New Internationalist

Keeping The Lid On The Babymilk Menace

Issue 110

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THE BABYMILK ISSUE[image, unknown] Guide to government action on the WHO Code

[image, unknown]

Keeping the lid on the
babymilk menace

Governments all over the world are trying to implement the World Health Assembly recommendations on controlling the infant formula companies and encouraging breastfeeding. Some appear more concerned about their nation's children than others. In this survey, the New Internationalist gives its own assessment of national action.
Illustration: Clive Offley

Illustration: Clive Offley Algeria has nationalised the importation of artificial babymilk. The state agency also labels and controls all product information, to conform to the national policy of promoting breastfeeding.[image, unknown] [image, unknown]

Australia plans to implement the World Health Organization Code —sometime — but with the voluntary agreement of the babymilk companies. Mothers who cannot or do not choose to breastfeed for whatever reason will have easy access to artificial milk. [image, unknown]

Bangladesh has not passed any marketing legislation; a few voluntary organisations are campaigning for a strengthened version of the WHO Code. [image, unknown] [image, unknown]

Brazil, through her National Food and Nutrition Institute, launched in March 1981 possibly the Third World’s largest breastfeeding campaign. Bearing slogans like 'Infant mortality is five times lower among breastfed babies’, millions of posters of breastfed infants are being tacked up in schoolrooms, health clinics and maternity wards. Television stars are used for aggressive radio and TV advertising. Light gas, water and telephone bills— and soccer lottery cards — carry the slogan: ‘Nurse your child.’ Maternity systems are to be modified to favour breastfeeding; working mothers are to have breastfeeding facilities; legislation is proposed to control artificial babymilk. promotion; improved maternal nutrition education to include pre-natal and weaning stages. [image, unknown]

Canada’s official attitude is ‘education not legislation’. No dialogue between government and industry. But free samples prohibited in Northwest Territories where native peoples predominate. And Toronto City Council has reaffirmed its endorsement of the Nestle Boycott You couldn’t buy a cup of Nescafe in a city government facility in Toronto. even if you wanted to. [image, unknown]

Colombia’s National Group for the Promotion of Breastfeeding helps train health workers, educate the public and limit artificial baby-milk marketing. July 1979 decree: hospital routines to be revised to promote breastfeeding through early mother-child contact and rooming-in, banning infant formula advertising in health clinics, teaching breast-feeding techniques, and avoiding hormonal contraceptives during lactation, In May 1980 the Ministry of Health prohibited any picture or mention of feeding bottles or human figures on labels; and forbade free samples being given to mothers or to health workers. [image, unknown]

Cook Islands introduced maternity leave for government workers in May1981. ?

European Common Market (Belgium, Denmark. France, Greece, Ireland, Italy, Luxembourg, Netherlands, UK and West Germany) through the European Parliament in 1981 voted overwhelmingly (103 to 14) for strict enforcement of the WHO Code throughout the member states, calling fora binding directive. It urges the Common Market authorities to ensure that babymilk companies respect the Code ‘in all their activities in whatever part of the world’ and prescribes sanctions against violators that include withdrawal of EEC or national grants to such companies, and denial of EEC stocks of subsidised skim milk powder. This has not yet been implemented by the member nations

Fiji’s Ministry of Health has implemented a breastfeeding campaign which includes a write-in radio competition using questions on the importance of breastfeeding; newspaper articles in Fijian and Hindustani as well as English on the importance of breastfeeding; cinema advertisements; and the formation of a Nursing Mothers Association. [image, unknown]

French Polynesia allows maternity leave on half-pay for 14 weeks to all working women, including domestics— the law is enforced by inspectors. [image, unknown]

Guinea-Bissau only allows powdered milk and feeding bottles with a doctor’s prescription. Plastic bottles are banned. [image, unknown] [image, unknown]

Indonesia is surveying national feeding practices to focus on clearing up specific breastfeeding problems — in rural areas, for instance, colostrum (the highly nutritious ‘premilk’ produced in the first few days after childbirth), was believed to be poisonous and discarded. ?

India seems to be struggling under heavy industry pressure. Resisting attempts by industry to push its own weak Code, the government speedily set up a working group to formulate a national Code, which reported back as long ago as April 1980. India’s Academy of Paediatrics unanimously passed a resolution in 1 981 to reject financial support from artificial babymilk companies for holding medical conferences, workshops etc.

The draft Code is to be debated in the current session of Parliament Meanwhile the bottle-makers have joined forces with the milk companies and promotion is rife. Advertisements are seen even on government TV; mothercraft nurses are reported to be still visiting mothers in hospitals. [image, unknown]

Jamaica’s government has proclaimed breastfeeding as a public health goal. In 1977 a major health-nutrition programme promoted breastfeeding; visits by commercial agents to mothers in hospitals and mass media for advertising of formula were prohibited; artificial milk imports were restricted. The programme ran out of funds and terminated in 1978, but preliminary evidence suggests the shift away from breastfeeding has been reversed in some areas. [image, unknown]

Kiribati (formerly Gilbert Islands): Breastfeeding breaks taken by most working mothers. ?

Lesotho has drafted a strong national Code based on the WHO Code. Additional legislation includes; 90- day post- natal maternity leave on full pay for mothers working in communal, industrial or government jobs; nursing breaks and facilities; special sick leave if a breast-fed infant is ill; discrimination against nursing mothers is a punishable offence.[image, unknown] [image, unknown]

Malaysia has a weak Code for the regulation of artificial babymilk promotion worked out in conjunction with the major importing companies. The Malaysian Baby Food Action Group (started in October 1981) seeks to bring it in line with the WHO Code. [image, unknown]

Mexico’s health authorities have produced no official statement about the WHO Code, nor made any special effort to promote breast-feeding (November 1981). The National Institute of Nutrition recently received an offer for finance for research into breastfeeding patterns from Nestle and other baby-milk companies. [image, unknown] [image, unknown]

In Micronesia, breastfeeding promotion is now part of the Health Department's nutrition programme. Educational materials include a videotape on the advantages of breastfeeding and the disadvantages of bottle-feeding shown in the hospital waiting rooms, narrated by local women in three local languages. Health workers are encouraged to breastfeed in their own families and home villages, Schoolchildren calculate the cost of bottle-feeding for a year and do experiments with spoiled milk, ‘Two years ago,’ says the Micronesian Reporter,’ most women seen in clinics were bottle-feeding —sometimes actively encouraged by clinic personnel. Women who breastfed were ashamed to do so in public not for reasons of modesty but because they were considered old-fashioned. Now mothers who have a bottle may try to conceal it... [image, unknown] [image, unknown]

New Zealand’s government has done ‘not an iota’ to implement the Code, according to the New Zealand Coalition for Trade and Development. But public concern is growing: e.g. the media, women’s groups, Church groups, have been demanding more information. [image, unknown] [image, unknown]

Nicaragua’s National Commission on Breastfeeding was formed in 1980. Their proposals include: changing pre-natal, delivery and post-natal practices to favour natural feeding methods; extensive educational campaigns; implementing labour regulations for breast-feeding working mothers, prohibiting free samples and advertising; including strong warnings on labels and controlling feeding instructions. Theory still has to become practice. [image, unknown]

Norway’s Directorate of Health proposed regulations in 1980 on artificial milk production, labelling. advertising and distribution of promotional materials. The term ‘breast-milk substitute’ (implying similarity to breastmilk) was to be replaced, and weaning food adverts could not imply superiority to home-made infantfoods. (One artificial milk company objected because the regulations ‘might constitute an example that could be followed in developing countries'!) [image, unknown]

Papua New Guinea — one of the leaders in controlling artificial baby-milk promotion — instituted breast-feeding counselling in hospitals to establish lactation before mothers went home. ‘Susu Mamas’ (Pidgin for mother’s milk) visit every mother in Port Moresby General Hospital. Mothers who can’t breastfeed are taught the cup and spoon method, Free samples are banned. Maternity leave, nursing breaks, and home visits by breastfeeding support counsellors have been instituted. All this did not stop the drift to breast-feeding. So in 1 977, feeding bottles and teats were made available on prescription only. Before giving prescriptions, health workers had to make sure that the purchaser had the money, facilities and knowledge for safe artificial feeding— and that it was in the baby’s best interests Within 20 months, the promotion of artificial milk fed infants dropped from 35% to 12%. The proportion of malnourished babies dropped from 69% to 35%. The restriction on teats and bottles also guarded against infants being fed on soft drinks— or even beer. In the two years following this legislation, there were NO DEATHS from gastroenteritis in infants under six months. [image, unknown] [image, unknown]

Peru has drafted a strong Code to be implemented soon by Presidential decree. [image, unknown]

The Philippines has drafted a Code put together with the artificial baby-milk companies’ help. It is full of loopholes. The National Coalition for the Promotion of Breastfeeding has drafted an alternative Code plugging the gaps and calling on government to take full responsibility. [image, unknown]

Solomon Is. have instituted ? maternity leave and nursing breaks. ?

In the Soviet Union. since 1968, mothers can take unpaid leave until the baby's first birthday without loss of job or a gap in their employment record. Breastfeeding mothers are excused nightwork and overtime, are guaranteed feeding breaks, and eight weeks paid post-natal maternity leave. ?

Sri Lanka banned all forms of artificial babymilk advertising in 1980. Violators are liable to fines of 3,000 rupees or three months in goal. [image, unknown] [image, unknown]

Mothers with radios wake up to jingles promoting breastfeeding. Sri Lanka has a very tough Code controlling artificial milk promotion, monitored to ensure that national legislation is implemented. Women’s groups have been actively supporting the islandwide breast-feeding campaign and hope to double the present three month maternity leave period. Hospitals have switched back to the breast no mother is permitted to bottlefeed (even in private nursing homes) without a doctor’s permission. [image, unknown] [image, unknown]

Sweden has passed national legislation mandating that infants should receive nothing but breast-milk for the first 5-6 days of life, A voluntary code of ethics for artificial babymilk promotion is in effect. [image, unknown] [image, unknown]

Thailand’s National Food and Nutrition Committee drew up a draft regulation based on the WHO Code in mid-i 981. Industry pressure heavy. No clear action vet. [image, unknown]

US government policy has been summarised as ‘look. don’t act. Ignoring the years of deliberation that produced the WHO Code, the Reagan administration has called for two further studies: the first to examine further the relationship between company marketing practices and bottle-feeding; the second to analyse the possible’ applicability of the Code in the US. [image, unknown] [image, unknown]

NEW INTERNATIONALIST ASSESSMENT
National action on breastfeeding

[image, unknown] [image, unknown] = Strong action taken

[image, unknown] = Promising start

? = Not enough information for judgement

[image, unknown] = Cosmetic change, potentially dangerous

[image, unknown] [image, unknown] = No action taken


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