International Code of marketing of Breast-milk Substitutes was drafted by the World Health Organization as a result of the 1977 boycott of Nestle after their formula campaign killed millions of babies in third world countries. The Code’s main focus was to call for no advertising to the public and to distribute factual and ethical information to parents the code was signed by all nations in the early 1980′s when it was drafted & finally signed by the United States in the mid 1990′s.
WHOCode – related to the marketing & practices related to the marketing of the following:
breast-milk substitutes including infant formula, other milk products, food &beverages when marked (or represented) as full or partial substitute of breast-milk, feeding bottles and pacifiers & bottle nipples.
My abridged version of the code:
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No advertising of any of these products to the public
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No special displays, discount coupons, special sales for products within the code to consumer at retail level to induce sales
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No free samples to mothers or pregnant women, infants or children – including gifts or articles which may promote use of breast-milk substitutes or bottle-feeding
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No promotion of products in health care facilities, including the distribution of free or low-cost supplies – no posters, brochures or special displays in a health care setting
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No company sales representatives, in their business capacity, are to advise mothers, pregnant women directly or indirectly
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No gifts, personal samples or low-price sales to institutions, organizations or workers within the health care field
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No words, pictures or statements idealizing artificial feeding, no pictures of infants on labels for breast-milk feeding substitutes.
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Information on artificial infant feeding should clearly state the superiority of breast feeding & a clear advisement to only use at the advice of health care provider
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Unsuitable products (sweetened condensed milk, almond milk etc) should not be promoted for babies & be clearly marked as so – including no instructions on how to modify for the purpose of infant feeding
I believe in this code and I do wish both Canada and the United States {and other countries} would make this a law. It might seem extreme to some people, but this really is not about the choice for women using formula – this really isn’teven about formula itself – it is about the way formula is marketed every day, year after year which directly affects the breastfeeding rates of our country and the ability for women to make INFORMED decisions for infant feeding.
I have been wanting to write this post for some time but at first I was a bit conflicted on my feelings about the WHO Code and what it meant for all women. I have read the code over and over and tried to think about both “sides”{families who are breastfeeding and families who are formula feeding}because as you know I have used infant formula for my older children and my third child was exclusively breastfed for 10 months and is still continuing now {she is 18mo}.
One of the larger arguments that I have heard {or thought} against the WHO Code is that people should be able to choose for themselves and that we are not so easily swayed by advertising. Problem with this thinking is – we are easily swayed-by advertising< – it’s a truth. If that wasn’t true there would not be huge advertising campaigns for everything under the sun. If all companies were committed to fairness there would be no need for TheCanadian Code of Advertising Standards. The WHO Code just protects us further from companies who are ruthless in their inaccurate advertising.
I can only speak from my life experience –I live in a predominately white middle/upper class area and I have had many conversations with well educated women who still feel that infant formula is “just as good” as breast milk. Advertising has led them to believe this. Any way you look at the situation infant formula is not the same as breast milk. Never will be. Yes, infant formula itself is NOT evil or poison – not what I am saying, but as with any synthetic product it does come with some potential risks. Women should be able to make informed decisions and if advertising is telling them infant formula is just as good as breast milk they are not making an informed decision.
Advertising bottles and nipples are also against the WHO Code. There is no bottle or liner that is close to breastfeeding and just like with formula advertising, bottles use misleading statements on the packaging and advertising that would suggest it’s close to breastfeeding. Using statements like “deliver an experience closest to breastfeeding”, “closer to nature” ,and the “breast flow bottle” give an incorrect and misleading descriptions and sway women to think they are just as good as breastfeeding which is not true. They also come with their own risks& need to be clearly marked as such.
One of my biggest peeves against theinfant formula companies is not only their sneaky language but theirintense campaign for handing out free samples to anyone who is pregnant, just given birth or on some sort of list they get a hold of. Hospitals sending out samples, infant formula companies handing out ‘breastfeeding kits’ with formula samples and coupons, doctors handing out formula. What this message totally sells to the women(even subliminally) is “Hey we know you are SUPPOSED to breastfeed,but when that doesn’t work, when your milk doesn’t come in or driesup – here is your formula. I am not sure I can come up with abigger way to make a women lose confidence in her body. Free samples are so dangerous to the breastfeeding relationship because when that woman is up at 3 am with her 4 day old baby who is latched on for the 5th straight hour she is going to be so tempted to reach for that formula. That sample is sabotaging your confidence and your breastfeeding relationship.
You might be saying now, “What about those women who are not going to breastfeed and want the sample” -well, this affects you too. As you know formula is not cheap. The samples themselves are not cheap yet they are throwing them to anyone who has a child (sometimes to women who don’t have children) and anyone who is expecting a child. That’s a lot of money being handedout. Where do you think that money is coming from? I can guarantee you it is not the infant formula companies doing that out of the goodness of their hearts. It is compensated through the price of formula so you end up paying more. If the marketing of formula was not done so aggressively (or better yet, not at all) the cost could actually be more reasonable and for those families who have to use it or wish to use it – the would not be paying out of their butt for it.
Breastfeeding is normal< and I am tired of seeing women sabotaged left and right because of giant companies who wish to make lots of money. If you choose not to breastfeed you should be granted the right to make an informed decision and provided with the correct information.The WHO Code protects this right for all women and protects breastfeeding.
The WHO code has been signed & agreed on in both the United States And Canada (and other countries) although neither have yet made it a law.
The WHO Code is monitored by organizations in a variety of countries that are part of International Baby FoodAction Network (IBFAN). A standardform can be downloaded & sent to the organization that monitors the WHO Code in yourcountry:
- United States: National Alliance for Breastfeeding Advocacy (NABA). Violations can be sent through mail to NABA, 254 Conant Rd, Weston MA 02493 email:Marshalact@aol.com, along with the code watch form.
- Canada: INFACT Canada monitors the Code in Canada and has a form you can fill in on its website.
{ 17 comments… read them below or add one }
Great information and I am so glad you posted it. Now I understand more about it – you provide women with such great information, thank you for this.
I feel that women should be informed of ALL of thier options and as a mom to be that due to meds that are going to keep me healthy and allow me to be a better mom (yet they can hurt my baby) I feel isolated and judged when I tell people that I am not going to breastfeed. I agree, breast Milk is Best but I also feel that the judgement put on Moms choosing not to breastfeed is getting out of hand. There are instances where formula has saved babies lives, so why shouldn't that info be made available to moms. I don't believe that formula should be treated like cigarettes (no advertising, no samples etc) I just believe that companies should be given a guideline as to what they can actually claim on thier packaging and in thier advertising.Because every time I go to make a bottle of formula in public—particularly in an area where I’m surrounded by moms—I don;t want to get “the look”, which would make me feel like I am giving my child poison…instead, I want to feel like it was okay that I made a decision that was right for me and my baby.
Choices:
Thanks for your comment. I had hoped to make this clear in the post but perhaps i didnt. I understand the need for formula – it save my children too.
Breastmilk is normal & ideal but in our "un-perfect" world it is not always the BEST choice for ourselves or family – that is ok.
The WHO Code protects families who have to/choose to use formula because of inaccurate info & relentless undermining. It is not asking for formula to be removed from the shelves. And like the post said stopping the advertising & samples would drive down the cost of formula which would be a benefit.
The decision is right for you & your situation. I am heartbroken that you feel like you are going to be 'given the look' – that is not what i advocate for and that is not what the WHO Code is intended to do.
"Choices" brings up an excellent point: there ARE risks to breastfeeding under certain circumstances that have been withheld from us for various reasons. For instance, many of the drugs that we are told are "completely safe" for use while BFing are simple NOT. Even on Hale or LactMed's sites, they'll say things in their research sections about the meds being "most likely safe" or "relatively safe". You can't tell me that a study sample of 10 women/baby pairs, studied in the short term, are enough evidence to reassure me that taking darvocet after a c-section and nursing my baby exclusively is 100% safe.
Likewise, while studies have shown that breastfeeding can reduce the risk of breast cancer, other studies have shown that long-term nursing can increase your chance of bone loss and osteoporosis. We aren't informed of this very often, either.
I understand your points, but I just think there is too much hypocrisy and cherry-picking going on in this debate. Yes, breastfeeding is natural, but our modern lived are not. We are exposed to any number of toxins in our environment, poor diets, etc, that might be affecting our milk in ways we can't even imagine. Does that mean we shouldn't breastfeed? Of course not. But I think the risks of formula are no greater than the risks of nursing under certain circumstances. ((unless you are talking about the risks of contamination of products, in which case, every food we eat needs to carry warning on their ads – like the dairy and egg lobby, for example, shouldn't be allowed to advertise b/c they sometimes cause food poisoning or mad cow; or the risks of contaminated water, which I certainly agree needs to be mentioned, but that's an entirely different issue than WHO Code) Should our boobs be tattooed with messages like "may carry a 5% chance of not nourishing a child b/c of low milk supply"?
I honestly don't mean to be argumentative here, and I think you have every right to feel the way you do about WHO code. But I can't agree with the "risks of formula feeding" argument, because in the grand scheme of things, when used correctly, I don't believe formula carried truly significant risks.
You wisely said "even if you choose not to breastfeed you should be granted the right to make an informed decision and provided with the correct information." I agree with this 100%. This means no propaganda from either side, so no breastfeeding ads trying to urge you into nursing by scare tactics or quoting controversial, hypothetical studies (the one from Breastfeeding.com/The Bump talking about saving millions in healthcare costs comes to mind – Bartick's study was hardly rooted in strong science). The way things are now, the only way women can make a truly informed choice is to have a degree in research methodology, and that isn't really fair.
I also agree that we are impressionable and that advertising works, but the women you know who think formula is "just as good" may have done their own research and decided that making a decision based on observational studies isn't right for them. Anecdotally, they may have seen formula fed kids grow up just as healthy and smart as breastfed kids. It may not be the advertising that is affecting our POVs as much as our own personal experience and observations, you know?
FFF thanks so much for your comment – always love hearing your take on the subject!
I ABSOLUTELY agree with you on the propaganda from the breastfeeding side using scare tactics – i am so against those as well & feel they do more harm then good.
As far as the 'risks' i am talking about & what the formula companies need to make MORE aware of are the RISKS of not following directions for preparation & sterilization – not so much for the scare tactics brought forth by some bfing campaigns. (your tattoo comment made me spit out my water – so funny). There are HUGE risks for not following the correct preparations and serializations and these are things that don't have to be worried about as far as breastfeeding.
There are risks for bottle feeding that are not present for babies that feed at the breast. these risks should also be more known – whether that is formula or expressed breast milk in the bottle.
You are right that there are some women who may be making the decision that formula is just as good as breast milk based on observation but there are also women who think it is the same as breast milk based on advertising – i have spoken to those women. I have spoken to women who do not always follow preparations and sterilizations methods and think that is ok.
Thanks again for taking the time to comment ♥
I just wanted to address the Smoking issue since it has been brought up twice.
I DO NOT believe formula is like smoking – so not the same thing. Advertising on smoking was banned because they are HUGE money & no one could match them in an anti-smoking campaign.
Where the restrictions on advertising are the same is that formula companies are HUGE money & HUGE business. Breastfeeding is natural & therefore no HUGE business behind it.
Encouraging people to make the healthier choice (when it is a choice) needs to be protected & when that healthier alternative is not also out to make money (if that makes sense). The ban on advertising is not made to tie formula to smoking – it is used to balance out the message the public is receiving.
If no company was making $ on bottled water & all we had was like well water you would see the same ban on drinks like soda if they were advertising up the wazoo that it was just as good as water. Does that make sense?
natural does not have the money to compete with man-made business products. This code is not out to get 'formula' it is out to level the message between breastfeeding and the formula COMPANIES.
THANK YOU!!!!!
I remember when I had Glade, I came home with 8 packages of those ready measured formula samples and they sat in my cupboard for a year until I gave them to my friend who was using formula. I would get letters with coupons and samples. I hated it.
Now that I am storing breastmilk, I pulled out the old bottles the NICU gave me to store my milk in, and all over the bottles it says "Enfamil Formula". Uh, why, if not to screw with my head, would they need to print that all over a breastmilk storage bottle?!?
I really really love this post. So many people think that saying breast is best is just judging those that can't use the breast. What needs to be done is to truly have help for those that have issues breastfeeding, and then if they can't produce, the babies need to have donor milk available to use (a whole other topic haha) so they are still getting breastmilk, even if they need a little formula supplementation. So much money goes into formula advertising, and rarely, if ever, do you hear about donor milk, from either milk banks or milk shares or even just from a woman down the block from you.
So much needs to change. Thank you for this post. Thank you thank you thank you!!!
There are parts of the Code that I can 100% get behind. Like no samples. I am all for no samples.
BUT. What I do struggle with is the lack of information on formula options. I wanted to breastfeed. We tried everything to make it work but ended up using formula. When my husband and I went to figure out what formula to give our daughter, we wanted some information. We try to eat healthy, unprocessed food and try to choose organic when possible. We knew formula was not the best option, but we didn't have a choice, so at the very least we wanted the least bad option.
It was impossible to get any information. Every website we looked at just said that breast was best. Our doctor said breast was best. Our lactation consultant said breast was best. Books said breast was best. This we knew. But no one could tell us anything about the ingredients in formula or how to make an informed choice about which one was least bad.
While I realize that marketing is often not very helpful in this regard, I do think that the code and the pressure around breastfeeding has really resulted in a lack of good information about formula feeding. I am not saying that what I want is a label on my formula equating it to breastfeeding. I don't. I don't want more marketing messages that aren't true.
But when we talk about informed choice, I just have to share that for someone who wanted to breastfeed and couldn't, I was denied an informed choice about formula because of focus on pushing people to breastfeed.
Kathleen
Thank you for your comment. I would agree with you that more information needs to be available on how to choose the right formula – that information is lacking in abundance.
In my opinion though the WHO Code really wouldnt affect this in any way. it is not against the code to give factual and correct information regarding formula.
The past marketing of breastfeeding was a HUGE push back from the formula marketing and it was necessary at the time. now it is not to push that hard because i think you are right the slogan "breast is best"is everywhere <– a term i am not cool with. Breastfeeding advocacy needs to tone down a bit & seeing more breastfeeding advocacy groups (Like Best for Babes) who advocate for this is huge.
Thank you so much for sharing your view!
The WHO code is not about a lack of information to formula feeding moms. The advertising out there is not communicating information. It is advertising–designed to be persuasive! For example, many FF moms don't know that the store brand of formula is just as good as the name brand. Both are subject to the same regulations. I don't understand how the ability for formula complanies to advertise is beneficial to FF mothers. The formula company that has the best ads may not be the one that is the best choice for your baby, so why muddle up the flow of information with advertising?
Great post! Thanks for putting together this summary.
I continue to be confused by the logic that restricting advertising is somehow a judgment on formula feeding moms. If the marketing of OTC pain meds were restricted, would you feel judged for taking Tylenol to treat your headache? Of course not. Formula and bottles can be found at any corner store – marketing just leads to inflated prices and bogus "most like breastfeeding" claims.
@FFF I'm a bit baffled by your assertion that breastfeeding is associated with higher rates of osteoporosis. All of the research I have read on the topic suggests that women who breastfed have, as a group, higher bone density/lower rates of postmenopausal osteoporosis. One study here: http://www.medconnect.com.au/tabid/84/s15/Rheumatology/ct1/c334036/Pregnancy-and-Breastfeeding-May-Impact-Osteoporosis-Risk/Default.aspx
@Devan
Thanks for your response. I think we are on the same page with a lot of this.
I just want to clarify though, that it is not so much the actual substance of the code that concerns me. I don't take issue with the points of the code. It is the impression that the code gives (as you acknowledge, in terms of it giving the impression that formula is a 'controlled substance' when it is not the same as tobacco, for example.) coupled with over zealous breastfeeding promotion that I feel has lead to the lack of information. It's not that I want to be marketed to. But I do think the ban on marketing has had an impact on the access to information. Marketing and information are not the same thing, but they can look like each other. So with all the animosity to formula marketing comes animosity to formula information. I don't know what the solution is though.
@Kate/Lactivista-
This is an excerpt from an academic paper, 'The Politics of Breastfeeding" by Jules Law. The studies are older, but I found this rather alarming:
"A 1986 study noted that women's loss of "bone mass" was directly proportionate to the length of their terms of lactation and that the difference was "significant" at the "ultra-distal [wrist] site" (Wardlaw and Pike 1986, 283-86). The study concluded that "the public health significance of this effect of longterm
lactation could be considerable" and that it could not be compensated for by dietary calcium supplements (286). The finding that calcium supplementation has little or no effect on bone loss during lactation has been corroborated by some studies (e.g., Hayslip et al. 1989; Prentice et al. 1995) and implicitly questioned by others. The encouraging news is that
much of the bone loss that occurs during lactation appears to be transient, and lactating women recover all or most of their lost skeletal calcium (perhaps depending on whether they take calcium supplements, perhaps not). All or most? The most recent studies are not in agreement. One research team is confident that "a comparable amount of bone is regained after weaning" if dietary calcium is supplemented, while another notes a possible
failure of femoral (neck) bone mass to return to pre-gestational levels (Sowers et al. 1993, 1995; Kalkwarf and Specker 1995). The scientific
literature on the subject is shot through with qualifications and warnings."
Glad to see that study you mentioned though… that's reassurring!
@Kate/Lactivista-
Sorry, also wanted to address your first point – it's a good one. I think that all pharmeceuticals should have WAY stricter laws regarding advertising. There's no reason we should be shown ads for medications and told to "ask our doctors". It's b.s. and puts our physicians in an uncomfortable position. (This goes beyond your original analogy about Tylenol, I realize…but I think about this a lot). Unfortunately though, these things are not policed, and that is my essential argument about WHO code. I'm fine with a lack of advertising, I really am… I just don't like what it implies. If formula is the only industry besides tobacco that is policed this way, what does that say about formula? I just can't get behind that.
@FFF Don't want to derail WHO Code Conversation, but one final comment on osteoporosis. I've seen much research documenting a decrease in bone mineral density *during* pregnancy and lactation, but this is regained after weaning.
A few more references:
Kalwart HJ and Specker BL "Bone mineral loss during lactation and recovery after weaning." Obstet. Gynecol. 1995; 86:26-32
Blaauw, R. et al. "Risk factors for development of osteoporosis in a South African population." SAMJ 1994; 84:328-32
Melton LJ, Bryant SC, Wahner HW, et al. "Influence of breastfeeding and other reproductive factors on bone mass later in life." Osteoporos Int. 1993;22:684-691
Cumming RG, Klineberg RJ. "Breastfeeding and other reproductive factors and the risk of hip fractures in elderly woman." Int J Epidemiol 1993;22:684-691
And one more link: http://www.ivillage.com/breastfeeding-reduced-risk-osteoporosis-nursing/6-n-136859
@Kate/Lactivista-
Thank you! I did some research on my own today too and found similar info. I'm really glad to hear that this isn't a concern for lactating moms.
Thanks for the great post. My husband is a resident and actually had a patient ask him if she had to use the formula the doctor had given her, because she had hoped to breastfeed. English was her second language and that may have come into play, but she assumed that since the sample had come from the doctor, it was important to use it up. I was livid when I heard that!
I was very clear with the nurses after I delivered that I intended to breastfeed exclusively, but they still wouldn't promise my baby wouldn't be given a pacifier in the nursery (so she roomed in). And, I was given premade individual bottles of formula with the nipples already on top. Talk about an easy out for the slightest hint of breastfeeding being difficult. Grrr…
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