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The International Code:

Yesterday… and Today

Juanita Jauer Steichen,

MA, IBCLC

Hét Borstvoedingcongres September 25, 2014 Willem Bartels van der Kooi, 1826

Musée Frison, Leeuwarden, Pays-Bas

Facebook : Photos et documents d'allaitement à travers les âges

SBO September 2014 J Jauer Steichen

Declaration of Competing Interest

I hereby declare that I have no financial links

of any kind with fabricants or distributors of

breastmilk substitutes, or accessories for

breastfeeding.

I have no actual or potential competing interests

or affiliations in relation to my presentation on

this programme.

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Where did the Code come from?

How does it concern us?

Why is the Code important to breastfeeding?

Why is the Code often misunderstood?

How do ethics and conflict of interest apply?

A historical perspective …

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1974: Nestlé Kills Babies

1,5 million infant deaths

per yearare directlylinked to

not breastfeeding

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1977: The Boycott


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1978 Senator Edward Kennedy calls for Senate

hearings on the unethical marketing practices

of the babymilk industry in developing

countries and directly cross-examined Nestlé

http://www.youtube.com/watch?v=1-_yitXcHU0Clip taken from the 1984 BBC/Baby Milk Action Film When Breasts are Bad for Business

Can a product which requires clean

water, good sanitation, adequate family

income and a literate parent to follow

printed instructions, be properly and

safely used in areas where water is

contaminated, sewage runs through the

streets, poverty is severe and illiteracy is

high?


1979

• Ist OMS/UNICEF Meeting on

Infant & Young Child Feeding

•Infant Babyfood Action Network

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1981 WHA34.22

Aim:

to “contribute to the provision of safe and

adequate nutrition for infants,

by the protection and promotion of breastfeeding,

and by ensuring the proper use of breastmilk

substitutes, when these are necessary, on the

basis of adequate information,

and through appropriate marketing and

distribution.”


1989

The Ten Steps to Successful Breastfeeding

�The Convention of the Rights of

the Child:

�the right to optimal infant feeding

and objective information

provided to parents

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The Innocenti Declaration 1990• Nominate national breastfeeding coordinator &

committee

• Implementation in maternities of the Ten Steps

• Implementation of the Code

• Maternity protection at work

Recommendations

Exclusive breastfeeding for 4 to 6 months

Breastfeeding

for 2 years or more


1991

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World Alliance for Breastfeeding Action

1991


1992

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2002

International

Code

and

subsequent

WHA

Resolutions

• Global Strategy for Infant

& Young Child Feeding

Innocenti Declaration

Codex

Alimentarius• Millenium

Goals…

• World

Breastfeeding

Week

Baby-Friendly

Hospital Initiative


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What is the Code?

• a minimum requirement to protect, promote

and support appropriate infant and young

child feeding practices.

• A set of basic rules for ethical marketing

practices.



• The Code advocates that babies be breastfed.

• If babies are not breastfed, for whatever

reason, the Code also advocates that they be

fed safely on the best available nutritional

alternative.

• Breast-milk substitutes should be available

when needed, but not be promoted.

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The Code protects:

• ALL babies - breastfed or not -

by protecting breastfeeding and

making formula feeding as safe

as possible

•Parents and everyone who

takes care of babies

•Healthcare professionals


WHA

55.25

(2002)WHA

(2005)

WHA

58.32

(2005)WHA

49.95

(1996)

WHA

54.20

(2001) WHA

45.34

(1992)

WHA

47.50

(1994)WHA

41.11

(1988)

WHA

43.30

(1990)

WHA

39.28

(1986)

WHA

37.30

(1984)

WHA

35.26

(1982)

WHA

61.20

(2008)

WHA

34.22

(1981)WHA

33.2

(1980)

It is not just the Code – the relevant World

Health Assembly Resolutions

are equally important!

Marketing practices of

the babyfood industry

Quality of food

products

Infant and young child

nutrition

Conflict of interest

WHA

65.60

(2012)WHA

63.23

(2010)

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The Code applies to the marketing and related

practices of the following products:

• breast-milk substitutes, including infant formula;

• other milk products, foods and beverages, including

bottle-fed complementary foods and follow-on milks;

• feeding bottles, and teats.

• It also applies to their quality and availability, and to

information concerning their use.


Code Basics

• no advertising of breastmilk substitutes, feedingbottles and teats

• no free samples to mothers

• no promotion in healthcare facilities, including no free or low-cost formula

• no company personnel to contact mothers directly

• no gifts or personal samples to health workers

• health workers should never pass samples on to

mothers

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• no pictures of infants or words idealisingartificial feeding, on the labels of the products;

• information to health workers should bescientific and factual;

• information on artificial feeding, including thaton labels, should explain the benefits and superiority of breastfeeding and the dangers

associated with artificial feeding.


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Follow-on and Growth Milks

VIOLATION


• 1986 WHA 39.28

• the practice of

providing infants

with follow-up milks

is not necessary

• October 2013

‘Growing-up’ formula:

No additional value to

a balanced diet, says

EFSA

Science investigates industry allegations

and confirms Code resolution

25 years later!!

http://www.efsa.europa.eu/en/press/news/131025.htm

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Example of inadequate

Instructions for safe preparation of powdered formula


Preparation instructions

do not meet WHO

recommendations for

reducing the risk of

pathological bacteria.

IBFAN works actively to

reinforce adequate

labelling under the Code

(WHA 58.32 2005)


This brand of formula was recalled in

August 2012 because of the

presence of dangerous bacteria.

Again, preparation instructions do not

meet WHO recommendations for

reducing the risk of pathological bacteria.

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�No advertising or promotional sales to the general public of products

under the scope of the Code

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9,000,000,000 $US

9,000,000,000 $US


Important:

It’s not the product,

but the ethics….

Any activity which undermines

breastfeeding also violates the

aim and spirit of the Code.

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SBO September 2014 J Jauer Steichen 15 juli 2014

Puzzel cadeau, rechtstreeks aan peuter gegeven

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"Article 5.3 There should be no advertising or

other form of promotion to the general public

of products within the scope of this Code.

(WHO International Code of Marketing of

Breast-milk Substitutes)


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So what’s the problem with

bottles anyway?

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The (original) Medela Dilemma


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Interpreting the Code….

• Human nature tries to find ways to justify

actions and interpreting ethics can be

tempting….

• It can be very hard to give up relations with a

product!


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The (continuing) Medela Dilemma

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With Calma - the ideal breastmilk teat –

your baby is on the safe side


Welcome to the Dark Side…

Calma - het unieke voedingssysteem voor uw

baby

Calma is ideaal voor moeders die op zoek zijn

naar een oplossing om hun baby moedermelk

te voeden.

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Ga of ben jij bevallen tijdens de Wereld

Borstvoeding Week (28 september t/m 6

oktober) dan heeft Medela een leuke actie

opgezet voor jou!

Medela verzamelt graag geboortekaartjes!

http://www.medela.com/BX/nl/breastfeeding/about-medela/Medela-Worldbreastfeedingweek.html

• But what about articles not under the Code?

• Let us consider the scope of the Code

•• not only in its defined limits

• but in the spirit underlying the very essence of the Code:

• The protection, support and promotion of breastfeeding

• …especially in regard to marketing


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Ethics and Conflict of Interest

WHA resolutions on infant and young child nutrition caution against conflict of interest:

– caution in accepting financial support for health professionals working in infant and young child health which may create conflict of interest.

– The need to avoid conflicts of interest is repeated in 2005 and expanded to cover health programmes.

– It was reiterated in the 2008 resolution within the context of Code

– May 2012 Resolution WHA 65.6 calls for specific conflicts of interest safeguards for policy development and implementation of nutrition programmes.



December 2013

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Say it

with

Chocolate!

J Jauer Steichen

Conference, seminars, workshops or

other meetings that deal with any

aspect of infant and young

child health and nutrition should not be

financially or materially sponsored in

any way, directly or indirectly by

companies that are engaged in the

production, marketing or distribution of

baby milks, foods or products

represented to be used for infant or

young child feeding.

Position Statement on Sponsorship and Conflicts of interest

72

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Just say

NO!

Choosing your bed partners….beyond the Code

• McDonald’s ?

• Coca Cola or Pepsi ?

• Perrier or Volvic or ……?

• Pampers?

• Mustela?

• Baby clothes / breastfeeding clothes?


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http://www.borstvoedingsraad.nl/siteAssets/PDF/Instru

ment%20weegpunten%20sponsoring.pdf

www.borstvoedingsraad.nl


http://www.borstvoedingsraad.nl/siteAssets/PDF/Instrument%20weegpunten%20sponsoring.pdf

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We all know breast is best…..

Although sometimes fighting for the Code

feels like going….


…from breast to wurst!

Thank you!

Art

ist:

Nik

ola

us

He

ide

lba

ch

Documents

The International Code - Borstvoeding.nl · The International Code: Yesterday… and Today Juanita Jauer Steichen, MA, IBCLC ... Facebook: Photos et documents d'allaitement à travers