The British Medical Journal’s recent decision to ban formula ads
March 20, 2019 1:04 PM   Subscribe

Formula Is Feminist. Her baby, her body, her breasts, her choice. It sounds obvious, but in the world of breastfeeding promotion, it has become anything but. The latest example is the British Medical Journal’s self-congratulatory announcement that the journal and its sister journals would ban formula advertising from their pages...It’s nice that they want to be part of the solution, but this action actually makes them part of a much bigger problem. Formula is a legitimate solution to what is often a serious health problem (and a feminist solution to an age-old gendered problem). The argument the BMJ has deployed to explain its decision to limit advertisements isn’t justified by the scientific evidence and instead shows its willingness to pressure women to use their bodies in culturally approved ways.

The truly demeaning nature of the BMJ’s advertising policy becomes most apparent when considering the only other substance it bans: tobacco.

The underlying assumption is that neither women (nor their doctors, apparently) can be trusted to weigh the risks and benefits of formula feeding for themselves. Instead, they must be protected from marketing efforts. Are formula advertisements uniquely confusing or misleading? Certainly not as compared with the pharmaceutical companies that will continue to advertise freely in the pages of the BMJ.
posted by Homo neanderthalensis (109 comments total) 28 users marked this as a favorite
 
Does formula need any advertising to increase awareness of it as an option? I don't believe so, myself.
posted by mikelieman at 1:16 PM on March 20 [14 favorites]


This is bullshit posturing. What does the BMJ do about the various reasons for bottle feeding like "I have to go to work and there is no way to pump"? Are you even allowed to advertise bottles or is it direct boob-to-mouth only?
posted by the agents of KAOS at 1:16 PM on March 20 [22 favorites]


Does formula need any advertising to increase awareness of it as an option? I don't believe so, myself.

That is not the standard by which we restrict advertising of literally anything else, and it positively reeks of paternalistic bullshit.

An incomplete list of other things which don't need advertising to increase awareness of them as an option:
Coca-cola
McDonalds
Amazon
Beer
Cars
iPhones
Viagra
Aspirin
Head-on: Apply directly to the forehead
posted by jacquilynne at 1:26 PM on March 20 [103 favorites]


...so tired.
posted by Omnomnom at 1:27 PM on March 20 [4 favorites]


Does formula need any advertising to increase awareness of it as an option? I don't believe so, myself.

Maybe. Realistically, doctors are very likely to be asked about various types or brands of formula; asked to give suggestions if one kind doesn't work; asked about options like non-dairy or hypoallergenic formula; etc. I don't know that advertising is the best way to give them that information, but it's not totally crazy to think that it's useful.
posted by internet fraud detective squad, station number 9 at 1:29 PM on March 20 [10 favorites]


Over the last few years, I've become quite pro-formula and supplementing with formula. Maybe it's knowing more than one person who had issues where they had to supplement or didn't produce milk at all. I've seen babies 'fail to thrive' on exclusive breast feeding and, even with conscientious parents, it's so hard to tell how much the baby is consuming.

But it's also part of how I feel about parenting and gender. If you have two parents, the non-bearing parent is by practicality not so involved in feeding if it's breast-exclusive. Male parents, especially, are already marginalized in a lot of discussion around babies and young children - I hope that if we are so lucky (we are trying), my male partner can be as involved as I am (as the uterus-haver).

There are lots of reasons to love breast-feeding: it's cheap, doesn't need sterile water, much lighter to carry around, and people tell me it's very bonding. But for people who can't or don't want to, formula is feminist in that it makes breast-feeding a choice, not a requirement.

Actually, as a uterus-having person and in a couple that has struggled to conceive: OH MY GOD, we need uterine replicators! Yesterday! So much stress and difficulty for so many people could be avoided. Maybe some people would still opt for 'au natural' (as on Beta Colony). But I want uterine replicators to be the space race of my generation.

Also, an end to world poverty - and clean water for all. That's not too much to ask.
posted by jb at 1:31 PM on March 20 [39 favorites]


It is strange. I could understand if this were happening forty years ago, when Nestle was under fire for pushing formula on mothers in developing countries where it was often an inappropriate choice. But I guess Nestle is still getting criticism for similar behavior. Seems like it would be a better choice to ban advertising of unhealthy uses of the product rather than the product itself, though.
posted by rikschell at 1:40 PM on March 20 [4 favorites]


No hate on formula, have literally just finished loading a bottle into my tiny child... I mean is it a weird place to be advertising formula anyhow?

We would have pretty much died without formula, anyway.
posted by ominous_paws at 1:49 PM on March 20 [2 favorites]


I'm a man, so will say only that bottle-feeding my eldest was lovely and a great bonding experience.
posted by alasdair at 1:50 PM on March 20 [14 favorites]


I mean is it a weird place to be advertising formula anyhow?

Not really - for instance my friend's baby was premature and underweight, and they were prescribed a specific high calorie formula to supplement breastfeeding.
posted by the agents of KAOS at 1:51 PM on March 20 [9 favorites]


Surely the old way is better: paying a poorer woman — ideally one who can’t raise her own child — to nurse the child instead. Or, for those of us who must toil in the mills, having a six-year old girl feed it with a rag and sugar water.
posted by Hypatia at 1:57 PM on March 20 [67 favorites]


I thought formula was supposed to be terrible (content-wise). I stopped breast feeding after two weeks because it just wasn't working (though I had some instruction/remediation attempts) and I was totally exhausted from staying up all night trying to little avail to pump (as well as all night because of the baby himself). I felt horrible and guilty about bottle feeding (but also SO RELIEVED).

As far as a partner enjoying bottle feeding, I get it, and mine said that too, but obviously you can bottle feed pumped human milk, so those two things are not mutually exclusive.

I'm kind of shocked that formula is now considered okay, healthwise.

I was thinking that this ban was similar to a ban on cigarette advertising, but I guess I was wrong (?) I see the arguments -- that some women can't breastfeed for a lot of reasons -- but isn't it still true that women in many places are not encouraged to breastfeed because the formula companies would lose money if they did, when, in fact, they can? And does that whole bogus "formula is modern" (as per, say, the 1950's) thing that got pushed on developing countries (can I say "developing countries"?) not apply anymore?

God I'm really too old to live at this point.
posted by DMelanogaster at 1:58 PM on March 20 [9 favorites]


I don't know that advertising is the best way to give them that information, but it's not totally crazy to think that it's useful.

I don't know, I do think that's kind of crazy, to think that's how that information should be distributed, based on the marketing budget of the company making the product and their priorities. It's not at all unreasonable to think that doctors who'd been reading journals full of advertising for certain brands and types of formula would be recommending those over others, or they wouldn't be doing that advertising.

But, along those same lines, I can think of a huge laundry list of products that shouldn't be advertised to doctors when they're reading medical journals, which consists of "any product the doctor isn't going to be consuming personally". I'd be happy to say it should actually just be unethical to advertise in that context, period, but I'm willing to accept that it's probably not super problematic if somebody wants to advertise letterhead or software, things that might impact physician quality of life but not quality of care.

The idea that literally anything can be advertised here except tobacco and baby formula is truly gross. I'm not a fan of this, but it's not exactly the top of my list of advertising-to-physicians concerns.
posted by Sequence at 2:04 PM on March 20 [14 favorites]


Well, it's not like formula companies have stopped their unethical practices in developing nations. I agree that formula has its place and can be lifesaving for some, but the way it is marketed (including with starter packs given to new parents) leaves a lot to be desired. I can't say I'm sorry to see it banned from BMJ.
posted by fiercecupcake at 2:12 PM on March 20 [19 favorites]


I think advertising is one of the ways a physician can learn about a product, like the rest of us do. That can literally be lifesaving. Baby has problem x, I just saw manufacturer y now makes product z that can help! Formula has medical applications, and I know several people whose babies were unable to consume breast milk and whose lives were improved or even saved by formula. This is NOTHING like tobacco, tobacco has no medical benefits, formula most definitely does.
posted by biscotti at 2:15 PM on March 20 [10 favorites]


Direct link to BMJ: Calling time on formula milk adverts (Editorials; BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1200) (Published 18 March 2019)
In 1981, the World Health Organization and Unicef launched the International Code of Marketing of Breastmilk Substitutes, which explicitly bans advertising and other form of promotion of these products to the general public. The code aimed to rein in unethical behaviour by industry that had coincided with a general decline in breastfeeding rates.
...
Concern is growing that industry continues to stretch and violate the rules. However, the monitoring of legislation is weak, and companies are rarely prosecuted for breaches. This allows the $50bn (£38bn; €44bn) a year industry to pursue customers without fear of sanction.
The issue is not that breastmilk alternatives are marketed, but how they are marketed, and who they target.

How formula milk firms target mothers who can least afford it -- Guardian/Save the Children investigation in deprived areas of Philippines finds companies flouting international code (Published Mon 26 Feb 2018; Last modified on Wed 28 Feb 2018)

That is the issue -- it's not that health care providers can't say "it looks like your baby is not getting enough from you as its mother, try some/this formula," it's the fact that companies are saying "hey poor mother, you can't provide enough for your child on your own, you should instead buy our formula!"

(As anecdotally included in America Is Not the Heart, as discussed on FanFare)
Hero remembered the Nestle campaign. She'd never intented to become an ob-gyn, so perhaps she'd avoided the worst of the push, but she distinctly remembered fellow students being encouraged to discredit breastfeeding. They were taught the science of Nestle formula, and interns and residents were used to the spiel, how to get new mothers hooked on the formula with a decent amount of intimidation and a free trial. Just mix with water. Easy enough. Easy enough, despite the fact that many of the poorer women they'd recommended the formula to lacked access to clean water.
(Copied from the Google books preview, and it goes on.)

Formula is not a new medical advance, though I recognize that there can be new types of formula. But medical professionals don't rely on adverts to learn about new medicine, it's how people in the US learn about new drugs that they can ask their doctors to sell them.
posted by filthy light thief at 2:18 PM on March 20 [34 favorites]


Easy: formula is bad. mother's milk is good.

Hard: mom's milk probably has benefits A through F, probably benefits G through M we don't know about yet, is likely superior to formula in most cases, but then again people's situations vary widely and formula may be acceptable or even practically superior in some cases.

Easy: formula is fine, lay off the guilt trips, advertising for everyone.

Hard: formula may be the most practical option in some cases, it should certainly be available, OTOH if you give a capitalist a market, he's going to want to grow it into milk alternatives and will be happy to use advertising as a vehicle to spread whatever conception moves more product rather than ever genuinely consider what information is most beneficial, assuming you could actually communicate that information *in* advertising considering that most people really want to boil things down to either "formula is bad" or "formula is fine," so maybe we should regulate advertising content, or maybe we should ban it and let medical professionals do the educating, or maybe everyone has already TL;DRd this and we should just say "breastfeeding may be better, formula can be fine" ...
posted by wildblueyonder at 2:19 PM on March 20 [19 favorites]


Are formula advertisements uniquely confusing or misleading? Certainly not as compared with the pharmaceutical companies that will continue to advertise freely in the pages of the BMJ.

For me this is the crux. Advertising medicine is terrible bullshit, and we know that advertising influences what and when Doctors prescribe. This is deeply problematic, I want my doctors to prescribe based on evidence, not ads... but this being said, I struggle to see how formula's often misleading ads are egregious in this respect. If they are advertising other medicine, then advertising formula should be okay, too.
posted by smoke at 2:22 PM on March 20 [21 favorites]


But medical professionals don't rely on adverts to learn about new medicine, it's how people in the US learn about new drugs that they can ask their doctors to sell them.

This is about advertisements in the British Medical Journal, not Good Housekeeping.
posted by jacquilynne at 2:22 PM on March 20 [12 favorites]


Does the BMJ ban opioid advertisements? Under the policies laid out here, it seems like they should.
posted by muddgirl at 2:28 PM on March 20 [13 favorites]


My impression was that there was something of a backlash (at least in the UK) against the really excessive and unwarranted pressure to breastfeed exclusively that had been experienced by many new mothers. Just last year the Royal College of Midwives issued new guidance stating that a mother’s decision to bottle feed or combination feed should be respected. This announcement feels like something from 10 years ago.
posted by tomcooke at 2:31 PM on March 20 [15 favorites]


I'm kind of shocked that formula is now considered okay, healthwise.

Formula has come a long way, and the evidence of the benefits of breastfeeding over formula-with-clean-water are mixed (some good, many inconclusive - the fpp has links to a good summary of the research (PDF, 2018 article). Without clean water, breast is definitely best. But with clean water, fed is best - and formula can be freeing.
posted by jb at 2:32 PM on March 20 [19 favorites]


I was an exclusively formula-fed baby. My mom had serious complications during delivery and was stuck in the hospital for weeks. By the time she got out, there wasn't any option to breast-feed as milk production had stopped.

I'm on the side of parents who have any number of reasons to formula-feed and don't need any additional societal or medical shaming for doing so. It's just weird because that means I also am de facto on the side of corporations/advertisers, and Nestle in particular has been terrible.
posted by spamandkimchi at 2:40 PM on March 20 [9 favorites]


Adoptive mother here; it was pretty much formula or nothing (because I am not a breastfeeding zealot). I was raised on formula because despite my own mother's attempts to breastfeed and practically turning herself inside out to do so, her milk was inadequate for a baby and she was told to use formula. TL;DR: Formula can be a Good Thing indeed.

Are formula makers like Nestlé a good thing? Hell no. As far back as the 1930s, Post writes, physicians knew that bottle-feeding infants in tropical environments with limited sanitation and refrigeration could be dangerous. Water used to prepare the formula was often contaminated. To make matters worse, formula was expensive, so parents were often forced to water it down or replace it with cheaper products like whole milk or cornstarch. Because mothers who don’t breastfeed soon after giving birth lose the ability to do so, starting infants on formula in developing countries was a disaster for babies’ health.

Still, formula companies aggressively promoted their product in the developing world, and not just through traditional advertising. Some hired “milk nurses” who dressed in nurses’ uniforms and walked around maternity wards, encouraging mothers to give their babies formula. By the late 1960s, medical officials in developing countries reported a dramatic rise in malnourished babies, and doctors and journalists began bringing the issue of formula feeding to international public attention.
And as documented above, this shit is still going on.

If they are advertising other medicine, then advertising formula should be okay, too.

With all due respect, I disagree. In fact, if I were queen of the universe, I would ban all advertising for medicines and medical devices intended for minors because they do not get to decide what they consume and are uniquely vulnerable to shit like this. Babies, especially. So I am more than okay with this decision. Even if it is largely symbolic, I applaud it.
posted by Bella Donna at 2:42 PM on March 20 [11 favorites]


Anybody who wants to guilt me about choosing to have a kid that was 99.999% formula fed can fuck right the fuck off into the face of the sun, especially if they're doing it with bullshit pseudo-science.*

Giant conglomerates like Nestle who push formula to families without consistent access to clean water should be wiped out of existence, and the executives who approve those marketing campaigns should be shot into said sun, especially if they're advertising using bullshit psuedo-science.




* Like the lady who tried to tell me that breastfeeding meant you were doing your part to keep your kid from developing cancer while I WAS SITTING NEXT TO MY HUSBAND WHO HAD BEEN EXCLUSIVELY BREAST FED FOR SIX MONTHS AND WAS, AT THAT MOMENT, MAYBE TWO WEEKS OUT FROM RADIATION THERAPY AND SIX FROM CHEMOTHERAPY FOR AGGRESSIVE CANCER DID YOU NOT FUCKING NOTICE THAT MY HUSBAND DIDN'T HAVE EYEBROWS OR HAIR
posted by joyceanmachine at 2:42 PM on March 20 [57 favorites]


This reminds me a bit about the plastic straw ban issue. In general, plastic straws are a category of single use plastics that I detest. In practice, disability justice activists have pointed out that there are real, non-trivial reasons that availability of plastic straws is an access issue. Blanket bans on consumer products that have become flash points for larger societal debates on health and the environment can be problematic as the product itself and the product users are subject to moral judgments.
posted by spamandkimchi at 2:45 PM on March 20 [13 favorites]


OMG joyceanmachine, what a nightmare on top of a nightmare. People are so terrible at times. So sorry that crazy person pestered you. Yikes.
posted by Bella Donna at 2:46 PM on March 20 [2 favorites]


It's perhaps worth noting that Britain has taken an increasingly tough line against advertising unhealthy food; e.g. you can't have ads for junk food directed at children, per the Advertising Standards Authority. (IIRC from people I talked to when it went into effect, this was sort of a compromise; banning their advertising altogether wasn't feasible, although that was some people's goal.) Even before the ban went into place, there were a lot of publications that voluntarily restricted ads for junk food, and still do. Hopefully the BMJ journals are in that camp.

I think there's a distinction between allowing a product to be sold, and allowing it to be advertised, and certainly between that and wanting to actively further its advertising in your publication. Companies have shown over and over that they basically cannot be trusted to advertise products that have complex risk/benefit tradeoffs, or where there's a short-term gain but a longer-term deleterious effect. In every situation where they've advertised products having either of those characteristics, absent very strong regulation, they always minimize the downsides. Every. Time.

I think it's fair for a publication to decide "hey, we don't want ads from you jerks, who we know full well would be selling asbestos slurry to preschoolers given the chance". Particularly if they think the publication itself carries some sort of weight or authority. But I do wonder if the BMJ is looking at all of its advertising as carefully. If they go only after formula and stop there, it's... a bad look. No matter how well-intentioned, picking out a product that's pretty much only used by women for special consideration is pretty shitty. But the better solution there is to look at all of their advertisers with the same critical eye, rather than just let it be a free-for-all of whatever happens to scrape by the minimum standard of legality.
posted by Kadin2048 at 2:50 PM on March 20 [18 favorites]


So medical cannabis is legal to prescribe in the UK as of last year, and CBD can be purchased as a food supplement. I'm not 100% certain of advertising regulations, but the idea that you can sell bongs or CBD edibles in the BMJ but not baby formula is interesting to say the least.
posted by gryftir at 2:54 PM on March 20 [4 favorites]


Fed is definitely best. I am currently supplementing breast milk with formula which has allowed my baby to finally catch up to her birth weight a month out. Without it, I don't know what I would have done and I'm pissed ay myself for letting the "breast is best" mantra guilt me into not supplementing sooner while baby dropped weight. At the same time, my watching hours of daytime t.v. while BFing has shown me there is no end to relentless direct to consumer advertising that push all sorts of medications. So I can't say I am upset about this ban...just wish it extended a bit further to cover most medical consumer adverts. These are things that need to be discussed between patient and doctor/ lactation consultant.
posted by ch3ch2oh at 3:05 PM on March 20 [11 favorites]


I don't really know where I fall on this. I'm an autonomy above all else person. I started my graduate program this past fall in Maternal and Child Health at the number 2 program in the country for public health. My mother was a lactation consultant for many years and had four kids. I find the idea of carrying a pregnancy terrifying and think having to lactate is just about the worst thing possible. Moms in particular get enough crap already about just every choice they make as women and then add all the judgement about parenting choices on top of that?!?!

But also there are some really big advantages to breastfeeding and most doctors don't actually do that much with it. Very few doctors are lactation consultants and can support new lactating parents, or trying-to-lactate parents in the ways they need. True, advantages of breastfeeding aren't as impactful in certain contexts. But what about the infant mortality rates for black babies in the US? Should only black mothers be encouraged to breastfeed to offset the systematic and structural racism that exists in the US and its medical system? What about Native American and American Indian women? Are economically secure white women the only ones allowed to choose formula? What about if they are the only group where formula feeding may impact health outcomes? If breastfeeding sucks (which honestly, hearing about engorged breasted and cracked nipples makes it sound like it does) why are we saying it's ok in the "developing" world? Why should those be the only people who have to do it? Why isn't there a bigger push for better formula that more accessible and affordable globally?

Mother's milk changes throughout feedings to adjust to the needs of the baby (particularly if they are breastfed rather than bottle or cup feeding). Breast milk also changes if a baby is sick to respond to those needs. There are advantages breastfeeding on a population level. That might not make a difference for your particular kid. But there are advantages on a population level. It's good for preemies, it's good for those who lack a clean water source, it's good for those who may not have the tools to properly clean and disinfect bottles, it's good for the people who may not be able to read the instructions on the bottle.

Formula can be good for those returning to work and can't pump, who are tired of breastfeeding and those who just don't want to breastfeed. It can be good for non lactating parents wanting to connect with their child or reduce the burden of work on their partner.

Again, I'm not sure that I really know where I fall on all of this. But I think it is good to stop advertising to people (and in this case, yes, doctors) who don't have a ton of training in this particular area on a product that can potentially be harmful.
posted by raccoon409 at 3:19 PM on March 20 [6 favorites]


smoke: If they are advertising other medicine, then advertising formula should be okay, too.

Direct-to-consumer advertising is only permitted in New Zealand, the United States, and Hong Kong; Brazil allows limited DTC ads, for OTC medication. In other words, advertising other medicine to the public is, by and large, not okay.
posted by filthy light thief at 3:28 PM on March 20 [8 favorites]


Frankly I hate advertising, ALL ADVERTISING. if this is the only advertising they're removing, I'm pretty sure it's bullshit sexism masquerading as concern. Fuck em.
posted by evilDoug at 3:42 PM on March 20 [12 favorites]


Isn't there a big difference between guilting those who need or want to use formula (obviously bad) and shutting down ads for formula in a medical journal? The ads are not directed at parents, but at doctors. Doctors who may not know all they should know about women or babies, and who may have weird preconceptions about women, because doctors are people, good and bad.
And: although medical journals have international outreach, conditions for mothers are not the same everywhere. I mentioned in another thread that parents here have a year of paid parental leave, which even if it is shared equally between the parents gives mothers plenty of time for breastfeeding the first 6 months, which is the WHO recommendation. After those 6 months, formula is not necessary. It looks to me that the British conditions are similar to, if not as excellent as those we have here. What I'm saying is: please don't let the horrible conditions some American parents deal with define what is a good advertising policy for the BMJ.
Finally, I know very well that some mothers depend on formula because I was a such a mother. My second daughter generally wasn't that much into eating when she was a baby, my milk nearly stopped because she didn't feed, so she survived on a mix. My best friend was completely unable to nurse. Would I blame or shame her? Of course not! I am able to have the opinion that formula is not the best option at the same time as having the opinion that formula is fine. Sometimes perfect is the enemy of good, but that doesn't mean we should allow good to advertise in medical journals. Which is what this is about. In my privileged view as a person living in a country where there is decent healthcare, similar to the NHS, in the UK, where this journal is published, I see the feminist angle in the article as contrived and click-baity, or just very US-centric. If it is the latter, I have a strong opinion about US health-care norms spreading to non-US countries, because I can see Conservatives and Neo-Liberals pushing for a US system in countries with good, affordable healthcare for everyone, and that is just wrong (though I don't imagine the author has thought of this).

(Also, some thoughts to those of you who haven't had babies: nursing can be very hard in the beginning even though there are no medical issues. Don't give up, and seek professional guidance and it can work out for most people. It's simple and very pratical when you have made it work for you. Using formula, on the other hand, was a constant pain and a stressor to me. I felt like my kitchen became a laboratory, with constant sterilizing of bottles and worries about supplies. Going out to meet friends was like packing for a grand expedition. If I could have avoided it, I would.
And to be very close up and personal: nursing didn't change my body significantly, or any of my friends' or sisters' bodies, or our sex lives in the longer term. I'm not saying it never happens, I am saying there is a lot of scary stuff out there on the webs which you should either ignore or talk with specialists about, because there may be other facts).

posted by mumimor at 3:48 PM on March 20 [12 favorites]


This is about advertisements in the British Medical Journal, not Good Housekeeping.

Maybe stop putting ads into scientific journals in the first place?
posted by tclark at 3:50 PM on March 20 [17 favorites]


In other words, advertising other medicine to the public is, by and large, not okay.

Well, I mean the entire thrust of my comment is that I think advertising should be banned, but I think it's hypocritical to only ban one type of product. Additionally, I also agree to consumer advertising of medicine is insane, but the BMJ is not something you pick up with the groceries - the audience is other medical professionals (and I still think advertising is just as problematic if not more so to them).
posted by smoke at 3:51 PM on March 20 [1 favorite]


Direct-to-consumer advertising is only permitted in New Zealand, the United States, and Hong Kong; Brazil allows limited DTC ads, for OTC medication

That article seems a bit mixed up, there’s plenty of DTC advertising of OTC medication in the UK for example.
posted by tomcooke at 3:54 PM on March 20 [3 favorites]


I thought formula was supposed to be terrible (content-wise).

Contemporary formula is a totally different beast than it was even ten years ago. It's basically nutritionally identical to breast milk, and in general has more iron and Vitamin D. Breastmilk is only as good as the mother's nutrition, and when feeding my now two year old Ms Potato as a newborn it became apparent my 10 months of vomiting and subsequent lack of interest in food was not allowing me to produce milk that was even a fraction of what she needed.

And that's a lot of this, in the end, really. These sorts of bans in a Western medical journal are not divorced from their context. The medical literature, and the way it's discussed, tends to cut out a lot of the women themselves. Rates of breastfeeding decline in conjunction with workplace participation, they pick back up with improved maternity (and other parental) leave and better social supports lead to better breastfeeding. Communities with good breastfeeding rates tend to have better supported mothers across the board. Many mothers I know who formula feed would rather breastfeed, but you can't pump if you work a job that relies on coverage (like retail or hospitality) or if your employment is unstable or at will. Two of my collegues bottle fed - one took a grand total of a week off, the other even less, and never got a chance to establish their supplies enough to pump, even if we'd had space and the opportunity to do it. Things like that. Even the middle class women I know are pumping in breakrooms to dwindling supply.

But the medical establisment is neither qualified or willing to talk about that. It's easier to look at those breastfeeding rates and assume that it's totally at the feet of the manufacturers and advertisers, and how easily swayed new parents are.

Like, advertising to doctors isn't going to really have a huge impact on those social factors. All it's doing is making the practicalities of formula feeding invisible to doctors. The fact that it's clumped in with tobacco in terms of advertising restriction tells a lot. Addictive, dangerous and deadly.
posted by Jilder at 4:07 PM on March 20 [23 favorites]


I keep writing comments and then other people make the exact same point, except better written.

If we look at the history of wet nurses and formula feeding, the use of wet nurses exploded with the rise of factory labor and only fell when safe sanitary bottle-feeding became possible. This article was published in the Journal of Lamaze International and yet the conclusion is that somehow the very existence of formula is why parents don't breastfeed.
posted by muddgirl at 4:10 PM on March 20 [12 favorites]


> I started my graduate program this past fall in Maternal and Child Health at the number 2 program in the country for public health. My mother was a lactation consultant for many years and had four kids. I find the idea of carrying a pregnancy terrifying and think having to lactate is just about the worst thing possible

I wonder how many of your classmates also think that having to lactate is terrifying, and if you're going to have ads for formula aimed at you.
posted by The corpse in the library at 4:15 PM on March 20 [1 favorite]


Apologies, that came across as more personal than I intended. I'm thinking medical students in general, that wasn't supposed to be "you" as in "you right there, you Mefite."
posted by The corpse in the library at 4:16 PM on March 20


Sounds like the problem is not formula per se, but the profit motive that comes with (and distorts the market for) it. Nationalize pharma research/production, nationalize the production of infant formula?
posted by aiglet at 4:20 PM on March 20 [4 favorites]


nationalize the production of infant formula?

I wish to subscribe to your newsletter
posted by Homo neanderthalensis at 4:24 PM on March 20 [2 favorites]


I'm kind of afraid to read the comments here.

Little Llama is ten now, and was exclusively formula-fed after horrible boob fail, which haunted me. At the time, that failure was devastating. Unless you have gone through it, you cannot understand the mix of hormones and pressure that goes with being a new mom.

It was the best thing that could have happened. I got a 50/50 split with my husband, right from the beginning. It never occurred to either one of us that *any* baby care was primarily my responsibility after that. You took your turn and that was that.

My daughter is super healthy, is almost never sick. I mention this because it is one of the snarky things we heard a lot, that people just drop in conversations. So-and-so has constant ear infections because, well, he wasn't breastfed. What do you expect? Of course s/he is sick all the time.

We think her robust immune system is because we let her make out with the dog, but in any case, she's always been more athletic than we were as children, healthier, etc., and she is super-smart and creative.

She is also really close to her dad and I think that is in part because she views him as an equal parent; someone to go to for nurturing and a sense of safety. She has an expectation of boys that they are friends, allies, and equals.

She'll be disabused of that notion at some point, and discover sexism is an actual thing, but I hope that at some core level the trust she has with her father, and the expectations that she subsequently has of male behavior, will be a real asset. (And she's the only girl-kid I know with boy 'friends'--true friends.)
posted by A Terrible Llama at 4:26 PM on March 20 [48 favorites]


Yeah, lots of consensus here. Support moms. As a dad, I loved the ability to feed the kid, finally.

Can they just mandate a swap of the formula ads for policy advertisements for 6 months of paid maternity leave? I promise that would improve breastfeeding rates, ADA.
posted by eustatic at 4:30 PM on March 20 [9 favorites]


Some more specific criticism of the article.
She writes: In their messaging, the BMJ editors embrace another position held by the WHO—that breastfeeding should continue for the first two years of a child’s life, another standard formulated for the nonindustrialized world that has been transported to the industrialized world. While this is not technically wrong, the readers of Slate may not realize that WHO's recommendation is Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.. Those things are not at all the same. The extent of continued breastfeeding should vary depending on where you are and who you are.
And while it is true that the only other product group BJM bans is tobacco, the journal also states: • Advertisements for products making therapeutic claims but without marketing authorisation or CE marking (or local equivalent), should be submitted with all claims substantiated in full length research papers published in peer reviewed journals. While tobacco is obviously poison, formula is equally obviously not medicine. It's not wrong or dangerous, but it is also not a therapeutic product.

Formula can be life-saving, and for my baby it was definitely necessary. But it is not medicine, and it is not, IMO, feminist.
posted by mumimor at 4:32 PM on March 20 [2 favorites]


Formula can be life-saving, and for my baby it was definitely necessary. But it is not medicine, and it is not, IMO, feminist.

I don't think anyone is saying formula is always medicine, although it can be. It's food. The BMJ appears to accept advertising for all sorts of things -- not just medicine. They're excluding formula for ideological reasons - to push breastfeeding.
posted by schwinggg! at 4:59 PM on March 20 [14 favorites]


nationalize the production of infant formula?
We're already well down that path; the majority of infant formula in the United States is purchased by the WIC program, for virtually nothing.

Source: I used to work for a state WIC program. The rebates we got from the formula manufacturer (the contract moved to a different company every few years) were 80-90% of the retail price we paid at the store. I occasionally even saw formula on sale for less than the amount that I knew we were getting back in rebates.

Kinda like how if you walk into a hospital and pay cash to get a broken bone fixed, you'll pay at least 10x what Medicare would pay for the exact same service.

And while hard numbers are difficult to come by because there are something like 90 different state WIC programs (territories and Indian tribes all have their own WIC programs), I heard through various sources that 60-80% of the infant formula in the US is bought through WIC.
posted by Hatashran at 5:02 PM on March 20 [6 favorites]


But it is not medicine, and it is not, IMO, feminist.

I would argue that anything that gives women more freedom and options is feminist, and there are many examples in this thread of how formula has done that. Whether it's medicine - well, no. It's food.
posted by showbiz_liz at 5:09 PM on March 20 [54 favorites]


mumimor, are you suggesting that formula ads are making claims to be therapeutic but not substantiating them? Because otherwise I don't see the relevance of that quote.
posted by the agents of KAOS at 5:23 PM on March 20 [2 favorites]


This is slightly off topic but maybe pertinent: there are some class issues associated with formula, particularly surrounding day care and maternity leave, and formula is expensive. Both our nearby supermarkets *lock formula up* in un-shopliftable cases.

I dearly wish the store managers would be just like, fuck it, it's a loss leader. If someone needs formula badly enough to steal it, we are essentially donating it. Have at it.

They don't have to advertise it, just maybe dispense with the giant locked case at the front of the store where they lock up *nutrition for children*.
posted by A Terrible Llama at 5:24 PM on March 20 [28 favorites]


It just seems so backwards to read that Guardian article which presents a young mother living with no electricity or running water, who had difficulties with breastfeeding that went undescribed, who can't afford the nutrition her baby needs, and conclude that formula marketing is the problem.
posted by muddgirl at 5:35 PM on March 20 [21 favorites]


I would argue that anything that gives women more freedom and options is feminist
What would give women more freedom and options is a paid parental leave to be shared between both parents.
Having had one child entirely breastfed, and one semi-formula fed, my personal experience was that the former gave me more freedom and options. If you are lucky enough to be able to breastfeed, as a large majority of women are, it is extremely practical. You can go anywhere and bring free food with you without worrying about bottles or products or sterilizing or heating. With babies below 6 months, who don't move about a lot and who do sleep a lot, you are able to see your friends, travel, even work as I did even though I am a privileged Scandinavian, because my husband and business partner was not picking up the baton.
Obviously if your infant has colic or something, that won't be possible, but let's be charitable and say that's the same regardless of wether you nurse or feed formula.

There is no doubt that for many women, formula is absolutely and non-negotiably necessary, and nobody should even begin to blame them or shame them. But it makes me sad to see how something simple and healthy is problematized. And it makes me sad to see how structural and societal issues are loaded onto the individual. The author mentions how the stress of breast-feeding can lead to postpartum depression. How about: the stress of having to work a fulltime job, be underpaid, live in less than ideal homes and struggle with a crazy sleep pattern can lead to postpartum depression?

mumimor, are you suggesting that formula ads are making claims to be therapeutic but not substantiating them? Because otherwise I don't see the relevance of that quote.
Well, obviously not, because I haven't seen the ads in question. I see it more as evidence that the journal already reviewed advertisements critically, and that the retorical siding of tobacco and formula in the article isn't really fair debate practice. I know that in some areas all over Europe, including the UK, the approach to breastfeeding is considerably behind the WHO guidelines, with bad health outcomes as a result. And on the population level, rather than the individual level, there is really no doubt that breastfeeding is optimal. There is a huge international consensus on this, based on tons of studies. On the individual level, formula can be very important, even life-saving. But you cannot extrapolate from your (my) personal experience to population needs.

It just seems so backwards to read that Guardian article which presents a young mother living with no electricity or running water, who had difficulties with breastfeeding that went undescribed, who can't afford the nutrition her baby needs, and conclude that formula marketing is the problem.


Did we read the same article? It's about how Nestlé targets young mothers to persuade them to spend their money on formula, in the reported case instead of feeding themselves.
posted by mumimor at 5:46 PM on March 20 [9 favorites]


The latest episode of Russ Roberts' Econtalk podcast touched on the formula vs. breast milk controversy, among other issues associated with childbirth and motherhood. A very interesting discussion.
posted by Pararrayos at 6:16 PM on March 20 [1 favorite]


Did we read the same article? It's about how Nestlé targets young mothers to persuade them to spend their money on formula, in the reported case instead of feeding themselves.

But she didn't decide to feed formula as an aspirational choice like the article tries to argue in the paragraph before it - she did it because she was struggling to breastfeed, which the article elides with half a sentence. It is taken as a given that that every mother could successfully breast-feed their child if they just chose to.

And the dumb part is that I absolutely agree that Nestle is unethical in how it markets its formula, but I don't agree that this story is an example of that phenomenon. The mother didn't say "I was told that formula was better for my baby." She was struggling to breastfeed and was told that formula was the same as breastmilk, that is not aspirational marketing at all.
posted by muddgirl at 6:16 PM on March 20 [16 favorites]


muddgirl, I'm really sorry, I hadn't seen that half sentence, that is indeed not good reporting.

None of us can really know if the particular young woman in the article could have been helped with better healthcare, but when I saw that only 34% of mothers in the Phillipines nurse their children, I knew that at least 34% more of them could have and should have had better help from midwives or lactation guides and maybe social workers than from Nestlé.
Specially for first time mothers, nursing can be very difficult the first month, and it should be a healthcare priority in every country to acknowledge that and help those young mothers succeed. Because it is so liberating when it works. And again: that is a structural and healthcare issue, not an individual issue.

I'm pretty sure that my friend who ended up not being able to nurse her son was not given the correct help and guidance, for reasons unknown to me. The pain she went through was terrible. I do not take women's individual experiences lightly, and I strongly believe women' health is under-prioritized. It's just that if there is a structural problem that causes individual pain, I believe we need to address the structural problem. Giving my friend painkillers and penicillin did not change the fact that she had not received relevant care. It doesn't mean I think she should have been deprived of the medicine.

We should always offer all the individual support and care we can, while we keep focused on the structural and societal issues at hand.

TBH, every time we have discussions about maternity and related stuff here on metafilter I get agitated, because to me, women's health is the single most important societal issue. If all women have access to proper care, education and work, all other problems can be solved. I believe there is actual evidence for this. And then sometimes I feel the issues get individualized. Maybe I'm completely wrong -- I didn't notice that the woman in the Guardian article struggled with lactation, because I focused on the fact that she didn't have clean water. Or a basic income. On the other hand, if I didn't have clean water or a basic income as a young mother, I can promise you I would have had problems with lactation.
posted by mumimor at 6:53 PM on March 20 [7 favorites]


I think advertising is one of the ways a physician can learn about a product, like the rest of us do.

And that is a real problem; advertising is not meant to educate, but to sell product. And if you can convince physicians to push your product, then you have really scored some points on the competition. I agree with those who say medical journals should have no advertising at all. Physicians are just as susceptible to marketing gimmicks as anyone else, but are viewed as authority figures by patients. Advertisers are very aware of this and take advantage of it whenever possible; look at all the cigarette ads featuring doctors back in the 1950s, for example.
posted by TedW at 7:00 PM on March 20 [11 favorites]


What would give women more freedom and options is a paid parental leave to be shared between both parents.
Having had one child entirely breastfed, and one semi-formula fed, my personal experience was that the former gave me more freedom and options.


How about parental leave and formula both give women more freedom and options? It's great that you found that breastfeeding gave you more freedom and options. Since formula gives other women more freedom and options, it is absolutely a feminist issue.

Because it is so liberating when it works.

For you. It was liberating for you. Focusing on structural problems is absolutely necessary, but some women will want to use formula for individual reasons. They shouldn't have to justify or defend that they're using formula for the right reasons or due to structural failure. Maybe they just don't want to breastfeed. Maybe they don't want to get through that first bad month. Maybe they want their partner to be able to carry half the load. Maybe they want to go back to work. Formula gives women those choices. The fact that formula companies are often awful doesn't change that.
posted by Mavri at 7:13 PM on March 20 [41 favorites]


I agree with those who say medical journals should have no advertising at all.

I imagine they have advertising for the same reasons that trade magazines have it - so that the end readers don't have to pay the full cost of production and distribution. Do we expect doctors to read medical journals? Would we expect them to read them, if they cost triple or quadruple what they do now?

I didn't notice that the woman in the Guardian article struggled with lactation, because I focused on the fact that she didn't have clean water. Or a basic income.

The article doesn't go the background of "breastfeeding had been hard." Does that mean she tried it for a week and couldn't find a comfortable position, or that her baby was showing failure-to-thrive signs? Trouble with lactation isn't likely any worse than, “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.” Nestle wants profit, not healthy babies.

I'm in favor of sharply limiting formula advertising. It's a food substitute that's only almost-as-good (and that "almost" may be negligibly short of "equally") for those families that have the money to buy enough, and the time and resources to prepare it correctly. Without all three of those, it's definitely less healthy than breast milk.
posted by ErisLordFreedom at 7:27 PM on March 20 [4 favorites]


Trouble with lactation isn't likely any worse than, “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.”

I don't presume to know any better than the woman in the position to make that choice! It's infantilizing to believe that she is too ignorant to try lactation to feed her baby when she knows her baby is not eating enough.
posted by muddgirl at 7:35 PM on March 20 [14 favorites]


Formula feeding was such a great thing for us.

The "education" we got prior to birth about breastfeeding focused on how easy it was going to be, and then when it wasn't, suddenly all the doctors and lactation consultants who said it would be easy were telling us we shouldn't have expected it to be so easy. It really felt like a huge deception to me.

One doctor took pity on us. When we reported trouble, she immediately got us some formula. When the lactation consultant came around, she was horrified.

Formula feeding let us split the workload, saved our sanity and gave us a better bonding experience with our child.
posted by mpbx at 7:38 PM on March 20 [15 favorites]


Focusing on structural problems is absolutely necessary, but some women will want to use formula for individual reasons. They shouldn't have to justify or defend that they're using formula for the right reasons or due to structural failure. Maybe they just don't want to breastfeed. Maybe they don't want to get through that first bad month. Maybe they want their partner to be able to carry half the load. Maybe they want to go back to work. Formula gives women those choices. The fact that formula companies are often awful doesn't change that.

Mavri, thank you so much for saying that. Women absolutely should have the freedom to choose, and there are lots of reasons why breastfeeding may not be the right option for someone. Those reasons should include personal choice and I really hate that this is so often left out of these conversations.
posted by DingoMutt at 7:51 PM on March 20 [20 favorites]


This is slightly off topic but maybe pertinent: there are some class issues associated with formula, particularly surrounding day care and maternity leave, and formula is expensive. Both our nearby supermarkets *lock formula up* in un-shopliftable cases.

I dearly wish the store managers would be just like, fuck it, it's a loss leader. If someone needs formula badly enough to steal it, we are essentially donating it. Have at it.


Here in Australia we've had full on organised cartels stealing infant formula for sale on the Chinese black market. We were often using single serve sachet packs bought day to day for Ms Potato. She's picky about what formula she takes and her brand was always picked clean and often unavailable for weeks on end. It was pretty hairy because even when we were primarily breastfeeding she was still getting at least half her nutrition from formula, and watching the tin get emptier and emptier with no supply was scary.

After the bust we've had considerably fewer problems with supply. It's fucking nuts.

Like I totally get what you're saying, and largely support that general notion that families that desperate should just get a pass on that kind of low key theft, but it's possible its locked to prevent pros stealing it, not parents. Because capitalism ruins everything, all the way down, apparently.
posted by Jilder at 8:47 PM on March 20 [5 favorites]


New mom to a four week old here, currently nursing at midnight browsing metafilter on my phone. I find so much of the conversation around breastfeeding and formula deeply frustrating. I gave birth at a “baby friendly” hospital in the US and the only time I heard the word formula was at hour 15 of labor, when my nurse gave me an unprompted lecture about how formula was “gross” and I just needed to pump in my car when I went back to work. Breastfeeding was assumed, but I didn’t actually get any guidance on it once in the recovery room. When my kid got jaundice and lost 10% of her birthweight, I’d read enough horror stories to know that I was potentially facing down another hospital stay, and I had gone into all this already pretty skeptical of the constant breastfeeding evangelism. There was NO mention of supplementing even then, and I couldn’t help but wonder if it was just because they wanted to keep their breastfeeding statistics up. I watched my baby get yellower and yellower no matter how much I nursed and despite all their reassurances it felt wrong. We gave her a bottle of supplementary formula the night we went home and it was the best decision we could have made as parents. (She probably would have been fine—plenty of babies get jaundice and her weight loss wasn’t extreme—but what if she wasn’t?) She regained her birth weight in a week. My husband gives her bottles at night so I can sleep, and she gets to nurse from a happy mom during the day. It’s great for us and the labor division absolutely feels like a feminist choice. But there are close to NO comprehensive resources about combo feeding out there, which is wild to me given how common it is. And I sure as hell still feel the guilt and the pressure. I’d love to see a lactation consultant to help figure all this out, but what if I get a shamey one? What kind of looks am I going to get from my midwives at my 6 week checkup? Being a new parent is stressful enough.

I go back to work in 8 weeks and at some point I need to decide: do I lug a pump to and from my office every weekday, wash the parts in my shared office sink and store a milk stash alongside people’s lunches, hole up in a windowless office 3x a day with my tits out? Or do I manage my supply so that I can nurse in the evenings and give her formula during the day? Or do I just say fuck it and go full formula? Don’t know yet, but I DO know that this would be a very different decision if we had actual parental leave in this country. I’d love to keep nursing until 6 months or even longer, but breastfeeeding as a working parent is not convenient or easy or free. If La Leche League & co really want to promote breastfeeding in the US, they’d go a lot further lobbying for real paid leave, not promoting the bullshit shaming culture that places all the pressure and guilt on individual choices instead of institutions.
posted by sonmi at 9:31 PM on March 20 [29 favorites]


Formula isn’t locked up because of shoplifters but because of scams.
posted by Ideefixe at 9:36 PM on March 20 [1 favorite]


There's no getting around that framing opposition to industry regulations in terms of personal choice and freedom comes from a very specific playbook so... I dunno, something about this gives me a bad vibe. Even though I don't think there's anything terribly wrong with the actually personal decision to use formula.
posted by atoxyl at 10:29 PM on March 20 [3 favorites]


There's no getting around that framing opposition to industry regulations in terms of personal choice and freedom comes from a very specific playbook so

What, the pro-choice playbook?
posted by muddgirl at 11:00 PM on March 20 [2 favorites]


So a comment upthread about Europe being "behind" WHO guidelines made me think of something that might be helpful here. Moving away from breast milk vs formula here for a second, and instead to when to start weaning; the WHO recommends breast milk only for the first six months, no solid food until then. The advice we were given by medical professionals in the UK was that this ruling is as it is because as a single ruling for the planet it must cover environments of varying food safety, and so is very conservative as breast milk is technically the safest way to feed, but in the UK they were happy for folks to start weaning much earlier.
Anyhow I think what I'm trying to get at is this situation seems to be a tangle of valid pushback against the marketing of formula.in situations and/or to degrees where its genuinely inappropriate, and equally valid pushback against mothers being shamed for using it in contexts where its fine?
The current UK stance seems to be that breast milk is technically best, there are hundreds of reasons why you might choose formula and you shouldn't feel bad at all for doing so, and any health benefits of exclusively breastfeeding would be moot after the first couple years of the child's life anyhow, which seems like good and supportive advice.
posted by ominous_paws at 11:48 PM on March 20 [2 favorites]


Giving my friend painkillers and penicillin did not change the fact that she had not received relevant care. It doesn't mean I think she should have been deprived of the medicine.

In your analogy, formula is the medicine. Perhaps you feel that issues get individualized instead of being seen structurally because you are arguing against the availability of the solution that individuals can use to mitigate the impact of structural issues, and so people try and explain why that solution is helpful to individuals.
posted by the agents of KAOS at 11:57 PM on March 20 [1 favorite]


I'm pregnant -in the UK fwiw. At my first appointment with a midwife there was a box on the online system thing that said something like "discuss benefits of breastfeeding" (worded a bit stronger than that). The midwife refused to tick it because, as she said, if you've had a difficult labour and a section or a host of other issues your supply will probably be low and formula is there to help you feed your baby. It's a good thing that it exists. I found this reassuring and realistic and was glad there was a human discussing this with me rather than someone who was just going by rote.

Anecdotally I know a lot of women who never breastfed or who stopped when they left hospital because it wasn't practical for them - no one else can help feed the baby, not feeling comfortable feeding in public, not knowing how much your baby's feeding, what about when you go back to work, getting up more in the night, etc etc. I don't think any of them were swayed by "industry influence" in any clear way.
posted by the cat's pyjamas at 1:56 AM on March 21 [6 favorites]


What about medical formula? My premie baby was breastfed until she was 2.5 but failure to thrive due to regurgitation Nd prematurity, and desperately need supplemental formula. It had to be a specific thickened formula that we got at the pharmacy then in tiny tins at a pricey supermarket, but she was able to hold down. I knew other premies who had to take specialist formula for problems too. Early delivery disrupts nursing production for the mother while ironically breastmilk is vey protective for NICU babies against specific infections. Donor milk banks are allowed in some countries for NICU babies, but not mine at the time. I wish the doctors and nurses had been more supportive of formula and less pressuring of pumping when I was already struggling but at least they helped me figure out which brand of formula was correct for the medical issue. The advertising was useless.
posted by dorothyisunderwood at 2:02 AM on March 21 [3 favorites]


In your analogy, formula is the medicine.
There is no analogy there. My friend became very ill with mastitis, probably because she wasn't given appropriate and sufficient guidance after giving birth. For the mastitis, she needed medicine.

I've read my comments again. In every single one of them, I make it clear that I believe every woman should have the choice to do what feels right for her in her given situation.

My opinion is that working class and many middle class women in the USA don't have a real choice both because they don't have a paid leave and because they are not given the right care after delivery. I can see some examples of this among the replies here. Those are structural issues, not personal issues.
On top of that, the very women who have the least real choice about breastfeeding because of structural issues are those who are most burdened by the cost of formula.

I'm not reacting to any mefites' personal choices, but to the article posted in the FPP, and its author who is an obstetrician who should know better.

you are arguing against the availability of the solution that individuals can use to mitigate the impact of structural issues, and so people try and explain why that solution is helpful to individuals.

I'm not arguing against the availability of formula. Formula will not become less available anywhere because the industry is banned from advertising in a UK journal of medicine. I can see that people are trying to explain why formula can be good. I know that already. I have used formula for my baby. I am arguing against the TFA which is written by an American obstetrician about ads in a European medical journal. She claims the journal is hypocritical. I claim the journal is published in a country where the context of breast feeding is different from where she is, and that its ban is appropriate given the actual issues in that societal context.
Since she is a doctor and it seems a feminist, I feel she should educate herself about the structural issues that inform women's choices instead of defending the industry. I find it weird that a medical professional with a long expensive education might not understand that women may be struggling with other issues in Europe than those they deal with in the US.
I've also pointed out that her argument is spurious. Apart from the issues I pointed out above, she twists facts and uses very small and specific data on hospitalized neonatal babies to claim something about normal children at home. For this you have to read her other Slate article, which she links to in the article.

I guess she is a living example of the fact that doctors are people like the rest of us. A long specialist education does not protect anyone from trusting bad science on the internet, nor does it prevent them from trolling. Which is in itself a good argument for the journal to stop showing ads for formula.
posted by mumimor at 2:12 AM on March 21 [7 favorites]


(including with starter packs given to new parents)

I was sent home with a baby fresh out of the nicu before my milk came in with a starter pack of formula. Not one of the lactation consultants or doctors told me I’d need to buy more formula, and after a 2-day labor experience and 3 in the nicu, I wasn’t thinking. That starter pack got us through the first night.

The idea that nursing is easy or convenient was not true for my first; even with the perfect latch and a baby who was happily gaining weight, I found it time consuming and painful for the first 6 weeks. It also made it impossible for my husband to participate equally, and those seeds of resentment bore fruit for years. Once we got nursing established, my child refused a bottle, making it impossible for me to work or be away from her for any length of time. She screamed until she passed out, woke up, and screamed again until I picked her up instead.

I really wish I’d kept supplementing with formula.
posted by snickerdoodle at 3:37 AM on March 21 [9 favorites]


Formula absolutely is a feminist issue, I can’t believe we’re even challenging that notion here. Bodily autonomy does not disappear just because one has a baby, no matter how much some people proclaim that it does.

I hated breastfeeding, every second, every suckle, every physical reaction my body would have (you know some women experience severe nausea every time their milk lets down? I didn’t, until I wanted to vomit every time I fed my child who also didn’t want to latch and was a supremely lazy eater.) I was actually one of those moms who had zero supply problems; once I admitted to myself that breastfeeding was ruining my life, I still switched to pumping instead of quitting, because I thought that even if there was something wrong with me (what kind of mother hates breastfeeding??) I still shouldn’t deprive my baby, so I was pumping 45 oz a day, easily, while she ate maybe 20 on a good day.

Please believe me when I say that the “breast is best” universal pressure ruined my first four months with my child. My feelings were not taken into account in the least. The refrain was, “well, you should try! For her!” and my whole experience of motherhood was pathologised because I did not want to breastfeed despite being more than able to.

When I got pregnant with my son, the only thing that kept me sane was telling myself that I could quit whenever I wanted. That happened to be the instant he sucked at my breast the first time and I had such a visceral reaction of panic that I almost leapt out of the gurney.

A nurse asked me, with thinly veiled aggression, how I could stand the thought that I might regret not having a “relationship” with my son if I didn’t breastfeed. I was too high off my own power (I have agency! I don’t have to do this!) and just smiled at her. Comments like that kept coming until we were discharged and every one of them was stupid, unhelpful, condescending, and hurtful.

I had a wonderful time feeding my son bottles. I had to fight for that formula at one of the most vulnerable times of my life. It was egregious and wrong. There are definitely systems in place (still too few) that advocate for mothers who can’t breastfeed, but mothers who willfully won’t breastfeed? We’re treated with something adjacent to contempt where “breast is best” is evangelized.

Formula is absolutely a feminist issue. My body, my choice applies to my breasts too.
posted by lydhre at 4:38 AM on March 21 [46 favorites]


Yeah, dorothy is underwood, I'm a preemie parent as well and I find the whole discussion of whether formula should be considered akin to medicine ridiculous. If anything should be advertised to doctors (yes, nothing should, I get it), formula should.

My daughter was breast fed and bottle fed and tube fed, with breast milk and human milk fortifier and Neosure and Pediasure and some others I have forgotten, and MCT oil and thickening agents. Her feeds were as complicated as her meds.
posted by gerstle at 4:42 AM on March 21 [5 favorites]


My firstborn refused to drink from a bottle. Refused. Yes, we tried all the tricks. Luckily I had endless maternity leave -- well, I didn't have a job to go back to -- and so I breastfed exclusively for six months. I don't know what we'd've done if I had to go back to work in an office.
posted by The corpse in the library at 7:23 AM on March 21


Breastfeeding isn't simple or easy. I don't think that it is in most cases. My experience with breastfeeding was a nightmare, starting off with the complicated supplemental nursing system they sent me home with since I wasn't producing milk (because I was exhausted. Because I'd just had surgery but nobody would let me sleep for days and days and days). The whole process was nothing but bullying.
posted by mmmbacon at 7:31 AM on March 21 [4 favorites]


Breastfeeding isn't simple or easy.

I feel incredibly apologetic saying this, and I don't mean to shame anyone, but it is at least sometimes for some people, it was for me with both of my children.

I don't know where to come down on advertising to doctors (really, I guess I'd like advertising in medical journals to be limited to things that were for the readers' direct use, rather than for patients. Particularly attractive white coats, rain covers for your midlife crisis convertible, things doctors buy and use. Education about what they're doing for patients shouldn't come in the form of advertisements.)
posted by LizardBreath at 7:36 AM on March 21 [3 favorites]


Education about what they're doing for patients shouldn't come in the form of advertisements...

...but since that is, unfortunately, the system we live under, those advertisements should not selectively exclude products which can help women have more choice.

A lot of the responses in this thread are strongly preferring pie in the sky as opposed to practically addressing our present reality. Everyone in this thread wishes corporations had less control over our lives, but that ain't the case.
posted by thoroughburro at 7:45 AM on March 21 [7 favorites]


I guess she is a living example of the fact that doctors are people like the rest of us. A long specialist education does not protect anyone from trusting bad science on the internet,

Please point me to the "bad science on the internet" that you're referring to here?
posted by schwinggg! at 7:45 AM on March 21 [1 favorite]


Everyone in this thread wishes corporations had less control over our lives, but that ain't the case.

I mean, but do we, really? Does anyone wish they didn't have corporations making and distributing any number of labor-saving devices and other things we depend on: dishwashers, clothes washers, flour, milk, clothes ... and infant formula?

What's irritating is that there actually ARE genuine issues with formula marketing (false claims about the health impacts of certain additives). But the BMJ's action clearly is just meant to be another prong in the "breast is best" campaign that manifestly disregards women's autonomy.
posted by schwinggg! at 7:49 AM on March 21 [2 favorites]


We’re treated with something adjacent to contempt where “breast is best” is evangelized.

As I always say, can anyone tell the difference between a breastfed person and a bottle fed person once they are an adult? No? Well, then it really doesn't matter much, does it. As long as a baby gets fed.
posted by agregoli at 8:27 AM on March 21 [6 favorites]


> I feel incredibly apologetic saying this, and I don't mean to shame anyone, but it is at least sometimes for some people, it was for me with both of my children

Yeah, same -- and formula feeding was impossible for us. Proof that we need to have as many options as possible for new parents.
posted by The corpse in the library at 8:45 AM on March 21 [1 favorite]


When I struggled with breastfeeding my second child, this is what happened:
-- first of all, the staff at the hospital observed it immediately even though I was in the "fast in and out" ward for no problems delivery, since there weren't any physiological issues.
-- They offered me a prolonged stay at the hospital in a private ward, so I could find some peace and have conversations with staff including a psychologist and a social worker at hours that fit me.
-- They fed baby when she was hungry if they sensed I was too exhausted to deal with my lactation problems.
-- They fed me all the time, which was important because it seems I am prone to hyperemesis gravidarum, and while getting back on the food wasn't an issue with my firstborn, it was with the second.
Oh, and this is within socialized medicine, so at no cost for me, and I returned home to a years' paid leave. I was also given some help from the council with cleaning the house, which was already organized at the hospital.
After all of this help, I still struggled, so obviously I will not and cannot disagree with anyone here who says they found breastfeeding too hard and preferred formula.

For someone recovering from surgery or with a neonatal child, all of what I experienced would be simple protocol here, and yet many of you have experiences where it wasn't.

A lot of the responses in this thread are strongly preferring pie in the sky as opposed to practically addressing our present reality. Everyone in this thread wishes corporations had less control over our lives, but that ain't the case.

I can't speak for anyone else, but my comments are about how healthy breastfeeding may be a pie in the sky for many US readers because of however the social reality is in the US; in the context of the actual journal that blocked the formula ads, the issues are completely different and need to be addressed in a completely different manner.

We don't know enough about why UK women in particular, and some women in other EU countries including my own are not breastfeeding, but they are not struggling with insufficient leave, or unaffordable healthcare. It seems that breastfeeding is less frequent in areas where a large part of the population are poor, less employed and less educated. It also seems that some GPs and nurses are part of the problem. I know my own mother felt insecure and ill-advised when my little sister was born in Yorkshire all the way back in the seventies, even though the NHS was a completely different thing back then, with excellent maternal care.
I know maternal care has huge regional variations here today.
An American obstetrician accusing a British journal of hypocrisy is rather rich, and in my view bordering on dangerous in these Brexit times, where one of the hopes of the hardliners is to sell out the NHS to corporate interests. But I could also just say that it seems to me like some sort of weird cultural imperialism when people like the author of the article in the FPP imposes her knowlege and experience on people in a different country, thousand of miles away.
posted by mumimor at 9:03 AM on March 21 [2 favorites]


Step away from the formula issue for a moment and recognize that BMJ should not be taking ANY advertising, and drug and supplement advertising, including ads for supplemental food for babies, convey an endorsement of specific commercial health products which should taint their hallowed reputation.

I think the basic point Tuteur makes, that women should have a choice in formula vs breastfeeding, is valid and I think the pushback some feminists have given in "the formula debate" has been valuable. But she really underplays the harms of the formula industry internationally (it's not just unsafe drinking water, it's making the baby reliant on a commercial product, then the mother stops producing milk, then if she can't afford more formula & the baby can't eat or she feeds watered down formula which can be deadly).

She's also exaggerating the real "choice" that even first world mothers have under the constraints of capitalism in countries with no meaningful family leave.
posted by latkes at 9:13 AM on March 21 [1 favorite]


We don't know enough about why UK women in particular, and some women in other EU countries including my own are not breastfeeding, but they are not struggling with insufficient leave, or unaffordable healthcare.

But why does it matter? You seem to be not internalizing that breastfeeding is a personal choice about how a woman uses her body and feeds her child. Research shows that there's basically no advantage to breastfeeding for the baby. Most likely, the vast majority of women who don't breastfeed just prefer not to, given a healthy and less taxing alternative (formula). The same way they buy bread instead of baking their own.
posted by schwinggg! at 9:22 AM on March 21 [5 favorites]


What about medical formula?

Thank you for raising this. My first child was almost exclusively breast-fed, which was a process full of trials and tribulations. Of note, it added an average of three hours a day to my wife's working hours, because while her employer made affordances for her to pump in a converted supply closet, they most certainly did not make affordances for her not to work the full 50 hours a week expected of the position. My second child had a moderate food allergy to... something. Two years later, we still don't know what he was reacting to. At the time, my poor wife eliminated basically everything but protein and steamed vegetables from her diet, at ruinous cost to both her health and mental well-being, and we STILL had a baby who was visibly in pain after very meal. After a few iterations with the gastroenterologist, we landed on a prescription-only formula made exclusively from deconstructed amino acids and unicorn tears (or maybe there was another secret ingredient justifying the $70/canister pricetag?) which was finally hypoallergenic enough that my little dude was able to eat enough to thrive.

Arguing that formula is not a feminist issue feels deeply disingenuous, bordering on downright misogynistic.
posted by Mayor West at 9:23 AM on March 21 [15 favorites]


[This back-and-forth needs to stop here, thanks. ]
posted by restless_nomad (staff) at 10:21 AM on March 21 [3 favorites]


We don't know enough about why UK women in particular, and some women in other EU countries including my own are not breastfeeding, but they are not struggling with insufficient leave,

Honestly, yes, many women in the UK are struggling with insufficient leave. Sometimes because they have literally been told that they will lose their job if they take it, and they don't have a couple thousand pounds available to fight back. Sometimes they are freelancers or 'gig workers'. Sometimes they just need more income than £145.18/week after six weeks. And we do know this - because the world doesn't consist of the US and Other Places.
posted by the agents of KAOS at 10:26 AM on March 21 [5 favorites]


Another example of women's experiences in the UK is that my sister left the hospital with her second baby after 36 hours, because she couldn't lift the baby out of the bed, the nurses weren't helping her with it, and she didn't feel comfortable staying through a night without her husband there to help. And she certainly wasn't offered any help cleaning the house, despite her hyperemesis gravidum and spinal headaches that required a return hospital visit a couple days later.
posted by the agents of KAOS at 10:41 AM on March 21 [2 favorites]


[mumimor, enough. Take a step back and let this thread be about something other than you. Thank you. ]
posted by restless_nomad (staff) at 10:45 AM on March 21 [4 favorites]


plenty of babies get jaundice

Jaundice is a cause of cerebral palsy. My (breastfed) son was hospitalized for it and very close to an exchange transfusion, for reasons other than insufficient milk but still. There is some evidence that breastfed babies might be ok with slightly higher levels of billirubin but please be aware it’s a serious thing. My baby was peeing so well that had it not been for a very thoughtful nurse we could be wrong.
posted by warriorqueen at 11:10 AM on March 21 [2 favorites]


But there are close to NO comprehensive resources about combo feeding out there, which is wild to me given how common it is.

Combo feeding is problematic, because breastmilk is a demand-driven supply. For most women, doing "50/50 breast-formula" means their milk supply won't increase as the baby grows, or won't increase enough, so they eventually wind up 60/40, then 75/25, and then the baby hits a growth spurt and milk can't keep up at all. There's also nipple confusion issues, where a baby will pick one as the preferred method and refuse to feed the other way.

Combine that with the fact that, as we've seen, ability to produce breastmilk varies wildly, and nobody has any idea why some women can nurse comfortably and with plenty to spare, and others are stuck with pain and nausea and not enough, or mix-and-match those traits at random.

All of the discussions are fraught because (1) women wind up being trapped by babycare; (2) formula is medically necessary in many cases; (3) health risks of formula are downplayed by the corporations that sell them; (3a) those corporations sometimes (often) participate in outright lies and fraud to sell more formula; (4) there really isn't an effective combo option for most people; (5) social issues of feeding in public, pumping at work, local-community-expectations etc. complicate all the physical/medical issues... everyone involved in babycare is affected by all of these. Making a choice about what to do, and what to encourage in others, and what to inform others about, often feels like an attack against anyone who's made different choices.

Everyone wants what's best for their babies. And "best for their babies" includes "a mom who's not exhausted or homeless;" moms who choose formula because it lets them have freedoms that breastfeeding doesn't, aren't being "selfish." There is no "right" decision that any reasonable person could say, "people should do THIS unless circumstance A, B, or C exists."

It's also worth considering that MetaFilter is a community of well-informed people who seek out alternative perspectives, track down statistics, and strive to understand the reasons other people make their choices. Most people aren't, and their breastmilk-vs-formula decisions are often made without the benefit of that kind of community, without educational resources that let them make an informed choice.

I'm not sure the best conclusion is, "eh, it's all a big tangle, so any decision someone makes is okay." It's possible that best-for-most-people would be a specific approach to public education, better explanations of the health issues, and so on. OTOH, I'm not sure there's any practical way to implement a system other than, "it's complicated; try to choose what works best for you."
posted by ErisLordFreedom at 11:58 AM on March 21 [3 favorites]


I’m still unclear on what, barring clean water supply issues, “the health risks of formula” actually are. As far as I know studies show there is little to no measurable difference in outcomes for breastfed vs formula fed babies.

I’m not excusing predatory behavior from formula suppliers like Nestle at all, but saying that breast milk is better for the health of the child is just misinformation. I had it thrown in my face a lot by LLL consultants and hospital nurses and then had it firmly debunked by multiple pediatricians. I was made to feel like I was actively choosing to harm my children when formula is not only perfectly safe, but also nutritionally and developmentally equivalent.
posted by lydhre at 12:12 PM on March 21 [15 favorites]


I’m still unclear on what, barring clean water supply issues, “the health risks of formula” actually are. As far as I know studies show there is little to no measurable difference in outcomes for breastfed vs formula fed babies.

With modern formula, the differences are there, but not very significant. There is a huge downside to formula: cost, which really impacts low-income mothers. There are also many other inconveniences: sterilizing water, carrying heavy sterile water around, it goes off faster than breast milk. But, as many have noted above, there are also upsides. Whether the upsides outweigh the downsides is a completely personal issue - and doctors and other health care practitioners should be trained to counsel parents to understand their own personal upsides and downsides, and help them make the choice that works before for them and their family.

And the rest of us should stay well out of anyone else's choices when both are perfectly safe.
posted by jb at 1:23 PM on March 21 [1 favorite]


Breastfed babies get significantly less diarrhea. I think that’s about it in terms of proven significant medical benefits.
posted by tomcooke at 1:37 PM on March 21 [1 favorite]


(I mean significant in the sense that there’s a substantial statistical difference, not that diarrhea is a huge deal!)
posted by tomcooke at 1:40 PM on March 21 [1 favorite]


Breast feeding can also confer low level malarial resistance/immunity from mothers who have life time exposure to malaria and their own low level malarial resistance.
posted by raccoon409 at 1:46 PM on March 21 [1 favorite]


Breastfed babies get significantly less diarrhea. I think that’s about it in terms of proven significant medical benefits.
posted by tomcooke at 1:37 PM on March 21 [+] [!]


A lot of that research was done prior to the rotavirus vaccine. The PROBIT trial did find fewer cases of gastro illness, but that was in the late 90s before the vaccine. If one truly cared about GI disease in infants, then the way to go is to promote the rotavirus vaccine here and abroad.
posted by schwinggg! at 1:54 PM on March 21 [6 favorites]


All I'd like to add is that it would be great if mothers with medical complications wouldn't have to feel like they are failing their baby when they cannot breastfeed.
posted by ersatz at 12:34 AM on March 22 [4 favorites]


This thread has been on my mind.

Formula, as long as it's not mixed with unsanitary water, is not bad for babies; it is nothing like tobacco or even Cheese Whiz or Nutella, with the exception of the times unethical companies do unethical things. If this were a Nestle ban over their exploitation that would be different.

Even if we accept that breastfeeding is optimal (questionable), the idea that if mothers are not doing the absolute, 100% best thing for their children ever, at all times, incessantly, is equivalent to smoking cigarettes or living in asbestos is toxic.

Why did BMJ take a stand on this particular convenience (for some) product? Was it because they want to see the inequity of the cost of formula eliminated? Was it because they believe that maternity leave should be better supported? Or is it because it's pretty easy to take high moral ground over an issue where it's women at their most vulnerable who would have to protest.

I breastfed both my sons. I had mastitis and with my oldest my metabolism was whacked and I dropped a lot of weight. He was not a great feeder, or at least was hungry a lot, so I also became exhausted to a degree that still gives me nightmares years later. With my youngest, after his NICU jaundice stay, my father had a massive brain aneurysm and so I dragged him to the ER, ICU, hospital, and rehab buildings while he was still not fully immunized.

I still found breastfeeding easier than sterilizing bottles, and although I tried pumping it never really worked out for us. So for both of my kids' earliest months, I was pretty much always within arm's reach of them. I was supported by Canadian maternity leave and I certainly am okay with my choices but I don't think the cost of those choices for me, personally, my health and my life energy, can really be overstated.
posted by warriorqueen at 6:30 AM on March 22 [13 favorites]


I’m still unclear on what, barring clean water supply issues, “the health risks of formula” actually are.

There are minor direct health detriments - diarrhea, lack of immunity transmissions, lack of "foremilk" vs "hindmilk," the slightly more serious lack of colostrum (which can be covered by breastfeeding for the first few days). While any of these could be bad for any one child, statistically, they're all very minor.

There are more substantial health problems with the delivery system: Needs clean water, needs sterile bottles & nipples, goes bad quickly, has to be mixed at the correct proportions, can overfeed. All of these can be avoided by having a good setup and paying careful attention, but that doesn't mean it's reasonable to ignore them, since new mothers often don't get to choose their circumstances and often don't have time, energy, or education to watch all the details.

And then there's cost issues, which exacerbate all of the above. If you can't afford half a dozen bottles and are stuck rotating between two, you're more likely to just rinse one out than sterilize it between feedings. If the cost of formula is excessive, you're likely to water it down to make it last longer, and you're likely to put a half-empty bottle in the fridge instead of emptying it.

For people for whom the cost is negligible and who have hygienic living conditions and the time and energy to manage the logistics, formula feeding has no notable disadvantages. And if formula companies only advertised to those people, or even focused on advertising to them, the discussions would be very different.
posted by ErisLordFreedom at 2:03 PM on March 22 [3 favorites]


needs sterile bottles & nipples
you're more likely to just rinse one out than sterilize it between feedings

This information is outdated, at least in America where pediatricians no longer recommend sterilization for bottles and nipples unless your baby is immunocompromised. Hot tap water and soap between usages are fine, unless your tap water is unsafe to drink.

Doesn't change the clean water issue, but.
posted by joyceanmachine at 2:29 PM on March 22 [6 favorites]


Even hot water and soap are likely to be skipped by someone with limited resources and no personal energy - when they've fallen behind on cleaning, a dirty bottle and nipple will be rinsed under maybe-warm tapwater just before giving it to the baby, rather than carefully cleaned. And for the most part, that'll be fine.

And they'll do that in situations in public - out shopping with the baby; has already gone through 1.5 bottles; rinse the first one in the bathroom and refill it, because "shop and for another couple of hours with a crying hungry baby" is the other choice.

And again: Mostly, it'll turn out fine. Many, many parents have done this. It's a cumulative risk setup, where people who don't have money for enough supplies, and don't have energy (or education) to keep up with managing the washing, will face higher risks over time.
posted by ErisLordFreedom at 3:55 PM on March 22


If we’re talking about cumulative risk, though, it seems like many of those situations would also affect low income women who breastfeed, especially since those women are likely to be food insecure. The increased caloric requirement of breastfeeding is rately taken into consideration when talking about the costs of formula.

If we count all risk, lack of adequate rest because of inability to share feedings with family or partners and the attendant risks to the mother and baby should also be considered, as well as the increased risk of accidental suffocation associated with cosleeping, especially cosleeping unsafely.

None of those are related to breastmilk, but they are related to breastfeeding, much like many of the issues mentioned are not related to formula but rather formula feeding.
posted by lydhre at 4:34 PM on March 22 [7 favorites]


"Research shows that there's basically no advantage to breastfeeding for the baby."

I thought there was a large body of evidence behind breastfeeding being better for babies' health.
posted by Selena777 at 5:28 PM on March 22


I thought there was a large body of evidence behind breastfeeding being better for babies' health.

No, there really isn't. Breastfeeding research, like all nutrition research, is complicated by the fact that you can't do a double-blind study. As a result, many of the positive outcomes in breastfeeding research are likely connecting to the socioeconomic status of the mother, not breastmilk. The few research studies that have addressed the counfounder problem have shown that breastfeeding makes very little difference. One study compared "discordant" siblings -- where one had been breastfed and the other hadn't. That study found very few differences between the siblings. Another study randomized new mothers into groups that received breastfeeding support and those who didn't. The babies that were breastfed did not show any great differences.
posted by schwinggg! at 3:45 PM on March 23 [8 favorites]


Does anybody know what formula tastes like? I've always* been curious. Does it taste like baby sick, or like protein powder, or...?

*Just now, and maybe like once before, decades ago.
posted by turbid dahlia at 7:48 PM on March 26


It's really sweet and also sort of protein-powderish. It tastes fortified, kind of like cereal. My own milk tasted sweet and less artificial, somehow (I nursed my son until he self-weaned at 23 months, yes I tasted it, and why not.)
posted by Daily Alice at 8:35 PM on March 26 [2 favorites]


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