Julie - Thanks very much for sending in the links about diluting formula and feeding inappropriate substitutes. One of them was a blog where a friend of the family was asking if it would be appropriate to report the mother who was doing this to CPS. The consensus was that it was. So there is one answer. If mothers trying to breastfeed can receive threats of removal of the baby by Social Services for not feeding a baby formula (as certainly happens here) then a similar scenario could be envisaged for a mother who has elected to formula-feed also not feeding the baby formula. Not, I hasten to say, do I think we should be necessarily penalizing mothers. But we should be protecting babies. And I do think that mothers who choose, against all professioal advice (AAP statement refers), to not breastfeed, should be expected to pay for it themselves. And - if the easy option of formula being available to all was to be withdrawn - I think that it would help to focus healthworkers and policy-makers on their responsibility to make sure that all mothers receive up to date assistance to breastfeed. The stories many are sending in about mothers not knowing that Kool-Ade, or Pepsi being unsuitable, are just astonishing. As to mothers' rights to choose their own preferred feeding method, there's a very interesting section starting on page 18 of the current WHO HIV and infant feeding guidelines, at <http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html>http://www.who.int/child_adolescent_health/documents/9789241599535/en/index.html The background is that from 1998 until 2009 WHO was firmly behind the concept of encouraging HIV+ mothers to choose their own infant feeding method, or what has been described as "a neutral presentation of options" (sound familiar?) What interested me was how strong the parallels were between mothers in developed countries who were encouraged to make that choice, and HIV+ mothers in developing countries also being encouraged to make the same choice. Both scenarios were stated to be underpinned by human rights considerations, although I always wondered, whose? One of the contributors to past guidance had suggested that promotion of infant feeding choice is only possible in a balanced state of ignorance, but perhaps it wasn't heard very clearly. What's interesting now is the about-face that's been taken on the issue. The experts meeting in Geneva in 2009 took a good close look at the concept, and they came up with this reasoning: "In considering the implications for principles and recommendations, the group extensively discussed why and how a focus on individual rights is important for public health activities. It was noted that: * Focusing on individual rights enhances the efficacy of public health activities; * A focus on rights also reminds public health practitioners of their reciprocal obligations; * Human rights principles are not barriers to essential public health activities, but they establish boundaries and parameters. "The group concluded that a more directive approach to counselling about infant feeding in which practitioners make a clear recommendation for or against breastfeeding, rather than simply presenting different options without expressing an opinion is fully consistent with an individual rights framework. In reaching this conclusion, it noted that there is no single approach to counselling and consent that is appropriate in all situations. Rather, with all medical interventions, there is a continuum of options that is available, with the choice among options dependent on various contextual factors ....The group considered "What does the 'reasonable patient' want to hear?" If there is a medical consensus in favour of a particular option, the reasonable patient would prefer a recommendation rather than simply a neutral presentation of options.... The group considered that this did not represent a conflict with the individual patient's interests, either the infant's or the mother's." [Me again] From this, it would seem that presenting a neutral presentation of options for infant feeding (either in or outside the context of HIV) is no longer seen to be acceptable, at least by WHO. From the way this is written, it would seem that there are some ethical concerns about endorsing formula-feeding just because a mother chooses to use it, particularly if her choice is likely to lead to compromised infant health. Health providers have a responsibility to promote health. To take it a step further, we could also ask if it is ethical to provide a mother with vouchers or tins as an inducement to formula-feed, when the reasonable patient would want to have a clear recommendation - and help - to breastfeed? Pamela Morrison IBCLC Rustington, England ------------------------------ Stories on parents diluting (or overconcentrating) formula: http://www.scientificamerican.com/blog/post.cfm?id=warning-a-little-water-can-hurt--es-2008-12-04 http://answers.yahoo.com/question/index?qid=20080801184428AAolR9p http://www.ismp.org/consumers/Formula.asp *********************************************** 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. 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