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.”

Spotlight on Fédora Bernard, Program Officer at The Right Livelihood Foundation

Fédora Bernard is currently Program Officer at The Right Livelihood Foundation, an organization established to “‘honour and support courageous people solving global problems’… now widely known as the ‘Alternative Nobel Prize’”. 

Bernard presenting in Rio.

Before transitioning into her work at The Right Livelihood, Bernard served as Geneva Association for Baby Food and International Liaison Office of the IBFAN Network (GIFA) Program Officer beginning in April 2019, having just newly graduated from the Institut des Hautes Etudes Internationales et du Développement with a Masters in International Affairs. 

This week, Our Milky Way is pleased to share a Q&A session with Bernard. 

Q: Please share a few highlights during your time with IBFAN. 

A: I am deeply passionate about human rights and GIFA was specialized in exactly that. I think that throughout my time at IBFAN, some highlights would probably be the sessions of the Committee on the Rights of the Child that I attended and advocated at, the World Health Assembly, the fifth session of the Open-ended intergovernmental working group on transnational corporations and other business enterprises with respect to human rights and of course, the World Breastfeeding Conference in Rio. They were all avenues where we could raise awareness and advocate for better national policies.

Q:  What would you consider your greatest triumph with IBFAN?

A: I am not sure I could speak of triumph, at the end of the day my time with IBFAN was quite short and all I did was trying to keep up with the amazing work that has been done by the Geneva office for the past 40 years. Nevertheless, I am very proud of the achievements with the Committee on the Rights of the Child, as during my time with IBFAN, “breastfeeding” was mentioned in almost all concluding observations.

Q: In November 2019, you had the opportunity to present IBFAN’s Green Feeding documents. What was that like? How was it received by participants at the World Breastfeeding Conference? 

A: It was an incredible experience, it was an honor to prepare this with Alison Linnecar, who wrote the document and to present it along with experts in the field. I don’t think that I can define myself as an expert, let alone a breastfeeding expert, but I am starting a career in advocacy. I therefore decided that I wanted to emphasize how the Green Feeding Documents could be used as an advocacy tool from an environmental perspective. Therefore, while Alison explained the science behind all of it, I focused on the link between breastfeeding and human rights, more in particular how it can be used in relation to the right to a safe, healthy environment. At the end of the presentation, I was so happy to see that most people in the audience wanted a copy of the green feeding documents…I thought that 30 copies would be enough, but clearly, I was wrong! I wish I had brought more.

Jose Angel Rodriguez-Reyes, expert of the Committee on the Rights of the Child pictured alongside Bernard.

Q: In your piece BREASTFEEDING: BEYOND “WHAT IS BEST FOR YOUR CHILD”, you mention the WHO/UNICEF Global Strategy on Infant and Young Child Feeding to Protect, Promote and Support Breastfeeding. We have the framework for better global health outcomes; What is holding us back? Is there one significant barrier standing in the way of a better world? 

A: I believe that from a political perspective, two things are holding us back: The first being the patriarchy and political systems dominated by men. As long as women will not be allowed to play a greater role in global health governance and domestic politics, public health issues such as breastfeeding or issues surrounding menstrual health will not be given the right amount of attention. 

The second element is political will, which is deeply related to the first. Breastfeeding is only seen as a public health issue in developing countries, and aggressive marketing from the formula industry has managed to convince women themselves that they are actually more empowered if they don’t breastfeed. Breastfeeding is thus seen as a weight imposed on them rather than a right that should be protected, promoted and supported by governments. In some societies, it is indeed currently a real hurdle for women to achieve their breastfeeding goals but instead of women in their breastfeeding journeys benefiting from policies, they are given a bottle. I am of the idea that improved breastfeeding policies are not only a matter of public health but also of women’s rights. 

Q: Any advice on how to navigate a climate where people dispute basic facts?

A: That is a very difficult question…Especially because those disputing basic facts are often deeply attached to their position and will give you alternative “facts”…I believe very much in trusted sources, and would always advise these people to check their sources and question them. For instance, if someone shows me an article from the industry containing “facts on breastfeeding” I would draw their attention on why this article could be biased and not based on adequate scientific evidence.

Q: Breastfeeding is a topic that spans across all disciplines. Will you please give us a glimpse into the work you’re doing at The Right Livelihood? 

A: The Right Livelihood Foundation honors and supports courageous people solving global problems, in all disciplines. IBFAN is actually one of them. With civil society space shrinking all over the world, human rights defenders are facing increasing difficulties, which is very true also for breastfeeding advocates. My work at the foundation therefore consists in using the advocacy skills that I developed with IBFAN, to support laureates all over the world.