>I'm following the WIC thread with much interest. 
>Many people have mentioned that if mothers are 
>prevented from getting hold of formula they will 
>just feed their babies something totally 
>unsuitable.  My question:  do we have any formal 
>research or journal articles documenting this?
>
>I ask because, as Heather has just mentioned, 
>here in the UK we have vouchers issued through 
>the Healthy Start scheme whereby low income 
>women can obtain fruit, veg and milk, including 
>infant formula, worth ~£6 per week for their 
>babies, and they can choose to use the whole 
>amount on formula. They can also save up the 
>vouchers during pregnancy so that they do have 
>enough to exclusively formula-feed for free. As 
>you may know, our breastfeeding rates are 
>extremely low (the lowest in the world after 
>France and Ireland ...)  And it doesn't take a 
>science degree to connect the dots.


Our rates of bf are indeed low (though initiation 
is higher at 81 per cent (Infant Feeding survey, 
2010)  than the US) but I think Healthy Start 
plays only a small role. I think it is possible 
that the move away from 'milk tokens' to 'Healthy 
Start' played a small role in raising our 
initiation stats from the high 70s (2005) to 
today's 81 per cent, but as no one seems to be 
doing the research or evaluation into this it's 
speculation!

It would be easy (practicably but less so 
politically) to test a scheme whereby Healthy 
Start changed in one area to exclude formula 
milk, and to compare feeding outcomes with a 
similar area where things remained the same. 
You'd need to do this over a wide area to make 
the study sufficiently powered and to allow for 
all the variables.

I think it would be important to do this, before 
policy was changed to prevent the ***law of 
unintended consequences***.

Here's an example of just that very law in action:

A few years ago, maternity units in the UK 
stopped giving formula to newborns unless for 
medical emergency.

Any mother who intended to formula feed was told 
she had to bring in her own ff equipment.  The 
idea was that hospitals were no longer seen as 
endorsing formula or subsidising its cost.

The result has been that in most units where this 
policy was adopted, there is *more* formula 
feeding. Women who plan to breastfeed bring in 
formula stuff 'just in case' and use it without 
even having a conversation with the midwife first 
-  the stuff is in their bag and they use it. 
Before they had to ask and there was a dialogue 
and some education going on, and mothers were 
often able to continue breastfeeding without 
formula.

Any change to Healthy Start in the UK would have 
to be tested first. It's just possible that 
knowing vouchered formula was not available any 
longer would change behaviour in  a way that 
meant more ff, not less.

Heather Welford Neil
NCT bfc, tutor, UK
-- 

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