perhaps everyone who is not in the us is sick of hearing this discussion go
on and on, but since our american values often get exported (more's the pity
with this one), then perhaps they will pardon me for pointing out ONCE again
- having a paternalistic attitude towards WIC clients doesn't make sense.
pitying the poor low income, poorly educated moms does them no good. if its
not clear what the implications are of this type of thinking, then perhaps it
needs to be discussed continually.

in the usa the government pushes formula, the doctors and hospitals push
formula, and the media pushes formula. with the rare exception, if you give
out formula, you are doing that INSTEAD of doing what you should be doing to
support and promote breastfeeding. and what does it say about someone who
does free work for the formula companies? they couldn't figure out that they
could get PAID to do this? to say that there isn't enough money to pay for
the things needed to truly support breastfeeding is a fatuous argument; if
the money spent on formula were used to encourage breastfeeding, there would
be enough.

what happens in countries like zimbabwe where the government, health system
and media don't push formula feeding? even "poor, uneducated" women
breastfeed. no one tells them "you are too stupid or irresponsible to
breastfeed." you cannot be neutral about pushing formula. you are either
"FOR" breastfeeding or "agin" it.

someone wrote this to me privately, i think it is a good description of how
this should be handled:

" I hate formula for the overwhelming majority of women.  Think it should be
available by prescription only. Free to those who need the prescription but a
full months supply.Illegal for others to use or be in possession of."

and of course, donor milk should be the first choice in all situations where
supplementation is needed. donor milk is now available only for cases of
medical need. i believe ALL babies need donor milk if they aren't getting it
from their own mothers.

if you don't think formula is bad, you will continually be justifying its use
and participating in its use. if you begin to understand that formula is a
powerful drug to be used only in specific circumstances, then you will begin
to seek out ways to make the alternative work well.

do we have proof that WIC alone is responsible for the increase in
breastfeeding rates? "the rates crept up" - is crept up all we expect?
perhaps if WIC weren't facilitating the problem and were facilitating the
solution instead, bf rates would have zoomed up.

its true that situations mothers find themselves in are often prohibitive of
breastfeeding. by providing formula we are sending a clear message that IT'S
OKAY to not breastfeed and that the other situations DON'T have to change.
while we are busy creating an underclass of children deprived of this
important health benefit, we will only find that their numbers increase with
each generation. maybe its ja ob security thing.

it's discriminatory to only support breastfeeding in some populations. if
breastfeeding is "the best" but only if you can afford it, then we are saying
that the poor deserve less than everyone else. i know, i know, this IS the
current medical model, but can we really have our tax dollars support this?
ITS IMMORAL.

there is a huge possibility for effecting change. think of this. wic begins
to fully support breastfeeding. if a mother gives birth in a hospital and
wants to not breastfeed, the staff patiently ignore her claims that she
"doesn't want to" and tell her that "we don't use that other stuff here." she
is cajoled into breastfeeding by staff and other patients alike. when she
goes home she knows that the cost of giving up on breastfeeding and switching
to formula is all up to her family. no free bottles to use, no free formula
to get started with.

she goes to her wic office and they inquire about breastfeeding. she gets a
lot of food for herself. if she is feeling some pain when the baby latches
on, she gets an instant referral to a lactation consultant. she mentions that
the conditions of her public support program is that she return to work at
three months (pretty good deal, most moms not on wic go back at 6 weeks). she
is given a hospital grade pump and some milk storage bags and bottles, and
plenty of instruction. she gets a note with the dates of the "working moms
breastfeeding support group" in case her LLL group doesn't have a meeting for
working moms, and off she goes.

whenever she has a problem, she can call wic and get a referral if needed. if
she gets a job that makes no provisions for pumping her milk, the wic office
can call and say "ALL moms breastfeed, get with the program." she continues
nursing until her baby is 23 months old. her baby is generally healthy, and
the mom is not pregnant.

the mom who does not choose to breastfeed is told at her wic office that she
can have an appointment with the lactation consultant to talk about
relactating. she doesn't get free formula. she is given a referral for donor
milk for the time period in which she relactates. if she refuses to try to
breastfeed, she is encouraged to use donor milk, for the health benefits, but
with the clear understanding that she will have to pay for it herself. or she
can pay for formula herself. she understands very clearly that using formula
presents health risks and that her baby may not be as smart or happy as all
the others. no one tells her that "formula is okay" because it is not.

a mom gives birth that cannot make milk because of previous health problems
that destroyed the tissue in the breast. she receives a a tube feeding device
"so you can feed your baby and have it look as normal as possible." she gets
counseling in the hospital immediately after birth so that she can deal with
the emotional trauma of not being able to breastfeed. donor milk is in the
hospital freezer for her to use, and she gets a prescription for free donor
milk from the wic office. she is given the extra food given to breastfeeding
mothers because "we don't want her to feel different." perhaps not
defensible, but surely a gesture towards the common good.

 the hospital lactation consultants have a lively debate for months about
whether this mom should have hormonal supplements to put her in the identical
hormonal state as a lactating mother. after all, they say, that's the normal
state she would ordinarily be in physically.

if it is true that we "have" to provide formula or otherwise babies will
starve or get inadequate nutrition, then we should be taking this much
farther. we should be giving out enough diapers so that the babies don't get
diaper rash. we should be giving free car seats so they don't get killed in
accidents. we should make sure the heat and electric bill is paid because
those pesky parents might spend that money on lotto tickets or crack cocaine
and not keep the baby warm enough.

here in denver there is a summer art program for kids with juvenile arrest
records. they get instruction and materials and even a chance to sell their
art work. all for free, the only price of admission being - getting arrested
for doing something bad.

on the other hand, my children, who love art (next year both of my boys will
be going to the denver school of the arts, i am so proud!). they would love
to take private art lessons. they would really like to have free materials,
because we can't afford to provide either one. and wouldn't it be wonderful
if someone helped encourage people to buy their art work and keep them off
the streets.

and they could do it, all they would have to do is break a few laws.

as long as the majority of those who call themselves "lactation
professionals" are giving formula to moms on a regular basis, then i despair
for the future of breastfeeding. no one else is going to do it; if our own
profession cannot truly support breastfeeding, then there is no hope. i often
feel that i must either think up a new name for what my work is, or give it
up entirely, because i am shamed to be considered in the same category. when
the majority are supporting casual formula use (as opposed to truly needful
situations, just so no one accuses me again of wishing for babies to die to
support breastfeeding), then it is hopeless.

formula bad, breastfeeding good. its a universal law. its not a privilege.
its a right.

carol brussel IBCLC
(former breastfeeding WIC client)

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