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Open letter to Medela

11/2013

Open letter to Medela

Under the scope of the International Code of Marketing of Breastmilk Substitutes, it is fine for a company producing products under the scope of the Code – such as feeding bottles – to sell, but it is not alright to promote sales.

Can there be breastfeeding without Medela?

Can there be breastfeeding conferences or breastfeeding events without Medela?

Can there be breastfeeding without Medela products?

Can there be breastfeeding without a breast pump?

Can there be breastfeeding without feeding bottles?

Do we protect, promote and support breastfeeding or breastmilk feeding?

You have done your basic science with your teat product. Using ultrasound imaging of the suckling process your studies demonstrated similarities in the way the baby suckles this teat and mother’s breast. But this is not independent research and evidence, is it? And then you immediately jumped from basic science to clinical practice and selling. Have you actually given any clinical studies, any randomized trials, comparing groups of breastfeeding mothers who come back to work for example? Have you actually demonstrated the safety and the efficacy of your intervention? I am yet to see a study where a group of breastfeeding mothers who return to work and give breast milk with your teat are compared to another group of breastfeeding mothers returning to work and using another bottle. And then see the outcomes; Can babies suck from your teat? Is it effective feeding? Is it safe? Do mothers have better outcomes in terms of duration of breastfeeding or exclusivity? As a clinician, I need to know these answers. How do you prove that with this teat one can avoid nipple confusion? This is a clinical question, not a basic science one. Anecdotal information clearly is not enough. I have seen a lot of mothers buying this expensive product, only to realize that the baby cannot suck from it and then use an ordinary bottle. The reality is you don’t have any clinical answers, apart from ultrasound studies. But this does not impede you from making unsubstantiated claims in your leaflets and your websites – “with our teat you avoid nipple confusion”.

Then you go on and even say that “this is not a teat”. This is crazy, unless this is actually a company that does magic; In reality, everything other that the breast of the mother is a teat, maybe a good teat, maybe a bad teat, but a teat, and it should be sold only to particular cases of mothers who need one, and not be promoted to all indiscriminately and to the general public.

You say “we offer solutions to breastfeeding mothers”. But you don’t just offer solutions to particular mothers who mind need help, this would be fine; Instead you promote teats indiscriminately to many mothers, even to dyads that do not need them. You develop false needs for many potentially harming exclusive breastfeeding. I remember that within the first year of the product coming into the market, your promotion in shops and via health professionals was so heavy that almost all breastfeeding mothers in Greece had bought or were given your teat. But this becomes an artificial need. Many just wasted their money and never used it. Many mothers who want to breastfeed can and should do so without any need to go into feeding bottles. And even if they need to give their milk apart from direct breastfeeding, many mothers can and should give it by means other than a feeding bottle – you can give your milk via a cup, via a syringe, a spoon or via a supplement system on the breast, remember? So you promote a “solution” to many more mothers than those particular ones who would actually need it.

“But what about modern women going back to work”, I hear you saying. This is not the issue here. If a particular mother returns back to work, it is me, the clinician, who will assess individual need together with the parents, and decide how the child will be fed when mother is away. In many cases there is actually no need for a feeding bottle whatsoever; If a mother works only for a few hours, she can breastfeed just before going back to work and just after she returns, and maybe the baby get a little bit of breastmilk in between via a syringe or a cup. If the baby is more 5 or 6 months old she can have solid food or be given some water or juice. In my practice, only for a 30% of mothers returning back to work – long hours, early in the first 3-4 months – a feeding bottle used with caution would be the preferable solution. And even in these cases, it’s me,the clinician who will decide if there is enough scientific evidence out there to prefer the use of one feeding bottle over another, in terms both of efficacy and safety. Thus the problem is not that we deny to some “modern” mothers the benefit from the use of feeding bottles, but rather the problem is the promotion of feeding bottles to many more mothers that do not need them and would do much better without them.

At the level of clinical practice, it is offensive for a health professional for a company to take away from him the individual decision of how to help a particular breastfeeding dyad and make the decisions yourselves. But this is what you have done with this feeding bottle. I propose to a mother to go and buy a certain type of breast pump. This might be a mother that wants to use it occasionally, for a night out, or a case where we have decided to give a little bit of breast milk as top up with a syringe or a cup. And then this mother goes to the shop or the pharmacy, buys a Medela pump and there is the teat inside together with the pump, promoted by your company to be given to every mother buying a pump! But I, the clinician, haven’t decided on this, you have, and it is offensive for you to take away my clinical decisions. Again your company promotes feeding bottles instead of other alternatives to offer breast milk – if and when needed.

You have become Code violators, and the response of your company to this was quite offensive, in my opinion. You almost implied that the Code is an old business, that it does not apply to today and to the developed world, and that you have to think outside the Code and offer “modern solutions” to breastfeeding mothers. But it is this very reaction of yours that reinstates the importance of the Code. Promotion of feeding bottles can harm breastfeeding and should be under the scope of the Code. This hasn’t changed since 1981, because it is still – and more and more – a problem today. The relevant WHA Resolutions are there usually every two years to update aspects of the Code. But the feeding bottle issue doesn’t need updating. The fact that you dismiss the Code in such a way just reinforces the fact that you do not want to apply marketing and promoting restrictions for your teats.

And then, it’s your support in breastfeeding conferences. A mother to be comes in a seminar to hear about breastfeeding. Outside she sees posters with feeding bottles, leaflets with feeding bottles. What impression does she get? Maybe that if she wants to breastfeed, she needs to buy those bottles and those sterilizers beforehand. But can there be breastfeeding without feeding bottles? Certainly there can be.

What is it that we should actually promote, breastfeeding or breastmilk feeding via a bottle? Definitely the first. The scientific evidence shows that breastfeeding is not only about the advantages of breastmilk. It also shows that breastmilk feeding via a feeding bottle is better than formula feeding, but has less advantages to health and bonding compared to direct breastfeeding. This is not to say that it is either exclusive breastfeeding on the breast or nothing, but that health professionals, institutions and companies should aim to help mothers do breastfeeding rather than bottle breastmilk feeding. Remember, the whole issue is to establish a breastfeeding culture and move away from the bottle feeding culture. The aim is not to replace bottle feeding culture with bottle feeding breastmilk culture. The aim is to facilitate exclusive breastfeeding removing obstacles and unnecessary interventions to the breastfeeding dyad, helping mothers with the least interventions possible, not more than the ones medically needed. Interventions that create artificial, commercial extra needs to families and extra costs can harm breastfeeding.

Then I can here you saying “the problem is infant formula promotion, not a company that has supported breastfeeding for years”. No, it is not only infant formula, and that’s why the Code is still so important – the EU legislation having removed feeding bottles from its scope. The problem is everybody who works to massively convert breastfeeding into bottle feeding, even with breastmilk inside. What you have done over the last years is to promote feeding bottles and violate the Code. And you keep doing it with no regrets.

You are probably aware that with your recent marketing of feeding bottles you have alienated quite a lot of knowledgeable people on breastfeeding worldwide. This is unfortunate for individual clinicians who strive to support mothers and desperately need allies. You show no signs to rethink your promotion, marketing and advertising tactics. Myself and many people in the field refuse to be used – their professional name and reputation – by your company to indirectly promote selling of your products to breastfeeding dyads. We will recommend products to individual mothers who need them, but we will not cooperate with your promotion tactics. I believe that all health professionals and other breastfeeding people (lactation consultants, paediatricians, midwives, la leche league leaders etc) should take the same stand towards your company, unless you become Code compliant. I believe that every health professional should abide by the Code of Ethics of his/ her profession and do the same, avoid conflicts of interest that result in compromising breastfeeding protection and promotion.

Stelios Papaventsis MBBS MRCPCH DCH IBCLC
Paediatrician Lactation Consultant

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