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Wednesday, July 26, 2006

The Formula Follies

By JENNIFER GRAHAM


The Merchants of Death in Christopher Buckley's novel "Thank You for Smoking" are spokesmen for the most vilified industries in Washington: alcohol, tobacco and firearms. A lobbyist for baby formula may have to join them in a sequel. Proponents of breast-feeding, emboldened by studies that trumpet human milk's superiority to its supermarket substitutes, are abandoning platitudes like "Breast Is Best" in favor of aggressive campaigns designed to portray formula feeding as not merely inferior but dangerous.

A startling television ad in a government breast-feeding campaign likened feeding an infant formula to being thrown from a mechanical bull while heavily pregnant. Iowa Sen. Tom Harkin has proposed mandatory warning labels for formula cans. Breast-feeding advocates are pushing legislation to stop hospitals from giving free formula to new mothers. A new book calls formula feeding "deviant behavior" that should occur only as an "emergency nutrition intervention to prevent starvation and death." "There's not so much talk now about the benefits of breast-feeding," says Katy Lebbing of La Leche League International, "but the risks of not breast-feeding."

Formula, its critics say, makes children sicker, fatter and dumber. Its inability to match the antibodies of breast milk is implicated in a range of maladies, including ear infections and diabetes. It is not yet the new cigarette; few suggest that formula actually kills babies, except in rare cases when powdered formula is mixed with tainted water, for example.

But formula, once seen as the perfectly engineered health food, has become the TV dinner of infant feeding: seductively easy, nutritionally challenged and oh-so-1950s. And the campaign against it has made strange cribfellows: liberals who demand accommodation in the workplace and open-shirt nursing in the public square and conservatives who believe that young children are best cared for in their homes by mothers free to nurse on demand. Pity the bewildered new mother who wants to nurse but can't because of physical problems or her job. She is offered an astonishing array of high-tech, vitamin-rich formula but lives in a nation that exhorts choice and free will except in the baby-food aisle.

The resurgence of breast-feeding follows a buildup of research confirming benefits to mother and child that formula manufacturers have been unable to duplicate. It also closely parallels the rise of La Leche, an organization formed in 1956 by seven Chicago-area women who wanted a network of nursing mothers to support one another in what was then considered radical behavior. At that time, less than 29% of mothers were nursing their week-old infants. The percentage would eventually dip to 25% in 1971 before climbing to 70% today.

La Leche, which promotes breast-feeding through meetings and telephone support, originally appealed to "young hippies," says spokeswoman Mary Lofton. "There had been this love affair with technology, thinking if something was made in a lab, it was better. But when the back-to-nature movement came along, we were there." And, Mrs. Lofton maintains, "all of the ideas we promoted -- to breast-feed right after delivery, to do it frequently...these were revolutionary ideas at the time, but every single one of those things is accepted pediatric practice today."

La Leche's influence is such that when the U.S. Department of Health and Human Services (HHS) launched a breast-feeding campaign in June 2004, La Leche trained the counselors who answered the government's hotlines. The goal of that continuing campaign is to get 75% of American mothers to breast-feed initially and 50% to breast-feed exclusively for at least six months. Using the catch phrase "babies are born to be breast-fed," the campaign distributes ads for television, radio and the print media. The mechanical-bull ad drew some complaints but was effective, claims Christina Pearson, an HHS spokeswoman.

While one government agency is promoting breast-feeding, however, another is handing out formula. The Women, Infants and Children (WIC) program, administered by the Department of Agriculture, gives states grants to provide free formula, food and breast-feeding support to low-income women. Nearly half of all infants in the U.S. are enrolled, and 54% of infant formula in the U.S. is distributed through WIC.

Since the late 1980s, states have negotiated contracts with formula manufacturers, who returned rebates to the states totaling $1.64 billion in 2004, the last year for which statistics are available. According to the Centers for Disease Control and Prevention, 29% of WIC recipients are breast-feeding at six months, compared with 46% of women who are eligible for WIC but don't receive the aid and 47% of ineligible women.

The result, says James Akre, the author of "The Problem With Breastfeeding" (a new book that takes issue with some of the popular aversion to breast-feeding) is that, by handing out more formula than breast pumps, the government is encouraging "deviant behavior" and "billions of dollars are going to provide poor children with food based on an alien food source" -- the alien being a cow.

Mr. Akre, a resident of Geneva, Switzerland, and a retired official of the World Health Organization, believes that, as in the case of seatbelts and tobacco, a society's attitude toward breast-feeding can change in a generation. "It's not women who breast-feed, after all. It's cultures and societies as a whole," he says.

Until the late 1800s, women had little choice but to breast-feed. The only question was whether the child's mother would do it or someone else -- a paid wet nurse or a slave. Every culture tried substitutes (sugared water or cow's or goat's milk early on, evaporated milk and Karo syrup more recently), but experimentation sometimes killed babies. Swiss pharmacist Henri Nestlé produced the first formula in the 1860s, saving the life of an orphaned baby and launching an $8 billion world-wide market in which Nestlé is still the leader.

The marketing of baby formula is tricky for manufacturers, which must admit on their labels that breast-milk is superior. To compensate, they rely heavily on coupons and formula samples offered through hospitals. New mothers typically leave American hospitals with a gift bag supplied by a formula manufacturer. Breast-feeding advocates want to end the practice.

Earlier this year, Massachusetts enacted the first ban on the gift bags, but it was killed by Gov. Mitt Romney, who cited the need for choice. The debate over breast-feeding simmers with political tension because it encapsulates the larger question of personal freedom versus social good. In likening formula to current public-health pariahs, breast-feeding advocates hope to send formula down a similar dark path.

The Massachusetts Breastfeeding Coalition announced plans for a nationwide "Ban the Bags" campaign at the International Lactation Consultant Association meeting in Philadelphia last week. Dr. Melissa Bartick, the coalition's chairwoman, has promised that formula marketing in hospitals won't last. She adds: "We'd never tolerate the thought of hospitals giving out coupons for Big Macs on the cardiac unit." So baby formula is not yet the new cigarette. But it's already the new Big Mac.

Ms. Graham is a writer and editor in the suburbs of Boston.

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