Dear Mary Ann O'Hara:

Its great that you have done some work researching this beforehand. Were these focus groups? In-
depth interviews?  Who was you target audience?

My change in attitude about how women react to such advertisements comes from several
sources.  Diane Weissinger's essay on "Watching your Language" has taught me to look carefully
about how this affects women's interpretation of feeding choice.  It is becoming increasing clear
that women all know that breastfeeding is best, but as the Ad Council campaign research showed,
this approach of looking at the positives of breastfeeding really doesn't work for large segments
of the population.  Unfortunately, the advertising about "breastfeeding is best, but....." has
counteracted this in many ways.  I still remember my first shock when I walked into a hospital in
Brooklyn and found lots of pamphlets, that had information about all the various infant formulas
that would cure "colic, lactose-intolerance, fussiness..."  all the things mothers struggle with and
blame on breastfeeding.  What mother wouldn't succumb.

Dealing with toxins in breastmilk is even more fraught.  I can guarantee you that this strikes terror
in the hearts of mothers.  Now, there may be some mothers who are well educated that read the
fine print, but most do not.  I deal with a predominantly highly educated clientele.  The "Toxins in
Breastmilk" article in the New York Times did serious damage.  Yes, if you read it carefully you
understood that she breastfeed herself for a relatively long time for a US woman.  Nevertheless,
what almost 95% of the calls we received and the discussion in our support groups in our
educated population were about "Toxic Breastmilk".

I totally agree that we need to look at the dangers of toxins, but we MUST do it in a real way by
discussing the risks of the alternative AT THE SAME TIME.  It would be very easy to include the
relative risks of the health outcomes of infants in a simple way.  I remember sitting in sessions at
CDC about how to simplify statistics in such a way to make them understandable.  The problem is
that many mothers have no clue that artificial infant milk has risks --- even in my population of
educated women.  Some of them drop their jaw when I do mention that, yes, indeed, artificial
infant milk has caused death in this country.  When I talk to them about the real risks, I always do
it in a balanced manner so that they understand the importance of their choices, yet are not going
to starve their infants in the event that their supply is too low and they have no access to human
donor milk.  Our particular group is not considered "Milk Nazis" even though we routinely discuss
the risks of artificial infant milk.  Its all in the delivery of how we talk about the risks.

Even the Inteternational Development community of which I was a part for 20 years, is making a
turnaround in how they talk about HIV.  They know realize that one must talk about HIV-free
survival rates rather than HIV transmission when talking about infant feeding choices.  This is
because the evidence is piling up that the mortality rates are greater for infants who are fed
artificial milk than exclusive breast milk in the first six months.  It is pretty clear that artificial
infant milk has not only harmed the population of infants at risk of HIV, but also the spillover
effects have harmed the population of infants who are not at risk of HIV.

Please, please, as you move forward with this, include the actual statistics on the alternative
feeding choices.  Otherwise, I know from my experience with well-educated population, that many
will not hear the soft "breastfeeding is still a good thing to do", they will hear the much stronger
"breast milk is toxic."

Susan E. Burger, MHS, PhD, IBCLC

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