A call to reinvigorate the International Code Of Marketing Of Breastmilk Substitutes

Last month marked the 39th anniversary of the World Health Organization (WHO) International Code Of Marketing Of Breastmilk Substitutes. As the World Alliance for Breastfeeding Action (WABA) reminds us,  “Following the adoption of the Code in 1981, governments have been called upon by the World Health Assembly to give effect to the provisions in the Code through national legislation. So far, UNICEF/ World Health Organization (WHO)/ #IBFAN have identified 136 countries as having Code regulations in place.”

Photo by Andre Adjahoe on Unsplash

You might know that the U.S. is not one of these nations. 

In a timely offering– when formula companies use the crises of the pandemic to prey on mothers and babies– The Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly Resolutions (#NetCode) has developed a toolkit to reinvigorate and reinforce ongoing monitoring and periodic assessment of the Code and national laws. The toolkit offers health advocates an opportunity to connect with governments to establish a sustainable system that will monitor, detect and report violations of national laws. Find it here: https://waba.org.my/netcode-toolkit-for-ongoing-monitoring-and-periodic-assessment-of-the-code/?fbclid=IwAR2PzeROMctrsCJ3ZiG8gah07IXQMhI-3eSn6EqLDhV3-TdGhhmk-IxDzt4

“Formula manufacturers are exploiting the panic and fears of contagion to intensify their aggressive marketing practices,” Patti Rundall writes in the Baby Milk Action policy blog. “In this context, government action to regulate the marketing of breast-milk substitutes has never been greater.”

On May 28, the World Health Organization (WHO), UNICEF, and the International Baby Food Action Network (IBFAN) launched the virtual 2020 Status Report which highlights which countries have implemented measures required by the Code. [The official launch event can be viewed here.]

Photo by Kelly Sikkema on Unsplash

“Given the important role of health workers in protecting pregnant women, mothers and their infants from inappropriate promotion of breast-milk substitutes, the 2020 report provides an extensive analysis of legal measures taken to prohibit promotion to health workers and in health facilities,” Thahira Shireen Mustafa, Department of Nutrition and Food Safety, writes. 

In the U.S. in late March, Baby-Friendly USA released a statement detailing access to adequate nutrition for babies born during the Covid-19 crisis with an announcement explaining that BFUSA  would relax one standard regarding the provision of small quantities of formula upon discharge to formula feeding families in communities experiencing shortages in retail outlets. 

“We did so to ensure that formula feeding families receive essential support during this global emergency,” BFUSA CEO Trish MacEnroe writes. “We did NOT loosen restrictions on interactions with formula companies.”

MacEnroe goes on to write, “Regrettably, some formula companies have interpreted our statement as a window of opportunity to reengage their aggressive marketing tactics with Baby-Friendly designated hospitals… 

“We at BFUSA are appalled that these companies would use the pandemic as an ‘opportunity’ to advance their business interests under the guise of an intent to support facilities during this difficult time.

So, please let us be perfectly clear: Our standards are still our standards. We have not ‘loosened’ our guidelines and we still expect Baby-Friendly designated facilities to shield health care workers, mothers and families from commercial influence, as outlined in the International Code of Marketing Breast-Milk Substitutes.”

Photo by Luiza Braun on Unsplash

In other parts of the world too, companies exploit the Covid-19 crisis. Baby Milk Action documents how one company violates Indian Law with their YouTube channel. Keep scrolling and scrolling and scrolling on Baby Milk Action’s page and you’ll find offense after offense after offense documented in multiple countries. 

In response, there are several documents cited offering guidance on how to navigate avoiding partnerships with these corporations.  Find them here

On an individual level, this is a great time to remind Certified Lactation Counselors (CLCs) of our Code of Ethics which states we must “Abide by the International Code of Marketing of Breast-Milk Substitutes and subsequent resolutions which pertain to health workers.”

How to support world’s coordinating authority in setting global health norms

I have a friend who describes her experience wading through the pandemic as paralyzing. 

Photo by The New York Public Library on Unsplash

In the first few weeks of the social distancing orders, she says she found herself just standing there at times, staring off into the distance with an utter sense of loss. 

It’s a familiar feeling. Even with so much to be grateful for, there’s static that surrounds us– a heaviness that lingers around the edges, as my friend puts it. 

“It’s a pretty big presence to try to push away with positivity right now,” she counseled me. 

Amidst the stillness, what sometimes feels like paralyzation, there are actions taken, decisions made– like President Trump’s decision to halt funding to the World Health Organization (WHO) during a global pandemic— with sweeping consequences. 

Trump’s plan to defund WHO has been met with mobilization by the International Baby Food Action Network (IBFAN) and partner civil society organizations who are  joining forces to support WHO. You can read IBFAN’s full statement of support to WHO from April 11 here

Patti Rundall is the Policy Director Baby Milk Action, Global Advocacy IBFAN.  

“We have been one of the most outspoken NGOs, calling for WHO to adopt a sound conflict of interest policy to safeguard its independence and resist the unjustified influence of powerful interests, be they commercial or political,” she writes in an email to Our Milky Way.  “…All our criticisms are focused on supporting WHO in its unique role as the world’s coordinating authority in setting global health norms.” 

Specifically, WHO “is absolutely critical to the world’s efforts to win the war against COVID-19,” as U.N. Secretary-General António Guterres declares in a UN News story

Guterres goes on to say in that piece that it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”

Bill Gates on Twitter writes: “Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds. Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them. The world needs @WHO now more than ever.” The Bill & Melinda Gates Foundation’s voluntary contribution to WHO is second to the U.S.’s assessed and voluntary contributions. [More here.] 

Rundall adds: “WHO is needed to guide not only country responses to COVID-19 but also the host of other global threats that we face – not least global heating, new viruses, antimicrobial resistance and non-communicable diseases.” 

Rundall explains that “the U.S. is not the only nation to lobby against the much needed increases of Member States assessed contributions, but it is one of the most powerful.”

“For goodness sake, WHO’s total annual budget of $2.5bn is about the same as the budget of a large US hospital,” she puts the money into perspective.  

Even without defunding, WHO is already underfunded

Even as many of us are feeling debilitated to some degree, Rundall offers suggestions on how to take action for good. 

“We hope that US citizens– and especially anyone working in infant and young child health– will remember the critically important role that WHO has had in child survival,” she begins. “and do everything they can: write to politicians, media, social media, friends  and distance themselves from President Trump’s statements about health.”  [Link added.] 

Rundall directs us to the Society for International Development’s stance on Trump’s move which reiterates the G2H2 statement as well as an open letter of support to WHO and Dr. Tedros Adhanom Gebrheyesus in BMJ

Visit Rundall’s frequently updated policy blog here