Manny was a friend in Manila, living in the same slum as me. He had just had his first child. He loved that kid.
Manny, who years earlier had been saved from a life of drug-dealing, wanted to go to Bible college and become a pastor. But he could not afford to go. I watched him spend his entire paycheck on infant formula and disposable diapers. And I knew this formula was likely to be mixed with unclean water inside unsanitized bottles to sit out on unrefrigerated counters in the stifling heat.
It sounds like a terrible idea. But if you are a poor Filipino, the social pressure of everyone pushing you to use that formula is difficult to resist. Under such pressure, only a third of Filipino mothers exclusively breastfeed for the first six months. An article in the February 26, 2018 issue of The Guardian explained why:
A Guardian/Save the Children investigation in some of the most deprived areas of the Philippines found that Nestlé and three other companies were offering doctors, midwives and local health workers free trips to lavish conferences, meals, tickets to shows and the cinema and even gambling chips, earning their loyalty. This is a clear violation of Philippine law.
Representatives from Nestlé, Abbott, Mead Johnson and Wyeth (now owned by Nestlé) were described as a constant presence in hospitals in the Philippines, where only 34% of mothers exclusively breastfeed in the first six months. Here, they reportedly hand out “infant nutrition” pamphlets to mothers, which appear to be medical advice but in fact recommend specific formula brands and sometimes have money-off coupons.
Hospital staff were also found to be recommending specific formula brands in lists of “essential purchases” handed to new mothers. Targeted advertising on Facebook and partnerships with influential “mummy bloggers” means mothers are being exposed to more unregulated formula promotion than ever before.
At the same time, powerful lobby groups have been working to curtail government legislation regulating formula marketing and promotion, in the Philippines and across the world.
There is no doubt that when a choice is possible, breastmilk is a preferable option to formula. It carries the God-designed mixture of nutrients that a baby needs, including antibodies and other biological components that can’t be replicated. And the process of breastfeeding is part of the natural development for both mother and child. Breastfeeding is advocated as the preferred option for infants by the American Academy of Pediatrics, the USDA, the American Pregnancy Association, and the World Health Organization.
Of course, for various reasons not everyone has a choice. And when a choice is not possible, infant formula is a reasonable alternative in the developed world.
But not everyone lives in the developed world.
In our slum, clean water is not available for most families. In my first four years here I contracted typhoid, hepatitis, amoebic dysentery, and various diarrheal ailments. And that’s despite drinking our own filtered water 95% of the time (that 5% of the time that we drink as guests at other people’s homes can be a killer). As a strong healthy adult, I was able to survive those ailments. Infants do not always have this same resilience.
What water do you think poor families use to mix their formula?
In our slum, sterilized containers are not available for many families. As mentioned above, the water that containers are washed in is itself dirty. Water hot enough to have a sterilizing effect is not used. Overworked mothers rarely have the time to fully wash every nook and cranny of a bottle between every use.
What do you think poor families serve their formula milk in?
Nor is refrigeration available for many families. Once the formula is mixed, it sits out at room temperature, which is sometimes as high as 120 degrees, for as many hours as it takes for the baby to finish it. Families who can barely afford the formula are reluctant to throw it out when the baby fails to finish it right away.
Where do you think poor families store their formula?
Then there are all sorts of factors driven by the fact that life is never predictable. How many times is a family member going to add sugar, or chai, or coffee, or beer to that formula? How often is the family going to run out of money to pay for formula and be forced to give the baby diluted formula, or milk, or even water?
And how much money that could have gone to keeping the mother healthy, to feeding the other children, is going to have to go to formula instead?
For a poor family in the slums, corporate infant formula is not a “valid though less ideal choice.” It can be a disaster. Of course it is possible for a poor family to raise a baby on commercial formula – it can and has been done. But for impoverished mothers for which the option is possible, breastmilk is clearly better. Especially if they are in the majority who lack access to clean water.
For some of you this information may be new. But none of it is new to the people who formulate international health policy. All of this has been common knowledge in development circles for decades. Every government official who has anything to do with such policies already knows about the studies detailing the health, sanitation, and financial difficulties that poor mothers in developing countries face when using formula.
As reported recently in the medical journal Lancet:
Breastmilk makes the world healthier, smarter, and more equal: these are the conclusions of a new Lancet Series on breastfeeding. The deaths of 823,000 children and 20,000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. The Series confirms the benefits of breastfeeding in fewer infections, increased intelligence, probable protection against overweight and diabetes, and cancer prevention for mothers. The Series represents the most in-depth analysis done so far into the health and economic benefits that breastfeeding can produce.
However, although the Series is comprehensive, the message is not new.
Indeed, campaigns to stop the inappropriate commercial promotion of baby formula in developing nations have been going on since Babies Mean Business was first published in 1973 and the Nestlé boycott started in 1977. The situation has improved in that time, more mothers are choosing breastfeeding, and extra deaths due to formula are down from a peak of 1.5 million/year in the 1980s to 800,000/year today. Yet those 800,000 deaths every year show that much more work needs to be done.
That is what makes recent actions by the US government so repugnant.
In the last week of May, the World Health Assembly gathered together to pass a well-researched resolution encouraging countries to limit “the inaccurate or misleading marketing of breast milk substitutes.” It was expected that the hundreds of nations involved would pass the resolution unanimously.
Until the American delegation interfered.
According to the New York Times, the American delegates sought to remove “language that called on governments to ‘protect, promote and support breast-feeding’ and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.”
Note that the language involved did not ban the use of infant formula. It did not ban the sales of infant formula. It only dealt with how breastfeeding and infant formula products were promoted and advertized.
Countries supporting the breastfeeding resolution refused to budge – the science was clear, and hundreds of thousands of babies’ lives were at stake. What happened next is almost impossible to believe:
When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs.
The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.
The showdown over the issue was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the United States.
It wasn’t enough for America to express its disapproval. It wasn’t enough for America to have one opinion and other countries to have a different opinion. The fact that any country would defy America on the issue of promoting commercial formula products was enough to earn threats of punishment and the withdrawal of aid.
And American power on this issue is strong:
Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States.
“We were astonished, appalled and also saddened,” said Patti Rundall, the policy director of the British advocacy group Baby Milk Action, who has attended meetings of the assembly, the decision-making body of the World Health Organization, since the late 1980s.
“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health,” she said.
Unbelievably, it was the Russians who came through in the end. Russia, a country both powerful enough and close enough to the American president to avoid any retaliation, was able to introduce the measure with something close to the original language. The only substantial part missing was a sentence that asked the World Health Organization to support countries who were working to halt “inappropriate promotion of foods for infants and young children,”
Russia of all countries stood behind a health measure the United States would not, because the Russian executive is not in cahoots with the particular multinational corporations involved.
When confronted with the facts of the case, the Americans lied.
This tweet was disturbing for two reasons. First of all, the recommendations blocked by the administration were not going to “deny access to formula.” The issues at hand involved the promotion of formula, not shutting off access.
Second, the idea that “malnutrition and poverty” are why women need formula is a callous inverse of the truth. As described above, those are the very reasons why the unethical promotion of infant formula is killing babies. If your issue is poverty and malnutrition, then how is paying for expensive formula that you can’t keep clean going to help?
This is not a partisan issue. This is not a difference of opinion with little consequence. On the one hand you have 800,000+ infant deaths each year caused by a move away from breastfeeding, on the other hand you have a $70 billion industry headquartered in the United States and Switzerland that hopes to grow 4% next year off of growth in the developing world.
In the same conference, the American delegation was able to eliminate statements in the obesity document that supported the idea of a soda tax. They tried, but failed, to stop an effort to adjust international patent law in a a manner that will allow impoverished persons in poor countries better access to expensive medications and vaccines.
On one issue after another, they were the delegation siding with corporate interests.
Most people in the developed world have become relatively distanced from infant deaths, but here in our slum I’ve had to watch families close to me twice as their babies died, and I know of dozens more. I’ve held a malnourished child on the edge of death. I’ve cried over those children. I’m crying again right now.
The American delegation, led by its chief executive, Donald Trump, has chosen profit over the life of babies.
The oldest Christian document outside of the New Testament is the Didache, a first-century listing of Church orders. The Didache carefully teaches the Church community how they should and should not act, leaning heavily on the gospels.
It begins like this:
There are two ways, one of life and one of death, but a great difference between the two ways. The way of life, then, is this: First, you shall love God who made you; second, love your neighbor as yourself, and do not do to another what you would not want done to you.
The fifth chapter breaks down exactly what is meant by “the way of death.” Among other things, the way of death is said to include “greediness…not pitying a poor man, not laboring for the afflicted, not knowing Him Who made them, murderers of children, destroyers of the handiwork of God, turning away from him who is in want, afflicting him who is distressed, advocates of the rich, lawless judges of the poor, utter sinners.”
The choice between the advertising of corporate formula manufacturers and the health of impoverished infants is not a morally neutral choice. Back in 1981 when 1.5 million children a year were dying due to improper use of formula, the USA was the only nation to object to agreed-upon restrictions on formula advertisers. Thirty-seven years later and we are still alone on the wrong side. And it is not difficult to see why.
We chose greediness, and in that we have become murderers of children afflicting those who are distressed in order to advocate for the rich.
We chose the way of death.
I used the following sources in writing this article. All sources are linked above at the point they were referenced:
- The history of the boycott of Nestlé over their infant formula marketing practices: Nestlé boycott
- The original 1981 WHA statement on infant formula marketing: International Code of Marketing of Breast-milk Substitutes
- The 1982 update of the New Internationalist‘s original 1973 article exposing unethical practices in the marketing of infant formula: Babies Means Business
- Lancet studies demonstrating the research in support of the advantages of breastfeeding: Breastfeeding: achieving the new normal
- NYT opinion piece suggesting some reasons not all mothers are able to breastfeed: The Breast Versus Bottle Debate is Fabricated
- Guardian story detailing ongoing unethical marketing practices by infant formula manufacturers: How formula milk firms target mothers who can least afford it
- New York Times story on American efforts to block the WHA resolution: Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials
- NPR interview following up on the NYT story: U.S. Tries to Derail WHO Resolution Endorsing Breastfeeding
- Trump’s tweet in response: Trump blasts ‘fake’ NYT story on US opposition to breastfeeding measure
- An English translation of the Didache: Didache. The Teaching of the Twelve Apostles