Extract | The Politics of Breastfeeding

	THE POLITICS OF BREASTFEEDING When Breasts are Bad for Business

extract

the wet-diapered philanthropists

The USA has led the world in promoting the philosophy of free

market economics with accompanying reduction of government

funding of public welfare systems. However, when it comes to

subsidising artificial feeding the US government is a hotbed of

socialism. It seems that US politicians cannot sleep easy in their beds

unless US tax payers’ money is streaming into the bank accounts of

infant formula manufacturers. The North American market is

approximately the same as that of Europe. As roughly twice as many

babies are born in Europe than in North America (because of

population size not because of a higher birth rate), this means that on

average European babies get far more breastmilk than do US babies.

(I will leave out Canada because there are far fewer babies and more

breastfeeding than in the USA.) Two companies, Abbot-Ross and Mead

Johnson, dominate and, according to business reporting and other

sources, one-third to a half of the market is supported by US

government programmes.34

The United States Department of Agriculture (USDA) Special

Supplemental Nutrition Program for Women, Infants and Children

(WIC) provides ‘nutrition services’ to 1.9 million infants,

approximately half the babies in the USA. WIC was created in the

1960s to help poor mothers provide better nutrition for their children,

and infant formula distribution was a cornerstone of the policy. WIC

has probably contributed as much to breastfeeding decline among

poor US women as bad hospital practices. Breastfeeding is now

promoted in the WIC programme, but it is under-funded. The

financial support for the provision of free infant formula, however, is

like a well-oiled juggernaut. The WIC progamme purchases half of all

the infant formula used in the USA. The food package given to a

mother who artificially feeds is three times the value of the package

the breastfeeding mother receives. WIC dieticians sometimes give out

infant formula vouchers in maternity wards.

The WIC system is a strong incentive not to breastfeed, even if

mothers want to. This is backed up by the 1996 Welfare Reform Act

which mandates that mothers on welfare are required to engage in

work activities even when their babies are very young.35 The USA has

no national maternity leave policy. Breastfeeding while returning early

to work outside the home needs organisation and support, especially

from the employer. In Robert Greenwald’s 2005 film Walmart: The

High Cost of Low Price, an exhausted and underpaid Walmart

employee explains how she can just about feed her children because

her low wages entitle her to WIC infant foods. Her work schedule

makes breastfeeding almost impossible. One group of researchers

calculated that if the 1996 Act had not been passed, US breastfeeding

at six months would have been 5.5% higher in 2000.36

To try and control costs, the US Federal government requires the

state governments to conduct competitive bidding from the infant

formula companies. To compete, the manufacturers offer rebates on

each can of infant formula bought by WIC. Yes, it is complicated I

know, but please stay awake. The companies might repay to state WIC

progammes between 85 and 98% of the wholesale value of their

products. In 2002 rebates totalled US$1.48 billion. I will not even

attempt to investigate tax benefits for the companies. The issue is,

why would a company give such an enormous cash-back on a

product? How could they still make a profit?

I was baffled until the redoubtable Marsha Walker of the US

National Alliance for Breastfeeding Advocacy (NABA) explained

matters. WIC is yet another marketing channel. If one manufacturer

gets its brand contracted to WIC in a region, then that brand has a

higher price in the shops, so the non-WIC parents pay more. As

Marsha explains, some US taxpayers pay the manufacturers twice,

once through their federal income taxes and a second time when they

buy WIC formula. They also help to subsidise the owners of Walmart

and other companies with similar low-wage policies, because WIC

provision helps maintain the low pay.

Many mothers might be in the WIC programme for their first baby,

but off WIC benefits when they have their second and third children.

However, they tend to use the same brand with subsequent babies.

WIC brands get more space and eye-level placement on retail store

shelves. Physicians recommend the WIC brand so as not to

differentiate between WIC and non-WIC mothers. Some hospitals

provide the WIC brand in hospital so that mothers do not have to

change their babies’ milk when they go home. There is now a trend to

use ‘non-contract’ formula, often newer, more expensive milks. The

companies love this because they do not have to give a rebate; in the

end the Federal government will always pick up the tab. The terms

‘WIC approved’ or ‘WIC eligible’ are used misleadingly in advertising

materials even when inappropriate. There are many more methods of

companies utilising WIC to promote their brands. It is the largest

single infant formula market in the world and a money-spinner.

What shocked me in learning about this system is how much WIC

contributes to the early establishment of artificial feeding. When there

is no free formula, even mothers who do not want to breastfeed might

do so for a few days which could have a positive impact on their

babies’ immune systems. We also know that the closeness of

breastfeeding promotes bonding, and often this virtuous circle

prompts mothers to change their minds: women who had planned to

artificially feed end up enjoying breastfeeding and stick with it.

Twenty-seven per cent (around a million) of US babies do not even

get their mothers’ colostrum. Even removing 2% of that 27% to allow

for orphans, abandoned babies, drug-dependent mothers, babies of

HIV-infected mothers who are told not to breastfeed, mothers with

breast cancer and babies with a rare medical problem, this still means

that a quarter of all US babies are artificially fed from birth for no good

reason. Why?

Considering the amount of breastfeeding knowledge and support

skills in the country, their must be only one reason: US taxpayers keep

shelling out the money. They must keep supporting those

manufacturers in the manner to which they have become accustomed.

The US taxpayers’ generosity continues beyond the provision of

federally funded artificial milk. Most WIC mothers depend on federal

government-funded Medicaid to pay for the treatment of the

infections and illnesses their children inevitably get from being

deprived of breastfeeding.37

A hundred years ago most US babies were breastfed and most

artificial feeding was done by rich women, or their servants. Now the

class pattern is reversed. Hospital birth, company promotion and WIC

have contributed much to this change. It is not just the avoidable

sickness of US babies that is so tragic. The USA is collapsing under an

obesity epidemic, diabetes is rising, and cardio-vascular disease (CVD)

remains a big problem. The world-famous US Centre for Disease

Control (CDC) states that the only two cost-effective strategies to deal

with the childhood obesity epidemic are decreased TV viewing and

breastfeeding promotion.38 I am no expert on how to decrease TV

viewing, but I feel confident to say that breastfeeding promotion is not

going to work if government-funded support for the companies

continues. They certainly do not tolerate effective and truthful

breastfeeding promotion. The 2004 federally-funded media campaign

‘Babies were born to be breastfed’ was scuppered because of

company pressure.39

Infant formula, baby food and bottle companies are thriving. Next

time you see a poor mother popping a bottle of infant formula into

her newborn’s mouth do not sigh, just think how much that little one

is contributing to the health of Wyeth, Abbott-Ross, Mead Johnson,

Nestle and other baby food and bottle manufacturers. Both the wet-

diapered philanthropists and the generous US taxpayer have those

companies’ interests at heart.

------------------

34 Global Industry Analysts Inc. www.strategyr.com Accessed 7 August 2008. The USA has approximately 20 million under five year olds, Canada has around one million. Source: UNICEF State of the World’s Children 2008.

35 The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) 1996.

36 Haider S, Jacknowitz A & Schoeni RF, Welfare Work Requirements and Child Well- Being: Evidence from the Effects on Breastfeeding. DemographyAugust 2003;40(3);479-497

37 Kent G, WIC’s promotion of infant formula in the United States. International Breastfeeding Journal2006; 1:8 http://www.internationalbreastfeedingjournal.com/content/1/1/8. Also: Walker M. Still selling out mothers and babies: marketing of breast milk substitutes in the USA. NABA REAL, 2007

38 Dietz WH. Breastfeeding may help prevent childhood overweight. JAMA 2001;285:2506-7

39 Caldwell, Karen and Turner-Maffei, Cindy. Promoting breastfeeding in the USA: what can we learn? Presentation at UNICEF UK BFI Annual Conference Cardiff, UK, 28-29 November 2006.