Nanny State Watch – Bloomberg’s Paternalism

The following is our complete thread on New York Mayor Michael Bloomberg’s efforts to ban certain sizes of soda and other beverages due to health concerns. The debate then segues to Bloomberg’s efforts to curtail the use of baby formula by new mothers.


Thu May 31, 2012 – 2:43pm:

Nanny State Watch

Jacob Sullum spells out the absurdity of Bloomberg’s latest paternalism:

Defending his proposal to fight obesity by restricting soft drink sizes [to 16 ounces and below], New York Mayor Michael Bloomberg says, “I think that’s what the public wants the mayor to do.” If the public wanted it, of course, there would be no need for the government to require it. … Bloomberg also plans to exempt fruit juices, which typically have more calories per ounce than sugar-sweetened soda, and milk-based drinks. So while New Yorkers won’t be allowed to order 20 ounces of Coke (240 calories), they will still be able to get a 20-ounce Starbucks whole-milk latte (290 calories) or even a 24-ounce Double Chocolaty Frappuccino (520 calories), not to mention a 20-ounce milkshake (about 800 calories).

Fred Schwarz furrows his brow as well:

After spending 30-odd summers in New York City, I can confidently assert that it won’t work. Most food carts stock sodas in 12-ounce cans and 20-ounce bottles, and on any reasonably warm and sticky day, a can won’t make a dent in your thirst, while a bottle is barely adequate. So if you can’t buy a 20-ounce container from the vendor, and there’s no bodega handy, you’ll buy two cans and end up drinking 24 ounces of death-dealing Dr Pepper instead of 20. Take that, health police!

Sarah Kliff, on the other hand, presents evidence that supports the left-liberal line on portion control.


Fri Jun 1, 2012 – 12:35pm:

Alex Koppelman’s uninspired defense of Bloomberg’s soda ban:

[T]he ban doesn’t have to work that well, or really at all, to be a success. Even if the ban does nothing but shift the discussion about what the government can do to protect the health of its citizens in his favor, Nanny Bloomberg will have won, and we’ll be better off for it.

Shorter Koppelman: Bloomberg’s ineffective government nannying will be a success if it leads to more ineffective government nannying. John Cole, like so many others, is against the ban:

Stupid, paternalistic, and completely unenforceable. My old platoon sergeant once told me that when it comes to keeping the guys in line, you never make a rule you won’t enforce, you never make a rule you can’t enforce, and you never make a rule you shouldn’t enforce. This new ban fails on at least the first two.

Bettina Elias Siegel, no fan of the soda industry, also disagrees with the ban:

[W]hile it’s true that Bloomberg’s other, similarly coercive health measure – the banning of smoking in restaurants – was controversial when announced but is now widely accepted, one key difference is that smoking in restaurants not only adversely affects the smoker, but also the non-smokers around him. With soda, though, there is no immediate harm to bystanders that might otherwise justify the proposal in the minds of many New Yorkers.


Wed Jun 6, 2012 – 7:57pm:

Bloomberg’s Health Hypocrisy

Will Saletan fumes:

To Bloomberg, it’s all in good fun. Shoving fat, salt, and white bread down your throat is a circus act, to be gawked at and celebrated on TV. But soda? That’s a health threat requiring government-enforced portion control. You can have it one way or the other, Mr. Mayor. You can preach moderation or the right to stuff yourself. But you can’t do both. The next orgy is four weeks away. We’ll be watching you.


Wed June 6, 2012 – 4:00pm:

Burke And Bloomberg, Sitting In A Tree?

Frum recently invoked the conservative giant’s skepticism of human reason in defense of his, er, support for Bloomberg’s soda-tax nannyism. Daniel Foster counters:

Burke’s greatest criticism of the French Revolution was that it sought to replace the “wisdom of nations, and of ages” with the vogue of few radical dilettantes. He reserved his greatest scorn for “sophisters, economists, and calculators” who sought to govern — to coerce — according to the latest intellectual fad or table of numbers. In other words, Burke would have hated Mike Bloomberg’s guts.

Yuval Levin steps back to make a broader point:

It is precisely when we make too much of the power of our reason that we also overemphasize man’s animality—coming to see ourselves merely as the only animal that knows it is merely an animal. Burke’s alternative was to emphasize the other not-simply-rational element of human nature, the sentimental intelligence that allows us to be the animal that is not merely an animal.

This kind of intelligence expresses itself not in explicit principles of government but in ways of living that have served human happiness for generations even if what justifies them cannot be fully articulated, and that is why Burke thought we could learn something (though not everything) from the forms and structures of our society’s life that we could not hope to learn from geometrical reasoning about politics alone. This is the “general bank and capital of nations, and of ages,” and it’s hard to see where in that bank we would find support for the notion that people’s access to sugary beverages beyond a certain size should be limited by their city’s mayor. On the contrary, the forms and structures of our society’s life suggest that a significant measure of personal liberty—even when it amounts to the freedom to harm oneself to some extent—is essential to our happiness.


Thu Jun 7, 2012 – 10:42am:

Bloomberg’s Health Hypocrisy, Ctd

A reader writes:

Saletan fumed: “You can have it one way or the other, Mr. Mayor. You can preach moderation or the right to stuff yourself. But you can’t do both.” Why not? I don’t support the soda ban, but there’s no contradiction between regulating ordinary people’s lives while allowing (or even promoting) a once-a-year public spectacle involving trained performers. It’s like calling laws against keeping tigers as pets hypocritical because Ringling Brothers comes to town every year, or arguing that street drag racing needs to be legalized in Florida because of the Daytona 500.

Another continues the “nanny state” thread from last week:

I’m a lifelong New Yorker and have a bit of a social libertarian streak in me. With that in mind, I’m OK with Bloomie’s Ban. Here’s my issue: People are fat.

People have no – and I mean NO – self control when it comes to this stuff (soda). People are going to buy soda; it’s that simple. The only way to keep them from becoming morbidly obese – which has negative impact on others, not in the same way smoking in public does, but through health care costs – is to limit the exploding portions of the past 30 years. I do understand the reservations of the “paternalistic” legislation, but sometimes, just sometimes, we need protection from ouselves.

Another:

What I haven’t seen in the soda defense is this: these enormous soda sizes are a very recent phenomenon, and they weren’t driven by consumer demand; they were driven by soda companies wanting more money. You can hardly find a 12oz soda anywhere these days, and that was the standard soda size for most of the 20th century. Buying a giant coke at a movie theater barely even qualifies as a conscious choice. I’d really like to hear a reasoned stance on why someone truly requires a 30oz Coke, because, like popcorn, most of it gets thrown out anyway. And what did they do at the movies in the decades before the giant cup’s invention? Was their thirst so unquenched that they went back for more? Somehow I doubt it.

If this were the banning of substance, I’d have fear for my liberties. But it’s not a ban on soda, just a ban on a particular type of convenience in certain places.

The Dish is with this reader:

This discussion really hits home. I have a degree in Public Health and have worked in the field for years, but I’m also a fervent believer in an individual’s right to sin, even if it drives up our insurance premiums. Obesity, along with smoking, drinking, and sex are all big risk factors for things like diabetes, lung cancer, liver cirrosis, HIV, and a whole lot of fun.

I sometimes get the feeling from some of my public health colleagues that they’d pass laws and run public service announcements against dancing and swearing if they could. Public health is filled with the same stock as the prohibitionists of an earlier era – generally upper-crust, well-meaning, hyperrational, and utterly uninterested in everyone else’s right to a good time.

Still, I’m a true believer in the importance of positive public health outcomes. Reducing obesity reduces suffering. It saves everyone a ton of money too. It’s the means to the end that piss me off, and the smug ethic behind them. I just can’t abide by laws that restrict a person’s right to a salty meal or a Super Big Gulp. I don’t think it’s especially effective public policy, and more importantly, it reeks of a patrician morality that goes against my every fiber as a free-thinking individual.

Instead of banning soft drinks, how about simply warning people of the real risks behind a 44 oz Sprite? How about a few celebrities getting on TV telling people that ordering a small is sexy? Or working on school curricula? Or a little guerrilla marketing? How about coming up with a clever pitch and putting it on a few billboards? There are any number of effective (even fun) alternatives to a blanket ban on big drinks.

Public health is mostly about behavior change, but the law is the crudest instrument for changing people’s minds. If New York wants to reduce obesity they should forget about City Hall and turn to Madison Avenue – the real behavior-change professionals.


Thu Jun 7 2012 8:09pm:

Bloomberg’s Health Hypocrisy, Ctd

Many readers keep the debate going:

Your reader with the degree in public health makes a very good point and then misapplies it. No one is trying to “restrict a person’s right to a salty meal or a Super Big Gulp.” This idea that Bloomberg’s ban has anything to do with individual’s rights is nonsense; the law is nothing more than a regulation of business practice.

Your reader recommends warning people not to buy big drinks, but I don’t see how that is any different. If the government can require a warning label on a dangerous product, that “infringes” my “liberty” to consume it without having to feel guilty about it. Warning labels and cup size restrictions are both merely inconveniences to the consumer in an attempt to make them more aware of what they are consuming, thereby promoting public health.

If you still want a salty meal, go out of your way to order extra fries or add more salt. If you need to drink more soda, buy two sodas. Right now my government prevents me entirely from consuming a harmless substance, marijuana; that is a real invasion of my liberty. I’ll be happy to see the day when were debating whether or not the government can restrict how many joints come in one pack.

Another writes:

I’ve loved reading the Dish on Bloomberg and soda, but I think that you’re neglecting the science behind his decision. The science shows that sugar is bad enough to warrant action, even that which seems nannyish. Sugar is a poison.

As your posts on nicotine pointed out, anything can be poisonous at certain levels. What’s the threshold for sugar? In the 1980s, the Department of Agriculture estimated it to be 40 pounds per person per year. Americans now consume over 90 pounds per year.

What are the consequences of this? Gary Taubes had an article in the Times Magazine last year in which he provided evidence that the increased consumption of sugar is responsible not only for the rise in obesity and diabetes, but also “heart disease, hypertension and many common cancers.”

Bloomberg’s is a tiny, cheap measure that may get people to limit the amount of dangerous poison they consume. That sort of limitation isn’t ridiculous when it comes to sugar, because nobody’s eating those 90 pounds in one sitting. And everyone you’ve quoted seems to think that the goal of the “ban” is to save from themselves adults who have chosen to drink soda despite its health risks. Nobody has brought up how this measure may affect lifetime eating habits in children.

Another:

I am amazed that nobody in the soda-ban debate is addressing the core issue. It’s not “freedom” vs. “government interference.” It’s what to do about the government interference WE ALREADY HAVE. For decades already, the US government has been promoting corn (high fructose corn syrup, animal feed) and cane sugar with direct subsidies and import tariffs. (See Michael Pollan’s excellent book, The Omnivore’s Dilemma.)

Another proposes the alternative:

I’m amazed at the capacity of such highly educated people, as your readers, to miss the simplest solution to this problem. Obesity is a negative externality. Governments have a legitimate role in addressing such externalities. Tax high-fructose corn syrup and sugar, the offending inputs, and let people choose a large water at 1/3 the price, if they are thirsty. Size of sodas will then regulate themselves. Any government in the US could use the revenue, as well.

Another:

Your reader wrote, “You can hardly find a 12oz soda anywhere these days, and that was the standard soda size for most of the 20th century.” Not even. Until the 1950s, the only size you could get a bottled coke was 6.5 ounces, half the size of a 12-ounce can, a third of a 20 ounce bottle and tenth of a half-liter. The largest size you could get in the ’50s was 26 ounces, but this was seen as a family size – an alternative to bringing home a six-pack of the little bottles. Now, with 20, 24 and 33 (half litre) bottles of soda, it’s about a single serving.

I think an underlying problem is that the profit margins go up for larger sizes. The cost for the syrup is negligible; even for big bottles it’s pennies. For a couple extra pennies for a bigger bottle (if that) Coke can charge 50¢ more. And for fountain drinks, where they don’t have to distribute the end product (there aren’t really economies of scale hauling around bigger bottles) the extra cost for a Big Gulp is almost negligible, which is why prices are often only a few cents higher – the few cents are all profit.

Another sees change in the other direction:

I haven’t seen this covered yet: the soda companies are currently experimenting with bloombergsmaller size containers. I love my Diet Dr. Pepper, but 20 oz. a pop is really a bit too much in terms of caffeine and fizz-bloat. Lately, I’ve been seeing 16 oz and even 12 oz plastic bottles at select locations in my neighborhood convenience stores. I’m so happy about it I will just walk out of a store if they don’t have anything smaller than the giant 20 oz bottles. And if I get the chance I will tell the clerk why I left, doing my best to express the market demand for smaller serving size.

But unlike political structures, there’s no check or balance on the demand by the public for bigger soda sizes. It may be that a lower price point on a 16 oz soda will popularize the smaller size. I hope so. Because I think I’m very much in the minority on this issue. I am the 12% (body fat, that is).


Fri Jun 8, 2012 – 10:53am:

Are Large Sugary Drinks Food?

Mark Bittman issues a ringing endorsement of the soda ban:

They are not food. Added sugar, as will be obvious when we look back in 20 or 50 years, is the tobacco of the 21st century. (The time frame will depend on how many decent public health officials we manage to put in office, and how hard we’re willing to fight Big Food.) And if you believe that limiting our “right” to purchase soda is a slippery slope, one that will lead to defining which foods are nutritious and which aren’t — and which ones government funds should be used to subsidize and which they shouldn’t — you’re right. It’s the beginning of better public health policy, policy that is good for the health of our citizenry.

Shani Hilton doubts the ban will change much:

Obviously what should be happening here is a federal move to end sugar subsidies. If Bittman wants to argue against added sugar in food—which he does effectively—then it’s silly to neglect the point that sugar is cheap because the government makes it cheap. Make it expensive and people will consume less.

Earlier Dish on Bloomberg’s misguided paternalism here, here, here, and here.


Wed Jun 13, 3:18pm:

The Left’s Prohibition Problem

Jack Meserve identifies it:

[T]hink of a few of the currently illegal vices: recreational drug use, gambling, prostitution. With some exceptions, the left has been in favor of legalization or decriminalization of these activities. Now think of legal vices: gluttony, cigarette smoking, alcohol use. On these habits, we’ve supported bans, onerous restrictions on place and time of consumption, and increasingly aggressive fines and taxes. There seems very little consistency between these positions, and few have even attempted justifying the differences. Progressives have been guilty of letting our temperament rather than our reason guide the policies; bans on activities like drug use are seen as naive or old-fashioned, but legal vices like cigarette smoking are public-health or collective-action problems to be solved through brute government action.

He thinks a form of “cultural elitism” is to blame:

Someone who buys a 20-ounce, 330-calorie Starbucks cinnamon dolce latte is viewed differently than someone buying a 20-ounce, 290-calorie Mountain Dew from McDonald’s. The latte would be allowed under Bloomberg’s ban, the Mountain Dew not. Similarly, marijuana smoking has a cultural cachet that cigarettes have lost. In fact teenagers now smoke pot more than they smoke cigarettes.


Thu Jun 14, 2012 – 7:17pm:

Curtailing Soda Won’t Make Us Skinny

In response to Bloomberg’s soda ban, Aaron Carroll calls for “a holistic approach to obesity.” He argues that even less draconian policies, such as soda taxes, won’t work:

We’d need a pretty high tax [on soda] to make a difference. A recent study showed that it would take a tax on soda of more than 16% to reduce the caloric intake from them by 100 calories per day. But that same study found that almost all of the calories saved from reduced soda intake would likely be replaced by increased calories from other foods and drinks. That’s borne out in research. Partial fixes don’t work. If you ban sugar-sweetened beverages in school, kids will just drink more when they’re not in school.


Thu Aug 2, 2012 – 6:52pm:

Nanny State Watch

First soda, now baby formula:

Mayor Bloomberg is pushing hospitals to hide their baby formula behind locked doors so more new mothers will breast-feed. Starting Sept. 3, the city will keep tabs on the number of bottles that participating hospitals stock and use — the most restrictive pro-breast-milk program in the nation. Under the city Health Department’s voluntary Latch On NYC initiative, 27 of the city’s 40 hospitals have also agreed to give up swag bags sporting formula-company logos, toss out formula-branded tchotchkes like lanyards and mugs, and document a medical reason for every bottle that a newborn receives.

Over to you, Hanna:

The question here is not whether breastfeeding is better or worse, we can all agree that breastfeeding infants is somewhat better than not breastfeeding them. The question is, as I have written many times before, that we do not want to feed into a culture that has made the failure or lack of desire to breastfeed seem like a shameful and even criminal affair. By the statistical odds, that woman those nurses are talking down to at the hospital probably has to go back to work in less than a month. … Take away infant formula and the millions of women who fuel our economy would no longer be able to work, because American employers are certainly not going to pay them to stay home and breastfeed.

Gayle Tzemach Lemmon lays out more reasons a mother might prefer formula:

Some cannot breastfeed because they must take anti-depressants or other medications that prevent healthy breastfeeding. Several women I know simply could not make breastfeeding work because a battering of infections and their body’s inability to produce sufficient milk made it both painful and unworkable. Others insisted on breastfeeding, only to find that they could not give their baby enough milk to help them put on weight and grow.

But that is not the point. … The real reason the Gotham policy is so objectionable is it infantilizes women by telling them they are no longer adult enough to decide for themselves what is best for their families and themselves. It is strange. Somehow we have reached a point where people who speak angrily of the “war on women” when it comes to family planning do not hesitate to exercise suffocation of choice when it comes to breastfeeding.

If you missed Hanna Rosin’s 2009 Atlantic cover-story, “The Case Against Breast-feeding,” it’s here.


Fri Aug 3, 2012 – 1:26pm:

Bloomberg Knows Breast?

Readers respond to the latest paternalism from New York’s mayor:

I take issue with the comparison you’re drawing between this ban and the soda ban. First of all, the “ban” on the bottle is not really a ban at all. It’s more like the “behind-the-counter” standard set for Pseudoephedrine – the mother still has access to it but has to ask for it. The really objectionable part is the speech that hospital workers are required to give women who opt for formula.

Another writes:

I am a lactation consultant. Believe me, my job is to know the problems breastfeeding moms and babies face.

One of the biggest problems is incorrect information such as that given by Gayle Tzemach Lemmon. Eighty percent of medications, including most antidepressants, are compatible with breastfeeding. Most breast infections and low milk supplies are caused by early breastfeeding mismanagement. Our health care system is a big part of the problem. It is very difficult and often expensive for new moms to get adequate breastfeeding information, help, and support.

So this ban is not about forcing women to breastfeed but a small step in helping women meet their own goals. If a new mother does not want to breastfeed, the hospital will still give the baby formula while there. It just won’t send her home with free formula or bags. Formula companies spend big money to cozy up to doctors, nurses, and new parents in order to undermine breastfeeding and to get babies drinking their brand of formula in the hospital because they know whatever formula is started in the hospital is the one most parents will stick with at home. This ban is purely about restricting marketing to a vulnerable population.

Another:

To understand the baby formula rule change, it helps to understand how entrenched the formula companies are in hospitals now. My wife gave birth five years ago and three years ago in a New York hospital. Each time, less than an hour after giving birth, we were presented with a backpack stitched with a formula company’s name, two cans of the stuff, branded bottles, and other supposed goodies. We told the nurse we didn’t want the materials, and she responded that they were required to give it to us. (We gave it to the couple in the next room, who wanted to formula-feed).

As I read the article, “hospitals have agreed” to stop forcing such advertisements and products on new mothers, and those who ask for formula will still get it. Of course, some nurses could turn into scolds, but my suspicion is that most will not want to spend all day lecturing patients, and will bring formula to those who want it. The difference between the baby formula rules and the soda ban is that big sodas were in fact banned – this rule mainly keeps people from being forced to accept a bunch of plastic crap with a formula company’s name on it.


Fri Aug 3, 2012 3:54pm:

Bloomberg Knows Breast? Ctd

Many readers are offering personal perspectives on the political debate:

This is an issue that really irks me. My wife and I just had our first child – a beautiful baby girl. My wife was intent on breast feeding, but our daughter simply refused to latch properly. After a long labor and a somewhat harrowing C-section, my wife had to endure painful lacerations on both nipples as she desperately tried to get our daughter to eat. The physical pain was bad enough, but it was compounded by the psychological trauma of feeling like an inadequate mother. Luckily, our daughter eventually figured it out, but if weren’t for formula, I don’t now how we’d have made it through those first weeks.

I have nothing but contempt for breast feeding zealots like Bloomberg. Their sanctimony is bad enough in the private sphere (and trust me, they are some of the most holier-than-thou people you will ever meet). But using the power of the state in a matter as personal as how a woman chooses to feed her newborn child is reprehensible.

Another asks:

And is Bloomberg going to create laws which give women 12 months of paid maternity leave (like our neighbor to the north) so that they can have the time, energy, and food and housing security to breastfeed their babies?

Another reader:

Years ago a mother came in with her son for the first postpartum visit. She announced, “I have decided to breastfeed.” I immediately replied, “No, you are not. You have gone 3 months since diagnosis without chemo or radiation. You will start them now. Your son needs to have a live mother more than he needs breast milk.” She was being harassed by people who didn’t know her cancer diagnosis about her shortcomings as a mother because she wasn’t breastfeeding! She listened to me and is alive today.

In the ’80s there was a cartoon strip. Cathy and her friend were walking, exchanging mutual admiration about what excellent friends they were, how tolerant and affectionate they were, etc. The friend raises her arm to wave to a friend in the distance pushing a stroller. Cathy knocks her hand down. “We’re not speaking to her, she’s bottle feeding.”

Breastfeeding is wonderful, but it is not Holy Communion. It is a wonderful way to feed a baby. But as long as women have medical problems and a need to return to a hostile work environment, there will be a need for baby formula. In the end, it is about feeding the baby, not about proving what a wonderful person you are.

Another:

Honest to god, who knew a choice like this was so fraught? How many times have I seen moms reduced to tears arguing over a Time magazine article? What is it about the human condition that compels us to judge others over personal parental preferences? Conversely, why are people so unsure of their choices that the judgement of random people in the park sends them into a defensive, existentially assaulted posture? I ask these questions without prejudice – maybe I’m just a man and too inexperienced a father to get it.

Another:

I loved breastfeeding. I thought it much, much easier than the endless bottle washing, etc. Diapers are hard enough. What made it easier for me was being able to take my child to work with me. When I went out and about, or traveled, I sat cross-legged on bathroom floors to feed him, with a blanket over us. That way, we didn’t disturb anyone.

What is needed in our society is more flexibility so that mothers can take their babies to work with them (or more “working from home” options). That, and more public areas for breastfeeding that provide some privacy. If people want to promote breastfeeding they should say that it is also one of the easiest ways to lose weight that can be imagined. After I gave birth I just cut out sweet snacks, ate the normal three meals a day, and all of the baby weight plus the flab from before fell right off. (Of course I was awake night and day for the first four months.) It’s the thinnest I’ve ever been since I was twelve.

Another:

When my wife had our child, she tried for a while, but was unable to produce enough milk for him. We were happy that we had formula available. However, we hated the whole issue around feeding our son. Everyone, from the floor nurses to the lactation consultants to the cleaning lady, constantly and firmly implied that, while we could make our own choices, the only option that really was good for our son was breastfeeding. It was pervasive, it was belligerent, and by the end it felt collectively abusive.

And while they were laying on the massive guilt trip, every fucking piece of anything baby related that they gave us (and they give you so. much. junk.) had a formula ad on it, or literature from a formula company, or both. It was like they were being paid off by the formula producers to put an ad in our hands every 10 minutes.

The mixed messages were astounding, and they came in at the least sane, most sleep-deprived point of our lives. Right when you need compassionate advice from someone you can trust, you have almost vicious voices telling you what you are doing wrong (and will hurt your baby forever!!!) and what you need to do right (which may be physically impossible) and what to absolutely not do, while giving you free samples and limitless ads and coupons for the thing they tell you not to do.

Bloomberg is an ass who wants to control people, and goes about everything the wrong way. But the way it works now is broken. I don’t want his solution, but anyone with compassion for new mothers needs to know that a change is needed.


Wed Aug 8, 2012 – 4:00pm:

Bloomberg Knows Breast? Ctd

by Chris Bodenner

Remaining thoughts from readers on the baby formula debate:

God knows I wasn’t going to comment, but I can’t help myself. Bloomberg is an ass. Sorry. I breastfed all three of my children – my 3rd one, due to a dairy allergy, until she was 13 months old. This won’t be a popular reaction, but I hated it. I did it because there was so much pressure on moms to breastfeed. With my 2nd child, I didn’t produce enough milk. I sat and wept in the pediatrician’s office when they weighed my baby and she had lost weight. I felt like a total failure. I went to a private lactation consultant. She told me to drink some special tea, get in bed with my daughter for 24 hours and nurse around the clock. She still wasn’t gaining enough weight. Our pediatrician told me to supplement with formula. Reluctantly, I did, but I felt so inadequate. With my 3rd, she refused a bottle so I nursed her exclusively until she was 13 months and we could transition her to rice milk due to her allergy.

Some women love breastfeeding and it’s obviously healthier, but we need to stop with all the guilt. And those terrible swag bags give free samples and coupons that families need. Formula is really expensive. It’s one of the top grocery items shoplifted. And Bloomberg, who is pro-choice, should be an advocate of women choosing how we use our bodies.

Another tempers such reactions:

Many of your readers have been mislead as to the true nature of the “Latch on NYC” breastfeeding choice initiative. The greatest myth is that the initiative is mandatory; it is entirely voluntary on the part of all hospitals.

Furthermore, there is absolutely no requirement that hospitals keep commercial baby formula under lock and key. The initative does limit access to formula by hospital staff, in the same way many hospital medications and supplements may not be accessed unless specifically approved my physicians and medical supervisors. A major reason for this limitation is due to the high incidences of breastfed infants being given supplemental formula feedings by hospital staff – against current medical policies and often without the approval of the parent(s). The initiative specifically states that formula should be made available to those who make an informed decision not to breastfeed.

There is no need to rehash the economic and health benefits of breastfeeding, as they are proven beyond a doubt. Yes, there are women who can not or do not wish to breastfeed, and the Latch On initiative respects the rights of these women. It’s the hospital that has no business – particularly without the express permission of the mother and her medical care givers – to promote the use of commercial products for its own convenience and possible financial advantage.

On the other hand, a reader details how expensive, and painful, breastfeeding can be for some mothers:

Before you attempt to do it, breastfeeding sounds easy: Step 1: Attach infant to breast; Step 2: Feed. At least that is what I thought before I had my baby. In reality there is a lot more that goes into it. You have to get the baby to latch on properly or else you will end up in excruciating pain (i.e. sore, bloody nipples). Even if you get a good latch from the start, you will still experience a lot of soreness, and so for a period of a few weeks even wearing a shirt can be uncomfortable. Also, just working on getting the latch and doing it right takes a lot of practice and can take a lot of time each time you go to feed your baby.

Then feeding your baby itself takes a lot of time. How much? For a newborn (a baby up to 3 months), you are generally feeding on demand which means every 3 hours. Doesn’t sound like that much, till you think that means 8 times a day (24 hour period) and takes 45 – 60 minutes each time. That is up to 8 hours of breast feeding a day. It gets faster and more efficient (I am told) as you go along, but if you have to go back to work after 6 weeks, and you are exclusively breast feeding, that is a lot of time – with baby, with your pump, and worrying about your supply (the less time you are feeding baby, the more likely you get a drop in milk supply as a pump is not as efficient as a baby).

My plan – as an older, yuppie, blue state city dweller, white collar professional, first time mom – was to breast feed exclusively for a year in accordance with the American Academy of Pediatrics recommendation. When reality got in the way, I managed to breast feed exclusively for a grand total of nine days – in which time my son gained half an ounce in total (when he should have been gaining an ounce a day and gotten back to and exceeded his birth weight), and I had bloody nipples, shooting pains through my chest, and a continual burning sensation on my nipples. Over the course of the next three months, I consulted with three different lactation consultants ($100 – $250/visit); started mainlining herbs and tinctures meant to increase milk production (~ $15 – $25/container); rented a hospital grade (more powerful) breast pump ($75/month + special tubes/attachments/bottles $60, and had to be replaced monthly) in addition to my standard commercial pump I had bought prior to baby’s arrival because i knew I would have to pump when I went back to work (~$250), bottles/storage for the pumped milk (~$50 – $75).

The burning sensation never really dissipated. My son spit up my blood on several occasions after nursing. Neither of us ever enjoyed it. It was a tense, stressful, painful and uncomfortable. And every day, I felt like a failure, someone who couldn’t even perform this most basic task of mothering: properly nourishing her child. We soldiered on like this for 3.5 months – supplementing with formula (which at first I really resisted because of this concept that formula is poison), because despite my efforts, I still couldn’t produce enough milk to keep up with him.

Before I went back to work, my husband and I decided that I would stop. The time involved for diminishing returns (5 oz of milk daily for a child consuming nearly 30 oz daily) coupled with the extreme emotional toll on me made it the right choice, especially when having to head back to work. Even with all the resources, money, time, help and support I had, it just didn’t work out for us. I cannot imagine what it would be like if you were strapped for cash, had minimal maternity leave, and didn’t have family support.

Another offers a glimpse of those mothers who lack support:

I was speaking to my wife about this issue and wanted to share her input. She is a dietitian in NYC who’s had some experience working in lower-income communities:

“I really think people are over-reacting to this. The initiative doesn’t block anyone from using formula – it just more appropriately regulates distributing it in the hospital. The people it will affect (poor, uneducated women) are the women who historically have had cultural practices that make them less likely to be successful breastfeeding and who may not have had enough (or any) education about breastfeeding to understand how to do it. When I worked with WIC, I learned that a lot of Latin cultures (in particular) have a mindset about breastfeeding that trails affluent/white populations by about 20 years, that breastfeeding is hard work and if you are successful and have enough money, you should use formula because it is easier/better/a sign to the community that you can afford it. That opinion used to be commonplace in the 1950s-70s and it was a huge barrier.

The people who are so outraged about Bloomberg’s initiative are the people who know that breastfeeding is better, understand that it is hard work, and have received education or have done their own research. But they are also the ones who can afford formula if they want to use it and have access to good doctors and lactation consultants and largely won’t have problems feeding their babies. But the point is that ALL women who deliver in a hospital shouldn’t just be given formula in their gift bag – it is a leftover from that mindset of the 1950s that formula feeding is what you should be doing. It sends a message to new moms who are having trouble breastfeeding in the beginning that they should just formula feed instead. And once a baby gets used to the bottle, it makes it MUCH harder to get it to latch back on to the breast AND it keeps the mom from making enough milk (because you need the constant stimulation of the baby feeding to build up the supply.)

So now instead of just handing formula to every mom leaving the hospital, nurses have to sign it out like medication and document why they are giving it out. That doesn’t hurt anyone. And it saves money for the hospital. So it should reduce healthcare costs a little. Wow, what a concept.”