Dear all: First, here in NY City, the ads for many health issues are completely in your face. They have shown a mother dying of lung cancer with tubes up her nose worrying about her daughter, followed by her daughter mourning her loss after her death and similar commercials with those suffering from the effects of their cigarette smoking. The latest is this full jar of black liquid that equates the amount of toxic fluids you accumlate in your lungs in a year. Along with these ads I have seen other ads suggesting where to get help. So it is the punch in the nose followed by the hand reaching out to help. I think Diane Weisseninger has the right approach. Having watched a shift in international nutrition in our approaches from the lame tired old nutrition education messages where mothers were told the "right way" to feed their infants in a boring group session with unattractive posters - there was a shift in approach with some innovative programs using MULTIPLE approaches. I don't think I can remember all the five or six P's or S's or other categories used by the social marketing organizations - but here's what I remember of the list: 1) Legislation --- some things won't happen without protective legislations. For example, for iodine deficiency --- if you want to ensure that salt is iodized to levels that compensate for soil erosion that has made it impossible to get enough iodine from food sources --- you have to legislate and back it up with checks on the iodine content from the source to the consumer. And our breastfeeding equivalent is the WHO Code. 2) Product placement --- this means that the "product is accessible" and visible. For instance, if you want people to use a product it is not on the top shelf or tucked away in the corner, it is in a highly visible area where everyone can see it and get it. If schools have candy dispensers and soft drinks in their cafeterias as opposed to fresh fruits and bottled water --- what foods do you think kids will eat? Why do you think candy is placed at the check out counter at the level that a toddler can reach from the shopping cart? So, this means the baby should be in the room with mom if she has a hospital delivery and the formula bags should not be there. As well as, breastfeeding in public should be widely practiced and promoted with images so everyone gets over their early training that it is the equivalent of elimination. 3) Service delivery --- this means that you have adequate and appropriate help with the product. For instance, if you live in an area of the world where you have to travel 25 miles on foot or hope you have enough saved to rent a donkey drawn cart, you are unlikely to seek health care services unless you are on death's doorstep. If you have just had a C-section, don't own a car, are afraid of germs on the subway and the ground is covered with freezing slush, you are unlikely to drag yourself out for a breastfeeding support group that is 50 blocks away. If you don't have enough money (or think you don't have enough money) then you are unlikely to call someone in to help. If, on the other hand, you have a health care system that sends someone to your home on the third or fourth day that is well trained in how to assist breastfeeding, it is going to make it much easier to overcome difficulties in learning how to breastfeed. If I had Bill Gate's money I would spend some of it right now on retraining the staff in many Manhattan hospitals out of the RAM method of shoving the head into the breast and have enough trained LCs in the city so that every mother would get a visit on the third or fourth day at home if she wanted it. 4) Support structures --- here is where Richard Manoff made a light bulb go off in my head. He listed all the things mothers were supposed to do in developing areas to protect their infants from illness and death on UNICEF's list. Even though I was single at the time, it really clicked in how impossible that was for that mother to do without help. If a mom has to walk 15 miles to collect water and to collect firewood as well, she is not going to have the energy to boil the contaminated water before her family drinks it, let alone cook up fresh complementary food for her toddlers three to four times a day. If a father makes all the purchasing decisions and eats all the iron-rich sources of food because that is the cultural norm, a mother may not be able to reduce her anemia during pregnancy. If he is convinced that buying liver snacks for his pregnant wife will make his wife less tired, he may see the value and she may have a better chance at survival during and after delivery. If Manhattan fathers are taught how to make a mother comfortable when she is learning how to breastfeed --- how to massage her tense shoulders, prop up a wrist that is headed into carpal tunnel territory from the "death grip" on her baby's head, bring her glasses of water and tasty snacks --- think how much easier that will make it for her to learn how to assist her baby to breastfeed and not decide to delegate her mothering to a baby nurse. 5) Channels of communication ---- it is very important to identify the many different channels of communication. It is not enough to have one channel. Some of us are only working through one channel of one on one contact. Some of us also do classes and have another means of communication. Some work in public health and have various media sources at our disposal. All of these channels should be accessed to reach women AND the influencers around her. Some of the best social marketing messages I have seen in developing areas have NOT targeted the mother herself. An example would be "Friends don't let Friends drive drunk". I'm sure I am missing many points that a social marketing would have at the tip of their tongue but I will jump to TIPS which I have mentioned before. I found it shocking at first. Nutritionists tend to get very preachy about the "RIGHT" foods to eat. This approach doesn't usually work. TIPS means "trials of improved practices" and this is what I often see good lactation consultants do. We all know the "ideal" ---- that rosy picture of what we would like to see for all mothers. Yet, mothers may cling to societal misinformation despite our best efforts at providing "evidence" or "logic" to convince her to do otherwise. So, we strive for improved practices on her part in a back and forth dialogue. It will not be perfect, it will not be the ideal, it may not be what we would have hoped --- but we acheive more than would have happened without the dialogue and back and forth over what the mother is capable of doing or "thinks" she is capable of doing. I'm sure someone who has kept up with social marketing strategies could do this topic more justice --- so feel free to pipe up with your comments. Best, Susan Burger *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome