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Who pays for your free lunch?

May 2021

When health care workers accept education, gifts, or promotional materials from the infant feeding industry, the cost isn’t borne by the health care worker or the company: the cost is, very directly, passed along to the families for whom they care.

 question mark

In last week’s blog, I used an illustrative example of the cost of ready-to-feed infant formula for a family encouraged to use this commercial product instead of breastfeeding. It makes for a neat short illustration, but if you wondered whether it really measures the likely reality, that is a fair thought. Where breastfeeding is not possible, regardless of the reason, and donated milk is not available, an infant will need human milk substitutes for at least six months.

Wouldn’t giving away infant formula that’s safe and free prevent more harm to the families who use the products, but can’t afford them? This seems logical, but remember that samples are sales inducements, not a secure supply. The straight cost of infant formula and related equipment, even without taking into account the costs of health care, absences due to illness, and other indirect costs, is substantial.

What’s not always obvious is how much the marketing of the products themselves adds to the cost to families - and how specifically marketing of premium brands through the health care system increases those costs. Generic and store brand products take advantage of existing consumer demand for a product, at a lower price. These brands use typically sales incentives such as samples, coupons, and giveaways much less than premium brands, who typically hold the contracts to supply health care systems. Premium products, which may still be marketed at different prices within a particular brand, are not superior in any objective way but are priced as though they are.

Do you want to see how? Let’s try another example - this time looking at the price difference between a premium brand and a store brand for the most common form of infant formula.


Generic Brand

Premium Brand

Cost per 30ml (1fl oz)



Daily cost (720ml/24 fl oz)



Cost difference over 6 months: $969.00


The cost difference above isn’t the difference between breastfeeding and formula feeding for 6 months: it is the price a family pays for successful marketing. The products involved are equivalent in every way and both are approved as breastmilk substitutes from birth to 12 months. The only practical difference is that a family who relies on the premium brand will spend more money to feed their baby.

Given how much influence health care providers have on brand selection and how heavily the premium brands market through the health care system, there is an urgent ethical responsibility on the part of health care professionals to avoid promoting brands, even to parents and caregivers who have a need for the product.

Health care providers who receive education, grants, or product donations from the infant feeding industry are in a conflict of interest, not with breastfeeding promotion, but the health and well-being of the families they care for, regardless of how those families feed their babies. It’s far past time that we stop allowing the narrative that the Code and the Baby-Friendly Initiative only protects breastfeeding families to the detriment of those who don’t breastfeed.

Michelle Pensa Branco MPH IBCLC
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This Privacy Policy describes how your personal information is collected, used, and shared when you visit or make a purchase from https://step2education.com (the "Site").


When you visit the Site, we automatically collect certain information about your device, including information about your web browser, IP address, time zone, and some of the cookies that are installed on your device. Additionally, as you browse the Site, we collect information about the individual web pages or products that you view, what websites or search terms referred you to the Site, and information about how you interact with the Site. We refer to this automatically-collected information as Device Information."

We collect Device Information using the following technologies:

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Additionally when you make a purchase or attempt to make a purchase through the Site, we collect certain information from you, including your name, billing address, shipping address, payment information (including credit card numbers), email address, and phone number. We refer to this information as "Order Information."

  • Users who are undertaking a course as part of a group or organization have certain data tracked as part of the service we provide to Clients and Facilitators. This includes information showing if you have logged in and when, dates of completion and what and when particular study topics, resources and assessments were viewed and completed. We refer to this information as "Student Access Information"

When we talk about "Personal Information" in this Privacy Policy, we are talking about Device Information, Order Information and Student Access Information.


We use the Order Information that we collect generally to fulfill any orders placed through the Site (including processing your payment information, arranging for shipping, and providing you with invoices and/or order confirmations). Additionally, we use this Order Information to:

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We use Student Access Information to provide accurate tracking to Users and Clients on completion and use of the courses, as well as for analysis on how to improve our services.

We use the Device Information that we collect to help us screen for potential risk and fraud (in particular, your IP address), and more generally to improve and optimize our Site (for example, by generating analytics about how our customers browse and interact with the Site, and to assess the success of our marketing and advertising campaigns).


We share your Personal Information with third parties to help us use your Personal Information, as described above. For example, with your employer who needs to verify your completion or progress of your studies. We also use Google Analytics to help us understand how our customers use the Site--you can read more about how Google uses your Personal Information here: https://www.google.com/intl/en/policies/privacy/. You can also opt-out of Google Analytics here: https://tools.google.com/dlpage/gaoptout.

Finally, we may also share your Personal Information to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect our rights.


As described above, we use your Personal Information to provide you with targeted advertisements or marketing communications we believe may be of interest to you. For more information about how targeted advertising works, you can visit the Network Advertising Initiative's ("NAI") educational page at https://www.networkadvertising.org/understanding-online-advertising/how-does-it-work.

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Please note that we do not alter our Site's data collection and use practices when we see a Do Not Track signal from your browser.


If you are a European resident, you have the right to access personal information we hold about you and to ask that your personal information be corrected, updated, or deleted. If you would like to exercise this right, please contact us through the contact information below.

Additionally, if you are a European resident we note that we are processing your information in order to fulfill contracts we might have with you (for example if you make an order through the Site), or otherwise to pursue our legitimate business interests listed above. Additionally, please note that your information will be transferred outside of Europe, including to Canada and the United States.


When you place an order through the Site, we will maintain your Order Information and Student Access Information for our records unless and until you ask us to delete this information. We are required to keep course completion records for at least 5 years in order to comply with certain accreditation requirements.


We may update this privacy policy from time to time in order to reflect, for example, changes to our practices or for other operational, legal or regulatory reasons.


For more information about our privacy practices, if you have questions, or if you would like to make a complaint, please contact us by e-mail at info@step2education.com or by mail using the details provided below:

5890 Monkland Avenue, #16, Montreal, QC, H4A 1G2, Canada

Last Updated: September 2018