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Leaders and the WHO Code

From: LEAVEN, Vol. 35 No. 2, April-May 1999, pp. 47-48

As Leaders work with mothers, questions may arise about our role in relation to the International Code of Marketing of Breast Milk Substitutes as well as any cooperative action LLL might enter into. The following are some real-life examples in which Leaders question their involvement in Code issues.

I am not sure how or if the Leaders in this Area should work to promote the WHO Code.

The focus of a Leader's work is the mission of LLLI. The Code deals with international marketing issues. However, as Leaders go about their daily work of helping mothers breastfeed their babies, they will often find that they touch on issues related to the Code. Therefore it is helpful if each Leader:

  • understands that in Code terms, each Leader can fit under the definition of the health system, because she is engaged indirectly in health care for mothers, infants and pregnant women, and that she could consider herself a voluntary, unpaid worker according to Code definitions.
  • ensures that no advertising of products under the Scope of the Code appears at Group Meetings, in telephone helping situations or in materials she distributes. Much of the information about infant feeding distributed outside LLL is not in compliance with the Code. Books, of course, may mention artificial feeding but products should not be named. You can be confident that LLLI publications as well as books included in the LLLI Bibliography comply with the Code.

There is a maternity hospital in our city where the staff adheres closely to the Code in its policies and patient care. I think it is important that the mothers in our Group know about this hospital and the support it offers breastfeeding. Is it appropriate for me to hand out their brochures at our Series Meetings?

This is not exactly a Code issue. Traditionally, LLL Leaders have been discouraged from recommending a specific hospital or doctor. Mothers may have their own preferences, such as a hospital close to their home or one where their health care provider has privileges. They may also prefer a birth center or home birth.

A Leader can encourage women to ask their health care providers and hospital staff about maternity and breastfeeding policies so that they can make informed choices. A Leader can also encourage mothers to share information and personal experiences. A mother may speak positively about her breastfeeding experience at the hospital that supports the Code.

In the Group discussion of birthing alternatives, the Leader could mention that LLLI supports the Code as does this particular hospital. However, care must be taken to avoid the appearance that LLL endorses the hospital over others in the area. Distributing brochures during discussion time could well be interpreted as endorsement and therefore, in most cases, would not be appropriate. If the Group regularly makes brochures available on a display table at Group meetings, the hospital's brochures could be displayed there. Check with your local support person to see if there are any Area or Affiliate restrictions on displays at Group meetings.

Does the Code prevent women from getting information about formula feeding?

No, it is important that objective information be given to any mother who needs it, but without advertising of particular brands and without provision of samples of free or subsidized supplies through the health care system. Failure to appreciate this fact can lead to serious misunderstanding of the purpose of the Code by health care providers and consumers. Leaders carry out this provision of the Code by referring a mother to her doctor or other health care provider if she needs information about artificial feeding.

Putting the WHO Code into effect at a national level through legislation or enforceable regulations is very important. Having a code in place that would protect all mothers against the unethical promotion of breast milk substitutes would make mother-to-mother breastfeeding support and the work of LLL Leaders much easier and more effective. The 11 articles that are part of the WHO Code seek to regulate the marketing of breast milk substitutes, bottles and teats and apply primarily to the actions of manufacturers and distributors, but also to health care providers and others, including LLL Leaders.

Leaders have been invited to represent LLL as part of the audience to hear a presentation on breastfeeding by a pediatric research fellow. We now find that his research grant came from a formula company. Should we attend?

Each Leader must decide for herself if her principles permit her to attend a function which is partially paid for by profit made from infants who are not breastfed. A decision such as this can be difficult. Some Leaders may choose not to attend because they believe being present would lend support to the formula company. Others may decide to attend so they know first hand what is being said in case this research is widely publicized and mothers ask questions about it. Each Leader must weigh the pros and cons carefully.

Consider a major event that includes formula companies among the sponsors. Leaders question whether or not LLL should be represented with an exhibit. If LLL did not have a presence at that event, the audience would receive all their breastfeeding information through materials provided by companies that manufacture formula.

In all cases, LLL and its representatives do not accept funds from formula companies, even when that funding would make it easier for LLL to participate in the event.

A cosmetic company wants to sponsor our LLL exhibit at a local health fair. A mother in our Group has heard that this company manufactures infant formula in another country. What should we do?

The responsible course is to avoid making a decision based on what a mother "has heard." The Leaders should ask the company representative directly about any connection with infant formula manufacturing anywhere in the world.

If the company is connected in any way to infant formula manufacturing, then LLL involvement with them at any level is inappropriate according to LLLI Policies and Standing Rules. This is another example of the way that LLLI policy supports the Code.

Because of the multinational nature of many companies today and the variety of business practices they engage in, a company could work in compliance with the Code in one country, yet violate the Code somewhere else. It may not always be possible for a Leader to unravel all of the connections a company may have. However, it is important for a Leader to make every effort to do so because if LLL accepts support from a company that manufactures infant formula, the company may well claim this as evidence of their support for breastfeeding despite their unethical marketing practices in other parts of the world.

A formula company manufactures a supplemental milk product for nursing mothers under a separate brand name. They are keen to supply the pregnant and nursing mothers in our Group with samples. Should we allow this?

Developing supplemental milk products for breastfeeding mothers allows formula companies to associate themselves with breastfeeding in a seemingly positive way. At the same time, it gives them the opportunity to reach these mothers through doctors, hospitals and perhaps even LLL Groups, who would never give out samples of infant formula. They will probably try to contact these mothers directly in some way, perhaps with a survey to evaluate the product. The next step would be to promote their brand of formula to these mothers. Their hope is that mothers who give up breastfeeding will have a favorable opinion about the company, perhaps influenced by the association with LLL.

Promoting the idea that mothers need "special foods" in order to breastfeed can be a subtle way to convince mothers that breastfeeding is "too much trouble." An LLL Group should not become involved in this kind of promotional effort by accepting samples of a product like this.

The LLLI Board of Directors voted to support the WHO Code on three separate occasions over the past 18 years. Leaders around the world have been strong proponents of the Code for many years. Many have seen first hand the devastating effects of unethical marketing of infant formula. Other Leaders may not be as familiar with some of the situations described in this article. As an international organization, LLLI wants all Leaders to be fully informed and aware of what is happening worldwide.

Where can I find more information about the International Code of Marketing of Breast Milk Substitutes?

LLLI Policies and Standing Rules -Appendices 32, 33 and 34

International Baby Food Action Network at*

Protecting Infant Health, a Health Worker's Guide to the International Code of Marketing of Breast Milk Substitutes, 8th edition. IBFAN, Penang, Malaysia, 1996. Available from LLLI, No.3096, $12.95 (US).

Baby Friendly Mother Friendly edited by Susan Murray; available from LLLI, No. 3281, $23 (US).

* This address updated 11/17/06

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