Enhancing national network of nonprofit donor milk banks and diversifying nation’s production of infant formula to secure infant nutrition in U.S.

The Infant Feeding Action Coalition USA, Inc. (IN.FACT.USA) has put together a piece detailing the global recall of contaminated Abbott powdered formulas.

In February 2022, the largest U.S. infant formula manufacturer recalled three brands of its powdered formula and one breastmilk fortifier and shut down its main manufacturing facility in Sturgis, Michigan following reports of Cronobacter infections in infants who had consumed formula manufactured at the Sturgis plant. It’s noteworthy that the initial recalls were voluntary–not required by the US Food and Drug Administration (FDA)— and they only came after nine babies died between September 2021 and January 2022 from infections.

Let’s focus on that, the death of these babies, Tameka L. Jackson-Dyer, BASc, IBCLC, CHW  urges in her Great Lakes Breastfeeding webinar Feed the Baby: Lactation, Contamination, and the American Formula Crisis.

One infant death is one too many. Initially, two deaths were reported; however, Freedom of Information requests and whistleblower action revealed that not only two, but another seven infants in the U.S. were reported to have died after consuming powdered infant formula manufactured at the Abbott factory.

“During the same period, 25 severe infections categorized as ‘Life Threatening Illness/Injury’ and 80 instances of ‘Non-Life Threatening Illness/Injury’ were reported among infants who were fed these formulas,” The Abbott Powdered Formula Scandal also points out.

“Until Cronobacter infections require mandatory notification, the number of cases of illness or deaths will never be known. Neither will their extent in the 37 countries which imported the potentially contaminated Abbott formula.”

In The Four Pillars of Infant Nutrition Security in the United States, author Amelia Psmythe Seger points out that  “The U.S. has not regulated the marketing practices of the commercial milk formula industry, unlike 70% of the world, which has implemented at least some part of the WHO’s International Code of Marketing of Breast-Milk Substitutes. In the absence of regulation, these marketing practices are predatory.”

Psmythe Seger goes on to urge, “Diversify the nation’s production of infant formula. Plainly it is a mistake to allow 42% of the infant formula in this country to be produced not only by one company but by one factory of that company. Infant formula companies are part of an infant food security system, but we don’t have to be so dependent on that industry.”

[For more on commercial influence, you can watch USBC’s series of Unpacking Commercial Milk Formula Marketing Webinar Recordings]

A history of breastmilk substitutes laid out by Jackson-Dyer reminds us that before the advent of commercial infant formulas,  wet nursing was the original supplemental feeding.

Considering the infant feeding landscape today, Jackson-Dyer quotes Michigan Breastfeeding Network Executive Director Shannon McKenney Shubert, MPH, CLC: “In my 12-year career in the field of human milk feeding, I have never once met a birthing parent who ‘chose not to breastfeed.’ In this country, whether to breastfeed is not a choice. In this country, whether to breastfeed is a question of ‘Within all the systems of oppression that I navigate, what is the best combination of things I can do to ensure the survival of my baby, myself and the rest of my family?’”

With this context in mind, Jackson-Dyer confronts the idea that yes, babies must be fed, but fed is not best; instead, it is required, she says in her webinar.

“It is the absolute minimum to sustain life,” she reminds us. “We can’t just feed the baby anything.”

Again in The Four Pillars of Infant Nutrition Security in the United States, Psmythe Seger shines light on nonprofit donor milk banks which provide pasteurized donor human milk for human babies, “the next best thing to mom.” 

“Enhance the national network of nonprofit donor milk banks,”  Psmythe Seger writes. “Support innovative partnerships across existing structures, taking a cue from a national model such as what exists in Brazil. Consider: Red Cross has the infrastructure to support donor screening; WIC offices or community health clinics could be donor drop-off sites; more hospitals could provide space and equipment for donor milk processing and distribution, as some have done. Models exist to create an affordable and plentiful alternative to commercial milk formula when a parent’s own milk is not available.”

Photo by: Sara D. Davis/
Source: United States Breastfeeding Committee (USBC)

This fall, the Access to Donor Milk Act (ADMA) was introduced in the House. ADMA would increase federal support for nonprofit milk banks and access to donor milk for medically-vulnerable infants.

What’s more, the legislation would allow state agencies to use WIC funding to promote the need for donor milk, provide emergency capacity funding when there is a demand for donor milk,  create a donor milk awareness program, and require the secretary of HHS through the FDA to issue a rule clarifying the regulatory status of donor milk provided by nonprofit milk banks.

Stay tuned for how you can help support this legislation. For other legislative and policies opportunities that support healthy infant feeding, visit USBC’s Take Action page here.

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.”