New mothers in our area of Madison, Wisconsin, USA have been  
receiving boxes of Enfamil (Mead Johnson) powdered formula, delivered  
unsolicited at home via first class mail.  The packaging shows a  
swaddled newborn baby.  In large print, the box says "I am not a  
baby.  I am a newborn."  Additional text in smaller print says, "As  
the makers of Enfamil, we understand that newborns are different from  
older infants - and different from toddlers, too.  That's why we  
created Enfamil Premium Newborn, the first stage of Enfamil Staged  
Formulas."

The side of the box says "Designed specifically for newborns through  
3 months, Enfamil Premium Newborn provides:
400 IU of Vitamin D in 27 fl oz.  The American Academy of Pediatrics  
recommends 400 IU of vitamin D daily.
An easy-to-digest protein blend
Natural Defense Dual Prebiotics designed to help support baby's own  
defenses"

The back of the box says, "Discover Enfamil Staged Formulas. Expertly  
designed to meet your baby's changing nutritional needs" and pictures  
containers of Enfamil Infant (6 - 12 months), Enfamil Newborn   
(through 1 month) and Enfamil Toddler (10 - 36 months).

Marsha Walker and others have posted in the past on the risks of  
using powdered infant formula with preterm babies or infants under 4  
weeks of age due to the fact that it is not sterile, and there have  
been incidents of contamination and illness due to enterobacter  
sakazakii (see, for example,  Marsha's post of March 4, 2006).  She  
stated then that the European Food Safety Authority recommended that  
no infant under the age of 4 weeks received powdered infant formula.

Now powdered formula is being mailed specifically to households with  
infants under 4 weeks of age, including those who are exclusively  
breastfeeding and with premature babies.  This mailing campaign is  
accompanied by similar, full-page advertisements in magazines for new  
parents, such as "American Baby."  And "American Baby" is sent to La  
Leche League leaders, IBCLCs, childbirth class teaches, and others  
who work with now mothers and babies, in hopes that they will  
encourage them to subscribe.


Some mothers are bringing these unopened packages of formula to  
mother-baby classes and support groups for new mothers with infants 0  
- 3 months of age.  They think it is helpful to share these packages  
with the formula feeding mothers.  But when these boxes are put out  
on the table of "free - help yourself" items, it looks like the  
sponsor of the class (in this case, a hospital) is endorsing the  
product.  It was suggested that the formula be given to a food pantry  
instead.  But this formula is not good for babies whose mothers have  
to rely on Food Pantries for a source of food either.  What do you  
all think should be done with it?  Maybe glue the box to a heavy  
brick and mark it "refused," and take it back to the post office so  
that it is returned to Mead Johnson, at a cost to them?

There is much to criticize in this campaign, including the misleading  
information aimed directly at new parents and failure to disclose  
pertinent facts.   In the US, the WHO International Code of Marketing  
of Breast Milk Substitutes is not law, and therefore it is not  
illegal to advertise in this way.  How do we combat this campaign?

Anne Altshuler, RN, MS, IBCLC, LLL Leader
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