Pediatric politics stalls Ad Council campaign Breastfeeding public awareness advertisements on hold

Dave C. Arendt/La Leche League International Breastfeeding through the first six months provides great health benefits. For breastfeeding information contact La Leche League at (800) La-Leche.

Federal officials are putting on hold a planned multi-million-dollar Ad Council public service campaign to promote breastfeeding. And if formula makers have their way, the current campaign, two years in development, may be scrapped altogether.

The companies, Ross Products, the unit of Chicago-based Abbott Laboratories that makes Similac and Isomil, and Mead Johnson, the Bristol-Myers Squibb subsidiary that makes Enfamil, say the Ad Council uses "scare tactics" to persuade new moms to nurse their babies for at least six months.

Even top officials of t

he American Academy of Pediatrics say they are concerned the commercials make scientifically-suspect claims. But other breastfeeding advocates suggest that the real issue is money-lower revenues to formula makers and lower donations to the American Academy of Pediatrics.

The commercials, aimed at all new mothers but with an emphasis on underserved minority communities, begin by showing pregnant women engaging in risky behavior-logging, roller blading and bull riding-followed by the message: "You'd never take risks while you're pregnant. Why start when the baby's born?"

The preliminary ads say babies that are not breastfed through six months are more likely to contract ear infections and other illnesses, even diabetes and cancer.

It is the claims about increasing a child's chance of contracting diabetes and cancer that caused the Academy's Executive Director Dr. Joe Sanders and President Dr. Carden Johnston to send a cautionary letter to Health and Human Services Secretary Tommy Thompson. "The concern we had was that the focus was going to be on the dangers rather than the benefits of breastfeeding," Sanders says. "We simply asked [Thompson] to think about couching the message in a more positive way: ‘If you nurse your baby, these are the things you are protecting him or her from.'"

Dr. Lawrence Gartner, who heads the Academy's executive committee on breastfeeding, however, supports the ad campaign. He has speculated that the Academy's stand is based on fear of losing large donations from formula manufacturers. "There's a lot of money involved," Gartner told the New York Times last month.

A spokesman for the largest formula manufacturers refused to address Gartner's charges directly. Instead, Tracey Noe, Ross' public affairs director, says, "We believe that moving forward with this particular campaign is inconsistent to good health policy and alarming to America's moms. We think focusing on negative messages will incite fear and guilt and do nothing to address real issues behind the low breastfeeding rates."

She adds: "Doing the right thing for moms is a way of doing the right thing for our business."

The original plan

Advocates originally expected the ad campaign to debut in early December. But Christina Pearson, spokeswoman for the U.S. Department of Health and Human Services, says the date has been pushed back indefinitely.

"We need to make sure when we put something out that all participants of the U.S. health department agree that the science supports it," she says. "This is too important a cause not to get right."

While the debate continues, information about the health benefits of breastfeeding for at least six months is not getting to enough new mothers. Past Ad Council public service campaigns have been credited with changing societal attitudes. Advocates say it can have the same success in increasing breastfeeding rates.

Ceal Bacom, a certified nurse-midwife in Oak Park, says: "It's high time for something like this. In many communities, breastfeeding is not visible and not part of the culture. I've lived through a lot of similar campaigns-smoking, seat belts-and seen dramatic changes in the social norms. I think this is worth a try."

By 2010, the government wants to raise breastfeeding rates to 75 percent and see 50 percent continue nursing beyond six months. In 2000, the most recent year for which numbers are available, 69 percent began nursing, but only 33 percent continued for six months. Among African-American mothers, the number is lower-21 percent are still breastfeeding at six months.

The Ad Council, a non-profit agency developing the ads pro bono, released drafts of the ads in mid-November. Formula makers immediately took exception. "Some [of the materials] weren't grounded in solid science," says Noe. "The overall approach and context is like a scare tactic. At a time when new moms are vulnerable, the claims made will incite guilt and fear."

But Carol Kolar, director of education and member services for Schaumburg-based La Leche League International, disagrees.

"Forty-six [government] focus groups showed that mothers, fathers and grandparents never thought about the risks of breastfeeding," Kolar says. "When they find out it would have made a difference [in their child's health], they're angry they didn't have all the knowledge to help them make the right choice, not guilty."

Kolar also is vice chair of the U.S. Breastfeeding Committee, a coalition of 41 advocacy, academic, medical and governmental organizations including Health and Human Services and the FDA.

The initial versions of the TV, radio and print ads say babies not breastfed exclusively for at least six months are more susceptible to ear infections and respiratory illnesses, and more likely to contract asthma, allergies, diabetes, even cancer.

After a Dec. 4 meeting, advocates agreed to drop the claims about diabetes and cancer, but to keep the information about ear infections and respiratory illness. "When you get into diabetes, obesity and leukemia, I'm not sure the data is as strong," Sanders says. "We just didn't want the message to get out and then down the line lose credibility if it's found that breastfeeding doesn't affect [those diseases]."

This is in line with federal government guidelines that say breast milk is best for at least six months-longer if possible.

Unlike the formula makers, the government has no problem with a campaign that emphasizes the risks.

The dollars and sense

Formula companies stand to lose a lot of money if the government meets its goals of raising breastfeeding rates. Noe declined to give specific figures, but with Ross Products and Mead Johnson cornering 80 percent of the market, formula sales constitute a major portion of the nearly $2.1 billion generated by Ross' adult and infant nutrition division in 2002.

The companies also hold lucrative state contracts to provide formula to 7.5 million mothers enrolled in the federal and state Supplemental Nutrition Program for Women, Infants and Children, known as WIC. Women served by WIC are low-income and minority-the same women targeted by the campaign.

Noe insists, however, that Ross advocates breast milk as the best option for optimal infant health. "We would support a positive, proactive campaign that would focus on two things: First, we'd like to see a campaign that would address the challenges of breastfeeding for women in the workplace, and second, focus on increasing education and support for women in the WIC program."

Kolar says she feels the government is committed to doing more to make families aware of the potential risks in choosing not to nurse and the benefits of choosing to nurse. She is optimistic the ads may begin running as early as the end of January.

Eryn McGary is a Chicago-based writer.

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