Dear all
Thank you to so many who wrote in with stories
and observations of what babies may be fed in
bottles when mothers don't have access to free
formula. Virginia, your history lesson was
particularly fascinating. I guess what I'm still
trying to get at is not whether babies in the
Phillipines receive mixtures of corn-flour, or
coffee creamer instead of breastmilk, nor whether
babies in Zambia receive Fanta. That one really
made me shudder, breastfeeding is the cultural
norm in Zambia - or was - until the first Zambian
HIV & Infant Feeding Counsellors were trained in
1999 .... I also hear the carefully researched
facts that babies in Australia and UK used to
receive all sorts of inappropriate mixtures. I
wasn't quite sure what you were saying Dawn,
about the economic downturn and an intention to
take cans of formula to the next county meeting
.... Logically, increasing poverty should
stimulate higher rates of breastfeeding since
breastmilk is a really low-cost, renewable
resource which frees mothers' scarce financial
reserves for other things. Julie, thanks for
your further input confirming the sad cases you
worked with, and mothers in real poverty. I
still tend to agree with Nikki who says "We can't afford not to breastfeed."
What I'd still like to know is whether there is
any current research to justify the wholesale
handing out of free formula in a concerted way by
governments and/or national health departments in
_industrialized_ countries in 2009 to the poorest
mothers to _justify_ the current policy of doing so.
For instance, the British Healthy Start programme
allows low income mothers to qualify for
vouchers/tokens to the value of £6 per week which
they can exchange in shops for fruit, vegetables
or milk. They can, if they wish, save up the
vouchers during their pregnancies and cash them
all in after the birth, and they can use the
vouchers to obtain free formula, rather than the
fruit, veg or ordinary milk. For non-breastfed
children under 1 year, the token may be used for
900g of infant formula milk per week instead. No
application is necessary; as long as the Inland
Revenue has up-to-date details about the family,
any award under this scheme is automatic. I'm
not sure if this is a way that the Department of
Health can distance itself from what is
happening, but it has the effect that low-income
mothers don't even need to go near a healthcare
provider if they have already decided to formula-feed.
I believe that there are similar provisions in
the US WIC scheme. At the same time, I know that
there are many dedicated breastfeeding
counsellors and IBCLCs working hard in government
departments to assist mothers to breastfeed, but
nevertheless, the choice of whether to breastfeed
or not is the mother's, and if she chooses the
latter she is actually _helped_ to do so by her government.
That governments and health departments should
continue facilitating formula-feeding of the
babies of the poorest mothers is what bothers
me. These babies will be disadvantaged all their
lives, and are the ones who most need
breastmilk. Heather makes some good points that
making gifts of formula doesn't guarantee good
mothering. In fact, we have research to show
that breastfeeding facilitates protective
mothering. So is there a body of researched fact
to justify continued freebies? Or is it all
about commercial interests? Or is it just habit
- because we've been providing handouts for xxxx
number of years and are afraid to stop _in case_ mothers starve their babies?
Part of my interest in this is due to the
parallels I see between what happens in the US
and UK and how the practice of free formula
handouts for "needy" (HIV+) mothers is being
exported to resource-poor countries, with pretty
dismal consequences. It's as if the
industrialized world has set the precedent for
what should happen, and endorsed its
rightness. Botswana provides a really chilling
example of the consequences. In 1999, their
breastfeeding initiation rates were 95%. Then
the government introduced a policy of providing
free formula for all HIV+ mothers. By 2006 only
65% of Botswana mothers even initiated
breastfeeding (a drop of 30% in 7 years) and many
more weaned their babies from the breast
prematurely. Early in 2006 it was found that over
500 formula-fed babies had died of diarrhoeal
infections caused by contaminated water. One
village lost a full third of its babies. An
investigation was conducted by the CDC who found
that 15% of uninfected mothers were also
formula-feeding. So provision of free formula by
the government had caused considerable spillover
to mothers who didn't "need" it at all, but
nevertheless had "chosen" to formula-feed. And
the normal practice or breastfeeding has been
seriously eroded. Similar situations are
occurring up and down the length of sub-Saharan
Africa, so things will only get worse.
We have libraries of research to show that health
outcomes for breastfed babies are consistently
better than health outcomes for formula-fed
babies. Or to show that formula-feeding is risky
in all but the rarest of individual circumstances
compared to breastfeeding, depending on how we
want to characterize what is happening. We have
the Code to prevent the inappropriate marketing
of breastmilk substitutes to parents. But what
do we have to protect babies from the
inappropriate gifts of governments?? Where is
the actual research to justify the gifts? Having
spent all but 12 years of my life in the poorest
countries, I can't get my head around a system
that doesn't expect that mothers will care for
their babies enough to feed them the best way
they can, even in the most limited circumstances.
Pamela Morrison IBCLC
Rustington, England
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