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