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Manufacturers market formula milk to mums

July 2003

A Parents Jury survey of mothers found that good intentions to breastfeed were undermined by free formula milk samples in 'Bounty packs'. Annie Seeley reports.

The government has recently confirmed advice from the World Health Organisation that exclusive breastfeeding for six months offers babies the best nutritional start in life. Yet nearly 30% of new mothers in England and Wales do not breastfeed at all. This compares with a remarkable 98% of mothers in Scandinavia who breastfeed their babies. Research has shown that breastfed babies are less likely to become overweight or obese and have a lower risk of developing heart disease in later life compared to formula-fed babies.

There are many reasons why a mother may not start breastfeeding, or may give up earlier than the recommended six months. Where there is a delay before the first feed, babies are more likely to stop breastfeeding in the first two weeks. Support and advice from health professionals at this time is crucial, whilst support from partners, mothers, friends and society are also important factors in whether a mother continues to breastfeed.

We asked 120 mothers from the Parents Jury (parents of children under the age of three) what advice they had received, and if they had been discouraged from breastfeeding.

Of the 120 mothers who responded:

  • 4% chose not to breastfeed;
  • 7% breastfed for less than 2 weeks;
  • 6% breastfed for up to a month;
  • 15% breastfed exclusively for between 2 to 3˝ months;
  • 64% breastfed exclusively for between 4 to 6 months;
  • 37% (44) continued breastfeeding beyond 6 months; coupled with solids, and of these, 16 continued beyond 12 months, 3 continued beyond 18 months and 3 were breastfed beyond 24 months.*

*The sample was taken from mothers on the Parents Jury who have joined the campaign because they are concerned about and aware of children's food and nutrition issues, the number who breastfeed is not necessarily representative of the UKpopulation.
Generally, mothers reported that health professionals (including NCT breastfeeding counsellors) and friends and family had been very supportive, giving mothers the confidence to start and continue with breastfeeding.

Many mothers felt that formula should not be marketed at all to 'vulnerable' young mothers: "Support of commercial exploitation by the government is wrong and socially and medically damaging. There is no practical government support of breastfeeding to offset. Why not ban formula advertising?"

Formula milk marketing

Although it is illegal to include samples or vouchers for formula milk in Bounty Packs for new-born babies, some mothers did report receiving such products. Over 80% of the mothers who had received Bounty Packs said their packs contained follow-on formula milk samples and vouchers.Many mothers felt that this encouraged mothers to switch from breastfeeding to bottlefeeding. One mother said "I don't think milk manufacturers should be allowed to put in any free samples or vouchers or indeed influence parents in any way with advertising."

76% of mothers received Bounty Packs when their babies were four months old, which included baby food samples as well as vouchers. Whilst many found these useful, some thought it was just a marketing opportunity for formula milk and baby food manufacturers, and that it would be more helpful to encourage mothers to cook fresh food for their babies by including recipes in the packs and/or vouchers for fresh produce. "I think the pack should perhaps contain vouchers for fresh meat and vegetables and details of how to prepare them rather than pushing ready meals." Others thought including milk samples and vouchers in the packs was "Appalling - all they wanted to do was make you feel guilty if you didn't give your 6 month old 'progress' milk."

Some manufacturers are very good at ensuring that mothers-to-be are aware of their brand of formula milk: one mother reported that an SMA formula-milk representative gave a presentation on 'emotional aspects of parenting' at an ante-natal class, offering branded gifts such as pens and writing pads.

Conforming to growth charts

Nearly 40% of mothers surveyed said that health professionals had expressed concern that their breastfed baby's growth rates were not conforming to the standard growth charts. Growth charts are based on bottlefed babies' progress, and as babies fed on breast milk tend to have more erratic growth rates, some mothers and health professionals think it inappropriate to compare the two. Of the 46 mothers who said that they had been given this advice, only eight were encouraged to increase breastfeeding, while 25 were encouraged to supplement with formula milk, and 14 were encouraged either to introduce solids early or to increase food intake. One mother was advised by a health visitor to give her baby chocolate to promote weight gain.

"Some health visitors definitely pushed bottled feeding as the 'easy option' after a few months if breastfeeding 'wasn't working'. One health visitor explained a few options for getting the babies to breastfeed more often."

Centile charts used by health visitors were reported to be the cause of much stress, one mother said "I think it's ridiculous that a child's health is measured on weight gain. A large child that was fed on formula, crisps and sweets would be considered 'healthier' than a child just getting breast milk, but who was underweight."

Pro-breast or pro-bottle?

Whilst many had support from partners, family friends and health professionals, nearly 30% of the mothers surveyed were discouraged either by their own mothers or mothers-in-law, or by friends who were bottle-feeding their babies. Some mothers reported that they were told by friends that their baby looked hungry or underweight and that bottle-feeding would help: "Friends said "bottle is so much easier", "when are you going to wean her?" repeatedly!"

"When I had my first baby I had feeding problems. There was always pressure to put her on the bottle as that would solve it! So I felt I had to struggle on my own."

"As a midwife myself, I had no particular problems with motivation to breastfeed but I was a little disappointed by occasional comments from friends who would comment on how tied down I must feel or midwife friends who even suggested, perhaps I didn't have enough milk if baby was unsettled." 

About one in five of the mothers were discouraged from breastfeeding by health professionals. This was either in hospital, just after birth because they were tired after childbirth, had had a caesarean or had to take medication: "minutes after my second child was born by section the midwife suggested giving her a bottle". Or because the baby was not gaining birthweight: "My midwife in hospital tried to suggest top-ups of donated milk (which would of course meant introducing a bottle) when my baby was 2 days old. I had to be very assertive to resist this… I knew that following their advice meant the beginning of the end of breastfeeding for me (it had happened with my first baby too) but they were emphatic that the baby had to gain weight so that the midwives could then pass my case over to the health visitors (which they had already delayed)"

"Hospitals/doctors are not doing enough to change the bottle feeding culture - first response to problems is too often to give a bottle."

"I was offered a 'top up' bottle in hospital, because my baby was very hungry and I was very tired. I felt cross as I wanted exclusive breastfeeding!"

Conflicting advice

Many mothers received good advice from health professionals. However, some reported receiving conflicting advice: "My first baby was investigated for failure to thrive because it failed to put on enough weight. My GP and health visitor put heavy pressure on me to supplement with bottle feeds at 10 days I knew that breastfed babies gain weight more irregularly so I wasn't enormously concerned. However, increasing solids did seem to work and at no time was I ever discouraged from breastfeeding. But in his second year I have been told he is chubby and needs to diet. We feel he is very healthy, full of energy and happy so we try to just give healthy foods and ignore the health visitor".

Another mother told us that their health visitor "Suggested a bottle to "give me a break". Visiting midwife with first child gave brilliant practical support. Health visitor in London was very negative about breastfeeding…. If I hadn't been so determined I would have given up."

"Peer groups show surprise when they discover I was still breastfeeding at twelve months."

"Occasionally other mums expressed surprise that I am still feeding."

"My mother and sister feel it unnecessary to continue for longer than 6 to 8 months" 

Breastfeeding after weaning

Those mothers who continued breastfeeding after weaning found that health visitors and friends and family were surprised they had not switched to bottlefeeding.

"Whenever I took my baby for weigh-ins or health checks after about 5 months the health visitors expressed amazement that I was still breastfeeding. They always made the assumption that I was bottle-feeding!"

"[The Health Visitor] thought it odd that I have breastfed all my children beyond a year."

"I always find it alarming how many women don't breastfeed and don't even try, thinking it's too hard or inconvenient. Also how few feed beyond a few months."

This would suggest that society expects mothers to switch to bottle feeding when their baby is weaned. This may be perpetuated by marketing of "follow-on" formula milk products, as well as convenience, particularly if mothers return to work. It is often thought unacceptable (because of cultural reasons) that women continue to breastfeed beyond 2 years, while the World Health Organisation and the National Childbirth Trust do not stipulate an age when breastfeeding should stop.

Support from society

Lots of mothers thought that society was not supportive enough of breastfeeding mums. This may be why some mothers were discouraged from breastfeeding by members of friends and family. Whilst some members of society find breastfeeding in public "distasteful", often adequate facilities for breastfeeding are not provided mothers: "I was generally discouraged by the lack of private breast feeding facilities when out and about", "I still find public breastfeeding awkward at times - we need society to accept and praise it much more."

"This is a subject on which I feel very strongly. I breastfed my first child successfully through sheer determination on my part and with the support of my husband but I would have liked to have been given more information during my pregnancy.

I was aware that breastfeeding was good for the baby but had no idea about positioning, etc, until after he was born. In my experience there is a shortage of staff in hospital able to give enough time to establish breastfeeding. Diagrams in the leaflets available are not very helpful."

To have breastfeeding counsellors available on maternity wards would be ideal and then helpline numbers for when you are at home although this is often a difficult time too because family and friends are often keen to say 'Give them a bottle it's much easier' (maybe because they want to have a go!) I think there needs to be more promotion of organisations like La Leche and NCT because if you have the back up of a counsellor in person or by phone and you can be with other breastfeeding mums then you have the confidence in yourself to continue despite what others say.

"I received very conflicting practical advice from nurses in hospital but there was a breastfeeding counsellor who was good but not easy to get down to the ward." 

Breastfeeding support

Many mothers give up breastfeeding within the first two weeks after their baby is born because of inadequate support. Some of the women felt they did not receive support and advice from hospital staff, because they were stretched for time: "They told me "you should breastfeed" but no advice on reducing the pain …Hospital encouraged [me to breastfeed] but didn't help", "I think midwives in hospital should get help supporting breastfeeding"

The presence of breastfeeding counsellors in hospitals and in the community gave many mothers guidance for breastfeeding. Whilst the majority of hospital staff encouraged breastfeeding, some mothers found these didnąt have time to provide needed support. Many women had gained confidence after having their first child, so that with their second baby they didnąt always get their baby measured, to avoid the pressure and worry involved. They also tended to extend the length of time they breastfed with subsequent babies and did not feel the need to supplement with formula or initiate early weaning.

"The National Childbirth Trust are excellent at promoting breastfeeding and their breastfeeding counsellor really was excellent. But they don't reach enough people."

Whilst this survey is a small sample of parents, we hope to conduct further surveys and interviews to examine the advice given to mothers across the UK, encompassing different social classes and ethnic groups.

Such research will help health experts to influence policy recommendations, such as the possible pre-approval of commercial products before they can be included in the Bounty Packs given to new mothers.

Currently no national body sets standards for what can be marketed to new mothers, nor are Bounty Packs monitored to get a picture of what is promoted throughout the country.

Patti Rundall of Baby Milk Action comments:
For over 20 years Baby Milk Action has been calling on the UK Government to protect parent’s rights to a health care, support and information which is free from commercial pressure. These rights are enshrined in countless UN Resolutions which the UK has signed up to. Having made the decision in May to support the latest Resolution about the benefits of six months exclusive breastfeeding, the Government must now follow this through and stop the health claims, bad labelling and promotion strategies (such as the Bounty Packs) which all mislead parents about what’s best for infant health.

The Parents Jury’s findings come at just the right time, as this week, baby milk manufacturer SMA is in court facing criminal charges brought by Birmingham Trading Standards. In its defence SMA is calling for the British Law - weak as it is - to be struck down, so that companies can have even greater freedom to mislead parents. We have to expose how these global giants will stop at nothing in their pursuit of greater market share in a world market worth $17billion.

Breastfeeding is a unique health intervention which provides a lifeline for millions of infants, packed with living cells which fight infection. There can be no other food more locally produced, more sustainable or more environmentally friendly than a mothers breastmilk – a naturally renewable resource which requires no packaging or transport, results in no wastage and is free.
Rosie Dodds of National Childbirth Trust comments:
The NCT wants breastfeeding to be a normal part of everyday life. We are calling for a complete ban on the advertising and promotion of formula and follow on milks, in line with World Health Organisation (WHO) agreements. Foods should not be labelled as suitable for babies younger than 6 months.

Health professionals recognise that the NHS could do more to support breastfeeding, although things are changing slowly. Families and friends could be more positive, so that women and babies can breastfeed for as long as they want to. Click here for more ideas on how to support breastfeeding.

Full implementation of the WHO Global Strategy on infant feeding would help our whole society, from employers to education, to be more supportive. Further details.

Baby Milk Action is a non-profit organisation which aims to save lives and to end the avoidable suffering caused by inappropriate infant feeding. Baby Milk Action works within a global network to strengthen independent, transparent and effective controls on the marketing of the baby feeding industry.

The Breastfeeding Network

La Leche

National Childbirth Trust