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Commentary to: Office Prenatal Formula Advertising and Its Effect on Breastfeeding Patterns (Howard C et al). José J. Gorrín, MD, MPH, FACOG Professor and Director Maternal and Child Health Program Graduate School of Public Health University of Puerto Rico. Variables studied:.

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Commentary to: Office Prenatal Formula Advertising and Its Effect on Breastfeeding Patterns (Howard C et al)

José J. Gorrín, MD, MPH, FACOG

Professor and Director

Maternal and Child Health Program

Graduate School of Public Health

University of Puerto Rico


Variables studied
Variables studied: Effect on Breastfeeding Patterns

  • Breastfeeding (BF) initiation

  • BF cessation prior to discharge

  • BF cessation < 2 weeks

  • BF > 2 weeks

  • Subgroup analyses

    • Mothers with uncertain goals

    • Mothers with goals 12 weeks or <


Results
Results: Effect on Breastfeeding Patterns

  • Not affected:

    • BF initiation and BF > 2 weeks

  • Negatively affected:

    • BF cessation prior to discharge (RR 5.80)

    • BF cessation < 2 weeks (OR 1.91)

    • Mothers with uncertain goals or goals < 12 weeks (Exclusive, full and overall)


Population studied
Population studied: Effect on Breastfeeding Patterns

  • White - not Hispanic - 92-95%

  • Private insurance - 97-99%

  • Cesarean - 17-24%

  • Married - 82-86%

  • Education - 13.9 - 14.1 years

  • Infant’s gestational age - 39.6 wks (SD 1.3 - 1.4 weeks)

  • Infant’s birth weight - 3510 - 3519 gms. (SD 487 - 545 gms)


Acknowledged limitations of the study
Acknowledged limitations of the study Effect on Breastfeeding Patterns

  • Lack of socioeconomic and racial diversity

  • Widely available BF education and support

  • Baby-friendly hospital environment

  • Results in more vulnerable populations may differ

  • Generalizability of results is limited


The artificial formula industry
The artificial formula industry Effect on Breastfeeding Patterns

  • Scientific evidence of the benefits of human milk and breastfeeding

Raisler et al 1999;

Lawrence, 1997; Anderson et al, 1999.


The artificial formula industry1
The artificial formula industry Effect on Breastfeeding Patterns

  • The hazards of artificial feeding

Walker, 1993; 1998


The artificial formula industry2
The artificial formula industry Effect on Breastfeeding Patterns

  • Position of the medical profession with regards to breastfeeding vs artificial feeding

Periodic Survey of Fellows, AAP; Howard et al, 1993, Howard et al, 1997


The artificial formula industry3
The artificial formula industry Effect on Breastfeeding Patterns

  • Promotional efforts

Bird, 1996; Valaitis et al, 1997; Howard et al 1997; Howard et al, 2000


Profit versus public health
Profit versus Public Health Effect on Breastfeeding Patterns

  • The profit motive of the formula makers is in contradiction with public health


Profit versus public health1
Profit versus Public Health Effect on Breastfeeding Patterns

  • The net effect of the marketing practices of artificial formula manufacturers


Profit versus public health2
Profit versus Public Health Effect on Breastfeeding Patterns

  • Bribery efforts to health professionals

Baumslag & Michaels, “ Milk, money and madness - the culture and politics of breastfeeding”, 1995; Margolis, 1991


The artificial formula industry4
The artificial formula industry Effect on Breastfeeding Patterns

  • The utilization of health professionals

Valaitis et al 1997; Greer & Apple, 1991; Baumslag , 1989


Health policy efforts for the protection of breastfeeding
Health policy efforts for the protection of breastfeeding Effect on Breastfeeding Patterns

  • WHO Code

  • IBFAN

  • WABA

  • BFHI

  • Public Policy for the Promotion of Breastfeeding - (PR)



Objectives of the who code
Objectives of the WHO Code Effect on Breastfeeding Patterns

“To provide breastfeeding infants with sufficient and secure nutrition by protecting and promoting breastfeeding and assuring the correct use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution methods.”


The who code covers
The WHO Code covers: Effect on Breastfeeding Patterns

  • All breastmilk substitutes (formulas, including those for toddlers)

  • Baby-foods

  • Other milk-based products

  • Teas and juices

  • Bottles

  • Nipples and related equipment


Who code dispositions
WHO Code dispositions: Effect on Breastfeeding Patterns

  • Prohibits publicity and promotion of these products to the general public

  • Prohibits the promotion of these products in health services installations

  • Prohibits the distribution of free samples to pregnant or breastfeeding mothers which could promote the use of breastmilk substitutes or bottle feeding


Who code dispositions1
WHO Code dispositions: Effect on Breastfeeding Patterns

  • Does not allow personnel provided or paid by formula manufacturers or distributors to offer orientation to mothers on infant feeding

  • Prohibits gifts or free samples of these products to health professionals

  • Prohibits the use of images or texts which could idealize the use of breastmilk substitutes, including baby pictures


Who code dispositions2
WHO Code dispositions: Effect on Breastfeeding Patterns

  • Information provided to health professionals on these products should be scientific and objective and will not imply or lead to believe that formula feeding is equivalent or superior to breastfeeding

  • Information on artificial feeding, including labels, should explain the advantages and superiority of breastmilk and the cost and hazards associated to artificial feeding


Who code dispositions3
WHO Code dispositions: Effect on Breastfeeding Patterns

  • Inappropriate products, such as condensed milk, should not be promoted for use in feeding of infants

  • All products should be of high quality and should take in consideration climate and storage conditions in each country


International baby food action network
International Baby Food Action Network Effect on Breastfeeding Patterns


The 7 principles guiding ibfan
The 7 principles guiding IBFAN: Effect on Breastfeeding Patterns

  • The rightof boys and girls all overthe world to reach the highest possible level of health

  • The right of families, especially women and children, to sufficient and adequate nutrition


The 7 principles guiding ibfan1
The 7 principles guiding IBFAN: Effect on Breastfeeding Patterns

  • The rightof women to breastfeed and make informed decisionsregarding the feeding of their children

  • The right of women to receive total support in achieving successful breastfeedingand adequate infant nutrition


The 7 principles guiding ibfan2
The 7 principles guiding IBFAN: Effect on Breastfeeding Patterns

  • The universal right of access to health services capable of fulfilling basic necessities

  • The rightof health services personnel and consumers to access health services systems freeof commercial pressures


The 7 principles guiding ibfan3
The 7 principles guiding IBFAN: Effect on Breastfeeding Patterns

  • The rightof persons to organize in international solidarityin order to achieve the necessary changes to protect and promote basic health


World alliance for breastfeeding action
World Alliance for Breastfeeding Action Effect on Breastfeeding Patterns

WABA

1991


Baby friendly hospital initiative bfhi
Baby-Friendly Hospital Initiative (BFHI) Effect on Breastfeeding Patterns

1991


The 10 steps for successful breastfeeding

1. Breastfeeding policy Effect on Breastfeeding Patterns

2. Capacitation of personnel

3. Education of women on benefits of breastfeeding

4. Initiate breastfeeding within 30 minutes after delivery

5. Assist mothers in initiating breastfeeding even if separated from their babies

6. Provide no other oral intake

7. 24 hour rooming-in

8. Encourage breastfeeding on demand

9. No artificial nipples or pacifiers

10.Encourage the creation of support groups

The 10 steps for successful breastfeeding



The industry of breastfeeding equipment
The industry of breastfeeding equipment Rico

Amin, 1996; Parrilla, 1999;

Wilson-Clay, 1994; Van Esterik, 1996;

Nommsen-Rivers, 1999


Guilt vs informed decisions
Guilt vs informed decisions Rico

  • Fear of health professionals of informing about the risks of artificial feeding

  • Instruments to undermine self-esteem among mothers

  • Fear of not being able to offer effective assistance


Guilt vs informed decisions1
Guilt vs informed decisions Rico

  • Decisions based on complete and correct information should not produce guilt feelings


Recommendations
Recommendations Rico

  • Health professionals should refuse to accept any and all monetary support from formula companies


Recommendations1
Recommendations Rico

  • Health professionals must develop a clear understanding of the ethical aspects of the work we do, of our image in society and, above all, of the implications for public health


Recommendations2
Recommendations Rico

  • Health professionals must fully understand the enormous importance for society of returning to breastfeeding as the cultural norm for child nutrition and rearing


Parrilla Rodríguez, A.M. & Gorrín Peralta, J.J. (2000). Aspectos Éticos en la Promoción de la Lactancia Humana y el Amamantamiento. Puerto Rico Health Sciences Journal, 19, 145-51.


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