Report from the Board:
LLLI and the World Health Organization International Code of Marketing
of Breast Milk Substitutes
Rachel O’Leary
LLLI Board of Directors
From: LEAVEN, Vol. 40 No. 2, April-May 2004, pp. 26, 46.
In May 2004, two LLL Leaders
will be standing up at the World Health Assembly (WHA) to talk to the
governments of the world. In a skyscraper by the lake in Geneva, Switzerland,
our representatives will talk about the importance of waiting to offer
babies family foods until around the middle of the first year of life
and explain how many mothers enjoy breastfeeding their babies exclusively
for six months. Listening to this LLLI statement will be senior officials
from health departments of the 192 member states. Our contribution will
add to their understanding of the importance of breastfeeding as they
deliberate on the resolutions before them.
Who’s WHO?
Every two years, the World
Health Assembly (WHA) decides on policies, programs, and budget priorities
for action by the World Health Organization (WHO), an agency of the
United Nations system. (Editor’s note: In the context of the United
Nations, agencies are “…autonomous organizations working with
the United Nations and each other through the coordinating machinery
of the [United Nations’] Economic and Social Council.”) The
WHO secretariat is headed by the Director-General, currently Dr. Lee
Jong-Wook. In addition to staff in the WHO headquarters in Geneva, there
are WHO regional offices in Africa (Brazzaville, Republic of Congo),
Europe (Copenhagen, Denmark), Southeast Asia (New Delhi, India), and
the Americas/Pan-American Health Organization (Washington DC, USA).
The resolutions that are passed this year will determine how the WHO
budget is spent all over the world, as well as which programs will be
prioritized. It will also affect how member states use their health
budgets, influencing their legislation and priorities.
Mothers’ Voices Heard
In the Corridors of Power
Breastfeeding is always an
important topic on the agenda at the WHA and a resolution is normally
passed every two years in support of breastfeeding. As a nongovernmental
organization (NGO) in official working relations with the World Health
Organization, La Leche League International can help to influence these
decisions that affect the lives and health of so many babies and their
mothers worldwide.
Others Will Speak, too
LLLI is one of many NGOs
who may speak at the World Health Assembly. Also speaking up for breastfeeding
are representatives of the International Baby Food Action Network (IBFAN)
and the International Lactation Consultants Association (ILCA). Among
the others are groups representing the artificial feeding industry,
whose interests are very different from ours. Networking and lobbying
are intense throughout the days of the Assembly. Every sentence of a
proposed resolution is hotly debated, since every sentence can affect
infant feeding throughout the world. A small change in the wording can
mean more customers for the artificial feeding corporations or more
mothers enabled to breastfeed.
Development of the International
Code
The first and most important
measure passed by the WHA to support and protect breastfeeding was the
International Code of Marketing of Breast Milk Substitutes, passed in
1981. Health professionals were concerned about the increasing number
of baby deaths from diarrhea and vomiting they saw when working in countries
without safe water supplies. They pressured the World Health Organization
to draw up a code to regulate the activities of firms that market artificial
feeding products. The Code covers marketing and promotion, saying that
marketing of artificial feeding products should not undermine breastfeeding.
The Code is designed to protect bottle-fed babies also—one section
states that formula and bottles must be available for those babies who
need them, and another section ensures the quality of formula.
Some campaigners have remarked
that the International Code is not a perfect instrument. In some parts
it reflects the influences of the many different interests involved,
with wording that is open to interpretation or deliberately vague. Every
two years, the World Health Assembly passes a resolution that supports
the Code and clarifies an aspect of it. These are some examples of subsequent
WHA Resolutions relevant to infant feeding:
• Follow-up (follow-on) milk is covered by the Code
• Internet advertising is promotion
The Code remains a vital tool to safeguard babies’ health.
How Can We Use the Code to
Help Us In Our LLL Work?
The LLLI Board of Directors
made it a policy to fully support the International Code in 1981. LLLI
implements this policy in a variety of ways, such as: by ensuring that
advertising in our publications adheres to the Code; by accepting exhibits
at LLLI events that adhere to the Code; by taking care that our relationships
with commercial organizations follow the aim of the Code. In these ways,
the International Code helps us to ensure that our message is not watered
down or undermined by promotion of artificial feeding products.
Request to Leaders
In future issues of Leaven,
we plan to study how the Code helps Leaders to carry out our LLL work
in different parts of the world. In 24 countries, all the measures of
the Code are law. Leaders who live in these countries are encouraged
to please tell us how the laws help mothers in your countries. In 31
countries, many provisions of the Code are law; 23 countries have implemented
it as a policy or voluntary measure, and 21 countries have a few of
the Code’s provisions as law. Leaders in these countries, please
tell us how these laws and regulations help you to help mothers and
babies. Are the laws enforced? What effects of these laws do you hear
about when you talk with mothers?
In 17 countries, some provisions
are voluntary. In 30 countries, measures have been drafted but not yet
approved. In 27 countries, possibilities for legislation are being studied,
and in 11 countries no action has been taken. We want Leaders in these
countries, please consider how it would help your work if there were
laws to stop the promotion of artificial feeding products. Can you see
any effects of the Code on the promotion of artificial feeding in your
part of the world?
Please write to Rachel O’Leary
roleary at llli.org (email) or at 9 The Paddocks, Burwell, Cambs CB5 0HQ,
Great Britain.
Useful Reading
Armstrong, H. & Sokol,
E. The International Code of Marketing of Breast-Milk Substitutes:
What It Means for Mothers and Babies World-Wide. Raleigh, NC: International
Lactation Consultant Association (ILCA), 2001.
Baumslag, N. & Michels, D.L. Milk, Money and Madness, The Culture
and Politics of Breastfeeding. Weston, MA: National Alliance for
Breastfeeding Advocacy (NABA),1995.
Cadwell, K. & Turner-Maffei, C. Reclaiming Breastfeeding for
the US: Protection, Promotion and Support. Boston: Jones and Bartlett,
2002.
Chetley, A. & Allain, A. Protecting Infant Health, A Health Workers’
Guide to the International Code of Marketing of Breast Milk Substitutes.
Penang, Malaysia: International Baby Food Action Network (IBFAN), 2002.
Devereux, A. The WHO code—a primer for Leaders. LEAVEN 1999 Apr-May;
35(2):26.
Global Strategy for Infant and Young Child Feeding. Singapore: World
Health Organization, 2003.
Leaders and the WHO Code. Leaven 1999 Apr-May; 35(2):47-48.
Palmer, G. The Politics of Breastfeeding. Pandora (Rivers Oram),
1993.
State of the Code by Country 2001. IBFAN, International Code Documentation
Centre, www.ibfan.org
Walker, M. Marketing of infant formula: The wolf in sheep’s clothing.
BREASTFEEDING ABSTRACTS 2003 Aug; 22 (4).
Walker, M. Selling Out Mothers and Babies, Marketing of Breast Milk
Substitutes in the USA. Weston, MA: NABA REAL, 2001.
www.who.int/en/
www.who.int/nut/documents/code_english.PDF
International Code of Marketing
of Breastmilk Substitutes
LLLI fully supports the WHO
International Code of Marketing of Breastmilk Substitutes and reaffirms
the stand taken by the LLLI Board of Directors in 1981 and 1988.
LLLI Policies and Standing
Rules “WHO Code,” 1981, 1988; revised Oct 1993
What does the Code cover?
The Code covers marketing and related practices for the following products:
breast milk substitutes, including infant formula; other milk products,
foods and beverages when marketed as replacements, partial or total,
for breast milk; feeding bottles and teats.
Products covered by the Code are referred to as being within “the
scope of the code.”
The main points of the International Code are:
• No promotion of all these products to the public.
• No free samples to mothers,
• No promotion in health care facilities, including no free or
low-cost formula.
• No company representatives to contact mothers.
• No gifts or personal samples to health workers (including volunteers).
• Labels—clear, accurate information—no words or pictures
idealizing artificial feeding—no pictures of infants on labels—appropriate
language for the country or area where it is sold
• Information to health workers must be scientific and factual.
• All information on artificial feeding must explain the benefits
and superiority of breastfeeding, and the costs and hazards associated
with artificial feeding
• Unsuitable products, such as sweetened condensed milk, should
not be promoted for babies.
• No promotion of complementary foods before six months (clarified
in the Global Strategy for Infant and Young Child Feeding).
• Governments are responsible for implementing this Code by national
legislation, regulations, etc., as locally appropriate.
• Manufacturers and distributors should comply with the Code’s
provisions even if countries have not acted to implement the Code as
law.
• Nongovernmental organizations, professional groups, institutions,
and concerned individuals report activities incompatible with the aims
of the Code to companies and governments for appropriate action.
For full wording of the International Code, see LLLI Policies and Standing
Rules Appendix 33, or www.who.int/nut/documents/code_english.PDF
Page last edited Sun Oct 14 09:32:03 UTC 2007.
