'Free' really isn't

Dear Editor,

Aug. 1-7 was World Breastfeeding Week in the United States. The theme for 2006 was "Code Watch: 25 years of Protecting Breastfeeding."

The "Code" is short for the International Code of Marketing of Breastmilk Substitutes.  It is a set of recommendations written in 1981 by the World Health Organization, intended to be a standard to regulate marketing by companies that profit when mothers don't breastfeed (primarily infant formula companies).

The Code's general aim is:

* to protect infant health (through breastfeeding) and

* to set guidelines for companies that market breastmilk replacements.

The Code recognizes there is a "legitimate market for infant formula," but that,

" ... in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices ... usual marketing practices are unsuitable for these products."

We are fortunate in the U.S. Babies here don't die everyday from malnutrition or the use of contaminated water to mix formula but we do have more sickness than normal due to a lack of breastfeeding (www.4woman .gov/breastfeeding/index.cfm?page=519).

The Code does not restrict the sale of or the right of a mother to choose to feed her baby formula. Commercial breastmilk substitutes should be available when needed or desired but, because they constitute a health risk, they should not be promoted.

Unfortunately, in countries like the U.S. where compliance with the Code is voluntary (not enforced by law), numerous violations occur.

For instance, the common practice of sending a new mother home from the hospital with a commercial "gift" bag containing infant formula is prohibited by the Code.

What most people don't realize, though, is these "free" gifts aren't really free:

Research has found breastfeeding mothers who take home commercial "gift" bags are more likely to partially or completely stop breastfeeding prematurely.

Is it possible receiving an advertisement for formula from their health care provider encourages its use?  In general, formula use leads to higher health care costs for families and for tax-payers through Medicare, Medicaid and the WIC program.

Commercial "gift" bags market the most expensive brands of formula. Research has shown the bags foster brand loyalty (possibly because it appears their health care provider recommends that brand). Each of these bags cost the formula company a few dollars but a one-year supply of name-brand formula costs families $1,000 or more, a significant portion of which pays for marketing.

In exchange for distributing the "gift" bags, formula and/or other rewards are donated by formula companies to hospitals. Because of commercial "gift" bags and formula company donations to the health care community, families who feed formula likely pay several hundred dollars more per year than they would if these forms of marketing weren't used.

Awareness of the rules set forth by the Code may:

* Prompt families to protest when voluntary compliance isn't heeded.

* Motivate governments to enforce the Code with legislation

* Inform health care providers of the ramifications of their practices and

* Induce formula companies to voluntarily comply with the Code.

Compliance with the Code isn't the only change needed in our culture to support breastfeeding. Paid maternity leave, insurance coverage of services provided by board certified lactation consultants and comprehensive and ongoing health care worker education on breastfeeding would go a long way to help mothers succeed. To stimulate changes such as these to occur, though, interested families must make their desires known.

Sally Myer

RN BSN ICCE

La Leche League Leader

McCook