Pamela and Marianne have posted on the Code's provisions about marketing bottles and teats, specifically about whether today's use of bottles to feed babies expressed breastmilk should be subject to the same restrictions on marketing as what the drafters of the Code had in mind 30 years ago.  Pamela points out that there were babies in her practice who were fed breastmilk by mothers who would not put them to breast but were willing to express and bottle feed them, and she observes that some of these babies later went to breast without difficulty, which prompts her to ask whether bottles and teats are really the threat to breastfeeding we have believed them to be.

Maybe, maybe not.  But once again we must remember that the Code was never meant to stamp out bottles or breastmilk substitutes, it is meant to protect the populace against the unethical marketing of these things, and that is not the same thing at all.

I have certainly seen plenty of babies who are able to take milk from a bottle if need be, but continue to breastfeed happily when their mothers are present, and for the most part, as long as there is plenty of milk in the breast the baby prefers to drink it there over anywhere else.   The exceptions are often puzzling; the commitment shown by mothers of children who are completely nourished on their own milk despite never coming to breast is one I have the utmost respect and admiration for.   I think what they do involves not only a considerable amount of practical physical drudgery, it may also involve an ongoing sense of missing out on what so many people take for granted and never appreciate the wonder of, particularly since they are generally far more knowledgeable about breastfeeding than the average person is.  I mention this lest anyone think I rank motherliness by whether the baby drinks from a breast or from a bottle.  And of course all babies whose food is served in a bottle deserve to be protected by stringent safety standards for the quality of those bottles.

But is it necessary to accept aggressive and indiscriminate marketing of bottles and teats in order to guarantee product safety or to give appropriate care and advice to mothers?  I don't believe it is; quite the opposite.  You could put forth the same argument for breastmilk substitutes.  How many of us would agree that because some children do in fact need these products, we should accept the marketing of them to *every* child's parents - that is in fact the whole point of the Code.  The people who do need products that come under the scope of the Code are precisely the people who deserve unbiased factual information about them, (I am getting ready to shout now) NOT PUFFERY PRODUCED BY MARKETING CONSULTANTS PUTTING A SPIN ON THE INFO WITH AN EYE TO INCREASING SALES.  If you still believe that the best evidence-based information about a product is to be found in the marketing materials from the company selling it, please take your ballpoint pens, post-it notepads and coffee mugs with the formula company logos on them and go back to square one and don't forget to say hi to Santa Claus and any flying pigs or unicorns you will meet on your way.  

I think that there is a real danger of losing sight of one of our fundamental goals if we accept *actively marketing* bottles and teats as long as they are meant to be used to feed babies a 'good product'.  This is a slippery slope.  If people like us who work to support, promote and protect breastfeeding go along with the notion that breastfeeding and bottle-feeding breastmilk are equivalent (in the literal sense, *of equal value* or *interchangeable with*) then we can say good-bye to any hope of securing real maternity leave for women who are denied it today.  The best we can hope for is that they not be harassed when they sit in a workplace milk expression room.  We underrate the meaning of a mother being with her child, and the child being with its mother, if we behave as if all we do on behalf of breastfeeding is only about the milk.  And if we who know that it is about so much more do not act accordingly, who on earth will?

Pamela asks how we can be so bothered by pump company marketing of bottles and teats while we turn a blind eye to the distribution of free formula samples in hospitals and by governments and aid agencies.  Who is turning a blind eye?  I for one am bothered almost to the point of despair by all these things and apart from it being very discouraging it is no problem keeping both thoughts in my head at once.   From Pamela's post one might deduce that UK hospitals are regularly giving free samples of breastmilk substitutes, but as far as I know this is not the case, and I don't believe PCTs in the UK have such ties to industry either.  

Rachel Myr
Kristiansand, Norway

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