Tag: International Code of Marketing of Breast-Milk Substitutes

Posted on

Conflicts of interest everywhere one turns

The authors of Call to end sponsorship from commercial milk formula companies published in The Lancet last month urge all health-care professional associations (HCPAs) to commit to ending sponsorships from companies that market commercial milk formulas (CMFs) by the end of 2024.

Greed depicted in an image that is part of a series of prints of the Seven Deadly Sins, engraved by Pieter van der Heyden after drawings by Pieter Bruegel the Elder. More at https://www.metmuseum.org/art/collection/search/338698

The CMF industry targets healthcare providers, because they understand providers’ influence on parents’ decisions.

The group of leading HCPAs  is working to compile case studies, references, guidance on how to manage without sponsorship, and more to help any associations in ending such relationships. 

The effort is not a restriction on parental choice, and the authors recognize that all healthcare professionals (HCPs) must support parents on a case-by-case basis. 

Instead, this work focuses on combating the inappropriate marketing of CMFs which interferes with parents getting accurate information to make decisions. The 2023 Lancet Series offers much more information on the industry’s tactics. Find it here.

The CMF industry has its tentacles tangled in affairs beyond the health care provider-patient relationship, raising concerns about conflicts of interest everywhere one turns. 

Healthy Children Project’s Karin Cadwell, PhD, RN, FAAN, ANLC, CLC, IBCLC points out that other fields have separated themselves from industry.  For instance, the Accreditation Council for Continuing Medical Education (ACCME) will not accredit an organization that it defines as a commercial interest. The American Medical Student Association (AMSA) adopted policies opposing gifts to physicians and medical students from the pharmaceutical industry in the early 2000s. This piece describes some of the more recent policies governing physician interactions with industry. 

Yet, formula companies and breast pump companies are right in the middle of the baby feeding arena at conferences, like at  WIC (Women, Infants, and Children) and the American Academy of Pediatrics (AAP). 

Industry at conferences 

Rob Revelette MD, PhD FAAP questions the AAP’s relationship with formula companies in this essay where he notes that the AAP, both at the national and state level, accepts money from formula companies for advertising and sponsorship of meetings.https://www.metmuseum.org/art/collection/search/335169

Greed Breaks the Bag (“La codicia rompe el saco”)
Leonardo Alenza y Nieto Spanish
1807–45
https://www.metmuseum.org/art/collection/search/335169

Saroj Jayasinghe offers in Pharmaceutical industry sponsorship of academic conferences: ethics of conflict of interest, “The most definite way to prevent COI is to completely avoid industry funding of conferences…” 

Because this isn’t always feasible, Jayasinghe writes, it is crucial to establish these proposed guidelines:  “(1) avoid the sponsors having any influence on the decision-making of conference; (2) avoid promotion of specific products; (3) transparency of sponsorship; (4) develop guidelines for future interactions; (5) consider contextual factors such as the trust in the profession and social roles of physicians; (6) ensure that the long-term objective of the organisations is independent of influences of the industry.” 

Dr. Revelette points out that The Royal College of Pediatrics and Child Health and the British Journal of Pediatrics have both cut ties with formula companies. He writes that “The time for the American Academy of Pediatrics to do the same and comply with the Code is long overdue.” 

CMF companies in science 

CMF marketing commonly and effectively uses science to build brand credibility and influence the scientific community as Rollins, et al detail in Marketing of commercial milk formula: a system to capture parents, communities, science, and policy.

‘Landscapes and seaports’ (Paysages et ports de mer, dans des ronds)
Stefano della Bella Italian
1639
https://www.metmuseum.org/art/collection/search/412519

The authors detail how they misrepresent research and their sponsorship of journals and conclude “the capture of science as a strategic objective of CMF marketing fundamentally shapes medical practice in addition to boosting CMF sales. Science is used in a pincer movement: parents looking to resolve problems accentuated by marketing, with health professionals offering marketing-constructed solutions.” 

One government employee, a practicing physician, who asked to remain anonymous suggests that “most academicians can’t survive (as academicians) without getting sponsor grants for research”. That’s because public funding has decreased in the last couple of decades.  

Patricia Baird notes in Getting it right: industry sponsorship and medical research “…the pharmaceutical industry has become the single largest direct funder of medical research in Canada, the United Kingdom and the United States.”

The anonymous physician says that the number and type of potential competing interests do not tend to concern him especially when there is supplementary data available for review. 

He shares that “Most multi-center studies are done by funding from sponsors since no one Institution has deep enough pockets to do these critically important studies.  I get red flags going off and my ‘BS detector’ starts sounding when I see a small, short author list with a single sponsor funding the study that lacks supplementary data and is making extraordinary claims.” 

One of the touted benefits of working with industry in research is the development of new therapies for patients, as Baird writes and is also noted in ‘Deal with the Devil’: Harvard Medical School Faculty Grapple with Increased Industry Research Funding. 

However, Baird shares: “…a lack of balance in research activities, with a focus mainly on potential medications, is likely to divert talented researchers from the pursuit of profound scientific questions, or divert them from the pursuit of questions without market relevance but with an aspect of public good. A company has little incentive to support trials evaluating whether inexpensive, off-patent drugs, or whether nonpharmaceutical interventions, could replace their profitable patented drug.”

Because profits are foremost for industry, Baird continues that “it is unrealistic to expect drug companies to stop making drugs to treat diseases that result from [unhealthy behavior].”

This reality, Baird goes on, “highlights the need for funding of research into new and effective ways to get people to change behaviour, and of research into policies that provide incentives and support for healthier behaviours at a population level.” 

*Ahem… Family-friendly policies that support breastfeeding and adoption and adherence of the Code!*  One has to wonder, would maternal infant health look differently if we put as much effort into breastfeeding and supportive policies as we did responding to the formula crisis? 

One group, the Access to Nutrition Initiative (ATNI) conducts the BMS and CF Marketing indexes which assess the marketing policies of the 20 largest baby food companies globally. This spring, the organization released the Breast Milk Substitutes and Complementary Foods Marketing in the United States: Launch of the 2024 Country Report as a complement to the indexes. The recording of this event can be accessed here. 

ATNI has created a model policy for companies’ full compliance with the Code. 

Interestingly, ATNI itself has been criticized for its interactions with CMF companies. 

During the release event, ATNI presenters addressed their involvement with CMF companies. It was reported that ATNI consults independent expert groups and releases their methodology on their website. It was also stated that ATNI engages companies at certain points in their process, but that companies cannot decide whether or not they will be evaluated and do not have influence over the research results.

CMF business affairs within nations 

The United States has an enmeshed relationship with formula companies.

L’Avarice (Greed), from “Les Péchées Capitaux” (The Deadly Sins)
Jacques Callot French
ca. 1620
https://www.metmuseum.org/art/collection/search/417673

For instance, in Scorched Earth Legal Tactics author Valerie McClain illuminates that “Both the CDC and the FDA have foundations that partner with corporations that donate to their organizations. While these US governmental bodies are not allowed to take money directly from corporations, their foundations through partnerships donate for programs run by the CDC or FDA. The CDC Foundation has a long list of partners who donate various amounts.” 

McClain goes on: “From a political science perspective, corporations entangled with governmental agencies is part of the definition of fascism-a merger of state and corporate power. Every US governmental agency that I have seen has a foundation. So one gets the impression that is one way to pretend that corporations have no influence on governmental policy.” 

She details some of these relationships with specific dollar amounts in the remainder of her piece. 

In another revealing article– The U.S. Government Defended the Overseas Business Interests of Baby Formula Makers. Kids Paid the Price.— author Heather Vogell demonstrates how “the U.S. government repeatedly used its muscle to advance the interests of large baby formula companies while thwarting the efforts of Thailand and other developing countries to safeguard children’s health.” 

And there was the disgraceful act when the U.S. opposed a WHA resolution in 2018 and “blackmailed” Ecuador. 

An administrator from Breastfeeding Advocacy Australia (BAA) explains their country’s involvement with industry: “…Our Government gave the Formula Industry co-operative body, the Infant Nutrition Council (INC) a government grant to expand their international markets. This government one was for India, a country working hard to improve breastfeeding. Last government gave a grant for expansion in Cambodia, a country with historically high breastfeeding now rapidly plummeting. It is immoral and unjust. We must fight for women and babies. It gets worse here in Australia as a developed nation who is enabling this industry. One of our main research organisations SAHMRI has joint trials with Nestle and validates their participation. Unsurprisingly, the result of one trial we’ve seen requires the administration of a Nestle product as an outcome. Then our Doctor group the RACGP, the doctors that virtually all Mums and Bubs see, has their annual conference sponsored by Nestle and that’s just what we’ve seen publicly stated. There is probably much more. We have much work to do.” 

Until our governments do a better job of protecting health over profits and untangle their industry ties, how can we, as maternal child health advocates,  turn down the commercial noise when its notes seem to play everywhere? 

Steven R. Brown’s, MD, FAAFP American Family Physician editorial Physicians Should Refuse Pharmaceutical Industry Gifts offers guidance that is easily adopted for those working as lactation professionals. 

Certified Lactation Counselors should remember the specific line in the Academy of Lactation Policy and Practice (ALPP) Code of Ethics for Certified Lactation Counselors (CLC) which reads that we must “Abide by the International Code of Marketing of Breast-Milk Substitutes and subsequent resolutions which pertain to health workers.”  

The aforementioned Call to end sponsorship from commercial milk formula companies is a promising launching pad in the dismantling of inappropriate care provider- industry relationships. It signifies progress and as BAA offered, we have so much more work to do.  

 

Further reading/ related resources 

 

Posted on

Breastfeeding is ours. Breastfeeding belongs to us.

–This post is part of our 10-year anniversary series “Breastfeeding is…” When we initially curated this series, we planned for 10 weeks, but breastfeeding is so many things that we just couldn’t fit it all in, which means we have two bonus weeks in our anniversary series.–

Breastfeeding is ours. Breastfeeding belongs to us.

Nicole Starr Photography Originally featured on Our Milky Way in ‘ Non-profit Julia’s Way proves babies with Down syndrome can breastfeed’

For decades, the 55 billion dollar formula milk industry has positioned itself as an ally to parents. 

Through conniving tactics, like the distortion of science to legitimize their claims, the systematic targeting of health professionals to promote their products, and the undermining of parents’ confidence in breastfeeding, the industry impacts the survival, health and development of children and mothers, disrupts truthful information– an essential human right as noted by the Convention on the Rights of the Child, disregards the International Code of Marketing of Breast-milk Substitutes, and exploits the aspirations, vulnerabilities and fears at the birth and early years of our children solely for commercial gain. (WHO/UNICEF, 2022, p. x) [More at WHO report exposes formula milk marketing, offers steps forward] 

Far before the advent of formula milks and their subsequent marketing campaigns, breastfeeding sustained the human species. When breastfeeding wasn’t possible, wet nursing was the primary alternative feeding option. [Stevens, et al 2009] 

For generations, cultures across the globe have honored breastfeeding as a central part of their identities, and now they’re reclaiming these traditions after being challenged by the formula milk industry and other forces.

Photo by Mehmet Turgut Kirkgoz : https://www.pexels.com/photo/a-woman-breastfeeding-her-son-12359528/

HealthConnect One’s program manager Brenda Reyes, RN, CLC describes that reclamation of Latino/Hispanic birth and breastfeeding traditions in Reclaiming Latino/Hispanic birth and breastfeeding traditions for instance. 

In It’s Asian American Native Hawaiian and Pacific Islander (AANHPI) Week: “Reclaiming Our Tradition”, To-Wen Tseng covers just what the title suggests. 

Navajo Breastfeeding Coalition/Dine Doula Collective, Amanda Singer, CLC discusses the revitalization of Indigenous breastfeeding in Honoring Indigenous Milk Medicine Week: “Nourishing Our Futures”. 

Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program manager and lactation consultant Cody Cuni, IBCLC, BS reminds us in Hispanic Health Council’s Breastfeeding Heritage and Pride (BHP) Program heals, empowers and celebrates through peer counseling model that breastfeeding has always belonged to the people.

Photo by willsantt: https://www.pexels.com/photo/woman-breastfeeding-her-toddler-under-the-tree-2714618/

Cuni offers commentary on her and her colleague’s responsibility to help facilitate breastfeeding without capitalizing, claiming and dominating. She sees her role as an empowerer. 

Without diminishing the need for larger structural supports, let us also remember and celebrate the innate power we hold as individuals who can nourish and nurture our young and ourselves through breastfeeding. 

___

Our 10-year anniversary giveaway has ended. Thank you to everyone who participated!

Posted on

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.

Posted on

USBC Deputy Director Amelia Psmythe Seger’s ‘The Four Pillars of Infant Nutrition Security in the United States’

Our headlines are overloaded with tragedy, perversion, inequities, the unthinkable yet preventable.

Journalist Mary Pilon says in Throughline’s Do Not Pass Go episode “It’s a shame to waste a crisis. A crisis can also be a moment when you look at things and make changes and improvements.”   

And so, from that vantage point, we are honored to be republishing United States Breastfeeding Committee Amelia Psmythe Seger’s piece The Four Pillars of Infant Nutrition Security in the United States originally published here last month. 

“We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust,” she writes. 

In celebration of World Breastfeeding Week and National Breastfeeding Month on the horizon, there’s no better time than now to take action.  #TogetherWeDoGreatThings

 

________

 

The Four Pillars of Infant Nutrition Security in the United States by Amelia Psmythe Seger, Deputy Director USBC

Throughout its 22-year history, the U.S. Breastfeeding Committee has been working towards the policy, systems, and environmental changes that build a landscape of breastfeeding support.
​
The catastrophic infant formula shortage demonstrates the value of this work and the need to build a robust infrastructure for infant nutrition security in the U.S. that holds all families in care.

This infrastructure includes four pillars: Parents, Programs, Policies, and a Plan for emergencies.

Parents:

Parents are critical stakeholders in infant nutrition security. The Parents pillar includes people of all races, genders, caregiving roles, routes to parenthood, immigration status, religious or political views, and infant feeding methods. Everyone who loves and cares for a young child belongs. Welcome.

Parents deserve the full support of a robust national infant nutrition security infrastructure. Without it, many are forced onto painful and difficult paths of infant feeding and care. The U.S. needs equitable programs, policies, and a plan for emergencies that centers on the most impacted.Parents and caregivers whose infants rely on formula are the highest priority right now. They need help finding formula, advice on switching between formulas, reassurance that reliable supplies are on the way, and an answer to the question: what should I feed my baby if I cannot find formula?  With appropriate caution, the American Academy of Pediatrics (AAP) published an article on what to feed babies of different ages and situations in an extreme emergency (such as this). Babies under six months should truly only consume human milk or infant formula. In considering very short-term alternatives, the stakes are so high that a physician should monitor the baby.

Parents who are breastfeeding or feeding human milk are in anguish right now, too. Many are feeling pressure to share their milk without acknowledgment of how hard this society has made it to establish and maintain milk supply. Few families have access to lactation support providers, paid family leave, and workplace accommodations to pump breast milk during the workday. In this context, many turn to formula as their backup plan, and it is very scary for them to see that their safety net is in tatters. To answer questions related to human milk, the Academy of Breastfeeding Medicine (ABM) published a guide. This ABM guide addresses pregnancy, low milk supply, re-lactation, options for donation or safe milk sharing, and healthcare guidance and training.
​
Additional burdens or blame should never be placed on the families and caregivers whose hands are literally full of babies and toddlers. When capacity allows, however, the collective potential power of parents is significant. Consider if parents insisted on being at the table with the commercial milk formula industry, playing a role in ensuring industry quality, safety, and ethics. They are key stakeholders, after all, so this should be encouraged. Parents could also insist the U.S. enhance our nonprofit milk banking system to ensure an affordable, plentiful donor milk supply for medically fragile infants and those whose parents cannot or do not wish to breastfeed. This would diversify the infant food supply and provide parents with more options.

Programs:

Federal programmatic funding needs to be expanded considering setbacks caused by the pandemic, including the current infant formula shortage.

Federal funding supports quality improvement investments to implement maternity care best practices in hospitals, especially while recovering from pandemic-induced breakdowns in those settings.

Expansion of this funding supports state and community efforts to advance care coordination and strengthen lactation support through policy, systems, and environmental change interventions to reduce or eliminate breastfeeding disparities along the fault lines of income and race.

Federal investments enhance and deepen partnerships to integrate infant feeding and lactation support services into emergency response systems and food security programs during acute disasters and prolonged public health crises.
​
This funding supports critical national monitoring and public reporting activities, including annual analysis of the National Immunization Survey (NIS), administration of the bi-annual Maternity Practices in Infant Nutrition and Care (mPINC) Survey, bi-annual production of the National Breastfeeding Report Card, and administration of the longitudinal Infant Feeding Practices Study. All of which is especially needed in light of recent updates to the Dietary Guidelines for Americans, which, for the first time, provides nutritional guidance for infants and toddlers.

Policies:

Due to major policy gaps, families face obstacles that make it difficult or impossible to start or continue breastfeeding. Policymakers must choose to prioritize the policies and investments for infant food security so that we never find ourselves in this situation again.

Critically needed policy solutions are waiting for Congressional action:

  • Establish a national paid family and medical leave program. The FAMILY Act (S. 248/H.R. 804) would ensure that families have time to recover from childbirth and establish a strong breastfeeding relationship before returning to work.
  • Ensure all breastfeeding workers have time and space to pump during the workday. The Providing Urgent Maternal Protections (PUMP) Act (S. 1658/H.R. 3110) would close gaps in the Break Time for Nursing Mothers Law, giving 9 million more workers time and space to pump. Contact your legislators about the PUMP Act!
  • Invest in the CDC Hospitals Promoting Breastfeeding program by increasing funding to $20M in FY2023. This funding helps families start and continue breastfeeding through maternity care practice improvements and community and workplace support programs.
  • Create a formal plan for infant and young child feeding in emergencies. The DEMAND Act (S. 3601/H.R. 6555) would ensure the Federal Emergency Management Agency can better support access to lactation support and supplies during disasters. Contact your legislators about the DEMAND Act!

Additional areas for policy development

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.
​
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.Enhance the national network of nonprofit donor milk banks. 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.

Plan:

All nations should have a robust plan for infant and young child feeding in emergencies that includes three phases: preparedness, response, and resiliency. The USBC-Affiliated Infant & Young Child Feeding Constellation has published a Joint Statement on Infant & Young Child Feeding in Emergencies (IYCF-E) in the U.S. context.
Emergency preparedness includes building a lactation support provider directory and a system to track the inventory of national resources such as infant formula.Emergency response for infants, young children, and their families must include priority shelter, trauma-informed care, lactation support providers in every community; access to breast pumps, and milk storage and cleaning supplies; non-branded infant formula, clean water, bottles, and cleaning supplies.
​
Emergency resilience includes trauma-informed care that centers on the needs of communities that have been historically undersupported, and disproportionately impacted in emergencies.

Every system is perfectly designed to get the results it gets. The insufficient system we’ve had, led to this crisis. It was predictable, and thus it was preventable.
​
Now that there’s a mass mobilization of activity – from neighbors driving many miles to find spare formula tins, to the President invoking the defense production act – we must collectively build the resiliency to support a community during a flood, a region during a power outage, or a nation during a pandemic and supply chain crisis. We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust.
Posted on

Industry lies and the Code

“Even in the harshest of trade regimes, there is space for public interest laws to meet legitimate health objectives when they are founded on internationally adopted standards and recommendations such as the Code and subsequent relevant WHA resolutions.”– WHO, 2016

All three of my kids sport a similar look when they lie.  As soon as the fabrication tumbles out, their cheeks suck in ever so slightly toward pursed lips. Once they’ve heard themselves, their eyes widen a smidge and their bottom jaw drops just a few degrees. 

Most of us don’t like to be lied to, but usually the dishonesty we encounter can be considered trivial. “I didn’t do it!” when there’s crayon art on the kitchen walls. “Your hair looks great!” when you know it doesn’t. “Of course I remember you!” when you haven’t the slightest clue. 

Just as humans tend to react physiologically when we lie, we have an ability to detect when someone is lying to us. Inundated by the lies told by marketing companies on behalf of major industries though, detecting truth and falsehoods can be majorly challenging. There’s no lip biting, no shifting eyes, no perspiring to give it away. Instead the tactics industries use are cunning, targeted, sometimes irresistible and truly brilliant in many ways. The lies they tell are perpetual, and their claims have completely saturated our culture, influencing just about every facet of our lives, all for commercial gain.

There’s a promotional video featured by a cooking show that showcases a chef professing his allegiance to gas stoves. The video was created by a utilities provider though, and having worked aggressively with state legislatures “to block legislation that would provide cleaner, electric-based building codes,” their marketing got us to believe that cooking on a gas stove is somehow the best while simultaneously waging “war on local electrification initiatives all over the country.” [https://www.thresholdpodcast.org/season-4-episode-6-transcript]  

Here’s another example. Most of the seafood that we purchase and consume in the U.S. is mislabeled as something completely different. This “Seafood Fraud” is detailed in (Mis)labeled Fish. 

President of the  Center for Science in the Public Interest Peter G. Lurie, MD, MPH calls out unfounded claims of “healthy alcohol” in Peter’s Memo: The Jungle. 

Fossil fuel companies are greenwashing their efforts, helping to sow doubt about the fossil fuel industry’s role in the climate crisis. 

As explained on How to Save a Planet: “They’ve… done it indirectly, by funding organizations who lobby congress, launching fake grassroots campaigns, and perhaps most importantly, through advertising. These ads, according to Martin Watters at the nonprofit firm ClientEarth, are greenwashing.” 

The tobacco industry pushes “green” public relations too.

Now consider the baby milk substitute (BMS) industry. A recent WHO report examines the scope, techniques and impact of digital marketing strategies for the promotion of breast-milk substitutes which reveals how the $ 55 billion baby formula industry “insidiously and persistently” targets parents online through “tools like apps, virtual support groups or ‘baby-clubs’, paid social media influencers, promotions and competitions and advice forums or services, formula milk companies can buy or collect personal information and send personalized promotions to new pregnant women and mothers.” [https://www.who.int/news/item/28-04-2022-who-reveals-shocking-extent-of-exploitative-formula-milk-marketing] 

Their efforts have further adapted to target older children with their toddler milks and  formulas. Lurie again calls out false claims like  “Brain & eye development” and “Plant-based protein for toddlers.”

He writes: “The multibillion-dollar infant-formula industry is trying to convince parents that children older than 12 months need formula. They don’t. The beverages—made largely of fortified powdered soy or dairy milk, oil, and corn syrup solids or maltodextrin—typically supply added sugars. They certainly don’t beat a diet of healthy foods.” 

The WHO report confirms these concerns: “Science is a dominant theme in the marketing of formula milk across all eight countries, including scientific imagery, language and pseudo-scientific claims. Formula milks are positioned as close to, equivalent and sometimes superior to breast milk, presenting incomplete scientific evidence and inferring unsupported health outcomes. Ingredients, such as human milk oligosaccharides (HMOs) and docosahexaenoic acid (DHA), are advertised as ‘informed’ or ‘derived’ from breast milk and linked to child developmental outcomes. Examination of the scientific evidence cited does not support the validity of these claims.” (p. 9)

In response to the absurdity of BMS industry claims during Protecting Breastfeeding in the United States: Time for Action on The Code, David Clark, International Public Health and Human Rights Lawyer and Legal Advisor for the UNICEF Nutrition Programme (1995 to 2020), laughed “I don’t think I’ve seen anything so outrageous in my life.”

The marketing of formula products is different from other commodities because it impacts the survival, health and development of children and mothers; disrupts truthful information– an essential human right as noted by the Convention on the Rights of the Child; disregards the International Code of Marketing of Breast-milk Substitutes; and exploits the aspirations, vulnerabilities and fears at the birth and early years of our children solely for commercial gain. (WHO/UNICEF, 2022, p. x) 

Considering the current state of affairs– the industry’s guileful tactics, the permeation of their influence in every sphere of life, our nation’s lack of adoption of the International Code of Marketing of Breast-milk Substitutes/ subsequent WHA resolutions and any monitoring or enforcement systems– it’s easy to feel crushed as a maternal child health advocate, like the way forward is straight into the Apocalypse. 

Fear not. Researcher Britt Wray has suggestions on how to keep ourselves within our windows of tolerance in order to continue to mobilize. While Wray’s work focuses on the climate crisis, her findings are easily applied to maternal child health advocacy. Learn about these techniques here. 

There are also simple actions (and some bigger ones too) that we can employ to continue to move the needle.

Françoise Coudray of ADJ+ Allaitement Des Jumeaux et Plus offered this to health advocates attending the launch of WHO’s latest report : “The mosquito: small, small, but have one in your bedroom and you will have a very bad night; so do the mosquito, let us all do the mosquito.” 

  • On Facebook, find the three little dots in the upper right hand corner of the ad to locate the “Report ad” prompt.

    When marketed formula products on social media platforms, report them directly to the platform.

  • Make a presence at the Codex Committee on Contaminants in Foods Public Meetings. In April, individuals like Consumer Reports Senior Staff Scientist Mike Hansen, Ph.D, Environmental Defense Fund’s chemicals policy director Tom Neltner and Center for Science in the Public Interest’s Thomas Galligan, PhD made clear in brief comments that we need to rethink how toxin levels are approached at CCCF. Hansen pointed out that the current permitted levels are not sufficient to protect infants and young children. Echo these demands for safer products. [While we wait for more stringent requirements, consumers can check out the Clean Label Project to find information about food and products not available on their labels.]  
  • Join forces with other advocacy groups to put pressure on the enforcement agencies responsible for food safety. 
  • Check out this Indonesian model of a platform for reporting violations of the Code. 
  • Support relactation efforts. Artificial feeding does not have to be the default.  Ines Fernandez in the Philippines has a model for this work.  There is also information about this included in the Global Breastfeeding Collective’s recordings of Building Better Breastfeeding Counselling Programs. 
  • Get people fired up. Increase public interest participation using NACCHO’s flyer on advocacy and lobbying to drum up attention about how the Code benefits all babies, no matter their feeding method. This has been grossly overlooked and cannot be overstated as formula companies often attempt to pit breastfeeding advocates against those who do not breastfeed.
  • Support the Baby-Friendly Hospital Initiative (BFHI). In the U.S., this is the only “federal” program that is enforcing the Code, albeit voluntary participation.  
  • Encourage divestment. Check out Norwegian Secretary-General of Save the Children Tove Wang’s push for the Norwegian Government Petroleum Fund’s withdrawal from investments in companies aggressively pushing infant formula in developing countries. According to Save the Children’s Don’t Push It, “The largest global fund management firms have more than $110 billion invested in companies that market milk formula. As we have documented in this report, the profits these companies generate are fuelled in part by marketing practices that directly – and profoundly – harm children….Active investment funds have the power to wield huge influence over the boards of the companies they have a stake in.” (p44-45)  
  • Support the work of Baby Milk Action. Patti Rundall, Mike Brady and colleagues work tirelessly to uphold the Code and its resolutions including speaking at shareholder meetings.
  • Stay tuned for an engaging opportunity with the newly formed INFACT USA to uphold the Code here in the U.S.

Many of these immediate and long term actions are outlined in Constance Ching and colleague’s piece Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic.

 

Add your name to #EndExploitativeMarketing here. Tell us about your efforts engaging with the Code. Email us at info@ourmilkyway.org.

Proudly powered by WordPress