In a few weeks, mothers in New York will turn into guinea pigs under a new program designed to boost breastfeeding rates.
Called Latch On NYC, the program requires participating hospitals to stop giving out free promotional infant formula, prohibit distribution of promotional materials, as well as restricting access to formula and tracking distribution.
The plans, championed by Mayor Michael Bloomberg, have been endorsed by organizations such as the American Academy of Family Physicians and New York Hospital Association.
Ask a woman what she thinks of it, however, and chances are she won't sing Mr. Bloomberg's praises. In fact, the response to the Latch On initiative has been vitriolic. Families are accusing the government of forcing New York mothers to breastfeed and taking away choice. Apprehension about the program stems from the false belief that formula will be locked up, mothers will be lectured by nurses every time they ask for a bottle and the only women who will be granted formula are those with a medical reason.
If that's the case, why are so many hospitals across Canada moving to adopt similar models?
"We've seen huge changes in hospital practices across Canada," said Elisabeth Sterken, director of INFACT Canada, a non-governmental organization that supports and promotes breastfeeding.
She noted that fewer hospitals are sending new mothers home with free formula given out by manufacturers, and many institutions encourage infants to stay in the same room as mothers to encourage breastfeeding.
The issue highlights the ever-present sensitivities around the subject of breast versus bottle feeding. It also pinpoints a vast shift. After decades of giveaways and in-hospital promotion, the days of free formula are drawing to a close.
"Research suggests when women get free samples, they're less likely to continue breastfeeding," said Teresa Pitman, spokeswoman for La Leche League Canada, a volunteer-based organization that supports breastfeeding. "These free samples are not given out because formula companies are feeling very generous and want to help people. They're given out as a marketing effort and a very successful marketing technique."
But the message many women are hearing is that restricting formula companies' activities in hospitals will take away their right to choose how they feed their babies.
When Mr. Bloomberg threw his weight behind the Latch On initiative last month, the reaction was instantaneous. Writing in the Wall Street Journal, Jacoba Urist says the city is trying to turn formula into a "controlled substance" while Lisa Suhay remarked in the Christian Science Monitor that Latch On NYC encourages nurses to be "militant" and that "formula is on lock-down." Katherine Stone, writing on a Babble blog, says she's against "browbeating women into breastfeeding."
In reality, Latch On is an extension of efforts started in 2007 to clamp down on free formula in New York hospitals, and is in line with the strategies that health-care institutions across North America are embracing.
Breastfeeding rates have been stubbornly low for decades, particularly a few months after birth. In Canada in 1982, only about 70 per cent of mothers started breastfeeding when their children were born. By six months, three-quarters had stopped altogether.
Canadian data from a 2009 study published in the journal Birth suggest more women are initiating breastfeeding – about 90 per cent – but only 14 per cent are exclusively breastfeeding by six months. The overall numbers for 2009 are slightly lower in the U.S., where 77 per cent of mothers initiated breastfeeding, with about 16 per cent continuing exclusively by six months.
The World Health Organization recommends exclusive breastfeeding for six months to achieve the maximum benefits.
The presence of formula companies in hospitals is identified as one of the major problems. Mothers may receive free formula as a hospital parting gift; promotional materials may be handed out; and formula bottles can be found in some hospital rooms, making it tempting and accessible if the first few breastfeeding attempts are challenging.
How common is the practice? A 2010 study from Toronto Public Health found that 40 per cent of new mothers leave the hospital with free infant formula. The study also found those mothers who didn't receive formula were 3.5 times more likely to be breastfeeding exclusively after two weeks.
For this reason, many institutions across Canada are clamping down on the use of formula and have achieved or are pursuing "baby-friendly" status, a World Health Organization-sponsored initiative that sets out strict criteria, such as having a written breastfeeding policy, ensuring all staff are trained to help women breastfeed and refusing to hand out pacifiers.
"[Formula companies] did have a very clear presence in the hospitals, giving free samples, free gift packs," said Pam O'Sullivan, vice-president of the acute perinatal program at B.C. Women's Hospital, one of the few baby-friendly institutions in Canada. "That is marketing, inappropriate marketing, of formula."
The hope is that by removing formula marketing from hospitals, women will feel more confident that they can breastfeed. While some women have complained the Latch On NYC initiative takes away their choice, Dr. O'Sullivan argues the initiative actually restores it. It's about "freedom of informed choice," she said. "In actual fact, it's not locking up the formula. It's speaking to a woman and saying 'Do you know about nutrition for infants?'"
The companies that sell major brands of infant formula in Canada did not respond, or declined to answer, questions.
Of course, not all women can or want to breastfeed, or have the will to continue trying after several exhausting days and nights. Author Sarah Fister Gale of Chicago summed up the anti-breastfeeding argument in a widely read piece on the site Jezebel last week, describing the challenges and pain she experienced before firmly deciding formula was the way to go. When she gave birth to her oldest child 14 years ago, she says, the lactation consultant and other members of her health-care team tried to bully her into breastfeeding.
Perhaps, as more hospitals move to better educate staff members and institute improved policies, mothers who choose to formula feed won't be made to feel badly about their choice.
Hospitals stress that any mother who needs formula for medical reasons, or those who simply don't want to breastfeed, will have no problem getting a bottle. "It's really to support women, regardless of their feeding decision," said Jocelyn Vine, vice-president of patient care at the IWK Health Centre, which serves Nova Scotia and other Maritime provinces, and prohibits formula advertising and free samples. "We would teach both groups of women...[the] best way to formula feed or breastfeed."