For 13 years, the United States was the only country not to adopt the code, a sign of how much power the lobbyists for the infant manufacturers have in the country. It wasn’t until the Bill Clinton presidency that the U.S. adopted the WHO Code. This took place at a meeting in Geneva in May 1994 and is listed as "World Health Resolution 74.5".
Much of the work needed to reach this point was carried out by former President Jimmy Carter, Dr. Benjamin Spock, Dr. Charles Everett Koop (1916–2013), Senator Edward Moore Kennedy, UNICEF director James P. Grant (1922–1995), and consumer protectionist Ralph Nader.
These immense efforts didn’t bring about as much change as they should have. The authors explain that this all has to do with profits:
Florida’s Attorney General calculated that for every dollar the formula company charges for wholesale baby milk, only 16¢ is spent on production and delivery (p. 171).
It therefore didn’t surprise readers when they read in The Washington Post that the CEO of Bristol Myers, the producers of Enfamil, receives an annual salary of $12'788'000.
It is also not surprising that the American Academy of Pediatrics (AAP) receives a million dollars each year from the formula industry. For example, the industry donated three million dollars to help with the costs of building an AAP headquarters in Illinois in 1983. And it is even more effective when the industry pays for AAP parties, receptions, and conventions.
Some other practices are also mentioned in the book.
This amount for special events increased 14-fold between 1975 and 1988. The results of a study conducted by Drs. Chren and Ladefeld in 1994 and published in the Journal of the American Medical Association concluded the following: The authors [Chren and Ladefeld] found that by giving physicians money, the companies are successful in influencing doctors to recommend their products
(p. 172).
For example, in 1989, Abbott Laboratories offered Grace Hospital in Vancouver $500'000 to have the privilege of distributing these packs in their hospital for three years.
And at this hospital, rather than bringing babies to their mother on the second day, 75 % of the babies are given glucose water or formula. This causes the mothers’ milk flow to decrease. This occurs in spite of the fact that 85 % of the mothers have the desire to breast-feed (p. 173).
The authors show that some hospitals receive donations in the millions from manufacturers who are then allowed to distribute these free starter packs.
When formula manufacturers help plan hospital nurseries at no charge, it doesn’t surprise us that there are hospitals where the nurseries are located on a different floor than the maternity wards (p. 175).
However, in 1991 UNICEF and the WHO started the Baby Friendly Hospital Initiative (BFHI), a program that includes ten steps designed to remove hospital barriers to breastfeeding and to create an environment in which mothers can breastfeed in an informed and supportive setting
(p. 175).
The U.S. Department of Health and Human Services provided funding for a study to analyze what would be required to implement more baby-friendly hospitals in the United States. The study was conducted by the Healthy Mothers, Healthy Babies coalition in June 1994. However, critics believe that breast-feeding activists weren’t included in the study and that the formula industry ultimately had the say as to what would be the outcome. In the end, the government helped many hospitals to start taking the necessary steps to become baby friendly. However, most of the private hospitals haven’t taken part in this initiative as it is not in their best financial interests.
We also learn more about the WIC program. The U.S. Federal Government started the program in 1974 with the goal of decreasing the high infant mortality rate in the United States.
However, the authors describe the many things that went wrong and explain why the main problem is that the program spends around $500 million on purchasing infant formula (23 % of the program’s total annual food costs).
And this means that the children in the WIC program are at a disadvantage as they don’t benefit from the immunological and nutritional properties of breastmilk
(p. 179).
The authors compare the formula industry with the tobacco industry and provide a number of reasons for doing so (p. 183). This reminds us of Dr. Cicely D. Williams’s speech titled "Milk and Murder" (1939) in which she stated that:
deaths resulting from misguided propaganda on infant feeding should be ‘regarded as murder’ (p. 186).
In part six (second part of the third section, pp. 189–212), the authors deal with the situation of women in today’s society. The focus is on the United States, but a few years later the rest of the Western world had adopted most of the practices.
The changes primarily have to do with emancipation and the increasing number of women who work. For various reasons, most women only breast-feed their children for the time that they are able to stay home. Women who don’t work outside the home tend to breast-feed for a year. In societies where women are at home with the baby for only six weeks, the baby generally is given formula when the mother goes back to work.
The authors list the key benefits that breast-feeding has for the nation, employers, employees, and babies. They include a total of 27 convincing arguments.
They also show how many women today have difficult living situations, for example, they might be divorced, remarried, and have step children. Sometimes they also have to take care of their parents or in-laws.
Social change has not only helped women to achieve equality, it has also brought significantly higher demands into their lives. In 1995, only 11 % of women were still stay-at-home mothers in traditional families.
The authors compare this with conditions in other countries, such as Pakistan, where a woman works in the home an average of 63 hours a week, not much less than is the case in the United States.
Although the International Labour Organization (ILO) stated in 1919 that women should receive paid maternity leave, the United States does not offer this.
Since 1946, the ILO, a special UN agency, has had 185 member states. The authors say that the United States is the only country that doesn’t have paid maternity leave, which is certainly a bit of an overstatement. In this section, they include a chart that compares the length of paid maternity leave for seven European countries.
The authors then provide a number of comparisons and describe the situation in the United States and the reasons why it is as it is. Next they discuss the problems with and possibilities for breast-feeding at work.
The solution is in part to use a breast pump to pump milk although this, in turn leads to the “triple nipple syndrome.”
We learn about positive measures that can help encourage women to breast-feed at work and read about some real-life examples.
Then in the first appendix, we find a list of about 20 organizations that work to promote breast-feeding.
The second appendix is a recommend reading and resource list, in which about a dozen books on the topic are recommended.
And in the third appendix, there is a list of formula recalls between 1982 and 1994 with information about the reasons and the severity of the cases.
Appendix D deals with information about the boycott. Consumers have not only successfully influenced the practices of infant formula manufacturers, but have also helped to bring about changes in the production of other foods. This includes cosmetics, pet food, medications, household and cleaning products, and other items.
Appendix E includes a chart showing four parent companies with their formula subsidiaries and the formula brand names produced by these.
The last two appendices include the physician’s pledge for UNICEF to protect, promote, and support breast-feeding and also a summary of enacted breast-feeding legislation in the various states in the U.S. and the dates that the legislative measures were passed. (As of March 1996).
We also find nine pages of bibliographic information (references listed by chapter). A total of 190 sources, for example, from reference books, scientific essays in medical journals, research papers, and reports are included as references for this book. The index is 10 pages long.
| Title | \t\t\tMilk, Money, and Madness | \t\t
| Subtitle | \t\t\tThe Culture and Politics of Breastfeeding | \t\t
| Author(s) | \t\t\tNaomi Baumslag, M.D., M.P.H. and Dia L. Michels | \t\t
| Publisher | \t\t\tBergin & Garvey, Westport (US) & London (GB) | \t\t
| Published | \t\t\t1995 (see also 2008 edition with 290 pages) | \t\t
| Pages | \t\t\t256 | \t\t
| ISBN | \t\t\t0-89789-407-3 and 978-0-313-36060-2 | \t\t
| Comments | \t\t\tThe book deals primarily with infant nutrition. | \t\t
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Chren MM, Landefeld CS, and Murray TH coauthored the article "Doctors, Drug Companies, and Gifts", JAMA, 1989 Dec 22–29,;262(24):3448–51. This paper outlines the problems with the practice of giving doctors gifts.
The authors’ full names and institutions are as follows: Dr. Mary-Margaret (Landefeld) Chren, USSF School of Medicine, Dr. Charles Seth Landefeld, University of California San Francisco, and Dr. Thomas H. Murray, The Hastings Center.
Don’t confuse this with Dr. Michael T. Murray, who wrote 23 books, including "What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know".