February 18, 2013

Nursing numbers reflect economic gap

Low-income Mainers are likely to choose formula despite much-touted breast-feeding benefits.

By BEN McCANNA Morning Sentinel

Breast-feeding rates in Maine are keeping pace with the rest of the nation, but the state's most vulnerable population stands in stark contrast.

click image to enlarge

Thomasina Hutchins feeds Eva, 3 months, both breast milk and formula, but says she can understand a “nervous nursing mom” caving to using only formula.

Michael G. Seamans/Morning Sentinel

A significant percentage of low-income mothers enrolled in the Maine Women, Infants, and Children Nutrition Program feed their babies formula instead of breast milk, and the state spends more than $1.4 million a year to provide it to them, despite widespread education programs, financial incentives and strong evidence that breast milk is significantly healthier.

Also, Maine mothers are receiving large, unsolicited samples of infant formula via the mail, which some think could undermine state educational efforts.

COST OF FORMULA

The percentage of babies in Maine fed breast milk at least once -- 76.1 percent -- is about even with the national average of 76.9 percent, according to statistics released last month by the U.S. Centers for Disease Control and Prevention.

In 2012, 41.5 percent of Maine babies still received breast milk at 6 months of age, along with other food sources (the national average is 47.2 percent). At 12 months, 23 percent were still receiving some breast milk (the national average is 25.5 percent).

"We're doing really good here in the state of Maine with breast-feeding education and encouragement," said Sheila Pinette, head of the Maine CDC.

Maine was ranked first in the nation for the number of births occurring at "baby-friendly"-certified birthing centers, third for the number of board-certified lactation consultants and fourth for the number of La Leche League leaders -- a peer-to-peer support group for nursing mothers.

But it's a different story at the Maine Women, Infants and Children Nutrition Program.

Every month, the program provides $118,000 in cans of formula to mothers who qualify for benefits, said Director Lisa Hodgkins. In a year, that's more than $1.4 million.

The program serves about 5,000 infants per month, 4,000 of whom (about 80 percent) are exclusively formula-fed. About 160 infants are fed a combination of breast milk and formula. About 1,000 infants (roughly 20 percent) are exclusively breast-fed.

Hodgkins said WIC promotes breast-feeding through counselors, nursing coaches and financial incentives. Breast-feeding mothers receive about $75 worth of food every month for a year through the program, while mothers who don't breast-feed receive about $49 a month for six months -- a difference of $600.

"We encourage breast-feeding for a number of reasons. It's better for the baby, it's good for the mother-child bond, there are a lot of health benefits, and it's cost-effective," she said. "That's our first conversation with folks that come to our program. If they say, 'No, I can't,' or 'I don't want to,' we do offer formula."

BREAST IS BEST

Reports from the American Academy of Pediatrics, the Surgeon General, the World Health Organization, UNICEF and many other authorities all point to widespread benefits from breast-feeding for baby, mother and society at large.

People who were exclusively breast-fed as infants are less likely to experience a host of ailments than their formula-fed counterparts, including ear infections, childhood leukemia, childhood obesity, allergies, diabetes and asthma.

Mothers who breast-feed for more than 12 months are at decreased risk for cardiovascular disease, diabetes, breast cancer, ovarian cancer and more.

There are economic effects, too. Mothers who favor breast-feeding over formula can save up to $1,500 a year, according to a report from the Surgeon General. The U.S. could save $13 billion a year in health-care costs if 90 percent of mothers breast-fed their babies exclusively for six months, according to a 2010 article in Pediatrics. The same practice would save more than 900 lives a year, mostly infants.

Pinette said there are several reasons why some moms choose formula over breast milk.

Babies born prematurely may lack the ability to suckle, or they may be separated from their mothers during extended medical care. Older babies are generally extra hungry during growth spurts and can make mothers feel "like they don't get a moment's break," Pinette said.

Sleep is also a factor. Breast-feeding babies nurse every two to three hours, while formula-fed babies eat every four or five hours, which can lead to longer periods of uninterrupted sleep.

Returning to work after maternity leave causes many mothers to switch to formula.

The early days of breast-feeding can be especially difficult. Latching on can be painful for the mother. There's a possibility of infections, blisters and bites. Also, milk production doesn't begin in earnest for about five days after delivery, so dehydration and weight loss are common in newborns. Babies also may cry a lot during this period, which can drive some mothers to try formula, Pinette said.

"Breast-feeding takes tremendous emotional maturity and commitment by the mom," Pinette said. "If you get past the first six to eight weeks, most moms are really successful."

SPECIAL DELIVERY

Within days of arriving home from the hospital, many new mothers discover hefty packages on their doorsteps.

Often unsolicited, the packages are filled with baby formula, bottles and coupons. A 2-pound box from Similac, for instance, holds two tubs of powdered formula, a 4-ounce baby bottle and $20 worth of store coupons for any Similac formula product. Enfamil sends similar packages.

State officials, health-care workers and mothers aren't sure how the formula companies obtain names and addresses of new mothers, and some wonder whether the packages undermine efforts to improve breast-feeding rates.

Michelle Trask of Augusta is a mother of four. Shortly after her first child was born, she received an unsolicited sample of baby formula through the mail.

Trask, now 33, was planning to try breast-feeding, but wasn't entirely sure. "As soon as things started to get difficult, I hit the samples I had," she recalled.

Trask's first two children were formula-fed, but her third child flatly refused to feed from a bottle, so she switched to breast-feeding. At first it was challenging, but it got easier. When she had her fourth child in July, there was no question that she would breast-feed.

"It's so much easier for me in the night. I don't have to wake up to make formula," Trask said, "and it's so much more cost-effective, obviously."

Trask occasionally receives samples in the mail, which she gives to a friend who supplements breast-feeding with formula. But she wonders whether some new moms might give up on breast-feeding when a free package of formula arrives.

"The first two weeks are always rough," she said of breast-feeding. "If a mom isn't very committed, then it (a sample package) could be enough to sway someone."

Thomasina Hutchins, 33, a mother of four in Winthrop, used to receive formula in the mail, but hasn't since the birth of her youngest child 3 months ago. She's not sure how she got on a mailing list before or why she isn't now, but she receives occasional packages from her friend Trask.

Hutchins said the free packages couldn't have swayed her.

"I was pretty confident that I was going to breast-feed," she said. "But if I were a nervous nursing mom or not completely comfortable with it, and I see that bottle of formula sitting there, one night when I'm having trouble feeding my baby, it would be a lot easier to just pick up the formula and give up breast-feeding."

MARKETING EFFORTS DEBATED

The WHO and UNICEF have ardently opposed any marketing of baby formula.

A 2001 report from WHO states that "infant formula should not be marketed or distributed in any environment that may interfere with the protection and promotion of breast-feeding." A 2011 report from UNICEF calls for communities and health services to "counter the formula marketing with strong protection of breast-feeding."

Christopher Perille, spokesman for Enfamil's parent company, Mead Johnson, said the formula makers strive to create the healthiest possible product.

"Given the acknowledged benefits received by children who breast-feed, our research and development efforts are focused on making our infant formulas as close to breast milk as possible," he wrote in an email.

Perille said the company obtains most of its mailing addresses directly from mothers and referrals by friends and family.

Lindsy Delco, a representative of Similac's parent company, Abbott Nutrition, wouldn't say how mailing lists are gathered.

"It is sensitive information we wouldn't want our competitors to know," she wrote in an email.

Morning Sentinel Staff Writer Matt Hongoltz-Hetling contributed to this report.

Ben McCanna can be contacted at 861-9239 or at:

bmccanna@centralmaine.com

 

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