On Tuesday, the HSE announced €1.58m to fund much needed lactation consultant posts in maternity hospitals, after sustained campaigning by advocacy groups highlighting the inequalities women have in accessing breastfeeding support.
On Wednesday, the Joint Oireachtas Committee on Health discussed breastfeeding support, or the lack of it, for more than two hours.
Then, the Royal College of Physicians in Ireland published a position paper committing to greater breastfeeding education for physicians and the ending of infant formula industry sponsorship of conferences, study days and educational events. This is important because the marketing tactics of baby food companies goes far beyond shiny TV ads. Fostering relationships with doctors and nurses is a long established marketing move by baby food companies.
Better known as ‘the Code’, this international framework, if fully implemented and legislated, has the potential to transform global health and protect all babies, whether they are breastfed or formula fed.
The Code is not about making those who need or choose formula feel bad or guilty. Infant milks are required for babies who cannot be breastfed or who require specialist feeding. The Code is about ending the inappropriate marketing of breastmilk substitutes that undermine breastfeeding and unregulated practices that commercialise infant feeding.
The Code was created after allegations in the mid-1970s about the aggressive promotion and sales of baby milks by multi-national companies in Third World countries. Published in 1974, the book The Baby Killer claimed formula companies used sales reps dressed as nurses, gave free or discounted samples to new mothers, and disseminated branded educational materials to health clinics to increase sales, and that these promotional tactics in impoverished communities led to malnutrition and death.
Nestlé sued the German publishers of the book, and after a two-year trial the court found in favour of the company, but it was considered a moral victory by the defendants, who were given a small fine, with the judge warning that Nestlé needed to modify its marketing methods.
The negative publicity surrounding the trial led to a Nestlé boycott which continues to today.
In 1978, U.S Senator Ted Kennedy held the Kennedy Hearings and put the baby food industry under the spotlight. Health advocates from the Philippines, Peru, Venezuela and Jamaica were flown to the U.S Senate and gave evidence of the damaging health effects of formula feeding on their communities. Industry representatives argued that the hearings were an attack on the free world’s economic system and that it was “simplistic and dangerous” to contend that more breastfeeding and less formula feeding will solve the nutritional and health problems of infants in the developing world.
The WHO and UNICEF convened a series of meetings with stakeholders, culminating in the signing of the Code in 1981. It states there should be no advertising of formula to the general public, no engagement by industry with healthcare professionals or with parents, and many other recommendations. Ireland is a signatory but we have few provisions of the Code enacted in legislation and much formula marketing industry here remains unregulated.
On Friday, the WHO and UNICEF are hosting an online global event to mark the anniversary and to strengthen country-level implementation of the Code. It is not being billed as a ‘celebration’ because the Code has struggled to resist the marketing might of the baby food companies. The global formula industry is growing, and is now worth $70 billion, with billions being spent on marketing annually, the cost of which is passed onto consumers/parents. No promotion would mean cheaper formula for families.
The need for the Code is as great as ever. NGOs such as the International Baby Food Action Network (IBFAN) monitor Code violations. As well as the obvious ongoing advertising of products, more subtle examples include making unfounded health claims about products and ingredients which have often been shown to have no proven efficacy, or using technological innovations to influence consumers through social media e.g. using ‘mummy bloggers’, peer to peer promotion through the recruitment of parents, celebrity endorsements and endorsements by influencers.
Ireland has substantial skin in the baby milk game with a third of Irish dairy exports leaving our shores as infant formula, much of it destined for China. Irish infant formula is a billion dollar business.
Pushback from the agrifood industry to any regulations that would curb business would be considerable. But the argument for protecting public health by rewriting the rules and tightening legislation is strong.
At the Oireachtas Health Committee, a few male TDs expressed their discomfort talking about the subject, feeling, as males, that they didn’t have a valid opinion on breastfeeding. How babies are fed matters to everyone.
Infant feeding is a deeply political issue that has wide implications for our health, economy and environment. If the government is genuinely interested in supporting and protecting infant, maternal and public health, it’s time to legislate the Code.