Jim Akre's reply to George Monbiot COMMENT in Guardian U.K.
   
  site posted previously - http://www.guardian.co.uk/Columnists/Column/0,,2095675,00.html
   
  Thanks for highlighting the difficulties the Philippines are facing in reining in multinational infant-formula manufacturers. The resulting disease and death are as unconscionable today as when the World Health Organization adopted its Code of Marketing in 1981. However, I would have greatly appreciated even a sentence reminding readers of breastfeeding’s universal importance, including the United Kingdom, which has some of the lowest rates for an industrialised country.
   
  It’s certainly true that in resource-poor settings, artificial feeding is dangerous, even deadly, because people don’t have enough money to buy and use enough of a substitute feeding product, their water is contaminated, they can’t read or follow accurately product-mixing instructions, their general level of hygiene is poor, they have no refrigeration, their feeding bottles and teats are of inferior quality, and household fuel is scarce. Unfortunately, many people living in conditions of relative wealth appear to have naively concluded that, since they face none of these constraints, they’re home free. Using this “logic”, one might even conclude that people in poor settings will need to breastfeed just until they have a viable alternative.
   
  My concern is that articles stressing only the catalogue of catastrophe of artificial feeding in resource-poor settings implicitly confirm for readers the uninformed stereotype of breastfeeding’s being terribly important for babies out there in poor countries but without all that much significance for babies at home. Infant-food manufacturers have eagerly exploited this bogus dichotomy, particularly since the advent of the International Code, by distinguishing between their conduct in so-called developing and developed countries and promoting “informed choice” in the latter. At its most simplistic, the consistently reinforced indirect message is this: At the end of the day, while breastfeeding is admittedly good for babies in general, it is in fact crucial only for babies in poor countries. Artificial feeding in rich countries – or among elites in poor countries – presumably carries no price tag beyond the cost of an infant formula and the equipment with which to mix and
 feed it safely.
   
  For the uninformed, this contributes to the perverse conclusion that, unlike people living in poverty, the relative rich are somehow able to feed their children fret-free formula. After all, in resource-rich settings artificially fed babies aren’t exactly dying in the streets; their added morbidity and mortality are found – or, given confounders like access to medical services, in fact hidden – elsewhere. What we already know about breastfeeding’s dose-response in terms of lowering morbidity and mortality in all settings should be adequate to motivate governments everywhere to take a closer look at artificial feeding’s negative short- and longer-term impact on their populations; but this will not happen, either in rich countries or among elites in poor countries, if the wrong messages are taken up.
   

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