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What is the WHO-CODE? | Best for BabesBest for Babes

What is the WHO-CODE?

by Bettina Forbes, CLC | November 8, 2011 2:07 pm

The primary purpose of the “WHO-CODE” is to protect mothers and babies from the highly effective, aggressive and predatory marketing of substitutes for breastfeeding (i.e. infant formula, bottles, artificial nipples) at the most vulnerable period of their lives, the birth of a new baby.

[1]

Formula-fed babies are at greater risk for Necrotizing Enterocolitis, a painful, often fatal, and expensive to treat disease.

Health workers helping vulnerable new moms and babies, day after day, have discovered an alarming trend: in areas where formula and bottles are marketed heavily, breastfeeding rates go down, and infection, disease and mortality go up.  This happens in countries around the globe, independent of  a country’s economic status.  In fact, it is estimated that globally, at least 1.5 million babies’ lives could be saved[2] every year from improved breastfeeding & complementary feeding; in the U.S., it is estimated that 900 babies’ lives could be saved[3] every year from improved breastfeeding rates, and $13 billion could be saved in health care and associated costs for ten pediatric diseases alone.

Some people[4] don’t believe that formula marketing affects a mother’s decision to try breastfeeding or her ability to continue. It’s understandable: it is human nature not to want to believe that we can be so easily duped out of protecting and advancing our own and our babies’ health! So, before you read further, we urge you to please read this article on the 10 Most Successful Ad Campaigns of All Time[5].   Read about what ad campaign helped Miller go from selling 7 million to 31 million barrels of beer, which ad increased Clairol’s sales 800%, and how Nike’s market share jumped from 18% to 43%.   Now consider that in 2004, just as the U.S. government was rolling out its largest effort, the three-year, $40 million “Babies Were Born to Be Breastfed” awareness campaign, formula advertising almost doubled to $50 million annually. More importantly, the government’s campaign was diluted and rendered ineffective under the influence of industry lobbyists[6].  Further, under lobbying pressure, a valuable, national meta-study conclusively showing the association of breastfeeding and lower rates of disease was suppressed.  No surprise:  Breastfeeding rates went down.  Breastfeeding was outmarketed, and this is precisely why examples of successful formula marketing make it into marketing textbooks.  Try to remain objective while watching this extremely sophisticated formula commercial[7], and then consider it in the context of research showing that breastfeeding protects against SIDS and is critical in the NICU[8].

In recognition of the devastating effect of formula and bottle marketing, the World Health Organization and Unicef adopted the “WHO-CODE” in 1981.  The “WHO-CODE” is short for the World Health Organization’s International Code of the Marketing of Breastmilk Substitutes[9]. Scores of countries have enacted legislation implementing all or many of the provisions of the Code, but the U.S. has not.  Because “The Code” is a voluntary pledge, it is easy for countries to say they uphold the code even when they don’t enforce the following stipulations:

  1. No advertising of breast milk substitutes to families. (Read: Why formula advertising is different from other types of advertising, making it predatory[10].)
  2. No free samples or supplies in the health care system.
  3. No promotion of products through health care facilities, including no free or low-cost formula.
  4. No contact between marketing personnel and mothers.
  5. No gifts or personal samples to health workers.
  6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or the product.
  7. Information to health workers should be scientific and factual only.
  8. All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.
  9. Unsuitable products should not be promoted for babies.
  10. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.

Note that several of these stipulations forbid the marketing of infant formula to health care workers.  Tremendous damage to mothers and babies occurs when formula companies market their products directly to parents through hospitals, physicians, health care professionals, and networking, peer support and “education” groups (such as expecting mother “classes”, lunches or events). [11] We love to claim we are savvier at looking past the claims of a print ad or commercial–even when studies show us that rates of breastfeeding decline when formula advertising increases[12]–but it is undeniable that we are easily influenced and persuaded by our trusted doctors, family members, and peers.  Formula companies are turning respected authorities, i.e. health professionals and organizations, into marketing arms for their product, a practice which is extremely unethical, and is especially hard for the public to see through.   Marsha Walker of NABA[13] has collected examples of formula companies sponsoring pediatrician conferences[14], donating to nursing professional associations, and providing “information” and gift bags to Ob/Gyns for their patients[15].

We’ve learned that formula companies donate to hospital NICUs–a terribly mixed message considering that intensive care babies need breastmilk the most–with the understanding that formula gift bags are pushed on breastfeeding mothers.  Formula companies sponsor name badges, frappuccinos[16] and breakfast “seminars” for hospital nurses, branded crib cards for the baby’s hospital bassinet, and funding for the hospital’s NICU.

Formula companies are now cross-marketing with maternity chains[17], huge baby registry sites and retail stores, photography studios like Olan Mills,  and even Disney[18] to undermine breastfeeding moms with coupons and giveaways.   They know we all love coupons and giveaways! Our email addresses are being sold to formula companies and we, who struggle against the breastfeeding booby traps, are being zeroed in on and bombarded by formula marketing.   Parenting, medical websites and well-known bloggers are protecting parents’ “rights” to be educated by advertisements, instead of by unbiased physicians and feeding experts such as IBCLCs.  Formula companies routinely advertise and win the top spots in Working Mothers Magazine’s 100 Best Companies for Working Mothers, even though infant formula means more employee absenteeism, sick days, and higher health costs.

Unfortunately, formula marketing hurts not only breastfeeding mothers, but formula-feeding mothers too.   A hefty marketing budget ($2-$3 BILLION globally) artificially drives up the price of formula, making it harder to afford for those who need it, and outcompeting lower-priced generic brands.   It forces the U.S. government, health organizations and non-profits like ours to raise funds to market breastfeeding, educate hospitals and health organizations, physicians, nurses, and health professionals.    The government purchases billions in infant formula for low-income women through the WIC program.  Formula contracts, “new” formulations and advertising drives up this cost. Formula marketing experts are smart; they say that “breast is best” so we are lured into a false sense of security, yet there is no mention, ANYWHERE, of the next best thing to breastfeeding or a mother’s pumped milk, which is screened donor milk. When mothers are being bombarded by inaccurate advertising, are they really making an informed choice?

Formula marketing has cleverly hijacked the conversation about infant feeding, playing “the guilt card” and igniting the mommy wars by pitting mothers against each other[19], instead of harnessing and focusing our energy to demand better maternity policies, Baby-Friendly Hospitals[20], employer protocol, and protection of mothers’ rights[21].  If more mothers were being allowed to achieve their personal breastfeeding goals without being discriminated against, harassed, or humiliated, fewer of the more zealous activists would be misplacing their energy by accosting or judging formula feeding moms–a practice that we strongly condemn. As for guilt, the only people who should feel guilty are those who know about the negative impact of formula marketing and do it anyway.

If you are interested in learning about how formula marketing tactics negatively impact breastfeeding rates, we encourage you to read this summary of Selling Out Mothers and Babies[22], by Marsha Walker, RN, IBCLC, or order the full report[23].

We have one of the lowest breastfeeding rates of any industrialized country, and one of the highest infant and maternal mortality rates of any industrialized country. We can do better!

What can we do to raise awareness of the WHO-Code in the U.S.?   What can we do to demand that laws are put in place to enforce it?

Organizations & Resources:
World Health Organization:  Health Implications of Direct Advertising of Infant Formula[24]

World Health Organization: Frequently Asked Questions on the WHO CODE[25]

Unicef and the WHO-Code[26]
[27]National Alliance of Breastfeeding Advocacy
BabyMilkAction.org[28]
IBFAN: International Baby Food Action Network[29]
Recommended Reading:
A Summary of the WHO Code (including, What, When and How)[30] by Pumpease.com
More breastfeeding could save 900 lives, $13 billion[31]; (news on study by Melissa Bartick, MD)
Disney and Similac Team up to Undermine Breastfeeding Moms[32]
Infant Formula Companies Milk U.S. Food Program[33]
Medscape.com:  Economics in the NICU[34]
PhD in Parenting:  How to Report a Unethical Promotion of [Breastmilk Substitutes][35], An Open Letter to the Attendees of the Nestle Family Blogger Event[36],  Similac and Babble Team Up to Dupe Breastfeeding Moms[37],  IBCLCs and Formula Feeding[38], oh, heck just search WHO CODE or infant formula on her blog!
There are LOTS of great articles on the WHO-CODE, sorry I couldn’t include them all–please let me know if I’ve missed an important, seminal link!



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Endnotes:
  1. [Image]: http://www.medscape.com/viewarticle/751782
  2. 1.5 million babies’ lives could be saved: http://www.who.int/mediacentre/factsheets/fs342/en/index.html
  3. 900 babies’ lives could be saved: http://www.usatoday.com/news/health/2010-04-05-study-breast-feeding_N.htm
  4. Some people: http://blogs.babble.com/babble-voices/catherine-connors-bad-mother-confidential/2011/09/12/shame-and-the-mom-on-formula-lactivism-and-why-it-seems-we-cant-just-all-get-along/
  5. please read this article on the 10 Most Successful Ad Campaigns of All Time: http://www.ddrewdesign.com/blog/index.php?cmd=article&id=136
  6. More importantly, the government’s campaign was diluted and rendered ineffective under the influence of industry lobbyists: http://www.washingtonpost.com/wp-dyn/content/article/2007/08/30/AR2007083002198.html
  7. this extremely sophisticated formula commercial: http://www.youtube.com/watch?v=IQdp9tmxGW8
  8. critical in the NICU: http://www.medscape.com/viewarticle/751782
  9. World Health Organization’s International Code of the Marketing of Breastmilk Substitutes: http://www.who.int/nutrition/publications/infantfeeding/9241541601/en/
  10. Read: Why formula advertising is different from other types of advertising, making it predatory: http://www.who.int/nutrition/publications/infantfeeding/infant_formula_trade_issues_eng.pdf
  11. [Image]: http://www.naba-breastfeeding.org/resources.htm
  12. studies show us that rates of breastfeeding decline when formula advertising increases: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595135/
  13. NABA: http://www.naba-breastfeeding.org/
  14. formula companies sponsoring pediatrician conferences: http://www.phdinparenting.com/2010/10/06/guest-post-inside-the-american-academy-of-pediatrics-conference/
  15. gift bags to Ob/Gyns for their patients: http://jexalt.wordpress.com/2011/10/04/disney-and-similac-team-up-to-undermine-breastfeeding-for-moms/
  16. frappuccinos: http://breastfeeding.blog.motherwear.com/2007/04/is_your_nurse_g.html
  17. maternity chains: http://theadventuresoflactatinggirl.com/2010/12/15/motherhood-maternity-boycott/
  18. Olan Mills,  and even Disney: http://jexalt.wordpress.com/2011/10/04/disney-and-similac-team-up-to-undermine-breastfeeding-for-moms/
  19. playing “the guilt card” and igniting the mommy wars by pitting mothers against each other: http://breastfeeding.blog.motherwear.com/2009/03/the-case-against-breastfeeding-a-response.html
  20. Baby-Friendly Hospitals: http://www.babyfriendlyusa.org
  21. protection of mothers’ rights: http://www.momsrising.org
  22. Selling Out Mothers and Babies: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595135/
  23. order the full report: http://www.naba-breastfeeding.org/resources.htm
  24. Health Implications of Direct Advertising of Infant Formula: http://www.who.int/nutrition/publications/infantfeeding/infant_formula_trade_issues_eng.pdf
  25. World Health Organization: Frequently Asked Questions on the WHO CODE: http://www.who.int/nutrition/publications/infantfeeding/Frequently_ask_question_Internationalcode.pdf
  26. Unicef and the WHO-Code: http://www.unicef.org/nutrition/index_24805.html
  27. : http://www.unicef.org/nutrition/index_24805.html
  28. BabyMilkAction.org: http://info.babymilkaction.org/
  29. IBFAN: International Baby Food Action Network: http://www.ibfan.org/
  30. A Summary of the WHO Code (including, What, When and How): http://www.snugabell.com/blog/2010/04/a-summary-of-the-who-code-including-where-what-when-and-how
  31. More breastfeeding could save 900 lives, $13 billion: http://www.reuters.com/article/2010/04/05/us-breastfeeding-study-idUSTRE6342ZG20100405
  32. Disney and Similac Team up to Undermine Breastfeeding Moms: http://jexalt.wordpress.com/2011/10/04/disney-and-similac-team-up-to-undermine-breastfeeding-for-moms/
  33. Infant Formula Companies Milk U.S. Food Program: http://www.womensenews.org/story/reproductive-health/111106/infant-formula-companies-milk-us-food-program
  34. Medscape.com:  Economics in the NICU: http://www.medscape.com/viewarticle/751782
  35. How to Report a Unethical Promotion of [Breastmilk Substitutes]: http://www.phdinparenting.com/2010/02/22/how-to-report-unethical-promotion-of-formula-bottles-and-other-breastmilk-substitutes/
  36. An Open Letter to the Attendees of the Nestle Family Blogger Event: http://www.phdinparenting.com/2009/09/29/an-open-letter-to-the-attendees-of-the-nestle-family-blogger-event/
  37. Similac and Babble Team Up to Dupe Breastfeeding Moms: http://www.phdinparenting.com/2010/09/03/similac-and-babble-team-up-to-dupe-breastfeeding-moms/
  38. IBCLCs and Formula Feeding: http://www.phdinparenting.com/2011/10/02/can-an-ibclc-be-a-source-of-objective-information-about-formula-feeding/
  39. [Image]: http://www.linkwithin.com/

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