I once heard a bit of sales advice, let’s say for shoes. After a potential customer has tried on two pairs, you shouldn’t ask if he likes one or the other. Instead say, “Which pair of shoes do you prefer?” With luck, the customer will accept your assumption that he has already decided to buy at least one pair.
This advice came to mind when I read that the Israeli health ministry, as stated back in June, will now be requiring maternity wards to offer two competing brands of breastmilk substitutes for newborns. Shoes and powdered milk are very different products, but both are sold using manipulative marketing tactics.
Until now, the companies paid huge sums for exclusive distribution within each hospital. Because mothers stick to the brand they got after birth, smaller companies, who can’t afford the initial outlay, failed to break into the market. This is blamed for the high price of substitutes compared to other countries.
The health ministry claims that “this is a revolution in the marketing of substitutes expected to encourage competition and the interest of the new mother in her preferred breastmilk substitutes and therefore the reduction of prices in the market. The health ministry will check the results of the reform in six months and decide on the required steps.”
Breastmilk substitutes are overpriced, but just because parents insist on buying the hospital’s suggested brand instead of buying a cheaper one (or breastfeeding) doesn’t mean there is a true duopoly (two brands out of four dominate the market). Still, the antitrust authority has decided to target the companies in an attempt to open up the market. Ironically, the drug company Teva’s new brand stands to gain the most. Why the the anti-trust authority need to help Teva, the largest generic drug manufacturer in the world, remains an open question.
All brands contain the required amounts of proteins, fats, vitamins and minerals needed to sustain a baby’s growth. Extras like oligosaccharides or probiotics increase the price, but do not lead to healthier or smarter babies. Studies have shown that use of breastmilk substitutes increases health risks for both mothers and babies.
The companies, while losing the exclusivity that guaranteed them customers for many months, have thus been granted the opportunity to extol their products to new mothers in the guise of helping her make an “informed” choice. But shouldn’t the health ministry be focusing on encouraging breastfeeding? By encouraging exclusive contracts, whether with one company or two, they are normalizing bottle-feeding in the hospital. The hospital should pay for the bottles of breastmilk substitutes, just like they pay for other supplies.
I’m wondering exactly when the mothers will need to proclaim their choice. You may remember the public uproar at the proposed law suggesting mothers sign a waiver before the hospital gives the baby a bottle, because the form might make mothers feel guilty. No one asks whether parents will feel guilty for signing permission to give a medication or vaccination. Bottles and breastmilk substitutes are an intervention that interferes with normal physiological processes, and parents need to understand the risks. Will mothers now get a form to check off their preferred brand? Or perhaps the limited amount of time with a nurse will be squandered on a pointless discussion about the advantages of the competing brands, instead of learning the baby’s cues or how to know that the baby is getting enough to eat.
An official in the health system expressed concern that the competition between distributors will trickle down into the hospitals, and distributors will use unethical marketing methods to get mothers to choose their brand of breastmilk substitute. “We’ll be playing a game of cops and robbers,” said the official. “It’s a market that generates so much money — the companies will fight using both legitimate methods, and not-so- legitimate methods. The problem is that we are bringing this battle into the delivery rooms.”
The health ministry’s website states that the goal of this is to encourage new companies to compete in the market. Yet by marketing the plan as a way to lower prices and give mothers a choice, it’s pretending to do a public service. The website fails to mention the NIS 3.5 million it will receive from companies supplying breastmilk substitutes to those hospitals it directly supervises.
Just like the shoe salesperson, the health ministry misleads parents by making false assumptions about choice. But the ministry should not be viewing mothers and their newborn babies as potential customers. They deserve the highest standard of medical care, including the conditions, knowledge and support to enable them to reach a full six months of exclusive breastfeeding as recommended by our ministry and the World Health Organization. This decision is far from revolutionary when it comes to protecting mothers and babies. By focusing on the choice between brands, the health ministry undermines breastfeeding and compromises the health of newborns.
Read more on breastfeeding at A Mother in Israel:
Breastfeeding Preschoolers: Not Sensational at All (Response to Time Magazine cover)