Marketing of breast-milk substitutes: National implementation of the International Code – Status report 2016

A recent comprehensive report by the World Health Organisation, UNICEF, and the International Baby Food Action Network (IBFAN), has revealed the status of national laws to protect and promote breastfeeding in 194 countries.[1] The World Health Organisation issued a media release on May 9th and commented that richer countries lag behind poorer ones in their implementation of the International Code. [2]

135 countries, out of the 194 analysed, have in place some form of legal measure related to the International Code of Marketing Breast-Milk Substitutes, [3] and subsequent, relevant World Health Assembly resolutions,[4] [5] and this number has increased by 35 since the last analysis which was carried out in 2011. The International Code had a birthday this year and is now 35 years old, so it is disappointing to note that only 39 countries out of the 194 reviewed have laws that enact all International Code provisions. The International Code, and the essential updates in the form of the World Health Assembly resolutions, are designed to not only protect breastfeeding by stopping inappropriate and misleading marketing of breast-milk substitutes, bottles and teats, but to also protect infants fed on breast-milk substitutes. All parents should have access to unbiased, commercial-free, information about infant feeding, and health professionals also need a source of unbiased, scientific and factual information.

To compile the Status Report 2016, countries were invited to respond to a questionnaire on Code implementation, and additionally IBFAN, the International Code Documentation Centre (ICDC), and UNICEF, reviewed and updated categorisation of information received about country practices and legal measures.

In the report New Zealand is one of the countries with no legal measures (Annex 1, p. 50) and although it is recorded that the Ministry of Health has formal mechanisms for monitoring the Code in place, which is noted to be transparent, independent, budgeted, empowered to take action, sustainable and monitored monthly to annually, the report states that it is not free of commercial influence (Annex 3, p. 62). Additionally the NZ monitoring mandate does not include retail shops or pharmacies and the report notes that although violations were recorded no sanctions were imposed (Annex 3, p. 63). As stated in the WHO media release, monitoring is essential to detect violations but it is important that these measures are fully operational and results should be published. Meaningful sanctions are also essential to reduce violations.

It seems timely to refer back to the recent Lancet Series on breastfeeding which contained the economic argument for breastfeeding, and the need for protection of breastfeeding and infant feeding, via the International Code of Marketing of Breast-Milk Substitutes. McFadden et al, called for a coordinated global action to combat inappropriate and misleading marketing. [6] WHO/UNICEF and IBFAN urge countries who have not yet adopted legal measures to do so. With the aggressive and misleading marketing of breast-milk substitutes continuing largely unabated, and a global sales revenue of US$44.8 billion, which is expected to rise to US$70.6 billion by 2019, this Status Report highlights the need for urgent action by governments now.

[1] World Health Organisation/UNICEF/International Baby Food Action Network. (2016). Marketing of breast-milk substitutes: National implementation of the International Code – Status report 2016. Geneva, WHO.

[2] World Health Organisation. (2016). Laws to protect breastfeeding inadequate in most countries. Geneva. WHO Media Centre.

[3] World Health Organisation. (1981.) International Code of Marketing of Breast-Milk Substitutes. Geneva, WHO.

[4] World Health Organisation. World Health Assembly resolutions and documents: Infant and young child nutrition.

[5] International Baby Food Action Network. The Full Code. WHA Resolutions.

[6] McFadden, A., Mason, F., Baker, J., Begin, F., Dykes, F., Grummer-Strawn, L., Kenney-Muir, N., Whitford, H., Zehner, E., & Renfrew, M. (2016). Spotlight on infant formula: Coordinated global action needed. The Lancet, 387:433-435.


Cows & their milk do not live in a parallel universe, so support women to breastfeed, and at the same time let’s clean up the world #Regulation #Accountability #Breastfeeding

A recent article by Du, Gridneva, and Gay et al in the journal ‘Chemosphere’, ‘Pesticides in human milk of Western Australian women and their influence on infant growth outcomes: A cross-sectional study’, is about the levels of persistent organic pollutants in human milk.[1]

Highlights were reported as being;

  • Cross-sectional study of 88 POPs in human milk over first year of lactation.
  • p,p′-DDE was detected in 87.5% of the human milk samples.
  • No significant associations between p,p′-DDE and infant growth outcomes.
  • Estimated daily intake overestimates human milk POP concentration.
  • Human milk infant intake of DDTs is below the recommended daily intake guidelines.

And the abstract concluded with this;

“Furthermore, for the first time no significant association was found between p,p′-DDE concentrations in HM and infant growth outcomes such as weight, length, head circumference and percentage fat mass. The calculated daily intake was significantly different to the estimated daily intake of total DDTs and was well below the guideline proposed by WHO. The DDTs levels in WA have also significantly decreased by 42 – fold since the 1970s and are currently the lowest in Australia.”

So, good news – pollution of the environment, and human exposure to it, is reducing through the restriction of usage of some chemicals. Whether it’s fast enough and widespread enough is another question.

Why I’m writing this really is in response to the Alternet article, ‘Pesticide Levels in Breast Milk Have Dropped Significantly, but Health Concerns Remain.’[2] The article itself is quite good, given that it mentions not only human milk but also blood and urine, which is a good thing, as sometimes articles miss this point and readers can mistakenly construe that breast milk is the only fluid with an issue. But the article forgot to mention that babies are exposed to chemicals in utero and breastfeeding is really important as it mediates this exposure. So here are a few important points gathered together –

  1. Levels of pesticides in breast milk have dropped significantly over the past 40 years.
  2. Alternet doesn’t mention it, but breastfeeding actually mediates the exposure that has already occurred in utero, and breastfeeding/breastmilk supports the development of the infant immune system.
  3. This means that breastfeeding is still recommended and is optimal for infant feeding and infant growth, wellness and development.
  4. It Illustrates the positive impact banning pesticides can have on the health of individuals, especially vulnerable infants.
  5. And that’s the issue – the need to keep up the pressure to clean up our pesticide-riddled world as babies and small children, and their mothers, are exposed to hazardous chemicals through contact with products such as carpets, clothing, furniture, household and cleaning products, as well as those in food, the air and the soil.
  6. So, the chemical industries responsible, and the governments who fail to regulate them, need to be held to account.
  7. And, just to remind everyone – cows & their milk do not live in a parallel universe either, so feeding formula to infants is not the answer.



‘Why the politics of breastfeeding matter’ – Author Gabrielle Palmer -Book review

This is another excellent book from the ‘why it matters’ series from publishers Pinter and Martin. Gabrielle Palmer is well known for her ground-breaking book, The Politics of Breastfeeding, which was first written in 1988. Palmer is a nutritionist with a myriad of experience in the world of infant feeding, including working in Mozambique and China, supporting the establishment of the UK International Baby Food Action Network (IBFAN) group Baby Milk Action, and health and development agency work, including UNICEF. This new book is a condensation of the central concepts from the Politics of Breastfeeding, and it delves efficiently into the systems set up to sabotage the intentions of breastfeeding women, milk economics and the creation of a market that aggressively pushes breast-milk substitutes. It describes the differences between advertising and information provision, and also describes the International Code of Marketing of Breast-milk Substitutes.  This new book provides an accessible introduction into the corporate forces and vested interests that affect infant feeding decisions, with explanation of the historical underpinnings, as well as provision of an up to date, contemporary focus. The World Breastfeeding Week theme for 2016 was shaped around breastfeeding and sustainable development, and Palmer addresses climate change, dairy and environmental damage as part of her analysis of the costs of not breastfeeding. This revealing book is essential reading for all those who work with mothers and infants. It challenges us to rethink what we think we know about women’s infant feeding decisions, from the frame of simple, independent choices to a frame that recognises that the dice have been very loaded against breastfeeding women for a significant length of time.  Some mothers have been unknowingly situated at a distinct disadvantage, with great costs to their own health, their children’s health, society and the planet.