Hi all 

I have spent the past year immersed in the marketing literature and it has
become clear to me that those of us in 'helping' professions (nurses,
doctors, midwives, LCs, BCs, Social Workers, lawyers) are just babes in the
woods.  (Marketing works - it draws on psychological, anthropological,
physiological research.  If it didn't work on us, that would be because we
were either less than human or suffering from a serious set of
disabilities.) We are trusting by nature and woefully unaware of the
sophisticated function of marketing and advertising.  The quality of
Medela's product, their commitment to research, the personalities and skills
of their reps are not the issue here (but Medela will encourage you to think
they are because these are all part of a complex marketing mix).

As I see it, the question is should IBCLCs and others concerned with the
protection promotion and support of breastfeeding have commercial
relationships with code violators?  The IBLCE Code of Ethics is clear about
this.  It doesn't matter how good the products are, if the company
advertises a product that falls within the scope of the code to the general
public or to mothers (or to health professionals beyond the provision of
factual information) it is a code violator.  Medela is advertising feeding
bottles and teats to the general public.  It is a code violating company.
If an IBCLC, continues in a commercial relationship with Medela it is a
breach of her professional Code.  This is true whether you like the
products, the rep is nice (all reps are nice - if they weren't you wouldn't
be inclined to buy what they are selling) or Medela funds useful research.
It is not a grey area.  There is no controversy.  It is how it is and I
acknowledge acting ethically will be expensive (and perhaps not even an
option) for those of you whose livelihood has become entwined with the sale
and hire of Medela products.

On the issue of whether advertising reflects or creates demand, this
question was settled decades ago.  Advertising does both on a kind of
feedback loop.  It selects from our cultures existing ideas that support the
associations it would like consumers to hold with regard to its products and
brands  (about motherhood and breastfeeding in this case) and amplifies
(sometimes distorting) them.   Let's think about the Medela TV ad.  It
displays a mother detaching a bottle from a pump, screwing on a teat and
placing the bottle in the fridge.  The voiceover says: Breastmilk is best
for your baby.  Medela breastfeeding products are best for both of you.
This is a powerful set of language and images because it sounds true.  Ad
professionals call this probabilogic or paralogic.  It makes a true sounding
statement followed by a marketing claim leading the audience to infer
something which is not actually true.  In this ad we hear, Breastmilk is
best for your baby.  We all feel pretty good agreeing with that statement
(actually I don't but I am not the target audience) - and you better believe
mothers who have heard the 'breastfeeding is best' message will find that
statement familiar and 'true'.  Notice the addition of the phrase 'for your
baby'.  This sets up the pins for the upcoming strike.  The next statement
'best for both of you' over the pictures of bottles suggests that bottled
breastmilk is superior breastmilk (superior to breastfeeding) (because it is
best for mother as well as for baby).  Furthermore, the mother is young,
attractive, calm and clearly engaged in public life - attributes to which
most mothers aspire and find difficult to achieve in western cultures
(economies).  I could wax lyrical about the depiction of breastmilk in
cartons on supermarket shelves and the implication that the only milk of
value is that which can be bought and sold . 

Now no one who knows anything about advertising will argue that seeing one
advertisement can be shown to significantly influence behaviour.  It is the
repetition, what is known as the 'mere exposure effect' that shifts
(probably incrementally) attitudes about brands and products and their uses.
(Seeing a brand advertised even just once significantly increases the
chances that a person will purchase a product bearing that brand - we all
like the familiar.)  The point is, the WHO recognised the power of
advertising in the 1970s, culminating in the Code.  In recognition of the
fact that public health authorities will never have the kind of research
budgets that multinational companies have, the WHA has asserted that the
onus is on the advertisers to demonstrate that their advertising does not
affect infant feeding behaviour.  If it didn't, these companies would be in
violation of their legal obligations to their shareholders.  And that is why
regulation is the best solution to Code implementation. These companies'
first ethical responsibility is to their shareholders.  Code compliance can
only be achieved if it is commercially advantageous or legislated.  

Code compliance protects mothers and babies from exploitation.  It ensures
that mothers can make informed decisions about how to feed their infants
(without undue influence from those who would part them from their money).
Code violating companies will try to convince us that adherence to the Code
will prevent mothers who would otherwise formula feed from giving their
babies their own milk.  This is just not true.  There is nothing to stop
Medela or anyone else from developing and selling their breastpumps (or even
their bottles) in the code.

*******

On another issue, if Medela has partnered with WIC, then it is no wonder
that they don't consider Code compliance to be a financial imperative.  I
find it interesting that the rep used this partnership as part of the case
in support of Medela's ethical credentials.  Medela is not partnering WIC
because it is a 'good' or 'morally upright' or 'benevolent' company.  It is
partnering WIC because doing so will improve the bottom line.  WIC services
around 50% of American infants and their mothers.  WIC is already the single
most effective marketing tool for infant feeding products in the world.  I
predict that WIC will also be a lucrative relationship for Medela.

Regards

Nina Berry

Australia

 


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