Ethical Leadership: Meeting obligations under the International Code

by ILCA Board Member Lisa Akers MS, RD, IBCLC, RLC

Organizations of all types have shown important advancements in ethical practices over the past century, even as the challenge of providing ethical leadership while following evidence-based practice and performance standards remains unchanged. ILCA^® is dedicated to promoting a climate that facilitates ethical decision-making and commitment to the profession. As such, ILCA supports the hierarchy of infant feeding as specified in the Global Strategy for Infant and Young Child Feeding (2003)[1]. Upholding the International Code of Marketing of Breast-milk Substitutes[2] and all relevant subsequent World Health Assembly resolutions (i.e. International Code) is one way in which ILCA reflects an ethical climate and positively effects decision-making. ILCA has long taken steps to ensure that it “does not invest in, nor accept funding, donations, advertising, or sponsorship from corporate entities that do not meet their obligations” under the International Code.

More recently ILCA took the seriousness of its obligations for upholding the International Code to a higher level by forming an independent panel of International Code experts in November 2013. The International Code Expert (ICE) Panel is recognized for their training and experience interpreting the International Code. The ICE Panel was first introduced through the Lactation Matter blog in June 2014 and continues to provide expert guidance to the ILCA Board behind the scenes. The ICE Panel has enabled ILCA to re-examine sponsorship relationships. Among its responsibilities, the ICE Panel has been charged with determining “whether potential commercial affiliates are meeting their obligations under the International Code.” All potential commercial affiliates are now subject to an examination process by which the ICE Panel determines if they are meeting their obligation specified by the International Code. When a commercial affiliate is determined to not be meeting their obligation, the ICE Panel provides feedback to the organization on meeting International Code standards.

While the ICE Panel recognizes that mothers choose to use feeding bottles or other devices to give their expressed milk to their babies, this is not the same as direct breastfeeding and is specifically addressed in the Global Strategy. When there are clinical or medical problems that temporarily or permanently prevent direct breastfeeding, alternative feeding devices are clinically appropriate and instruction in their use should be taught by healthcare professionals (International Code Article 4). ILCA supports one-to-one instruction from the IBCLC^® and health professionals[3] as the appropriate action.[4] Under its obligations of the International Code, ILCA does not support the public promotion of bottles and teats to the general public.

ILCA’s mission “to advance the International Board Certified Lactation Consultant^® (IBCLC) profession worldwide through leadership, advocacy, professional development, and research” would not be realized without fostering a positive ethical climate. ILCA continually strives to uphold the International Code while remaining cost effective and considerate of the external patrons during the decision-making process. ILCA asks that members also support their obligation to the International Code through their personal interactions with mothers and commercial relationships.

[1] “The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.” World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[2] World Health Organization. (1981). International code of marketing of breast-milk substitutes. WHO Chron, 35(4), 112-117.

[3] World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[4] Global Strategy, article 19.

Lisa Akers is a Registered Dietitian Nutritionist (RDN) and an International Board Certified Lactation Consultant (IBCLC). She has been working in the field of public health and human lactation for over 14 years. Her current position as the State Breastfeeding Coordinator is to support and promote breastfeeding endeavors for the Commonwealth of Virginia, which includes the development of public policy and media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding Peer Counselor Program; and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. Lisa serves as the Director of Marketing on the ILCA Board of Directors. She also serves as the Chair of the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee.