TARGETED MARKETING: FORMULAS FOR SUPPLEMENTATION OF BREASTFED BABIES

Maureen MinchinInfant Formula, Milk Matters

(Excerpt from Milk matters: infant feeding and Immune disorder, pp. 512-516)

So in the USA breastfeeding is strongly supported by the White House, and data collection routinely collected by the CDC. This probably helps explain the emergence of so much recent industry advertising aimed at positioning the use of infant formula as a way to continue breastfeeding. (Truly, the Abbott website said that 8 out of 10 mothers agreed that feeding their babies Similac helped them to breastfeed longer.1680)

It seems to be American companies which have pioneered this recent revival of the older “formula for supplementation” strategy that had existed for a century before Mead Johnson used those images of Mrs Rabbit bottle feeding a baby rabbit while Peter stood by her side with a sippy cup. Is it proof of the companies’ deep desire to promote breastfeeding? Perhaps. It is the best way to ensure that real differences between breastfed and formula-fed children are blurred in research findings, now that more subtle tools like MRIs and immune investigations are uncovering physical biological differences between the groups. I can also see the PR value of companies marketing an infant formula for breastfeeding mothers to use to supplement. The formula is just another infant formula, but the marketing positions the company as Good Guys wanting to support and help ‘moms who choose to supplement’ now that the healthcare professions are seeing breastfeeding as important. Yet industry must know that supplementing undermines milk production. So how do they sell this ‘new’ ‘helpful’ formula?

Using Abbott as an example makes it clear. Their website says:

“Similac For Supplementation is the first Similac formula designed for breastfeeding moms who choose to supplement. It has more prebiotics than any other Similac formula, along with the same benefits as Similac Advance. Some moms may notice changes in stool patterns when introducing formula to a breastfeeding routine, and studies have shown that prebiotics produce softer stools more like those of breastfed infants. 8 out of 10 moms who supplemented with formula agreed it helped them continue to breastfeed.”1681

This is really a bit odd. All breastfeeding mothers – other than those who are blind, have no sense of smell, and who employ nannies to deal with nappy changes – will notice stool changes when formula is introduced. The nappies stink, where before they did not. But why more prebiotics than in their regular formula? To compete with breastmilk prebiotics and probiotics? To make more work for the infant digestive system? To overload the normal quota of digestive enzymes supplied by both breastmilk and the baby’s body? When there is precious little evidence that the prebiotic doses in formula offer any real benefit to healthy term babies, why do this? To justify increased costs? To subtly imply that breastmilk lacks their super-duper prebiotics and probiotics and so mothers should supplement, as a matter of ‘nutritional insurance’, one of the phrases industry popularised in relation to Toddler formulas. Surely Abbott could have created a formula without any added biotics for a breastfed baby, unless there will be almost no breastmilk going into the child? And double the dose for the formula fed? While baby is getting breastmilk there is absolutely no need to worry about adding bacteria and food for bacteria because breastmilk does a better job than industry can ever do in that regard.

But industry will invent new ways to coax naive healthworkers to use their influence with parents to promote a particular brand. Abbott, like its rivals, knows perfectly well that breastfeeding is a far better strategy for gut health, and that breastfeeding is now formula’s chief competitor, no longer evaporated milk or whole cows milk. Eliminating the use of the latter products was industry’s 1960s rationale to justify advertising infant formula to parents, even though by the mid 1960s there was almost nothing of such products in use and by 1970 they were gone. It’s interesting that fifty years later, as breastfeeding initiation rates rise, Abbott chooses to create a product that, if used, will decrease the duration of breastfeeding and increase the risks of infant feeding for mother and child alike, making breastfed babies more like formula-fed ones. Mixed feeding is the way to maximise industry profits and minimise industry risks.

Look a little closer too, at some subliminal PR messages I hear in this short statement.

  • Mothers “choose to supplement.” (Not are forced to by social structures and expectations such as those Abbott creates; choice is an act of adult self- determination, and sensible women like our “StrongMoms”1682 choose to mix breast and bottle feeding.)
  • Mothers will give their child “the benefits of Similac” if they supplement with this formula. (Infant formula only has benefits, never risks, and only the meanest of mothers refuse to benefit their child.)
  • Introduce formula into your breastfeeding routine. (Routines are normal, and determined by mothers, who vary them as they choose. Mothers who feed responsively and fully are abnormal; babies are a management problem, not persons in a relationship.)
  • Prebiotics produce softer stools (Gentle, caring, “comfort” formula makes softer stools for babies…. Does that word mean looser, runnier, sloppier, more liquid, than breastmilk stools? This emotive language is appealing, and indeed sometimes accurate: the stools of diarrhoea, more common in formula-fed and allergic infants, are soft – but hardly desirable.)
  • More probiotics than for formula-fed babies. (Why? Does this imply breastfed babies need ingredients to soften their stools? In fact constipation is relatively common in formula-fed babies.)
  • Supplementing helps mothers breastfeed longer. (Breastfeeding duration is more important than ensuring complete breastfeeding to around 6 months and continued breastfeeding while introducing other foods. After all, just one breastfeed a day means mothers may be classed as breastfeeding in some research. )

Reading on in this website is instructive as to the likely outcomes of using Similac for supplementation. Abott advises that mothers who breastfeed directly have no way to measure what their babies get (more undermining), and suggests that mothers “Try to feed 2 ounces of baby formula at a time to see how much your baby will eat. You might discover at first that your baby will eat more or less than that amount every two to three hours. As your baby gets older, he might be able to eat more in one feeding, and eat less frequently.”

Helpfully, they add that formula is available in premeasured 2-ounce bottles that do not require any mixing. (After all, they are targeting the advantaged breastfeeding mother, who can afford ready-to-feed types.) Nowhere do they say that if you feed your baby 60mL of formula every 2-3 hours, your milk supply will rapidly dwindle by as much as 60mL every 2-3 hours.

The website continues with other advice. If your baby does refuse the breast, try feeding him when he is sleepy. (Which may ensure he falls asleep after his 60-90mL of formula, without breastfeeding well. Babies fed by bottle may refuse the breast if not hungry, a fact nowhere mentioned.) And when milk supply does fall, they recommend pumping to boost supply, not cutting back on formula intake. So now the new mother is breastfeeding, pumping and bottle-feeding, a huge time burden. Guess what happens next? The incentive just to use the ‘gentle’ powder is likely to be considerable.

Other companies are pushing formula for supplementation of the breastfeeding infant, even though the World Health Organization and every credible paediatric authority is urging exclusive breastfeeding from birth on the basis of good science. This is targeted advertising at its canniest. Marketing budgets can be bigger than research and development budgets, which says much about priorities and the purpose of this industry. Unless countries like China and Vietnam and India take drastic steps now to curb the growth of artificial feeding, they will repeat the disasters of the twentieth century in the twenty-first, just as affluent nations are beginning to count the multiple and intolerable costs. It is probably already too late to do more than reduce the scale of the disasters they face, if the Chinese State Television (CCTV) report saying that 70% of Chinese children receive infant formula is correct.1683 Certainly breastfeeding has dwindled in this last decade:

Government surveys show a low breastfeeding rate – just 28 percent of Chinese women were exclusively breastfeeding at six months as of 2008, down from 51 percent in 2003. Independent researchers suggest the real figure is much lower. One study published in the Journal of Health, Population and Nutrition in 2010 found exclusive breastfeeding rates at six months in parts of China were as low as 0.2 percent.)1684

Infant formula’s damage is not confined to obvious disease. As an eminent researcher into the roots of violence in society has said, infant formula

“may be the single worst invention of the twentieth century, as it deprives the infant/child of not only essential physical nutrients but also the essential sensory-emotional nutrients that can only be obtained at the breast of the mother -touch, movement, smell and taste of the mother’s body – that forms the foundation for intimacy, pleasure and love of mother and of women throughout adulthood.1685

It is not a coincidence that rates of maternal abuse and neglect are higher when infants are not happily breastfed.1686 How much of the worst aspects of western culture has its roots in the loss of such intangibles, and the unbreakable bonds they create? Does the developing world really want to duplicate western attachment disorders and their cultural consequences? Surely we must emphasize to women who cannot breastfeed –for whatever reason – the need for frequent and deeply intimate physical contact, for their own sake as well as their baby’s?

For there are things we cannot measure about the value of breastfeeding. Bottle feeding mothers love their babies no less than breastfeeding mothers –how can anyone measure love? – but I do think that breastfeeding creates a unique learning environment that helps women adjust to motherhood. Yes, the hormones help, and all those other physical differences. But as Marni Jackson said:

Breastfeeding is an unsentimental metaphor for how love works, in a way. You don’t decide how much or how deeply to love – you respond to the beloved with joy exactly as much as they want. In all our efforts to demystify motherhood and free women from their identification with the life-force, we risk overlooking the amazing integrity of the female body and its power. Breastfeeding is above all a relationship.1687

All infant feeding should be made the basis for such a relationship and responsive parenting style, instead of a competition to push independence on the child. Dr Pamela Douglas has written a wonderful description 1688 of how to bottle feed carefully and responsively, a process which demands at least as much as time and attention, and often much more than, breastfeeding.

Of course the ad men recognise that infant feeding is deeply emotional. Providing food is an expression of love, whether that food is breastmilk or an expensive substitute. Women who love their babies feed them; food is love made tangible, and so for some, the more expensive the food the greater the proof of love. Industry exploits this. How else can we explain the proliferation of heart shapes and love images and doting mothers in formula logos and marketing? It may be that the mother’s love helps the bottle fed child ovecome some of the deficiencies of its artificial feed, for love does indeed help babies grow.

Figure 3-13-4 Love makes babies grow. Image © Neil Matterson.

From Sleepless Nights. (Marion Books 1988).

1678 Blaser MJ op cit., p. 208.

1679 Ibid, p. 209.

1680 https://similac.com/baby-formula/similac-for-supplementation. Source: Abbott Nutrition, data on file 2013

1681 https://similac.com/baby-formula/similac-for-supplementation. Source: Abbott Nutrition, data on file 2013

1682 The title of the online club Abbott has set up for mothers. Women don’t need industry to tell them they are strong. And it seems to me a cynical attempt to play on mothers’ insecurities.

1683 Cited in ICDC Public Statement on Danone/Dumex Bribery scandal. http://www.ibfan-icdc.org/index.php/alerts/2013-12-18-10-44-32

1684 Harney A. op cit.

1685 Prescott JW. Nurturant versus non-nurturant environments and the failure of the environment of evolutionary adaptedeness. In Narvaez D, Panksepp J, Score AN, Gleason TR (eds) Evolution, early experience and human development (Oxford University Press, 2013) p. 427

1686 Strathearn L, Mamun AA, Najman JM, O’Callaghan MJ. Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study.(PMID:19171613) Free full text article Pediatrics 2009;123(2):483-

  1. DOI: 10.1542/peds.2007-3546 Read the rest of this corpus of work.