Medical Examiner

Formula Is Feminist

The British Medical Journal’s recent decision to ban formula ads doesn’t add up.

A purple spoon scoops formula out of a can.
Formula is a legitimate solution to what is often a serious health problem. Photo illustration by Slate. Photo by dragana991/iStock/Getty Images Plus.

Her baby, her body, her breasts, her choice. It sounds obvious, but in the world of breastfeeding promotion, it has become anything but. The latest example is the British Medical Journal’s self-congratulatory announcement that the journal and its sister journals would ban formula advertising from their pages. As a group of editors for BMJ wrote in their statement announcing the decision: “We believe this is the right thing to do based on our desire to support the [World Health Organization] code, actively promote breastfeeding, and campaign against industry influence in this area. Instead of being part of the problem, we want to be part of the solution.”

It’s nice that they want to be part of the solution, but this action actually makes them part of a much bigger problem. Formula is a legitimate solution to what is often a serious health problem (and a feminist solution to an age-old gendered problem). The argument the BMJ has deployed to explain its decision to limit advertisements isn’t justified by the scientific evidence and instead shows its willingness to pressure women to use their bodies in culturally approved ways.

To understand this, it helps to back up. Until recently, biology was destiny for women. The single biggest issue was women’s inability to control their fertility—blighting sexual enjoyment, imposing the tremendous economic hardship of unwanted children, and bringing death to young mothers whose last moments were spent agonizing over what would become of their older children. The pill changed that.

Breastfeeding was also biological destiny. It bound women to the home and posed serious health problems for babies of mothers who couldn’t produce enough milk and turned to unsafe supplements. Infant formula changed that.

It is easy to understand how making it difficult for women to access contraception, or even just limiting contraceptive-makers’ ability to advertise their product, is an unacceptable way of using women’s biology to control them. It seems that it is harder for some people to understand that making it difficult for women to access formula, as well as pressuring them to breastfeed, is equally unacceptable (and for the same reason). It is up to the individual woman to decide whether she wants to use her breasts to feed her baby and whether that is the best choice for her baby and herself.

Moreover, there are many babies for whom breastfeeding is not best, including those born to women who must take medications incompatible with breastfeeding, women who cannot produce enough breast milk, and women whose mental health is compromised by the exhaustion that results from being the only one who can feed the baby in the middle of the night.

Governments and public health authorities have an interest in breastfeeding. Many such bodies, including the World Health Organization, consider their ability to push breastfeeding to be an unambiguous good because of the purported benefits of breastfeeding. In truth, though, when it comes to breastfeeding full-term infants in industrialized countries, the benefits are trivial and have no measurable impact on mortality rates for full-term babies. Therefore, governments and public health authorities can’t possibly have such an interest in breastfeeding that it supersedes women’s own rights to determine how to use their breasts and how to feed their babies. (They certainly don’t have any interest in breastfeeding more compelling than the baby’s right to be fed to fullness and not be distressed by hunger around the clock.)

What’s behind the BMJ ban on formula advertising? One problem that rears its head here is a decades-old but legitimate scandal around how formula companies once promoted their product in developing nations. In the 1970s and 1980s, Nestle and other formula companies engaged in the unethical promotion of infant formula powder to women who had access to only contaminated water with which to prepare it. Tens of thousands of infants died as a result of the switch from breast milk to formula mixed with dirty water.

In response to this scandal, the World Health Organization issued its International Code of Marketing of Breast-Milk Substitutes, arguing for a ban on formula advertising altogether.
Furthermore, it mandated that all formula carry labeling declaring the superiority of breastfeeding. That policy was extended to industrialized countries on the grounds that it was necessary to promote breastfeeding there, too. BMJ leans heavily on these recommendations in its op-ed announcing its decision.

But it can be simultaneously true that formula companies should not have done what they did decades ago and that the BMJ’s ban on formula ads doesn’t make sense for the audience it reaches today (primarily doctors, who are likely aware of the risks posed by contaminated water). In their messaging, the BMJ editors embrace another position held by the WHO—that breastfeeding should continue for the first two years of a child’s life, another standard formulated for the nonindustrialized world that has been transported to the industrialized world. They ignore the impact that aggressive breastfeeding promotion has on the physical health of some babies and the mental health of some mothers, even though, according to a recent comprehensive review of the scientific evidence about breastfeeding, exclusive breastfeeding is now the leading risk factor for hospital readmission of infants. Many women have also identified breastfeeding pressure as a factor in postpartum depression, and others have explained how the pressure to breastfeed can contribute needlessly to anxiety in their early days of motherhood.

The truly demeaning nature of the BMJ’s advertising policy becomes most apparent when considering the only other substance it bans: tobacco. “We do not accept advertising or sponsorship relating to tobacco products, or to products and services from tobacco companies, their foundations, or their wholly owned subsidiaries,” the journal’s site states. The only other banned product has no health purpose and, when used as directed, is a killer of hundreds of thousands of people each year. In contrast, formula saves and improves countless lives each year and harms no one.

The underlying assumption is that neither women (nor their doctors, apparently) can be trusted to weigh the risks and benefits of formula feeding for themselves. Instead, they must be protected from marketing efforts. Are formula advertisements uniquely confusing or misleading? Certainly not as compared with the pharmaceutical companies that will continue to advertise freely in the pages of the BMJ.

With its new policy, the BMJ is not making a medical decision based on the best available evidence; it is making a cultural decision about what it feels is most acceptable. This sort of choice is not something to be celebrated as a point of pride—it’s a decision that shows a bias toward a behavior that restricts women.

Her baby, her body, her breasts, her choice … and none of the BMJ’s business!