Reproduced from 'Essence' magazine
Volume 36, Number 4
Exclusively for ABA subscribers
August is Breastfeeding Awareness Month. The theme for 2000 was 'Breastfeeding: It's Your Right'. ABA strives to encourage every mother to believe that it is her right to breastfeed her baby, anytime and anywhere.
During Breastfeeding Awareness Month 2000, ABA focused on the positive initiatives that already exist within our communities - programs that aim to improve the facilities and conditions for breastfeeding women.
It is interesting and helpful to consider how other countries deal with these same important issues.
The WHO Code - 19 years on. A quick look at the rest of the world.
Isobel Williams, NMAA Breastfeeding Counsellor
Introduction
The World Health Organisation's International Code of Marketing of Breast Milk Substitutes (WHO Code) aims to protect and promote breastfeeding and to ensure that when breastmilk substitutes are necessary they are marketed, distributed and used appropriately. It came into being to protect the rights of babies to have their mothers' breastmilk and the rights of mothers to have their decision to breastfeed supported. The WHO Code was ratified in 1981 and the agreement signed by many countries around the world, including Australia. In Australia those aspects of the WHO Code relating to marketing of infant formula have been implemented through the Marketing in Australia of Infant Formula Agreement (MAIF Agreement). (More about the Australian situation will appear on this web site in the future - Ed)
Infant formula advertising does not give parents unbiased information: it is used by companies to increase their market share, that is increase the number of people using their product. All parents have the right to make an informed choice about the way they feed their babies. This is not possible if they can only rely on biased information from infant formula manufacturers.
'What makes a woman believe that she cannot breastfeed her baby is the constant undermining of her confidence by advertising.' Gill Wilcox UNICEF UK
In Australia, numerous breaches of the WHO Code are reported to NMAA each week, despite the Commonwealth Government's commitment to the promotion of breastfeeding and the self-regulatory model of implementation of the WHO Code. Australia is not alone in this. This article will take a quick look at different situations that are happening around the world.
Groups monitoring activities in other countries
The International Baby Food Action Network, IBFAN, was formed in 1979 and is now composed of more than 150 citizen groups in 94 countries around the world. IBFAN works to promote better child health and nutrition by promoting breastfeeding and eliminating inappropriate advertising of infant formula, bottles and teats. Baby Milk Action UK is an activist group with members around the world looking out for violations of the WHO Code. They write to companies, lobby politicians and provide information to mothers wishing to breastfeed.
Breastfeeding rates in other countries
Although figures for different countries are not complete, some samples of recent figures will be considered. In India the rate for exclusive breastfeeding until four months is 51% and combined breastfeeding to 24 months is 66%. In countries where there is a strong breastfeeding culture and mothers are supported in their choice to breastfeed the rates are high, eg Norway, Sweden, Denmark, Poland, Romania and Czech Republic. Where there is little support for breastfeeding mothers and where most of the information about infant feeding comes from the formula companies, the rates are much lower, eg Ireland, France and Scotland. In Britain the rate of breastfeeding has dropped to 21% by six months of age.
Breastfeeding rates in Norway are among the best in the world. This relates to the strong community support for breastfeeding mothers. Current maternity leave is for one year at 80% of pay or 46 weeks at full pay. Mothers who work and breastfeed are entitled to a two-hour break every day. Since 1970 the Norwegian Government has supported the right of a mother to breastfeed her baby and has encouraged mothers to breastfeed. Only two companies market infant formulas and they comply with the voluntary agreement by not promoting their products. Furthermore, the Norwegian Health Service is not flooded with promotional materials from formula companies; all mothers are aware of the benefits of breastfeeding and have access to support groups.
Medicalisation of infant food
We have started to see a disturbing trend in Australia with infant formula companies promoting formula designed to solve a medical problem. Concern has been expressed that these claims may be unsubstantiated (APMAIF 1999). Furthermore, promotion of these specifically designed formulas may lead to breastfeeding being undermined because parents become unnecessarily concerned about their babies' health, self-diagnose a problem and begin to use these products. For example, parents of unsettled babies are made aware of a special formula to 'fix' reflux and may inappropriately wean in order to use the product. This tactic is used overseas as well. In the UK a high-energy infant formula for 'failure-to-thrive' babies was promoted. No mention was made of the benefits of breastfeeding for these babies or if this formula may be harmful to babies without this problem. Soy-based infant formulas are promoted to parents who are vegetarian or who believe their baby has lactose intolerance. UK and New Zealand Health Departments state that soy milk should only be used in very specific situations and only on the advice of a health professional. In the UK only 2% of babies are fed soy milk formulas but in the USA 25% are fed soy milk. The USA has a much more active promotion of these formulas. The promotion of such specifically designed formulas may also encourage parents to seek their own solutions to what may be a serious undiagnosed medical problem simply by using a particular infant formula.
Water
Many infant formula manufacturers are now moving into the area of bottled water sales, advertising it as suitable for use with infants. The quality and purity of the water is emphasised, with one company in Colombia stating, 'If the bigger part of the bottle is water, why bother only about the milk?' Other slogans promoting water include: from Malaysia 'clean crystal clear water that is as pure and untainted as parental love from you' under a picture of a father bottle-feeding; and in Pakistan 'the perfect mothers' choice for baby's milk'. A major mineral water company has developed two new lines, one with low mineral content specially designed for infants and children and the other a low cost bottled water for the third world. This is clearly attempting to allay the concerns many have about the quality of water available in less developed countries. Prior to the introduction of this water in Pakistan the company ran 'awareness seminars' that claimed that the urban water supply and other bottled water was contaminated. Shortly after this there was a huge advertising campaign for the new bottled water. Billboards and leaflets with the slogan 'welcome to purity' appeared throughout Karachi. The head of the Lahore Water Supply Company was concerned that, 'These foreign companies are misleading the people to make money'. In Spain a company sold the water in ready-to-use feeding bottles and included a coupon for a free sample of infant formula.
Humanitarian Aid donations
While the issue of humanitarian aid is seen by many as an extremely emotive issue, it is also seen by some infant formula companies as a good opportunity for aggressive marketing of their products. The Ghanaian Ministry of Health received a letter from a marketing consultancy firm representing a US infant formula manufacturer. They asked the ministry to identify non-profit organisations to solicit free samples of the infant formula. They suggested that the formula would be distributed free of charge to children's hospitals, clinics and women's hospitals. As part of the project they offered to sponsor and conduct infant nutrition seminars. The most disturbing thing about the situation is that companies claim that they are only providing the aid after a request from the governments, yet they originally asked for the requests of aid to be made. This demonstrates that there are strategies in place to solicit these requests. Many tonnes of infant formula were sent to Albania for use in Kosovar despite the fact that most babies are breastfed. The formula was not requested. Breastfeeding protected the babies living in poor sanitary conditions. There are fears among the aid workers that this excessive amount of formula will be sold on the black market and in turn affect the breastfeeding rates and health of babies.
Lobbying of governments
In many countries including Sri Lanka, Ireland, South Africa, Zimbabwe, Pakistan and Uruguay, the infant formula companies lobby the governments to weaken the effectiveness of any legislation implementing the WHO Code and the marketing of infant formula. Included in the lobbying are threats to withdraw factories and thus increase unemployment in any country that does not listen to the lobbying. It has been reported that the companies usually do not follow through with these threats.
Progress in India
India has a population of 936 million with adult female literacy at only 38%. Only 81% of the population have access to safe water and a mere 29% to safe sanitation. One quarter of the world's population live in India and the paucity of safe water and sanitation put infants at great risk. The Indian Government passed a strong act, the 'Infant Milk Substitutes, Feeding Bottles and Infant Food Act' in 1992. This act is being used to bring about changes to policies and educate health workers to protect breastfeeding.
An example of a success story in India is the Sion Hospital in Mumbai, one of over 900 Baby Friendly Hospitals in India. This hospital cares for some of the poorest families in India and caters for the largest slum area in Asia. Up to 40% of babies born here are premature. Breastfeeding has increased the survival rate of infants from three out of ten to at least eight out of ten now surviving.
Advertising nutritional supplements for mothers is one way companies exploit mothers. In India mothers have access to a low cost nutritional diet from local food sources. Yet advertising claims about supplements place undue financial stress on families. A day's food for a mother may cost $3 per month, yet the supplement may cost $50 per month for a mother whose income is only $80 per month. The cans of supplement include coupons for free booklets that contain inappropriate advice about breastfeeding. Such poor information is likely to undermine breastfeeding.
In India the Academy of Paediatrics and the Federation of Obstetrics and Gynaecology Societies reject the idea of sponsorship from baby milk companies.
The Indian Ministry of Human Resources has launched a National Creche Fund to enable working mothers to have access to suitable child care and appropriate breastfeeding information. Currently India has 30,000 creches, yet needs 800,000.
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Dr Anand of the Baby Friendly Jaslok Hospital and Research Centre told Baby Milk Action
" If you do not allow a bottle to come between yourself and your child I am sure that you will be able to breastfeed. If you cannot, I will give up practising medicine."
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Conclusion
After 19 years some positive things are happening worldwide with appropriate promotion of artificial formula but we still have a long way to go. Food has been an important trading commodity for centuries. Huge transnational companies now have control of much of the world, their budgets bigger than many individual countries! Mothers have little or no resources to advertise the best product .... breastmilk. Yet companies are keen for us to spend our money with them. If they realise that we do not approve of their tactics in other countries they may change their policies. We can do something to demonstrate our belief that it's our right to breastfeed our babies.
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What can you do?
- Ask your local Group to run a discussion meeting on the WHO Code and how it applies in Australia.
- Look out for inappropriate advertising of infant formula in the media and report it to your local Counsellor.
- Report any health professional who offers you free samples, to your Branch WHO Code Advocate.
- Report any pharmacies who offer free samples, to your Branch WHO Code Advocate.
- When sending a report include details of incident: date of incident; product and/or company names; title and source of publication; copy of violation.
- Incident report forms are available from your local Group Leader or can be downloaded here. PDF format
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References
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