0 Should We Trust Similac's "The Mother'Hood"?

If any of you frequent parenting blogs, Facebook groups, or classes, you no doubt saw a link to Similac’s new video “The Mother’Hood”. Trust me- please watch…

I laughed (and cried) watching this video, because it is right on. My favorite line:
“Drug-free pool birth, dolphin assisted”.

In my 51 weeks of parenting so far (yes, my little guy will be 1 year old next week!), I have found the following issues to be HOT and often full of judgment in my circle of parenting groups:

• Feeding- the early months (breastfeeding vs. formula feeding- or both!)
• Feeding- the later months (purees vs. baby led weaning; organic food vs. regular food; how and when you introduced solid food)
• Vaccination 
• Stay at home vs. parents who work outside the home (and many parents, fall into both camps depending on the day!)
• Car seats (how long you stay rear-facing; whether you use them on planes)
• Cloth vs. disposable diapers (and other decisions which impact the environment)
• Sleep practices (cribs vs. co-sleeping, crib bumpers, sleep training)
• The type of childcare you select (day care center, in-home daycare, nanny, au pair) 

The list could go on and on….and these are just the hot topics I’ve found in the infant world!

The Mother’Hood Message: Why Does It Help?

The reality is that new parents can often feel very isolated and judged. This has many public health implications, especially for women at risk for postpartum depression. So for that reason, I like the primary message of the campaign which is that we should focus on the things that unite us, not divide us. At the end of the video, we read:

“No matter what our beliefs, we are parents first”.

And although the “cliques” (e.g., the bottle feeding group, the breast feeding group) are meant to show our separations…I also think it can mean that you will find others to spend time with who have a similar approach to parenthood that is compatible with yours. And that is reassuring.

This video is part of a larger campaign from Similac called “The Sisterhood of Motherhood”. The tag line for the campaign is, “Where moms get encouragement, not judgment”.

Can We Trust This Message From a Formula Company?

When I watched the video, I thought to myself- “makes sense this comes from Similac, their customers know a thing or two about being judged”. As I have previously written, it concerns me that public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

So I was a little surprised to see (in social media and news article comments) that many viewers liked the video until they realized it came from Similac. Some expressed feelings that the message was less genuine since Similac stands to benefit financially when there is less public stigma about formula-feeding. One commenter wrote, “I was all for this, until I found out that it was created by Similac”.

Tell Me What You Think:

• Does the fact that the video comes from a formula company make the message less meaningful or genuine? 
• Why or why not?

And Can We Trust A Message That Forgot About Dads?

I was really excited to see Dads in the video! They were baby wearing and caring for their kids- it was great. They were even included in the tag line “No matter what our beliefs, we are parents first”…but in the next screenshot, we find out they were excluded from the campaign overall: “The Sisterhood of Motherhood”.

Many online commenters focused on this exclusion. Several asked, “Why not call it “The Parent’Hood”.

In my opinion, this is an unfortunate miss in an otherwise funny, relevant, and moving video. Why include Dads in the video just to exclude them at the end? What about families that have two fathers or a father who serves as the primary caregiver?

Tell Me What You Think:

• Was the video and overall message ruined for you because fathers were excluded? 
• Why do you think that the video and campaign developers made that decision? 
• Do you think they regret it now?

Detail: Should We Trust Similac's "The Mother'Hood"?

0 Olivia Wilde, World Breastfeeding Week, Infant Formula, and A Critique of the Language We Use to Talk About It

My son taking a bottle of formula in the NICU (February 2014)

When my baby boy arrived, he weighed 4 pounds, 13 ounces. He entered the world 8 weeks early and spent 29 days in the Neonatal Intensive Care Unit (NICU). When your baby is in the NICU, there is enormous pressure to breastfeed. The nurses rolled a hospital grade pump to my bed side just hours after delivery and minutes after my first visit to my baby’s incubator in the NICU. “Breast milk is like medicine for preemies”, I was told. Every day I pumped around the clock and delivered milk to the NICU in the insulated bags they provided…like I was packing his lunch for school. Every milliliter was carefully inventoried and measured by the NICU nurses. I always knew from the looks on their faces if I had made enough to feed him for the day. Like I said- enormous pressure. Things were going okay until about 10 days after delivery. I developed mastitis on the right breast. For those unfamiliar, mastitis is an infection of the breast tissue. I had pain, high fever, and chills. After two antibiotics it resolved. Then I developed a second mastitis infection on the other side. The pain was excruciating. The infections did a number on my body, my sleep, and my milk production (and yes we worked with lactation consultants and did all sorts of tricks to try and increase production). My husband and I made the decision to switch my son to formula at 3 weeks old. We did it for his health, my health, and my ability to care for him when he was discharged. I can easily say it was the best decision we could have made. My sweet boy absolutely thrived on his special preemie formula. He tolerated it very well, grew, and got stronger. We are incredibly grateful for formula. To us, it is an amazing public health innovation. It feeds our baby when I cannot.

So it is through the lens of both a (proud) formula feeding mom and public health practitioner, that I examine the current public health campaigns focused on birth and infant feeding. A recurring theme for me is concern about the language being used in these campaigns. Somehow public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

For example:

• All birthing hospitals in Philadelphia have officially discontinued the practice of giving free formula to new mothers. While I understand that this strategy is supported by evidence, it is part of a larger international initiative to make hospitals “Baby Friendly”. So using that logic, providing formula is “unfriendly” to babies? This message was reinforced by Nurse McGinn who was interviewed for the philly.com story. She reports that she “was given free formula and threw it out”. Quotes like these reinforce the message that feeding with formula is equivalent to giving your kid poison. 

• A friend sent me a link to a wonderful story about supporting formula feeding moms during World Breastfeeding Week. This article does a great job of examining the language being used in this campaign. The terms connect breastfeeding with “winning” and achieving “goals”. So the flip side is “losing” and “falling short of your goals”? This can be a rough reminder for formula feeding moms. For many women, the switch to formula was made after extreme pain, guilt, and feelings of failure. 

Recommendation: When thinking about health communication, I’m a big fan of testing out campaign terms, along with their antonyms. This can help you to anticipate unintended consequences of your messages.

For example, a public health colleague tweeted that we should use the language “breastfeeding is normal” instead of “breast is best”. Although it was not her intention, I read that as meaning that anything other than breastfeeding is abnormal. So formula feeding is abnormal?! Not a great message to send to women.

However, this kind of message is often communicated. In the Olivia Wilde photo spread for Glamour Magazine which includes a photo of her feeding her son, she says “Breastfeeding is the most natural thing…” I guess it is, unless it did not work for you and your baby. Then it feels pretty unnatural.

So I ask readers: 

(1) While these breastfeeding and baby friendly campaigns have well-intentioned public health goals (which I support):

• What are the unintended consequences of their language and communication choices? 
• Do they help reinforce the divide between formula feeding and breastfeeding mothers?
• What about the women who both formula and breastfeed? Where do they fit in?

(2) What are your suggestions for more effective language? How can we simultaneously promote breastfeeding without stigmatizing formula feeding?

Detail: Olivia Wilde, World Breastfeeding Week, Infant Formula, and A Critique of the Language We Use to Talk About It

0 Do Celebrities and the Media Combat or Perpetuate Stigma Around Breastfeeding?

This week's guest post was written by Jennifer Breaux, DrPH, MPH, CHES.  She is an Assistant Teaching Professor & Director, Undergraduate Education at the Drexel University School of Public Health.  Her work is focused on maternal & child health, nutrition, and health as a human right.

Over the past month, Alicia Silverstone has entered the public health conversation once again by launching a vegan mother breast milk sharing program through her website The Kind Life.  The program has been featured by several national media outlets.  Although her idea of milk sharing is not a new one, it has reignited arguments and opinions on both sides.  For example, US Weekly ran a short piece about the proposed milk sharing program where it provided the information but did not give an opinion.  Unfortunately, many uneducated and harsh opinions were given in the comments section of this piece.  They ranged from stating that this was a horrible idea that would give babies diseases to questioning why someone would choose to give breast milk in this situation when there is formula.

I felt compelled to write this blog post because issues relating to breastfeeding and breastfeeding policies are extremely near and dear to me both personally and professionally.  The issue is also quite timely considering that August 1-7 is World Breastfeeding Week and the month of August is Breastfeeding Awareness Month.

Combating Stigma
Alicia’s program was first reported on by Good Morning America (GMA) and I was struck by the uncomfortable nature of the anchors when the health reporter presented breast milk on the table.  Seeing the breast milk out in the open resulted in a visceral reaction of unease for some of the hosts.  I was happy to see the reporter debunk some milk sharing myths like (1) the milk is unsafe, (2) it transmits disease and (3) it is an unnecessary service.  Overall, I thought that GMA did a balanced job of reporting the story.

Perpetuating Stigma
While stories like that on GMA  (in which a medical professional reinforced the safety of breast milk sharing) can help combat stigma, stories like the one in Life & Style can perpetuate it.  The Life & Style magazine ran a story with a quotation by TV host Wendy Williams who basically equated milk sharing with slave nurses and the Civil War.  

The roots of milk sharing date back to wet nursing and this practice actually dates back to before Christ and has been practiced through the centuries.  Yes, wet nursing did exist during times of slavery but it is also something that still exists today – largely invisible to the general population.  However, it did make main stream news outlets a few years ago when Salma Hayek breastfed a malnourished infant during a humanitarian trip to Sierra Leone.    The whole concept of wet nursing and milk sharing is not new and truly a selfless act that has become a life saving option for mothers who can’t or choose not to breastfeed.

The Facts About Safety
The Human Milk Banking Association of North America (HMBANA) was established in 1985 and remains the largest group to acquire breast milk.  It is a lifesaving organization for premature and ill infants and has locations across the country.  One of the main arguments against something like milk sharing is the spread of disease.  Milk that is obtained for the HMBANA meets rigorous standards.  Milk donors are screened and once the milk arrives at the bank it is:

• Pasteurized to eliminate harmful bacteria,
• Lab tested to make sure the milk is safe and free of any communicable diseases that are able to be spread in milk, and
• Once it is ruled free of any cultures, the milk is able to be shipped to recipients

These standards enable parents to give donated milk knowing that it is safe and what is best for their infant.

That being said, there are informal milk sharing programs that are not regulated; the milk does not go through the rigorous testing done by HMBANA, which could pose a public health risk for those receiving the milk.  However, those who choose to participate in these networks are aware of the risks and feel that the benefits provided by breast milk outweigh possible consequences because the amount of external substances absorbed in breast milk is quite small.   An additional reason that families may choose this alternative route is cost.  Babies drink A LOT of milk and to get certified milk from HMBANA for the first year of life is extremely expensive and is only covered by insurance under certain circumstances.

A Call To Action
We, as a society, have opinions on these types of breastfeeding programs, but the debate will continue until we deal with the root cause of the need for increased milk sharing - our poor breastfeeding rates.  According to the World Health Organization and the American Academy of Pediatrics, it is recommended that mothers exclusively breastfeed their infant for the first 6 months of life followed by breastfeeding, in combination with the introduction of complementary foods, until at least 12 months of age and continuation of breastfeeding for as long as mutually desired by mother and baby.  In 2012, the national breastfeeding rate of exclusive breastfeeding at 6 months was only 16.3% with certain subgroups falling far below this percentage.

Stigma surrounding breastfeeding and the lack of support on every level will continue to plague this issue. The irony is that the science is clear – breastfeeding has overwhelming positive benefits for the baby, mother and society.

Some of the proven positive health benefits for breastfed babies are reductions in/of:

• Hospitalization from lower respiratory infections
• Ear infections
• Serious colds, ear and throat infections
• Necrotizing entercolitis
• Sudden Infant Death Syndrome (SIDS)- after accounting for confounders
• Allergic disease
• Celiac disease
• Irritable Bowel Syndrome (IBS)
• Obesity
• Type I Diabetes
• Childhood Leukemia and Lymphoma

Some of the proven health benefits for the mother (time dependent) of breastfeeding:

• Decreased postpartum blood loss
• More rapid involution of the uterus (post childbirth)
• Increased child spacing (lactational amenorrhea)
• Possible decrease in postpartum depression
• Decreased risk of Type 2 Diabetes
• Inverse between breastfeeding and rheumatoid arthritis
• Reduction in hypertension, Cardiovascular Disease (CVD)
• Reduction in breast and ovarian cancer
• Reduction in osteoporosis

Additional benefits from breastfeeding annually:

• $13 million in direct health care savings
• Prevention of at least 5,000 cases of breast cancer
• Prevention of at least 54,000 cases of hypertension
• Prevention of at least 14,000 heart attacks
• Prevention of the three outcomes above result in about $860 Million in health care savings

Breastfeeding is good public health.  Maybe we should start investing more in making sure babies are able to be breastfed and, if not- afford them the ability to receive affordable and safe breast milk.  We MUST stop considering breastfeeding as a woman’s lifestyle choice and view it for what it really is:  an important health issue, a public health issue and a human right.

Detail: Do Celebrities and the Media Combat or Perpetuate Stigma Around Breastfeeding?