Watering Down a Campaign to Promote Breastfeeding

Last week, the Washington Post published a front-page, 2,050-word story that explains quite clearly how the Bush administration put the wishes of lobbyists ahead of access to important information about the health benefits of breastfeeding.

Here’s an excerpt from the story by Marc Kaufman and Christopher Lee:

In an attempt to raise the nation’s historically low rate of breast-feeding, federal health officials commissioned an attention-grabbing advertising campaign a few years ago to convince mothers that their babies faced real health risks if they did not breast-feed. It featured striking photos of insulin syringes and asthma inhalers topped with rubber nipples.

Plans to run these blunt ads infuriated the politically powerful infant formula industry, which hired a former chairman of the Republican National Committee and a former top regulatory official to lobby the Health and Human Services Department. Not long afterward, department political appointees toned down the campaign.

The ads ran instead with more friendly images of dandelions and cherry-topped ice cream scoops, to dramatize how breast-feeding could help avert respiratory problems and obesity. In a February 2004 letter (pdf), the lobbyists told then-HHS Secretary Tommy G. Thompson they were “grateful” for his staff’s intervention to stop health officials from “scaring expectant mothers into breast-feeding,” and asked for help in scaling back more of the ads.

The formula industry’s intervention — which did not block the ads but helped change their content — is being scrutinized by Congress in the wake of last month’s testimony by former surgeon general Richard H. Carmona that the Bush administration repeatedly allowed political considerations to interfere with his efforts to promote public health.

Rep. Henry A. Waxman’s Committee on Oversight and Government Reform is investigating allegations from former officials that Carmona was blocked from participating in the breast-feeding advocacy effort and that those designing the ad campaign were overruled by superiors at the formula industry’s insistence.

“This is a credible allegation of political interference that might have had serious public health consequences,” said Waxman, a California Democrat.

The milder campaign HHS eventually used had no discernible impact on the nation’s breast-feeding rate, which lags behind the rate in many European countries.

And here’s the other kicker: this wasn’t the only situation in which political meddling trumped science:

In April, according to officials and documents, the department chose not to promote a comprehensive analysis by its own Agency for Healthcare Research and Quality (AHRQ) of multiple studies on breast-feeding, which generally found it was associated with fewer ear and gastrointestinal infections, as well as lower rates of diabetes, leukemia, obesity, asthma and sudden infant death syndrome.

The report did not assert a direct cause and effect, because doing so would require studies in which some women are told not to breast-feed their infants — a request considered unethical, given the obvious health benefits of the practice.

A top HHS official said that at the time, Suzanne Haynes, an epidemiologist and senior science adviser for the department’s Office on Women’s Health, argued strongly in favor of promoting the new conclusions in the media and among medical professionals. But her office, which commissioned the report, was specifically instructed by political appointees not to disseminate a news release.

Wanda K. Jones, director of the women’s health office, said agency media officials have “all been hammering me” about getting Haynes to stop trying to draw attention to the AHRQ report. HHS press officer Rebecca Ayer emphatically told Haynes and others in mid-July that there should be “no media outreach to anyone” on that topic, current and former officials said.

Both HHS and AHRQ ultimately sent out a few e-mail notices, but the report was generally ignored. Requests to speak with Haynes were turned down by other HHS officials.

I wish it were shocking that HHS sat on its own research and refused to to allow its science advisers to speak to the press. But for this “pro-life” administration, it’s yet another example of how concern over an infant’s well-being stops at the point of birth.

Oh, and if you want to take a look, here’s that AHRQ report.

The history on the federal breastfeeding ad campaign goes back to 2000, and the Post’s reporters do an excellent job of explaining the various lobbyists and HHS officials who played a role in watering down the message. Ads discussed in this story are available here.

“The campaign the industry mounted was a Washington classic — a full-court press to reach top political appointees at HHS, using influential former government officials, now working for the industry, to act as go-betweens,” they write.

And sometimes watering down meant doing away with:

Another top agency official who weighed in on the campaign was Ann-Marie Lynch, then in charge of the agency’s Office of Planning and Evaluation. Lynch, a former lobbyist for the drug industry trade association PhRMA, reversed an HHS decision to finance a $630,000 community outreach effort to promote breast-feeding, according to an e-mail obtained by The Washington Post. Asked to comment, Lynch said she never discussed “baby formula issues with baby formula manufacturers” at HHS.

It’s important to note that the 2004 correspondence that the Washington Post obtained between hired lobbyists for the International Formula Council and then-HHS Secretary Tommy Thompson includes language that we might very well agree with — mainly that women should not be shamed or made to feel guilty about not being able to breastfeed.

Last year, a television ad showed a pregnant women being thrown off a mechanical bull at a bar and compared the behavior to failing to breastfeed. “You wouldn’t take risks before your baby’s born,” said the advertisement. “Why start after?”

Over at the blog Angry Pregnant Lawyer, the ad sparked plenty of criticism. “[P]romoting breastfeeding with scare tactics and misinformation, while never actually providing women with the assistance they may need is both pointless and cruel,” wrote APL.

She’s right. Besides the physical barriers some women encounter, there’s a serious lack of supportive work and public environments that would make it easier for mothers to keep breastfeeding for at least six months (come on, help a bill along).

Yet it’s difficult to believe that the lobbyists were protesting the ads mainly with the interests of new mothers in mind. The pharmaceutical companies that manufacture infant formula stand to lose big money if more women breastfeed, and they’ve proven how much they’re willing to spend to ensure their message gets heard:

The industry substantially increased its own advertising as soon as the HHS campaign was launched. According to a 2006 report by the Government Accountability Office, formula companies spent about $30 million in 2000 to advertise their products. In 2003 and 2004, when the campaign was underway, infant formula advertising increased to nearly $50 million.

Both Post reporters took part in an online discussion following the publication of this story. Their responses to readers’ questions are quite thoughtful and show a true understanding of all the important issues.

They also leave readers with some hope that HHS ads will improve in the future. In response to a question about “the underlying causes of low numbers of breast-feeding women — things like no paid maternity leave, difficulty finding affordable quality child care close to work, and the limited nature of the current Family and Medical Leave Act law,” WaPo reporter Marc Kaufman responds that the breastfeeding group within the Office on Women’s Health plans to emphasize these issues next.

“American workplace policies are not nearly as generous to young mothers as in most European countries, and that has a definite effect on the breast-feeding rate,” said Kaufman, adding, “That said, the group with the lowest breast-feeding rate in the U.S. is unemployed mothers, according to the Ross Mother’s Survey. I’m sure this involves the availability of formula through the federal Women, Infant and Children program, but it also raises interesting questions about the social and advertising messages that mothers receive.”

Kaufman later notes that about half of the formula used within the United States is made available through the WIC program.

One last link: Here’s a 2006 Government Accountability Office report on strategies used to market formula and recommendations for protecting the WIC acronym and logo from being inappropriately used in infant formula advertisements.