Haredi Public Shortchanged by Formula Freebies

haredi formula giveawayQ: How was the haredi public mekupach (shortchanged)?

A: Because Superpharm, the drugstore chain, included only regular dairy infant formula in its giveaway for new parents. Haredi parents require mehadrin formula, produced under a higher level of kashrut supervision.

Readers reported this “injustice” to the newspaper Hashavua, which contacted the formula manufacturer. In response the company offered to send a coupon for a free 900-gram package of mehadrin formula to anyone who left a name and address with the customer service office.

I think the formula company got a good deal. With any luck, it will be seen as a champion of downtrodden haredi consumers. It also gets a list of new names and addresses for its marketing database without having to shell out too much—formula has a large markup because it is so inexpensive to produce.

Hidden Costs of Formula Giveaways

Gifts of formula sound like a good idea, but the newspaper and its readers are misguided. The coupons will be requested by many families whose babies are still nursing, including some very young babies (if they are even born yet). Those mothers who fully intend to breastfeed will now have “free” formula on hand for whenever there is a concern that the baby is still hungry (this could be whenever the baby cries), or the mother has to go out. There are numerous studies showing that free formula samples greatly increase the risk of early weaning.

Hidden costs to formula giveaways include:

  • The cost of advertising, marketing and giveaways raises the price of the product for families who rely on formula to feed their children. The poorest families suffer the most from high prices.
  • 900 grams of formula lasts a few days at most. If given to the baby at a young age or within a short period of time it can lower the mother’s milk supply, which operates on supply and demand. When the package runs out the parents will need to purchase more—they won’t get another coupon.
  • Money spent on formula forms a significant portion of the budget for poor families. This means less money for the family’s other needs, including healthy food.
  • Even one bottle of formula at an early age increases the risk of allergy and Type I diabetes.
  • Formula-fed infants get sick more frequently and for longer, requiring days off of work. This affects both short-term income levels and long-term job security. Large companies in the US invest in facilities for breastfeeding employees, including private pumping rooms with expensive equipment, because employed breastfeeding mothers are more reliable employees.
  • In haredi society where artificial birth control is discouraged, breastfeeding serves as a natural means of spacing children. Even if you don’t believe that it is a reliable method for an individual mother, there is no question that it delays return of fertility within a large population. Closely spaced children put economic and physical stress on families.
  • Maternal Health. Formula-feeding mothers have higher rates of breast cancer and Type II diabetes.

But what about the free market?

Formula should not be subject to marketing competition for several reasons:

  • It’s meant to replace a free, readily available and superior substance. When formula is necessary (in the absence of regulated milk banks), it should be available at low cost, without fancy packaging and advertising.
  • We limit marketing and sales of cigarettes to children and teens. Surely babies should be protected just as much. While parents must be the ones making health decisions for their children, these decisions shouldn’t be influenced by misinformation or manipulative techniques.
  • The decision to stop breastfeeding is usually final, as relactation is a lot harder than maintaining a good supply in the first place. Just a little bit of marketing at a vulnerable point can start the course toward early weaning.

Israel is a signatory to the WHO International Code for Marketing Breastmilk Substitutes, but our health ministry rarely enforces it.

You may also enjoy:

M* Mitzvah (another misguided formula PR scheme)

Breastfeeding Basics with Christina Smillie

Reports: Widespread Damage to Remedia Babies 7 Years Later

 

 

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Comments

  1. “This is an especial concern in the haredi community in Israel, where women have lower life expectancy than men (!).” – Source? That’s a statistic I’d be particularly interested in seeing with it’s detail (such as leading causes of death among charedi women).

    • Akiva, I looked it up and it may be wrong, apparently it is difficult to find accurate statistics by sector. In the meantime I took out the line. Thanks!

  2. It was mentioned at the fertility conference I attended. I’ll see if I can get the source.

  3. Source for the idea that one bottle of formula causing allergies, obesity and diabetes? I think that would be extremely difficult to control for genetics, class, diet, and the myriad of variables that can really be the cause of these maladies. I’m suspicious of any claims pointing to a single thing mothers do in childhood that dooms their children for the rest of their lives. Aside from the fact that I’m sure there are plenty of overweight/borderline diabetes adults walking around whose mothers exclusively breastfed them for six months at least, like my husband.

    • I didn’t write doomed–I said that it increases the risk. Yes, there are many factors. But aside from studies showing a connection, there is aspecific reaction in infants who receive early exposure to cow’s milk protein. By the way I meant to write Type I, as the relationship with Type II is more controversial.
      Borch-Johnsen K et al. (1984) Relation between breast-feeding and incidence rates of insulin-dependent diabetes mellitus. A hypothesis.
      Malcova H et al. (2006) Absence of breast-feeding is associated with the risk of type 1 diabetes: a case-control study in a population with rapidly increasing incidence
      Perez-Bravo E et al. (1996) Genetic predisposition and environmental factors leading to the development of insulin-dependent diabetes mellitus in Chilean children
      Gerstein HC (1994) Cow’s milk exposure and type 1 diabetes mellitus. A critical overview of the clinical literature. http://www.ncbi.nlm.nih.gov/pubmed/8112184

    • This page has resources regarding allergies: http://www.health-e-learning.com/articles/JustOneBottle.pdf. By the way, the AAP recently said that delaying allergenic foods longer than 4 months or so doesn’t help prevent atopic disease (including most allergies, eczema and allergic asthma) even in allergenic families. There is also a new study showing that hypo-allergenic formulas also don’t prevent development of allergies: http://www.jacionline.org/article/S0091-6749(10)00740-2/abstract The connection between allergy and early exposure to cow’s milk is the easiest to document, because allergies start earlier than the other diseases. Obesity, while also caused by many factors, seems to be dose-dependent and not triggered by one exposure to cow’s milk protein so I removed it from the list.

    • I have read research (proper research) that says that one bottle changes the balance of bacteria in the baby’s intestine and has a long term affect on the baby. You can see this from the change in stools, which is not just once, but over quite a few days.

      Disclaimer: formula was essential to my baby’s well being in the first few weeks on life .

  4. I’m always up for reading posts that give chizuk in nursing! I think that nursing is the one thing that’s relatively simple for us mommies to get just right in our mothering. I know that some women have issues with it, but it seems to me that everything that comes after it in parenting is much more complicated. At least the data on this one issue is clear…

  5. Formula isn’t as evil as you like to portray it. Some of us who plan to breastfeed simply aren’t physically able to. I was unable to produce milk, even after seeing an excellent lactation consultant. I’m very grateful to live in a time when formula is available, because my babies would have been in big trouble without it.

    • So Shawna you (and I) are people for whom formula should be available at low prices. (As MIL suggests in the post)

      There is no doubt that there are babies whose lives are saved by the possiblity of formula. On the other hand the widespread distribution of large amounts of free sample should be limited. (there is a famous example of a 3rd world country where enourmous damage was caused by Nestle giving out the free formula, then mothers stopped nursing, the bought formula was too expensive so they started giving their kids formula that was diluted with far too much water and damaged their health – this was one of the reasons for the fomulation of strict codes about advertising formula)

      Another example is where my Dr used to give the kids free materna stickers, till I told him it is agains the takanot (regulations) of ministry of health (it is forbidden to give such adverts out in the kupat holim building)

  6. I don’t believe Hannah said formula was evil. She talked about the epidemiological impact of formula on the entire population, not the impact on your family, Shawna.
    I think the point is that a mother struggling to breastfeed will give up more easily if she has formula on hand. This might not be the case for some women, but for others it will definitely make BF less likely to succeed.
    Hannah, is your point that the formula companies should not be giving formula to any new mothers, not just haredim?
    Disclaimer – I just can’t believe that formula is OK – I think it has many serious side effects that we are not even aware of yet. This is a gut feeling – I am a scientist and i really trust my gut feelings.

    • This line really damns formula and mothers who give it to their children: “Even one bottle of formula at an early age increases the risk of allergy and Type I diabetes.”

      Who wants to be responsible for increasing the risk of allergy and diabetes in their tiny infants?(I believe obesity was in there previously)? Especially mothers who exclusively breastfeed after that one “sinful” bottle.

      After reading the article you linked to (titled, “Just One Bottle”, I think) it’s clear the author is very biased about her analysis. Comparing her article to one of the originals she links to (Developmental microbial ecology of the neonatal gastrointestinal tract) she skims over and simplifies a lot of the research to fit her hypothesis. The authors of the original research repeat a number of times that “Dynamic balances exist between the gastrointestinal microbiota, host physiology, and diet that directly influence the initial acquisition, developmental succession, and eventual stability of the gut ecosystem. ” This does not square with the idea that one bottle of formula could put your child at risk for the rest of their life. The GI tract is constantly bombarded by environmental influences from the home of the infant (which would be a dirt hut if the family lived in the bush), to bugs carried by every other member of the infant’s family. The infant must find a way to fight off bacteria from all of those sources and the system is extremely complex. If one bottle could “ruin” everything, I don’t think we could have lasted as long as we have as a species.

      In any case, I think to prove this supposition in any way, you’d have to find a substantial group of adults whose mothers gave them just one bottle of formula and then exclusively breastfed them afterwards and measure the rates of allergy, obesity and diabetes.

      • Abbi, we don’t live in a perfect world. Life is always a matter of benefit vs. risk.
        Formula changes the gut flora of the baby. This is an observable difference. The baby’s immune system is undeveloped at birth, and his mother’s milk contains components that help compensate for that immaturity. Cow’s milk protein stimulates a defensive immunological response in babies. These are the theoretical reasons (somewhat more than theoretical) that early exposure to cow’s milk affects short- and long-term health. It’s difficult to design studies that take into account every possible consideration, especially for complex diseases like diabetes. The definitions of breastfeeding are also not always clear in the studies. It could be that more or fewer effects on disease will be found with further research. I explained above why I removed obesity.

        My point is not that formula “ruins,” “dooms,” or “damns” anyone. Everyone has to make their own choices and that life as a new mother isn’t easy. At any rate we are not talking about direct cause and effect, only increased statistical risk. The point is that for-profit companies should not be allowed to influence parents to do something that interferes with the baby’s natural development even if the effect turns out to be “minor.” Every major health organization recommends exclusive breastfeeding for 6 months. It might not always be possible or even convenient, but the recommendations are based on a large body of research.

  7. Honestly, what signatories to the WHO code really enforce it? (Formula is big money.)

    Of course the LIST of signatory countries is impossible to find, so who knows…really, is it that much of a secret?

  8. A couple of quick comments as someone with a newborn. I came home from the hostipal with several formula samples. The first couple of days, I was supplementing, partially because one day he hadn’t had any wet diapers, so the nurses were concerned he wasn’t getting enough to eat. I made it home about two hours before Shabbat and having the samples to use then was wonderful, because otherwise I would have done nothing but nurse over the entire day.
    Also, today I managed to get a mild case of food poisoning. While I did ultimately simply continue breastfeeding, my first thought when vomiting was, “well, at least I have some formula if I need it.”

    • Jackie, I’m also nursing a newborn. She received formula at night at the hospital, because I wanted/needed to sleep. On her first day, she nursed on and off from 2-8 pm, with very unsatisfactory results, because my milk hadn’t come in (she was crying, fussy and couldn’t be put down, which meant I got no rest). According to standard breastfeeding procedure, I should have kept nursing, but I wouldn’t have gotten any sleep. I gave her over to the nursery (where after drinking 30 cc she promptly fell into a deep sleep) drank a large bottle of water, ate dinner and 2 additional sandwiches and went to sleep. I woke up at 3 am, full of milk, went to nurse her and that was that. I don’t know what continuing to nurse her that night would have done aside from make me miserable. I look at the formula in that case like an epidural in a long labor, which gave me a chance to rest and regain my strength.

    • Jackie, Mazal tov on the birth of your baby! I’m glad you had a smooth transition and that the bottles didn’t interfere with your supply.
      Babies do nurse a lot in the early days (8-12 times or more), as frequent removal of milk is necessary for more milk to be produced.

  9. Allan Katz says:

    Hi,

    Hechsherim – One of the problems is ( I am generalizing ) is that those who can afford the stricter and more expensive hechsherim don’t , and those who can’t , to the detriment of their kids buy the more expensive products. There is less food on the table.

    Giving formula samples to BFing women
    there is a very subtle message that BF is likely to fail , so while every one encourges BF , they say if it doesn’t work for you you will have this to fall back on. S mom is struggling, needs a break , baby gets a bottle and then sleeps longer than ever slept before and then mom begins to think that her milk is inadequate. Tipat Chalav nurse reckons that the baby is not putting on enough weight , mom needs to supplememt , then mom’s supply begins to suffer he joins the ever-growing ranks of women who “couldn’t” BF.

    this subtle message needs to be confronted.

    Allan

    • Allan, I understand that mehadrin formula is sometimes cheaper than regular. I agree that the formula samples and advertising undermines a mother’s confidence.

  10. Hi,

    should read ‘ he – she joins the ever-growing ranks of women who “couldn’t” BF.

    how would you define a mom who did BF ?

    Allan

  11. Nathalie says:

    I’m the mom of a newborn too, and here are my thoughts.
    1- Formula is not evil per se, but as Abbi wrote- should be used like you’d do with an epidural- when it’s really needed. My first born was fed formula after I couldn’t pump enough milk for him ( he was born at 26 weeks and after 3 months of round the clock pumping I just didn’t produce enough any more). My second child and my newborn also got formula the first day(s) in NICU because there they need a strict amount of food every 3 hours, and my milk had not come in yet.
    2-A mother should be given the choice to nurse or not her child. If pumping for a baby in NICU is too much for an already distressed mother, so be it. If she’s working full time and does not want/cannot pump, it’s also fine. Even if she just does not want to nurse for no other reason than it being her own choice, it’s fine too.
    but she should not be biased.
    3- Jackie B – you say that having the samples really helped- and I am happy for you if they did, But if it had been me, I would not have given them, just continued nursing- yes even round the clock. This is how you get your supply up. The issue of “not having enough” repeats itself every so often when the baby has a growth spurt. So what, I’m going to give a bit more formula each time this happens? M y supply would never keep up with my baby’s demand then!
    4- Being given formula samples is a not so subtle way of saying “we know you won’t really make it” or (even worse) “any “normal” mom gives formula ” – after all, the formula samples come with diaper samples which “everyone” needs for their baby too…
    I think hey should not hand them out… or at the very least , hand out a voucher. If you actually have to go out to the shop to get your sample, then at least the mother might put it some though before she sets out to the store ….

    Just a side note. When my sister gave birth (outside Israel) almost a decade ago, she got beer together with her formula and diaper freebies, since “beer brings milk in”. Now had would you react if you got this here too!!!

    • I recently read a theory about “growth spurts.” because apparently the amount of intake doesn’t increase with the frequent nursing (although the amount of milk might). According to the theory, the extra nursing is in reaction to normal pain from bone growth at these ages. An example of how hard it can be to tell why the baby is crying.

  12. I had my first son in Australia and my second in the UK. My two daughters were born in Israel. I was really suprised how readily available formula was in the hospital in Israel, with everyone being advised to “top up” the baby at the end of every feed. The formula was readily available in sterile bottles that all the new moms I spoke to had used it within a day of giving birth. They all said they liked knowing how much their baby had eaten, and I saw moms who’s babies had finished a feed and were turning away fromt he breast then offering a bottle.

    On the other hand, my sister’s experience in the UK, which very much backs the “breast is best” meant that when BF didn’t work out for her she was left feeling really guilty and quite ignorant about how to formula feed her baby.

  13. I was planning on nursing exclusively when my first daughter was born, but a combination of things (undiagnosed pregnancy induced hypertension and being back in the hospital, extreme stress from moving and my husband being sent out of town when she was a week old) caused a huge delay in my milk coming in. My pediatrician (who is pro BF) told me to nurse first and then if she seemed hungry to give her a bottle. This worked really well until my milk came in (after nearly two weeks) and because i had a supportive Dr and mother i kept going and she nursed until 18 months (would have gone longer but i was pregnant again). With my second daughter was born she was 3 weeks early. Pediatrician recommended supplementing until my milk came in which i did and i had a wonderful nursing consultant who gave me a lot of support and did not undermine the doctor. DD2 nursed for 13 months and the self weaned. both of my daughters are healthy, suffer no allergies and have had no delays B”H. They are happy well adjusted children and had both nursing and formula. Having formula available for those who need it is important, which is why it is available through WIC (a program in the US for poor mothers), but women should have the support to BF if they are able to.

  14. There are a lot of wonderful insightful comments already, so I’ll just say this – formula should be available to those who NEED it, but if the only cases of formula use were those of real need, formula manufacturers would never make the big bucks they make now, and they KNOW it.

  15. oh, I’m late to this discussion, but thank you for your detailed and straightforward analyses, Hannah.

    Everyone’s individual situation is different, and I am sympathetic to mothers who believe they couldn’t breastfeed. But honestly – if all the women who believe they “could not produce enough milk” for their babies really couldn’t produce enough milk, our species would have died out long ago.

    Nursing just isn’t supported in the US and Israel, from what I hear and observe. Formula is pushed. Even expectations are twisted. Newborn babies are supposed to nurse constantly (well, five minutes at a time, punctuated by brief periods of sleep.) They also tend to cry a lot. That is normal, and healthy. But mothers who don’t get enough support/recovery time in the beginning can feel this is impossible and there must be something wrong with them or their milk. And that bottle of formula is waiting right there on the counter. Even when there is nothing wrong and baby is gaining lots of weight and developing normally, doctors hand out free tins of powdered formula “just in case.” And if mom says no thank you, they press them on you! (This really happened to me, about six weeks ago, right after the doctor exclaimed at how fast my newborn was growing and how there must be “no problems feeding”.) I am sure they have no idea that what they are really doing is undermining the baby’s health, but it is. Until this culture of formula feeding changes, many women will find their efforts to feed their baby in the normal manner are not supported, and will continue to believe they “couldn’t” breastfeed.

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