The Competitions and Markets Authority (CMA) published a report on the UK formula industry in February. One of the recommendations it made was that formula should be in ‘plain packaging’ if provided to parents in hospital, so as not to influence their brand choice.
The Guardian reported, ‘The watchdog said parents often chose a brand of formula for their baby at a time when they were vulnerable, often in hospital immediately after birth, when they did not have “clear, accurate and impartial information needed to make informed decisions”.’
I was struck by the description of the fraught context in which parents are choosing formula. I felt the discussion needed more context about what is actually going on here. I wrote the following comment on X, based on my experience and the experiences we hear about every day at IFA.
Government agencies and healthcare providers promote breastfeeding to all women throughout pregnancy. The NHS and other agencies provide inaccurate and misleading information about the frequency of breastfeeding problems. For example, the NHS website claims that low milk supply is rare, when it is in fact common. The fundamental claim is that basically all women can exclusively breastfeed.
Meanwhile, WHO and UNICEF restrictions (some law, some guidance) restrict the information that can be given to families about formula. The UNICEF so-called Baby Friendly Initiative tells accredited hospitals: formula should not be discussed with women who are planning to breastfeed; information on formula should not be on public display, etc.
Therefore, women go into hospital with the understanding that breastfeeding will be straightforward. If breastfeeding is not straightforward, they have been told that ‘breastfeeding support’ will solve all problems. They have not brought formula with them, because agencies have advised them not to, telling them it will ‘undermine their confidence to breastfeed’.
Then, after birth (often complicated), the newborn baby struggles to feed, for one of many common reasons. But the so-called Baby Friendly hospital will not suggest formula supplementation. Instead, staff encourage the mother to keep trying to breastfeed, and, if necessary to ‘top up’ with drops of expressed colostrum in tiny syringes.
This goes on for hours, even days. It causes great stress to everyone and puts the baby at risk of complications of underfeeding. The family have not been told that any of this can happen and they do not have formula with them. One or more of the following then occurs:
- The family, still at hospital, ask for formula and are told the hospital isn’t allowed to give it.
- A concerned dad, partner or family member goes to get formula themselves. First they find the hospital pharmacy doesn’t sell first stage formula because of the so-called Baby Friendly restrictions. Or it is closed because it’s the middle of the night. So they go off on a stressful mission to find a shop.
- A member of staff breaks Baby Friendly rules and provides formula, but requires a consent form or needs to put a stamp in the baby’s record or give an info sheet to the family about ‘risks of formula’. Sometimes the staff member adds their own personal judgment to the process.
- Or the family have come home ‘exclusively breastfeeding’ and the baby is then found to have lost excessive weight, be jaundiced, or worse suffering from dehydration or hypoglycaemia. They go back to hospital where they are given emergency formula supplementation in Paediatrics.*
*I am not exaggerating here. Readmissions to hospital for newborns with jaundice and feeding complications have increased year on year over the past decades. This is the period that exclusive breastfeeding policies and the UNICEF Baby Friendly Initiative have bedded in.
So, it is in this context that families receive formula in hospital and may now receive it in plain packaging like a shameful and dangerous product. In my opinion, it is the government’s own exclusive breastfeeding policies (following WHO and UNICEF guidance) that leave families unprepared to use formula before birth. If the government dropped coercive policies to get more women to breastfeed and gave parents the information they are entitled to, they would be in a position to make informed decisions; they would be in a position to prepare for needing formula ahead of a hospital stay. Plain packaging not required!
Our response to the CMA’s interim report can be read on the government website.
Sue Haddon