Like most of the world, I was mistaken. I thought that the aggressive promotion of baby formula was a problem confined to the poorer nations, where weak or complicit governments are pushed around by corporations, and mothers are gulled into swapping the breast for the tin. But after I wrote about the bullying of the government of the Philippines by baby formula companies a fortnight ago, the National Childbirth Trust and Baby Milk Action got in touch to tell me a story much closer to home.
We don't have mass deaths from dysentery in the United Kingdom, though babies here are five times more likely to be admitted to hospital with gastroenteritis if they are bottle-fed. But if children don't breastfeed they become susceptible to an astonishing range of illnesses and conditions, regardless of how rich their parents are. A study of 600 Dutch people around 50 years old found that those who had been bottle-fed had higher rates of risk factors for cardiovascular disease than those who had been breastfed. A meta-analysis of studies covering 69,000 children found that breastfeeding protects against obesity. It also appears to reduce the incidence of asthma, allergies, childhood cancers, diabetes, ear infections, Crohn's and colitis (the references are on my website).
So how well do we do? About as badly as a developed nation can. In a recent survey of 16 European countries, the UK comes second to last, beating only Belgium. When our babies are six months old, just 21% receive any breastmilk, while in Norway the rate is 80%; 24% of British babies never taste breastmilk at all - in Norway it's 2%. Remember this next time someone tells you that the rate can't be increased because lots of women can't produce milk. The constraint is not biological but political. The Norwegian government has passed laws that make breastfeeding as easy as possible: all women are entitled to a year's maternity leave on 80% pay, and state employees are given special breastfeeding breaks.
Here we have been allowed to remain in an almost medieval state of ignorance. A survey by the Department of Health found that a fifth of women under 24 thought breastfeeding would ruin their bodies, and that women greatly overestimated the difficulties of producing milk. Perhaps most significantly, 34% believed that infant formula milks were "very similar" to or "the same" as breastmilk. A poll by Mori for the National Childbirth Trust found that about a third of women had received the impression that infant formula was "as good as" or "better than" breastmilk.
How could this idea have persisted, despite all that we now know about breastfeeding? Partly because the formula companies have been able to keep making bold claims about their products. In January the body that coordinates the enforcement of trading standards sent a letter to all the local authorities in the UK. It listed five kinds of claim that are not compliant with British regulations on selling infant formula. One of them was "closer than ever to breastmilk". Yesterday morning I bought three cartons of infant formula from my local co-op and chemist. On the front of Cow & Gate's packet is "Closer than ever to breastmilk". SMA Gold is "now even closer to breastmilk", while Milupa's Aptamil is "the closest to breastmilk".
The claim that "prebiotics" support a baby's "natural defences" is also ruled out. But yesterday I learned that "babies thrive when their natural immune system is supported, so Cow & Gate babymilks are developed with special nutrients, such as prebiotics, that can do this. It's our way of helping you to protect your baby." The Aptamil packet claims that "prebiotics ... support your baby's natural immune system". It also made claims, about fatty acids, nucleotides and betacarotene, of the kind the letter warned against. All five of the examples listed in the letter, in other words, appear on just three packets. The packaging also seems to contravene a guideline laid down by the World Health Assembly in its international code on breastmilk substitutes: that containers should not show "pictures or text which may idealise the use of infant formula". The Aptamil box carries a picture of smiling faces hanging from a baby's mobile. Cow & Gate's carton has a cute picture of a teddy bear with a bottle, and SMA has a fluffy duckling sleeping with a contented smile.
Baby Milk Action contends that some companies have found a clever way of getting round the law banning adverts for infant formula. They legally advertise follow-on formula instead. The packets of infant and follow-on milk sit next to each other on the shelf and look very similar: the advertising for one product is likely to affect sales of the other. Campaigners point to some adverts that don't make it clear which of the two products they are promoting. When Baby Milk Action complained to the Advertising Standards Authority, it was told that the authority won't investigate unless the adverts specifically mention infant formula. Follow-on milk, according to the World Health Assembly, is unnecessary.
I would not suggest that a woman sees a fluffy duckling and thinks, "Right, I'll give up breastfeeding." But if she is having trouble producing milk, the packaging appears to offer reassurance: "Closer than ever to breastmilk" might sound close enough.
The law can be tightened, but only with your help. For the past three years, the Food Standards Agency - having at last got something right - has been pushing the European commission for tougher rules. Outgunned by corporate lobbyists, it has mostly failed. In December the commission issued a new directive that, far from banning the advertising of follow-on milk, appears to ban the banning of it. Though the commission's own scientific advisory body says the manufacturers should remove all nutrition claims except "lactose free", the new directive would allow companies to make other statements for which the scientists say there is no evidence. An obscure rule allowed the commission to draw up the directive without consulting the European parliament. The bureaucrats and the corporate lobbyists have been unmolested by the interests of the hoi polloi, and it shows.
The British government has some discretion about how this directive will be passed into law, and the Food Standards Agency is currently drawing up a legal instrument for implementing it. But it has hit another obstacle: a corporate sleeper cell inserted into the heart of government by Tony Blair, called the Better Regulation Executive. Its function seems to be to block any rule that might interfere with a company's ability to make money. Its executive chairman, William Sargent, previously ran a company which produces digital images for the advertising industry. Government officials report that Sargent is fiercely opposed to making the advertising rules any tougher than the directive requires.
Left to their own devices, our two prime ministers will put healthy profits ahead of healthy children. So they must not be left to their own devices. We have one chance, by lobbying Downing Street, to help the progressives in government to beat back the corporate yes men. We should use it.
