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Health

Baby bottles, boards and making mums feel like Hitler

This advert is causing a bit of controversy: it’s an EU ad about work/life balance, and it shows a laptop and a baby bottle.

There’s a very impassioned argument against it here:

But when I see a media image of a baby bottle…
…I see death.
I see all the the real maggots crawling in all the real bottles.
I see the tiny white bundles being put in the shallow shallow graves.
I see corporate greed and profiteering, being put before baby’s lives.

It’s a bit dramatic for my taste, but she does have a point. There are risks to bottle feeding, especially in developing countries.

The water mixed with baby milk powder can be unsafe and it is often impossible in poor conditions to keep bottles and teats sterile. Bottle feeding under such circumstances can lead to infections causing diarrhoea, the biggest killer of children worldwide.

Baby milk is also very expensive, often costing more than half the entire family income. This means that bottle feeding will contribute to family malnutrition. Furthermore, poor mothers trying to make the milk go further sometimes overdilute the powder, and the baby may not then receive the nutrition he or she needs.
Bottle baby disease is the name given to the deadly combination of diarrhoea, dehydration and malnutrition which is the result of unsafe bottle feeding.

Even in developed countries there are risks, which is why the NHS offers this advice:

Powdered infant formula milk is not a sterile product, and even though tins and packets of milk powder are sealed, they can contain bacteria such as Enterobacter sakazakii and more rarely Salmonella. If the feed is not prepared safely, these bacteria can cause infections – and even though these are extremely rare, when they do happen they can be life-threatening. Therefore, it is important to make up the formula milk with water at a temperature of around 70ºC.

Factor in the way that formula milk companies have behaved in the past and you can understand why people might be dead against formula. However, on mums’ discussion boards that’s often translated into something a bit different: posts telling mums that if they bottle feed their kids, they’re trying to kill them.

Here’s an example from iVillage.co.uk. This one’s a fairly innocuous example, because while I’ve seen much more aggressive posts on the subject I forgot to bookmark the links. Anyway. The post title:

higher risk of cot death in formula fed

The post links to this news story:

The Foundation for the Study of Infant Deaths (FSID) announces its latest advice that breastfeeding your baby can reduce the risk of cot death.

In the footnotes, the article links to various studies, including this one (emphasis mine), which is the one I’ve seen posted most often to support Formula Is Evil posts:

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. Also, there is a wide range of quality of the body of evidence across different health outcomes.

Back to iVillage. The original post has sparked a debate, and this post is fairly typical.

The exact reason that fewer breastfeeded babies die from cot death is actually unknown.

Which is true.

(mainly because so many of the properties of breastmilk are still unknown. And because they change form baby to baby, day to day and morning to night.)

That’s not so true. The reason we don’t know why fewer breastfed babies die of SIDS is because we still don’t know what causes SIDS.

However the most popular theories that i have heard have been these:

That as the protective properties of breastmilk result in far fewer illness and infections, this in turn is thought to lower the chances of cot death.

That as breastmilk is more easily digested by babies, and does not over fill their tummies, breastfed babies do not fall into such a deep sleep. It is thought the deeper sleep that formula milk produces, makes it harder for a baby to wake it’s self when it has difficulty breathing. (the scary sudden jolt and then deep breath, that is often seen in tiny babies).

But they’re just theories.

Here’s another theory. It could be the environment around breastfeeding in the developed world. Let’s have a look at Glasgow, courtesy of the Evening Times.

In the East End just 14% of mums were breastfeeding alone at six to eight weeks compared with 32.2% in the West End. Statisticians say there is a clear link between breastfeeding rates and levels of deprivation.

Glaswegians are all too familiar with the grim statistics coming out of different parts of the city. The Herald:

In some postcode areas in the east end, 60% of children live in workless households, almost 50% of adults of working age are on incapacity benefit and life expectancy can be as low as 54.

The contrast with some west end postcodes is staggering, where life expectancy is over 80, fewer than 5% of children live in workless households and there are virtually no benefit claimants.

I’ll cheerfully admit to doing what some of the anti-formula mums do on boards: I’m taking two different things and sticking ’em together to support the particular argument I want to make – which is that if breastfeeding is more common among well-off, well-educated people with excellent support networks and the like, in areas where fewer people smoke and exist on poor quality food, then it’s hardly surprising that health outcomes for kids are better in those areas. It could be the breastfeeding, but equally it could be that people aren’t sterilising the bottles properly. Or it could be the better food, the nicer houses or the proximity to really good restaurants. I’m not a scientist, and I’m not an expert in this field, so I have absolutely no bloody idea.

Which is why I’m not hanging around parenting discussion boards shouting OMG FORMULA WILL KILL YOUR KIDS or OMG FORMULA IS TEH BEST.

But some people are, and when I see mums try to argue against it – without disputing that breast is indeed best – they’re jumped on. People post links to scientific papers they haven’t read, or to articles whose footnotes make a very different point to the one they’re trying to make, or to other people’s interpretations of scientific papers they haven’t read, and they argue again and again that formula milk is by definition bad. Which would be fine if every single woman could breastfeed, but every single woman can’t. Some can’t for physical reasons, others because they can’t afford to stay at home with the baby. And in those circumstances, telling a mum she’s a child killer really isn’t very helpful.

Back to the advert. This time, a discussion about it on Mumsnet – from which I got the impassioned blog link.

However the fact that some parents need to, and some parents choose to bottle feed does not make it OK for governments to portray it as ‘normal’ or aspirational. Its not the same as breastfeeding and we shouldn’t have to apologise for wanting more babies to be fed in the optimal way.

All too often, though, the issue of whether governments should promote breastfeeding gets confused, and manifests itself on messageboards where mums tell other mums that bottle feeding is bad. Most women who don’t breastfeed are ill-informed, the argument goes. Which may be true, but most is not the same as all. Not all women who choose bottle feeding are doing it because they’re uninformed, or because they’re lazy, or because they’re influenced by the evil marketing of formula companies. “We shouldn’t have to apologise for wanting more babies to be fed in the optimal way” is fair enough, but the mums who don’t go that route shouldn’t have to apologise or feel guilty either.

Should formula companies be ashamed of themselves for the way they’ve marketed their products? Sure. Should more effort be devoted to encouraging mums to breastfeed? Absolutely. Should mums who can’t or won’t breastfeed be made to feel like Hitler? I’d like to think not. Messageboards can be a lifeline for new parents, and they get enough crap without getting more of it online.