Saturday

Is breast best? book launch - a bit less polarisation please for the sake of the children

Get ready for another round of 'Breast not best' headlines in the UK that will echo around the world as a book by Joan Wolf, a political scientist, is launched here. It has the title: "Is Breast Best?: Taking on the Breastfeeding Experts and the New High Stakes of Motherhood" and Joan Wolf is speaking on it at a conference on 21 March.

We saw similar headlines last month with the publication of an article in the British Medical Journal questioning the World Health Organisation's recommendation that babies be exclusively breastfed for 6 months, with continued breastfeeding beyond this alongside the introduction of complementary foods. Interestingly one of the co-authors of that paper pops up on the panel at the book launch. In fairness to Mary Fewtrell, she did not question the benefits of breastfeeding in her article, even if that's what some newspaper headlines said. She was questioning the duration of exclusive breastfeeding, when no other liquids or foods are introduced.

Also on the panel is Guardian journalist, Zoe Williams, who also has a book to sell on her take on childcare. Personally, I have always liked Zoe's writing in The Guardian and I note she always prefaces her pieces relating to breastfeeding with comments like: "So before I start, can I just reiterate how good it is for baby; and I think I've mentioned already a million times, it's an incredibly beautiful thing, when it works."

But I do wonder about Zoe's understanding of how science works when I read her criticism that in research on health outcomes: "these haven't been adjusted for social class and environment. It boils down to: 'Middle-class babies do better; middle-class babies tend to be breastfed.'"

Now, I'm not a scientist, political or medical, but I've read plenty of research papers and know that adjusting for confounding variables is one of the most basic aspects of research. It's not always easy to do, but the class factor is not something that slipped the minds of scientists in analysing their data. I don't see them reading Zoe Williams and rushing back to their ivory towers, hitting their foreheads and exclaiming, 'How could we have been so stupid!'

I haven't read Joan Wolf's book yet, so I'm not going to critique the argument she has with 'breastfeeding experts' at this stage.

There are two points that I would like to make, however.

Firstly, 'breastfeeding experts', sometimes labelled more emotionally as the 'breastfeeding mafia' and worse, are often really objective 'health experts' basing their comments on evidence. And the evidence is that babies who are not breastfed, as a population, have poorer health outcomes in the short and longer term than babies who are breastfed. It is an uncomfortable fact when in the UK a quarter of babies receive no breastmilk at all, but fact it is.

Saying so does not make someone anti-baby milk. Baby Milk Action is sometimes attacked as anti-baby milk, even though our work is, as our slogan says, about 'Protecting breastfeeding - Protecting babies fed on formula'.

I have been working with experts in a range of disciplines (pharmacy, midwifery, paedology etc) over the past 18 months to produce a DVD called Infant Formula Explained. Yes, you've got me - we too have something to sell, well license for use in health facilities. The DVD has been produced by the Baby Feeding Law Group (BFLG), which consists of 23 health professional, mother support and consumer protection organisations, and Mark-it Television. This is my quote from our DVD press release - Mike Brady, who appears in the film speaking about the BFLG monitoring project which examines company marketing materials, said:

"The media and people with books to sell sometimes like to sensationalise health advocates as breastfeeding zealots, but the fact is we want the best for babies. In the UK nearly a quarter of babies are never breastfed and many mothers who start breastfeeding will use formula at some point. We believe they all have a right to accurate information. As the BFLG monitoring projects shows, company information for both health workers and parents and carers is designed to push the brand and so the Baby Feeding Law Group decided to produce an independent, objective film."

After trying to persuade others to produce such a film, we took it on as the BFLG because of the lack of objective information for mothers and carers who use formula. All baby food companies claim that their particular brand is better than their competitors, leaving people confused.

I asked the Advertising Standards Authority to investigate the claims of one company that its formula, the most expensive on the market, is the 'best'. The ASA ruled two years ago, after a long investigation, that the company could not substantiate its claim.

Paying more for expensive brands does not give a health benefit, it provides the company's marketing department with more money for television advertisements, free cuddly toy gifts, jollies for health workers and whizzy websites (examples here).

However, price can be used as a basis for choosing formula, in terms of not wasting your money: all formula on the market has, by law, to contain what is know to be necessary and beneficial to health. Optional ingredients are allowed, but the reason they are not on the required list of ingredients is exactly because there is no proven benefit from them. If there was a benefit, we would be campaigning for the ingredients to be a legal requirement so that inferior formula is not on the market. All the same, companies base their multi-million pound marketing campaigns on them. In the Infant Formula Explained films, the health experts dig into the research to give health workers the information and confidence they need to answer questions from parents and carers about formula and these optional ingredients.

It also includes films for use with parents showing how to mix up formula in line with World Health Organisation and Department of Health guidance.

You see, what we and our partners in the BFLG want is the best for babies.

Which brings me to my second point: this constant fuelling of the so-called 'breastfeeding versus bottle feeding debate' may help to sell books and bring traffic to websites, but it is unhelpful for mothers and babies. For many mothers in the UK, it is pitching them against themselves.

According to the Infant Feeding Survey from the Office of National Statistics, only 63% of mothers who started breastfeeding were still breastfeeding at 6 weeks and only a third were still breastfeeding at 6 months (pg. 35). Many mothers in the UK both breastfeed and use formula.

Another statistic tells us that 90% of mothers who stopped breastfeeding by 6 weeks would have preferred to breastfeed for longer. Of those who stopped by 6 months, 40% wanted to breastfeed for longer.

We can decide how we want to respond to these figures - and the feelings of distress that may lie behind the statement that mothers wanted to breastfeed for longer.

The response of the formula companies and people who try to negate the evidence regarding infant feeding and health outcomes is to suggest it doesn't matter, formula is almost as good as breastfeeding - or maybe even better if you take the formula companies' claims about benefits to eyesight, brain development and building the immune system at face value. The more 'breast not really best' headlines they can generate, the better they seem to think it is.

Alternatively, we can acknowledge that there are differences in health outcomes. We can use the fact that the National Health Service spends millions of pounds every year treating some of the extra illness amongst formula fed babies (according to NICE, the National Institute of Clinical Excellence) to make the case for better support for mothers.

I think we should be shocked that 90% of mothers who stopped breastfeeding at 6 weeks wanted to breastfeed for longer and be calling for better support. We should also be shocked that formula companies target mothers so aggressively in breach of international marketing standards, profiteer by playing on mothers fears over which is the 'best' formula and market unnecessary, expensive, heavily-advertised products. Aside from exceptional cases of medical need, the only formula that a baby needs when not breastfed is whey-based formula used from birth. Follow-on milks and growing up milks are unnecessary products - any extra nutrients a baby requires can be supplied by solid foods introduced alongside breastfeeding or the whey-based first milk.

So-called 'hungry baby' and 'good-night' milks do not have any evidence to support the claims they are more satisfying - and as you have to clean a baby's teeth after feeding with 'good-night' milk because of the risk of tooth decay from its sugar content (check the instructions), it is counterproductive even if it did do what it says on the tin.

We should also be concerned that some of the unnecessary illness comes from formula not being reconstituted properly.

I would like to ask everybody to write to the Secretary of State for Health, Andrew Lansley, complaining that the Department of Health is planning to scrap its Infant Feeding Coordinator posts and its support for National Breastfeeding Awareness Week. These were manifestations of government commitment to the Global Strategy for Infant and Young Child Feeding and the Innocenti Declaration. It seems that commitment is being forgotten under the cuts agenda. This is one of the worst examples of short-term penny pinching that will lead to medium and long-term costs to the health service and growth in health inequalities.

The Department of Health was not only promoting and supporting breastfeeding, it was working to help mothers who bottle feed. The Infant Feeding Coordinators have just updated the guide to bottle feeding that we used the basis for the guidance in the Infant Formula Explained DVD (alongside that from the World Health Organisation). The DVD is in line with the new guide and is also appropriate for use in UNICEF Baby Friendly accredited facilities.

No doubt we will have a spate of 'breast not best' headlines in response to Joan Wolf's book launch and these will echo around the world, undermining breastfeeding cultures in other countries.

What we really need are headlines saying, 'Department of Health plans to abandon mothers and babies'. Those might help reverse the decision to scrap efforts to improve breastfeeding rates and reduce unnecessary illness amongst formula-fed babies.

That would benefit ALL mothers and babies.

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