Abstract
This month's issue of Breastfeeding Medicine highlights a small and limited, but intriguing, article by Mahavni and colleagues who investigated the influence of formula shortage on mother's infant feeding decisions. The investigators hypothesized that the knowledge of an existing formula shortage, in the year 2022, would impact on the mother's decision and that the rate of exclusive breastfeeding and breastfeeding frequency would increase with their current newborns as compared with what were the rates with their previous infants.
The results of the study indicated that the mothers' decision how and what to feed their newborn infant correlated with their decisions as to what and how their previous infant was fed. Knowledge as to a reality of formula shortage had no significant influence or correlation with the mother's decision making. Simply put, global issues were outweighed by previous personal experience. The message, thus, was clear, an existing formula shortage cannot be relied on as a motivator to choosing to nurse and advocacy and support of breastfeeding has to be proactive and focused on the mothers and their existing medical and social situation.1,2
Formula shortage has a history in of itself and unfortunately it confirms that shortages have led, all too often, to searching for alternative formulas rather than a more logical and appropriate increase in the feeding of human milk. In 2005 some 20 Chinese manufacturers of breast milk substitutes were found to be adulterating their formula by adding melamine, a substance used in the manufacture of plastic as a whitening agent and to artificially raise the measured protein level. This led to a loss of confidence by the Chinese public as to the quality and safety of all Chinese formulas.
The response was the development over the years of a network of professional buyers (“daigous”) who organized the purchase of formula in Australia and shipped it back to China for reselling at three times its cost. This practice led to a shortage of formula in Australia to a degree that the local Australian stores began to ration the formula, did not display it on the store's shelves, and limited its availability to local residents so as to be able to supply the needs of their public. 3
More recent shortages have resulted from COVD-19 supply chain logistical problems that have limited the availability of raw materials for the manufacture of formula. Hopefully, with better planning and stocking, this problem will be minimized in the future. More disconcerting, however, has been the recent recall of formula secondary to documented contamination of formula powder with Cronobacter sakazakii bacteria leading to serious infant infection including documented infant death secondary to overwhelming sepsis from these bacteria. 4
The resulting recall of the contaminated formula that was manufactured in one factory by the major United States formula manufacturer (Abbott) led to an absolute acute shortage and a country-wide ripple effect of concern regarding all formulas. However, no discernible change in breastfeeding rates or patterns ensued or has been reported, a phenomenon that is now “confirmed” by the results of Mahavni’ study.
It is thus clear that emphasizing the problem of safety and or quality of infant formula will not solve our need for directed breastfeeding support program for mothers if we want to increase breastfeeding exclusivity and duration rates. Yes, formula shortages and potential contamination of formula powder can be added to the long list of the “disadvantages and risks of feeding breast milk substitutes (formula),” but the reality may well be that the emphasis on the positive aspects of breast milk per se rather than the negative results of formula feeding will succeed more in increasing breastfeeding rates.
Marketing studies by advertising professionals have long documented that negative campaigns do not sell as well as positive campaigns, and Mahavni's study supports this conclusion. Thus, its results should serve as a guide for us in developing breastfeeding advocacy and support programs that have the best chance of success. Simply put, “the increased health benefits of feeding breast milk” is a more convincing slogan than emphasizing “the risks and negative medical consequences of formula feeding.”