After Infant Formula Debacle,
Armenia Goes Back to Basics
Government Moves to Ban Formula Ads
Princeton, N.J. (22 November 1998)—Infant formula distributors will no longer be able to advertise their wares in Armenia, according to legislation now under consideration by Armenia’s Parliament. Debate on the government-sponsored bill began on 10 November. The move reflects concern that the mass marketing and distribution of infant formula in Armenia has destructive effects.
Ten years ago, after the earthquake that devastated Armenia, the Armenian Ministry of Health actively solicited donations of infant formula. Armenian diaspora charities and foreign agencies, including the United States Agency for International Development (USAID), flooded Armenia with this form of relief.
A 1993 study sponsored by the USAID Yerevan Mission Office showed, however, that the free distribution of infant formula did more harm than good. The government reversed course and committed itself to a campaign to promote breast-feeding in the nascent republic.
The evolution of infant nutrition policy in Armenia is carefully elucidated in a recent article by Kim Hekimian Arzoumanian. The article appears in the current (Summer 1998) issue of Armenian Forum. Arzoumanian, who holds a Ph.D. in public health from Johns Hopkins, was the author of the pivotal 1993 USAID report.
Formula was solicited and distributed after the earthquake on the faulty premise that the nutrition provided by breast milk is somehow inadequate. Arzoumanian found, however, that the real problems lie with infant formula. One problem was that people sometimes used impure water to dilute the formula. This practice led to infant diarrhea and other morbidities.
Another problem lay in the simple fact that unlike milk, formula had to be acquired from sources not under the mother’s control. According to Arzoumanian, the free distribution of four-to-six-week supplies of formula got untold numbers of mothers hooked. Fresh supplies were not always available, however, and mothers would run out of formula. By then they had stopped lactating and had no nutritious and appropriate way to feed their infants.
Deeper Problems
The problems did not begin with the 1988 earthquake, however. Arzoumanian found that standard practices in hospitals (which is where most children in Armenia are born) were not conducive to breast-feeding. Whereas almost 100 percent of mothers initiated breast-feeding, few breast-fed exclusively for long.
The most outrageous practice was that of separating newborns from their mothers for the first twenty-four hours postpartum. This practice deprived infants of important first opportunities to latch on to their mothers’ breasts. It also deprived them of colostrum, the first milk, which is highly nutritious and enhances the immune system.
Arzoumanian identified several other problematic practices. One was the system of rigidly scheduled breast-feeding. Infants who were hungry off-schedule were bottle-fed, leaving them uninterested when they were finally allowed to breast-feed.
An Intensive Campaign
A practical advantage, in public-health terms, of the vestigial Soviet system was that hospital practices nationwide could be changed by ministerial decree. Acting on the USAID findings, the Ministry of Health ordered hospitals to change their neonatal practices. Meanwhile, UNICEF began an intensive campaign to encourage exclusive breast-feeding. The campaign included the retraining of physicians and awareness-raising through television advertisements.
The effects of the reforms and the campaign were tracked in a major follow-up study recently completed by Arzoumanian. The study was sponsored by UNICEF and conducted through the American University of Armenia. In her Armenian Forum article, Arzoumanian reveals the hitherto unpublished, encouraging results of the study.
The proposed ban on formula advertisements (which includes advertising by distributing free samples) is but the latest phase in the Armenian government’s enlightened campaign to improve infant nutrition and public health.
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