It has been an eventful weekend in the world of infant feeding. First off, the new president of the RCPCH (the Royal College of Paediatrics and Child Health), Dr Camilla Kingdon, used the Daily Mail to pronounce that formula fed babies are more likely to grow up to be obese. She also said that formula companies pursue stressed out parents and that the fall in health visiting numbers means parents aren’t getting the support they need to breastfeed.
But what she ignores is that while there is an association between feeding type and BMI, that doesn’t mean that feeding type causes obesity. It is hardly a surprise as both formula feeding and BMI are strongly associated with socioeconomic factors. Is it a causal relationship?
Well, studies comparing breastfed and formula fed siblings have found mixed results. The one and only randomised trial found that a breastfeeding intervention that increased breastfeeding rates also increased children’s BMIs. Anyone convinced that breastfeeding is the answer to childhood obesity?
And what of these health visitor shortages? Is it really the role of the health visitor to get us to breastfed? If so, how are they to do this? Recent NICE evidence reviews found no evidence as to anything that could be recommended to prevent or resolve common breastfeeding problems. As parents whose babies had excessive weight loss, jaundice and dehydration identified by health visitors, we are concerned about how cuts to services might result in more children becoming seriously ill as a result of attempts to exclusively breastfed.
We’d be a lot happier if public services focused on supporting the safety and health of our families. Health visiting services would do well to focus their efforts on things that have been evidenced to improve health outcomes. And guess what? That’s not breastfeeding promotion!
Then, oh, horror of horrors, the National Trust announced a partnership with HiPP Organic. This was described as ‘horrifying’ by breastfeeding doctors. Threats of boycotts, banning, petitions and a great furore ensued. It remains to be seen whether the National Trust will cave to the pressure they’re under to sever ties with HiPP Organic.
We wonder whether the good folks at the National Trust saw this coming. We certainly would have predicted it, if had we’d known. Because the battle against and hatred for Big Formula has a long and bitter history. The WHO ‘Code’ came in 1981 to limit formula advertising. This was in response to predatory and deadly marketing practices of formula companies, notably Nestlé in developing countries. But this is 2021 and we are in the UK. What we mainly see are breastfeeding advocates constantly wanting to be judge, jury and executioner of Big Formula.
The ‘Code’ has remained unchanged for 40 years. Meanwhile, babies in the UK are not infrequently readmitted to hospital with complications associated with underfeeding. Mothers report intense shame, stress and upset about their infant feeding experiences. Poor nutrition contributes to 45% deaths of children under 5 worldwide. In 2018 there were 2.4m nutrition deaths of children worldwide. This excellent paper describes the history and context.
Babies and children need food. That’s true whether they are hungry newborns who cannot get enough milk from breastfeeding or children growing up in the direst of poverty. Let’s not forget current UNICEF policy seeks to prevent food banks in the UK from distributing formula. Clearly current policy is not working here or anywhere. Public health crises like hungry and underfed children (not breastfeeding rates) cannot be tackled with moral outrage, horror or boycotts.
UNICEF believe that wanting to breastfeed and not being able to is a trauma:
No. Seeing your child suffer the potentially life-threatening and life- changing consequences of under nutrition is a potential trauma. Feeding them formula is a solution. Breastfeeding advocates never consider their own role and the role of jumped up claims about the health effects of breastfeeding (looking at you, Camilla Kingdon) in creating emotional distress related to infant feeding. They ignore the feeding complications many of us suffer, as that makes breastfeeding look bad. Seriously, breastfeeding advocates, you are not the good guys here and formula companies are not the bad guys! Get used to a little moral ambiguity. It is a fact of life!
We call on healthcare bodies to get off your moral high horses and start working with industry for the good of children across the world and including the UK. You know who suffers because of your ‘activism’? Not Big Formula – us and our babies! What you are doing is the equivalent to trying to tackle the Covid-19 pandemic without cooperation between the pharmaceutical industry, governments, NGOs and healthcare providers across the world. We need a thriving baby food industry as much as we need a thriving pharmaceutical industry.
Enough is enough. Healthcare policy exists to serve us, not anti-industry agendas and public health initiatives that have remained unchanged for 40 years and have never proven themselves to improve health outcomes in the contexts in which they are implemented. We wonder whether you have the moral courage to do so, in the service of ensuring no baby and no child ever goes hungry or suffers the effects of under nutrition in the UK or anywhere else in the world. Surely, that is a more pressing public health issue than breastfeeding rates?
This blog was adapted from a thread on Twitter.