Enhancing national network of nonprofit donor milk banks and diversifying nation’s production of infant formula to secure infant nutrition in U.S.

The Infant Feeding Action Coalition USA, Inc. (IN.FACT.USA) has put together a piece detailing the global recall of contaminated Abbott powdered formulas.

In February 2022, the largest U.S. infant formula manufacturer recalled three brands of its powdered formula and one breastmilk fortifier and shut down its main manufacturing facility in Sturgis, Michigan following reports of Cronobacter infections in infants who had consumed formula manufactured at the Sturgis plant. It’s noteworthy that the initial recalls were voluntary–not required by the US Food and Drug Administration (FDA)— and they only came after nine babies died between September 2021 and January 2022 from infections.

Let’s focus on that, the death of these babies, Tameka L. Jackson-Dyer, BASc, IBCLC, CHW  urges in her Great Lakes Breastfeeding webinar Feed the Baby: Lactation, Contamination, and the American Formula Crisis.

One infant death is one too many. Initially, two deaths were reported; however, Freedom of Information requests and whistleblower action revealed that not only two, but another seven infants in the U.S. were reported to have died after consuming powdered infant formula manufactured at the Abbott factory.

“During the same period, 25 severe infections categorized as ‘Life Threatening Illness/Injury’ and 80 instances of ‘Non-Life Threatening Illness/Injury’ were reported among infants who were fed these formulas,” The Abbott Powdered Formula Scandal also points out.

“Until Cronobacter infections require mandatory notification, the number of cases of illness or deaths will never be known. Neither will their extent in the 37 countries which imported the potentially contaminated Abbott formula.”

In The Four Pillars of Infant Nutrition Security in the United States, author Amelia Psmythe Seger points out that  “The U.S. has not regulated the marketing practices of the commercial milk formula industry, unlike 70% of the world, which has implemented at least some part of the WHO’s International Code of Marketing of Breast-Milk Substitutes. In the absence of regulation, these marketing practices are predatory.”

Psmythe Seger goes on to urge, “Diversify the nation’s production of infant formula. Plainly it is a mistake to allow 42% of the infant formula in this country to be produced not only by one company but by one factory of that company. Infant formula companies are part of an infant food security system, but we don’t have to be so dependent on that industry.”

[For more on commercial influence, you can watch USBC’s series of Unpacking Commercial Milk Formula Marketing Webinar Recordings]

A history of breastmilk substitutes laid out by Jackson-Dyer reminds us that before the advent of commercial infant formulas,  wet nursing was the original supplemental feeding.

Considering the infant feeding landscape today, Jackson-Dyer quotes Michigan Breastfeeding Network Executive Director Shannon McKenney Shubert, MPH, CLC: “In my 12-year career in the field of human milk feeding, I have never once met a birthing parent who ‘chose not to breastfeed.’ In this country, whether to breastfeed is not a choice. In this country, whether to breastfeed is a question of ‘Within all the systems of oppression that I navigate, what is the best combination of things I can do to ensure the survival of my baby, myself and the rest of my family?’”

With this context in mind, Jackson-Dyer confronts the idea that yes, babies must be fed, but fed is not best; instead, it is required, she says in her webinar.

“It is the absolute minimum to sustain life,” she reminds us. “We can’t just feed the baby anything.”

Again in The Four Pillars of Infant Nutrition Security in the United States, Psmythe Seger shines light on nonprofit donor milk banks which provide pasteurized donor human milk for human babies, “the next best thing to mom.” 

“Enhance the national network of nonprofit donor milk banks,”  Psmythe Seger writes. “Support innovative partnerships across existing structures, taking a cue from a national model such as what exists in Brazil. Consider: Red Cross has the infrastructure to support donor screening; WIC offices or community health clinics could be donor drop-off sites; more hospitals could provide space and equipment for donor milk processing and distribution, as some have done. Models exist to create an affordable and plentiful alternative to commercial milk formula when a parent’s own milk is not available.”

Photo by: Sara D. Davis/
Source: United States Breastfeeding Committee (USBC)

This fall, the Access to Donor Milk Act (ADMA) was introduced in the House. ADMA would increase federal support for nonprofit milk banks and access to donor milk for medically-vulnerable infants.

What’s more, the legislation would allow state agencies to use WIC funding to promote the need for donor milk, provide emergency capacity funding when there is a demand for donor milk,  create a donor milk awareness program, and require the secretary of HHS through the FDA to issue a rule clarifying the regulatory status of donor milk provided by nonprofit milk banks.

Stay tuned for how you can help support this legislation. For other legislative and policies opportunities that support healthy infant feeding, visit USBC’s Take Action page here.

Industry lies and the Code

“Even in the harshest of trade regimes, there is space for public interest laws to meet legitimate health objectives when they are founded on internationally adopted standards and recommendations such as the Code and subsequent relevant WHA resolutions.”– WHO, 2016

All three of my kids sport a similar look when they lie.  As soon as the fabrication tumbles out, their cheeks suck in ever so slightly toward pursed lips. Once they’ve heard themselves, their eyes widen a smidge and their bottom jaw drops just a few degrees. 

Most of us don’t like to be lied to, but usually the dishonesty we encounter can be considered trivial. “I didn’t do it!” when there’s crayon art on the kitchen walls. “Your hair looks great!” when you know it doesn’t. “Of course I remember you!” when you haven’t the slightest clue. 

Just as humans tend to react physiologically when we lie, we have an ability to detect when someone is lying to us. Inundated by the lies told by marketing companies on behalf of major industries though, detecting truth and falsehoods can be majorly challenging. There’s no lip biting, no shifting eyes, no perspiring to give it away. Instead the tactics industries use are cunning, targeted, sometimes irresistible and truly brilliant in many ways. The lies they tell are perpetual, and their claims have completely saturated our culture, influencing just about every facet of our lives, all for commercial gain.

There’s a promotional video featured by a cooking show that showcases a chef professing his allegiance to gas stoves. The video was created by a utilities provider though, and having worked aggressively with state legislatures “to block legislation that would provide cleaner, electric-based building codes,” their marketing got us to believe that cooking on a gas stove is somehow the best while simultaneously waging “war on local electrification initiatives all over the country.” [https://www.thresholdpodcast.org/season-4-episode-6-transcript]  

Here’s another example. Most of the seafood that we purchase and consume in the U.S. is mislabeled as something completely different. This “Seafood Fraud” is detailed in (Mis)labeled Fish

President of the  Center for Science in the Public Interest Peter G. Lurie, MD, MPH calls out unfounded claims of “healthy alcohol” in Peter’s Memo: The Jungle

Fossil fuel companies are greenwashing their efforts, helping to sow doubt about the fossil fuel industry’s role in the climate crisis. 

As explained on How to Save a Planet: “They’ve… done it indirectly, by funding organizations who lobby congress, launching fake grassroots campaigns, and perhaps most importantly, through advertising. These ads, according to Martin Watters at the nonprofit firm ClientEarth, are greenwashing.” 

The tobacco industry pushes “green” public relations too.

Now consider the baby milk substitute (BMS) industry. A recent WHO report examines the scope, techniques and impact of digital marketing strategies for the promotion of breast-milk substitutes which reveals how the $ 55 billion baby formula industry “insidiously and persistently” targets parents online through “tools like apps, virtual support groups or ‘baby-clubs’, paid social media influencers, promotions and competitions and advice forums or services, formula milk companies can buy or collect personal information and send personalized promotions to new pregnant women and mothers.” [https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing

Their efforts have further adapted to target older children with their toddler milks and  formulas. Lurie again calls out false claims like  “Brain & eye development” and “Plant-based protein for toddlers.”

He writes: “The multibillion-dollar infant-formula industry is trying to convince parents that children older than 12 months need formula. They don’t. The beverages—made largely of fortified powdered soy or dairy milk, oil, and corn syrup solids or maltodextrin—typically supply added sugars. They certainly don’t beat a diet of healthy foods.” 

The WHO report confirms these concerns: “Science is a dominant theme in the marketing of formula milk across all eight countries, including scientific imagery, language and pseudo-scientific claims. Formula milks are positioned as close to, equivalent and sometimes superior to breast milk, presenting incomplete scientific evidence and inferring unsupported health outcomes. Ingredients, such as human milk oligosaccharides (HMOs) and docosahexaenoic acid (DHA), are advertised as ‘informed’ or ‘derived’ from breast milk and linked to child developmental outcomes. Examination of the scientific evidence cited does not support the validity of these claims.” (p. 9)

In response to the absurdity of BMS industry claims during Protecting Breastfeeding in the United States: Time for Action on The Code, David Clark, International Public Health and Human Rights Lawyer and Legal Advisor for the UNICEF Nutrition Programme (1995 to 2020), laughed “I don’t think I’ve seen anything so outrageous in my life.”

The marketing of formula products is different from other commodities because it impacts the survival, health and development of children and mothers; disrupts truthful information– an essential human right as noted by the Convention on the Rights of the Child; disregards the International Code of Marketing of Breast-milk Substitutes; and exploits the aspirations, vulnerabilities and fears at the birth and early years of our children solely for commercial gain. (WHO/UNICEF, 2022, p. x) 

Considering the current state of affairs– the industry’s guileful tactics, the permeation of their influence in every sphere of life, our nation’s lack of adoption of the International Code of Marketing of Breast-milk Substitutes/ subsequent WHA resolutions and any monitoring or enforcement systems– it’s easy to feel crushed as a maternal child health advocate, like the way forward is straight into the Apocalypse. 

Fear not. Researcher Britt Wray has suggestions on how to keep ourselves within our windows of tolerance in order to continue to mobilize. While Wray’s work focuses on the climate crisis, her findings are easily applied to maternal child health advocacy. Learn about these techniques here

There are also simple actions (and some bigger ones too) that we can employ to continue to move the needle.

Françoise Coudray of ADJ+ Allaitement Des Jumeaux et Plus offered this to health advocates attending the launch of WHO’s latest report : “The mosquito: small, small, but have one in your bedroom and you will have a very bad night; so do the mosquito, let us all do the mosquito.” 

  • On Facebook, find the three little dots in the upper right hand corner of the ad to locate the “Report ad” prompt.

    When marketed formula products on social media platforms, report them directly to the platform.

  • Make a presence at the Codex Committee on Contaminants in Foods Public Meetings. In April, individuals like Consumer Reports Senior Staff Scientist Mike Hansen, Ph.D, Environmental Defense Fund’s chemicals policy director Tom Neltner and Center for Science in the Public Interest’s Thomas Galligan, PhD made clear in brief comments that we need to rethink how toxin levels are approached at CCCF. Hansen pointed out that the current permitted levels are not sufficient to protect infants and young children. Echo these demands for safer products. [While we wait for more stringent requirements, consumers can check out the Clean Label Project to find information about food and products not available on their labels.]  
  • Join forces with other advocacy groups to put pressure on the enforcement agencies responsible for food safety. 
  • Check out this Indonesian model of a platform for reporting violations of the Code
  • Support relactation efforts. Artificial feeding does not have to be the default.  Ines Fernandez in the Philippines has a model for this work.  There is also information about this included in the Global Breastfeeding Collective’s recordings of Building Better Breastfeeding Counselling Programs
  • Get people fired up. Increase public interest participation using NACCHO’s flyer on advocacy and lobbying to drum up attention about how the Code benefits all babies, no matter their feeding method. This has been grossly overlooked and cannot be overstated as formula companies often attempt to pit breastfeeding advocates against those who do not breastfeed.
  • Support the Baby-Friendly Hospital Initiative (BFHI). In the U.S., this is the only “federal” program that is enforcing the Code, albeit voluntary participation.  
  • Encourage divestment. Check out Norwegian Secretary-General of Save the Children Tove Wang’s push for the Norwegian Government Petroleum Fund’s withdrawal from investments in companies aggressively pushing infant formula in developing countries. According to Save the Children’s Don’t Push It, “The largest global fund management firms have more than $110 billion invested in companies that market milk formula. As we have documented in this report, the profits these companies generate are fuelled in part by marketing practices that directly – and profoundly – harm children….Active investment funds have the power to wield huge influence over the boards of the companies they have a stake in.” (p44-45)  
  • Support the work of Baby Milk Action. Patti Rundall, Mike Brady and colleagues work tirelessly to uphold the Code and its resolutions including speaking at shareholder meetings.
  • Stay tuned for an engaging opportunity with the newly formed INFACT USA to uphold the Code here in the U.S.

Many of these immediate and long term actions are outlined in Constance Ching and colleague’s piece Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic.

 

Add your name to #EndExploitativeMarketing here. Tell us about your efforts engaging with the Code. Email us at info@ourmilkyway.org.