This week in the news Dr Jennifer James was quoted as saying that baby formula should be issued by prescription only. The theory being that it would make formula less readily available, and would therefore boost breastfeeding rates.
Statistics have shown in recent years that breastfeeding rates in Australia are alarming low. Close to half of all babies are still breastfed at 6 months of age, down from over 90% at birth. This despite the fact the World Health Organisation recommends breastfeeding for at least two years. Meanwhile in many other countries such as Norway, breastfeeding rates are much higher. So it is understandable that Dr James, as well as others, would be looking for ways to increase the number of breastfed babies, hence this latest recommendation.
Personally, having to get a prescription for formula doesn't scare me. My child was bottlefed from birth, however this was not by choice. It was due to surgery I had in my teens that left me unable to breastfeed. I know that I could waltz into any doctor and ask for a prescription, and after quoting my reasons I would be given one on the spot. I am also not so naive as to think I would need a seperate prescription for each individual can, because I take several other medications for which my doctor gives me enough repeats to last me well over a year.
It also is clear to me that others would have no trouble obtaining that all important piece of paper. Already patients have ways to manipulate doctors into giving them pain killers, sedatives, and diet pills. I myself have gone to see doctors I have never seen before, asked for prescriptions for very potent steriod treatments, and have been given them with no questions asked.
It is a concern that it would create a further sense of guilt among mothers who find themselves having to resort to the bottle. Even knowing I'm physically unable to breastfeed I was still struck with the guilt of giving my child the inferior option. I can only imagine the guilt mothers must experience when they feel they have no other choice but to give up. Getting that prescription would be a massive inconvenience for a mother with cracked, bleeding nipples and a screaming, hungry baby. But if it must be done, mothers will do it.
Despite all this, I simply cannot support this recommendation. Because I honestly believe that it will not acheive the desired result of increased breastfeeding rates.
The recommendation to make formula prescription-only seems to be based on a number of assumptions about why mothers choose to give their baby formula. It is assumed that mothers don't know the benefits of breastmilk, that they are taken in by advertising, that they opt for the bottle for selfish reasons, or that they give up too easily.
Any mother would have to be living under a rock not to know the benefits of breastmilk. Even I have been known to chant the "breast is best" mantra, even though my children will never taste the stuff. The books all tell us breast is best. The posters tell us. The pamphlets. There is even a big red sign on the side of every formula can saying that breastmilk is better than what is contained in this tin. We are all fully aware that formula is inferior, so that assumption is wrong.
There is no advertising for formula. There are ads for toddler milk, but this isn't formula, it's a vanilla milk drink. One that no doctor, nurse, or midwife recommends using. One can argue that this is advertising by association, but bottom line is that from-birth formula has only one opportunity to win over a customer, and that is with the branding on the can itself. When choosing which formula to give my child we found ourselves choosing between the cheap one, the expensive one, the organic one, and the one with the bear, having no idea of the difference between them. So that assumption is wrong.
There can be no doubt that some people choose the bottle for selfish reasons. They don't want their breasts to sag, or they want to be able to drink, or they want the father to do the night feeds. However this is a small minority. Most mothers want what is best for their child, and would rather be whipped with a cat o nine tails than feed their child formula. So that assumption is, well not wrong, but not right either.
But the big one, the assumption that mothers give up too easily. This is offensive to so many people. Over 90% of babies are breastfed at birth, meaning that over 90% of mothers give it a go. Within a few weeks this number drops sharply. In the mean time any number of mothers find themselves in agony, exhausted, and desperate. At which point their own mother, their partner, or a friend says "why don't you give the baby a bottle?" And mothers listen because they have no-one else to give them advice.
I mentioned before that breastfeeding rates are higher in Norway. Well support for new mothers is also higher. In Australia new mothers can be discharged from hospital within hours of birth, after which support from health professionals is limited. In hospital staff are overworked and unable to give each patient the support they need. I cannot count the number of times I have heard a mother say they tried so hard to breastfeed, and feel they could have done it longer if they had more support.
That word right there is the key to improving breastfeeding rates - support. More support for new mums while they learn. If formula is available by prescription mums will still get it somehow. But if they have the correct support they might in fact find themselves able to breastfeed.
At the end of the day though, mums who bottlefeed also need support. While in hospital I had problems teaching my child to feed. Bottles are meant to be the easy way out, but they aren't always easy. Not to mention the judgements and the guilt, because what you're giving your child isn't the very vest. But really, formula isn't the end of the world. Many babies thrive on formula. So why can't we advertise it?
There are two products we don't advertise in Australia. These are formula, and tobacco. One nourishes infants that might otherwise starve to death. The other kills people. Why are these treated in the same way?
I agree that we should never say that formula is better than breastmilk, because it's not. But surely formula advertising can be regulated in the same way as alcohol advertising. Advertisors know what they can and can't say, and won't break the rules for risk of a fine. And surely this would make the choie easier for mums than having to choose between the cheap one, the expensive one, the organic one, and the one with the bear.
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