Dear BBC World Service…. KG

3 07 2010

From: Karleen Gribble
Sent: Friday, 2 July 2010 12:10 AM
To: ‘worldhaveyoursay@bbc.com’
Subject: formula feeding in resource poor settings
Hello,
I listening to your program on whether breastfeeding is “creepy.”  I thought that it was a very interesting program and that the exploration of the issues surrounding why women in a country like the UK might choose not to breastfeed was valuable. However, I thought that because the BBC World Service is broadcast worldwide that there was a responsibility to ensure that it is made clear that while the “choice” to formula feed in the UK or Western Europe might be one that can be made with limited negative impact on child and mother that this is simply not the case in much of the world- that (as Morgan Gallagher tried to communicate) that formula feeding commonly results in death in much of the world. This is a message that MUST be broadcast.
In two months I will be conducting training at a meeting convened by UNICEF in the Philippines on infant feeding in emergencies. One of the things I will be talking about is how whenever there is a natural emergency, media reporting drives the literal flooding of emergency areas with donations of infant formula- usually sent by well meaning individuals and organisations that are simply unaware of the risks associated with formula feeding in resource poor contexts. Programs like yours, that presented formula feeding as a simple, legitimate and costless choice add to this problem.  They cause harm. Increased infant morbidity and mortality results directly from media reports that present infant formula as something that will help infants, ignoring the risks. Health ministers and aid orgs like UNICEF and Save the children working in countries affected by emergencies tear their hair out trying to stop the container and truck loads of formula arriving in emergency aid arriving and being distributed. 
Please, could you consider actually having a world view in your programs and understand that what might be OK in the UK may not be OK in India or in Botswana or Peru. Could you please consider having interviewees  who know what they are talking about- are experts on infant feeding, on the marketing of infant formula, on the support needed by women to breastfeed, on the relative importance of infant feeding decisions in developed vs underdeveloped contexts?? The cultural blinkers of living in a privileged environment with good sanitation and health care were evident in your interviewer.
If you did consider doing something on this I could certainly put you in touch with a variety of such experts and would be happy to be interviewed myself.
Regards
Karleen Gribble
Dr Karleen D Gribble BRurSc PhD
Adjunct Research Fellow
School of Nursing and Midwifery
University of Western Sydney
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8 responses

3 07 2010
Valerie W. McClain

Karleen wrote an excellent letter to the BBC World Service. I'd like to add that some researchers also believe that infant formula has an impact on morbidity and mortality in developed nations, too."Assuming causality, however, promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the United States each year." Chen A, Rogan WJ, "Breastfeeding and the risk of postneonatal death in the United States," Pediatrics 2004 May;113(5)e 435-9.From the Joint Center for Political & Economic Studies 9/28/07 article, "Joint Center Says New Approach to reduce Black Infant Mortality," a key recommendation from this Center is for an education campaign to increase the rate of breastfeeding in African American women.Where I live on the east coast of Florida,USA, my county has seen the black infant mortality rate double each year from 2006-2008 (6% in 2006, 12% in 2007, to 24% in 2008). I believe breastfeeding can be life-saving for many babies and not just babies in developing countries.

3 07 2010
Helen

Excellent letter!

3 07 2010
StandardSpicyWhatnot

well said. The blinders of privlege cause so mush damage.

3 07 2010
Morgan

Valerie, those stats look wrong to me. Have you mixed up percentages?

4 07 2010
Valerie W. McClain

This should look better:6 deaths per thousand in 200612 deaths per thousand in 200724 deaths per thousand in 2008

4 07 2010
Valerie W. McClain

Percentage is not what I meant, although it is what I wrote.It should read: in 2006 there was 6black infant deaths per thousand, in 2007 there was 12 black infant deaths per thousand, and in 2008, there was 24 black infant deaths per thousand. Overall infant mortality for my county in 2008 (all races) was 9.7 infant deaths per 1000.

5 07 2010
Alison Sauer

Hi Valerie – that's HUGE! Why such a change in such a short time?Has something changed? What are these children dying of – any ideas? And how old are they – a couple of months or older?(as percentages these figures look like 0.6%, 1.2% and 2.4% respectively by the way, in case you want to show them like that again!)

6 07 2010
Valerie W. McClain

Alison, You ask if something has changed in my area. In 2005, we missed getting Hurricane Katrina, but we got hit by back-to-back hurricanes(4). Charlie was the worst–people had blue tarps on their roofs for up to 18 months. Roofing supplies were difficult to obtain. We are a tourist area (Daytona 500-racing, and drivable white sand beaches). Tourists don't come to visit because the area was a disaster. Economically this county is one of the poorest, wages are the lowest, jobs scarce. Then the housing crisis –on my street many houses abandoned or up for sale. Factor in racial discrimination in housing, jobs, and no medical care (there has been an on-going problem for pregnant mothers who qualify for free care not getting that free care).Babies are dying from pneumonia,gastero-intestinal diseases, SIDS. Exclusive breastfeeding does protect infants from these diseases. No deaths in those years from hiv/aids-despite Florida being supposedly 3rd highest state in country for hiv/aids cases.This is infant mortality, so babies range up to a year old. I have not seen age of death of these infants.Thanks for the percentages. I prefer to use rate (not sure why I wrote percentages because my mind was not seeing percentages). The belief seems to be by health officials in this county that the whole problem is that poor women are not getting access to medical care. They never publicly use the black infant mortality rate. Instead use the combined rate of all races (9.7 deaths per thousand). In fact there is a category called non-white (includes hispanic, oriental, and black infant mortality). The non-white infant mortality rate is lower than black infant mortality because hispanic and orientals in this community have lower infant mortality. The focus of public health officials has not been on the issue of infant feeding but rather on access to health care. I have written to the newspaper several times and never had my letters to the editor printed. I have emailed my local Healthy Start Coalition and received a response but under the impression that support for lowering infant mortality will be only for getting increased medical care for pregnant mothers not breastfeeding. (in interviews with local paper Healthy Start Coalition members never mention breastfeeding)

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