Pumping Profits: Hating on Formula Isn’t the Solution

So this piece of journalistic garbage in the NYT just came out and has blown up my Facebook feed and now God damned Donald Trump is tweeting about it in a way that I can’t totally disagree with. I don’t have time to go through all the reasons why this article is so terrible and The Skeptical OB hits a lot of what I might say (most notably, in reference to Trump, that even a broken clock is right twice a day). She notes that the “science” of breastfeeding is hardly as conclusive as the NYT’s piece would have you believe and I can tell you she’s right based on my own original research. Breastfeeding is good and should be supported but no studies have compared breastfeeding to formula feeding. If you find one, I’d love you to send it to me but please first make sure that it’s comparing breastfeeding to “formula” and not breastfeeding to “not breastfeeding” which could include who knows what. I’ll keep writing while you’re looking, this could take a while.

But there’s one thing that’s bugging me way more that I don’t see too many people talking about in all of the boo’s and hisses at the evil Big Formula manufacturers: Formula manufacturers are not the only corporations at the table!!!

Let me situate myself at the outset:

First: Fuck Trump.

Second: I have used formula for all three of my sons and for my mother’s feeding tube when she was dying from ALS (she was prescribed formula made by Nestlé to be exact, here’s a picture after it first arrived, that was literally her lifetime supply 😦 )

moms formula.

Third: I have no stocks, bonds, or other ties or affiliations to any formula or other manufacturers (which you would believe for sure if you saw my credit score and my bank account. *sigh – divorce – sigh*).

Okay, now that we have that out of the way.

The claim made in the article: Trump is aligning himself with the formula industry and rejecting a very simple policy that just wants to protect babies around the world from the dangers of formula.

Supporting evidence to this claim: Somewhere on Facebook  breastfeeding advocate and international scientist Ted Greiner noted correctly that Trump’s stance on these international infant feeding agreements is in line with other republicans since Reagan who have fought against international anti-formula initiatives since the early 1980s.

Ted Greiner

I don’t know what the Heritage Foundation did specifically and I’m interested in finding out more. I believe Greiner with what he says here b/c (a) I don’t like the Heritage Foundation (when I was a summer intern at the Feminist Majority in the 1990s I crashed a few of their meetings and they’re conservative and a lot of white men) and (b) the US has a hugely long history of bullying the world into doing what it wants, and (c) it’s just a fact that the US didn’t sign on or support any breastfeeding initiatives until Bill Clinton came along.

I could write about the ways in which it’s not coincidental that they were supported by an administration that was fixing to shrink the size of the welfare state but I already wrote about that in the first article I ever published on breastfeeding. Instead, I want to point to the obsession about the profits of formula manufacturers and the near total disregard for the profits of breast pump manufacturers.

I submit to you the following pieces of evidence:

1.) The Policies 
2010–The Affordable Care Act (i.e. Obamacare) was introduced, supporting breastfeeding and mandating that employers provide time and space for mothers to pump their milk

2011–The US Surgeon General’s Call to Action to Support Breastfeeding was released noting that working in paid employment outside the home is a barrier to breastfeeding success

2.) The money

2012–Evenflow sold their Ameda breast pump division to Platinum Products, LLC for $71.5 million dollars (that’s $71,500,000 — LOTS of zeros!). In the business document where I got this information (that was largely SO boring I skimmed a lot) , in 2011 and 2012, the Ameda division was estimated to have generated revenues of $30,251,00USD and $28,297,000 respectively.

According to an excerpt from this story in Bloomberg Business Week, Obamacare was said to have boosted Medela’s profits by 34% due to the mandatory insurance coverage of breast pumps and increased brand awareness.

Breast pump sales haven’t just boomed since the Affordable Care Act was introduced, however. According to a different NYT story, the dutch technology company Philips agreed to buy the then British company Avent, which also sells breast pumps, bottles, and other baby feeding technologies, in 2006, a deal estimated to be worth $868 million US dollars.

Interestingly, according to this  Avent was a floundering company until it “stormed world markets for baby-feeding products with it’s ‘Isis’ breast pump, which won a 1997 Millenium Award.”  The 1990s were also a time of increasing policies to protect breastfeeding in the workplace.  It was in October 1999 that Bill Clinton signed a treasury bill that included breastfeeding protections on federal property. That part of the bill had been introduced by Democrat Representative Carolyn Maloney who lobbied for years for “the Right to Breastfeed Act”. A few states in the United States had already introduced laws mandating and/or encouraging the support of breastfeeding in the workplace, including Minnesota, Tennessee, Texas, and California, according to this article in a law journal. 

3.) The scientists:

Breast pump companies employ research scientists for the development of their products. At Medela, the current Head of Research is Leon Mitoulas who has published a lot of research. In that first link, you can see him talk about why research is so important to Medela. This isn’t bad.  In fact, it’s good. I want products that people buy to be based on sound research (especially to avoid things like breast pumps that get recalled because the wiring is faulty and mothers get shocked while pumping!!!). However, research done by an organization with a financial interest in the outcomes is not the same as research done by those without a financial interest in the outcomes.

Not only do they have researchers that publish in journals but there also are ways of encouraging research that are less direct, such as through Family Larsson-Rosenquist Foundation  this foundation was started by Olle and Doris Larsson-Rosenquist. Olle Larsson founded the company based on his own inventions in 1961 and then turned the company over to his son Michael as CEO in 2001. This foundation offers grants for “projects that clearly promote and support breastfeeding and human milk.” Again, this isn’t inherently wrong, but this does go against the argument that only formula manufacturers have money to pay for research.

4.) The locations: 

Ameda: Invented by a Swede but now headquartered in Lincolnshire, IL; International Offices in Vilvoorde, Belgium and Shanghai, China

Philips Avent: Sudbury, UK (subsidiary of the multinational Philips corporation headquartered in Amsterdam, Netherlands)

Playtex: Dover, Delaware, US

Hygeia: One of the newest players on the market, pumps are part of a Greek company founded by physicians in the 1970s that went on to create all of their own medical equipment.

The First Years: Avon, MA, USA

Medela headquarters: Barr, Switzerland

Ardo medical: manufactured in Zug, Switzerland with four subsidiaries in Germany, Netherlands, England, and China (founded by Werner Krähenbühla, former CEO at both Ameda and Medela).

World Health Organization: Geneva, Switzerland

5.) The Promotion

Looking at their websites, many (but not all) of the pump manufacturers state that they support the WHO’s International Code of marketing of Breast-milk Substitutes, including Hygeia, Ardo, and Medela. Although there are breastfeeding advocates who say that they are not actually code compliant, at least not as of last year.

Regardless of whether they are actually in keeping with the Code, they clearly find it at least important to them to say that they are. This is very similar to formula companies that claim that “breast is best” but if you can’t have the best, pick us (or something like that).

6.) The Verdict

The NYT article ended with a link to a 2016 series in the medical journal The Lancet which included an article entitled “Spotlight on infant formula: coordinated global action needed.” And after they began by citing my article with Mary C. Noonan *cough-shameless self promotion- cough – and thank you very much -cough*, then went on to note that

“The active and aggressive promotion of BMS by their manufacturers and distributors continues to be a substantial global barrier to breastfeeding. The reach and influence of the BMS industry is growing fast. The retail value of the industry is projected to reach US$70·6 billion by 2019. In many low-income and middle-income countries, growth in sales of BMS exceeds 10% annually. Global sales of milk formula (including infant formula and follow-on milks) have increased from a value of about $2 billion in 1987 to about $40 billion in 2013, and account for two-thirds of all baby food sales internationally. Sales of BMS in China, worth more than $12 billion in 2012, are projected to increase annually by 14%. This growth is not difficult to understand, given that investment in promoting BMS exceeds the spending by many governments on efforts to promote, protect, and support breastfeeding. Promotion and marketing have turned infant formula, which should be seen as a specialised food that is vitally important for those babies who cannot be breastfed, into a normal food for any infant.”

The fact that the formula industry is profitable is used as evidence for why global action is needed to stop it. Medela’s profit growth was TWICE that of the profit growth listed here in China. Why are only the profits of one kind of company to be used against it but not of others?

Based on my Facebook feed, there is an increasing sense that to be a good lefty/liberal/democratic socialist/feminist means that I have to see formula companies as inherently bad b/c they are so profitable. Granted, there are also reports of formula manufacturers offering lavish gifts to midwives in poorer countries to encourage them to recommend formula to mothers and they used to (still do?) give out free formula to new mothers in places where they wouldn’t be able to afford to continue with it. It’s a major problem if poor people begin on free formula, their milk dries up, and then they have no money for formula AND no more breast milk. Pumping will at least maintain the milk supply of mothers if they choose to pump.

But, still, if the critique is that formula companies are bad because they are profitable, breast pump manufacturers are doing many of the things that formula manufacturers have been doing in the last 20-30 years. Breast pump manufacturers are multi-national corporations that are making huge profits. I don’t know what they’re doing to in terms of bullying or back-door bargaining, but I do know that they are benefiting financially from policies that mandate space for pumping. I also know that the primary organization promoting breastfeeding over formula is headquartered in the same country as two of the leading breast pump manufacturers. I also know that breast pump researchers are producing tons of research showing the benefits of breastmilk and funding research doing the same. And yet, few seem to view these companies with the same disdain as the formula manufacturers.

We could also pile on the claims that breastfeeding at the breast is healthier than pumped milk or we could also point to the the environmental waste of disposable breast pumps.  We could raise arguments made by many feminist, such as Penny Van Esterik or Jacqueline Wolfe (not Joan Wolfe, the other Wolfe), who point out that a pumping culture does nothing to challenge the masculinist work spaces which we accept as normal. Without pumps, successful extended breastfeeding at the breast requires having one’s baby in close proximity, which has the potential to radically transform workplaces and break down public and private divides.

But I’m not interested in banning breast pumps. I’m not interested in limiting the supply of breast pumps. I’m not interested in stopping mothers from getting the help they need to breastfeed. I’m also not interested in rejecting science to make formula feeding moms feel less guilty. What I’m actually interested in is actually good science that seeks to rout out untested assumptions and eschews ideology in favor of truth. I’m interested in sound measurement of our concepts and in reflexively situating ourselves in our research agendas so we can see what we have to gain and what we have to lose in admitting we’ve been wrong. I’m also interested in addressing the historical legacies of misogyny and racism that have seen women’s bodies, especially brown women’s bodies, as both defective and as the location for solutions to global problems.

Formula isn’t the enemy.  The enemy is a misogynist, racist, global capitalist system that benefits all kinds of rich and powerful figures at the expense of the most vulnerable and impoverished. When we say “formula is bad because formula manufacturing isn’t regulated as much as you think” we are equating the product with the producer. When we denigrate the product for being controlled by a bad producer, we are throwing up our hands and ignoring solutions that involve actually having tighter controls on formula manufacturers. When we call formula dangerous because it’s makers do bad things, we deny the reality of the many mothers and fathers who rely on formula for their survival.

I agree with Donald Trump’s tweet that that NYT’s article needs to be called out and that many women need formula because of malnutrition and poverty. I also know that Donald Trump doesn’t give a shit about women or children, obviously. But that does not mean that whoever he disagrees with have women’s or children’s best interests at heart. We need be careful that as we run away from the hands of an abuser, we not fall into the arms of another.

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