“Baby-Friendly Hungary”- The La Leche League, Baby Formula Companies, and Postnatal Care in Post-Communist Hungary

Alison Langley reflects on how the La Leche League fought an outdated medical system and the lobbying power of baby formula companies in early 1990s Hungary.

It’s impossible to overstate the shock I felt when the voice on the other end identified himself as a Milupa baby formula representative. Immediately my jaw locked and my body tensed while I waited to hear why he had called. I didn’t even sit down for the conversation, standing instead frozen next to the phone in the living room.

It was 1993, and Milupa, Wander, Nestlé, and other baby formula companies weren’t reaching their sales goals. I was one of the reasons why. Milupa Man—his actual name escaped me—claimed he wanted to discuss “collaboration,” but I knew what he really wanted: to corrupt me. A movement I helped start in Hungary three years earlier had reduced infant mortality and childhood illnesses like gastrointestinal infections, ear infections, and colds. Babies were healthier—and that was bad for Milupa Man’s bottom line.

I hadn’t planned any of this. It began with a simple idea: I wanted to connect with other mothers who shared my parenting philosophy. When I was pregnant with my first child in Switzerland, my birthing preparation coach, Christine Prager-Hurst, had instilled in me the importance of breastfeeding.

At that time, bottle-feeding was the norm, even in wealthy Western countries, and preventable illnesses in newborns and infants were on the rise. Christine’s message—that “breast is best”—made perfect sense. Breastfeeding provides tailored nutrition, boosts immunity, and reduces the risk of infections and chronic diseases for babies. For mothers, it speeds recovery, lowers cancer risks, and reduces postpartum complications. Christine was one of the founders of La Leche League (LLL) in Switzerland, and her passion for breastfeeding lit a fire in me.

Through LLL, I found a network of mothers with similar parenting philosophies. We wore our babies, co-slept, breastfed on demand, and let our children lead the weaning process. These practices were healthy and cost almost nothing—no cribs, strollers, bottles, or formula to buy—which made us subversive to corporations. Our babies were thriving, and we were a problem for the market.

When I moved to Hungary in 1990, I brought that philosophy with me. Newly certified as an LLL leader, I started a mothers’ group in Budapest. It grew quickly. Hungarian mothers, many of whom had been raised under a Soviet-style medical system, were hungry for up-to-date, scientifically backed information about infant care. Anikó Ágoston and Bianca Martinovichné, two remarkable Hungarian women, became the first certified LLL leaders in Hungary, starting their own groups to spread this knowledge.

At the same time, UNICEF and WHO were taking a closer look at maternal and infant health in post-communist countries. In 1991, I got a call from Elizabeth Hormann, a lactation consultant working for WHO. She asked if I could help organise a fact-finding tour of Hungarian hospitals. The data was grim: Hungary had some of the highest infant mortality and gastrointestinal illness rates in the region, and maternal suicide rates were alarmingly high.

Hospitals were clean and efficient, but the practices were brutal by modern standards. Mothers gave birth in sterile rooms, their legs strapped into leather slings, and were then wheeled into shared wards while their babies were placed in distant nurseries. Feeding was regimented: every four hours, babies were brought in for precisely 15 minutes on each breast, whether they were asleep or hysterically crying. No one guided mothers on latching or addressed sore nipples. Upon discharge, women received baskets filled with formula samples, bottles, and pacifiers—despite WHO’s International Code of Marketing of Breastmilk Substitutes banning such practices.

Hungary’s saving grace was its network of védönö, wellness nurses who visited mothers at home. But even this system was hampered by outdated Soviet-era manuals filled with advice that often did more harm than good. With modest funding from WHO and UNICEF, Elizabeth and her colleague Diedre organized a week-long training for védőnős and medical professionals. My role was to find English-speaking nurses and secure a space for the event. Initially, we planned to train 30 nurses, but the interest was so overwhelming that we moved to Semmelweis Hospital to accommodate 50 attendees, including doctors and hospital staff.

Elizabeth and Diedre delivered lectures on the anatomy and physiology of breastfeeding—knowledge new to nearly everyone in the room. They taught how breastmilk changes throughout the day and adapts to a baby’s needs, the benefits of colostrum, and techniques for encouraging successful breastfeeding. Participants shared their own struggles and triumphs, often blurring the line between professional and personal.

Out of this training emerged a determined group of leaders, including a védőnő named Mónika, who translated hundreds of pages of breastfeeding resources into Hungarian. Her work laid the foundation for rewriting the védőnő manual. Everyone involved worked unpaid, driven by a shared belief in the cause.

The training also planted the seed for an extraordinary transformation in Debrecen, a city with one of Hungary’s highest infant mortality rates. Dr. Borbála Ádám, a doctor from the local hospital, attended the workshop and resolved to turn her hospital into the world’s first Baby-Friendly Hospital. Against incredible odds, and with almost no budget, she succeeded.

Dr. Ádám’s team reimagined maternity care. Mothers and babies roomed together. Kangaroo care—skin-to-skin contact—was introduced, even for premature infants. Instead of receiving free formula samples, mothers were taught how to breastfeed confidently. The results were extraordinary: infant mortality rates dropped, gastrointestinal illnesses declined, and postpartum depression decreased.

In 1992, Debrecen Hospital became one of the first in the world to receive a Baby-Friendly Hospital designation. Improvements in infant health were immediate. The hospital saw drops in infant mortality and improvements in maternal health, contributing to Hungary’s overall IMR falling from 15.6 in 1990 to around 11–12 by 1994. Babies’ and mothers’ lives were saved almost overnight and on a shoestring budget.

Within six years, 19 hospitals in Hungary achieved the same status. The lives of women and babies improved. This was bad news for the Western formula companies flooding into the newly opened Central and Eastern European markets. For the first time since World War II, giants like Milupa, Wander, Johnson & Johnson, Gerber, and Nestlé saw an opportunity to expand in Europe.

The Milupa man who phoned me was concerned Hungary wouldn’t be profitable for him, and he was in charge of that region. I’m guessing his job—or at least his year-end bonus—was on the line. He called to see if we could collaborate. I blew him off. What could Milupa possibly offer that would benefit women and children, I asked him. He weakly suggested the "six-month formula." I scoffed and signed off. I’m ashamed to admit I was probably a little haughty.

But I shouldn’t have been, because he got the last laugh. Hungary in the 1990s was under severe economic distress. Without exaggeration, every institution needed an overhaul—schools and hospitals were crumbling (and still are). Not just the buildings, but also the care being provided. In the end, Milupa and other formula companies offered hospitals desperately needed funds for renovations. Debrecen was one of the hospitals that took the money. To accept the funds, hospital administrators had to agree to renovate the birthing wards according to formula company-funded designs. These included separate rooms for mothers and newborns, often a long corridor apart. The hospitals also accepted formula at favourable rates in obstetrics and reinstated free samples for new mothers.

The WHO International Code of Marketing of Breastmilk Substitutes explicitly warns against the marketing practices of formula companies that undermine breastfeeding. Studies have shown that they undermine breastfeeding promotion efforts, shifting culture toward formula instead of breastfeeding. Dr. Ádám’s progressive approach to maternal care and her commitment to breastfeeding advocacy led to her eventual dismissal, likely due to the growing influence of the formula industry and the political climate at the time.

Meanwhile, the renovations that separated mothers from their babies took place. In addition, the heads of obstetrics in Hungarian hospitals were sent to conferences in Western countries—paid for by Milupa, Nestlé, Wander, and other formula companies. Their attendance at these events during the 1990s, and the lavish nature of these trips, are well documented and paint a clear picture of the relationship between the formula industry and the healthcare system.

Currently, no hospital in Hungary holds a Baby-Friendly designation. Breastfeeding rates have fallen since 1998, and they are the lowest in Hungary in the region. The country also has one of the highest caesarean rates in Europe. Both maternal and infant mortality rates have stagnated or risen, ticking upward in recent years. The number of babies and mothers dying in Hungarian hospitals is high. But Milupa man and the hospital administrators did quite well for themselves.

In 2011, sixteen La Leche League groups helped 6,000 Hungarian women. When Viktor Orbán’s government made it difficult for NGOs to accept funding from outside the country, those funds were cut off. LLL Magyarország continues, and now lists just three groups in Budapest and Sopron on its website.

Until her death, Dr. Ádám ran a private practice as a lactation consultant.

Alison Langley is a writer. Her first novel, Budapest Noir: Ilona Gets a Phone, was published by Dedalus Books in 2024. Previously, Langley was a foreign correspondent with extensive experience covering events across Europe for publications like The Guardian, New York Times, Dow Jones News Wires and Deutsche Welle. From 1990 to 1994, Langley freelanced for the Wall Street Journal Europe in Budapest.