Dear friends:
I work with limited resource population in southeastern North Carolina (WIC). 
  Our Hispanic population case load has grown from 100 families in 2000 to 
over 1000 last year. I provide breastfeeding education as well as interpreting 
services for this population.   Our immigrants are new (in the US less than 5 
years usually) and we do see them mixing formula incorrectly in about 50% of 
cases.

I think the most outrageous way to mix formula came this summer when a mother 
was mixing 1 oz of sweetened (with honey) chamomile tea with one scoop of 
powder "to prevent colic" (she was also breastfeeding but doing "both" - we'll 
save that one for another post).

I say this because do believe we cannot "fix" the problem of inadequate 
infant feeding until we find out why these women are doing what they are doing.   
As was pointed out, perhaps these women are trying to 'stretch out the milk" 
and are the victims of poverty in our society.   But in many cases its sheer 
ignorance.   In our hospital they go home with a six pack of ready to feed 
bottles and a small sample can of formula in their discharge gift bags but no 
instructions on how to mix it.   If they read a little (big "if" here) they might 
see the microscopic writing on the side of the can that says the instructions to 
mix the formula are on the inside of the label (!) but if not, then they just 
do what they can.   If they're lucky they get to me and I tell them they 
don't need to use the formula just because the hospital gave it to them.   

Yes, we do need to get rid of the gift bags in our hospital.   We also need 
to stop giving free formula through our government. . .. but what do we do in 
the meantime?   In my opinion a large part of the problem could be fixed if we 
treated formula like a drug that needed clear dosing instructions and signed 
informed consent.   But also finding out what is going on before assuming that 
formula is the answer is so important!   Particularly for those of us working 
in the WIC system.

Hispanic women tell me they use formula:
1. because the hospital gave it so they must need it
2. because they don't have milk "no tengo leche" ( in the first days)
3. because the baby is not satisfied with just the breast "no se llena"
4. because they plan to go back to work and baby needs to get used to it "se 
tiene que acostumbrar"
5. because they don't want to breastfeeding in public (believing that it is 
not allowed)
6.   formula makes the baby 'big' and 'healthy'

I do agree with the Feb 2006 JHL article on Barriers to Compliance with 
Infant Feeding Recommendations that we need to address mother's concerns, teaching 
them coping skills for normal infant behavior, not just telling them what we 
know.   If they believe that a crying baby is always hungry, then they will 
resort to supplementation because "they don't fill him up."   It doesn't matter 
how many times we tell them that the baby's weight is great or that the 
stooling/wet diaper count is wonderful.
 
M. Jane Heinig, Jennifer R. Follett, Kara D. Ishii, Katherine 
Kavanagh-Prochaska, Roberta Cohen, and Jeanette Panchula  Barriers to Compliance With 
Infant-Feeding Recommendations Among Low-income Women 
J Hum Lact 2006 22: 27-38.

great article - check it out!


Norma Ortiz Escobar, LLLL, IBCLC, RLC
Wilmington NC
Mom to Michael (10/91) and Andres (07/97)

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