Last month, the non-profit group Corporate Voices for Working Families released an updated version of its worksite lactation toolkit, initially released in 2009. Again working with Working Mother Media, the toolkit “is made possible by the generous support of Abbott Nutrition,” makers of Similac infant formula. Corporate Voices also thanks Abbott for serving as a critical reviewer of the content of the toolkit.

The toolkit provides an excellent illustration of what happens when well-meaning organizations partner with the formula industry, potentially tarnishing their own credibility and hard-earned reputation. Research has already shown that when formula companies provide information on breastfeeding, mothers who use that material are more likely to use formula.

Yet, in its most egregious flaw, the toolkit repeatedly refers users to Abbott’s materials on breastfeeding, including a pamphlet they produced, their hotline and their website. There is also plenty of inaccurate information in their other materials in the toolkit.

The influence of the formula industry may be too subtle to be readily apparent to the average user, including editorial staff at Corporate Voices.

What is most notable about the toolkit are the many things that it doesn’t say. For example, the toolkit contains long lists of resources, many of which are well respected, but nowhere does it mention the federal government’s Business Case For Breastfeeding, a competing worksite toolkit that is evidence-based and has no commercial bias. It also does not highlight the National Business Group on Health’s worksite material, which is also well respected.

In its main brochure, the Corporate Voices toolkit describes the health benefits to infants such as reduced ear infections, diarrhea and colic. But it fails to mention any more scary or serious conditions such as hospitalization for lower respiratory tract infection, Sudden Infant Death Syndrome, obesity, and diabetes. There is little risk to the formula industry to concede milder diseases of infancy that most of the public knows about anyway.

When the toolkit’s main brochure discusses the “benefits” of maternal health, it mentions only breast cancer, cervical cancer, and weight loss. These latter two conditions are without a strong evidence base, and are not included the 2007 Agency for Health Care Research and Quality analysis of breastfeeding data. Other serious maternal diseases that are in the AHRQ report go unmentioned: ovarian cancer and type 2 diabetes, for example.

The toolkit features many common but subtle problems often seen when the formula industry produces materials on breastfeeding such as:

• Repeatedly describing only the “benefits” of breastfeeding, and never referring to the risks of not breastfeeding. Breastfeeding is the biologically normal way babies are fed; to describe the “benefits” of breastfeeding implies that formula is the normal way babies are fed.
• Using superlative language to describe breastfeeding or breastmilk such as “best” or “optimal,” knowing that most people will settle for “good enough” or “average” and the ideal or optimal products are often beyond the reach or desire of the average person.
• Overemphasizing how difficult breastfeeding can be—focusing on mothers’ struggles, pain, guilt, leaky breasts, etc. Included in this category are materials that emphasize the different kinds of equipment a mother “needs” in order to breastfeed: creams, pads, cover-ups, pumps, special clothing, etc.
• Using language above the reading level recommended for health literacy when producing educational materials for the general public. Health literacy experts recommend that materials be written at a sixth grade level. Materials written at sixth grade reading level have short simple sentences, without the need for commas.
• Using subtle language to ensure formula feeding mothers are included in all breastfeeding initiatives, as was illustrated in a letter from an Ohio representative to the Surgeon General included in the toolkit, predating the Surgeon General’s release of her Call to Action to Support Breastfeeding. The representative asks that the Call to Action be “balanced and supportive of all mothers,” and “improve the nutritional well being of all infants in this nation.”
• Failure to mention more serious diseases associated with early cessation of breastfeeding, and only mentioning more minor risks that are already commonly known.

Aside from referring mothers and providers to Abbott materials, the toolkit includes many videos purporting to give tips on breastfeeding. Again, what is important is what is not included. Many of the videos are amateur productions by ordinary mothers with no particular expertise in breastfeeding, and they have little practical information about how to pump at work, or how to breastfeed and some even have overt misinformation. It is concerning that an organization with such resources as Corporate Voices would ignore any number of well-made professional resources in favor of amateur videos that provide little actual support.

Finally, there is almost no mention of the effect of introduction of formula on mother’s milk supply or her ability to breastfeed. Readers may be especially confused because well-respected material is included with obvious formula marketing material, making the entire package appear more credible than it really is.

Conflicts of interest are rife in the health care field, and that is why a growing number of academic medical centers are minimizing their faculties’ relationships with pharmaceutical and device makers. Increasingly, well-meaning doctors and administrators are learning that there is “No Free Lunch”. It is time that well-meaning non-profits learn the same lesson.

Non-profit organizations must be careful not to enter into agreements with any corporation whose activities compromise their own mission and policies. A non-profit interested in children’s health should not be entering into financial relationships with tobacco companies or makers of sugar-sweetened beverages, for example.

These corporations cannot be expected to compromise their bottom line for a good cause—their own shareholders would not stand for it. Thus, true promotion of breastfeeding will only hurt Abbott’s sales. However, a skillful manipulation of a worksite lactation program may actually help its sales, or at least ensure the sales are not negatively impacted. Abbott is well aware that the only way to sell more formula is to sell less breastfeeding. Corporate Voices has partnered with them at its own peril.

Abbott’s support of the Corporate Voices toolkit is not “generosity,” but a sensible marketing investment for its formula products. The result: Corporate Voices appears to be no more than a foolish pawn in Abbott’s greater marketing scheme, and not a good citizen legitimately trying to help working mothers and their employers.