By promoting formula instead of natural mother’s milk, hospitals are making money at expense of newborns’ health.
By ARTHUR J. EIDELMANBreast-feeding 311(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 Ministry.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.In other words, hospitals’ default situation should be for mothers to breast-feed unless the mother exercises her right and requests otherwise.Thus, hospitals 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 nutrition.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 “freebies.”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 company.
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 discharge.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 endeavors.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 arrangements. 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.
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