I have pasted my letter to Secretary Thompson below. If I can be of any help 
to any of you in this effort to keep the formula companies from negatively 
effecting this breastfeeding campaign please let me know. The footnotes for the 
references in this do not show when translated to Lactnet, but I would be happy 
to provide them to anyone who wished to use documentation in their letters.

Honorable Tommy G. Thompson                 November 21, 2003
Secretary
Department of Health and Human Services
200 Independence Ave, SW
Washington, DC 20201

Dear Secretary Thompson:

I am writing to express my dismay regarding the postponement of the National 
Breastfeeding Awareness Campaign, jointly created by the Office on Women's 
Health and the Advertising Council. I find this perplexing since a national 
breastfeeding media campaign has been recommended by the Federal government since 
1984.
·   Office of the Surgeon General 1984 , 1985 , 1991  in its workshop on 
breastfeeding and human lactation and follow up publications
·   Breastfeeding Promotion Act of 1992: P.L. 102-341. Congress asked for a 
breastfeeding promotion program by law 11 years ago
·   Office of the Surgeon General 2000 in HHS Blueprint for Action on 
Breastfeeding specifically recommends, "Launch and evaluate a public health marketing 
campaign portraying breastfeeding as normal, desirable, and achievable." 

In spite of these strong recommendations, the launch of this campaign has 
been delayed yet again by the actions of infant formula manufacturers directed to 
your Department, agency heads, Members of Congress, and indirectly through 
its allies such as the American Academy of Pediatrics. Criticisms include: 
·   Concerns that the campaign is negative- because formula and breast milk 
are not the same thing or equivalent in health outcomes, the public has the 
right to know that not breastfeeding increases the chances that infants, 
children, and adults will experience increased rates of acute and chronic diseases and 
conditions for which breast milk can be protective. Thirty-six diverse focus 
groups were conducted around the country and indicated that it was essential 
that the health consequences of not breastfeeding be clearly communicated in 
the campaign
·   Concerns that the campaign was critical of formula. Not one ad mentioned 
the word formula. 
·   Concerns that the campaign would make formula-feeders feel guilty. 
Scientific data does not support this claim. There is no evidence that informing 
mothers regarding the differences in health outcomes of infants fed formula or 
breast milk makes them feel guilty if they formula feed. Guilt, like any other 
emotion, is something one chooses to feel. The mental health literature does 
not support guilt as an excuse to withhold information from mothers. This 
patronizing attitude is used to exempt health care providers and policy-makers from 
fully supporting breastfeeding. Women have the right to quality information 
needed to make informed decisions about their health and that of their children. 
Women can handle the data, including the risk estimates, as clearly 
demonstrated in the 36 focus groups.
·   Concerns that there is general disagreement among health professionals 
regarding the science behind some of the ads. A group of experts and researchers 
were convened to scrupulously review the research used as the basis of the 
campaign. Selection criteria of studies were stringent, and expertly analyzed 
and interpreted. This concern is most interesting since the Federal government 
has published extensively on the health benefits and disease protective effects 
of breastfeeding, including a recent report for Congress from the 
Congressional Research Service. 

Outcomes of not breastfeeding include not only increased risks of preventable 
diseases and conditions, but also a staggering cost in dollars to the US 
health care system that pays for them. A government analysis of the cost of just 
three childhood diseases indicated that the health system would save $3.6 
billion if the prevalence of exclusive breastfeeding increased from current rates 
to those recommended by the Healthy People 2010 breastfeeding objective.  

As a registered nurse, I am a licensed health care provider whose duty to her 
patients requires providing full information for parental decision-making. I 
would be remiss in my duty if I deliberately withheld information to a patient 
regarding the importance of buckling their child into a car seat because I 
feared inducing guilt if the mother did not secure her baby in a moving car and 
the child went through the windshield in an accident. We do not hesitate to 
inform pregnant women of the hazards of consuming alcohol during pregnancy 
because we fear she might feel guilty if she drinks and gives birth to a baby with 
fetal alcohol syndrome. Why is breastfeeding any different? When information 
is withheld from women, they usually feel anger, not guilt.

Just as I as a nurse endeavor to protect the health of my patients, I urge 
the Department of Health and Human Services, whose duty it is to protect the 
health of the entire nation, to move forward with the National Breastfeeding 
Awareness Campaign. Our nation's health depends on it.

Sincerely,


Marsha Walker, RN, IBCLC

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