“Knowledge serves no purpose if it is not spread around. As the poor get poorer and the rich get richer, an entrenched ignorance is kept in place through a culture created and maintained by commercial interests.” – Gabrielle Palmer, The Politics of Breastfeeding
The international WHO Code of marketing breastmilk substitutes reached its 33rd anniversary this week. This means that for 33 years the United States has failed to live up to international standards AND for 33 years infant formula corporations have successfully ignored the WHO Code. In addition, they have convinced over half of U.S. hospitals to serve as marketing shills for their products—distributing their marketing materials—-samples, coupons, booklets, and other ads-—in health care settings in a manner that is well-established to undermine women’s breastfeeding success and to have a negative impact on infant health. Quite simply, getting breastfeeding “advice” from a formula company in a form of a cute little booklet with a happy baby on the front is like getting nutrition “advice” from McDonald’s. It is not neutral or benign and it does not have the interests of mom and baby at heart, it is a skillful marketing tactic, nothing else. I have long repeated the Ban the Bags catchphrase: Doctors’ offices and hospitals should market health and nothing else. To be clear, I would consider all medication-sponsored posters, etc. to fall in same category, not just formula. Refusing to honor the WHO Code isn’t actually illegal, however. The US voted against the proposal in the first place—on the original signing of the Code there were 118 votes for the Code, one against (the United States!), and 3 abstentions. Eventually more than 160 countries participated in the WHO Code. When the United States did accept it, they adopted it as guidelines to distribute to large manufacturers. Providers should follow it, but they can actually can do what they want. UNICEF has a state of the code chart that breaks down which country does what with the Code. US is under the no action category along with a small handful of other countries that includes Somalia and Kazakhstan.
This issue is a systemic problem and it goes WAY beyond just the individual mom and her baby! Breastfeeding or not breastfeeding is actually a political and public health issue in the US, not simply a “personal choice.” Personal choice is the language American people and formula manufacturers love to use and it is a very, very successful manner of appealing the individualist nature of our culture, but in this case it is actually code for, “let huge multibillion dollar corporations exploit women at will and our health care providers will even help them do it!“
While the WHO code has no legal teeth in the US (it IS law in some other countries, but it was written in terms that allow national governments to make their own decisions about how/if to enforce or participate in it). It is still VERY important for health care providers and US distributors and marketers to be aware that their actions are out of sync with international guidelines and that they are in violation of international standards.
…breastfeeding, like all aspects of women’s lives, occurs in a context, a context that involves a variety of “circles of support” or lack thereof. Women don’t “fail” at breastfeeding because of personal flaws, society fails breastfeeding women and their babies every day through things like minimal maternity leave, no pumping rooms in workplaces, formula advertising and “gifts” in hospitals, formula company sponsorship of research and materials for doctors, the sexualization of breasts and objectification of women’s bodies, and so on and so forth. According to Milk, Money, and Madness (1995), “…infant formula sales comprise up to 50% of the total profits of Abbott Labs, an enormous pharmaceutical concern.” (p. 164) And the US government is the largest buyer of formula, paying for approximately 50% of all formula sold in the nation…