Keeping formula marketing out of hospitals: A campaign for women

Picture of baby

Last week’s launch of Public Citizen’s campaign to stop infant formula marketing in healthcare facilities got lots of people talking – and acting. In less than a week, more than 13,000 people signed their names to a petition calling on the three major formula companies to stop using healthcare facilities to market their products. Dozens of news outlets and blogs covered the campaign’s launch, which also included sending letters, co-signed by more than 100 other organizations, to more than 2,600 hospitals across the country. The organizations are calling on hospitals to stop allowing formula companies to co-opt their facilities for profit-making purposes that undermine the advice of all major healthcare provider organizations: Breastfeeding is best for babies and mothers’ health.

People signed on to the petition and cheered our efforts because they agree that allowing corporations to commercialize an environment that we turn to in our most vulnerable moments – when we seek out healthcare – is unconscionable. Moreover, many families know just how challenging breastfeeding can be. Obstacles to successful breastfeeding abound. Prominent among these is the unrelenting pressure Big Formula marketing places on women to use their products. Formula marketing also creates barriers by instilling doubt in many women about their capacity to successfully breastfeed.

The Infant Formula Council, the industry trade group, responded to our campaign in typically misleading fashion. The IFC claimed that we had called for the elimination of “infant feeding education materials and samples for mothers in hospitals.” This “education,” they claimed, is necessary to ensure the health and safety of babies. In similar fashion, the American Hospital Association defended its members’ practices, claiming that “having information and resources” available to moms in hospitals is the duty of responsible hospitals.

Education materials? Information? Since when do samples of commercial products, provided by corporations that profit when patients use these products, constitute information? The best information comes from the people trained to provide us with what we go to healthcare facilities for in the first place – healthcare, not marketing. Does the IFC believe that doctors, nurses and lactation consultants are ill-equipped to provide their patients with adequate information about infant feeding, be it breastfeeding or formula feeding? The claims of both the IFC and AHA aim to bolster the mistaken perception that these companies provide marketing materials for altruistic reasons and are most interested in helping women and their families. But nothing could be further from the truth.

Like any campaign, the launch brought out other detractors who questioned our goals. Indeed, the IFC’s leadership team members must have been rubbing their hands together in delight when they read some of the comments on news stories about the campaign, and one particularly inflammatory blog post on feminist blog, Jezebel. Wrote Jezebel’s Tracie Egan Morrissey, “these free samples don’t undermine a women’s abilities, but questioning the choices she makes regarding her body certainly does. How does this differ from pro-life sentiments?”

Morrisey’s suggestion that eliminating formula industry marketing materials from hospitals is equivalent to questioning women’s choices is, to use her language, “borderline illogical.” Morrissey’s notion of choice is based on an individualistic ideal of autonomy that situates women’s choices in a vacuum. Women’s choices about feeding their babies are, like all choices, made in the context of social norms, structures and forces. When it comes to breastfeeding, these might include access to paid leave, workplaces policies, cultural background or marketing. To blind ourselves to these forces is to limit our ability to clearly see the obstacles that women face in making choices that are best for them, whatever those choices may ultimately be.

Marketing works. That’s why corporations spend billions of dollars on it. It works not on our rational decision-making capacities (which might induce us to be skeptical of marketing), but our emotions and subconscious. And using healthcare providers to facilitate marketing is a perfect example of a marketing tactic that bets on our subconscious association between a product and the institution that is supposed to be providing us with sound, unbiased advice. To suggest that marketing affects women is not to suggest that we are stupid or incapable of making decisions, but that we are human and make decisions that are shaped by a variety of forces.

The campaign is not about compelling women to breastfeed or questioning women’s choices not to do so. We aren’t calling for a “ban on formula.” Formula is available in hospitals for medical use, or for use by women who choose not breastfeed, and readily available for purchase almost everywhere, as it should be. Removing formula marketing from hospitals is not the same as removing the option of formula feeding.

Our letter to hospitals does emphasize that exclusive breastfeeding is recommended by all major healthcare provider organizations, and that not breastfeeding comes with certain risks. This is a point that highlights the questionable nature of the practice of allowing infant formula marketing in healthcare facilities – beyond the problem of commercialism in hospitals more broadly, this specific example of commercialism also serves to send a message that contradicts public health advice. That the distribution of commercial infant formula samples contravenes public health recommendations isn’t, as Morrissey suggests, a reflection of Public Citizen’s idiosyncratic “preference for exclusive breastfeeding,” but rather of indisputable scientific evidence.

Does this mean that some women won’t or shouldn’t choose not to breastfeed, or that some women physically cannot do so? Of course not. As with many other health recommendations, there are a variety of reasons why, and circumstances under which, people may not be able to or want to live up to them. That doesn’t make these recommendations oppressive or wrong. Perhaps the  breastfeeding recommendation feels this way to some women because our society still has a long way to go before we can say we provide adequate support for women to breastfeed if they so choose. But the solution to this is not to keep in place one of the many obstacles women face when they attempt to breastfeed – infant formula marketing. This is surely not the only obstacle women face, but it is a powerful one.

Most women want to breastfeed. The CDC reports: “Although approximately 80% of women in the United States indicate before delivery that they intend to breastfeed, and 75% initiate breastfeeding, at 1 week half of women have already given their infant formula, and only 31% are breastfeeding to any extent at 9 months.” If women want to breastfeed their babies but are often unable to do what they have chosen, something is impeding their autonomy – and it is not the recommendation to breastfeed. Rather, it’s the obstacles they encounter in attempting to fulfill those intentions, including the obstacles created by formula marketing, that hinder women’s choices.

Formula companies exploit both women and healthcare facilities by compromising these spaces in the service of their bottom line. They create barriers to women making informed decisions and acting on these decisions. They also perpetuate a divisive and toxic rhetoric of so-called “choice” that in fact undermines women’s autonomy. Knowing how powerful and meaningful this language is for women, the formula industry co-opts it and uses it to undermine solidarity between women that could be used to help us achieve our goals rather than to profit a multibillion-dollar industry. Breastfeeding is a feminist issue: it is shaped by the distribution of women’s access to social, cultural and economic resources. Infant formula industry marketing, particularly in healthcare facilities, obstructs women’s access to the crucial resources they need to live autonomously.

Are you ready to support women and fight commercialism in our healthcare facilities? Sign the petition and get involved.

Elizabeth Ben-Ishai is a senior researcher at Public Citizen and the campaign coordinator for Public Citizen’s Commercial Alert. Follow her at @CommercialAlert.