Efforts to curtail dubious marketing practices of commercial milk formula industry

The commercial milk formula (CMF) industry uses marketing tactics similar to those of the tobacco, alcohol, and ultra-processed food industries.

Photo Credit: Boston Public Library
Date: ca. 1870–1900 https://ark.digitalcommonwealth.org/ark:/50959/3b591d51p Please visit Digital Commonwealth to view more images: https://www.digitalcommonwealth.org.

Earlier this winter, the Lancet published a three-paper series outlining the multifaceted and highly effective strategies used by commercial formula manufacturers to target parents, health-care professionals, and policy-makers.

“The industry’s dubious marketing practices—in breach of the breastfeeding Code—are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations,” the Lancet summarizes.

Two new publications corroborate WHO findings on the digital marketing of commercial milk formulas in Mexico:

In another recent publication, Pediatricians’ Reports of Interaction with Infant Formula Companies, the authors found that: “Of 200 participants, the majority reported a formula company representative visit to their clinic (85.5%) and receiving free formula samples (90%). Representatives were more likely to visit areas with higher-income patients (median = $100K versus $60K, p < 0.001). They tended to visit and sponsor meals for pediatricians at private practices and in suburban areas. Most of the reported conferences attended (64%) were formula company-sponsored.”

The authors write that “Seventy percent of countries follow the World Health Organization International Code of Marketing Breast Milk Substitutes that prohibits infant formula companies (IFC) from providing free products to health care facilities, providing gifts to health care staff, or sponsoring meetings. The United States rejects this code, which may impact breastfeeding rates in certain areas.”

The Lancet series authors provide recommendations to restrict the marketing of CMF to protect the health and wellness of mothers and babies, and ultimately society and the planet.

  • Curtail the power and political activities of the CMF industry
  • End state practices that do not uphold, or that violate, the rights of women and children
  • Recognise, resource, and redistribute women’s care work burdens in support of breastfeeding
  •  Address structural deficiencies and commercial conflicts of interest in health systems
  •  Increase public finance and correct the misalignment between private and public interests
  • Mobilise and resource advocacy coalitions to generate political commitment for breastfeeding

In Mexico, UNICEF and Instituto Nacional de Salud Pública have designed infographics for policymakers as well as parents and caregivers to educate on the impact of digital marketing.

The partners are also working on proposed modifications to current Mexican regulations that involve commercial formula milk and ultra processed food marketing to infants and young children. Further, development is underway for a mobile app tool for monitoring the Code in Mexico.

Legislation in El Salvador was recently passed–“Love Converted into Food Law, for the Promotion, Protection, and Support of Breastfeeding.”

PAHO is monitoring the implementation of the Baby-friendly Hospital Initiative in the Americas BFHI requires full compliance with the Code and subsequent WHA resolutions.

In other efforts to protect parents and babies, Breastfeeding Advocacy Australia released a video on how the organization monitors predatory marketing. Find it here. You can find their Facebook group here.

Also read:

Follow IBFAN’s coverage of the 43rd Codex Nutrition Session of the Committee on Nutrition and Foods for Special Dietary Uses here.

Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model

Photo by Luiza Braun

Over half of the Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program peer counselors were once served by the program as mothers enduring mastitis or going back to work early or other barriers to healthy infant feeding. Yet, some of these mothers still managed to breastfeed into toddlerhood.

“They took the knowledge to not only be able to succeed but [brought] it back into their community,”  BHP program manager and lactation consultant Cody Cuni, IBCLC, BS says. “This is a success story.”

BHP is a person-centered, peer support counseling program intended to increase breastfeeding initiation, duration, and exclusivity among low-income, minority women in the greater Hartford, Connecticut area. For over 20 years, the program has existed in some form. In 2000, an official review of the program was completed and solidified the peer-counseling model.

The program’s name was born out of community feedback, mainly from Puerto Rican families. Cuni explains that as community Puerto Ricans were heavily targeted by formula marketing,  the name ‘Breastfeeding Heritage and Pride’ grew from the idea of reclaiming breastfeeding as part of their heritage.

Photo credit: United States Breastfeeding Committee (USBC)

Often, the lactation model of care is rooted in colonization, but Cuni says that their program  strives to respect and celebrate diversity.

“Our program seeks to empower…” she begins. “[Breastfeeding] is something that is yours, and something that has always been yours,” she says, speaking to the people they serve.

As program manager, Cuni trains the peer counselors through a 40-hour comprehensive lactation training. She approaches the training through a lens of diversity and cultural competence, helping peer counselors learn to have respectful conversations and teaching them how to be an advocate.

She explains, “Our peer counselors are working with mothers who do face a lot of bias in their health care and in lactation, so we have whole trainings on how to communicate with a provider, how to approach hospital staff who say things like ‘Don’t waste your time on that mother…’”

Peer counselors embark on visits with senior peer counselors and other lactation care providers as part of their mentorship model.

Photo by Felipe Balduino

The program also provides continuing education to stay relevant and weekly meetings to complete case reviews.

As part of their grant funding, BHP is required to track their breastfeeding rates, but Cuni says that what she finds more compelling than these numbers, is the documentation of the lactating person’s individual goals.

Empowering mothers to seek their own goals is our ultimate goal, Cuni says.

BHP is nestled in the Hispanic Health Council’s Parent and Family Learning department which offers other supports throughout the “cycle of learning throughout a family’s lifespan”.

Photo by Omar Lopez

“A holistic approach of care is vital especially for maternal child health care,” Cuni explains. “The first 1,000 days of life are critical to laying a healthy foundation.”

Practicing on a continuum of care gives Cuni and her colleagues the ability to gain a deep understanding of the families they serve, she says.

“Because we work so closely with the families, we establish trust and are able to refer in a way that they might not be open with [other providers].”

The clients that BHP serves are up against every breastfeeding challenge that every family faces in our country, but the issues are compounded and amplified by the stress of living in communities steeped in systemic racism and lack of resources, Cuni explains.

Their clients are managing intergenerational trauma and all of the symptoms associated with trauma, at a cellular level and beyond. For instance, BHP clients have a higher propensity of birthing babies with complex medical needs because of higher rates of preterm labor, gestational diabetes and other health concerns.

Cuni points out other challenges like those associated with being an undoumented immigrant. Gaining access to basic tools like breast pumps can be nearly impossible. Some of their clients return to work at two weeks postpartum after a cesarean section, not by choice of course, but for fear of losing their work as part-time employees.

And although Connecticut has workplace lactation laws in place, mothers will find that if they make noise about those protections, they might not see their name on the schedule any longer.

Photo source: United States Breastfeeding Committee (USBC)

Yet, despite all of these obstacles, Cuni says, “There is a sense of resiliency. They’re overcoming so much and they’re not even sitting in that; they’re just living their lives and wanting to do the best for their baby. That resiliency is really inspiring.”

Cuni shares about a mother who lost her baby late in her pregnancy and decided to pump and donate her milk for six months.

“This mom, her experience, her unimaginable tragedy…she still wanted to do something with her milk, and it was really a privilege for our peer counselors to support her.”

Another client they served, after struggling to assert her workplace lactation rights, had a position created for her by their HR department as “breastfeeding liaison”. Now, she is an advocate for any breastfeeding or lactating mother at her workplace.

“Not only did she win for herself, she left it better,” Cuni comments.

Cuni came to this work as a stay-at-home mom with ten years of breastfeeding experience. She was a single mother, returning to the workforce after leaving an abusive marriage.

“My breastfeeding experience was valued as an asset,” Cuni remembers. “My lived experience counted.”

She goes on, “As women, and especially as mothers, we’re always caring for someone else. The pressures that we face make wellness difficult. Our society needs to do more to recognize the value that women have and the support they need to succeed. I want to …. amplify the voices, because if we listen, the answers that we need to solve the maternal mortality crisis, the answers are there if we listen to the women and families we are working with.”

For those interested in supporting the work of the Hispanic Health Council’s BHP, they are looking for donated breastfeeding supplies. You can get in touch at  codyc@hispanichealthcouncil.org.

Educate, motivate, normalize: one mom’s experience harnessing harassment into empowerment

Chenae Marie is an Author, Maternal Mental Health & Breastfeeding Advocate and Speaker.  In November 2018, she released a coloring book entitled Breastfeeding Mamas. The book was created in response to being ridiculed for breastfeeding.

She says it is an honor to see her work circulating. 

“This was such a purpose project for me and to see it still circulating 4 years later, wow,” Chenae Marie begins.  “You hope for the best, you hope people not only love it but deem it just as necessary as you; so seeing its impact has been so deeply rewarding.” 

Since its release, over 3,000 copies have been sold. 

Earlier this year, Chenae Marie was awarded the USBC Emerging Leader Award. 

We’re so thrilled to be sharing this interview with such a force on Our Milky Way! Read on. 

 

On Chenae Marie’s journey into motherhood…

Whew, where do I even begin? I found out I was pregnant during separation from my then husband. It was certainly a shock. We tried to work it out but the more we forced it, the more it became obvious that we were growing in two different directions. I ended up moving from New Orleans where we were living, back to my hometown of Baltimore, MD. It was imperative for me to be close to my village during such a profound life transition. It’s funny, because looking back I remember having so much anxiety prior to moving to MD. I wasn’t sure if it was nerves, or maybe the shock was still wearing down, or it was normal feelings to feel after finding out you are pregnant. But it’s like the moment that I touched down and hugged my mama, that deep sinking anxiety feeling went away. I finally felt safe again- emotionally and spiritually safe. My appetite came back, I was sleeping regularly and at a decent hour, and I was finally recognizing the woman looking back at me in the mirror. I missed her so much and it was a breath of fresh air to be in a space that I could get to know her again- prior to the arrival of my baby girl. 

Finally, the time had come for me to meet my Leilani Marie. It’s hard for me to even put into words how that first moment of looking into her eyes felt. It was like my world stopped for a moment and all I saw was her, all I felt was her, and I needed was her. If I could bottle that moment up, I certainly would. 

Now my journey had begun and all of who I was and all of who I had yet to become was ready to take on this journey called motherhood. 

 

On being ridiculed for a breastfeeding image she shared…

After noticing how underrepresented black women were as it pertains to motherhood and breastfeeding, I decided I’d start sharing images and partnering each one with either a clever little caption or a more thought-out caption detailing some of my thoughts and where I was on my motherhood journey at that time. 

One afternoon, I was eating ice cream while simultaneously breastfeeding and my mom snapped a picture of it. We were both wearing my handmade mustard yellow bonnets and we were in our own little world. I loved the picture and decided to share it. 

About an hour later I began to get what felt like nonstop notifications on my phone. I remember that I was putting my daughter down for a nap at the time so I placed my phone down away from me so the vibrations wouldn’t awake her. Finally, she was asleep, and I checked my phone. I was so confused because I saw an extremely large number of notifications and was so confused as to what was happening. Apparently, the picture went from Instagram to Twitter and then back to Instagram again. It went viral. 

From that day, I was getting hundreds of followers, hundreds of comments, and nonstop messages. Some of the comments and messages were full of love and support while others were full of negative comments, judgements, and unsolicited/obscene pictures. It’s like on one hand I felt supported and empowered but on the other hand, I was so incredibly bothered by the amount of ignorance I was reading on a day to day. 

I have always been someone who never let anyone make me feel inferior without my consent and this was one of those moments I had to take my power back. I took a long shower that involved lots of thinking and strategy. How can I take advantage of a moment that a lot of eyes were on me? How can I change the narrative? How can I use this moment to educate? 

Thus, the idea to create an adult coloring book!

 

On her partnership with the illustrator… 

Many are surprised when I tell them that I found my illustrator Mariana, on Upwork! I took a gamble and posted an ad describing my project and what I was looking for. She sent me some of her previous work and I knew she’d be the perfect fit! She was not only an incredible illustrator, but she completely understood my vision. 

 

On the feedback she’s gotten since the book’s release…

I’ve received great feedback since its release, but I’d have to say my favorite was when a mother told me she used my images to put on her wall during her at home water birth. She told me they were incredibly motivational and just what she needed to see to remind her of her strength. 

 

On receiving the USBC Emerging Leader Award…

It feels incredible! I haven’t met a single person in this industry who goes into it seeking rewards or recognition. You go into it because there is a fire burning in you for CHANGE! You go into it because you have a passion for women, for MOTHERS! So to be able to stop for a moment and truly reflect on my journey and also take a deep dive into all the work that has been done and still needs to be done, was beautiful and necessary. USBC does INCREDIBLE work, so to be recognized by them was honestly unexpected but an honor, nonetheless. Receiving this kind of award gave me that extra push I didn’t even know I needed to go harder. To keep having the uncomfortable but necessary conversations, and to keep pushing for change. 

 

On current projects…

I am working to step full force into speaking. I am currently working with Mississippi Public Health to organize monthly virtual workshops/panels to discuss motherhood, mental health, self-care, and wellness. My goal is to create a space for like-minded individuals to come together to share their experiences and have the “uncomfortable” conversations in hopes to inspire and educate others, specifically mothers.


On plans during National Breastfeeding Month/ Black and World Breastfeeding Week(s)…

I’m all about spreading knowledge! Knowledge is power. National Breastfeeding Month/ Black and World Breastfeeding week(s) is a great opportunity to shed as much information as possible while the spotlight shines on the subject.

 

On future goals…

As for future goals, I would like to create another project. I’m not sure what as of yet, but I want to think of another creative way to educate, motivate, and normalize. 

Find Chenae Marie on Instagram here. 

22 more actions in 2022

 In our third installment of 22 in 2022, we bring you 22 MORE Actions in 2022, because there is always work to do. 

Source: United States Breastfeeding Committee

22 in 2022 was inspired by Life Kit’s 22 Tips for 2022, and we hope it provides inspiration for you to forge forward with this important work.

  1. Learn about the Girls’ Bill of Rights. Empowered women start with empowered girls. 
  2. Watch a film centered around maternal child health like  A Doula Story, The Milky Way breastfeeding documentary, Chocolate Milk, Zero Weeks, Legacy Power Voice: Movements in Black Midwifery or register to play Factuality. 
  3. Identify and network with an individual or organization with a mission that intersects with maternal child health. This shouldn’t be a challenge… “All roads lead to breastfeeding!” (A popular adage at Healthy Children Project.)  Often, we find ourselves preaching to the choir, shouting in an echo chamber, whatever you want to call it. It’s time to reach beyond our normal audience. 
  4. Follow Dr. Magdelena Whoolery on social media to stay up to date on strategies that combat the multi-billion dollar artificial baby milk industry. 
  5. Sign on to USBC’s organizational letter in support of the DEMAND Act of 2022.
  6. Congratulate, encourage or simply smile at a mother. 
  7. Explore White Ribbon Alliance’s work around respectful care. You can start by watching this poignant webinar Healthcare Professionals Honoring Women’s Demands for Respectful Care. 
  8. Read The First Food System: The importance of breastfeeding in global food systems discussions.
  9. Read Lactation in quarantine: The (in)visibility of human milk feeding during the COVID-19 pandemic in the United States. 
  10. Sign this petition to stop unethical formula research on babies. 
  11. Check out the updated Center for WorkLife Law’s Winning New Rights for Lactating Workers: An Advocate’s Toolkit. 
  12. Register for a free PQI Innovation webinar.
  13. Read the revised Academy of Breastfeeding Medicine (ABM) Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads here. 
  14. Gear up for World Breastfeeding Week 2022 and National Breastfeeding Month. 
  15. Check out this NIH project Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project which seeks a deeper understanding of human milk biology to address ongoing and emerging questions about infant feeding practices.  
  16. Learn about the Melanated Mammary Atlas.
  17. Consider becoming a ROSE community transformer or share the opportunity with someone who may be interested. 
  18. Get familiar with WHO’s recent report How the marketing of formula milk influences our decisions on infant feeding and disseminate the corresponding infographics. 
  19. Sensitize journalists and the media to stimulate public debate on the links between breastfeeding and the climate crisis as suggested by the World Alliance for Breastfeeding Action (WABA).
  20. Get to know how breastfeeding and proper nutrition fits into the Sustainable Development Goals (SDGs). 
  21. Access one of the National Institute for Children’s Health Quality’s (NICHQ) webinars on breastfeeding, infant health, early childhood or health equity here. 
  22. Engage with the PUMP Act Toolkit! This is crucial, time-sensitive work that will make a huge difference for families across our nation.

Read our original list of 22 Actions here and our celebration of unsung sheroes/heroes here. 

Graduate student explores complexities of nutrition and health from cradle to grave

Originally from New Orleans, Erin Bannister, lab instructor and dietetic intern at Northern Illinois University, says that food is tied to her identity.  Bannister was ten when she first learned to make a roux. Those early skills prepared her for her later work as a chef, which she describes as a kind of manual labor with long, hot hours. 

Bannister shares with a laugh, that she started to wonder how she could work with food and continue to nourish people with weekends and holidays off. Eventually, she discovered the field of dietetics.

Photo by ja ma on Unsplash

Currently in the thick of her Master’s thesis, Bannister is exploring the metabolic energy needs in adults and determining whether the default equations we use are accurate in the populations they’re used in. 

For instance, it is widely accepted that an average allowance for a roughly 170 pound man is  2,300 kcal/day; for women, it is 1,900 kcal/day. We expect that pregnant and lactating people will have higher metabolic energy needs. 

As Bannister spends a swath of her days compiling and extracting data, she says she’s discovering that some of the accepted equations need to be delineated. 

“The real root of my thesis and the root of most of my studies and the goals that I have, is to use accurate evidence-based interventions in the populations that they are meant to be used in and to not remove ourselves from that evidence,” Bannister begins. “… Often times, things are taught and then they are believed because the person that taught it is an expert and the evidence gets lost on the way; don’t forget to review the evidence.” 

As Bannister continues to pursue this idea that we can do better than sludging through the status quo, she sought out the Lactation Counselor Training Course (LCTC). Although Bannister has great interest in the complexities of nutrition and health from cradle to grave, she says that there is a solid argument that the health of a population is highly correlated with the health of its mothers. 

Source: United States Breastfeeding Committee (USBC)

“[I want] to be as helpful and effective as possible… to have the knowledge to be able to contribute meaningfully, and the certification adds credibility,” she explains. “The training was quite eye-opening, almost embarrassing to say how little I knew about breastfeeding.” 

Bannister goes on that ultimately, she would like to work with nutrition intervention in low and middle income countries where the burden of improper nutrition is most severe. Currently, many countries worldwide face the double burden of malnutrition – characterized by the coexistence of undernutrition along with overweight, obesity or diet-related noncommunicable diseases (NCDs). In fact, nearly one in three people globally suffers from at least one form of malnutrition: wasting, stunting, vitamin and mineral deficiency, overweight or obesity and diet-related NCDs. (WHO 2017)

As Bannister buckles down at the end of the semester, she says, “I want to make sure I am utilizing all the forks I’ve got in the fire.” 

You can learn more about Bannister’s work by exploring the various topics she has presented on, ranging from potatoes to prison to poop. Connect with Bannister on Linkedin and Instagram @calibrating_palates.