Remember the law, misnamed “The Law to Encourage Breastfeeding?” Unfortunately that law had nothing to do with public health but everything to do with breaking exclusivity contracts between hospitals and formula companies so that new brands could get their foot in the door. This was presented as being for the public good because more competition would mean lower costs of formula (but not as low as breastmilk).
The sponsors put in a clause about a permission form, listing risks of formula feeding, for moms to sign before their baby received formula. That clause got ditched because moms argued that they would feel guilty, putting adult emotions ahead of babies’ health.
It seems that the Israeli Health Ministry felt guilty too. Its policies are so poor that a proposed law about economics was attempting, however clumsily, to step into the ethical breach of unnecessary formula feeding to newborns. The proposed law also required hospitals to buy formula instead of getting it for free, something that ought to make the health ministry queasy.
So the administrator of the ministry’s medical department, Arnon Ofer, took the ball and published a hozer mancal, or administrator’s statement. The statement, which can be downloaded from the ministry’s website, sets up a breastfeeding policy for getting Israeli hospitals in line with the policies of the World Health Organization.
The WHO is not comprised of breastfeeding fanatics, and its recommendations are based on careful study of current research. They have been in place for years, and apply equally to developed and undeveloped countries.
I have translated the health ministry’s statement except for the Ten Steps for Successful Breastfeeding, which I took from the UNICEF website.
Date: July 1, 2012
To: Hospital managers and administrators of gynecological and obstetrical departments
Topic: Encouragement of breastfeeding
We wish to bring to your attention the wording of a statement that replaces and updates the previous statement.
Human milk is the optimal food for a baby because of its contribution to growth and development, prevention of infections, and the mother-baby connection. The health ministry recommends exclusive breastfeeding for the first six months, and breastfeeding with added foods for a year or longer.
Ensuring encouragement of breastfeeding by the hospital staff. With an emphasis on the instances of formula being given to babies.
- Distribution of gifts containing infant formula, bottles, baby food, tea or infusions is prohibited.
- Advertising formula in the medical system, including in hospital wards, health clinics and Tipat Halav, is prohibited.
- Encourage, support and protect breastfeeding through the 10 steps for successful breastfeeding (Baby Friendly Hospital Initiative WHO, 1992):
The Ten Steps:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within half an hour of birth.
- Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk, unless medically indicated.
- Practise rooming-in – that is, allow mothers and infants to remain together – 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
- Distribution of formula by the hospital:
- Each hospital with a license for a maternity word must allow feeding of infant formula with a manufacture or import permit from the health ministry.
- Hospitals will allow mothers to choose the formula from at least two different brands. This instruction will be in force from September 1, 2012 even if a hospital has an exclusivity contract with current suppliers.
- The choice of formulas for each hospital will be done through a contract with the supplier according to the procurement standards of the institution.
- Emphasis of feeding formula to newborns: Every hospital must create a clear and known protocol for all of the staff regarding the encouragement and protection of breastfeeding, training of nursing staff, paramedical and medical staff, in order to ensure the implementation of this entire statement. The introduction of the statement and the method of implementation will be checked during the health ministry’s hospital inspections.
- Formula feeding will only take place when there is a medical contraindication for the mother or baby as a result of breastfeeding, or when there is objection to breastfeeding by the mother after she received an explanation of the benefits of breastfeeding.
- The options of choosing between kinds of formula with an explanation of how to feed the baby formula. In every case of an instruction to give formula or other liquid to the newborn, the instruction will be marked in the mother’s and baby’s chart with a note that an explanation was provided to the mother.
- The nutritional instruction will be noted carefully and include:
- The type of formula chosen by the mother;
- Content and amount of the recommended feeding for each meal, and the amount that the baby actually received;
- Emphasis on clear and exact charting is essential to avoid mistakes in feeding the baby.
- Every hospital must create a clear protocol on advertising and marketing known to the entire staff about the encouragement and protection of breastfeeding, providing training for nursing, paramedical and medical staff, in order to ensure the complete implementation of this statement. The presentation of this protocol and the manner of its execution will be checked at the health ministry’s hospital inspections.
- We again repeat and emphasize the prohibition of advertising and marketing infant formula in hospitals or by hospital staff. The importance of this prohibition is especially important in light of the choice that will be given to mothers between types of formula.
Signed by Professor Arnon Afek, administrator of the medical division of the health ministry.
The Health Ministry has sent out similar recommendations over the years, but they were not implemented. Perhaps this time things will be different.