Thursday, 5 March 2015

Nutrimum: new product, same old formula company tactics

This morning the First Steps Nutrition Trust newsletter hit my inbox (if you don't get this already I highly recommend it). They've issued a statement on nutrimum, a new product on the market that I'd heard about thanks to a Facebook post from Michael Walne at Your Nutrition Matters (who is busy writing evidence-based nutrition books for the Pinter and Martin Why It Matters series at the moment).

Nutrimum is a range of cereal bars and granola aimed at pregnant and breastfeeding women, made by Nutricia, owned by Danone, which makes Cow & Gate and Aptamil infant formula. The new products are currently available through Boots stores and are heavily marketed on the Boots website, with advertorials accompanied by 'buy now' prompts. The advertorials stress the importance of maternal nutrition during pregnancy and breastfeeding; the clear implication is that the nutrimum bars and cereals can form part of the healthy diet that is being discussed. Associating general nutrition information with specific products is a deliberate strategy. Marketing products that combine food
and supplements through a store such as Boots, which although it has dropped 'the chemist' from its name still has a reputation for selling pharmacy products, also helps to support the idea that these products are somehow 'scientific' or 'beneficial' (they aren't). Using partner organisations for 'reputation transfer' is a tactic often used by formula manufacturers: for example in 2013 Danone sponsored a 'Big Toddle' in aid of Barnardos to promote its Cow & Gate brand.

The First Steps Nutrition Trust statement on nutrimum explains how the products undermine public health by stating that women should stop taking other supplements (which will have been recommended to them by midwives or health visitors in accordance with current guidelines) while consuming the products. Folic acid (which is recommended for those who are planning a pregnancy and pregnant women) and vitamin D (recommended for all pregnant and breastfeeding women) supplements are widely available in supermarkets and pharmacies at low cost, or may be free on the Healthy Start scheme. The nutrimum products are expensive: the cereal bars cost £4.99 for five bars, or £1 a day. A large part of the cost of the product will go on marketing. (As with infant formula, the marketing is paid for by those who buy the product.) Equivalent vitamin D and folic acid supplements cost just pennies per day. The cereal bars and granola are highly processed and high in sugar; the main ingredient (listed first in the ingredients list) in the bars is glucose syrup (sugar). A crucial difference between granola/cereal bars and vitamin supplements is that the granola/bars are food - they will fill you up, and increase your blood sugar levels, potentially displacing more nutritious foods (vegetables, fruit, nuts, eggs, meat) in your diet. Tablets and liquid supplements do not have this effect.

When formula companies stress the importance of nutrition while breastfeeding, they do so in order to make breastfeeding seem difficult, expensive and inconvenient - an unachievable ideal. Mothers who doubt the quality of their breastmilk may turn to formula for 'reassurance' that their babies are getting all that they need. In reality there is little difference in the nutritional profile of breastmilk worldwide: mothers everywhere, despite wide variations in diet, produce milk that will nourish their babies and keep them healthy. A mother needs good food for her own health, not to support breastfeeding. Mothers in the UK (where nutrimum is marketed) have access to better, cheaper food than these highly processed cereal products that are high in sugar and expensive. As First Steps Nutrition say:
'Good nutrition from food is perfectly possible for pregnant and breastfeeding mums and we show how nutrient requirements can be met through simple, cost effective menu choices in practical eating well resources. The money spent on these supplements could be more wisely used buying fresh and minimally processed foods for the household.'
Formula companies target medical and health workers to promote their products. Perhaps the most disturbing part of the First Steps Nutrition statement on nutrimum is the section about how company representatives have contacted infant feeding coordinators and NHS staff. An email to an infant feeding coordinator in February 2015 states that the product is:
‘designed to meet all the nutritional requirements for mum during pregnancy…and that neonatal nurses are particularly interested in Nutrimum for breastfeeding mums with babies in special care baby units’
It's this that makes me actually want to scream. For the last few months I've been working on a short book about the politics of breastfeeding, and this type of contact with health professionals, implying that the product is beneficial for mums breastfeeding special care babies (for which there is certainly no evidence), is reminiscent of all the marketing abuses I've been writing about. That this isn't infant formula doesn't matter. These products offer no benefits, play on fears mothers have about their own and their babies' nutrition, and the profits will line the pockets of the world's second biggest baby milk manufacturer. Thank goodness for the work of First Steps Nutrition and other organisations like Baby Milk Action that scrutinise and monitor the companies. Do visit their websites and join or donate to support their work if you can. And if you work with mothers, tell them that these products are unnecessary, expensive and heavily marketed (and that if they buy them, they are paying for the marketing).

Friday, 28 November 2014

BabyFriendly 2014: a conference report

I've just got back from the UNICEF BabyFriendly Conference in Newcastle. I'm full of thoughts, ideas and inspiration and wanted to mention a few points before I get caught up in other work again.
Dr Kasja Brimdyr speaking at BabyFriendly conference

Breastfeeding and politics are never far apart, and the opening address was a reminder of that. Dr Dan Poulter, MP is the Parliamentary Under Secretary of State at the Department of Health and the Conservative MP for Central Suffolk and North Ipswich. He spoke about the vital importance of the first few years of a child's life in terms of development, health and longer-term outcomes, about relationship-building supported by the BabyFriendly standards, and he talked about increased numbers of midwives in training and money that's been invested in improving the environments of maternity facilities.

Unfortunately for Dr Poulter, I wasn't really in the mood for his carefully-worded speech. Earlier in the week I'd read this article about Newcastle - the host city - which explains the utter hopelessness of the city's financial situation and the impact cuts are having on family services (spending on children and family services, via Children's Centres, has been cut by 40%). When asked how much worse it will get, the city council leader replies '[With cuts to] transport for kids with special educational needs and disabilities. That is in the pipeline.' The day before conference I had read this article too, about how families with disabled children are being forced into grinding poverty - the article itself is hard enough to bear, but read the comments for many more real-life examples. Closer to home I've been filling in consultation documents about cuts to family services in my own area. As volunteer peer supporters affiliated to the Children's Centres we deliver our breastfeeding groups, hold our training sessions and support families there. Recently I've also been supporting Cambridge Breastfeeding Alliance's campaign to secure funding to continue their incredibly valuable breastfeeding drop-ins, the victim of cuts to children's services in Cambridge, as well as the RCMs campaign for fair pay for midwives (Dr Poulter told us - again - that more midwives are in training, but - again - didn't address the question of whether there would be jobs for them when they graduate...)

He went on to talk about breastfeeding statistics - another area of concern for me: I've been emailing the Department of Health, writing to my MP and signing this petition to contest the decision to cancel the Infant Feeding Survey 2015. This survey is of immense value to anyone working in breastfeeding as it gives detailed information about national breastfeeding rates, introduction of solids, continued breastfeeding, use of formula milk and so on. Many of the conference speakers referenced the survey in their presentations. According to Dr Poulter the government will be improving the quality, quantity and timeliness of breastfeeding statistics at targeted local level - I'm not sure how, or how the national picture will be monitored, and he didn't elaborate.

So far, so depressing... fortunately, the rest of the conference was a genuine celebration: of 20 years of the BabyFriendly initiative, of accreditations across the country, of the hard work and dedication to supporting mothers and babies that underpins the whole thing, and looking ahead to how the achievements of BabyFriendly can be made sustainable into the future. It's hard to pick out my personal highlights, but I particularly loved Dr Nikk Conneman's presentation about gentle, baby-centred neo-natal care that fully involves the parents: when asked how he handled ward rounds in his unit (when parents are often asked to leave their baby's bedside), he replied 'I don't do ward rounds' and the audience broke into spontaneous applause: I think because it's so refreshing to meet someone so prepared to change the system if it isn't working for the babies and parents. Laurel Wilson's engaging talk about the emerging new science of epigenetics and breastfeeding was described by someone sitting near me as 'mindblowing'; we now know that how a baby is fed can influence the way their genes are expressed, and that breastmilk is packed with genetic material (the only way that this can be transmitted other than through sexual reproduction). It's a topic I can't wait to read more about, and it's closely linked to the work that's going on into the microbiome.

Dr Kasja Brimdyr talked about skin-to-skin in the first hour after birth - there was so much in her presentation that I found fascinating, particularly her observations about the effect of epidural fentanyl on infant responsiveness in the first hour (which ties in with a post I wrote about the effect of epidural on breastfeeding). The fentanyl (a commonly used epidural drug) delays the stages a baby must go through to find the way to the breast and latch on. It doesn't mean they won't or never will, but it may take longer, and those babies need even more skin-to-skin time to facilitate it. She cautioned against paying 'lip-service' to skin-to-skin; it shouldn't be interrupted or hurried if at all possible. Kerstin Uvnas Moberg touched on epidural too - explaining how it blocks the release of oxytocin, causing subtle changes that may affect breastfeeding behaviour.

There's so much more I could mention, but my take-home message was one of positivity and belief that the work we're all doing in breastfeeding really matters. One delegate asked how, given the daily pressures on midwives and breastfeeding supporters, we could give mothers and babies the best possible care? It's a frustration we all share at times, and the answer Sue Ashmore gave was simple but inspiring: keep doing your best, keep trying, keep the BabyFriendly standards at the heart of what you do, and it will be good enough. We don't need to be perfect to make a difference.

Were you at the conference? I'd love to know what your personal highlights were. Leave a comment below...

Thursday, 13 November 2014

Exciting times...

My desk today.
I've not written as many blog posts as I'd like over the last few months. It's not for want of material - there's always plenty to comment on in the world of birth and breastfeeding - but other projects have been taking up most of my work time (which is squeezed in around the demands of the three small people in my house). But now, as the the pile of work on my desk grows ever higher, I can reveal what I've been up to.

I've done quite a bit of work for Pinter and Martin in the last couple of years, in my freelance editorial capacity - editing and proofreading some of their most recent titles. Earlier this year Martin Wagner asked me to go a step further and commission a new series of books: to be called the Why It Matters series. So I've been hard at work finding and talking to authors, finalising titles and overseeing the first few books in the series, and it's now starting to come together. A formal announcement, and new website, will be coming from Pinter and Martin very soon - but for the eagle-eyed the books are already listed (albeit without jackets) on both the Pinter and Martin site itself and other bookselling websites.

The first three books in the series are Why The Politics of Breastfeeding Matters by Gabrielle and Palmer and Susan Last (eek!), of which more below, Why Doulas Matter, by Maddie McMahon, and Why Hypnobirthing Matters, by Kat Berry; these will be published in March 2015. The next three, to be published in summer 2015, are Why Pre-conception and Pregnancy Nutrition Matters, by Michael Walne (of Your Nutrition Matters), Why Breastfeeding Matters, by Charlotte Young (aka The Analytical Armadillo) and Why Baby-Led Weaning Matters, by the pair of them working together. I am so excited to be working with all these wonderful authors, each one passionate about the vision of the series - to provide evidence-based, clear information that will genuinely help new parents, and anyone involved with them, to make properly informed decisions. More titles are planned for next autumn and beyond... watch this space!

The manuscript for one book has been delivered, the second is well advanced... and I find myself, as joint author of Why The Politics of Breastfeeding Matters, with Gabrielle Palmer, with a lot of work still to do on my own manuscript. In fact I've realised that I've been procrastinating about getting on with it and I've had to address a whole heap of doubts: about my ability as a writer/editor, about my time management skills and about whether I actually know enough to do justice to Gabrielle's work - it has been hard to buckle down. I hope I've turned a corner with it... let's see. It would be ironic if I failed to deliver my own manuscript on time, given that I've spent a good proportion of my career coaxing authors through the writing process! I need to take my own advice, I think, and just get on with it. Please feel free to nag me.

Another project I've been involved with is Laura Dodsworth's fabulous photograph/interview book Bare Reality - which you may have seen in the press or online as she ran a phenomenally successful Kickstarter campaign in September. I'm editing the text of the book and am delighted that Laura has actually now linked up with Pinter and Martin to publish and distribute the book - the jacket has just been announced and it looks amazing.

As if all of the above wasn't enough, I'm thrilled that Milli Hill's book Water Birth: stories to inspire and inform for my own tiny company, Lonely Scribe, has reached the proof stage and should be published very soon. It's been a long time since we started the project - and in the meantime she's set up the Positive Birth Movement, had a third baby and become a columnist for Best - but it's wonderful to finally be approaching publication. Here is a sneak peek of the jacket - watch out for news of when the book is published.