceptible to industry wheeling and dealing, then anyone can be. They wouldn’t spend so many hundreds of billions of dollars on advertising unless it worked.

          • I wanted to answer the case of the mothers separately because they describe the case so well.

            These mothers are NOT stupid. But look at what formula dependence forces them into:

            “Mothers living in the ramshackle neighbourhoods of Metro Manila spoke of spending three-quarters of their income on formula milk, often forgoing food themselves.”

            “Stick thin, her cheek and collarbones sticking out, Icawat was visibly malnourished, as was Trista, whose swollen stomach stuck out beneath a faded pink Little Mermaid T-shirt. The average cost of Nestogen is 2,000 pesos (£28) a month but Icawat could afford to spend only 800 pesos.”

            ““I didn’t eat just so I could feed the baby,” she said. “There were some days when I didn’t eat anything. And Nestogen is expensive so I could not always give it to my baby when she was hungry, I only gave her half bottles, four times a day.””

            “She does not have running water or electricity and admitted she found it difficult to sterilise bottles and make up the milk powder, which needs to be mixed with very hot water to be safe.”

            “My baby has been sick: she was admitted to the hospital three times with diarrhoea and asthma.”

            I’ve been to the slums of Metro Manila twice, once living there for six weeks. One of my friends there, a young first-time father, spent literally his entire paycheck on disposable diapers and infant formula – not because breastmilk and cloth diapers weren’t working, but because he had internalized the community’s belief that a “good” father is one who provides commercial products for his baby.

            Because of the money he spent on baby formula and disposable diapers, he was not able to pay the fees he desired to further his education for his dream job. Other people, like the families mentioned in the story, become malnourished and watch their other children become malnourshed because they are buying infant formula instead of food. Infant formula is so expensive there it can easily eat up the food budget for multiple other children.

            On top of that, as you see they often lack available money to buy enough formula, so they eventually have to start diluting it, and the baby becomes malnourished.

            On top of that, they lack the clean water necessary (and considering the places they live, clean water isn’t coming anytime soon unless an entire new government comes to power and massive infrastructure changes are enacted), not to mention lacking the ability to properly sterilize bottles or preserve formula in a safe manner. So their babies are subjected to additional health issues at the most vulnerable stages.

            And that’s all without adding the issue of adulteration (both pre-consumer and post-consumer) that is extremely common with commercial milk products in these countries. I have personally witnessed such adulteration myself and it is a huge issue.

            In my experience, and in the literature that I’ve read, the community attitudes towards breastfeeding and formula that have been carefully cultivated by corporate representatives have led to suffering for the entire family in many cases – not just the child malnourished and sicked from diluted and contaminated formula, but also the mother and father and other children who become malnourished and suffer other opportunity costs due to the high costs of formula.

            In a perfect world, clean water would be available for everyone (in fact many project that this may become progressively tougher, not easier, in many cities in coming years), the ability to sanitize drinking containers would be available to everyone, formula would be available that would be completely affordable without forcing siblings into malnutrition themselves, adulteration would be stopped, and every mother would have a free choice to feed her baby as she desired in light of the best information out there.

            But we don’t live in a perfect world. And in the imperfect world we live in, the chasing of corporate profits by formula companies continues to cost lives.

            And to answer the weird witchhunt that has developed at the hands of a few commenters, this is NOT the result of some “gullible women” or “uneducated mothers.” In many cases the mothers believe the company propaganda, the fathers believe the company propaganda, the entire community has internalized it. The doctors and medical professionals are targeted for this manipulation just as much as the mothers are. You can be in any position and of any education and be susceptible, especially if those doing the manipulation are leveraging their superior social standing (due to nation of origin, wealth, or perceived position of authority) in order to push their framework onto those “below” them in the nation’s social strata.

            If DeBeer’s can manipulate the wealthiest people in the most developed and educated countries to buy into an engagement ring campaign and create an incredibly expensive yet completely utility-less need out of thin air, then I’m quite confident in the ability of corporate manipulation campaigns to trap anybody.

          • Montserrat Blanco

            I refuse to believe that people for which breastfeeding is working (enough milk, mother willing to do it, paid maternal leave or mother not working, etc) is spending all their paycheck on formula just because company marketing. I did spend A LOT on special preemie formula and diapers on my son’s first months at home. I am lucky I have a good paycheck and live in a Western country, so even taking that into account it was nowhere near my whole paycheck.

          • Montserrat Blanco

            Spending almost all your money in something you do not need because of marketing, well, you are not saying they are stupid or gullible, but I would say it is pretty much my definition of stupid behaviour.

          • Who?

            I have no trouble believing people drift into spending more than is sensible on things they don’t need. That happens everyday, everywhere. And as we know, the very folk who egg on the purchases are often the first to judge when things hit the fan.

            It just feels like when it’s formula it somehow isn’t the buyer’s fault, they are tricked and duped into it. But if it was nail polish, or alcohol, or whatever other indulgence, then that would be TERRIBLE personal decision making. Regardless of the fact that almost everything is advertised to the hilt, and many things way more than formula.

          • Montserrat Blanco

            You are right. I believe people spending too much into something they do not need at all. And I have seen that behaviour quite a few times. I would edit my previous comment if so could.

            I do consider it stupid and does not speak very well of those people intelligence in my opinion.

          • These mothers are NOT stupid. But look at what formula dependence forces them into:

            “Mothers living in the ramshackle neighbourhoods of Metro Manila spoke of spending three-quarters of their income on formula milk, often forgoing food themselves.”

            “Stick thin, her cheek and collarbones sticking out, Icawat was visibly malnourished, as was Trista, whose swollen stomach stuck out beneath a faded pink Little Mermaid T-shirt. The average cost of Nestogen is 2,000 pesos (£28) a month but Icawat could afford to spend only 800 pesos.”

            ““I didn’t eat just so I could feed the baby,” she said. “There were some days when I didn’t eat anything. And Nestogen is expensive so I could not always give it to my baby when she was hungry, I only gave her half bottles, four times a day.””

            “She does not have running water or electricity and admitted she found it difficult to sterilise bottles and make up the milk powder, which needs to be mixed with very hot water to be safe.”

            “My baby has been sick: she was admitted to the hospital three times with diarrhoea and asthma.”

            I’ve been to the slums of Metro Manila twice, once living there for six weeks. One of my friends there, a young first-time father, spent literally his entire paycheck on disposable diapers and infant formula – not because breastmilk and cloth diapers weren’t working, but because he had internalized the community’s belief that a “good” father is one who provides commercial products for his baby.

            Because of the money he spent on baby formula and disposable diapers, he was not able to pay the fees he desired to further his education for his dream job. Other people, like the families mentioned in the story, become malnourished and watch their other children become malnourshed because they are buying infant formula instead of food. Infant formula is so expensive there it can easily eat up the food budget for multiple other children.

            On top of that, as you see they often lack available money to buy enough formula, so they eventually have to start diluting it, and the baby becomes malnourished.

            On top of that, they lack the clean water necessary (and considering the places they live, clean water isn’t coming anytime soon unless an entire new government comes to power and massive infrastructure changes are enacted), not to mention lacking the ability to properly sterilize bottles or preserve formula in a safe manner. So their babies are subjected to additional health issues at the most vulnerable stages.

            And that’s all without adding the issue of adulteration (both pre-consumer and post-consumer) that is extremely common with commercial milk products in these countries. I have personally witnessed such adulteration myself and it is a huge issue.

          • In my experience, and in the literature that I’ve read, the community attitudes towards breastfeeding and formula that have been carefully cultivated by corporate representatives have led to suffering for the entire family in many cases – not just the child malnourished and sicked from diluted and contaminated formula, but also the mother and father and other children who become malnourished and suffer other opportunity costs due to the high costs of formula.

            In a perfect world, clean water would be available for everyone (in fact many project that this may become progressively tougher, not easier, in many cities in coming years), the ability to sanitize drinking containers would be available to everyone, formula would be available that would be completely affordable without forcing siblings into malnutrition themselves, adulteration would be stopped, and every mother would have a free choice to feed her baby as she desired in light of the best information out there.

            But we don’t live in a perfect world. And in the imperfect world we live in, the chasing of corporate profits by formula companies continues to cost lives.

            And to answer the weird witchhunt that has developed at the hands of a few commenters, this is NOT the result of some “gullible women” or “uneducated mothers.” In many cases the mothers believe the company propaganda, the fathers believe the company propaganda, the entire community has internalized it. The doctors and medical professionals are targeted for this manipulation just as much as the mothers are. You can be in any position and of any education and be susceptible, especially if those doing the manipulation are leveraging their superior social standing (due to nation of origin, wealth, or perceived position of authority) in order to push their framework onto those “below” them in the nation’s social strata.

            If DeBeer’s can manipulate the wealthiest people in the most developed and educated countries to buy into an engagement ring campaign and create an incredibly expensive yet completely utility-less need out of thin air, then I’m quite confident in the ability of corporate manipulation campaigns to trap anybody.

          • Who?

            I don’t know if it is an intelligence thing, or if the buying is filling some kind of need, perhaps that the buyer can’t quite identify. Or just prioritising things I wouldn’t choose to.

            But to blame advertising? I sometimes feel the biggest dupes of the advertising industry are the clients who buy the advertising in the first place. If advertising were as zombifying as the lactivists suggest, we’d all be walking around in a permanent stupor laden with flaming credit cards and store shopping bags, or unable to leave the house for the volume of home shopping coming through the door.

          • It’s stupid/gullible if there’s an overriding reason that you should “know better.” But if your entire community has been deceived and they have employed the medical professionals to help push the trick, then why should you know better? Most of these communities are ones for which over the last couple generations they moved from an agrarian lifestyle to a more industrialized lifestyle and MANY things have changed. They’ve been told their traditional medicines are inadequate now and that they need to buy western medicine, they’ve been told home births are inadequate and they need hospital births. And certainly in many cases those other changes were legitimate. So why wouldn’t they believe it when they’re told by those same medical professionals and everyone else in their community that breastfeeding is inadequate and their babies really need formula?

          • Who?

            I know you’ve taken your bat and ball and gone home, but for my own interest I will ask whether the issue you raise is in fact one of framing.

            So,’they’ve been told their traditional medicines are inadequate now’ might be reframed as ‘they see that modern medicine actually cures or significantly relieves conditions they had always experienced as fatal or debilitating’ and therefore, they want more of it.

            Rather than ‘they’ve been told homebirths are inadequate and they need hospital births’, it could be reframed as ‘they see mothers and babies living when in the past they would have died, or well when they would otherwise have been injured or sick’ and so prefer hospital births.

            Indeed, would those people not feel foolish to ignore information about formula when their own experience tells them that these changes had improved health and quality of life for many in their communities?

          • It’s not just direct marketing in any sense, it’s the result of a multi-decade marketing effort that has worked to rope in the doctors, the nurses, the community workers, literally anyone who could be seen as an authority in order to create an entire culture of, “This is the way you really take care of your baby today.”

            Baby formula is an extreme case due to the desperate importance of feeding one’s baby, but it’s not unique in terms of how advertizers work. Even in the USA there are advertizers working overtime to create perceived needs for very pricey items that we don’t actually need at all (diamonds are a great example that I already brought up), the main difference simply being that our financial situations tend to be such that we won’t starve if we spend the money. But advertizers don’t appear to really care about that aspect when they target people.

          • Amy Tuteur, MD

            So you are smart and the rest of us are dupes even though we are the ones with the medical training who care for those injured by aggressive breastfeeding promotion?

          • No. I don’t believe you are a “dupe” at all.

            But I do actually have a lot more experience on the ground in the specific places that I was talking about in those comments, which may lead my perspective to be different than yours.

            And the many thousands of medical professionals who disagree with you, such as those in the American Academy of Pediatrics, the World Health Organization, the Lancet surveys I linked previously, etc. are not dupes, and discredit your attempt to use an argument from authority here.

          • Amy Tuteur, MD

            Honestly, Jon, there’s really no scientific evidence we could show you that would change your mind. You will believe whatever the priests and priestesses of lactivism tell you and the facts be damned. So why are you here arguing with us if you aren’t willing be swayed by anything other than the conventional wisdom?

          • As there are no “priests and priestesses” involved, but rather the vast majority of both medical professionals and community health experts on the ground that are coming to a vastly different conclusion than you, demonstrating through numerous studies of the issue and their own practical experience over decades. I have no qualms with my evidence-based and experience-based position.

            The fact that you and others have tried 10-15 times to make it an ideological issue rather than a practical issue, and keep resorting to name-calling and personal insults, leads me to feel even more comfortable in the medical and public health consensus. If you really believe that elevating formula use over breastfeeding is a women’s empowerment issue, then be confident in expressing that position despite the health problems it may cause in developing countries, don’t try to fight against it.

            Most neutral observers might think that the charges you make in the above comment would be much more effective if they had been directed towards yourself.

            I’m out with that.

          • Amy Tuteur, MD

            In other words, there is no scientific evidence that could change your mind. You believe the conventional wisdom because it is popular.

          • Oh, and since I won’t be replying again, I would appreciate if you would release 3 of my most complete responses, which were all pulled for unknown reasons. Especially the two that pulled the specific quotes from The Guardian’s investigation that supported my position. I’ll accept that there’s nothing malicious intended in the fact that the comments were for some reason marked as spam and pulled from public view, but the message says that you can approve them, so I would appreciate if you do.

          • Amy Tuteur, MD

            If a lot of people downvote a comment it may end up in the spam filter. I pulled them out.

          • Gæst

            It’s what poverty forces them into far more than formula.

          • Merrie

            She’s obviously malnourished herself and presumably wasn’t able to provide sufficient breastmilk for that reason. It’s not like she made plenty of milk and instead opted to give her daughter insufficient formula rations. People who decry formula promotion, I wonder what solution they have to that situation.

          • Montserrat Blanco

            I agree with you. She probably did not have enough to eat herself. This is something lactivists always dismiss as non existent, because a mother’s body would starve itself before not producing enough milk.

            I suggest the solution is not breastfeeding promotion. I suggest the solution is more money directly to the mom and more money for clean water. And let her decide what she wants to do after that.

            The problem from my point of view is that she does not have enough money to feed her family as she chooses, not the formula choice.

          • Gæst

            And this practice *was* what I was asking about, because I encounter people who argue like it’s still happening.

  • The Bofa on the Sofa

    In terms of breastfeeding studies, which, if any, have controlled for day care?

    You can’t take any conclusions, especially about illness, seriously unless they control for day care.

    • Gæst

      I think you might even want to control for city living vs. suburban and rural living, as well. My kids had a nanny and were breast fed, but they went out to the public playgrounds of NYC all the time and were exposed to kids who did go to daycare, etc. When they were old enough to move around, they would lick the playground equipment and the bus windows and all kinds of nasty stuff.

      • Montserrat Blanco

        It happens the same to me. My son did go to local playgrounds with a lot of exposure to other children and he used to get his bigs there…

      • EmbraceYourInnerCrone

        My kid was born in LA (we took her out the the Olive garden when she was 2 weeks because I was getting cabin fever from being stuck at home) and we moved to Guam when she was 3 months old(lots of plane travel/airports) then we lived in a hotel for a week then moved into base housing. Meanwhile she started day care at 6 weeks in LA and went back to new day care when we got to Guam. In Guam she probably have 4 different day care situations as the home day care people we used would get transferred Stateside. When I moved to San Diego we enrolled her in an on base nursery school (she was 2 years old).

        She had one minor cold at 8 weeks and a double ear infection at 11 months and again at 18 months. She got roseola at about 2 and half and probably a cold or 2 a year until she started kindergarten. (oh and 2 bouts of head lice..so much fun). She has mild asthma but surprise, so did my mother and grandmother.

        Not sure what it all means or how one would control for confounders…

        • Kelly

          Kids who are in daycare tend to get sick more often at a young age. Kids who aren’t in daycare tend to get sick more often once they go to school. I can say that my daughter got sick once before school besides the random cold and then bam, got sick five times in two months while in full time school and got her first case of head lice a few weeks later. It doesn’t happen with all kids and I really thought I had dodged a bullet with her as she didn’t get sick in half day kindergarten but I was wrong. I’m not sure if there are any real studies on it or if it’s more anecdotal.