New Infant Growth Reference Standards

The World Health Organization conducted the Multicentre Growth Reference Study (MGRS) between 1997 and 2003 to generate new growth curves for assessing the growth and development of infants and young children around the world. Primary growth data and related information was collected from approximately 8500 children from widely different ethnic backgrounds and cultural settings in the countries of Brazil, Ghana, India, Norway, Oman, and the US. The new growth curves are expected to provide a single international standard that represents the best description of physiological growth for all children from birth to five years of age and to establish the breastfed infant as the normative model for growth and development.

The new standards differ from current growth charts as they provide data that describe how children should grow, by including in the study’s selection criteria specific health behaviors that are consistent with current health promotion recommendations such as breastfeeding and standard pediatric care. A striking premise of the new standard is that it makes breastfeeding the biological “norm” and establishes the breastfed infant as the normative growth model. The previous reference was based on the growth of artificially-fed children or a mixture of breastfed and formula-fed infants.

The new standards will change current estimates of overweight and under-nutrition in children because of differences in the pattern of growth between the new standards and the old reference, especially during infancy. With respect to overweight, use of the new WHO standards will result in a greater prevalence that will vary by age, sex and nutritional status of the index population. The new references include BMI calculations, generating concern that many formula-fed babies will now be classified as overweight or obese. This is interesting since innumerable breastfeeding mothers have been told for years that their breastfed infant is underweight and must be supplemented with infant formula.

More information and a copy of the charts can be accessed at:
http://www.who.int/childgrowth/en/

Hard copies of the charts can be purchased from International Lactation Consultant Association at:
www.ILCA.org

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When is a Baby Too Fat?

Thursday, May 18, 2006
By Betsy McKay, The Wall Street Journal

Parents are notoriously obsessive over how their babies stack up on the growth charts pediatricians use. Now, new guidelines from the World Health Organization are prompting a debate over how big a healthy baby should be.

The WHO, the United Nations' health agency, is urging every country to adopt its growth charts, which aim to show how children ideally grow in their first five years of life. The new guidelines also include for the first time measurements for body mass index, or BMI, for babies under age 2 -- a weight and height calculation used to determine whether people are overweight or underweight.

But the charts—and particularly the new BMI standards—are raising concerns that worries about obesity will be pushed into infancy—a time when adequate nutrition is crucial for brain development and other important growth. Pediatricians and health officials in the U.S. say they aren't sure whether the WHO guidelines should be adopted in this country.

One reason is that the WHO growth curves generally make U.S. infants and toddlers look heavier than the current charts American pediatricians use. The WHO growth curves are based on babies who were breast-fed for at least a year, while the American charts are based on children who were primarily formula-fed after the first few weeks. Formula-fed children tend to be bigger than breast-fed children in late infancy. (Specifically, the WHO charts are based on children from affluent, educated families in six countries. The U.S. charts are based on a broad sample of U.S. children.)
So a 1-year-old boy who weighs just over 25 pounds would rank approximately in the 85th percentile for his weight on current U.S. pediatric growth charts, which are compiled by the federal Centers for Disease Control and Prevention. But he would hit the 95th percentile on the new WHO charts.

About 14 percent of U.S. toddlers ages 2 to 5 years old are estimated to be overweight, according to the CDC. Currently, BMI doesn't appear on U.S. growth charts until age 2. The WHO estimates that under its new guidelines, the number of U.S. children from birth to age 5 who are considered overweight could rise by as much as 30 percent. Babies' weights often fluctuate in infancy, making it hard to determine whether they are too heavy or just going through a growth spurt. "You can't predict overweight in kids in the first six months," says Frank Greer, professor of pediatrics at the University of Wisconsin and chairman of the American Academy of Pediatrics' committee on nutrition. "We don't want mothers calorie-counting."

Moreover, a baby's size usually has little bearing on whether he or she grows up to become obese, researchers and pediatricians say. But creators of the new WHO charts argue that with rising rates of obesity, prevention needs to begin as young as possible. "I would rather put a tool in the parents' and health-care providers' hands rather than say we think this may worry you, so we're going to keep this information from you," says Cutberto Garza, academic vice president at Boston College and chairman of the steering committee that developed the new charts. "Health means much more than just the absence of disease."

Indeed, the debate over whether to adopt the new growth charts comes as pediatricians and public-health officials are already searching for better ways to identify signs of poor diet or budding obesity in young children, as weight-related diseases such as type-2 diabetes appear at young ages. In a new set of well-child guidelines to be released at the beginning of next year, the pediatrics association plans to recommend that doctors measure their patients' "weight/length ratio" starting from the age of one month, says Joseph Hagan, a Vermont pediatrician who is co-chairman of the committee writing the guidelines. The measurement is similar to BMI.

U.S. government officials and representatives from the pediatrics association plan to convene at the end of June to pore over the new charts and discuss the possibility of adopting them, or parts of them, in this country. "People are raising lots of questions," says Laurence Grummer-Strawn, chief of maternal and child nutrition at the CDC, who helped develop both the CDC and WHO charts. "We're not ready just to say yes or no." Rather than depicting babies relative to their peers, the WHO data set "ideal" conditions for infants who are properly fed and cared for. By setting up breast-feeding as an ideal, the new report offers one of the strongest endorsements yet for the practice. But some note that could compound stress for mothers who are unable to breast-feed or who turn to formula when they return to work, says Shari Lusskin, director of Reproductive Psychiatry at New York University School of Medicine.

If the new charts are adopted, "some women will react to this by feeling even more guilty than they did before about their breast-feeding practices," says Dr. Lusskin. While about 70 percent of U.S. infants are breast-fed in the first few weeks of life, the number drops sharply as their mothers return to work and by 12 months, just 18 percent are breast-fed. But breast-feeding advocates hope the WHO charts will breathe new life into their efforts to promote exclusive feeding with human milk for the first six months of life and continued doses of human milk for at least a year. Breast-feeding reduces the incidence and severity of infectious disease, infant mortality, ear infections and other maladies, the pediatrics association says.

Doctors are concerned that a high weight-length ratio could prompt some parents of formula-fed babies to put their babies on diets. Putting a young baby on a diet would be "dangerous," warns Dr. Hagan. A high BMI should raise a red flag only if a child measures that high on the growth chart several times, he says. But the new charts could raise questions in the pediatric community about whether formula-feeding schedules need to be altered in order to slow growth in later infancy, he says. While the WHO and CDC charts diverge in infancy, they grow more similar for average-sized children above age 3. A heavy baby won't necessarily become an obese adult. There are few links between overweight in children under age 3 and adult obesity, says Robert Whitaker, a senior fellow at Mathematica Policy Research. In a 1997 study in the New England Journal of Medicine, he and colleagues found that overweight toddlers face a significant risk of becoming obese adults only if their parents are obese. A 2005 study done for the U.S. Preventive Services Task Force, a panel of experts that reviews and develops recommendations for the government for clinical preventive services, found insufficient evidence to support screening children under 12 or 13 years old for BMI.
Still, Dr. Whitaker says, the new charts give public-health officials, pediatricians, and families the opportunity to redefine normal growth in infancy and rethink the social norm in which parents boast about 95th percentiles for their babies. "The prevalence of obesity is increasing and affecting children at younger and younger ages," he says. "If we talk about healthy weight earlier, it may be a good opportunity to start obesity prevention early."

• to ensure that nutrition and health claims are not permitted for breastmilk substitutes,
except where specifically provided for in national legislation;

• to ensure that financial support and other incentives for programs and health professionals do not create conflicts of interests;

• to ensure that research contains declarations of conflicts of interest and is subject to independent peer review;

• to alert consumers and health providers to intrinsic contamination of powdered infant formula by Enterobacter sakazakii and other pathogens.

Innocenti Declaration

Fifteen years ago, at the Spedale degli Innocenti, Florence, Italy, August 1990, participants, including representatives from 30 governments, produced and adopted the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. The occasion was the WHO/UNICEF policymakers' meeting on "Breastfeeding in the 1990s: A Global Initiative." on the Protection, Promotion and Support of Breastfeeding, and the Declaration, adopted by all WHO and UNICEF Member States, has been a key strategy on improving health of infants and young children through optimal nutrition.

To mark the 15th anniversary of the adoption of the Innocenti Declaration the Regional Authority of Tuscany and the UNICEF Innocenti Research Centre convened a celebration in Florence, November 21-22, 2005. This celebratory event was jointly organized by a coalition, including WHO, UNICEF, the Italian National Committee for UNICEF, USAID, the World Alliance for Breastfeeding Action (WABA), the International Baby Food Action Network (IBFAN), La Leche League International and the International Lactation Consultant Association (ILCA).

The 15th Anniversary of the Innocenti Declaration provided an opportunity to take stock of progress made in the protection, promotion and support of breastfeeding since 1990, including the implementation of the Global Strategy for Infant and Young Child Feeding, adopted by the World Health Assembly and endorsed by the UNICEF Executive Board in 2002. The meeting highlighted that all sectors of society are responsible to ensure that breastfeeding be promoted, protected, supported, and preserved as an important component in infant and child health. An internationally endorsed statement from the meeting is expected to call on all relevant parties to fulfill their obligations and responsibilities articulated in the Global Strategy. Further information about this event and subsequent documents and activities will be provided as it becomes available. For more information go to: http://www.innocenti15.net.

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National News and Alerts

Ross products has recalled several batches of formula, which can be viewed at the FDA website: http://www.fda.gov/oc/po/firmrecalls/abbott09_06.html. The 32oz liquid formula bottles from the recalled lots are deficient in vitamin C and the formula is a very dark color. 100,000 bottles of Alimentum and 200,000 bottles of Similac Advance were recalled. Of interest is that one recalled batch is for one lot of hospital discharge gift bags that contained the deficient formula. The lot numbers appear on the teddy bear tag. Now how many hospitals actually record the lot numbers of the bags they give out like the American Dietetic Association says they should? This means that many mothers were given an adulterated product by the hospital. The hospital has no means of contacting the mothers and warning them of this problem. Perhaps this could be an incentive to help hospitals stop the practice. For help with this see the Ban the Bags website at www.banthebags.org.

Consider printing out the recall notice and posting it in your hospital or taking it to the powers-that-be (Risk Management Department, hospital attorney, chiefs of OB and pediatrics, director of nursing) and asking how much risk the hospital is taking in the distribution of these bags.

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CDC's Healthier Worksite Initiative (HWI) is pleased to announce the availability of their Web site http://www.cdc.gov/hwi, which is intended to complement the Office of Personnel Management's HealthierFeds campaign. The healthier worksite initiative includes policies and guidelines for worksite lactation programs – all integrated into the larger framework of worksite wellness.
This resource is designed as a "one-stop shop" for planners of workforce health promotion programs at federal and state agencies. The site features timesaving planning information, policy examples, step-by-step toolkits, and other quick resources to assist federal and state wellness planners in developing programs that foster healthy lifestyles among their employees.

NABA REAL Activities for 2006

1. Understanding and Monitoring Gestational Diabetes and Obesity during Pregnancy
   The bill creates a Research Advisory Committee headed by the CDC and includes representatives of federal agencies, and health organizations. This committee will develop multi-site gestational diabetes research projects to expand and enhance monitoring of gestational diabetes by standardizing procedures for accurate data collection and identifying this disorder. This bill will also track mothers who had gestational diabetes and develop methods to prevent their development of Type 2 diabetes.

   Demonstration Grant Programs
   This bill provides demonstration grants that focus on reducing the incidence of gestational diabetes. Grants may be used to: 1) expand community-based activities; 2) help State-based health programs increase their prevention activities; or 3) train health providers on this condition.

   Research Expansion of Gestational Diabetes and Obesity during Pregnancy
   Building on current efforts at the CDC and NIH, the GEDI Act will expand basic, clinical, and public health research investigating gestational diabetes and obesity during pregnancy. These studies shall include: 1) investigating therapies; 2) facilitating enrollment into clinical trials for populations that disproportionately suffer from this condition; 3) developing diagnostics; and 4) understanding factors that influence these conditions.

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Reports from the Breastfeeding Promotion Consortium meeting,
August 3, 2006, Washington, DC and the US Breastfeeding Committee meeting August 4-5, 2006, Washington, DC

The Breastfeeding Promotion Consortium (BPC) was established by the United States Department of Agriculture (USDA), Food and Consumer Service (FCS) and the Department of Health and Human Services (HHS) in 1990.

It meets twice each year in Washington, DC and is composed of over 40 organizations.

Mission Statement: The Breastfeeding Promotion Consortium will be a forum for dialogue between breastfeeding advocacy groups and Federal agencies to promote, protect, and support breastfeeding.

Selected organization updates:

WIC (Supplemental Nutrition Program for Women, Infants, and Children): Approximately 49% of infants in the US are served by the WIC program.

• Implementation of Model Peer Counseling Program. Training materials are available from WIC. Peer counselors can also refer mothers in need of advanced lactation support to lactation consultants. LCs interested in contracting with WIC, both in the US and overseas through the Department of Defense, should contact their local WIC programs

• State Collaborations to Build Breastfeeding Friendly Communities. 24 grants went to states to bring partners into WIC community outreach. Breastfeeding advocates who belong to state or local breastfeeding coalitions and task forces should include WIC in these groups

• WIC Hispanic Breastfeeding Promotion and Education Project. Materials will be available for targeting this population

• Breastfeeding Anytime, Anywhere Display and Posters. This poster was created for World Breastfeeding Week and depicts breastfeeding as a normal part of a woman's day in a number of different locations.

• National Breastfeeding Campaign. Loving Support materials are now available from WIC rather than having to purchase them from Best Start

• Posters, toolkits, media materials and a wealth of breastfeeding materials can be found at http://www.nal.usda.gov/wicworks/

• The Institute of Medicine has put forth proposed food package changes to the WIC program. One which is of great significance to breastfeeding is the recommendation that WIC not routinely provide infant formula during the first month after birth to mothers who intend to breastfeed. The entire proposed food package rule was placed in the Federal Register on August 7, 2006 for a 90 day public comment period. Breastfeeding advocates should take the time to read and comment on this very important issue at http://www.gpoaccess.gov/fr/index.html

Baby Friendly USA There are now 54 Baby Friendly hospitals in the US with 67 more hospitals holding a certificate of intent. Changes have been made in the criteria for the Baby Friendly certificate. California is using tobacco settlement money as an incentive for hospitals to become Baby Friendly. A new report, The 10 Steps to Successful Breastfeeding-Final Report can be downloaded from www.babyfriendlyusa.org/eng/docs/BFUSAreport.pdf

CDC (Centers for Disease Control and Prevention) has released the new breastfeeding statistics from the 2005 National Immunization Survey. Key Findings of the 2005 National Immunization Survey Regarding Breastfeeding Practices:

Initiation and Duration of Breastfeeding

• Consistent with previous research, the NIS breastfeeding data reveal that non-Hispanic black and socioeconomically disadvantaged groups have lower breastfeeding rates.

Exclusive Breastfeeding

Any breastfeeding increased from 70.3% to 72.9%, any breastfeeding at 6 months increased from 36% to 39%, any breastfeeding at 1 year increased from 18% to 20%. However, exclusive breastfeeding rates did not go up. All data can be found at: http://www.cdc.gov/breastfeeding/data/NIS_data/data_2005.htm. Breastfeeding advocates are encouraged to use the CDC data rather than Ross products data in their work.

IHS (Indian Health Service) has a new policy for lactation support for its workforce. This can be found at http://www.ihs.gov/publicinfo/publications/ihsmanual/circulars/circ06/
circ06%5F05/circ06%5F05/circ06%5F05.htm

FDA (Food and Drug Administration) In collaboration with other federal agencies, the FDA is conducting a longitudinal consumer-based research study. This study collects information from mothers using a series of questionnaires administered from the woman's seventh month of pregnancy through the infant's first year of life, with more information available at http://www.cdc.gov/ifps/index.htm. When completed, the study will provide detailed information about

• Foods fed to infants, including breast milk and infant formula

• Factors that may contribute to infant feeding practices and to breastfeeding success

• Mothers' intrapartum hospital experiences, sources of support, and postpartum depression

• Mothers' employment status and child care arrangements

• Infant sleeping arrangements

• Other issues such as food allergies, experiences with breast pumps, and WIC participation

• Diets of pregnant and postpartum women

Food and Drug Administration (FDA)
The FDA plans to use the data to inform consumers about infant formula handling and use and to provide a context for infant formula and formula labeling policies. The data will be analyzed to describe when, why, and how infant formula is used at various infant ages and a mother's use and evaluations of formula labels. The data about breast pump practices will be used to describe when, why and how breast pumps are used. Mother's consumption of specific foods will be used to evaluate acceptance of certain consumer messages related to food safety and to provide a context for future development and dissemination of consumer food safety messages. Other data will be used to provide an understanding of areas of interest to the Agency, including current infant feeding practices that may affect the development of food allergies, consumption by infants of foods marketed to the general population, mothers' and infants' use of fortified foods and dietary supplements, and mothers' sources of information on various topics.

Centers for Disease Control and Prevention (CDC)
The CDC will use the data to describe current breastfeeding behaviors, barriers to breastfeeding, and breastfeeding motivators. The data will also be used to understand mothers' perceptions of infant feeding advice and the extent to which such advice is followed, and to identify influences on feeding choices and behaviors, including hospital practices, workplace policies, and child care provider factors. A clearer understanding of these elements will help to shape future activities to promote breastfeeding, one of the CDC's four strategies to address the national obesity epidemic.

DHHS Office on Women's Health (OWH)
The Office on Women's Health in the Office of the Secretary of the U.S Department of Health And Human Services (DHHS) plans to use the data to evaluate the DHHS National Breastfeeding Awareness Campaign, which was launched in June 2004 and ended in September 2005. Survey questions on the IFPS II will assess the awareness of pregnant women and postpartum mothers of the campaign's television, print, and billboard ads. The OWH will use the data to determine whether women exposed to these ads had higher rates of exclusive breastfeeding for six months compared with women who did not see the ads. Exposure to the campaign will also be compared to a number of knowledge and attitude items in the surveys. These data will help OWH evaluate the effectiveness of the breastfeeding awareness campaign and will provide direction for future activities of the OWH.

National Institutes of Health (NIH) National Institute of Child Health and Human Development
The National Institute of Child Health and Development (NICHD) plans to use results from this study to develop and implement more effective and culturally appropriate strategies to achieve Healthy People 2010 objectives. The results will also be used to work with the American Academy of Pediatrics (AAP) and other professional organizations to formulate practice guidelines on several issues. For this purpose, NICHD will use the data to identify social factors that influence women's choices about infant feeding; to identify a time frame by which mothers make choices with regard to infant feeding (such as duration of exclusive breastfeeding and timing of introduction of complementary foods); and to describe other practices that might potentially impact maternal and infant nutrition and health (such as use of dietary supplements and infant sleeping positions and arrangements). The results will also be used for further research.

The NIH Office of Dietary Supplements (ODS) will use the results to assess whether the American Academy of Pediatrics' recommendations concerning dietary supplements for breastfeeding infants are being followed, in addition to describing dietary supplement use among pregnant and lactating women. An analysis of maternal dietary intake is essential for a valid assessment of supplement use. These results will be used to develop materials to educate health care professionals and clinical practitioners who work directly with pregnant and lactating women and their infants so that they can provide proper guidance on diet and on the judicious use of dietary supplements.

Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB)
The MCHB will use data from the IFPS II to inform state and local Maternal and Child Health agencies of effective strategies to promote and protect optimal breastfeeding practices. State Title V programs are required to report their annual breastfeeding rates to the federal government as one of the 18 National Performance Measures. MCHB will use the results to improve breastfeeding outcomes and to inform research initiatives.
MCHB (Maternal and Child Health Bureau in Department of health and Human Services) MCBH has completed “Business Case for Breastfeeding” which is in draft format and has been released for Federal review prior to being printed. The Title V (MCH) Performance measure on breastfeeding has been changed to the following - “The percent of mothers who breastfeed their infants at 6 months of age.” This is one of 18 performance measures that states must improve on each year to secure Title V funding for their maternal/child health programs.

ABM (Academy of Breastfeeding Medicine) ABM currently has 14 clinical protocols and a new journal, “Breastfeeding Medicine.” Details can be obtained from www.bfmed.org

HMBANA (Human Milk Banking Association of North America) Milk banks with the HMBANA system dispensed 713,500 oz of donor breast milk in 2005. This is almost double from the previous year. Three publications are available, “2006 Guidelines for the Establishment and Operation of a Donor Human Milk Bank,” “2006 Best Practice for Pumping, Storing and Handling of Mother's Own Milk,” and “2006 Starting a Donor Human Milk Bank: A Practical Guide.” Details can be found on www.hmbana.org

National Business Group on Health presented a lecture on how to secure employer-sponsored benefits for employed breastfeeding mothers. Highlights included:

• Educate women (and men) to stimulate demand
-Learn from the pink bracelet

• Make sure employers learn that lactation support isn't just a “family-friendly benefit” it is a health benefit
-Draw parallels between worksite lactation programs and well accepted health promotion and disease management programs

• Use medical evidence as a criteria for inclusion in benefit packages (while the women's/human rights perspective is important it isn't salient to an employer)

• Build the business case
-Provide short-term and long-term cost-savings/ health impact for baby and mother (e.g., ROI, costs-avoided)

• Tell employers what they can do to “make a difference” in simple, actionable language
-Baby-friendly hospitals

• Preferentially select baby-friendly hospitals and birth centers for inclusion in health plan networks

• Provide incentives and rewards for beneficiaries who birth at baby-friendly hospitals

• Reduced co-pays/co-insurance for services rendered at baby-friendly hospitals

• Educate beneficiaries on the importance of breastfeeding

• Push for the inclusion of breastfeeding metrics in HEDIS measures, NCQA quality measures, hospital accreditation

More information can be found at www.businessgrouphealth.org

 

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More Deception from Nestle USA

The Food and Drug Administration (FDA) rejected an attempt by Nestle USA to add labeling language to its Good Start formulas claiming that use of the formula would reduce the risk of common food allergy symptoms such as allergic skin rash. Nestle tried this when it first introduced its Carnation brand of formula into the US. It’s claims that the 100% whey protein in its formula was hypoallergenic had to be removed due to allergic infants’ reactions. Now, Nestle has been sponsoring research and physicians to make recommendations that all non-breastfed infants receive a partial whey hydrolysate formula rather than a standard cow’s milk based formula, irrespective of allergic history or status.
See www.foodnavigator-usa.com/news/printNewsBis.asp?id=67525

The FDA stated that there was no credible evidence to support the company’s claim. The entire letter of denial from the FDA can be viewed at:
www.cfsan.fda.gov/~dms/qhcwhey.html

Gift Bag Ban Foiled by Massachusetts Governor

Press Release
Romney Scandal Kills Ban on Formula Marketing
BOSTON, May 23, 2006

In a setback for Massachusetts families, the Public Health Council allowed hospitals to continue participating in formula company marketing campaigns. The decision comes in the wake of an eleventh-hour shakeup in which Gov. Romney replaced three Council members who supported marketing restrictions just before the Council’s scheduled meeting today.

"We’re not surprised," says Dr. Melissa Bartick, an internist who chairs the Massachusetts breastfeeding Coalition. "Gov. Romney has gone out of his way to protect the $8 billion a year formula industry. Not only did his administration block the proposed regulation, but then the Governor resorted to replacing a third of the Public Health Council just before the meeting." The Coalition intends to use the momentum created by the bag controversy to launch a state and national "Ban the Bags" campaign.

Romney had initially overturned a regulation in February, arguing that limits on marketing gimmicks in hospitals forced mothers to breastfeed. In fact, the regulation would have protected all new mothers from aggressive marketing tactics that use hospitals to endorse high-priced brand-name formula.

"There's overwhelming scientific evidence that breastfeeding is good for mothers and babies," says Dr. Alison Stuebe, a Boston obstetrician. "Despite unanimous recommendations to him from physicians and public health advocates, Romney has dismissed the facts, putting corporate profits above public health. Now, doctors, nurses and hospital administrators have an opportunity to show Massachusetts families that their expert opinion is not for sale. Formula marketing campaigns targeting new mothers do not belong in our state's hospitals. Hospitals should market health, and nothing else."

Public discussion about the proposed ban is already changing practice. Since the initial regulation passed on December 20, four Massachusetts hospitals have chosen to protect the doctor-patient relationship from corporate influence, removing the bags from their maternity wards, bringing the total to 11 of the states 52 maternity hospitals and birth centers, including three who serve the lowest-income patients.

Romney has been increasingly isolated in his stance: he received letters opposing the hospital distribution of commercial bags from regional chapters of the American College of Obstetrics and Gynecology (ACOG) and the American Academy of Pediatrics (AAP), as well as from the Centers for Disease Control and Prevention, Harvard Vanguard Medical Associates, the American Public Health Association, and the Massachusetts Public Health Association. These letters join statements from the US Surgeon General, the Government Accountability Office, the Massachusetts Medical Society, and the World Health Organization, who all oppose this marketing practice.

Research shows that the bags are linked with introduction of formula, thus making it difficult for the 74% of mothers who breastfeed to follow the widely-accepted medical recommendation to give no other food or drink besides breastmilk for the first six months of life. Research also shows that feeding choice is usually made during pregnancy, not when mothers come to the hospital to give birth." Romney may have successfully silenced opposition on his Public Health Council, but he cannot change the facts," says Dr. Bartick.

To obtain more information: www.massbfc.org

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US Breastfeeding Committee Meeting

The US Breastfeeding Committee met January 20-21, 2006 in Washington, DC. Notable updates from member organizations include:

• African-American Breastfeeding Alliance (AABA): AABA offers breastfeeding information and support to mothers of color and those who work with them. A warm line operates Monday through Friday from 9:00am to 5:00pm EST that is staffed by volunteer peer counselors. The toll free number is (877) 532-8535. There are new chapters in New York, Los Angeles, and Orlando providing monthly support group meetings as well as a breastfeeding drop-in clinic in Washington, DC. The website, www.aabaonline.com has enhanced chat capabilities, breastfeeding information, and a downloadable copy of An Easy Guide to Breastfeeding for African American Women from the Office on Women’s Health.

• Academy of Breastfeeding Medicine (ABM): The ABM will be launching a new journal in March 2006 entitled Breastfeeding Medicine which will replace its newsletter. Twelve evidence-based guidelines can be downloaded from the website at www.bfmed.org. The 13th protocol, Contraception During Breastfeeding, will appear in the first issue of the new journal.

• Human Milk Banking Association of North America (HMBANA): There are currently 9 milk banks in the US with several more in the developing stages. HMBANA has issued two position statements, The Value of Human Milk and Donor Human Milk: Ensuring Safety and Ethical Allocation. Both are available on the HMBANA website at www.hmbana.org.

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National Conference of State Breastfeeding Coalitions

Immediately following the USBC meeting was the USBC sponsored National Conference of State Breastfeeding Coalitions. This summit gathered representatives from state coalitions and task forces to provide a venue for developing and maintaining active breastfeeding coalitions in each state. This networking opportunity was designed to strengthen the capacity of each state to work within coalitions to improve breastfeeding rates and to enhance resource sharing and support. Follow-up is planned through the development of a web-based mechanism to identify and distribute information to all participating coalitions and task forces.

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Infant Formula

• An interesting article in the Los Angeles Times described how infant formula (as well as other consumer goods) are increasingly the target of shoplifting rings who re-sell the goods to fund terrorism activities. One person was caught re-selling over 70,000 cases of infant formula. The story can be read at:
http://www.latimes.com

• The US Drug Enforcement Administration (DEA) also reports similar criminal activities associated with the theft of infant formula. In a section on myths regarding illicit drugs, the DEA explains that infant formula is not used as a cutting agent (diluent) for drugs such as methamphetamine. They explain that infant formula is mostly stolen from retail stores andre-sold on internet auction sites, at flea markets, and at convenience stores. Some criminal groups steal large quantities of infant formula and smuggle it into other countries where it is sold on the black market. To view this information see the DEA website at:
www.usdoj.gov/dea/programs/forensicsci/microgram/
mg0205/mg0205.html
This theft contributes to retail stores placing popular expensive name brand formulas behind counters or in locked cabinets to reduce easy access to the cans. The juxtaposition of infant formula placed next to cigarettes has not been lost on many breastfeeding advocates! Theft also contributes to higher pricesof the products.

• The price of infant formula is also affected by the state’s WIC contract formula and WIC’s relative size in a local area. A manufacturer’s brand is generally priced higher if it is the WIC brand in an area. Because of the large formula rebates that WIC receives from formula manufacturers, an indirect effect of the program is higher retail prices for non-WIC consumers of infant formula. For example, if a family moved from an area where WIC infants accounted for half of all formula-fed infants to an area where they account for two-thirds, a family with a typical 12 lb formula-fed baby would see monthly expenditures for standard milk based formula rise by $3 to $5 per month. WIC contracts can improve profits to formula manufactures through a spillover effect. Winning the WIC contract often results in increased shelf space of the contract formula on the supermarket shelves, leading to increased sales of the brand to non-WIC participants. Sales also rise if physicians recommend WIC contract brand formulas to non-WIC mothers.

Oliveira V, Prell M. Sharing the economic burden: who pays for WIC’s infant formula? Amber Waves 2004; 2(4):30-36 www.ERS.USDA.GOV/AMBERWAVES

Oliveira V, et al. WIC and retail price of infant formula. FANRR-39, USDA/ERS, May 2004. Available at: www.ers.usda.gov/publications/fanrr39/

Oliveira V, et al. Infant formula prices and availability. E-FAN-02-001, USDA/ERS, October 2001. Available at: www.ers.usda.gov/publications/efan02001/

Prell M. An economic model of WIC, the infant formula rebate program, and the retail price of infant formula. FANRR-39-2, USDA/ERS, December 2004. Available at www.ers.usda.gov.

• In the February 2006 issue of Redbook Magazine, an article looking at the cost of having a baby showed the average price of a number of baby items had decreased since 1994 (diapers, wipes, first year’s clothing layette). However, in 1994 a 16 oz can of name-brand formula at the grocery store cost $10.17 while in 2005 it cost $17.60, a 73% increase! This is reflected in the corporate bottom line. Bristol- Myers Squibb’s third largest selling product is not a drug, but Enfamil baby formula, sold by the company’s Mead Johnson unit. Sales of Enfamil formula grew 11% in the 4th quarter of 2005 and 15% for the entire year, reaching almost $1 billion.

• A new report to Congress from the Government Accountability Office (GAO) has just been published looking at how infant formula is marketed, how it discourages breastfeeding, and how WIC might better protect mothers from being mislead by formula manufacturers. The GAO reports that some forms of marketing are very widespread and increasing, with two formula manufacturers noting that most hospitals provide formula discharge packs to new mothers, with an estimated 86% of WIC mothers receiving them. The annual number of TV and print ads for infant formula increased from about 7,000 in 1999 to over 10,000 in 2004, most of which were placed on television. Annual formula company expenditures for TV and print ads grew from $29 million in 1999 to over $46 million in 2004. The GAO report also noted that as of 2005, the majority of state WIC contracts with infant formula companies did not limit the use of the WIC acronym or logo in formula advertisements, giving the false impression that the Food and Nutrition Service is endorsing and promoting formula feeding.

Breastfeeding: Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect Against Misuse of WIC Name. GAO-06-282, February 8.
http://www.gao.gov/cgi-bin/getrpt?GAO-06-282

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Fit Pregnancy’s “The Best Cities to Have a Baby” Survey

Fit Pregnancy conducted a survey of the 50 US cities with the largest populations to find out the best cities in the US to have a baby. Under the breastfeeding category the following factors were evaluated:

1. Access to lactation consultants
2. Access to breastfeeding-support stores
3. Proximity to Baby-Friendly Hospitals (those that meet UNICEF/WHO standards for supporting breastfeeding)
4. Laws supporting a mother’s right to breastfeed or pump in public, including workplaces; laws excusing breastfeeding mothers from jury service
5. Percentage of mothers who initiate breastfeeding
6. Percentage of mothers breastfeeding at 6 months

The top ten cities for breastfeeding were:

1. Portland
2. Seattle
3. Minneapolis
4. San Francisco
5. Oakland
6. San Diego
7. Boston
8. Honolulu
9. San Jose
10. Sacramento

Other rankings were constructed for overall best place to have a baby, affordability, risk, birth options, stroller access, fertility, hospitals, child care, and safety. The entire survey results are available at www.fitpregnancy.com.

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NATIONAL WIC ASSOCIATION
Updated Presidential Proposals to WIC Program Budget
for FY 2007

WASHINGTON, 7 February

In yesterday's Legislative Alert, 6 February 2006, it was advised that the President's budget proposal included $20 million for MIS funding provided those funds were not required to meet caseload needs. That was a misread of the budget amendments that actually bracketed that section, thereby removing the monies from their proposal. This failure to include MIS monies is particularly troubling as WIC considers the possibility of changes to the WIC food packages and is required to increase vendor cost containment efforts.

In all other respects, with the exception of the $15 million in breastfeeding monies, $14 million in infrastructure funding, the maintenance of the contingency funding level at $125 million and the likelihood that the overall funding level will meet caseload needs, the fiscal year 2007 budget proposals shared by the Administration for the WIC Program present some alarming recommendations to be included in their appropriations requests to Congress later this month.

While the President has essentially frozen funding for WIC for the fiscal year 2007 at $5.4 billion and projects that funding level will be adequate to serve 8.2 million participants, which may indeed be adequate to serve anticipated caseload, what is particularly alarming about the Administration's proposals is that they have once again decided to include two funding limitations that will negatively impact the value and success of WIC including a cap of 25% on nutrition and administrative services (NSA).

This proposal was not included in final appropriations bills by either the House or the Senate as it was determined to be counter-productive to state cost-containment efforts and would likely lead to a reduction in key WIC services seriously eroding the benefits of the Program to participants and its preventive value to the nation's health care system. That the White House has made this proposal again flies in the face of sound reasoning.

In another repeat proposal, that was defeated last year by House and Senate delegations from the seven states most directly affected, the Administration has once again calls for a cap on Medicaid adjunctive eligibility, freezing that eligibility level at 250%.

Perhaps as worrisome as the repeat proposal to cap NSA is the Administration's plan to recommend legislative language to require a state match of 20% for nutrition and administrative services beginning in the year 2008. Only a handful of states currently provide any funding to support WIC efforts and often this funding level is targeted to meet a specific state agenda. It is highly unlikely, given the strain state budgets are currently feeling and legislated efforts to curb services to low-income populations by state legislatures that governors and state legislatures would be willing to provide for matching funds. This proposal would be disastrous for the future of the WIC Program and likely lead to a deterioration of the Program.

The specific earmarked funding proposals and overall funding proposals notwithstanding, overall, the Administration's proposal should be worrisome to state and local agencies. Not surprisingly it is in keeping with a greater agenda to reduce the alarming deficit which evolved largely as a result of Administration-proposed tax cuts and continues the ideological agenda to reduce the overall size of government by reducing access to programs, particularly those impacting the disadvantaged.

This year's Washington Leadership Conference will need full participation from the membership of *NWA* as together we work to urge members of the House and Senate to understand the negative consequences of these proposals for the future of WIC and for the health and nutritional well-being of the families WIC serves.

You may view the Administration's proposal by visiting:
http://www.usda.gov/agency/obpa/Budget-Summary/2007/FY07budsum.pdf

NWA's mission: providing leadership to promote quality nutrition services; advocating for services for all eligible women, infants and
children; and assuring the sound and responsive management of WIC. Please direct all questions to NWA at 202-232-5492.

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Breastfeeding Promotion Consortium Meeting (BPC)

August 4, 2005
Washington, DC

The Breastfeeding Promotion Consortium (BPC) was established by the United States Department of Agriculture (USDA), Food and Consumer Service (FCS) and the Department of Health and Human Services (HHS) in 1990. It meets twice each year in Washington, DC and is composed of over 40 organizations.

Mission Statement: The Breastfeeding Promotion Consortium will be a forum for dialogue between breastfeeding advocacy groups and Federal agencies to promote, protect, and support breastfeeding.

The BPC’s morning session was joined by the National Advisory Council on Maternal, Infant and Fetal Nutrition, a group that makes recommendations to the President and Congress on ways to improve WIC and related programs. The Food and Nutrition Service has funded 19 states with training and technical assistance grants to help WIC build community partnerships that extend the Loving Support theme into the local community. Reports on these show that this concept is very productive in raising breastfeeding awareness and rates. You may wish to contact your local and state WIC agencies to explore methods of partnering with WIC in community outreach efforts. The Centers for Disease Control and Prevention (CDC) funded 4 states, Montana, Illinois, New Mexico, and South Carolina to obtain this training as a mechanism to address obesity in their states by using breastfeeding interventions. The CDC has released obesity grants to over half of the states to reduce overweight and obesity. Since, one of the mechanisms required in the grant is an effort to improve breastfeeding, you may wish to contact your state public health department to see if and how the obesity grant is funding breastfeeding improvement. Funds may be available through these grants for support of local and state breastfeeding initiatives.

Highlights of Member Organization Updates

Office on Women’s Health (OWH)/Department of Health and Human Services (HHS)

The National Breastfeeding Awareness Campaign surveyed almost 1000 people before and after the Campaign’s 2004 launch, with these outcomes reported so far:

• 69% of men were comfortable seeing a baby breastfed in public in 2005, compared to only 59% of men in 2004.

• 63% of men said they would be willing to have their own baby breastfed in public in 2005, compared to just 53% of men in 2004.

• In 2005, 67% of women and 62% of men felt the best way to feed a baby was to give only breast milk – up from 60% (women) and 50% (men) in 2004.

• In 2005, 59% of women and 65% of men agreed that babies should be breastfed exclusively for the first 6 months, up from 55% (women) and 53% (men) in 2004.

• 75% of people who had seen the TV ads disagreed that formula is as good as breast milk, compared to 59% of those who had not seen the ads.

• 59% of women who had seen the TV ads were more likely to be comfortable breastfeeding in public, compared to 39% of those who did not see the ads.

• 73% of women who had seen the TV ads were more likely to be comfortable seeing other women breastfeed their babies in public compared to 55% of those who had not.

The TV ads for the campaign will end in December 2005 and the radio ads will finish in April 2006. The Ad Council sent out reminders to the media to run the ads during World Breastfeeding Week. Billboard materials will be available until they run out. You can visit www.WomensHealth.gov for more information and can contact your local media to urge them to run the ads. Easy Guides to Breastfeeding are a set of breastfeeding booklets for mothers that are free from the OWH, are available in a number of different languages, and make great handouts to replace formula discharge bags. These can be ordered from the OWH.

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Baby Friendly USA

There are now 50 hospitals in the US designated as Baby Friendly, with an additional 54 hospitals holding a certificate of intent to become Baby Friendly. Some hospitals have been the recipients of grants from local breastfeeding coalitions and advocacy organization to help defray some of the costs of becoming Baby Friendly. Breastfeeding advocates whose hospitals have resisted becoming Baby Friendly due to the cost of the process may wish to look to the community for possible funds or fund raising opportunities as an incentive to become Baby Friendly.

Centers for Disease Control and Prevention (CDC)

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