Commentary to: Office Prenatal Formula Advertising and Its Effect on Breastfeeding Patterns
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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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José J. Gorrín, MD, MPH, FACOG Professor and Director Maternal and Child Health Program

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Jos j gorr n md mph facog professor and director maternal and child health program

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:

  • 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:

  • 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:

  • 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

  • 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

  • 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

  • The hazards of artificial feeding

Walker, 1993; 1998


The artificial formula industry2

The artificial formula industry

  • 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

  • Promotional efforts

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


Profit versus public health

Profit versus Public Health

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


Profit versus public health1

Profit versus Public Health

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


Profit versus public health2

Profit versus Public Health

  • 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

  • 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

  • WHO Code

  • IBFAN

  • WABA

  • BFHI

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


International code of marketing of breastmilk substitutes

International Code of Marketing of Breastmilk Substitutes


Objectives of the who code

Objectives of the WHO Code

“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:

  • 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:

  • 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:

  • 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:

  • 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:

  • 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


The 7 principles guiding ibfan

The 7 principles guiding IBFAN:

  • 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:

  • 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:

  • 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:

  • 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

WABA

1991


Baby friendly hospital initiative bfhi

Baby-Friendly Hospital Initiative (BFHI)

1991


The 10 steps for successful breastfeeding

1.Breastfeeding policy

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


Jos j gorr n md mph facog professor and director maternal and child health program

Public Policy for the Promotion of Breastfeeding in Puerto Rico

1995


The industry of breastfeeding equipment

The industry of breastfeeding equipment

Amin, 1996; Parrilla, 1999;

Wilson-Clay, 1994; Van Esterik, 1996;

Nommsen-Rivers, 1999


Guilt vs informed decisions

Guilt vs informed decisions

  • 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

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


Recommendations

Recommendations

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


Recommendations1

Recommendations

  • 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

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


Jos j gorr n md mph facog professor and director maternal and child health program

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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