Infant formula – stop the sermonising

A culture of paternalism

Sir, – The authors of an article outlining proposed changes to baby formula marketing argue for extending those restrictions into the online arena (“We must close the loophole that facilitates misleading online ads for baby formula”, Opinion & Analysis, August 9th).

While I support the curtailment of nefarious corporate advertising, I question the article’s rhetorical framing.

The authors note that “the first few months with a new baby are some of the most intense and challenging of a parent’s life. For first-time parents], it can be especially nerve-wracking, full of anxiety.” Infant feeding is a “fraught question” and “mixed messaging” a major contributor.

I’ve never seen the relevant social media ads. Perhaps, as someone who exclusively formula-fed, or never had cause to Google whether my baby was sufficiently well-nourished, I’ve avoided the targeting of certain algorithms. However, I have seen mixed messaging and a questionable framing of the infant-feeding issue.

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This article, for example, proudly leads with an association of formula with tobacco, an association potentially suggestive of comparative harm.

The article notes that the International Code of Marketing of Breast-milk Substitutes (formula marketing) is not aimed at limiting choice or “removing formula products from the shelves”. While it’s terribly generous of the authors not to want to eliminate the main food source of the majority of Irish infants, I can’t help but wonder at the sensitivity of raising this while a formula shortage continues overseas.

The article appeals for “accurate, independent, science-based information”. Private companies, after all, are hardly “neutral advisers”. However, the authors might equally consider whether their own rhetoric contributes to a climate that makes “informed choice” difficult. The benefits of breastfeeding are touted without links to relevant studies, qualifications, or any acknowledgement that the primary methodological basis for the majority of the evidence is in observational studies, which, in most other domains of science (where randomly controlled trials are the standard) are regarded as insufficient for demonstrating cause and effect.

The choice to describe women who formula feed as “those unable to choose to breastfeed” is patronising and contributes to a culture of paternalism that treats women who don’t breastfeed as lacking some kind of capacity.

The authors should focus on the actual issue, which is manipulative advertising aimed at causing anxiety in a vulnerable community. Instead, we find the suggestion that, by minimising the exposure of infants to formula, we are “protecting the health and rights of children”, again implying that formula is damaging.

The World Health Organisation’s lone recommendation on infant feeding is that mothers should exclusively breastfeed (eschewing bottles, soothers, or any supplementary nutrition) on demand (whenever a child seems hungry) for the first six months, and continue to breastfeed in conjunction with other nutrition until the child is two and beyond. This advice, which the HSE endorses, is far from the typical practice of Irish families. We should question the wisdom of recommending as a norm a standard that so few meet, especially in the “fraught” domain of early parenthood. Policy that makes the vast majority feel that they are failing to meet medical standards is ill-advised.

Families pursuing the WHO version of things deserve more material support and resources. The rest of us could do with a break from the sermonising. – Yours, etc,

CLARE MORIARTY,

Dublin 4.