I HAVE read the original research from which the 4/1000 mortality rate (that
I quoted from Rogan) and the 1 SIDS death in 1000 live births (from Damus)
and as a public health professional (specifically a methodologist at the
doctoral level) I do "believe" that the application is correct.  People do
manipulate and lie with statistics all the time; however, I don't think this
is one of those instances.  For those of you who have not seen the ILCA
publication SUMMARY OF THE HAZARDS OF INFANT FORMULA PARTS I & II, written
by Marsha Walker, these are just two little references of dozens of
compelling citations listed.  I highly recommend that you order copies from
ILCA (no, ILCA doesn't pay me to say that).

Now, on a related topic, I fail to see why the same people who are willing
to use other epidemiologic studies to support their health education wording
of "if you do this, you'll increase your risk of this" are not willing to be
as forthright about formula.   As the oft quoted presentation from
illustrious and captivating "the Kathy and Cathy" team, guilt is what you
get when you KNOW what you are doing is not the right or best thing (I still
cherish my copy of their tape on this from a conference 5 years ago).  We
use guilt all the time in health education and medicine.  As a Certified
Health Education Specialist, I've read a huge amount of this literature and
the theory behind behavior change.  True fear is not the best motivator, but
it IS a motivator.  And, my intent with the use of these epidemiologic
statistics is more to motivate hcps to act, not throw them at moms directly.
I have many times spoken to physicians about their tenacious insistence that
ALL babies be immunized exactly on schedule and that ALL children under 40
lbs ride in a cert. restraint.  The reality is that not all (or even most)
unvaccinated kids will come in contact or contract the microbe in question
and not every unrestrained child will be in an accident. YES, I cringe at
saying this, and I'm certainly NOT implying that we stop pushing the
message.  We use relative risk, attributable risk and odds ratios all the
time in health.  What I am saying is that we are using and reinforcing a
double standard.  These same physicians tip toe around the issue of
breastfeeding--fearing that they'll make a mom feel "guilty for not
breastfeeding."  They don't see formula as a significant threat to the
health of babies.  IMNSHO (and many others on this list), it most certainly
IS when it is used to replace breastmilk and when that formula undermines
the success of breastfeedingI know many of us are nonconfrontational and
surely we would rather "win" people over with honey rather than vinegar, but
folks someone has got to send this message home.   Just think about it for a
minute and substitute in the wording that we use most of the time into other
health campaigns (say smoking, mammograms, or any others).  There are many
instances where the "evidence" is much shakier than with breastfeeding and
yet we deliver a much stronger message.

Yes formula is necessary for certain situations, but its pervasiveness in so
many aspects of our society demonstrates how "normal" it is and how much of
a near equal.  Even non-formula ads contain subtle messages reinforcing
this.  State Farm is now running an ad about now that we're getting older,
women's life concerns shift from this and that to blah, blah, blah and
<<bottles>>.  Refrigerator ads have bottles in them and Seasame Street
antropomorphises animals with bottles.

Perhaps if we, as advocates, were a bit more direct with other hcps we could
make safe donated human milk banks ubiquitous for those who cannot
breastfeed.  There are industrialized nations where women are paid well for
pumping milk so that EVERY hospitalized child under the age of 5 is given
heat-treated human breastmilk to aid in their recovery from any illness.
Why don't we do this?  Because there is a cheap (relative to expressed human
milk) alternative that is perceived as "almost" as good.

So, I'm sorry (really) if I've insulted anyone, but that's a risk I'm
willing to take.
--
--Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
INFANT CUISINE AND MOTHER CARE: Lactation Consulting, Perinatal Health
Education and Attachment Parenting Classes for parents and practitioners

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