By Luchina Fisher
Monday, December 22, 2003
Statistics in a government-sponsored ad campaign focusing on the health risks of not breastfeeding infants have been removed, apparently because of protests from the formula industry and the heads of an organization of pediatricians.
(WOMENSENEWS)--The largest government-sponsored advertising campaign to promote breastfeeding in the United States has drawn controversy even before its launch.
The campaign's print, television and radio ads had been expected to launch by the Department of Health and Human Services during the first week of December. Instead, breastfeeding experts early this month were huddled in meetings in Washington with Kevin Keane, an assistant secretary in the department,to discuss changing the ads. At the same time, government scientists were reviewing the campaign's scientific claims.
The group that developed the ads, the New York nonprofit Ad Council, set off a debate among formula companies, doctors and breastfeeding advocates last month, when it posted a bulletin on its Web site describing how the campaign would focus on the negative consequences of not breastfeeding.
Previous breastfeeding campaigns had always focused on the pros, not the cons. Some of the benefits include strengthening the baby's immune system and providing the best possible nutrition.
After conducting a series of focus groups, the Ad Council and the Department of Health and Human Services decided the ads would be more effective if they warned women, rather than encouraged them, according to Marsha Walker, a nurse on the leadership team of the Raleigh, N.C.-based United States Breastfeeding Committee, a nonprofit organization that promotes breastfeeding.
The Ad Council had included in its bulletin statistics published in the past decade showing a higher risk of formula-fed babies for developing diabetes, leukemia and other illnesses.
Earlier this year, the Department of Health and Human Services convened a panel of five breastfeeding experts to review the scientific studies supporting the ads.
"We all realized that if this wasn't carefully done, this kind of thing would happen," says panel member Dr. Audrey Naylor, referring to the criticism the campaign is now facing.
Naylor, a San-Diego based pediatrician and head of Wellstart International, a nonprofit organization in San Diego that educates health professionals about lactation and breastfeeding, says studies clearly show that not breastfeeding puts infants at greater risk for developing diarrhea, ear infections and respiratory infections. She says, however, that medical opinion differs over the level of risk.
Because the panel felt there was not enough hard data to show a direct link to leukemia or diabetes, they recommended those two conditions be dropped from the ads.
Nonetheless, Naylor doubts that the real issue in the current attacks on the campaign are based on the solidity of the scientific data. "It really is not a battle of science," she said. about the dispute over the campaign. "This is a battle of politics and money."
The formula industry has annual revenues of $4 billion in the United States. It was first sold in the United States in the late 1880s, but became a growth industry in the 1940s when women went to work during World War II.
A recent survey by formula maker Ross Products, Columbus, Ohio, indicated that about 70 percent of new mothers breastfeed, although just 33 percent are still nursing by six months. But Spangler says those figures include women who breastfeed just once as well as those who supplement with formula, which makes them unlikely to pass on the preventive effects of breast milk to their babies. She says the protection breastfeeding provides is dose-related although there is no agreement on how long a baby must breastfeed to receive those benefits.
The Centers for Disease Control and Prevention based in Atlanta has just begun tracking breastfeeding rates, and preliminary data indicate that the number of women who breastfeed exclusively for the first six months is between 8 percent and 15 percent.
That means a huge shift is in order if the Department of Health and Human Services has any hope of realizing its 2010 goals to have 75 percent of newborns breastfed and 50 percent of babies exclusively breastfed at six months. For infants one year and beyond, it has set a goal of 25 percent.
Formula companies are focusing their opposition to the campaign's cautionary tone.
"It could frighten parents," says Mardi Mountford, the executive director for the International Formula Council, an Atlanta-based trade association. Mountford says her organization has asked the independent Cato Research, based in the Research Triangle Park of North Carolina, to look at the statistics used by the Ad Council. So far, she says, the organization has not been able to confirm the numbers.
Dr. Joe Sanders, executive director of the American Academy of Pediatrics, and Dr. Carden Johnston, the academy's president, in early November co-signed a letter to Tommy Thompson, secretary of Health and Human Services, expressing concern about the campaign's strategy and the validity of the science behind the claims.
"We don't want to go out there and lose credibility by putting out false data where people will accuse the groups of using a scare tactic," Sanders told Women's eNews.
That letter did not sit well with the academy's own breastfeeding experts who had been working with the government on the campaign and supported the aggressive approach.
Dr. Lawrence Gartner, the head of the academy's breastfeeding committee, sent his own letter to the Department of Health and Human Services expressing support for the campaign. "To not breastfeed is a risk, that's what the research data show," he says.
Gartner says the formula industry may have influenced Sanders and Johnston. "They donate a lot of money and they buy a lot of books, which obviously brings a lot of profit to the academy," he says.
Last year, Ross Products, which makes the formula Similac, purchased 300,000 copies of the academy's book on breastfeeding, for about $500,000. The company recently bought another 300,000 copies.
But Sanders says that while Ross has purchased books and sponsored programs by the American Academy of Pediatrics, it has not donated money, because the academy does not accept what he terms "unspecified funding." "If any company supports us, we make it clear that they will have no input while we will acknowledge their support," he says. The formula companies, he adds, did not ask him to send a letter to Secretary Thompson.
Amy Spangler, chair of the United States Breastfeeding Committee, saw three of the television ads. One, she says, showed a pregnant woman riding a mechanical bull with a voice over saying, "If you wouldn't take risks before your baby was born, why start now?" Accompanying each ad is the tag line on the screen: "Babies are born to be breastfed."
"Some of the ads are a little hard-hitting," says Spangler, a nurse who has been working with the Department of Health and Human Services to develop the ads. "But we don't hesitate to tell parents what smoking does to themselves and their children. Why should we not tell people the consequences of not breastfeeding?"
Spangler says that after meeting with Assistant Secretary Keane in early December the department has decided to drop mentions of leukemia and diabetes in the ads.
Ear infections, diarrhea and lower respiratory infections will be mentioned, but there will be no discussions of statistics.
Spangler says she does not have a problem with the changes.
"We need to find that point where everyone has a comfort level," she says. She would object, however, if the campaign were forced to shift its strategy away from risks.
Many, however, continue to object to the campaign's emphasis on the negatives of not breastfeeding.
"If a woman can't breastfeed or chooses not to and then her baby develops one of these conditions, what kind of guilt feelings is that going to put on this young mother?" asks the American Academy of Pediatricians' Sanders.
Gartner calls the concern about guilt bogus. "This is a line that has been used for many years by people who are ambivalent about breastfeeding," he says.
Walker of the United States Breastfeeding Committee says the argument about guilt is patronizing toward women. She believes women should know all the risks. "Women are strong," she says. "They do not need to be protected from the outcome of their decision."
Luchina Fisher is a writer and producer in New York.
United States Breastfeeding Committee:
Department of Health and Human Services' Office on Women's Health--National Women's Health Center
Breastfeeding - Best For Baby. Best For Mom: