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HHS Toned Down Breast-Feeding Ads

Both HHS and AHRQ ultimately sent out a few e-mail notices, but the report was generally ignored. Requests to speak with Haynes were turned down by other HHS officials.

Regarding the changes made to the earlier HHS ad campaign, Kevin Keane, then HHS assistant secretary for public affairs and now a spokesman for the American Beverage Association, said formula companies lobbied hard, as did breast-feeding advocates.

"We took heat from the formula industry, who didn't want to see a campaign like this. And we took some heat from the advocates who didn't think it was strong enough," Keane said. "At the end of the day, we had a ground-breaking campaign that goes further than any other administration ever went."

But the campaign HHS used did not simply drop the disputed statistics in the draft ads. The initial idea was to startle women with images starkly warning that babies could become ill. Instead, the final ads cited how breast-feeding benefits babies -- an approach that the ad company hired by HHS had advised would be ineffective. The department also pulled back on several related promotional efforts.

After the 2003-05 period in which the HHS ads were aired, the proportion of mothers who breast-fed in the hospital after their babies were born dropped, from 70 percent in 2002 to 63.6 percent in 2006, according to statistics collected in Abbott Nutrition's Ross Mothers Survey, an industry-backed effort that has been measuring breast-feeding rates for more than 30 years. In 2002, 33.2 percent of women were doing any breast-feeding at six months; by 2006, that rate had declined to 30 percent.

The World Health Organization recommends that, if at all possible, women breast-feed their infants exclusively for at least six months.

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The breast-feeding ad campaign originated in a formal "Blueprint for Action on Breastfeeding" released in 2000 by David Satcher, who had been appointed surgeon general by President Bill Clinton. The Office on Women's Health convinced the nonprofit Ad Council to donate $30 million in media time, and it hired an ad agency to work alongside scientists from the National Institutes of Health, the Centers for Disease Control and Prevention, and elsewhere.

Officials met with dozens of focus groups before concluding that the best way to influence mothers was to delineate in graphic terms the risks of not breast-feeding, an approach in keeping with edgy Ad Council campaigns on smoking, seat belts and drunken driving. For example, an ad portraying a nipple-tipped insulin bottle said, "Babies who aren't breastfed are 40% more likely to suffer Type 1 diabetes."

Gina Ciagne, the office's public affairs specialist for the campaign, said, "We were ready to go with our risk-based campaign -- making breast-feeding a real public health issue -- when the formula companies learned about it and came in to complain. Before long, we were told we had to water things down, get rid of the hard-hitting ads and generally make sure we didn't somehow offend."

Ciagne and others involved in the campaign said the pushback coincided with a high-level lobbying campaign by formula makers, which are mostly divisions of large pharmaceutical companies that are among the most generous campaign donors in the nation.

The campaign the industry mounted was a Washington classic -- a full-court press to reach top political appointees at HHS, using influential former government officials, now working for the industry, to act as go-betweens.

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