Half of the infant formula sold in the U.S. is distributed by the government to low-income mothers. Critics say marketing inhibits black women from breastfeeding and the bottle habit needs to be broken. Fourth in a series on black maternal health.
Two rave about an infant formula's new packaging.
And one cuddles a sleeping newborn.
These images fill the Web site for Similac, the most popular infant formula in the United States. Enfamil and other leading brands also publish ads featuring African Americans.
"Since 1999, infant formula advertising increased from 7,000 print and television ads to 10,000 per year," says Mishawn Purnell-O'Neal, founder of the Chicago-based Breastfeeding America and author of "Breastfeeding Facts Over Fiction: Health Implications on the African-American Community," published in 2001. "With this aggressive marketing, it stands to reason that breastfeeding rates across all races, and particularly rates among African American women, do not meet government health objectives."
Along with a growing number of black women's advocates, Purnell-O'Neal is sounding an alarm about two major ways that formula companies (which derive $4 billion of their $8 billion worldwide sales from the U.S. market) target African Americans: through government food subsidy programs and formula giveaways at public hospitals.
"These particular forms of marketing have a high impact on the black community," she says. "And they help account for the fact that black women have low rates of breastfeeding."
In April 2008, a report from the Atlanta-based Centers for Disease Control and Prevention indicated black women are less likely to breastfeed than white or Latina women. Only 65 percent of African American mothers had ever tried breastfeeding. And only 20 percent were following government recommendations and exclusively nursing when their infants were six months old, compared to the 40 percent of white women who did so.
"The same health problems that are common in the African American community--asthma, obesity, diabetes and childhood infections--are problems that could be reduced through more breastfeeding," says Miriam Labbok, a professor of maternal and child health at the University of North Carolina at Chapel Hill.
Lower Nursing Rates for Black Women
Both the International Formula Council, a manufacturers' coalition based in Atlanta, and Bristol-Myers Squibb, the nation's top-selling infant formula maker, based in Princeton, N.J., deny making a special effort to market to black customers or track sales within this ethnic group.
Researchers say one reason black women breastfeed less is that many rely on formula dispensed by WIC, the shorthand name for the federal government's Special Supplemental Nutrition Program for Women, Infants and Children, which was founded in 1972 and provides vouchers for free food to low-income mothers.
The majority of WIC participants are white. But African Americans--just 12 percent of the U.S. population, according to the U.S. Census Bureau--account for a disproportionate 20 percent of WIC families, a total of 420,000 people, according to the program's parent agency, the U.S. Department of Agriculture.
WIC's African American clients are less likely than its white clients to receive breastfeeding advice from WIC counselors and are more likely to receive tips on bottle feeding, found a 2003 study from the New York-based Commonwealth Fund.
More than half the infant formula sold in the United States is distributed through WIC, and this greatly inflates formula's overall demand, according to a 2007 University of Hawaii study.
WIC distributes nearly 700 million cans of formula annually, according to Department of Agriculture records, at a cost of $578 million.
"Individual handouts don't last a full month," says Labbok. "A woman who uses formula continuously will need to go out and buy some on her own to supplement her monthly WIC subsidy."
WIC Changes Approach
In recent years, in response to studies about the health benefits of breastfeeding, WIC has started to actively encourage its recipients to breastfeed.
In 2009, the program plans to spend $51 million to promote breastfeeding. It will continue giving formula vouchers to recipients who want formula. But it will also offer pamphlets and counseling sessions on breastfeeding to recipients and their partners, and will offer special incentives (such as a greater variety and quantity of food vouchers) to recipients who do choose to breastfeed.
The program may need to do more to change some of the negative press and findings.
Enrolling in WIC makes a woman half as likely to breastfeed as a non-WIC woman in the same income bracket, according to a 2005 study by the Centers for Disease Control.
In 2006, a report by the U.S. Government Accountability Office found that most states allow formula makers to use the WIC acronym and logo in their ads in violation of the program's rules.
"In inner-city communities where most residents are black, these ads for formula assistance and formula giveaways are everywhere," says Kathi Barber, founder of the Baltimore-based Black Mothers' Breastfeeding Association and author of "The Black Woman's Guide to Breastfeeding."
Health advocates say that like WIC giveaways, the practice of offering new mothers free "hospital discharge bags"--also started in the 1970s--boosts black women's formula use.
"Research shows commercial discharge bags from formula companies disproportionately impact women of color," says Melissa Bartick, chair of Massachusetts Breastfeeding Coalition, in Weston, Mass. "And women who get these bags are more likely to start using formula instead of exclusively breastfeeding."
Mothers who receive discharge bags become habitual formula consumers more often than mothers who don't, according to a 1992 study in the Journal of Human Lactation.
Through a national campaign called "Ban the Bags," more than 200 U.S. hospitals and birthing centers have stopped distributing formula discharge bags.
Seventy hospitals in the United States have won "baby friendly" designation from the Geneva-based World Health Organization for refusing any form of formula companies' freebies and for promoting breastfeeding.
Despite efforts like these, 93 percent of U.S. hospitals still hand out discharge bags, according to a study conducted by Boston University School of Medicine researchers and presented in October at an American Public Health Association meeting.
Health advocates say that whether formula giveaways come from food subsidy programs or maternity wards, they have the same effect: enticing African American mothers--and mothers of all races--to rely on formula.
"When government agencies, doctors and nurses hand out infant formula, mothers naturally assume that authorities are endorsing this product as the healthiest choice," says Deborah McCarter-Spaulding, an assistant professor of nursing at Saint Anslem College in Manchester, N.H.
McCarter-Spaulding's studies indicate black women of distant African descent have less confidence in their ability to breastfeed than black women who come from the Caribbean or directly from Africa.
After three decades of receiving formula handouts, black women whose families are long-established in the United States are thus more likely to bottle feed than black women who are recent immigrants, she found.
Molly M. Ginty is a freelance writer based in New York City
This series is supported by the W.K. Kellogg Foundation.
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