First ever Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes spurs multi-national project

Earlier this summer, the World Health Organization (WHO) hosted its first ever Global Congress on Implementation of the International Code of Marketing of Breast-milk Substitutes.

INFACT USA’s Cadwell and Mulpeter ready for the Congress

INFACT USA Convener Karin Cadwell PhD, RN, FAAN and INFACT USA Program Coordinator Ellie Mulpeter, MPH, CLC were of the roughly 400 Congress participants.

The conference aimed to to increase knowledge and skills of national actors on strategies to end the unethical marketing of breast-milk substitutes, bottles, and teats, develop national roadmaps/work plans to strengthen legislation, monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes, and build regional networks to share information and support of national action on the Code.

Mulpeter says the overall energy was upbeat and eager.

“It was inspiring to see so many people from around the globe all dedicated to the same mission, and all passionate about implementation and enforcement of the Code to protect families across the world,” she reports.

Congress participants proudly pose

The Congress was intended to be as interactive as possible with breakout sessions organized by region. The U.S., Canada and the Caribbean were grouped together.

“The work being done in all of the Caribbean Islands is very impressive,” Mulpeter explains.  “They are all unique islands with their own unique policies and legislative processes, so it was fascinating to hear their representatives brainstorm together and discuss ways to work regionally in the future.”

Congress conveners created an industry influence grassroots monitoring simulation where participants had the opportunity to spot and record Code violations using the KoboToolbox platform.

Congress leaders also shared the the International Special Dietary Foods Industries (ISDI) statement released in response to being excluded from the Congress.

“It really drove home the point about how integrated the industry is when it comes to Code monitoring and enforcement,” Mulpeter comments.  “It’s a wild marketing tactic to blatantly lie about their dedication to breastfeeding families.”

As laid out by INFACT USA: “Here in the United States, there is an incredible amount of work to be done to advance the Code and its subsequent resolutions. To date, the U.S. is one of three countries in the world that did not sign onto the Code back in 1981. While that step may never come for the U.S., there are other options and avenues to implement protections against predatory marketing practices of these commercial baby-food product companies.”

Mulpeter points out that the Federal Trade Commission (FTC) already has an avenue to monitor false advertising and hold companies accountable for making claims that are not evidence-based.

“Additionally, the fact that the US is hyper-focused on data sharing and digital privacy at the moment may allow an opportunity to explore how targeted advertisements of formula companies are directed towards pregnant individuals and new parents,” she goes on.

Participants engaging at the Congress

What’s more, last week INFACT USA started the recruitment phase for a multi-national research project on the Code. The U.S., Canada, the UK and Australia are all participating in a Code monitoring project that will collect real-world violations from the general public.

Research participants are asked to download the Goose Chase Adventures application on their mobile device and participate in the missions outlined within the app. Submissions will help monitor Code adherence in several countries.

Individuals interested in learning more about this research study can visit: https://surveyswesternsydney.au1.qualtrics.com/jfe/form/SV_cN14ryUEZriqHL8

Should you have any questions about the project prior to or after signing up to participate, please contact Ellie Mulpeter at: info@infactusa.org or Jeni Stevens at: Jeni.Stevens@westernsydney.edu.au

Mulpeter explains: “We hope that the results from this study will not only allow us to assess what types of violations are happening most frequently in these four countries, but also to assess the frequency with which people see and recognize them as problematic at all. Pending the outcomes of the study, we hope that INFACT USA will be able to use the evidence gathered in this project to persuade legislators in the U.S. to implement stricter monitoring of predatory marketing practices of infant and young child feeding products. Ideally, Australia, Canada and the UK can use the results from this study to enforce stricter implementation and monitoring of the Code in their respective countries.”

Mulpeter and Cadwell applaud the efforts of the hosts of the first Global Code Congress: “It was a huge success!”

Centers for Disease Control and Prevention (CDC) changes their breastfeeding policy for HIV-infected mothers

Without major announcement, in February 2023,  the Centers for Disease Control and Prevention (CDC) changed their breastfeeding policy for HIV-infected mothers and no longer recommend advising against breastfeeding.

Photo by Paul Hanaoka

The new recommendation gets closer to the updated 2010 World Health Organization (WHO) guideline on HIV and infant feeding. Before 2010, “WHO guidance on HIV and infant feeding (UNICEF et al., 2003; WHO et al., 2006) recommended an individualized approach in which women living with HIV would be counselled on feeding options according to their household circumstances.”

The new CDC guideline acknowledges that, “For mothers on antiretroviral therapy (ART) with a sustained undetectable HIV viral load during pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero,” as determined in the PROMISE Study.

The guideline goes on to recommend “patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making.” Read the full document here.

Organizations like the National Institute of Health Office of AIDS Research, the Infectious Disease Society of America and National Association of County and City Health Officials announced the new guidance, but it has gone largely unacknowledged in the field of lactation.

“This change in HIV policy serves as a reminder to always check sources. New research findings and policy reconsiderations make it imperative that the most up-to-date information is available to the families we serve,” Healthy Children Project’s Karin Cadwell PhD, RN, FAAN, IBCLC, ANLC comments.

Photo by Wren Meinberg

In the U.S., HIV diagnoses among women have declined in recent years; still, nearly 7,000 women received an HIV diagnosis in 2019. (The CDC has commented on the effect of the COVID-19 pandemic: “Data for 2020 should be interpreted with caution due to the impact of the COVID-19 pandemic on access to HIV testing, care-related services, and case surveillance activities in state and local jurisdictions. While 2020 data on HIV diagnoses and prevention and care outcomes are available, we are not updating this web content with data from these reports.”)

How does the U.S. compare in their recommendations to other high-income countries?

The British HIV Assocation’s 2018 guidelines for the management of HIV in pregnancy and postpartum states that “Women who are virologically suppressed on cART with good adherence and who choose to breastfeed should be supported to do so, but should be informed about the low risk of transmission of HIV through breastfeeding in this situation and the requirement for extra maternal and infant clinical monitoring” among other recommendations for helping manage lactation in HIV-positive mothers.

Photo by Laura Garcia

A National Health Service (NHS) Greater Glasgow and Clyde document Management of infants born to HIV positive mothers reads: “There is now evidence from developing countries that breast feeding while mum’s viral load is fully suppressed is safe, and BHIVA/CHIVA no longer regard a decision to breast feed as grounds for referral to child protection services. For HIV positive women who choose to breast feed, maternal HAART should be carefully monitored and continued until one week after all breastfeeding has ceased. The mother’s viral load should be tested monthly to ensure that HIV virus remains undetectable; this testing will be undertaken by the obstetric/ID team. It is recommended that breastfeeding be exclusive, and completed by the end of 6 months.”

You can learn more about Canada’s approach here and Switzerland’s here.

For more, check out  Lacted’s Clinical Question and the CDC’s Preventing Perinatal HIV Transmission.