This week, in a move that contradicted decades of research proving that breastfeeding benefits babies and mothers, the Trump administration rejected a World Health Organization resolution limiting the misleading marketing of formula, which—if replaced with breast milk—could save more than 800,000 infant lives a year.
Health officials were "shocked" and "stunned" by the news, the New York Times reported. But for the scholars who study this issue, nothing about this decision is surprising. The United States government, the largest purchaser of formula in the country, does more than market milk substitutes: It gives them away for free.
A network of federal policies, including Farm Bill subsidies and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), ensures that the formula industry remains profitable. In doing so, these programs disproportionately harm low-income women, specifically black mothers, who already face greater health risks.
Pacific Standard spoke to Andrea Freeman, a legal expert on racial disparities in breastfeeding, about how this latest decision furthers a decades-old pattern of placing profit above health.
The U.S. not only resisted a World Health Organization resolution promoting breastfeeding over formula, but pressured other nations not to support it. What does this decision mean for the country?
This is part of a long history of the U.S. government supporting the formula industry over the health of mothers and children. All of the medical and scientific evidence says breastfeeding is better. Even so, the U.S. was the only country not to sign the WHO [International Code banning] advertising. That's the precedent for this. The U.S. has never wanted to put any limitations on formula marketing.
Your research suggests that the U.S. promotion of formula is a pattern. How does this decision align with policies we've seen in the past?
I'd say it's a direct continuation. The only difference here is the extremity of the threat used—this idea that they would cut off military aid and start a trade war over it shows more support than we've seen in the past for the industry, suggesting a very strong relationship between this administration and the pharmaceutical industry.
What is the role of lobbyists from the formula industry?
They're front and center. There's no actual reason, despite [President Donald] Trump's tweet [in favor of formula], for the good of any human being to try not to promote breastfeeding. It is purely to protect money and industry. You increase poverty and malnutrition by promoting formula over breastfeeding.
In your work, you describe the racial disparities in breastfeeding in the U.S. as a kind of "food oppression." How does that factor into or reflect on this latest decision?
All of the policy decisions are influenced by the formula industry, in an attempt to keep that industry profitable. Because black women are one of the most vulnerable populations in the country, they're easy to target with structural factors that make it impossible for them to actually breastfeed, disproportionately. It's one of the ironies of the way this country works, that the people at lowest rungs are the ones being milked for profits. They're making money off the most vulnerable populations.
What are the specific policy levers at work here?
One of them is the previous WHO resolution, which would limit marketing, which most countries have taken on, so they don't market to expecting mothers and new mothers and they don't market through pediatricians. When you look at the wording of those kinds of laws, you see that people haven't even contemplated the idea that the government itself might be marketing formula. Here, it's given away free through WIC. The way that it's sold, it's presented as government endorsement of the product. Pediatricians also endorse the product. They put it on their pamphlets, they put it in their waiting rooms. And there's a strong relationship between the formula industry and the American Association of Pediatrics.
I'm looking at this web and framework of breastfeeding policies, which includes WIC distribution, the failure to sign on to the WHO resolution, the distribution in hospitals, the lack of support for breastfeeding. It's a difficult issue because all of these things operate in combination. I look at how [federal subsidies provided to industry lobbyists] through the Farm Bill funnel into this issue, because the government supports the three main ingredients of formula: milk, corn, and soy. They then use their own programs to distribute formula, to increase the ability to get rid of the surplus that results from the subsidies.
The U.S. government is the largest purchaser of formula in this country. They then distribute it to people through WIC, but they're benefiting themselves, because they're getting rid of this surplus that they have created through the Farm Bill. It's very circular.
So how would we go about ending this cycle?
The real solution is to have the government act independently of the industry, so cut the influence—not allow contributions, not allow the extreme lobbying, not allow people from these industries to hold important government positions.
But under this administration....
Right, we're going the other way. That's the problem. The solution is not viable, and the problem is getting worse.
This interview has been edited for length and clarity.