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Implementation of the WHO International Code

Norma Escobar
Wilmington NC USA
From: LEAVEN, Vol. 42 No. 1, February-March 2006, pp. 14-5.

In June of 2004 a message went out to La Leche League Leaders through the LLLI News email list. It caught my attention despite my first intention to scan and delete it. It was an invitation to participate as representative of La Leche League International in a course on the implementation of the WHO (World Heath Organization) International Code of Marketing of Breast Milk Substitutes to be held in Penang, Malaysia, September 20-28, 2004. World travel, as well as new opportunities to learn and share, appealed to me and I sent the requisite 250-word essay along with my curriculum vitae to Rebecca Magalhes at LLLI.

Little did I know what my decision to accept was going to mean when I received Rebecca's reply email saying that I had been selected to attend. Where was Penang? I didn't know it would take two days and five airports to get there! Malaysia is as far away from Wilmington, North Carolina, USA as you can get. If I had travelled any farther around the world, I would have been on my way back home. However, I was committed. With some trepidation, I began the necessary plans to make this trip the adventure of a lifetime.

I knew I would encounter new ideas but I had no idea how much I had to learn. Although I had been a Leader for 10 years and a lactation consultant for two, I was to discover how little I really knew about the "Code."

We started the discussion with an assessment of background knowledge. Here are some answers from the assessment (For more information on what's behind the answers, see page 15.):

  1. The International Code of Marketing of Breast Milk Substitutes is voluntary in all countries that voted for it in 1981.
  2. Countries should enact as law all parts of the Code, and not simply those parts that best fit with their customs and cultures.
  3. The Code applies to industrialized and developing countries.
  4. The Code applies to formula and other human milk substitutes, and also to bottles and teats.
  5. The Code allows the sale of products under its scope.
  6. Where water and sanitation, food supply, and education are adequate, formula feeding is inferior to breastfeeding.

What became truly alarming to me was that the Code is an important part of the entire breastfeeding environment and, as an LLL Leader, I am responsible for knowing about it and how it influences mothers in their decisions on how to feed their baby.

After attending this training, I hope to be able to translate the very legal sounding verbiage into something all Leaders can use. If you are interested in finding out more, I invite you to join an email workgroup on the Community Network called "Artificial Baby Milks." We need as much participation from Leaders as possible.

Why is this Code work so important? Anneleis Allain, one of the course instructors and the Director of the International Code Documentation Center, explained it to us in this way:

There is a river. As you look at the river you are shocked to see that there are babies floating by and you quickly decide to save them by pulling them out of the water one by one. Soon there are so many babies you realize you can't do it all by yourself. You call your friends to come help you save these babies. Together, you recruit and train new helpers as fast as you can and at a great cost. We are working very hard and investing our resources in order to pluck as many babies as we can out of the water. Yet we are still not making much headway. It just seems that for every baby we save, more are floating downstream. Then someone looks upstream. Upstream is a person. Horrified, we realize this person is throwing babies into the water faster than any of us, even working together, can save them! The person upstream represents the manufacturer and distributor of any product that through its marketing strategies undermines breastfeeding. This person has to be stopped so we can continue our work without being overwhelmed by the added burden of these actions on mothers and society.

As Leaders we have seen the results of unchecked advertising of artificial feeding products. Many women have come to believe that their milk is easily replaceable, insignificant, insufficient, and in some cases, even dangerous. What can we do? So many of us already do so much! It may be overwhelming to think of what needs to be done to protect breastfeeding and the mother-baby dyad, But think of what we already are doing as Leaders. We are taking small but important steps, leading meetings, talking to mothers, and changing things one baby at a time.

Yet there is one other thing that is important for us as LLL Leaders: we need to know the Code and how it applies to us. Then, if we wish, as individuals, we can also start looking for violations (and most of us don't have to look very hard for violations; they may even come to our door step!) and report them to our country's IBFAN (International Baby Food Action Network) group. In the United States this is NABA (National Alliance for Breastfeeding Advocacy). Both have Web sites where violations can be reported.

I've been writing email letters to complain to magazines to which I subscribe about their marketing practices. Many publishers don't even know there is a Code that regulates the marketing of breast milk substitutes as well as bottles, nipples, and weaning foods. Pressure from consumers can go a long way. As an example, Lamaze magazine has eliminated all formula and bottle advertising in its publications because of pressure from individuals.

Code Assessment Questionnaire
What's behind the answers?

  1. Answer: The International Code of Marketing of Breast Milk Substitutes is voluntary in all countries that voted for it in 1981.

    The International Code was adopted as a recommendation of the World Health Assembly (WHA), but is not legally binding on Member States. However, as a WHO recommendation, Member States may not ignore the International Code altogether as it expresses the collective judgment of the membership of the WHO. The International Code and subsequent WHA Resolutions (which clarify the International Code and try to keep pace with marketing developments and scientific knowledge) carry moral and professional force and should have persuasive authority.

  2. Answer: Countries should enact as law all parts of the Code, and not simply those parts that best fit with their customs and cultures.

    WHA Resolution 34.22 (1981) urges Member States to give full and unanimous support to the implementation of the provisions of the International Code in its entirety and to translate the International Code into national legislation, regulations, or other suitable measures.

    Adoption and adherence to the International Code is a minimum requirement. At the national level, the International Code may be strengthened and modified to fit national situations.

  3. Answer: The Code applies to industrialized and developing countries.

    All Member States of the World Health Organization (WHO) should implement the Code. Breastfeeding is a universal issue and should be protected all over the world.

  4. Answer: The Code applies to formula and other human milk substitutes, and also to bottles and teats.

    Article 2 of the Code states: The code applies to the marketing, and practices related thereto, of the following products: breast milk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable with or without modification for use as partial or total replacement of breast milk; feeding bottles and teats. It also applies to their quality and availability, and to information concerning their use.

  5. Answer: The Code allows the sale of products under its scope.

    The Code does not prohibit the sale of any products under its scope. It only prohibits certain marketing practices in relation to promotion and distribution.

  6. Answer: Where water and sanitation, food supply, and education are adequate, formula feeding is inferior to breastfeeding

    Human milk is the best food for babies as it contains all the necessary nutrients required for the growth and development of the child physically and mentally. Infant formula cannot match the quality of human milk, no matter how hard baby food companies try to match it. Artificially fed babies are more prone to severe respiratory infections, meningitis, earaches, eczema, cancer, diabetes, general malnutrition, diarrhea, and vomiting, etc.

You can learn more about the Code and report violations at the following Web sites: www.ibfan.org or www.naba-breastfeeding.org.

Author's Note: Please let me know if you have any questions or concerns about the Code. In order to make any education efforts relevant to our work as Leaders, I need to be aware of the actual scenarios with which we are confronted. Please contact:

Norma Escobar
3803 Providence Ct.
Wilmington, NC 28412 USA
(910) 392-1335
NORMESC at aol.com
Or you may wish to post to the Community Network "Artificial Baby Milks" discussion group.

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