Bottled Up. Suzanne Barston
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campaign. The campaign most famously featured a thirty-second public service announcement showing a massively pregnant, attractive African-American woman in her thirties riding a mechanical bull. She falls off; the bar patrons watching are appropriately horrified. And the words flash on the screen, ominously: “You wouldn’t take risks before your baby is born. Why start after? Breastfeed exclusively for 6 months.” Another similar spot relayed the same message with an expectant mother engaging in a log-rolling contest.
By appealing to mothers’ propensity to guilt and fear, the PSA assumed a few things: first, that the target audience was committed to a healthy pregnancy and a healthy baby; second, that they were committed to the nutrition of their children; and third, that they were committed to being the best parents possible. So we’re starting with a group of women who are already nervous, probably overloaded with information (my living room was a veritable obstacle course of pregnancy and parenting books), and the host of a ton of pesky hormones that make us cry at something as innocuous as a rerun of Saved by the Bell. The campaign’s creators were well aware of the impact these ads would have; one member of the AAP’s breastfeeding committee claimed the campaign signified “a change to promote breast-feeding as a public health issue rather than simply as a personal parenting choice.”17 Even the slogan used in the campaign—“Babies are born to be breastfed,” rather than the well-known adage “breast is best”—was significant. The Department of Health and Human Services (DHHS) intended the slogan to address its growing concern that breastfeeding should not be seen as the “ideal,” but rather that formula should be framed as risky.18
Even if one were to accept the general premise that babies were, indeed, sprung from the womb with a breastmilk birthright, where was the mother in the scenario presented by this slogan? Rebecca Kukla, professor of philosophy and internal medicine at the University of South Florida, voiced these concerns in a 2006 paper examining the campaign. Rather than addressing the real reasons women don’t breastfeed—reasons that range from histories of sexual abuse and body image issues to economic and physical constraints—the campaign “portrays anything short of exclusive breastfeeding … as a sign of moral corruption and bad character. … We can only conclude that DHHS believes that women can choose to breastfeed yet are failing to do so, not because there are any impediments to their voluntarily making this choice, but rather because they simply aren’t willing to do the best thing for their babies unless more pressure is exerted.”19
There was a ton of controversy surrounding these ads, which were pulled shortly after their launch (but not before they scared millions of potential, current, and future moms, I’ll bet). They even caused dissension within the American Academy of Pediatrics. On a 2003 episode of CBS’s Early Show, Dr. Carden Johnston, the AAP’s president at the time, claimed that he was absolutely in favor of a campaign to promote breastfeeding but worried about the tone of this particular campaign. “We want women to be able to choose to breastfeed and do that for positive reasons and not feel intimidated or scared,” he said on air. “We are for the breastfeeding campaign and we want to encourage it and support it and we want it to be accurate and credible. … Pediatricians raise their children and support their families with positive nurturing experiences, not with scare tactics.”20 A rational and considerate point of view, to be sure; unfortunately, Johnston and others who shared his concerns were accused of being in the pockets of the formula industry by some on the other side of the debate, and these cautious, balanced voices were silenced.
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The DHHS/Ad Council campaign marked a significant change for the AAP. Although it had come out with statements supporting breastfeeding in the past, the organization had been cautious not to alienate the parents it served. At the time the bull-riding/log-rolling ads were released, the AAP was still relying on documents from the 1980s that, according to one breastfeeding activist, simply “encouraged breastfeeding and acknowledged the superiority of human milk.”21 Then in 2005, “Breastfeeding and the Use of Human Milk,” now used as the go-to for AAP breast-feeding policy, was released; it was profoundly different in tone, saying in no uncertain terms that “human milk is uniquely superior for infant feeding” and recommending that infants be breastfed for at least a year.22
It seems likely that the new, unequivocal tone was at least partly inspired by the dissent in the AAP’s ranks over the DHHS ads—especially when you consider that this statement was written by members of the 2003 AAP Section on Breastfeeding, the same group that cried foul when its parent organization, led by Dr. Johnston, pulled the plug on the DHHS campaign.
An older Southern gentleman with a slow drawl and kindly demeanor, Dr. Carden Johnston is like the poster child for a homey, warm, idealistic view of pediatrics; quite a contrast to how the defenders of the DHHS campaign had portrayed him in the press. In the kindest light they shone on him, he was a daft industry pawn; in the harshest, a slick political animal willing to throw the baby out with the formula water. “Dr. Johnston … developed this sudden and seemingly urgent interest in this issue not via a last minute clinical review of the scientific literature, or even after consulting with the AAP’s own recognized lactation science experts … his concern came immediately after aggressive, personal lobbying by representatives of one of the AAP’s biggest financial contributors, the $3 billion U.S. infant formula industry,” wrote lactivist Katie Allison Granju in “The Milky Way of Doing Business,” a rebuttal to the AAP’s actions regarding the campaign. “Johnston hurled the considerable credibility and persuasive impact of the esteemed American Academy of Pediatrics into an explicit effort to stifle the most ambitious initiative ever undertaken to promote breastfeeding in the United States.”23
When I met with Johnston seven years later, his recollection of the events was less dramatic. “I found out that there was pressure to have an advertising campaign come out of the Office on Women’s Health, which would use fear tactics to promote breastfeeding. … [S]ome of the things they were saying pushed the data to a level so that it was no longer credible … ‘If you don’t breastfeed, your child is going to develop leukemia’ … those kinds of scare tactics were there,” Johnston explained to me on the rare sunny day that we met in Seattle, where he and his wife live part-time. “Now, if the data that something in infant formula might cause leukemia was solid, the Academy would have to find out what in the formula was causing leukemia and eliminate that, and meanwhile, encourage everyone to breast-feed … but the data was not that strong. And [the executive committee] needed to respond, because the Ad Council was working hard on this campaign and were likely to get something out pretty quickly. I signed a letter saying where the Academy was coming from; that the ads should be more positive than negative in promoting breastfeeding; and I think it’s a very good letter. … What we didn’t do, in retrospect, was to involve a lot of our breastfeeding advocates before we mailed it. We wouldn’t have had to change the letter, but they should have been notified and consulted.”
As for the claim that the formula companies were influencing the AAP, Johnston says that “the formula company was monitoring the website [so they] were able to show me what was on the website before the Office of Women’s Health pulled it down. So, is that influence or not?”
Certain members of Johnston’s own organization clearly believed that it was. Dr. Lawrence Gartner, head of the Breast-feeding Section of the AAP, spoke harshly about Johnston when interviewed for Granju’s article. “Some of us within the AAP have long suspected that the infant formula companies had this sort of direct access to AAP leadership. … Dr. Johnston’s actions have revealed the extent of this influence more clearly than anything else I’ve seen. Many doctors within the AAP are very disturbed by this.”24
Whether there really had been “many doctors” offended by the executive committee’s actions, or if it had merely been the vocal few that comprised the Breastfeeding Section, is likely a matter of interpretation. It’s tough to know where the majority of the AAP really stands, since you’d be hard pressed to find anything on the AAP website having to do with breastfeeding that hasn’t been written by the Breastfeeding Section. Johnston spent about twenty minutes trying to explain the role of a section to me; basically, it is “a group of individuals [within the AAP] who are enthusiastic about an issue.” The executive committee will then