Why The Politics of Breastfeeding Matter

An interview with Gabrielle Palmer

Gabrielle Palmer has been campaigning to end the unethical marketing of artificial baby milks for almost 40 years. In both her seminal book The Politics of Breastfeeding and her recent book Why the Politics of Breastfeeding Matter she describes how the relentless marketing of artificial milks contributes to the illness and deaths of babies. Saffia Farr talked to her about what fires this passion in her life.

How did you become involved in campaigning about breastfeeding? I had my own children in the 1970s. I knew nothing about breastfeeding, I had to save money, and it seemed easier than making up bottles. In those days 70% of British babies were artificially fed from birth, and if you breastfed you were made to give top-up feeds in hospital. Babies went straight to the nursery after birth. I didn’t get any information, but one midwife woke me up in the night and said, “Your baby’s asking for you,” and took me to the nursery. I was thrilled. She didn’t show me what to do, but her absolute confidence that I could breastfeed got through to me. The next day I told the paediatrician I wasn’t sure I had enough milk and he said, “God never fails to send the milk.” I’m not religious, but his certainty boosted me. To this day I think confidence is more important than hours of technical advice. Health professionals have often had bad experiences themselves and lack confidence in the process, and this gets across to mothers. I never read a breastfeeding book until years later. In the 1980s, working in Mozambique, I observed that no woman doubted her milk supply, despite hunger, poverty and warfare.

In 1972 I came across a leaflet about the NCT Breastfeeding Promotion Group. I thought what a good idea it was to support other mothers. I had felt so alone and had even been reduced to tears by a baby clinic paediatrician who had berated me for breastfeeding an 8-month-old, telling me that I was malnourishing my daughter (who was huge and healthy). She ordered me to send my baby away to my mother, who should leave her to scream for the weekend. I trained as an NCT breastfeeding counsellor and worked happily with my lovely health visitor who, unusually for those days, encouraged mothers who wanted to breastfeed.

In 1974 I saw an ad for the War on Want booklet The Baby Killer, which hada cover image of a malnourished baby inside a bottle. I sent off for a copy and was shocked to learn that mothers could be tricked into buying products that led to the deaths of their babies. I felt I must do something.

What do you think motivated you? I’m not quite sure, but in situations of hardship or suffering I often think, “That could be me.” I’ve always had a strong sense of justice and see it as unacceptable that I can have two healthy children when another woman loses hers for entirely preventable reasons. I was inspired by the poet John Donne’s words, “No man is an island” and especially the later lines, “Any man’s death diminishes me, because I am involved in mankind.” [By mankind, he means humankind – men, women and children.] I suppose those words express my philosophy of life.

When my children started school I got a job with Save the Children and met people who educated me more about the formula companies’ immoral practices. I got involved with the newly formed Baby Milk Action Coalition founded by War on Want and other development agencies. By that time my family had moved to Cambridge, so I set up a group there which eventually became Baby Milk Action, the UK member of the International Baby Food Action Network (IBFAN).

How have we made something that is natural so complicated? I do worry that we’ve made it too cerebral. Mothers seem to spend more time on the internet or reading books than actually enjoying their babies and working it out for themselves. It’s like dancing. You could spend days reading books about dancing, but just having a go with an eager partner makes learning easier – and more fun. In societies that dance everyone does it without thinking, and so it is with breastfeeding. I certainly think if every small child saw breastfeeding happening daily like coffee drinking or phone calls they would unconsciously pick up techniques for later in life. We’ve lost that gift. If the common perception is that you will struggle, then you will. Breastfeeding is made out to be complicated, or something that it’s normal not to be able to do, so people approach it with fear and it becomes a vicious cycle. All the advertising endorses this, and, my goodness, doesn’t that increase sales! But I must emphasise that I’m filled with admiration for all those dedicated health professionals and mother support groups who have transformed practices in this country and around the world. Just look how nurseries and pre-lacteal bottle feeds have stopped being the norm. What impresses me too is how so many women want to breastfeed despite everything being stacked against them.

How has this situation come about? The full answer is set out in my book, but in short, pushing the artificial feeding products while infiltrating health systems with mistaken ideas about how women’s bodies work is a good way to shut down breastfeeding. You can turn a confidently breastfeeding society into an artificially feeding one in a generation. Vietnam in the late 20th century is a perfect example.

What bothers you most about the issues you face in your work? Most frustrating is the weakness of governments, who are seduced, bribed and bullied by the companies. When, at the 1981 World Health Assembly, the world voted overwhelmingly to adopt the International Code of Marketing of Breast-milk Substitutes, everyone believed that governments and the companies would honour their promises to regulate marketing. Few predicted how two-faced the companies would be and how powerful their influence would be over government policies. At every World Health Assembly when infant feeding is discussed, government representatives say, “Oh yes, we are fully committed to the Code,” but then go back home and ignore their own regulations.

In what way? Well, for example in the UK we have a law, but there is no inspection or scrutiny. It’s up to aware citizens to take a complaint to Trading Standards, and they often don’t have the funds to pursue a case. Even if the government provides good information (as required by the Code), it’s drowned out by the marketing. Safer artificial feeding is jeopardised too. The companies provide no full, accurate information even to health professionals. For example an ad for Aptamil Follow On Milk in the Journal of Family Health (February 2016) claims that it is “inspired by breastmilk research to create a new formula closer to breastmilk”, but there is nothing new in this product except the unexplained use of egg phospholipid. It’s an embarrassment to us all that a respectable journal should accept such misleading information, which deceives health professionals, who then unwittingly misadvise those in their care. The government does nothing to stop such malpractice.

Image taken by Jo Haycock https://johaycockphotography.co.uk/

I understand it in countries where families do not have access to the fuel necessary to boil the water, and that babies die from unsafe use of artificial foods, but why is a lack of breastfeeding important in countries like the UK where there aren’t always the hygiene issues? Actually we do have hygiene issues in the UK. Any artificial feeding carries some risk. There are intrinsic pathogens that are extremely difficult to exclude from the product. To be as safe as possible you must make each bottle feed separately with water boiled to 70 °C. Amongst artificially fed babies we have rates of diarrhoea, respiratory and other infections equal to those in some developing countries, but we have our brilliant NHS. Rapid diagnosis and treatment prevent more serious illness and death. However, we must face up to the fact that most of our paediatric wards are filled with artificially fed babies. For example, the risk of pneumonia is strongly related to feeding method. If every mother in the UK were supported to breastfeed for just 3 months, it would save both family anguish and millions in NHS health costs. You can’t make this happen if the marketing is allowed to continue. It undermines confidence and persuades families and health professionals that artificial feeding is just as good, when it is not. There are long-term issues too, such as an increased risk of both type 1 and type 2 diabetes, and also a greater risk of breast cancer for women who don’t breastfeed. These are all serious and painful issues, and we have the right to know about them. Every woman has the right not to breastfeed, but she must also have the right to be well informed about the risks. I would love it to be an equal choice, but facts are facts. Most UK women want to breastfeed and feel regret and sadness if they stop earlier than they wanted to. It’s invariably outside pressures, misinformation and poor support that make it go wrong; this sabotages confidence and turns a joy into a nightmare.

But my own priority is that most people in the world are poor. (3.5 billion people live on less than US$4 a day.) They’re the ones whose babies die of diarrhoea and respiratory infections when they’re not breastfed. Every day over 2,000 babies die because they are not optimally breastfed. When rich societies model artificial feeding as just fine and do nothing to stop our companies peddling their products, we’re complicit in these illnesses and deaths. Even if lives are saved, the cost of all the inevitable ill health (short term and long term) holds a poor society back.

What can an individual do to stand up to this corporate tide? We need to find ways of educating people in a sensitive and effective way. IBFAN, UNICEF UK and other breastfeeding support groups all provide information on their websites. Contact your MP, or anyone with power and influence. Remind them politely and gently of the facts and the UK government’s long-standing commitment to baby-food marketing regulation. Even Margaret Thatcher was pro-Code, and it’s always been an interparty issue. Remind them that the Code protects all babies, whether breastfed or artificially fed.

But those reading this article might not feel they are expert enough to have those conversations. Once, when I was fretting about not knowing enough to appear in a TV programme, my sister said to me, “You know more about breastfeeding than you do about steam engines.” Don’t claim to know more than you do, but I bet you already know more than your average politician. Keep it short and simple and memorise a couple of salient facts that might attract interest. For example, I once influenced a hospital finance manager to support the UNICEF Baby Friendly Initiative when I mentioned that breastfed babies had a lower risk of type 1 diabetes and cited how many millions were spent over a lifetime of the illness. Though I didn’t know it, his wife was diabetic, so he had a personal interest. Double-check that whatever you are saying is accurate and don’t be huffy if the politician gets all the credit. Rejoice. But most importantly, take care of yourself and do only as much as you can manage.

Why the Politics of Breastfeeding Matter by Gabrielle Palmer is published by Pinter & Martin and is an excellent and accessible resource for helping explain the issues and impacts of aggressive marketing of artificial baby food.