The infant formula scandal, thought by many to be unique to the Third World, is also a serious health problem in the United States. UNICEF estimates that every year 1 million infants worldwide die as a result of bottle feeding. Dr. Alan Cunningham of Columbia University believes that about 5,000 of these deaths occur in the U.S. In most instances, the reasons are similar, whether the babies are from Caracas, Los Angeles, or Pine Ridge. The Third World problem has received international attention, but now there are efforts to stop the U.S. infant formula tragedy as well.
Sen. Edward Kennedy put the Third World problem succinctly in 1978 when he asked, "Can a product which requires clean water, good sanitation, adequate family income, and literate parents to follow printed instructions be properly and safely used where water is contaminated, sewage runs in the streets, poverty is severe, and illiteracy high?" The answer then, as now, is clear. Under such conditions, people often overdilute the expensive milk powders. The dilution leads to malnutrition frequently complicated by diarrhea and disease when contaminated, unsterile water is used.
Though generally not as severe as in the Third World, bottle baby disease is a hidden fact of poverty in the U.S. In June, 1981, Charlotte Frey of St. Joseph's Hospital in Patterson, New Jersey, said, "I know plenty of instances where the babies are getting formula, but the parents don't have enough food.... We [also] see the exceptions, what I call disaster cases--[parents] giving nothing to the baby but water, diluting the formula much higher than they are supposed to."
Wilma Warran of the Virginia Water Project confirms that contaminated water is also a factor in bottle baby disease. She cites census figures showing that 50 per cent of all wells in the U.S. are shallow and show a high degree of contamination. These wells primarily serve rural people. She says much of the problem is due to "feedlot run-off (cattle manure in the rain) and human privies located uphill from water supplies. For many households, such privies are the only toilets, and some lack running water as well, hence the need to use creeks and ponds for water. Such homes are said to have "incomplete plumbing." In Mississippi, 72 per cent of rural black households have incomplete plumbing. Nationwide, about 2.9 million rural homes lack complete plumbing.
As Warran says, "We Americans like to think of primitive villages as being 'over there,' but in the Southeast and Southwest U.S., there are communities in which conditions are no better." Nonetheless, when the U.S. cast the sole vote against the United Nations Code of Marketing of Breastmilk Substitutes in May, 1981, one of the official reasons given was that the code was "largely irrelevant to the United States--a country where there is safe drinking water and extensive health care."
While there are many similarities between bottle feeding problems in the U.S. and various parts of the Third World, the main difference is that canned, ready-to-feed formula and liquid concentrate are far more commonly used here than powdered formulas. Dr. Paul C. Domson of Greater Southeast Community Hospital in Washington, D.C., notes that there is a real danger among people who can't read the labels on the formula. People are often unable to distinguish between the ready-to-feed and the concentrate, which in the case of Mead-Johnson's Enfamil are sold in identically colored pink cans. The result of diluting the ready-to-feed is malnutrition and loss of essential body chemicals. Consumption of the straight concentrate can lead to severe diarrhea, dehydration, and kidney damage due to high levels of sodium in the blood.
The infant formula story has been detailed in a 180-page petition filed with the federal government by Public Advocates, a public interest law firm representing 14 minority and consumer organizations, including the National Council of Negro Women, League of United Latin American Citizens, Women of All Red Nations, and the Infant Formula Action Coalition (INFACT). The petition presents some startling facts. The recent trend back to breast feeding in the U.S. is primarily among upper-income and better educated groups. A study of Houston hospitals, for example, revealed that the rate of breast feeding among women leaving private hospitals, which serve those who can afford them, was 90 per cent. However, only five per cent of women leaving public hospitals, which serve low-income and minority groups, were breast feeding.
The figures are similar in many parts of the country. Public Advocates attorneys Angela Blackwell and Lois Salisbury state, "Reliance upon formula feeding by the poor is particularly alarming since it is they who could benefit most from breastmilk's superiority, and it is they who are most susceptible to the severe risks...[that]... result from improper use." For example, "Severe diarrhea...is the number one cause of infant mortality among Hispanics in Del Rio, Texas, where breast feeding is the rare exception. On the Navaho reservation, a bottle fed baby is 10 times more likely to be hospitalized than a breast fed infant."
Even the not-so-poor may be adversely affected if never breast fed or if prematurely weaned. Dr. Cunningham studied a largely middle-class population in Cooperstown, New York, and found that during the first year of life, bottle fed infants were hospitalized three times more frequently, and 15 times more frequently in the first four months. The largest difference in the cases, he found, was the instance of respiratory illness, which indicates that the risks of bottle feeding are not due to dirty water and gastrointestinal disease alone: "These risks were evident whether the families were poor or well off," he said.
Human milk is a unique, live substance which provides immunological protection against a variety of common illnesses for as long as the first three years of life. There is general agreement that all babies should be exclusively breast fed for at least the first four to six months, followed by a gradual weaning to other foods.
Unfortunately, most doctors receive little or no training in human lactation and relevant therapies, making it all too easy for uninformed and usually male doctors to prescribe formula rather than treating even such simple problems as sore nipples. Hospital routines that drug the mother and separate her from the baby interfere with the establishment of lactation at the most crucial time. Human milk production is, generally speaking, a demand-and-supply relationship: The more the baby sucks, the more milk is produced. Supplementary bottles diminish the baby's appetite and thus the mother's milk supply. Additionally, anti-lactation shots or pills are sometimes administered without the informed consent of the mother.
Since nursing is in part a learned behavior, giving a baby a bottle too soon can confuse the baby's sucking patterns. Public Advocates reports that at New Orleans Charity Hospital mothers only see their babies once a day, through the window of the nursery. Since the poor rarely have access to adequate prenatal care and counseling on infant feeding, such experiences can be the primary determinant of how a mother will feed her baby.
Dr. Katharine Lobach of Albert Einstein College of Medicine says that "becausc advice by doctors has a powerful effect...hospital staff should not encourage or appear to encourage formula feeding. The routine distribution of infant formula to women about to be discharged...is likely to be interpreted by the new mother as encouragement for formula feeding, and even endorsement of a particular brand of formula."
The industry recognizes this and spares no effort or expense in courting the health professions. Little gifts to medical students and doctors, big research grants, donations for conferences, and endless personal contacts are the name of the game, as a Ross (Similac) sales manual makes plain: "If they [nurses] are sold and serviced properly they can be strong allies. A nurse who supports Ross Laboratories is like an extra sales person."
The manual also underscores Dr. Lobach's concern about the appearance of endorsement when it states that 93 out of every 100 mothers who receive afree sample of a particular brand will continue with that brand. Currently, 90 per cent of all new mothers get samples even if they are breast feeding, without regard to their ability to use the product safely.
The controversy about the failure of doctors to support breast feeding and their perhaps unwitting promotion of bottle feeding has grown in light of the recently adopted WHO/UNICEF Code of Marketing of Breastmilk Substitutes. In early 1981, the 22,000-member American Academy of Pediatrics (AAP) accepted a $1 million "educational" program gift from Ross Laboratories. This unusually large gift has led many to question the official silence of the AAP on the code, which recommends not only halting sales promotion of formula to the public but also to the health professions.
The ethical problem at stake here was well summarized by D.B. and E.P.F. Jelliffe of the UCLA School of Public Health in a recent letter to Pediatrics magazine: "It is the age old, but underappreciated, psychological influence of financial support on behavior which is at the core of this whole issue, especially when funds are short and on a possibly continuing basis. This is really no new idea and has been much more succinctly expressed by an earlier author: 'Thou shalt take no gift; for the gift blindeth the wise and perverteth the words of the righteous' (Exodus 23:8)."
INFACT, which has led the boycott of Nestle, the largest seller of formula in the Third World, has pledged to pressure the U.S. industry to halt unethical promotion of formula in the U.S. as well. The Interfaith Center on Corporate Responsibility, which has led the church stockholder actions with the U.S. companies, plans to continue them, and Rep. Tom Harkin has introduced legislation to eliminate the federal tax write-off for promotion of formula.
All such efforts aside, one fact stands out as a source of hope for change: Poor or rich, parents want to do the best they can for their babies. Several major studies show that when presented with the facts, the rate of breast feeding among low-income mothers doubles or triples, particularly when the mothers are supported in their choice, and eventually reaches a rate comparable to higher income women. The occasional usefulness of artificial feeding can no longer be considered an adequate excuse for indiscriminate sales promotion of infant formula nor for the failure of the health system to support and inform natural human nurture.
Fred Clarkson was a Washington, D.C. writer active in the infant formula campaign when this article appeared.
Got something to say about what you're reading? We value your feedback!