Re: BMJ article

Jane wrote:

> Having read the report in
> full, I was struck by one
> of the case studies. One
> woman (whose baby, sadly,
> died of severe malnutrition
> and pneumonia) stated that
> she had read the label and
> understood that the creamer
> was not for use instead of
> breast milk (so illiteracy
> was not the problem here),
> but she noted that the can’s
> label showed a mother bear
> with baby, and that people
> in her village consider
> this an acceptable infant
> food.

I'm not so sure we can dismiss the problem of (visual) illiteracy here.

According to the article's Table 3, 49.7% of respondents "Never
noticed it/don’t know" what the "picture of feeding bottle with cross
through it" means.

Moreover,

	"As our sample was more literate than the national average
	(90% v 70%), we might have underestimated the level of
	misconceptions and the nationwide use of the coffee creamer as
	a substitute for breast milk because secondary education was
	associated with a lower risk of giving the coffee creamer to
	infants (unpublished data)."

And according to Table 2, only 10.7% of respondents recognized the
Bear Brand logo as "Advertising."

This has to be a major factor in community acceptance of the creamer
as a substitute for breast feeding.

And if its ongoing use isn't popularly perceived as risky behavior --
because there's no obvious correlation between the practice of feeding
children Nestle Bear Brand creamer and the alarmingly "high rates of
malnutrition and infant and child mortality" in Laos -- little will
change.

Learning how to read packaged food labels and critically assess
nutrition claims is a useful literacy in today's world.

According to the authors, for the Bear Brand creamer,

	"The first listed ingredient is sugar and it contains 3.6% of
	calories as protein and 27.3% as fat. For infant formulas the
	recommended content is 7.2-12.0% protein and 40-54% fat."

If adults understood what these numbers meant for the health of their
children, and were able to make their own trade-offs, I expect the
village consensus would change.


> It has been shown in several
> contexts with healthcare
> information that people will
> go to what might seem
> extraordinary lengths to fit
> new information into the
> model they have formed and
> with which they feel at least
> partially comfortable. So the
> combination of the logo and
> her cultural background was
> powerful enough to override
> any disclaimers, and her
> decision made sense to her.

I don't think this was so much a matter of having "to fit new
information" to a world view (with which it may or may not be
compatible), as it was a matter of having to choose between
conflicting messages.

According to the BMJ article, the mother had been concerned that her

	"infant was vomiting with breast feeding shortly after birth.
	She stopped breast feeding and bought the coffee creamer with
	the Bear Brand logo."

To me, the Bear Brand logo doesn't connote breastfeeding: it connotes
healthy & happy families.

When I look at the logo, I don't see a baby bear breastfeeding; I see
a baby bear being cradled by an adult bear in much the same position
as that used by humans to feed and rock and interact with a baby.

The striking thing about the logo is that it exudes all the desired
energy associated with good health: from the sunburst surmounting the
Nestle logotype, to the smiling, fat and frolicking Baby Bear ...
which is almost *half* the size of Mama Bear.

Given the situation of an infant at home who was vomiting and appeared
sickly from breastfeeding, the emotional appeal of the Bear Brand logo
(presumably located on the front of the can, so it has immediate and
lasting impact) would outweigh the written warning

	"This product is not to be used as a breast milk substitute."

and crossed-out baby bottle (presumably located on the back of the
can, where it's much less in-your-face, demanding to be reckoned with)
for all but the most critical of us.

Plus, when you have conflicting messages/symbols like this, it's
always harder to sell audiences on a negative (a truism for verbal
rhetoric, anyway ;-).

For years, cigarette packages in the U.S. have carried a message from
the Surgeon General warning that smoking is hazardous to one's health.

But how many people took heed and stopped smoking because of it?

Very few, I expect.

In this case, cultural changes (and peer pressure) were key.

As I understand it, smoking in the U.S. continues to be prevalent in
some social classes, but has become stigmatized and relatively rare in
others.

So even though the Madison Ave. *image* of smokers has changed from
heroic stereotypes like the Marlboro Man and the Newly-Independent
Woman etc. to tired and aging, sickly addicts who have lost control of
their lives (the image that sticks in my mind is of the older woman
who now has to talk -- and smoke! -- through a gaping hole in her
throat because of cancer), the change in symbolism is not by itself
sufficient to stamp out smoking in all communities.

Deborah
_____

Deborah Taylor-Pearce
[email protected]












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