The World Health Organization Would Ban This Video

The other day, I saw a heartwarming video on Facebook. It gave me a serious case of the feels…the kind that I get when watching the Cheerios bi-racial family commercial or the Budweiser’s Clydesdales commercial or the Coca-Cola America the Beautiful commercial. I cry every time. Like first trimester of pregnancy ugly tears. And this is coming from someone who does not like Cheerios, Budweiser or Coke. If you haven’t seen it, check it out below.

For those who haven’t seen it, it is a satirical representation of a playground brawl, featuring teams of parents fighting – breastfeeding moms vs. formula feeding moms, baby wearers vs. stroller pushers, working moms, stay at home dads, women who had a natural birth in a pool attended by dolphins. You get the picture. It’s every internet debate about parenting presented in a comical video. Something happens and they all come together and realize that all of these wars are silly and cause us to lose sight of what parenthood should be about – loving and caring for our kids.

I was surprised when one of my friends, a prominent supporter of ending the mommy wars, didn’t share it, and then she told me why. You see, the creator of the video (if you watch to the very end you will realize who it is) was Similac, a company that makes infant formula. My friend is a lactation consultant certified by the International Board of Lactation Consultants (IBCLC). As such, she is forbidden from promoting or associating with formula companies and many other companies, including Medela, Lansinoh, and Evenflo. She can’t accept free formula samples for her practice to give to women who need to supplement with formula for their babies to THRIVE or need to learn how to use a supplemental nursing system. She also can’t speak at conferences sponsored by one of these companies. If she attends an infant feeding conference, she must pay for meals that would otherwise be complimentary. She can’t accept any materials created or distributed by formula manufacturers at all, even if they have nothing to do with formula or everything to do with breastfeeding. Why? The International Code of Marketing of Breast-milk Substitutes (commonly known as the WHO code).

To explain why the World Health Organization felt the need to adopt a code related to formula marketing, let’s journey back to the late 1970’s and early 80’s. Nestlé, a huge international company that manufactured infant formula, along with thousands of other products, decided to engage in horribly unethical and despicable marketing strategies in less developed countries. Other companies followed suit. Their main tactics – introduce infant formula to women in hospitals in the less developed world and convince them that it is superior to breast milk. Give them enough formula so that by the time they run out, their breast milk supply will have ceased or greatly diminished, forcing women to purchase formula to feed their babies.

Why was this problematic? Powdered formula must be mixed with water, which in the less developed world, can often be contaminated due to poor sanitation. Many mothers in these countries were not aware of the sanitation methods needed to prepare of bottles and even if a mother could read and understand how to prepare bottles safety, they might not have had the means to ensure the water was safe (fuel/electricity to boil water or water filtration). UNICEF estimates that in low-income countries, breastfed infants are much less likely to die from diarrhea, acute respiratory infections and other diseases: a non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child. Additionally, watering down formula is a common practice, which results in infants not receiving adequate nutrition. For a mother, breastfeeding exclusively could help her avoid pregnancy in areas with limited or no access to birth control and to space her births, which could dramatically impact health and outcomes for women and babies.

In short, an evil company decided that it cared more about selling formula than it did about killing babies and women. I remember hearing about the Nestlé boycott from my mom or aunt at a very early age and decided to give up Nestlé candy bars and chocolate milk. They still don’t taste good to me. What fuckers.

In response to these devious tactics of Nestlé and other companies, the World Health Organization decided to bring this issue up with its membership. On May 21, 1981, the 34th World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes in the form of a recommendation, in the World Health Organization (WHO) Constitution. More than 160 countries and territories, including the United States, agreed to take steps to implement the Code (World Health Organization Publication WHO/MCH/NUT/90.1). However, enforcement of the code (like most international treaties and resolutions) is a matter for the government of each country to decide, within its own social and legislative framework. The aim of the Code is the “protection and promotion of breast-feeding” and “ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.”

In a nutshell, it says:

• NO advertising of breast-milk substitutes to the public.
• NO free samples to mothers.
• NO promotion of products in health-care facilities
• NO company “mothercraft” nurses to advise mothers.
• NO gifts or personal samples to health workers.
• NO words or pictures idealizing artificial feeding, including pictures of infants on the products.
• Information to health workers should be scientific and factual.
• All information on artificial feeding, including the labels, should explain the benefits of breastfeeding, and the costs and hazards associated with artificial feeding.
• Unsuitable products, such as condensed milk, should not be promoted for babies.
• All products should be of a high quality and take into account the climatic and storage conditions of the country where they are used.

You probably have already guessed that this is not being fully implemented and enforced in the United States. With regards to quality and safety – formula is one of the most heavily regulated products in the US, with regards to safety and nutrition (Anti-Drug Abuse Act of 1986 and the Infant Formula Act of 1980, December 1991 amendment to the Federal Food, Drug and Cosmetic Action, International Digest of Health Legislation, 43(3):556 (1992). On a voluntary basis, many professional groups including the International Board of Lactation Consultants have chosen to implement it and formally separate from any company that markets formula directly to women or violates the code.

And formula companies? They have agreed to not market to women in less developed countries. However, they don’t think such measures are necessary in the industrialized world. I agree. The WHO code does not need to be and should not be implemented in the United States or similarly industrialized nations. Before you start throwing nursing bras at me, hear me out.

The premise behind the WHO code is flawed when applied to an industrialized nation. The idea that a majority of moms in the United States who choose or are forced to use formula are unable to do so safely is laughable. Not only does the majority of the country have access to clean, safe water, but most families also have access to a stove or microwave, which they could use to boil water for formula and sterilize bottles, if they don’t have a safe water system. Most moms (and dads) have the ability to understand formula preparation guidelines.

One might even say that implementing the WHO code and other WHO initiatives breastfeeding initiatives ( like their Baby-Friendly Hospital initiative), which make infant formula seem like a dangerous substance, if mentioned at all, and may make parents less likely to be able to use formula effectively and safely, because they receive a dose of shame around formula feeding. Because they might not even admit they are going to use it, they won’t receive adequate information about how to use formula to nourish their babies. Additionally, formula today is far superior to formula in 1981. Yay science. And one recent study indicates that supplementing breastfeeding with formula in the hospital when a baby is losing weight can actually help moms breastfeed longer. Add to that the fact that we now know that differences in outcomes for breastfeeding babies and formula fed babies are negligible.

In a country where most people don’t get adequate parental leave and many jobs don’t make pumping possible, where science has given us great alternatives and the government regulates that industry, should the government also attempt to control parent choice through restrictions on marketing? Some proponents of the code compare formula marketing to cigarette marketing and suggest that warning labels are necessary. I just can’t.

It’s bad enough that every can of infant formula tells me that breast is best, but to then hear that I am harming my child, when science says that the benefits of breast milk are overstated, and I live in a country where parents have access to safe and regulated infant formula? That just seems cruel. And anti-Feminist. You see, being pro-choice extends to my whole body. The choice to breast feed or to formula feed or in my case, both, should be protected. Breast is best for those whom breast is best. For others, formula is best. Or exclusive pumping (fist bump for those women. I could never do that). Or combo feeding (combo feeders are clearly the best).

Any proponents of the code still reading who aren’t yet sold? Okay, say we do implement the code, exactly as written in 1981, in the United States today. Shouldn’t we also implement to fidelity all of the other recommendations of the WHO? So – universal vaccination, universal access to free contraception and low-cost, safe abortion care, and routine circumcision of male infants.

I will leave you with this. Watch the video above again. Pretend that it has nothing to do with a formula company. And think about all of the ways that we fight when we should unite and support each other. And try to forget this post the next time you are craving a Nestlé Crunch bar.

Featured image credit: Similac

Other images: Nestle boycott: PhD in Parenting; bottles: Brian Zambrano