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As presented at the 8th Breastfeeding and Feminism Symposium: March 21, 2013

“Oh no. It looks like the Death Star.” - WHO Code advocate

Last year, the world’s largest infant formula company, Nestle, rolled out a new center for managing its social media, described by Reuters as Nestle’s site for reaching consumers and “engaging with the online enemy.”

Nestle’s new “digital acceleration center,” designed to both reach consumers and manage conflict, “looks like mission control” with walls of screens where red lights flash when online dissent is detected. Advocates for the fair marketing of formula were disheartened but not surprised to see this well-funded effort to reach mothers and diffuse controversy.

How infant feeding choices are marketed matters. It matters enough that formula companies are reported to spend more than $50 million annually in the US alone. It matters enough that the World Health Organization developed an entire set of rules (known as the WHO Code) around how formula should - and should not - be marketed worldwide. Now, the efforts to ensure accurate information about feeding choices have moved online to social media.

Those that defend those rules - WHO Code advocates - are working to ensure that those rules are upheld online. But defenders of the WHO Code are up against formula companies that are better-funded and are using the most up-to-date tools and strategies for reaching mothers using the Internet. Sound like David and Goliath? Once you see the technological power of the digital acceleration team, you will see why the online efforts of the formula companies feels like the Death Star of the Star Wars franchise fame.

This “formula Death Star” is not going unchallenged. Using the incredible capacity of social media for the advocacy, education, and the mobilization of grassroots efforts, a rag-tag group of rebel forces--online WHO Code activists--are working to protect the WHO Code and breastfeeding families everywhere.

What is the WHO Code?

The International Code of Marketing of Breastmilk Substitutes (commonly called the WHO Code) was written with the goal of reducing the impact of marketing practices that aim to mislead new and expectant mother into believing that infant formula is nutritionally, immunologically, and otherwise comparable to breastmilk. Despite common misconceptions, the code DOES NOT limit access to or use of formula or related products. The code addresses marketing--and for good reason. When marketing spending on formula goes up, breastfeeding rates go down.

The WHO Code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (the United States cast the lone dissenting vote). Thirty-two countries have adopted the code as national law, with 76 others adopting portions of it as law. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law.

As providers who work with women, we believe in their capacity to make the best choices for their families, when presented with evidence-based information. If that's our goal, we have two options:

  1. We can increase marketing budgets for breastfeeding to the levels of formula companies. In the past years, they have spent at least $50 million..OR

  2. We can uphold the WHO Code.

We want to make abundantly clear that our support of the WHO Code comes from a desire to ensure ALL families have good information, not from any motivation to instill guilt or shame in families who use formula. The WHO Code does not limit options for mothers. It takes away the barriers to informed choice. As Bettina Forbes of Best for Babes puts it: “The only people who should feel guilty are those who know about the negative impact of formula marketing and do it anyway."

Meeting Us Where We Are Means Using Social Media

Social media represents a revolution in communication that rivals the introduction of the printing press. For those of us of childbearing age, the notion of checking into Facebook on our iPhones, tweeting a photo of our dessert or going to Pinterest for a classic recipe instead of our family cookbooks, is second nature. Ninety-three percent of the “Millennial Generation” (those born after 1982 and who “get” technology because they grew up with it being an integral part of their lives) are communicating online, and in the United States, nearly 3 of 4 of them are using a social networking Website, such as Facebook, Twitter, or Pinterest.  While the stereotype of the white, suburban mom certainly exists, we access social media widely, regardless of race, ethnicity, or socioeconomic status. We as mothers are the “power users” of social media...and marketers know it!

These changes are having a significant impact on how we talk about, learn about, and share information around birth and breastfeeding. More than half of all women responding to one survey expressed their intention to share their birth experience, as it happens, on social media. Moreover, time online increases after the birth—44% of US women spend more time online after a new baby is born, and the likelihood that a new mother will seek breastfeeding information and support online is high.

We Are Seeking Information About Health Care -- Including Breastfeeding -- Online

Research tells us that health care providers continue to be the “first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the United States.” Eighty percent of U. S. Internet users have sought health care information online, and birth and related topics are an area of focus. We are using social media not only to seek information online, but we are also sharing our knowledge with others . . . and our iPhones make it as easy as sending a tweet or replying to a Facebook status update.

The savvy marketers at corporations who produce infant formulas are fully aware of these changes. We argue that it is our responsibility, as advocates for breastfeeding families, to understand these changes. We know that there is POWER in using social media to reach and rise up and converse with mothers to affect change.


Formula Companies Are Making Significant Investments In Social Media

Savvy institutions understand what we’d teach in any “Social Media 101” presentation: social media is an unprecedented tool for listening to and engaging with an audience. Nestle has become a leading example of the use of social media both to reach consumers and to manage conflict and dissent.

Nestle is the world’s largest food company and is also among the world’s most controversial corporations. Nestle was founded on the formulation of artificial infant milk. However, Nestle is not alone in its use of social media to reach parents. 10 out 11 infant formula brands commonly available in the United States, have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive websites.

How Do the TOP Breastfeeding Profiles Stack Up?

Nestle and other formula companies have used large budgets to build their audiences. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004 and Nestle has been reported to have doubled their social media spending in recent years. Compare this to the resources of top breastfeeding organizations. La Leche League International, the breastfeeding advocacy organization with the most significant financial resources had total revenues of $1.5 million in 2011 and spent a little over $115,000 on “public relations, external relations, and advocacy.”

Other organizations, like KellyMom, Best for Babes, and Breastfeeding USA have small budgets and rely largely on volunteer efforts. The result? Although all of these organizations make a significant impact on the women they reach, compare the total number of all of their followers on Facebook: about 145,000 as of this writing, to that of Gerber (the Nestle owned brand that manufactures Good Start formula) at more than five million followers.

Nestle has used its significant financial resources to hire social media experts and develop tools that have made it a shining example of effective corporate social media strategy. Nestle’s “Digital Acceleration Team” has a trained staff that monitors every mention of Nestle’s brands across various social media platforms. Team members identify negative “emerging issues” by the volume of mentions and respond to those with a high level of engagement with a scripted playbook for team members.

The Formula Death Star, as it has become known to WHO Code activists, can feel overwhelming, both because it limits our capacity to reach families and because it can feel impossible to influence change at the world’s largest food company. However, it is encouraging to remember that Nestle developed these tools in response to its inability to manage an onslaught of angry advocates and consumers. In 2010, Greenpeace activists were able to enact significant changes in how Nestle sources palm oil, thanks to a YouTube video spoof that garnered over 1.5 million views, along with a resulting social media campaign that netted more than 200,000 e-mail complaints. Policy change at Nestle, based on calls from all of us, is possible.

Examples of Efforts to Support the WHO Code Online

Although Nestle may have the Death Star, rebel forces are pulling together to provide much needed social media support for the WHO Code.

A recent campaign demonstrates the power of social media to organize individuals, even without an official organizing body like Greenpeace. A blog post exposing that the Pan-American Health Organization -- the regional representative in the Americas for the World Health Organization--accepted more than $150,000 in donations from Nestle sparked outrage among activists who were concerned that the fox was helping to buy the hen house. Within days, a private Facebook group was birthed and experienced rapid growth to 400 members, now at almost 1000 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO. Members shared impromptu trainings on Twitter use and etiquette, researched the money trail, and quickly developed strategy, including a decision to target WHO and call for a rejection of the Nestle funding.

The result: A relatively small group of consumers and advocates, through the use of Facebook and Twitter alone, were able to force the World Health Organization to respond. More importantly, the group began to organize and mobilize motivated individuals (including breastfeeding professionals, volunteers, families, researchers, and advocates!) who will come to the next battle more organized and prepared to engage.

How The Rebel Forces Can Defeat The Death Star

As the Greenpeace example shows, social media provides all of us with a unique opportunities to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change its policies; but this will not come without significant work. Some areas that need support:

Ongoing consumer support and education around the WHO Code: In our experience, families generally are unaware of the WHO Code, or, if they have heard of it, they believe that it limits access to formula rather than limiting the marketing of breastmilk substitutes. The importance of the WHO Code needs to be distilled into social media-friendly images and infographics to build awareness and support for all future efforts.

Ongoing education of maternal health advocates. The WHO Code is about more than just breastfeeding. Anyone concerned with infant and maternal health should be aware of and providing support for the adoptions and enforcement of the WHO Code worldwide.

Bring even more social media savvy to the table. After Nestle’s run-in with Greenpeace, it brought in a top notch social media strategist to revamp its approach and provide training for its social media team. Nestle uses sophisticated tools to monitor and respond to issues. The Friends of the WHO Code--and any group hoping to use social media for impact--needs people on hand who are savvy in the use of social media and the funding for some basic tools to make the job collaborative.

Keep doing what we know best. One the greatest results of the PAHO/WHO crisis was the assembly of a worldwide community with much work still to do. This and other groups need to use traditional community organizing strategies, incorporating social media to create a more level playing field.

To learn more about what you can do to help promote the WHO Code through social media, join the group “Friends of the WHO Code” on Facebook.

An earlier version of this post originally appeared in Science and Sensibility.

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