August 2010 - Hot Topic

Breastfeeding Workgroup Supports the International Code of Marketing of Breastmilk Substitutes

The OPHA Breastfeeding Promotion Workgroup is developing a position paper about the International Code of Marketing of Breastmilk Substitutes (the Code). It has been the intent of public health educators to improve the health of populations based on scientifically proven facts. Public health educators promote health to benefit society whereas private interest and industrial groups often have monetary gain as the main reason for their activities. The Code was developed in 1981 as a way to protect parents from marketing when they make decisions about feeding their babies and young children.

In Canada and throughout the world, trends in infant feeding have been influenced by social and medical changes in society, such as birth practices and changing roles of women. These trends have led to declining breastfeeding rates starting in the early 1900s. At the same time, artificial infant foods were invented. However, use of non-sterile water to reconstitute infant foods became problematic, resulting in high child mortality and morbidity in Canada in the 1920s1. Rates of disease in children also rose because they were no longer exposed to the protective elements in breastmilk. Despite this, companies that marketed infant feeding products engaged medical professionals to provide credibility to their promotion of artificial baby milk. As a result, the public trust and popular use of these products increased while breastfeeding rates declined.

In recognition of this growing problem, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) hosted an international meeting on infant and young child feeding in 1979. The meeting — which included representatives of governments, organizations of the United Nations system, and other intergovernmental bodies, nongovernmental organizations, the infant-food industry, experts in related disciplines, and campaigning groups — called for the development of an international code of marketing for breastmilk substitutes, as well as action on other fronts to improve infant and young child feeding practices. The International Baby Food Action Network (IBFAN) was formed by six of the campaigning groups at the meeting. IBFAN started to grow as other groups joined or were formed.

By May 1981, the International Code of Marketing of Breastmilk Substitutes was endorsed by the 34th World Health Assembly of the WHO. At the time, Canada gave its approval to the International Code as part of a near global consensus. The Code was passed as a recommendation to all member states of the WHO “to take action appropriate to their social and legislative framework and their overall development objectives to give effect to the principles and aim of this Code, including the enactment of legislation, regulations or other suitable measures”2.

The International Code of Marketing of Breastmilk Substitutes includes the following measures:

  • No advertising of any of the breastmilk substitute products to the public;
  • No free samples to mothers;
  • No promotion of products in health care facilities, including the distribution of free or low-cost supplies;
  • No company sales representatives to advise mothers;
  • No gifts or personal samples to health workers;
  • No words or pictures idealizing artificial feeding, or pictures of infants on labels of infant milk containers;
  • Information to health workers should be scientific and factual;
  • ALL information on artificial infant feeding, including that on labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding;
  • Unsuitable products, such as sweetened condensed milk, should not be promoted for babies;
  • Manufacturers and distributors should comply with the Code's provisions even if countries have not adopted laws or other measures.

Because there has been an inability in Canada to legally enforce and uphold the principles within the WHO Code, there has been a profound effect on the outcomes for health promotion as it relates to infant feeding practices. Government and public health budgets cannot compare or compete with the advertising measures adopted by large corporations that produce infant feeding products. This results in a disproportionate exposure of information and representation of infant formula products in the media and the creation of a formula feeding culture.

Additionally, the non-compliance to the WHO Code regulations by infant formula companies results in the distribution of free formula, free related products, and aggressive marketing to prenatal audiences without the awareness by parents of the effect of this marketing. Informed decision making becomes difficult for parents under these conditions as the advertising of products often can mimic scientific information, making objective decisions difficult.

Successful breastfeeding is highly vulnerable to brief episodes of formula use, resulting in premature weaning when this had not been the parent’s intention. Lower income populations may be at greater risk of the consequences of aggressive marketing since free formula and product giveaways may have a greater attraction for these groups.

In 1991, WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI). This initiative is a global effort to implement practices that protect, promote, and support breastfeeding, including compliance of the organization with the standards of the Code.

The Breastfeeding Workgroup would like to see more organizations receive BFHI designation so that the public can be assured that the information they receive from hospitals, health units, and community health centres will be free of the influence of marketing. To this end, the Workgroup’s position paper will be used as a resource in policy development, staff education, and resource development as organizations work to implement the standards of the BFHI.

This position paper will be presented to OPHA members for approval at the Annual General Meeting; 4:00 p.m. on Tuesday, September 28th at the Courtyard Marriott.

 

 

References

[1] Tasnim Nathoo, Aleck Ostry. 2009. The One Best Way?: Breastfeeding History, Politics, and Policy in Canada. Wilfrid Laurier University Press.

[2] World Health Organization. 1981. International Code of Marketing of Breast-milk Substitutes [PDF]. Geneva: World Health Organization