The International Code: Is It Still Relevant in an Information Age? {Part 2}

We are proud to present the second of two blog posts about the International Code of Marketing of Breastmilk Substitutes (You can read the first part HERE). This document is vital to our work and is a critical piece of advocacy for the families we serve. After our previous post, which was a basic “WHO Code 101”, today’s posts asks “What Now?” as we discuss how our interpretations and applications of the Code have to change with the advent of new styles of marketing, including in the use of social media.

By Norma O. Escobar, IBCLC
(with input from Annelies Allain from the International Code Documentation Center)

Most of us are familiar with the most common Code violations, direct advertising in print media, free samples in hospitals and doctor’s offices, coupons for discounts. But what about the marketing methods that have popped up with the advent of social media and the “ever present” smartphone?

What is new?

The biggest changes in the last few years have been the explosion of social media and the expanded use of smart phones. Social media use accounts for an estimated 20% of all time Americans spend online on their computers and 30% of their time on their mobile device.

Women, and people aged 18-34, are more likely than other groups to visit social media sites.  For example, women account for 62% of all page views on Facebook.  These statistics suggest that for many American women, important life events like pregnancy, birth and early motherhood are playing out against a backdrop of social media use. And these figures are growing yearly.  According to the Nielsen report, time spent in social media in 2011 was 88 minutes per month.  In 2012 that number had jumped to 121 minutes.

According to Nielsen: “The days when companies could tightly control brand messaging and progress consumers along a linear purchase funnel have long ended. Social media has fundamentally changed the consumer decision journey. Consumer decisions and behaviors are increasingly driven by the opinions, tastes and preferences of an exponentially larger, global pool of friends, peers and influencers.”

Sheryl Abrahams

As a result of these changes, marketing of products within the scope of the code has also changed.  Enter Sheryl Abrahams,a graduate student with the Carolina Global Breastfeeding Institute, who thought it would be a good research project to find out how the code is being followed, or not, in the social media playing field.  Her results have been published in the Journal of Human Lactation, August 2012.  I was doing my own informal research when I was able to talk to her in the fall of 2011.

Commercial interests have a very strong presence in social media: Several manufacturers have established a Facebook and Twitter presence, including Gerber and PBM products, the largest US manufacturer of store brand formulas, which has launched pages for its various labels: Bright Beginnings, Parent’s Choice, Vermont Organics and Member’s Mark.  Earth’s Best, which manufactures formula, also has a Facebook page.  All of these pages are set up to enable member comments and to allow users to “like” or “follow” the page.  Users would then be on record as “liking” the page, a fact which might give their own contacts reason to check it out.

The Gerber Facebook page, in a section marked for pregnant moms, contains a link to information about a hospital discharge bag, including a feature to search for participating hospitals that are currently giving out the bag.   It also contains bios of registered dietician “experts” who are on hand to answer posted questions.  The site in the past has linked to formula coupons.

Gerber, Parent’s Choice, Bright Beginnings and Member’s Mark at certain times sponsor photo contests, wherein users submit photos of their children to the site for chances to win gift cards and other prizes.   Users are often required to “like” or become a fan of the page to be eligible to win.  These user-posted photos, or the winners, are then posted on the site for others to view.

No information on superiority of breast milk found on any of these pages, except the Facebook page of Earth’s Best, which manufacturers formula and complementary foods.  None of these pages contained the full list of warnings called for in the Code, such as information on the adverse effects on breastfeeding of introducing partial bottle feeding.

Then there are the “apps”.  Doesn’t every mom wish to add more predictability to their life?  And who does not want to be a “strong mom”?

What kind of information are these moms receiving?  One of the fans of the Unlatched, a breastfeeding support Facebook page, sent this email she received when her baby was 5 weeks old.

You can see that the intention is to promote a product, not to promote breastfeeding. And you can get a FREE container of formula to get you started!

Another aspect of social media are blogs – on-line “celebrities” that people follow and read to get much of their information.  Much to my surprise – there is quite a bit of sponsorship of these bloggers – they get paid to review products and services.  Many moms believe that these are ‘independent’ opinions, but they are in fact, very biased.  The source of these payments is through third parties.  One such third party is called Collective Bias.

And who are these Collective Bias clients?  Their website says,

“Collective Bias is a content marketing company that weaves organic social content into real-life stories to create millions of impressions, drive organic SEO and ultimately sales for brands and retailers like Starbucks, Nestlé, Elmer’s and Walgreens.”

Who are the people wishing to build dedicated communities to foster shared conversations, creating and advocacy platform that fosters organic dialogue. . . ultimately enhanced loyalty and SALES? They are the multi-national companies that put profit ahead of the health of millions of mothers and babies.

Social media is being used in clear violation of the International Code.

Several practices, such as enabling of user-generated content like photos, videos, comments, one-click endorsements, and sponsorship of third-party blogs, raise issues not anticipated by the original Code.

Abraham concludes her research by stating: “Future revisions of the Code should consider new marketing strategies enabled by social media, including  use of user-generated content, disclosure of sponsorship  of reviewers, bloggers and other media creators, and financial ties to those providing education to mothers and families.”

So, is the Code still relevant?

YES.  Just because the marketing is less transparent and obvious than before, does not mean we give up.  While the Wold Health Assembly may take the time to clarify the new issues that social media has generated for the Code, we don’t have to wait around for the next resolution.  We can and should still make a difference! In fact, I propose that thanks to social media, it is even easier to make your voice heard.

What can you do?

• You already do a lot! Helping moms breastfeed is a great way to help defeat commercial interests! Talk to mothers about the risks of unnecessary supplementation and their impact on milk production including the difficulty of reestablishing breastfeeding
• Become familiar with the Code. The International Baby Food Action Network (IBFAN) is a wonderful resource and their website contains a wealth of information.
• Commit to abide by the Code provisions for “Health Workers” by talking to mothers, health professionals, and anyone involved with mothers and babies about the importance of the Code.  Write letters to magazines, Facebook pages and media outlets that violate the Code.  Don’t eat lunches provided by Code violating companies, take their gifts, or accept their sponsorship for your education or conference.
• Monitor by collecting samples from magazines, exhibits, stores, web sites and doctor’s offices. Take pictures of store and conference displays.
• Report violations to IBFAN or your local “Code Watcher” like the National Alliance for Breastfeeding Advocacy (NABA) or the Infant Feeding Action Coalition (INFACT).
• Make sure you do not use or provide posters, educational materials, pads, magazines, pens, magnets, etc. that are given to you by or that bear the logo of code violators.
• Use social media yourself – tweet, post, like and share!

You can make a difference.  We must make a difference.  I always like to tell the story of the River Babies when talking about the Code– it is a common story that applies to many  public health issues lots of public health issues, but I believe it bears repeating here. It goes something like this:

One summer in a village, the people in the town gathered for a picnic. As they leisurely shared food and conversation, someone noticed a baby in the river, struggling and crying. The baby was going to drown! Someone rushed to save the baby. Then, they noticed another screaming baby in the river, and they pulled that baby out. Soon, more babies were seen drowning in the river, and the townspeople were pulling them out as fast as they could. It took great effort, and they began to organize their activities in order to save the babies as they came down the river. As everyone else was busy in the rescue efforts to save the babies, two of the townspeople started to run away along the shore of the river. 

“Where are you going?” shouted one of the rescuers. “We need you here to help us save these babies!” 

“We are going upstream to stop whoever is throwing them in!” 

The Code was set in place to stop the babies from being thrown into the river of corporate greed.  Please help by upholding it and monitoring and hopefully one day all our countries will have strong government legislation that can help us.  Until then, we cannot give up and we must continue educating ourselves and the mothers we serve so that they do not fall prey to commercial interests.  You have a voice, use it.

Originally from Mexico City, Norma Escobar has been working with breastfeeding women since 1994, first as a Leader with La Leche League, then as a Board Certified Lactation Consultant (2002).  Her current work focuses on serving low-income mothers in Wilmington, North Carolina.  She is the mother of two sons without whom she would have never discovered the joys and challenges of breastfeeding. Norma posts avidly on facebook through the Tri-County Breastfeeding Coalition  and La Leche League of Wilmington NC.