Here's Looking at You, Kid

...What's more, over- or under-dilu-tion of formula can lead to serious damage...

...Public Advocates, a public interest law firm in San Francisco, presented a 150-page report to Congress last summer supported by statements from doctors, nurses, and mid-wives on the infant morbidity they encounter in formula misuse cases in American hospitals...

...In the private rooms of some large hospitals, more than half of the new mothers breast-feed, while in the wards, only 10 to 20 per cent do so...

...When the plan to stop giving samples to breast-feeding mothers failed, staff members decided not to give out any samples at all...

...Not all the new programs have been so successful...

...endorsement of the code at home and abroad would violate principles of free enterprise and free speech...

...They also urged that hospitals receiving Federal funds be required to give out information on breastfeeding...

...Vardith Fox, a pediatrician at the San Fernando Pediatric Clinic near Los Angeles, told Public Advocates that incorrect preparation and contamination of formula cause a major portion of the diarrhea and stomach inflammations seen in the clinic...

...THE BABY FORMULA FIGHT: HOME FRONT NOTES Here's Looking at You, Kid BY MARY ELLEN SCHOONMAKER When a Southeast Asian woman— let's call her Lin—took her new baby home from the hospital not long ago, she also took home a complimentary sample of infant formula...

...Her work has appeared in In These Times, The New York Times, and other publications...

...When a mother is given a pack of formula at discharge," the letter said, "the hospital is saying: 'Your baby received the best alternative to breast milk in the hospital and we want you to continue giving this for the best nutrition.' " Bronx Municipal officials say that endorsement is just what they want to avoid...

...The formula producers deny that hospital promotion makes much difference...

...Benjamin Sp?ck has said, "The combination of a mother lacking confidence in her ability to breast-feed and the availability of bottle formula [is] the most efficient method of discouraging breast-feeding...

...They say their cans already carry symbols showing when to add water, and that instruction booklets in other languages are available on request...

...Soon after Lin left the hospital, though, a public health nurse on a routine check found her child seriously ill...

...Ross and Mead Johnson fight ferociously for a hospital's business...

...But cutthroat competition kept the challengers out...

...The FDA is reviewing the petition and has until December to respond...

...He wrote to the hospital staff, urging them to reconsider...

...Kafka, chief of pediatrics for four Los Angeles County health clinics, blames formula misuse for some of the severe diarrhea and dehydration he sees among children of low-income Hispanic families...

...Not until page twenty-five of the forty-page booklet is it conceded that breast milk is the perfect food for babies...

...Paradoxically, the problem comes to light at a time when breast-feeding is back in vogue, particularly among better-educated middle-class women...

...But some pediatricians say a bottle's mere presence can inhibit successful breastfeeding...

...Ready-to-use formula and concentrate are sold in cans of the same color...

...The labels on some of their brands even say breast milk is preferable...

...Katherine L?bach, director of the hospital's family care center...

...Outlays cover the cost of give-aways ranging from pens and notepads for the desks of pediatricians to research and teaching grants, such as the $1 million grant that Ross Laboratories made last winter to the American Academy of Pediatrics to help publish a journal...

...One can of formula doesn't interfere with breast-feeding, they claim...

...While formula is the most nutritious alternative to nursing, it cannot match breast milk, which provides immunity against many infections, viruses, and, possibly, allergies...

...Some of these mothers have no money at all...

...Another Third World mother victimized by a formula-peddling conglomerate...

...But the table of contents of one such booklet, a guide for doctors printed by Ross, lists some discouraging topics under a section on breasts...

...Some staff members at the hospital, which uses both Similac and Enfamil, tried to stop giving out the samples to breast-feeding mothers last year...

...I see no problem with the samples as long as there is an education program about breast-feeding at the hospital," said Dr...

...I have a real concern about sending an infant out without some kind of safe and nutritious resource...

...Another said she had tried to breast-feed in the hospital but the nurses had discouraged her, telling her that her breasts were too small...

...The Medical Center of the University of California at San Diego no longer gives discharge packs to breast-feeding mothers as part of a program that includes prenatal counseling, staff training, and post-birth follow-up...

...Wehrle, a member of the executive board of the American Academy of Pediatrics, insists that the hospital's policy is made independently of the Academy and the formula companies...

...When the World Health Organization passed its code to curb baby formula marketing last spring, and the United States made headlines by voting midwife at a Jersey City clinic recently made an unsuccessful attempt to persuade a pregnant eighteen-year-old to consider breast-feeding...

...Not quite...

...The inside cover of the booklet is a full-page ad for Similac...

...they generally choose the company that gets to them first...

...According to Kittie Frantz, a nurse-practitioner and director of the hospital's breast-feeding clinic, there was a noticeable decrease in the number of mothers who were supplementing breast-feeding with a bottle, making them more likely, she thoughts to breast-feed longer...

...Luckily, she was also giving the baby an occasional bottle of water, and the infant's tiny stomach was working hard to cut the thick syrupy formula on its own...

...Hospitals do not select a brand on any medical basis...

...For nine days, the mother, who spoke no English and was hard of hearing, had been feeding the baby concentrated formula at full strength, instead of diluting it by half with water...

...I want to be close to my baby," the young woman said, "but not that close...

...In four years, the breast-feeding rate at the hospital has gone from 60 per cent to 80 per cent...

...But when those women saw other mothers getting packages, a nurse said, they would follow the nurses into the hall, saying that they had changed their minds about breast-feeding and wanted free samples too...

...The formula companies—Ross Laboratories (Similac) and Mead Johnson (En-famil) control 90 per cent of the domestic market—say that breast-feeding is on the rise in all socio-economic groups...

...The idea of something free is compelling, especially to a woman ^without much money to spend on a new baby...

...Lin gave birth in San Diego...

...Allan Cunningham, a pediatrician at the Mary Imogene Bassett Hospital in Cooperstown, New York, told a Congressional oversight committee last summer that bottle-fed infants are hospitalized three times more often than breast-fed infants before their first birthday...

...The most severe problems develop, Fox said, when an infant is fed concentrated formula without dilution, which typically happens when the mother cannot read the directions printed in English on the label...

...Gerber had been trying to gain a toehold for ten years before that...

...Its importance is described in a Similac sales manual: "A hospital gained generates untold sales increases, while a hospital lost means watching helplessly as competition reaps all the benefits...

...At the Bronx Municipal Hospital, the breast-feeding rate has doubled since the hospital stopped handing out all formula samples last spring...

...In fact, breast size has nothing to do with the ability to nurse...

...Public Advocates was joined by the National Council of Jewish Women, the National Council of Negro Women, a branch of the National Council of Churches, and the Infant Formula Action Coalition (IN-FACT), among others, in calling for changes in formula marketing in this country...

...It mentions engorgement, sore or cracked nipples, mastitis (a painful infection), lumps, leaking during intercourse, and sagging...

...The problems at Los Angeles County General Hospital-University of Southern California Medical Center are indicative of the uphill road ahead...

...All mothers, the salespeople insist, must receive discharge packs whether they want to breast-feed or not...

...And they point to the literature on nursing that they give to doctors and hospitals...

...Many hospitals receive all the formula they use in their nurseries free as long as they promise to give each mother a sample...

...They say 95 per cent of all new mothers decide how to feed their babies before they deliver and stick with their decisions...

...Resistance is usually led by staff women—pediatricians, nurse practitioners, and mid-wives—trying to counter the promotional overkill of the formula companies with an equal amount of enthusiasm for breastfeeding...

...She may be glad to get something like formula for nothing, not realizing how much it will cost later to keep the baby supplied—about $10 to $12 a week...

...The salesman for Ross Laboratories was upset when he received word of the decision, said Dr...

...Audrey Naylor, who helped set up the program in 1977, says the sample handouts can induce reluctance—if not outright failure—to breast-feed, simply through the power of suggestion...

...James Post, a business professor at Boston University and an expert on the industry, believes the companies as a group spend more than $100 million each year on indirect advertising and promotion...

...Eager to adapt to American ways, she welcomed the formula sample as an alternative to "backward" breastfeeding...

...In recent years, the companies have expanded their market, promoting longer bottle-feeding and the convenience of more expensive types of formula...

...Cunningham and others who testified said low-income and non-English-speaking women are particularly vulnerable to a "disturbing pattern of heavy-handed infant formula promotion" that discourages breast-feeding...

...The domestic formula market is likely to top $700 million in total sales this year, according to one industry estimate, thanks to aggressive marketing and public relations...

...Ross and Mead Johnson began supplying hospitals with free formula in the early 1970s when Baker-Beechnut Corporation tried to break into the market...

...Some hospitals rotate the brands they stock, just to keep the salespeople out of their hair...

...When only the first four months of life are taken into account, bottle-fed babies are hospitalized against the measure, Assistant Secretary of State Elliot Abrams tried to assure critics that there was no cause for concern: The United States spends millions of dollars promoting breast-feeding, he said...

...A new mother in the waiting room said she preferred formula because it was easier, and all her friends and relatives bottle-fed their babies...

...They petitioned the Food and Drug Administration (FDA) to require bilingual labeling on cans of formula sold in Spanish-speaking communities, clearer pictorial directions for use, and color coding for different kinds of formula...

...A fifteen times as often...

...Free architectural service for nursery design, cocktail parties and fishing trips for the house staff, equipment and printing—whatever it takes to keep in a target hospital's good graces and stave off the competition—are all thrown in with the free formula...

...Elsewhere in urban ghettos and barrios, in rural areas, and on Indian reservations, health officials say they see many babies who are sick or malnourished because their mothers do not know how to use infant formula...

...True, this is not one of the Third World nations where hundreds of thousands of babies are reportedly dying because their mothers mix formula with polluted water or put it in dirty bottles...

...But misuse and overpromotion of infant formula do happen here, often among those women who can least afford the products and could better use the money to feed themselves...

...Top administrators said they were afrajd that by doing away with the samples altogether, they might inadvertently force some mothers to feed their babies less nutritious liquids, sttch as cow's milk, or worse...

...Despite the trend toward breast-feeding, they continue to use formula, thinking it the modern way, or lacking impartial information...

...But the time, energy, and money spent to line up a hospital belies that denial...

...In the fall of 1980, however, after about four months, that plan was dropped too...

...Paul Wehrle, Los Angeles County Hospital's director of pediatrics...

...It may be mere coincidence, therefore, that the Los Angeles County General plan to stop trafficking in formula samples fizzled somewhere around the time the Academy accepted its $1 million grant from Ross Laboratories...

...furthermore, a U.S...

...Mary Ellen Schoonmaker is a reporter for The Record in Bergen County, New Jersey...

...But the focus of all formula marketing is still the hospital...

...Afew hospitals have begun to fight back...