Why Formula Marketing in Israeli Hospitals is Bad for Babies

My post on Green Prophet yesterday turned out different than expected:

Why Baby’s First Gift Shouldn’t Be Formula from the Hospital
By Hannah Katsman

Soft drinks. Fast foods. Cigarettes.

Companies that market these products are well-known for targeting children and teens in order to develop “brand loyalty.”

But the campaign to capture the taste buds of future consumers begins even earlier–in the hospital nursery, where formula companies use aggressive methods to ensure that babies’ first taste of artificial milk comes early and bears the name of their company.

They know that parents are most likely to continue feeding the brand served to babies in the hospital.

What’s the problem with formula, and why is this a “green” issue?

Ironically, early introduction of formula and a diet of “junk” food are both implicated in increasing the incidence of diseases such as diabetes and obesity.

Formula companies insist that they do not want to undermine breastfeeding–they merely want to compete for their share of the formula market for women who cannot or choose not to breastfeed. Sound familiar?

Cigarette companies have long claimed that they do not encourage smoking and only want current smokers to switch brands. Most governments reject this claim and severely restrict the way tobacco companies market their products.

Breastfeeding is an easy target. It’s free, already under attack, earns little profit for anyone and therefore has virtually no corporate funds backing it. But just one bottle of formula compromises a baby’s immune system and increases the risk of illness in the short and long term.

A bottle of formula implies that formula is endorsed by the hospital, and worse, sends the not-so-subtle message that the mother’s own milk is not good or plentiful enough. And just like it only takes a few cigarettes to become addicted, early introduction of formula can lower milk supply and is associated with early weaning.

Israel and the WHO Code

The World Health Organization (WHO) recognized the deleterious effects of formula marketing on the health of babies and mothers and developed the WHO Code of Marketing Breastmilk Substitutes in 1974. The aim of the Code is to

. . . contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

The Code prohibits companies from targeting pregnant women, parents and health-care workers with free samples and promotional and “educational” materials.

As a signatory, Israel is obligated to enforce these prohibitions. There has been some progress: Gift bags of formula samples are no longer given out to mothers as they leave the hospital, and formula advertising and samples have largely disappeared from Tipat Halav, the government-sponsored well-baby clinics. Yet serious infractions occur with the tacit approval of the health ministry.

Formula Companies Target Public Israeli Hospitals

In January 2008, Ynet investigated the relationship between Israeli maternity wards and the two large formula importers, Materna and Similac. (The third company, Remedia, withdrew from the market after a lack of vitamin B-1 in a batch of soy formula led to the deaths of three babies.)

Despite the fact that the hospitals are publicly owned, the hospitals and the health ministry refused to release data regarding their agreements.

Ynet reported that every three years hospitals submit a tender for their supply of infant formula. Usually, an institution tries to buy a product at the lowest possible price. But in the case of formula the companies actually pay hospitals for stocking their products exclusively. Reportedly these contracts earn hundreds of thousands of dollars of shekalim for the public hospitals, and at least one hospital received valuable state-of-the-art equipment.

Others received outings for its staff, linens, and funds to hire additional “lactation consultants,” creating a serious conflict of interest. In return companies earned the right to provide a constant supply of pre-mixed bottles of formula with the company’s name and logo in large letters.

Ninety percent want to nurse, only 70% do

According to health ministry statistics, 90% of pregnant women intend to nurse, but a full 70% of babies receive their first bottle in the hospital. It’s easy for a nurse to offer a bottle to a mother who has even a mild concern about her baby’s feeding patterns. Worse, babies often receive formula against parents’ wishes. Hospitals allow a situation where overworked staff suggest formula instead of ensuring that trained staff sit with the mother, answer her questions and help her breastfeed. But Israel’s health-care system may be acting against its own interests by accepting formula money–one study showed that the it costs huge sums to treat health problems of formula-fed babies in the first year alone.

Big business must be kept out of the public health system through legislation, and Israel should not permit infant-formula companies to influence health-care decisions relating to newborns. Parents deserve accurate, unbiased information about the risks of formula. The health ministry must ensure that all mothers have easy access to instruction, information, and their babies–without input from self-interested parties.

Often there are questions about whether a newborn is getting enough to eat. The appropriate medical response is to evaluate the situation, and, if necessary, encourage the mother to express colostrum–her own antibody-rich milk. Formula should be reserved for cases when it is truly needed. Stopping formula gifts to hospitals is a critical step in ensuring that our babies get the healthy start they deserve.

Reprinted with permission from Green Prophet.

Related:
Babies and Breastfeeding: What Did You Not Know but Wish You Had? Thanks to the readers who shared moving stories in the comments.
Breastfeeding and Judaism
Guest Post on Crunchy Domestic Goddess: Diane Wiessinger in Israel on Breastfeeding Language

Check out the 2016 fashions at Hydrochic modest swimwear.

Comments

  1. Fantastic post! Can you translate it into Hebrew to send to the hospitals and/or Israeli newspaper? I would offer, but could not translate it. Wow – to this day I still get adds from Materna and my baby is 1.5. I just throw them away. This is exactly what I meant when I wrote that women do not get support to breastfeed and even get overt messages NOT to breastfeed. The poor mothers whose breastfeeding experience is underminded by this.

  2. Great post. Thanks so much for writing about this. I cannot get some people to understand why I’m part of the American, “Ban the Bags” movement. The more I find out about how the business side works, the more furious I am.
    I once wrote briefly about our experience and how the formula marketing could have killed my children (there was a recall on premie formula here in the States when my daughters were very small). People don’t realize that this can absolutely be a life or death situation. Even when it’s not so dire, it can still lead to all sorts of problems for both mom and baby.
    Here’s my experience: http://offthespaceship.blogspot.com/2007/04/were-you-sold-out-for-sandwich.html
    If more people fully understood how this works, I think far more people would truly understand that they and their babies are being sold out.

  3. I agree with sylvia rachel. I read this post and couldn’t keep my mouth shut. I just had to respond but in a lengthy way. Check out my blog for details.

  4. sylvia_rachel says:

    Excellent post!
    I get so frustrated trying to explain how extremely non-altruistic certain formula-company behaviours are (such the “clubs” where they send you samples and coupons, and the “welcome packages” that are full of samples and coupons, and the monetary and in-kind “donations” to hospitals and clinics …).
    And my least favourite sentence: “It doesn’t hurt to have a can of formula in the cupboard, just in case…” (Following the example of another poster to the parenting message board where I used to hang out when my daughter was younger, I took to responding with “In case what? In case both my breasts suddenly fall off?”) It really does send a very strong message that everyone will need to supplement with formula at some point, that it’s no big deal.
    And, yes, rule number 1 is Feed The Baby. But in so many cases it would never get to that point if the parents had good information and adequate support, instead of formula coupons and free samples and “helpful” hospital staff giving the baby a bottle …

  5. I think this post is very powerful.
    My baby was given a bottle in hospital as I had a ceasarean. Maybe those first bottles caused her problems suckling?? Who knows?
    At any rate, in hospital here, you still have to write a big notice “BF only” in the crib, and the nurses will tell you that your baby is only crying since you will not allow them to give the baby formula.
    re the WHO code, I had to argue with my children’s Dr. that it was against the instructions of the Ministry of Health for him to give Materna stickers to children who behaved well (and he has stopped doing this).
    Keep up the good work.

  6. Lion of Zion says:

    i don’t disagree that breastfeeding is better, but . . .
    1) i don’t agree with the cigarettes/junk food to formula analogy. cigarettes/junk food are not a replacement for anything and play no role in supporting healthy living. formula does have an important role. it may not be the best option and it may (or should) not be for everyone. but there is a legitimate need for it.
    2) how strong is the link between formula and obesity/diabetes?
    3) “A bottle of formula implies that formula is endorsed by the hospital . . .”
    where do you draw the line with this? does the hospital appear to endorse specific drugs it places on formulary (which is definitely influenced by economic considerations) or the toilet paper it stocks? (that was an attempt at humor, not trying to be snide.) hospitals don’t generally offer a choice of anything.
    4) maybe my wife was an exception but i’m pretty sure that in the hospital he was on formula but then breast milk at home.
    anyway, is the US a signatory to that WHO code? we definitely received promotional items (i don’t remember if it included actual formula or not)

  7. mother in israel says:

    Thanks Ariela. I’m not too optimistic about it getting published in Hebrew.
    Thanks, Reiza. These things are scary when you are talking about a premie. Israel had started talking about a human milk bank for premies, which would pay for itself in reduced hospital stays. I haven’t heard anything about it lately.
    Hi BB, thanks for your response. I plant to comment on it soon.
    Keren, good for you for educating your doctor. Unless mothers speak up things will not change.

  8. mother in israel says:

    LOZ:
    1)It’s not a perfect analogy as products. But as far as marketing and consumer brand identification, it works. Yes, there is a legitimate need for it. Now while fast foods are bad and unnecessary, adults make their own choices and can limit how much they eat. Babies have no say, formula may be their only food source during a critical stage of development, and once the mother’s milk supply has dropped to a certain level it will be very difficult to restore it. The choice to breastfeed or bottlefeed is eliminated once the baby has been weaned. (But women motivated to relactate have succeeded.)
    2) Hard to say, but enough to raise a concern. There are other studies mentioned at the bottom of this page:http://diabetes.diabetesjournals.org/cgi/content/abstract/48/7/1389 and this one: http://www.bmj.com/cgi/content/full/319/7203/147
    I linked to both articles in the post itself.
    3.LOZ, we know that there are ethical problems surrounding marketing of prescription drugs. But why is offering formula to a baby that doesn’t need it different from giving a drug to a patient who doesn’t need it?
    4. Your wife’s experience is common. Mothers whose babies got bottles in the hospital may still nurse, but wean earlier as a group.
    The US is not a signatory and it’s a big busha (embarrassment). But gift bags of formula for new mothers have been outlawed in MA, and I believe NYC.

  9. for the record, that particular cow’s milk and diabetes connection study is not considered conclusive for other places (esp. the US. not sure about here in israel) it was one study in finland that others could not replicate, and the current thinking is that maybe it had/has something to do with very specific beta caesin’s in that herd of cows.
    my daughter, who nursed exclusively until 10 months old (with some failed attempts at introducing solids after 6 months) and continued to nurse until about 2 years old, was diagnosed with type 1 diabetes at 12 months old. all the nurses in the hospital saw me nursing her and said ‘we thought that nursing prevents diabetes’.
    at that point, that finland study had just come out, and was still common thought. i’d just say to that, that it is a statistical thing too – may be less likely to develop, but could still develop diabetes.
    (i’m speaking to type 1, not type 2, where the obesity link may come into play)

  10. for the record, that particular cow’s milk and diabetes connection study is not considered conclusive for other places (esp. the US. not sure about here in israel) it was one study in finland that others could not replicate, and the current thinking is that maybe it had/has something to do with very specific beta caesin’s in that herd of cows.
    my daughter, who nursed exclusively until 10 months old (with some failed attempts at introducing solids after 6 months) and continued to nurse until about 2 years old, was diagnosed with type 1 diabetes at 12 months old. all the nurses in the hospital saw me nursing her and said ‘we thought that nursing prevents diabetes’.
    at that point, that finland study had just come out, and was still common thought. i’d just say to that, that it is a statistical thing too – may be less likely to develop, but could still develop diabetes.
    (i’m speaking to type 1, not type 2, where the obesity link may come into play)

  11. mother in israel says:

    Chanie, thank you for sharing that information. I’m sorry to hear about your daughter and I hope she is doing well. I’ve never heard of diabetes being diagnosed so young. How common is it?
    Thanks, Ariela, for taking the time to locate those articles.

  12. This is from a peer reviewed medical Journal from Pubmed about the benefits of breastfeeding over bottle feeding (one of many):
    1: Evid Rep Technol Assess (Full Rep). 2007 Apr;(153):1-186. Links
    Breastfeeding and maternal and infant health outcomes in developed countries.Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J.
    OBJECTIVES: We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries. DATA SOURCES: We searched MEDLINE(R), CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were searched through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts. REVIEW METHODS: We included systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding and relevant outcomes published in the English language. Included studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. The studies were graded for methodological quality. RESULTS: We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear. CONCLUSIONS: A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.

  13. Sorry to hog up your comments, but here is another link to a great paper. THe previous paper talks about correlations and this one discusses causation:
    http://www.ncbi.nlm.nih.gov/pubmed/11115792?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  14. catching up on old posts…
    You mentioned a few posts ago about starting nursing on the left side. I took a class a couple months ago to become a CLC, and the teacher said something about this in “hebrew writings.” Do you know where I could find this? Also interesting – we saw a couple videos on baby led bfing, and in EVERY ONE the baby went on his/her own to the left side first – it was amazing.

  15. mother in israel says:

    From a comment by Erika on the Green Prophet article:
    According to, Tzava?at Rabbi Yehudah HaChasid, ?When nursing her newborn child for the first time, a mother should begin on the left side. because the baby should have his first meal from the place that?s closest to the seat of understanding – the heart.?
    I believe this line of thought in Judaism proves the important role that breastfeeding DOES have in both feeding and mothering a child.
    I think Marilyn Tokayer (search for a review of her book) has pointed that out as well–that babies seem to choose the left side after birth. Of course if most of them are right-handed and they are on their mothers’ stomachs, face-down, it makes sense anatomically too.

  16. Tired of Arguing says:

    First of all, Marilyn Tokayer holds extreme views. As an RN and mother of 5, I find her dogmatic and intolerant of the situations of specific women. Tokayer has good intentions, but makes it sound as though every mother who does not comply with her ideal is, if not criminally negligent, at least a bad Jew. I don’t own a copy of her book, (though I have read it) or I’d give you some quotes. Tokayer is a True Believer in the Eric Hoffer sense, and the wise consumer of ideas is wary of such fanatics.
    There is no need to treat the adult mother as a child unable to make her own decisions. She should have access to the facts, which are that nursing has certain absolute advantages for both mother and baby, especially if baby is premature and/or suffers from special problems. She should be offered coaching and information both in hospital and in the community how to facilitate the nursing process and how to best continue it as long as she wishes.
    She should also have access to information about how to bottle feed safely, should she so choose, and how to wean when she finds it necessary or even just preferable. When I decided to bottle feed Baby #2, it was actually difficult to find specific information.
    Baby #2, as I have noted here before, turned out fine, and I went on to nurse babies #3-5 for over a year, as I had Baby #1. By choice.
    Letting adult women receive freebies at the hospital is not like Tom Lehrer’s “Old Dope Peddler” giving the kids free samples to get them hooked. Formula is an OPTION, sometimes the best or the only option. It is not perfect, but it isn’t crack cocaine.
    Let’s treat mothers like responsible adults.

  17. mother in israel says:

    Tired of Arguing:
    I won’t debate the views of Marilyn Tokayer, who is a personal friend. But I am willing to clarify my own views.
    I agree with much of what you write. Women are adults, they can choose to formula feed if they like, and they should have access to accurate information about breastfeeding and weaning. Safe bottlefeeding is not my expertise (and no one asks me), but I do provide information on weaning whenever a mother asks. Formula companies should provide safe bottlefeeding information with their products.
    I am wondering if you feel that your decision to bottlefeed #2 was questioned, or judged, by some. If so I’m sorry you experienced this. No one should second-guess a mother’s reasons for not breastfeeding.
    Formula marketing material does not give objective information about breastfeeding–it gives biased, misleading information. The marketing and formula samples don’t even help bottle-feeding mothers, because they significantly raise the price of the product.
    It is well-known that free formula samples are instrumental in encouraging new parents to start bottle-feeding–a spur-of-the-moment decision they may regret later. It’s naive to say that the marketing has no influence on inexperienced –and even experienced–parents. And unlike with other products, the consumer–i.e. the baby–has no say in the matter.
    Acknowledging this and prohibiting the marketing is not the same as forcing people to breastfeed or preventing mothers from getting information about weaning or formula feeding. No one is stopping anyone from using formula, even in the hospital.
    However, the choice between formula-feeding and breastfeeding should not be presented as equal, with advantages and disadvantages, any more the choice between a vaginal birth and and c-section (although we are headed in that direction. Obviously, not a perfect analogy.)
    Formula feeding is an intervention, while breastfeeding is the biological norm.
    All mothers know about formula. We are not denying its existence by banning its marketing in the hospital.
    And one more word about choice. Mothers only have the choice while they are breastfeeding–they can continue or they can wean at any time. Once they stop nursing, though, it’s harder to rebuild milk supply. Stopping nursing for just one day can lead to a baby refusing to nurse, and an uphill battle with regard to milk supply. Most mothers do not even know that relactation is even possible.

  18. mother in israel says:

    Thanks, Keren. I also know of recent cases where formula was given against the mother’s wishes.
    ToA–I went back to find your previous comment. I missed it and I apologize. I’ll respond in a few minutes:
    http://www.haloscan.com/comments/motherinisrael/2849806166135956393/#95119

  19. I would like to add and emphasize the problem. Formula is given in Israeli hospitals without the mothers persmission. My Daughter’s friend just gave birth and she said that there are fixed feeding times in the hospital and if the baby cries in the middle it is given formula, so she therefore tries to go often to the nursery!!! (this week, not 15 years ago).
    My SIL gave birth a few years ago, the first baby was allergic to milk, they had not time to tell the hospital this before baby no 2 was given formula and became ill!
    When hospitals have formula that they do not have to pay for, they do not think twice before stuffing a bottle of formula into the mouth of any baby that cries too much whose mother did not WRITE THAT SHE DOES NOT AGREE.
    i.e if formula was not given to hospitals free of charge as a promotion, the attitude of nurses in the neonatal units towards encourageing nursing would be different

  20. I know that it is a bit late to comment on this post, but I wanted to ask if anyone has ever heard of using frozen cabbage leaves to relieve engorgement? I came across this in a work of fiction; the nurse in the hospital recommends it to the new mother. In the book it works. I wonder if anyone has tried it in RL.

  21. mother in israel says:

    I’ve never heard of frozen cabbage, only fresh. I’m not sure that it’s ever been proven to work. Nowadays the most common recommendations for treating engorgement are frequent nursings, ice packs and analgesics. Ice should be removed 15 minutes before a feeding.

  22. Yes, I did the frozen cabbage for engorgement thing. Worked for me.

  23. The explanation in the book was that there is a chemical in the cabbage that is effective in this case. I suppose that the chemical, combined with the cold — like the ice packs — would offer a 2 pronged attack. I didn’t find ice packs terribly helpful and wasn’t told of anything else really. I did express to ease the heaviness even though I was told that would just increases the milk supply.

  24. mother in israel says:

    Tired of Arguing:
    Thank you for the efforts you make for mothers and babies in the surgical ward. Nursing mothers face many challenges when their babies need treatment.
    There has been tremendous improvement in hospitals, but there are still serious problems. Not one Israeli hospital has a “baby-friendly” hospital initiative designation (BFHI).
    Israeli maternity wards do not buy formula. (I don’t know about expensive premie or hypoallergenic formulas.) Not only do they not pay, the hospitals receive funds and gifts for stocking a particular brand exclusively. The health ministry does not deny this, as you can see from the Ynet article I linked to.
    Not that this is proof, but when my friend’s baby was in Schneider children’s hospital for a virus, they dropped off a bottle of formula at every feeding even though she told them she was nursing. Rehospitalization of mother or baby is a big risk factor for early weaning.

  25. Tired of Arguing says:

    “i.e if formula was not given to hospitals free of charge as a promotion, the attitude of nurses in the neonatal units towards encourageing nursing would be different”
    Keren, I think we have a misunderstanding here. Hospitals definitely pay for their baby formula, just as they pay for all other medical supplies. The only thing being given out is the bag of freebies the mother gets from the companies, and as that is the personal property of the patient. the hospital doesn’t touch it.
    Mothers who want to make sure their baby is nursed exclusively need only request that a relevant note be put on baby’s bed. It’s no more convenient for the nurse to give the baby a bottle than it is for her to page the mother to come feed him, in fact, it’s less work.
    Israeli hospital policy is, in fact, very pro-lactation, particularly in Neonatal Intensive Care.
    As an Israeli-trained nurse, I received hours of classroom and clinical training that was exclusively pro-lactation, including instruction on how to encourage nursing childred with surgical or other problems.
    I work in a Pediatric Surgery ward, and we supply pumps and storage space for mothers who need to store milk, and frequently spend the extra time preparing bottle- or nasogastric-feedings of expressed mother’s milk when the mother herself cannot be there.
    I finally beat it into the heads of some of the medical residents that according to research, pre-surgical fasting time for mother’s milk is 4 hours only, not 6 hours as with formula, though there are medical sources who hold that 3 hours is enough.
    We do have a high percentage of Russian-trained nurses, and one of them told me that the nurse-baby ratio in the neonatal nursery where she had worked in Russia was so bad that policy was to give the off-hour crying babies, not formula, but phenobarbitol, literally to knock the baby out.
    As a nurse and as a mother, I am definitely pro-lactation, and my education, experience, and training all incline in that direction. However, as a citizen, I believe that women of sound mind are adults who are capable of making their own decisions. It is no more desirable to be watched by “Big Mother” than “Big Brother”.

  26. mother in israel says:

    TOA,
    Please don’t put words into my mouth. I never suggested or implied that one should avoid medical treatment to prevent weaning. Obviously sometimes weaning or temporary weaning is necessary. I’m not referring to those cases.
    Like I said, I respect what you do to protect breastfeeding in the hospital. I’m agreeing with you–it takes special effort on the part of the staff. This is not a given.
    I’m aware of the issue with soy formulas.
    Thank you for sharing your real-life experiences in the hospital, from the perspective of a health-care professional.

  27. Tired of Arguing says:

    Well, of course rehospitalization brings a risk of early weaning. Please do bear in mind that babies are not rehospitalized for fun but because their health or lives are at risk. Early weaning is not the best option, but it is better than early death. Please try to keep your sense of proportion here.
    Post-surgically, one of the problems with nursing is that surgeons may need to know exactly how much food the baby is getting and/or absorbing. In these cases, weighing the baby before and after nursing isn’t precise enough, as our scales are not exact enough. Babies are frequently given expressed mothers milk in bottles or in neogastric tubes, if they can’t or won’t suck effectively, or if they only absorb efficiently when given food in slow, constant drip feedings. We often monitor absorbtion effieciency by removing, measuring, and reinserting the “remainder” of the stomach content. If the food is just building up, inert, in the stomach, we need to know.
    There are also babies who cannot absorb and digest mothers milk, who may be given special formulas that are easier to break down. They may be weaned early, but this also may allow them to live.
    We have many lively discussions with some of the doctors as to whether it is better to begin post-surgical nutirition with glucose water or with expressed mothers milk. It often does not occur to the physician that mothers milk, being a physiological substance, is by definition simpler than sterile water. This is scientific, not sentimental or magical thinking.
    Our department most definitely has to pay for formula. We’ve had problems with shortages when Palestinian mothers were caught stockpiling and stealing it to take home.
    The Remedia soy milk scandal was attributable to bottle feeding for more reasons than you may suspect. Obviously, in the majority of cases, human milk is the most easily tolerated. Having gone over to artificial formula and experienced feeding or absorbtion problems, many parents and even doctors erroneously assume that soy formula will be “better” than the cow-based formula. Then they are surprised that reconstructing a formula for a lactating mammal may be more complicated than they at first thought. We don’t routinely carry soy formula any more, it has to be specially ordered. I have no doubt that the well-meaning but hypochondriacal belief that “more intervetionalist” is better leads to a lot of babies being unnecessarily put on the inferior soy formula.

  28. mother in israel says:

    One more point: I don’t know that paging the mother is easier. If that’s true, I don’t know why so many babies seem to get formula against their mothers’ instructions. But the babies should be with their mothers in the first place, barring exceptional circumstances.
    If Israeli hospitals are so lactation friendly, why aren’t any of them “baby friendly” according to BFHI standards? Read the steps and tell me whether they sound like “Big Mother” or the “nursing police” to you. Until they are implemented I will continue to speak out.
    http://www.unicef.org/programme/breastfeeding/baby.htm

  29. Tired of Arguing says:

    Paging the mother is easier if your goal as a nurse is increasing patient autonomy and knowledge. Even if some mothers say they want to be called and then don’t wake up or won’t come. Even if, having done your best, Client yells at you in the middle of the night when you are only doing as she requested. Even if Client complains to Management that you woke her up, and you know you’re going to get an earful.
    Paging the mother may not be easier if your primary goal as a nurse is, and this is true of a lot of Russian-trained staff, to get the job done as quickly, as thoroughly, and efficiently as possible, and to be able to hand over an organized, tidy department to the next shift.
    The above approach is not my Nursing Mission, but they’re not entirely wrong. In departments like maternity and the baby nursery, my colleagues have to work like Lucille Ball preparing the cakes on the production treadmill that keeps speeding up. Not only are they on their feet all night (this is supposedly the quiet shift), but they literally can’t get to the bathroom. Certain non-negotiable tasks must be completed or problems get missed; they have to be ruthlessly systematic just to keep things going.
    “But the babies should be with their mothers in the first place, barring exceptional circumstances”, you say. Sounds like you’re imposing a personal preference on a public tht may not want it. My colleagues tell me that mothers who don’t WANT rooming in are frequently forced to do so becase that’s the only room that is free. My sister-in-law was pretty ticked off about this, as she preferred the freedom to leave the room occasionally. Given that both options are safe and that there is public demand, why should rooming-in be the only choice a woman gets?
    Regarding the little gift packages, I clearly remember that we drank the bottled water and gave the formula to a gemach. It was our choice to make.
    “If Israeli hospitals are so lactation friendly, why aren’t any of them “baby friendly” according to BFHI standards?”
    Maybe the Client/Consumer wants other things. Maybe (“MAYBE”???) there are budgetary constraints. I never claimed that Israeli maternity departments were perfect, merely that they supply an excellent baseline of decent care for ALL, which is more than the American health care system can claim.
    Again, my professional goal is to be the patient’s Advocate, and to encourage the patient to act autonomously as much as he/she is able, and to take full responsibility for those decisions.
    Maybe the biggest obstacles to successful lactation in modern society are not necessarily in the hospital. In most areas, there is a lack of real community support for the birthing woman an her family. Poverty, or at least relative poverty, plays a role here too.
    Humorist Dave Barry has astutely pointed out that it is absurdly easy to take care of a newborn as long as you have to do absolutely nothing else. Adult women have t

  30. I don’t understand why Meir Hospital isn’t considered baby friendly. All of the nurses are lc’s or have been trained to aid in breastfeeding; they won’t give out pacifiers even on request (i know, I tried); they certainly won’t give formula without consent; and they expect the baby to be with the mother all day if they are not rooming in.
    At hadassah, they paged me throughout the night after my first was born. They finally begged me to allow them to give her a bottle at 5 am, after I had been up with her all night, when I finally consented since I had not had any rest since I gave birth at 7pm. She had literally been nursing the entire night. And since I wasn’t allowed to nurse in bed with her and I had no idea how to nurse in bed even if i was allowed to, I sitting up the entire night with her, when I desperately needed rest. I survived and she survived but sleep deprivation for a new mother is not healthy either.
    I did rooming in for my second and similarly, I was up at 2 am changing a meconium diaper. Why? I think rooming in is problematic because the mother is left literally without help when she needs it most. A mother who just gave birth needs at least 5- 6 hours of straight sleep after the birth. She should not be up changing diapers or even trying to get breastfeeding going.
    My first two babies were up the entire first night after they were born (both were unmedicated births). They didn’t get the memo that newborns are supposed to sleep for the first 24 hours, which left me awake and caring for them without help, instead of in bed and regaining my strength. I also suffered from terrible anxiety and stress because of this set up, to the extent that I was dreading it (the anxiety) as the third birth approached. (and i saw it would be compounded by another shabbat birth, like my first, when i knew once again my husband couldn’t be around till late in the day on shabbat).
    After my third, I finally got smart. After delivering at 10:30 pm, I told the nursery that I wanted him to be there till the morning, with a bottle if necessary. I needed that first night of sleep. What a difference it made. I suffered none of the anxiety that I had from the previous births, I felt much calmer the following day when I had him next to me the entire day, despite the constant noisy flow of visitors to my neighbor.
    This neighbor of mine was actually crying that first night after she gave birth, because she was worried about waking up and nursing her newborn when she was so exhausted. I told her the same thing- she needed the rest and one bottle would not kill him. And I really believe that’s true (I’m sure you’d disagree).
    I wonder how much post partum depression is compounded by the pressure to breastfeed from the get go.

  31. Tired of Arguing says:

    (Excuse me) Adult women have to make some hard choices here too. Perhaps lip service and a rigid, judgemental attitude are easier to offer from the outside.

  32. BTW, Eli did not get a bottle the first night, because he actually didn’t wake up at all. He probably would have been a great candidate for rooming in.
    Also, UNICEF probably doesn’t have any Israeli hospitals on their list because the UN generally hates anything Israeli.

  33. This is an excellent post. We are are so screwed up by corporate greed.
    Formula companies undermine breastfeeding. Pharmaceutical comanies pollute the minds of physicians. Meat and dairy industry dominate “nutrition” research (countries where meat and dairy are consumed have highest rates of heart disease and osteoporosis). Alcohol companies are teaching us to drink responsible and sponser a few theme parks/gardens here in my country(how nice of them). Tobacco companies hook you too. Marketing is so powerful. We confuse it with fact.

  34. Tired of Arguing says:

    Thank G-d for “corporate greed”. It gives us access to a lot of options we might not otherwise have, and pushes forward solutions which are profitable to solve because their solution is worth something to people.
    Formula companies will not succeed in stopping a mother determined to breastfeed her child. Serious health situations, and far more frequently, relative poverty and a lack of family and community support are far more likely to disrupt the breastfeeding connection.
    It is notable that the Arab population, which features supportive extended families, and assumes co-sleeping has a much higher rate of successful long term breastfeeding. They are less likely to breastfeed exclusively than Israeli Jews, but they continue the nursing process much longer. It’s partly the “either/or dichtomy that trios sus up.

  35. Tired of Arguing says:

    excuse me, “that trips us up”.

  36. mother in israel says:

    I agree with you, TOA, that hospital policy is not the main deterrent to bf, and that a determined woman will usually succeed even if things go badly at first. But a mother shouldn’t have to overcome difficulties imposed by the system, and it’s still unethical for formula companies to be sponsoring maternity wards.
    Abbi and PTM, thanks for your thoughts.

  37. I don’t see any problem with gifting parents with cans of formula. Those who want to breastfeed, will. I can think of situations that it can come in handy even for a fully breastfed baby: if the Mother has a medical emergency, if expressed milk has been mishandled or spilled…
    I have a friend who became suddenly ill while her son was exclusively breastfeeding. Luckily, she had a neighbor who nursed him along with her own child, but that is a rare situation and many people would not be comfortable with it. As for myself, when I was expressing milk for my preemie it was a comfort to know that if there wasn’t enough that she would still have something to eat.

    • Elisheva, many studies show that among those who want to breastfeed, the ones who get formula are much more likely to use it.
      Formula is never far away if the mother suddenly becomes ill. But if parents wants to have formula in the house in case of emergency, they should buy it instead of getting it as part of a marketing campaign via the hospital.

Trackbacks

  1. […] Formula Marketing in Israeli Hospitals […]

%d bloggers like this: