All Parents Deserve a Seat at the Consumer Protection Table: An Open Letter to Public Citizen

Public Citizen is known for its advocacy for ordinary citizens who have been harmed by large entities -- and rightly so. Much good has been done by this organization in the name of everyday citizens who otherwise have little power to lobby our government for stronger laws and regulations to protect our society. However, Public Citizen's recent event, "Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities ," does not accomplish the goal of protecting consumers. A consumer protection advocacy organization has an obligation to women to support their right to bodily autonomy, as well as support their and their children's health care needs -- issues that are sometimes incompatible with breastfeeding and do not currently receive sufficient support in our breastfeeding-centric postpartum health care model.

The Day of Action fails to address many of the true issues that affect women's and children's ability to breastfeed. A complete lack of formula advertising is not going to enable women with insufficient glandular tissue (IGT) to make sufficient milk, or change the fact that many women have to take necessary medications that are incompatible with breastfeeding. It is not going to prevent complicated births or medical conditions in babies that sometimes make it exceedingly difficult -- or impossible -- for moms to breastfeed. It does not reduce adoptive or foster families' need for formula. And a lack of advertising is not going to change the fact that some women do not want to breastfeed, and have a right to their bodily autonomy. While of course it would be best for parents to receive information about formula from a non-profit source, currently, there is no such source that provides accurate, unbiased formula information, even to families for whom breastfeeding is not an option at all.

The Day of Action implies that information about formula is plentiful and accurate. Nothing could be further from the truth. Information about formula is typically riddled with fear mongering about not breastfeeding and uses value-laden language that assumes women who use formula lack perseverance or are selfish, lazy, uneducated, immoral, or ambivalent about their children's health, despite ample evidence to the contrary. Formula supplies in hospitals are hidden in drawers or even locked up. Lactation consultants are often urged by their governing bodies not to discuss formula unless under special circumstances (lest it send a message that formula is "just as good as breastfeeding," even though it is a medically appropriate option, and sometimes the only option). Doctors are not taught about formula preparation and are frequently scared off of even talking about formula for fear of being labeled anti-breastfeeding. Where are formula-feeding families supposed to get the accurate, unbiased, judgment-free information they need?

Perhaps Public Citizen is unaware of the extent to which breastfeeding marketing relies on shaky claims. Maternity wards are typically papered over with literature that claims breastfeeding improving babies' IQ and helps new moms lose weight -- claims that some assert are based on poorly-done research that frequently confuses correlation with causation, and that have not been borne out in more powerful, well-designed studies. Recent research on breastfed and formula fed siblings (three well-regarded published studies [1] ) showed little to no long-term effect of breastfeeding for a number of oft-mentioned issues. These studies are powerful because, unlike many other studies on breastfeeding, variables such as parental IQ, educational status, and socio-economic status are much better controlled. Several large metastudies (including those conducted by WHO itself [2] and the United States' Agency for Healthcare Research and Quality [3] ) have found that the evidence in favor of breastfeeding is marred by confounding factors.

A consumer protection advocacy organization has the responsibility to ensure that advertising claims are based on sound science, but the "absolutes" plastered on maternity ward walls, city buses, and doctor's offices ("Breastfeeding prevents asthma[4] ", "breastfeeding makes babies smarter [5]", "Breastfed babies grow up stronger, healthier and smarter [6]") and liberally sprinkled in literature distributed to new parents do not fulfill this criteria. Public service messages cannot be immune to the regulations that restrict other advertising.

Further, perhaps Public Citizen is unaware of how much of the advertising for breastfeeding actually benefits corporate entities. New moms in hospitals are given sample tubes of Lansinoh nipple cream, Medela breast pads, and coupons or ads for local boutiques that sell breastfeeding products such as Boppy nursing pillows and covers. It is common for new mothers to receive sample magazines, which exist both to promote themselves as well as the advertisers within. It seems counter to Public Citizen's goals to protest one form of advertising and not others.

Women deserve to know the full range of medically viable options for feeding their children, in an unbiased, accurate, and judgment-free manner, and a consumer protection organization should be at the forefront of that fight. Formula feeding parents need help, advice, and support just as much as breastfeeding parents. Unless Public Citizen is willing to help establish a non-profit center to train "infant feeding consultants", not just "lactation consultants," whose job is to support all medically viable methods of feeding a baby, this Day of Action seems just another way to deny formula-feeding families what little information they can still get about their health care options for their children. It seems to contradict the stated goals of Public Citizen to protect consumers.

It would be beneficial for Public Citizen to speak with actual formula feeding parents, many of who feel marginalized in our healthcare system for the choice or necessity of formula. Breastfeeding--and products and service providers who support it -- is so heavily promoted in hospitals that formula feeding families are left without the kind of education or support that breastfeeding families receive. As there are no non-profit sources of education for formula, other than a few websites run by mothers who have taken up the charge, companies are the only remaining source. This is not ideal, but it is currently all we have. If Public Citizen would consider how they may equitably represent the needs of pregnant, birthing, and post-partum mothers and their babies at the consumer protection advocacy table, it would go a long way in supporting the needs of all American families - not just the ones who can make exclusive breastfeeding work.

References

[1] Evenhouse, Eirick and Reilly, Siobhan. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res. Dec 2005; 40(6 Pt 1): 1781-1802; Geoff Der, G David Batty and Ian J Deary. Effect of breast feeding on intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis . BMJ 2006;333;945-; originally published online 4 Oct 2006; Colen, Cynthia G. and Ramey, David M. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, Volume 109, May 2014, Pages 55-65.

[2] Horta, BL and Victora, CG Long-term effects of breastfeeding: A systematic review . World Health Organization, 2013.

[3] NIH Agency for Healthcare Research and Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/Technology Assessments, No. 153, April 2007.

[4] Poster, Kaiser Breastfeeding Campaign: http://www.fearlessformulafeeder.com/2011/11/fun-and-games-with-kaisers-new-breastfeeding-policy/

[5] Poster, Texas WIC campaign: http://www.dshs.state.tx.us/wichd/bf/2009wbm.shtm

[6] Poster, Louisiana Breastfeeding Coalition: http://www.louisianabreastfeedingcoalition.org/wp-content/uploads/2010/09/ABC-poster-in-bus.jpg

This article originally appeared on FearlessFormulaFeeder.com.