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Session 14 protecting breastfeeding revised 2016
- 1. Protecting Breastfeeding Session 14 Larry Hogan, Governor Boyd Rutherford, Lt. Governor Van Mitchell, Secretary, DHMH
- 2. Describe strategies that protect breastfeeding as a public health goal Understand the International Code of Marketing of Breast Milk Substitutes and its impact on breastfeeding Identify the health worker’s role in recognizing and preventing marketing practices that undermine breastfeeding Understand the importance of breastfeeding in emergency situations
- 3. Prohibits marketing of infant formulas and infant formula-related products to the public Provide education that is impartial, free of formula marketing, and evidence-based Provide information on risks of formula that are mitigated by breastfeeding Source: Maryland WIC Program
- 4. Ethical issues of accepting free products
- 5. Free formula samples Formula company diaper bag “gift” Formula company educational materials Promotional marketing give-aways for staff XSource: Maryland WIC Program
- 7. Support the continuation of exclusive and complementary breastfeeding Emergency relief agency policies should ideally support, promote, and protect breastfeeding Provide breastfeeding training to humanitarian workers, when possible Include someone trained in breastfeeding support Source: United States Breastfeeding Committee
- 8. Issues regarding preparation Effects of formula on breastfeeding © World Health Organization/Searo 2008. Used with permission
- 9. Encourage donations of donor milk Exclude improper donations of formula ◦ Too much sent discourages breastfeeding ◦ Outdated product should not be used ◦ Product label in language of user Encourage breast milk substitutes in ready- to-use form ◦ Reserve for families not breastfeeding Source: A. Miano
- 10. Promote Breastfeeding Source: Maryland WIC Program (both photos)
- 11. Armstrong, H., & Sokol, E. (2001). The International Code of Marketing of Breast Milk Substitutes: What It Means for Mothers and Babies World-Wide. Raleigh, NC: International Lactation Consultant Association. Bergevin, Y., Dougherty, C., & Kramer, M.S. (1983). Do infant formula samples shorten the duration of breastfeeding? Lancet, 1, 1148-1151. Declercq, E., Labbok, M.H., Sakala, C., & O’Hara, M. (2009). Hospital practices and women’s likelihood of fulfilling their intention to exclusively breastfeed. Am J Public Health, 99(5), 929-935. Dungy, C.I., Christensen-Szalanski, J., Losch, M., & Russell, D. (1992). Effect of discharge samples on duration of breast-feeding. Pediatrics, 90, 233-237. Frank, D.A., Wirtz, S.J., Sorenson, J.R., & Heeren, T. (1987). Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial. Pediatrics, 80, 845-854. Kaplan, D., & Graff, K. (2008). Marketing breastfeeding – reversing corporate influence on infant feeding practices. J Urban Health, 85(4), 486-504.
- 12. Kent, G. (2006). WIC’s Promotion of Infant Formula in the United States. Int Breastfeed J, 1, 8. Merewood, A., Grossman, X., Cook, J., Sadacharan, R., Singleton, M., Peters, K., & Navidi, T. (2010). U.S. hospitals violate WHO policy on the distribution of formula sample packs: results of a national survey. J Hum Lact, 26(4), 363-7. Mizuno, K., Miura, F., Istabashi, K., Macnab, I., & Mizuno, N. (2006). Differences in perception of the WHO International Code of Marketing of Breast Milk Substitutes between obstetricians and pediatricians in Japan. Int Breastfeed J, 1, 12. Perez-Escamilla, R., Pollitt, E., Lonnerdal, B., & Dewey, K.G. (1994). Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview. Am J Public Health, 84, 89–97. United States Breastfeeding Committee (2009). Breastfeeding saves lives in emergencies. Washington, DC: USBC. http//www.usbreastfeeding.org/LinkClick.aspx?link=Publications/BF-Emergency- Response-2009USBC.pdf&tabid =707mid=388
- 13. WABA. (2009). Breastfeeding: a vital emergency response. Penang, Malaysia. http://www.worldbreastfeedingweek.net/wbw2009/images/english_2009actionfolder.p df Walker, M. (2007). International breastfeeding initiatives and their relevance to the current state of breastfeeding in the United States. J Midwifery Women’s Health, 52(6), 549-555. Walker, M. (2007). Still selling out mothers and babies: marketing of breast milk substitutes in the U.S.A. Weston, MA: NABA REAL. WHO/UNICEF. (1981). The International Code of Marketing of Breast Milk Substitutes. Geneva: World Health Organization. www.who.int/nutrition/publications/code_english.pdf
Editor's Notes
- Read slide title and subtitle
- In this session, we will learn about ways that those of us in healthcare can support breastfeeding without inadvertently undermining it. Unfortunately, some hospital practices have historically hampered the success of those who choose to breastfeed. These practices, which need to be avoided if we are to work towards helping families achieve breastfeeding success, are outlined in the International Code of Marketing of Breast Milk Substitutes and have contributed to the decline in breastfeeding in the latter part of the 20th century. We’ll cover how you can make a difference! We’ll also touch on the value of breastfeeding in emergency situations.
- The International Code of Marketing of Breast Milk Substitutes was developed by the World Health Organization in 1981. It is not a law, but rather a recommendation to focus healthcare workers and governments in protecting, promoting, and supporting breastfeeding and also protecting the small group of infants who truly require breast milk substitutes. Contrary to what many people think, the aim of the code is not to force women to breastfeed against their will. By following the Code, patients receive unbiased and accurate information about infant feeding.
- Historically, infant formula manufacturers have provided standard infant formula without charge to maternity hospitals. This cost savings to the hospital creates an ethical dilemma. Payment for the free product comes in the form of marketing provided through endorsement of the brand, gift bag give-aways (also provided free to the hospital), and staff brand loyalty from repetition of use. In addition, hospitals are accepting a product that may not be in the best interest of the health of their patients. Keep in mind that in other areas, items hospitals use for day-to-day operations are all purchased.
- Merewood and colleagues, in 2010, reported that 91% of US hospitals give formula advertising materials and free samples of formula to new mothers, even if they are breastfeeding. Hospital supplies and patient educational materials with company proprietary logos are purchased or provided free of charge to hospitals. Distributing formula gift bags and or bottles of formula, just in case it’s needed, communicates the message to the patient that she should use formula and that breast milk alone is not enough. Although this may not be the intention, this sends a mixed message. Even when breastfeeding is going well, mothers who leave the hospital with formula often wonder when they should begin giving the formula that they were sent home with. The research clearly shows that marketing formula to mothers causes them to stop exclusively breastfeeding earlier and discontinue breastfeeding altogether sooner than they would have if they did not get the bag or samples. Even for those who formula feed, receiving formula samples implies that the hospital endorses the specific brand provided, sending a biased message that the brand given is the only one that should used. Formula is inadvertently marketed by healthcare providers in other ways, also. Patient educational materials, even on breastfeeding, are available through formula companies and used by some hospitals. These are often biased and include some misleading information, along with company names, logos, and advertisements. Formula company representatives give nominal gifts such as pens, pads, lanyards, measuring tape, badge holders and name tags. While these seem small and are useful to healthcare providers, patients begin to recognize the brand names and logos they see, in turn developing brand loyalty to the product. In addition, it non-verbally implies that the use of these products is encouraged. On the other hand, if staff were to display a similar promotional item with a breastfeeding message, it markets evidence-based healthcare, rather than a product. Finally, one should recognize that when staff accept any gifts from company representatives, it often creates relationships where staff want to support that representative’s company, creating staff loyalty to that brand. Bottom line, in healthcare, the best practice is to follow the scientific evidence.
- Removal of formula and coupons from discharge bags is not sufficient – the bags are printed with proprietary logos. Hospital public relations departments might prefer to advertise the hospital with their own version of a discharge bag. Materials included may be developed in-house or purchased from a commercial vendor that doesn’t support a formula-related products. On the other hand, some hospitals choose not to provide a substitute “gift” at all. Ultimately, the patient leaves the hospital with the gift of her baby.
- According to the United States Breastfeeding Committee, the safest food in an emergency is the mother’s own milk. Donor human milk is the next best option. Mothers who cannot directly feed their babies can also be supported to express their milk. We never know when an emergency will happen in our geographic area. The best way to prepare is to plan ahead. It is recommended that during emergencies, continuation of exclusive and complementary breastfeeding be supported; Families should be kept together; Mothers should be fed so they can continue to supply milk for their breastfeeding infants and children. In order to provide this support, agencies that aid disaster victims need to have policies that support, promote and protect breastfeeding. Response workers should have some breastfeeding training to enhance their abilities and understanding of how to support nursing mothers. Community resources with more breastfeeding expertise can be identified, in case needed during an emergency. Ideally, someone among the response crew with more lactation management experience should be available to assist as needed. Identified community resources can either work with that individual or serve in this capacity when no one on the response team is qualified. International Lactation Consultant Association Position on Infant Feeding in Emergencies USBC Position—Breastfeeding During Emergencies
- Due to the nature of the emergency, preparation of formula may be hazardous. There may be no clean, safe water for mixing formula, and no means of sterilizing bottles, pacifiers, and water. This could lead to contamination. Electricity or refrigeration may be nonexistent. Infants and children can get sick and die when exposed to contaminated water, dirty feeding equipment, and unsterile formulas. Formula use by a breastfeeding mother decreases her milk supply. The cleanest, safest food for infants in an emergency situation is breast milk. It is readily available and no supplies need to be shipped in. It is nutritionally ideal and prevents malnutrition, while also providing hydration. Breast milk is protective against infectious diseases which are widespread during emergencies. Think about the devastation that natural disasters, such as Hurricane Katrina caused to New Orleans or Hurricane Sandy caused to New Jersey. Entire communities were without power, clean water, and shelter. Limited fuel restricted people from accessing what they needed. Breastfed infants could continue to receive adequate nutrition, as long as mother and baby were together.
- When emergency situations occur with wide media coverage of events, donations are often volunteered. It is important to restrict donations to that which can be safely and effectively used. One needs to be mindful that after the emergency resolves, the individuals will need to continue with their lives and be able to access the feeding method used. Above all, donations of human milk are encouraged. These can help infants and maintain those who have been breastfed with similar health benefits. Responding agencies must understand that overabundance of formula in these situations is not necessarily helpful. It often is distributed even to women who intended to or had been breastfeeding. These women may not be able to safely use breast milk substitutes once the emergency situation resolves, due to availability, cost, safety of water supply, and/or refrigeration once the relief agencies have left. Relief agencies need to monitor the donations of breast milk substitutes that are accepted. To insure the greatest safety, product accepted should be in ready-to-use form (which eliminates need to prepare it and may eliminate need for refrigeration). The product accepted should also be within the ‘use-by’ dates, and labeling, including instructions, in the language of the individuals to whom it is provided. Finally, infant formula should be provided only to those families who are not breastfeeding. Those who are breastfeeding can continue with breastfeeding support and additional donor milk, if necessary.
- In conclusion, be careful that the messages you provide to your patients, whether verbal or non-verbal, support the scientific evidence. Thank you for helping to promote, protect, and support breastfeeding! (Picture of staff wearing various breastfeeding buttons/lanyards/badge holders)