(photo credit: Reuters)
Infant nutrition, more specifically breast-feeding, is not a lifestyle choice
but rather a basic health decision that determines the optimal health of both
mother and child. This is the basis for the recommended infant feeding policies
of all responsible medical organizations including the World Health
Organization, the American Academy of Pediatrics and the Health
Children who are not breast-fed are at increased risk of
infection, allergies, immunological diseases, sudden infant death, obesity,
leukemia/lymphoma and diabetes. As such, public health and administrative
policies must create an environment that encourages mothers to initiate and
sustain breast-feeding and minimize factors that discourage and ultimately
interfere with the establishment of breast-feeding. These are vital for the
well-being of the next generation.
Simply put, breastfeeding is the
normative standard of infant nutrition and is the best guarantee for optimal
growth and development of all infants.
In this context one should applaud
legislation proposed by MK Danny Danon that would regulate the relationship
between manufacturers and distributors of infant formula on one hand, and
medical facilities on the other. The bill would also regulate the use of infant
formulas in hospital nurseries.
Repeated studies have documented that if
one wishes to optimize the number of mothers who will successfully breast-feed
it is critical to limit the use of infant formula to situations where either the
mother or the infant have medical conditions that warrant a breast milk
substitute (such as maternal AIDS or an infant with galactosemia) or when the
mother explicitly expresses a preference not to breast-feed.
words, hospitals’ default situation should be for mothers to breast-feed unless
the mother exercises her right and requests otherwise.
should not be included in promotional campaign for free samples of baby formula,
nor should they display advertising material or distribute samples of infant
formula in hospital discharge packs. All such practices have been documented to
impact negatively on mothers’ success in breast-feeding and thus are rejected by
hospitals committed to encouraging breast-feeding as the optimal means of infant
SUCH PROHIBITIONS have been formalized by the World Health
Organization. The International Code of Marketing Breast Milk Substitutes, a
document that has been signed by the Health Ministry (but unfortunately, has not
been implemented in most Israeli hospitals) and serves as the basis for the
ministry’s Baby Friendly Hospital campaign.
The contention that allowing
companies to provide free formula saves hospitals valuable funds is a spurious
argument. As they say, there are no free lunches, surely not from companies out
to make a buck. Consumers eventually bear the cost of these
Even the supposed savings to the hospital (which are minimal
given the actual cost of formulas considering the small quantity of formula
consumed by newborn infants) do not warrant awarding a monopoly to a specific
In contrast, when a hospital negotiates a price for the purchase
an antibiotic, it is not prevented from purchasing similar drugs from another
company. Most importantly, whatever the financial relationship that may develop
between a hospital and a pharmaceutical company, this agreement remains unknown
to the patient and his or her family, and surely has no impact on what
medications will be prescribed by Health Fund doctors after
Paying off a hospital to create a situation that will
influence consumer decisions after discharge raises serious ethical question.
Hospitals should be in the business of medical care, not partners in commercial
The argument that the donations hospitals receive are critical
to hospital educational programs is even more problematic. Unrestricted
educational grants from for-profit enterprises can be appropriate and serve as
an additional source of much-needed funding for important
programs. However, linking these donations to monopolistic agreements
that require a public medical facility to use a product exclusively surely
doesn’t qualify them as “unrestricted.”
Equally disturbing is the
argument that these funds are vital to pay salaries. Having a lactational
counselor’s salary paid by a formula company is not only in bad taste, but it
inevitably leads to a conflict of interest. If such personnel are an integral
part of the health team then it is the responsibility of the health care system
to fund these positions, not to “solve” the lack of funds by selling itself to
the highest bidder. Surely, the salaries our infectious disease experts are not
paid by pharmaceutical companies.
The medical benefits of breast-feeding
and human milk are overwhelming and thus the issue of infant nutrition and how
to create the appropriate supportive environment should be treated as a public
health issue, not as a mechanism for hospital fund-raising or a platform for
furthering commercial interests.
Responsible medical personnel who are
concerned about infant welfare should fully support those elements in the Danon
bill that seek to regulate and limit the current inappropriate
The writer is president of the Academy of Breastfeeding Medicine, chairman (emeritus) of the Department of Pediatrics at Shaare Zedek Medical Center in Jerusalem and chairman (emeritus) of the American Academy of Pediatrics committee on breast-feeding.