by Jeanette McCulloch, IBCLC and Amber McCann, IBCLC

Jeanette McCulloch and Amber McCann recently presented a session at the 8th Breastfeeding and Feminism Symposium on March 21, 2013, speaking about the ways that social media can be used to support breastfeeding by protecting and promoting the WHO code. They share their presentation today on Science & Sensibility to encourage all of us to be active participants in promoting action steps that help mothers and babies. Sharon Muza, Community Manager, Science & Sensibility.

© http://flic.kr/p/e2E4Cu

Reaching breastfeeding women today means being savvy about the use of social media. While breastfeeding organizations - long without sufficient marketing resources - are stepping up to increase online efforts, formula companies are better funded and are developing sophisticated tools for reaching mothers using the Internet. Nestle, in particular, has launched a well funded social media center that has the effect of undermining women's breastfeeding efforts. This 'Formula Death Star,' though, is not going unchallenged. Using the unprecedented capacity of social media for advocates to educate and mobilize concerned consumers, a rag-tag group of rebel forces - online WHO code activists - are working to protect the WHO code and breastfeeding mothers everywhere.

Meeting Women Where They Are At Means Using Social Media

Social media represents a revolution in communications that rivals the introduction of the printing press. Ninety-three percent [1] of the 'Millennial Generation' (those born after 1982, who have come of age in a time of dependence upon technology) are communicating online, and in the United States, for example, nearly 3 of 4 are using a social networking Website, such as Facebook, Twitter, or Pinterest.[2] Social media is widely accessed by women 18 - 29, regardless of race, ethnicity, or socio-economic status.

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.[3]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.[4]

Women Are Seeking Information about Health Care - Including Breastfeeding - Online

Research tell 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.'[5] Eighty percent of US Internet users have sought health care information online, and birth and related topics are an area of focus. Consumers using social media are not only seeking information online, but are sharing their knowledge with others. As connectivity soars through increased Internet access and the rise of the smartphone,[6] so does altruistic sharing of what mothers learn online.[7]

Formula marketers are fully aware of these changes. As advocates for breastfeeding mothers, we argue that it is our responsibility as advocates to understand these changes. We also can take advantage of unparalleled opportunities social media provides for advocacy organizations to engage in dialogues with mothers and affect change.

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 predatory marketing worldwide of formula and related products to new and expectant mothers.

The code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (United States was the lone dissenting vote). Thirty two countries have adopted the code as national law, with 76 others adopting portions of the code. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law.[8]

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.[9]

Formula Companies Are Making Significant Investments In Social Media

Savvy institutions understand what we'd teach you 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 also one of the world's most controversial.[10] Nestle was founded on the formulation of artificial infant milk, made of cow's milk, wheat flour and sugar.[11]

But they are not alone in their use of social media to reach parents. Research conducted in 2011 - before Nestle doubled their social media budget - found that 10 out 11 brands commonly available in the US have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive web sites.[12]

How Do the TOP Breastfeeding Profiles Stack Up?

Nestle and other formula companies have built these audiences using significant budgets. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004[13] and Nestle has been quoted saying they have doubled their social media spending in recent years.[14] Compare this to the resources of top breastfeeding organizations, groups like La Leche League International, which is by far the best resourced breastfeeding organization in the US. In 2011, LLL International had total revenues of $1.5 million and spent a little over $115,000 on 'public relations, external relations, and advocacy.'[15]

Other organizations, like KellyMom, BestforBabes, and the relatively new 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 Nestle Good Start at five million followers.[16]

Rebel Forces vs the Death Star

Nestle has combined its significant financial resources with social media experts and tools that have made it a shining example of how corporations should handle social media. Nestle's 'Digital Acceleration Team' has a trained staff monitoring each and every mention of Nestle's brands. Team members identify negative 'emerging issues' based on the volume of mentions and respond to those with a high level of engagement using a scripted playbook for team members.[17]

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, Nestle developed these tools in response to their inability to manage an onslaught of angry advocates and consumers on social media. In 2010, Greenpeace activists were able to secure significant changes in how Nestle sources palm oil, all 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.[18] Policy change at Nestle based on calls from consumers 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 using social media tools to organize individuals, even without an official organizing body like Greenpeace. A blog post[19] exposing that Pan American Health Office - the regional representative in the Americas for the World Health Organization - accepted more than $150,000 in donations from Nestle sparked outrage among activists concerned that the fox was helping to buy the hen house. Within days, a private Facebook group experienced rapid growth to 400 members, now at 900 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO.[20]Members provided 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. But more importantly, advocates began to organize and mobilize a group of motivated individuals, 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 advocates with a unique opportunity to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change their 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 anecdotal experience, mothers generally are unaware of the WHO code, or if they are aware, think that it limits access to formula (rather than limiting 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 future efforts.
• Ongoing education of maternal health advocates. The WHO code impacts 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, they brought in a top notch social media strategist to revamp their approach and provide training for the digital engagement 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 at least some basic tools to help make the job collaborative.
• Keep doing what we know best. One the greatest impacts of the PAHO/WHO crisis was to bring together the community that will need to continue to take action. This and other groups need to use traditional community organizing strategies, with social media as the tools they use 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.

References

[1] Howe N, Strauss W, Matson RJ. Millennials Rising: The Next Great Generation. New York, NY: Vintage Books; 2000.

[2] Lenhart A, Purcell K, Smith A, Zickuhr K. Social media and mobile Internet use among teens and young adults. Pew Internet and the American Life Project. http://web.pewinternet.org/~/ media/Files/Reports/2010/PIP_Social_Media_and_Young_ Adults_Report_Final_with_toplines.pdf. February 3, 2010.

[3] Social media giving birth to new generation of parents-to- be. Chicago Tribune Website. http://connect.mayoclinic.org/ news-articles/863-social-media-giving-birth-to-new- generation-of-parents-to-be/portal.

[4] Bartholomew M, Schoppe-Sullivan S, Glassman M, Kamp Dush C, Sullivan J. New parents' Facebook use at the transition to parenthood. Fam Relat. 2012;61:455-469.

[5] Fox S. The social life of health information. Pew Internet and American Life Project. http://www.pewinternet.org/~/media// Files/Reports/2009/PIP_Health_2009.pdf. May 12, 2011.

[6] Smith A. Cell Internet use 2012. Pew Internet and Ameri- can Life Project. http://www.pewinternet.org/~/media//Files/ Reports/2012/PIP_Cell_Phone_Internet_Access.pdf. June 26, 2012.

[7] Kibbe D, Kvedar J. Building a research agenda for participatory medicine. J Particip Med. 2009;1:16.

[8] http://lactationmatters.org/2013/03/12/the-international-code-part-1/

[9] http://www.bestforbabes.org/what-is-the-who-code

[10] http://www.corp-research.org/nestle

[11] http://www.nestle.com/AboutUs/History

[12] J Hum Lact. 2012 Aug;28(3):400-6. doi: 10.1177/0890334412447080. Epub 2012 Jun 6. Milk and social media: online communities and the International Code of Marketing of Breast-milk Substitutes. Abrahams SW.

[13] http://www.bestforbabes.org/what-is-the-who-code

[14] http://uk.reuters.com/article/2012/10/26/uk-nestle-online-water-idUKBRE89P07Q20121026

[15] La Leche League Annual Report: http://www.llli.org/docs/00000000000000001AnnualReport/llli_ar2011_final.pdf

[16] www.facebook.com/Gerber

[17] https://www.youtube.com/watch?v=ktsMa8hfgY0

[18] http://mashable.com/2010/05/17/nestle-social-media-fallout/

[19] http://lactationmatters.org/2012/11/08/if-you-dont-advocate-for-mothers-babies-who-will/

[20] http://lactationmatters.org/2012/11/14/world-wide-impact-in-10-minutes-or-less-using-social-media-for-powerful-change-2/

About Jeanette McCulloch and Amber McCann

© Jeanette McCulloch

Jeanette McCulloch, IBCLC, has been combining communications work and women's health advocacy for more than 20 years. She is a co-founder of BirthSwell, which is working to improve infant and maternal health - and the way we talk about birth and breastfeeding - by making social media accessible for birth and breastfeeding professionals. She is a board member of Citizens for Midwifery, and is active in local, statewide, and national birth and breastfeeding advocacy projects.

© Amber McCann

Amber McCann, IBCLC is a board certified lactation consultant with the Breastfeeding Center of Pittsburgh. She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition to her work as the co-editor of Lactation Matters, the International Lactation Consultant Association's official blog, she has written for a number of other breastfeeding support blogs including for Hygeia, The Leaky Boob, and Best for Babes and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms. Amber is particularly interested in the impact of the WHO Code and has worked on grass-roots campaigns to support its efforts online.

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