A Letter from the ILCA President: Our Shared Obligation to the Code

As we honor how much has been accomplished in the 40 years since the adoption of the International Code of Marketing of Breast-milk Substitutes (“the Code”), we must also recognize that our work to enact and enforce the Code is far from complete.

Of the 194 countries in the world, only 25 countries have enacted laws that are substantially aligned with the Code. Even where the Code is enacted, enforcement of the Code continues to be uneven. Commercial milk formula companies are exploiting these gaps and using their massive marketing budgets to spread their influence at an ever-increasing scale. The recent video by Global Breastfeeding Collective partner Save the Children highlights how sales of commercial milk formula is growing eight times as quickly as the world’s population.

The Code recognizes the critical role that healthcare workers play in “guiding infant feeding practices, encouraging and facilitating breast-feeding, and providing objective and consistent advice to mothers and families” and provides guidance on how we can help avoid being influenced by the marketing of commercial milk formula.

One insidious way that formula companies attempt to influence healthcare workers is through “free” educational opportunities. These so-called “free” opportunities represent a Conflict of Interest on the part of formula companies, as described in one of the subsequent resolutions to the Code.

Recently, an ILCA member alerted us that a formula company is posing as a “health institute,” offering no-cost CME and nursing credits to health care providers, and using ILCA’s name to confer legitimacy to their efforts. 

We immediately investigated, and learned that the Abbott Health Nutrition Institute had taken advantage of a relationship ILCA shares with InJoy, with whom we had partnered to educate healthcare workers that serve breastfeeding and chestfeeding families. (InJoy Health Education is a company in the field of maternity education that produces and provides educational videos and other multi-media content to health care facilities and health educators.) 

InJoy was unaware that Abbott Health Nutrition Institute is a subsidiary of Abbott Global, maker of Similac, a longtime code violator. Abbott recently failed to make any commitments to improve their marketing policies and practices to bring them more closely into line with the Code. InJoy allowed Abbott to purchase licenses for the course. We are deeply frustrated to see that Abbott has been offering it for free to healthcare workers, alongside courses like “Handling Human Milk and Formula in Healthcare Facilities: Tried & True and What’s New.”

Based on our efforts, InJoy is now severing its ties with Abbott. ILCA will be donating the proceeds that resulted from InJoy’s license with Abbott. We are doing so out of our deep commitment to upholding the Code, including avoiding conflicts of interest. 

ILCA has a number of processes in place designed to help us ensure that ILCA – and our vendors – are free from Code violations and conflicts of interest. We also recognize that, just as formula companies’ strategies are constantly evolving, so must we. 

We are particularly grateful to our member who brought this matter to our attention. Your ongoing vigilance in spotting and reporting these issues is essential as a part of our efforts to uphold the Code and all subsequent relevant World Health Assembly resolutions. This action is completely inline with the call to health workers and all of civil society to uphold the Code and to address violations through reporting mechanisms.

ILCA and IBCLCs alone cannot stop formula companies from influencing health care providers. We call on all professional health care organizations to stop accepting funding from companies that don’t meet their Code obligations in the form of advertising, sponsorship, and the awarding of CME and other educational credits. We recognize that there are challenges in holding conferences and funding membership benefits without this funding. We believe that you cannot put a price on ensuring that families are served by health care workers that are free from influence from companies that are spending billions to put formula samples into the hands of new families.

Sabeen Adil, MBBS, IBCLC
President, ILCA

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