Archive | WHO Code/BFHI

El Código Internacional: ¿Sigue siendo relevante en la era de la información? {Parte 1}

We are proud to offer this Spanish translation to our popular post “The International Code: Is It Still Relevant in the Information Age? {Part 1}“.

Originalmente publicado en inglés el 12 de marzo de 2013 por lactationmatters.

Estamos orgullosos de presentar la primera de dos entradas al blog sobre el Código Internacional de Comercialización de Sucedáneos de la Leche Materna. Este documento es vital para nuestro trabajo y es una pieza clave en la defensa de las familias que servimos. El post de hoy es un “Código 101 de la OMS”, destacando la historia y los fundamentos del Código. Continuaremos en nuestra siguiente entrada al blog que explica cómo nuestras interpretaciones y aplicaciones del código tiene que cambiar con la llegada de nuevos estilos de comercialización, en particular en el uso de los medios sociales.

Por Norma O. Escobar, IBCLC (Con el aporte de Annelies Allain del Centro de Documentación del Código Internacional)

Photo by Nadia Samperio

Photo by Nadia Samperio

El Código Internacional para la Comercialización de Sucedáneos de la Leche Materna existe desde 1981. Fue escrito en un esfuerzo conjunto por entidades privadas y el gobierno. Los intereses comerciales también fueron invitados a participar y se comprometieron a seguir sus disposiciones. El Código fue adoptado por la Asamblea Mundial de la Salud con 118 miembros a favor, uno en contra (EE.UU.). Desde entonces, varias resoluciones han sido adoptadas para esclarecer los artículos del Código. En la actualidad, unos 32 países de todos los continentes han hecho el código completo parte de su legislación nacional. Setenta y seis países ponen muchas de las disposiciones del código en sus leyes. Algunos otros han adoptado directrices voluntarias para los trabajadores de la industria y de la salud. Incluso en lugares donde el Código no ha sido legalmente adoptado, el Código tiene un peso moral y ético y debe ser seguido.

¿Por qué un código?

¡La publicidad funciona! De acuerdo con un informe de Save the Children “Superfood for Babies” (Superalimento para bebés) la leche artificial para bebés es una industria de $ 25 mil millones dólares por año. El crecimiento se prevé que sea del 31% en 2015. Lo único que hace posible este crecimiento es la comercialización. Sabemos que el objetivo del marketing es vender más productos. El producto que estamos hablando (fórmula) es muy peligroso cuando sustituye la leche materna en la dieta de los lactantes de todo el mundo. En el 2004, $ 50 millones se gastaron en publicidad por las compañías de leche en los Estados Unidos, en comparación con $ 30 millones en 2000. Las tasas de lactancia materna ese año disminuyeron del 70% al 63%.

¿Cómo es la comercialización de los sucedáneos de la leche materna diferente a la comercialización de otros productos?

Aquellos de nosotros que vivimos en los países capitalistas, donde las economías de libre mercado han reinado durante años, conocemos el valor de la competencia. Debido a esta competencia sana, tengo una computadora, televisión o teléfono mejor y más barato, en cualquier momento que lo necesite. Pero aquí no estamos hablando de un producto más barato y mejor. Estamos hablando de sustituir la leche materna con un producto más caro e inferior. Y con el fin de “vender” a las madres este producto, se utilizan técnicas abusivas de marketing dirigidas a los miedos de la madre, su deseo de “encajar” y francamente mentir o exagerar en gran medida, los atributos del producto.

La Asamblea Mundial de la Salud determinó que era necesario un código “en vista de la vulnerabilidad de los lactantes durante los primeros meses de vida y los riesgos involucrados en las prácticas inadecuadas de alimentación, incluido el uso innecesario e incorrecto de los sucedáneos de la leche materna.” Al eliminar la presión generada por la publicidad y promoción, poniendo fin a la entrega de muestras y otras prácticas predatorias, y centrando la atención en la lactancia materna, es más probable que se cree un entorno se donde la lactancia será una vez más la norma.

Lo que el Código no es:

No es una prohibición de la disponibilidad de los productos. Simplemente se prohíbe la promoción y requiere un etiquetado adecuado ya que estas cosas engañan a las madres en el período más vulnerable de su vida: el nacimiento de un nuevo bebé.

¿Qué productos están cubiertos?

  • Fórmula para bebé y otros líquidos que reemplazan la leche materna: fórmula de seguimiento, fórmula casera, agua, jugo o té.
  • Cualquier alimento que se comercializa para un bebé menor de 6 meses
  • Los biberones o tetinas

En pocas palabras, ¿qué dice el Código?

  • No a la publicidad directa al público
  • No a las muestras gratuitas a las madres
  • No a la promoción de productos en los centros de salud incluyendo ninguna fórmula gratis o a bajo costo
  • Ningún representante de productos comerciales para asesorar a las madres
  • Ningún regalo o muestras personales a los trabajadores de la salud
  • No a palabras o imágenes idealizando la alimentación artificial, incluyendo imágenes de bebés en los productos
  • La información a los trabajadores de atención a la salud debe ser científica y factual
  • La información sobre alimentación artificial, incluyendo las etiquetas debe explicar:
    • los beneficios de la lactancia materna
    • costos y riesgos asociados con la alimentación artificial
    • Los productos inadecuados, como la leche condensada, no deben promocionarse para los bebés
    • Todos los productos deben ser de alta calidad y tener en cuenta las condiciones climáticas y de almacenamiento del país en el que se utilizan.

En 2004, tuve el privilegio de visitar el Centro de Documentación del Código en Penang, Malasia y participar en su formación para la implementación del Código. Desde entonces, he hablado con muchos proveedores de atención médica que no entienden el Código y su lugar en la promoción, protección y apoyo de la lactancia materna. Algunos creen que el Código es una imposición en su trabajo. Los violadores del Código están ofreciendo lo que parece como un alivio en la forma de materiales, educación y muestras gratuitas. Mientras la colaboración público-privada puede sonar bien, especialmente en una época de recursos cada vez más escasos, quiero desafiarte a que no hay tal cosa como un “almuerzo gratis”. Los intereses comerciales quieren que usted se sienta en deuda con ellos. Al aceptar sus “regalos”, aunque pequeños, se corre el riesgo de comprometer su eficacia como defensor de la lactancia.

Las tecnologías modernas añaden otra capa de complejidad, por lo que el marketing moderno es aún más específico y depredador. Los defensores de la lactancia son desafiados diariamente a competir con mentes más brillantes de marketing en el mundo por los corazones y en la leche de madres lactantes. El primer paso en la lucha contra este ataque a la lactancia materna es la comprensión de lo que sucede y luego usar nuestra influencia para exponer las tácticas comerciales cuando las vemos. Podemos utilizar las mismas tecnologías para defendernos. Vamos a hacerlo.

Por favor, esté pendiente a nuestro próximo post donde vamos a seguir discutiendo cómo vamos a continuar utilizando este documento fundacional sobre como los estilos de comunicación y la comercialización de productos han cambiado con el advenimiento de las redes sociales.

normaOriginaria de la Ciudad de México, Norma Escobar ha estado trabajando con las mujeres que amamantan a partir de 1994, primero como líder de La Liga de la Leche, y luego como consultora de lactancia certificada por la Junta (2002). Su trabajo actual se centra en atender a madres de bajos ingresos en Wilmington, Carolina del Norte. Ella es la madre de dos hijos sin lo cual nunca habría descubierto las alegrías y los retos de la lactancia materna. Norma postea mensajes en Facebook a través de la Tri-County Breastfeeding Coalition  y La Leche League of Wilmington NC.

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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.”

sherylabrahams

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.

gerberThe 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.

similacThen 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.

containter

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!

benkenobi

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.

normaOriginally 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.

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The International Code: Is It Still Relevant in an Information Age? {Part 1}

We are proud to present the first of two blog posts about the International Code of Marketing of Breastmilk Substitutes. This document is vital to our work and is a critical piece of advocacy for the families we serve. Today’s post is a “WHO Code 101”, highlighting the history and the basics of the Code. We will follow up with our next blog post which discusses 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.

We have also published this blog post in Spanish, which can be found HERE.

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

Photo by Nadia Samperio

Photo by Nadia Samperio

The International Code of Marketing of Breastmilk Substitutes has been around since 1981. It was written as a joint effort between private and government interests. Commercial interests were also invited to participate and pledged to follow its provisions. The Code was adopted by the World Health Assembly with 118 members in favor, one against (USA). Since then, various resolutions have been adopted to clarify the articles in the Code. Today, approximately 32 countries on all continents have made the entire Code part of their national legislation. Seventy-six other countries put many of the code’s provisions into their laws. Some others have adopted voluntary guidelines for industry and health workers to follow. Even in places where the Code has not been legally adopted, the Code carries moral and ethical weight and should be followed.

Why a Code?

Advertising works! According to a Save the Children Report “Superfood for Babies” artificial baby milk is a $25 Billion per year industry.  Growth is predicted to be 31% by 2015. The only way this growth is possible is through marketing. We know that the goal of marketing is to sell more product. The product that we are talking about (formula) is very dangerous when it displaces breastmilk in the diet of infants across the world. In 2004, $50 million was spent on advertising by the formula companies in the United States, compared to $30 million in 2000. Rates of breastfeeding that year declined from 70% to 63%.

How is marketing of breastmilk substitutes different than marketing other products?

Those of us who live in capitalist countries, where free market economies have reigned for years, know the value of competition.  Due to this healthy competition, I have a better, cheaper computer, television or phone any time I need one.  But we’re not talking about a cheaper, better product here.  We are talking about replacing mother’s milk with a more expensive and inferior product.  And in order to “sell” mothers this product, predatory marketing techniques are used that target mother’s fears, their desire to “fit in” and downright lie about, or greatly exaggerate, the product’s attributes.

The World Health Assembly determined that a code was necessary “in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breastmilk substitutes.“ By removing the pressure generated by advertising and promotion, by ending the giving of samples and other predatory practices, and by focusing attention on breastfeeding, it is more likely an environment will be created where breastfeeding will be once again the norm.

What the Code is not:

It is not a ban on the availability of products.  It simply bans promotion and requires adequate labeling as these things mislead mothers at the most vulnerable period of their lives: the birth of a new baby.

What products are covered?

  • Baby formula and other liquids that replace breastmilk: follow-up formula, homemade formula, water, juice or teas.
  • Any food if marketed for a baby younger than 6 months
  • Feeding bottles or teats

In a nutshell what does the Code say?

  • No advertising directly to the public
  • No free samples to mothers
  • No promotion of products in health care facilities including no free or low cost formula
  • No commercial product representatives to advise mothers
  • No gifts or personal samples to health care workers.
  • No words or pictures idealizing artificial feeding, including pictures of infants on the products
  • Information to health care workers should be scientific and factual
  • Information on artificial feeding, including labels should explain:
    • benefits of breastfeeding
    • costs and hazards associated with artificial feeding
  • Unsuitable products, such as condensed milk, should not be promoted to babies
  • All products should be of high quality and take into account the climactic and storage conditions of the country where they are used.

In 2004, I had the privilege to visit the Code Documentation Center in Penang, Malaysia  and participate in their Code Implementation Training.   Since then I have spoken with many health care providers who do not understand the Code and its place in the promotion, protection and support of breastfeeding.  Some believe the Code is another imposition on their work .  Code violators are offering what appears like relief in the way of materials, education and samples.  While public-private partnerships may sound good on paper especially in a time of dwindling resources, I want to challenge you that there is no such thing as a ‘free lunch’.  Commercial interests want you to feel indebted to them.  When you accept their ‘gifts’, however small, you risk compromising  your effectiveness as a breastfeeding supporter.

Modern technologies add another layer of sophistication, making modern marketing even more targeted and predatory. Breastfeeding advocates are challenged daily to compete with the brightest marketing minds in the world for the hearts and milk of nursing mothers.  The first step in fighting this attack on breastfeeding  is understanding what is happening and then using our influence to expose commercial tactics when we see them.  We can use the same technologies to fight back.  Let’s do it.

Please check back for our next post where we’ll continue to discuss how we’re continuing to use this foundational document as communication styles and the marketing of products have changed with the advent of social media.

normaOriginally 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.

For the Spanish language version of this post, please click HERE.

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Applauding Maryland’s Ban the Bags Initiative

The Maryland Breastfeeding Coalition has recently initiated a movement to “Ban the Bags” in Maryland. They sent the following letter and video outlining their efforts to to the CEOs of all birthing hospitals across the state, requesting the removal of all commercial infant formula discharge bags. We applaud their efforts and look forward to hearing how their actions support mothers and babies in Maryland. We hope that their letter and the influence it has can serve as a model for other states and countries to make the same changes in their communities.

banthebagsThe Maryland Breastfeeding Coalition lauds and strongly supports the recent release of the Maryland Hospital Breastfeeding Policy Recommendations by the Maryland Department of Health and Mental Hygiene (DHMH). As part of these recommendations, in an effort to protect and improve maternal and infant health in our state, we write today to urge your hospital to join with all hospitals in Maryland in discontinuing the distribution of commercial infant formula discharge bags. The initiative to ban the practice of marketing formula by health care institutions and professionals in all birthing hospitals is supported by DHMH’s recommendations, as well as other public health authorities, including the American Academy of Pediatrics, the Centers for Disease Control, and the 2011 Surgeon General’sReport.

Banning the bag is feasible!  Your hospital can join those hospitals that have committed to protecting breastfeeding and refuse to act as marketing agents of formula companies.  Several Maryland hospitals have already banned the formula company discharge bags without significant hardship or obstacles. In the process, they have been able to simultaneously increase their marketability.

  • Through working with their purchasing and marketing departments, some like Upper Chesapeake Medical Center and Shady Grove Adventist Hospital have designed and distributed their own discharge “gifts” which advertise their respective hospitals.
  • Johns Hopkins Hospital stopped giving out formula samples over three years ago as part of a hospital-wide effort to stymie the marketing of pharmaceuticals within its facilities.  The hospital administration has chosen not to give out a replacement bag.
  • Other hospitals such as Memorial Hospital at Easton discontinued distribution at the behest of Risk Management upon investigating their liability in the event of a formula recall or a baby getting sick from expired or contaminated formula.

While these hospitals and others no longer hand out formula bags upon discharge, banning the bag never prevents a mother from obtaining free formula samples if she so requests.   She can simply be directed to call the toll-free number on the back of every formula container to receive free bags, coupons, or samples. Your hospital aims to promote the health of infants and mothers, but when providing the bag and/or formula samples, the ongoing promotion of infant formula sends the inaccurate message that these products are medically approved, endorsed, and necessary.

The Maryland Breastfeeding Coalition has prepared a brief power point presentation to highlight the research regarding the effects of formula discharge bags and discuss further how hospitals can approach banning the bags. We encourage you to view and share it with your staff.

For more information, you can browse www.banthebags.org, and Public Citizen .  You can also visit the website of the Massachusetts Breastfeeding Coalition which has successfully led all 49 of Massachusetts’s birthing hospitals to ban the bag.  Our own Maryland Breastfeeding Coalition website will soon contain links to the You Tube video for staff and other resources. Help us make Maryland the next state to successfully put the health of our youngest citizens first by banning the formula discharge bags from all birthing hospitals. Please contact us if the Maryland Breastfeeding Coalition can be of further assistance to you, or if you have any questions.

Please share this information with other relevant departments within your hospital. We very much appreciate your time with this matter.

What is your community doing to eliminate the marketing of formula in your hospitals?

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Breastfeeding is a Human Right. What Does That Mean? {A Response from Baby Milk Action}

Editor’s Note:  While Lactation Matters typically publishes original material, occasionally we encounter a blog post that we feel especially deserves to be read by all IBCLCs and breastfeeding supporters.  This is just such a post.  It was originally published by Mike Brady and Baby Milk Action on the Baby Milk Action website. We appreciate their permission to repost it here.

The World Breastfeeding Conference (6 – 9 December 2012) came to an end in Delhi with participants from 86 nations approving a declaration that:

“calls upon all concerned to adopt a human right based approach to the protection, promotion, and support of breastfeeding and infant and young child feeding at international, national, and community levels.”

This is a very powerful concept, backed by international law, which campaigners can use in calling on policy makers to act. We can use it to challenge governments that have failed to provide maternity protection or to regulate the marketing of breastmilk substitutes or that invest in the baby milk industry to boost economic growth while failing to protect, promote and support breastfeeding.

But what does it mean to say breastfeeding is a human right? And what about babies who are not breastfed and mothers who do not breastfeed? Here’s the way I understand it.

Mike Brady, Baby Milk Action’s Campaigns and Networking Coordinator, at the World Breastfeeding Conference 2012 alongside campaigners from the Philippines

Human rights apply universally and it is the responsibility of governments to deliver and protect these rights.

The right to breastfeed is seen as applying to the mother/child dyad.

In other words, the mother and child as a unit have a right to breastfeed. It is not the unconditional right of the child to breastfeed, or that would oblige the mother to breastfeed regardless of her own situation. The right to breastfeed means that no outside party has the right to interfere with the relationship between the mother and child.

This is an interpretation of existing rights, such as the right to adequate food in the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, amongst others. Professor George Kent of the University of Hawaii, who has written and spoken extensively on this topic and has provided the bibliography given below, wrote in a paper on Human Rights and Infant Nutrition prepared for the World Alliance for Breastfeeding Action Global Forum in 2002:

“The principles are based on the concept that mothers should not be legally obligated to breastfeed, but rather they should be supported in making their own informed choices as to how to feed their infants.”

Protecting the right to breastfeed does not force mothers to continue breastfeeding if they want to stop. We have the right to free speech, but that does not mean we are forced to give an opinion on every subject under the sun; if we want to speak, that right is protected.

In the UK, 90% of women who stop breastfeeding before six weeks do so before they wish to (Bolling et al, 2007 cited in UNICEF, 2012 – full Infant Feeding Survey details available at http://www.ic.nhs.uk/pubs/ifs2005). If the Government had protected the right to breastfeed, might the situation have been different?

Speaking at the Conference, Miriam Labbok suggested that instead of talking of “protecting, promoting and supporting” breastfeeding, we could speak of “empowering, inspiring and counselling” mothers and the wider public with regard to breastfeeding.

To protect and empower, we need to provide an environment that makes breastfeeding possible. Many societies present obstacles to breastfeeding, rather than remove them. Maternity leave for working women needs to be sufficient, at least for the recommended period of 6 months exclusive breastfeeding (so those who wish to do so, can do so), and working conditions must be conducive to continued breastfeeding into the second year of life and beyond. Convention 183 (2000) of the International Labour Organisation states:

“A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child… These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly.”

Not all countries have ratified the Convention – click here for those that have. The UK has not yet done so.

There are many other areas where the right to breastfeed may be undermined and action should be taken. For example, in the UK mothers are sometimes abused for breastfeeding in public and the Government has acted by protecting the right for the mother/child dyad to feed in public in legislation.

Mothers also need protection from aggressive marketing of breastmilk substitutes. In part, the right to breastfeed derives from the Convention of the Rights of the Child. Article 24 speaks of the:

“right of the child to the enjoyment of the highest attainable standard of health… States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures… To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding…”

Ensuring parents have the required information and support on breastfeeding entails implementing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant Resolutions of the World Health Assembly. The aim of the Code is clearly stated:

The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Note that the Code also aims to protect mothers who use breastmilk substitutes, who also have a right to accurate, independent information. Its provisions prohibit companies from advertising and seeking direct and indirect contact with pregnant women and the mothers of infants and young children. Companies are required to label products correctly and are limited to providing scientific and factual information to health workers, who are responsible for advising parents and carers.

The Committee on the Rights of the Child now routinely looks at how governments have implemented the International Code and Resolutions when assessing their progress in complying with the Convention. It has twice called on the UK Government to implement these minimum standards in national measures, but the calls have so far gone unheeded. The Committee commented in 2008, “it is concerned that implementation of the International Code of Marketing of Breastmilk Substitutes continues to be inadequate and that aggressive promotion of breastmilk substitutes remains common”.

To promote breastfeeding and inspire mothers and their families may require investment in social marketing.

In the UK, the coalition government scrapped the Infant Feeding Coordinator posts at the Department of Health, even though these posts are called for in the Global Strategy on Infant and Young Child Feeding.

It is also short sighted if the intention is to save money. UNICEF UK issued a report this year on the unnecessary illness that could be prevented and costs saved if breastfeeding rates increased, if the mothers who stopped breastfeeding earlier than they wanted were able to continue for longer.

The theme of the World Breastfeeding Conference was “Mom-made, not man-made”. Perhaps “Mum-made, not manufactured”works better in our culture and helps us to highlight that the European Union prioritises trade and growth over health.

So we see the Irish Government’s Enterprise Ireland and Danone announcing investment of €50 million in a baby milk factory to boost the economy by exporting formula around the world. According to Enterprise Ireland “98% of the output from [the] Macroom [facility] will be exported and commercialized in more than 60 countries worldwide”. This will inevitably displace breastfeeding in other countries as well as its own. To benefit its economy, the Irish Government could instead invest in mothers, the “real milk” producers, in a country where less than half (47%) of mothers are breastfeeding on discharge from maternity services (NPRS, 2008 cited by the Health Service Executive).

In the Philippines, Nestlé is leading an industry effort to replace strong marketing regulations with a new weak law (I was honoured to share a platform with campaigners from the Philippines at the conference, pictured above) and the Department of Trade and Industry has written to Members of Congress calling on them to back the draft bill because otherwise US$400 million of investment could be cancelled by the corporations and because of the revenue infant formula sales generate for the Government. The Philippines Department of Health, UNICEF and WHO have said in a statement that the draft bill: “aims to support multinational companies while damaging the Filipino society: families, the mothers and children.”

To support breastfeeding requires provision of health care services, a supportive environment and counselling and seo services, particularly in countries where breastfeeding is not entrenched and visible.

As Prof. George Kent comments with regard to the right to adequate food :

“There is increasing recognition at the international level that good nutritional status is an outcome that depends not only on good food but also on good health services and good care. Health services consist of a broad range of measures for the prevention and control of disease, including the maintenance of a healthy environment.”

In the UK we have the National Health Service, free at the point of use, and an increasing number of hospitals are entering the UNICEF Baby Friendly Initiative, which aims to ensure support is provided to pregnant women and mothers in hospital and in the community. However, there are growing concerns about the way health workers are being targeted in the UK and other countries by baby milk companies, including through funding training and other events.

Mother support groups provide counselling services in the UK and the Department of Health does provide a grant towards the National Breastfeeding Helpline operated by a coalition of them. This is one example of the Government acting on its human rights obligations. However, a coherent approach is needed as the failure to adequately regulate the baby food industry means companies encourage pregnant women and mothers to contact company-branded telephone “carelines” for support on infant feeding and to sign up to their mother and baby clubs for information. There is an intrinsic conflict of interest in baby milk companies with products to sell making direct and indirect contact with pregnant women and mothers, and this is prohibited by the Code. The fact this is a marketing strategy was demonstrated last month when Baby Milk Action won a case against Pfizer/Wyeth before the Advertising Standards Authority (ASA) over its illegal advertising of infant formula when ostensibly providing breastfeeding support.

A human rights approach requires action on many fronts. It helps us to think coherently and logically about what is required to protect and deliver the rights in question.

In the cultural context of the UK and Europe, we need to articulate that protecting the mother/child dyad’s right to breastfeed is to provide space for all mothers to breastfeed, particularly those mothers who say they want to breastfeed for longer, but who experience problems that could not be overcome under the current circumstances. At the same time we should understand that not everyone has to exercise the rights they hold.

We need to persuade policy makers to act, because it is governments who are responsible for protecting and delivering rights.

We need to persuade governments to invest in mothers, the “real milk” producers, rather than factories built not to meet existing requirements, but to export baby milk around the world and to create new consumers and markets for economic reasons. Danone aims to supply 20% of the world’s infant formula from Ireland, supplanting the most locally produced and consumed food there is at great environmental and health cost.

We sometimes speak of breastfeeding being free and perhaps this led to it being undervalued by policy makers. But as Anwar Fazal, Chairperson Emeritus of the World Alliance for Breastfeeding Action (WABA), told the Conference in his inaugural address describing the five principles of breastfeeding: it provides medicine, it provides nutrition, it is sustainable, it protects the environment and it plays a special role in the mother/child bond.

For these benefits to be enjoyed as widely and as fully as possible, governments need to invest political effort and funding to meet their obligation to protect the right to breastfeed.

At the conference there were many inspiring stories of governments that have and are taking action and of the situation in countries where breastfeeding cultures continue to exist or have been recovered.

For those of us living in cultures where many mothers are unable to breastfeed as they would wish, this provides welcome reassurance that a new reality is within our grasp if we reach for it.

Bibliography of publications on infant feeding and human rights by Professor George Kent

“Breastfeeding: A Human Rights Issue?” Development, Vol. 44, No. 2 (June 2001), pp. 93-98.http://www2.hawaii.edu/~kent/breastfeedingrights.pdf

“Human Rights and Infant Nutrition,” WABA Global Forum II-23-27 September 2002-Arusha, Tanzania (Penang, Malaysia: World Alliance for Breastfeeding Action, 2004), pp. 178-186.http://www2.hawaii.edu/%7Ekent/HUMAN%20RIGHTS%20AND%20INFANT%20NUTRITION.pdf

“Food is a Human Right,” in Richard Pierre Claude and Burns H. Weston, Human Rights in the World Community: Issues and Action. Third Edition. Philadelphia: University of Pennsylvania Press, 2006, pp. 191-201.

“Child Feeding and Human Rights,” International Breastfeeding Journal, Vol. 1 (2006).http://www.internationalbreastfeedingjournal.com/content/1/1/27

“Breastfeeding; The Need for Law and Regulation to Protect the Health of Babies.” World Nutrition, Vol. 2, No. 9 (September 2011), pp. 465-490. http://www.wphna.org/2011_oct_wn3_kent_breastfeeding.htm

Regulating Infant Formula. Amarillo, Texas: Hale Publishing, 2011. Publisher’s announcement athttp://www.ibreastfeeding.com/catalog/p270/Regulating-Infant-Formula/product_info.html

Also see Global Obligations for the Right to Food, edited by Professor George Kent, with a chapter on Holding Corporations Accountable by myself (Mike Brady) and a chapter on International Legal Obligations for Infants’ Right to Food by Dr Arun Gupta, organiser of the World Breastfeeding Conference. Available in Baby Milk Action’s online Virtual Shop.

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One Every 21 Seconds: Let’s Remember What We are Fighting For

By Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA

Photo via www.mrqa.com

One of my favorite movies is The Girl in the Café. It is a quirky, and somewhat improbable love story between two very lonely people, Lawrence and Gina (played brilliantly by Bill Nighy and Kelly MacDonald), who meet by chance in a café in London. Lawrence works for the Chancellor of the Exchequer (the minister of economics and finance) in Great Britain. His team is preparing to attend the G8 Summit with the other world leaders. On impulse, he invites Gina to accompany him to the G8, and she learns about the Millennium Development Goals for the first time. What she learns becomes the central focus of the rest of the movie.

The Millennium Development Goals

In 2000, 189 heads of state issued the UN Millennium Declaration, which was a plan for countries and development partners to work together to reduce poverty and hunger, tackle ill-health, gender inequality, lack of education, lack of access to clean water, and environmental degradation. They established eight Millennium Development Goals (MDGs), with targets set for 2015. One of the most important goals is MDG 4: Reduce child mortality.

Fortunately, there has been some progress here, but there is obviously more to do. Annual deaths of children under five years of age in 2009 fell to 8.1 million, down by 35% from 1990. Diarrhea and pneumonia cause the deaths of nearly three million children under five each year worldwide. An estimated 40% of deaths in children under five occur in the first month of life.

According to the World Health Organization, infant and young child feeding is a key area to improve child survival. The first two years of a child’s life are particularly important, as optimal nutrition during this period will reduce morbidity and mortality, reduce risk of chronic diseases, and lead to overall better development. “In fact, optimal breastfeeding and complementary feeding practices are so critical that they can save the lives of 1.5 million children under five every year.”

UNICEF also made a similar statement regarding deaths from pneumonia and diarrhea, the two most-common causes of child death worldwide.

We know what needs to be done. Pneumonia and diarrhea have long been regarded as diseases of poverty and are closely associated with factors, such as poor home environments, undernutrition, and lack of access to essential services. Deaths due to these diseases are largely preventable through optimal breastfeeding practices and adequate nutrition, vaccinations, hand washing with soap, safe drinking water and basic sanitation, among other measures. 

Does MDG 4 Apply to Mothers in the U.S.?

Yes, you might say, breastfeeding is important in the Third World, but not really critical in the U.S., where “safe” alternatives abound. Of course, I’ve heard all this before. But consider this. The U.S. now ranks 41st in infant mortality.  In other words, our
babies are dying too. What is particularly concerning is the large disparity by ethnic group.

According to the Centers for Disease Control and Prevention, African Americans have 2.3 times the infant mortality rate as non-Hispanic whites. They are three times as likely to die as infants due to complications related to low birthweight as compared to non-Hispanic white infants.

Infant mortality rate per 1,000 live births, 2008

Source: CDC 2012. Infant Mortality Statistics from the 2008 Period Linked Birth/Infant Death Data Set.
 

A key factor in these statistics is breastfeeding. In a national CDC survey, 54.4% of African American mothers, 74.3% white mothers, and 80.4% of Hispanic mothers attempted to breastfeed. Breastfeeding rates were the lowest for African American mothers in 13 states, where they had breastfeeding initiation rates at least 20% lower than white mothers. In six states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, and South Carolina), the prevalence of initiating breastfeeding among African-American women was less than 45%.

Now for some good news. As Tanya Lieberman shares in a blog posts for Best for Babes, the answer to this problem right in front of our face.

Evidence is accumulating that not only does following the Ten Steps improve breastfeeding success rates in general, it actually eliminates or significantly reduces race-based disparities.

Consider the following examples:

One study of Baby Friendly hospitals in the U.S. found that “breastfeeding rates were not associated with number of births per institution or with the proportion of black or low- income patients.” In other words, whether you had a large or small population of women who were African American, breastfeeding outcomes were the same. Disparity? Poof!

Here’s another study, of Boston Medical Center, which became a Baby-Friendly Hospital in 1999. The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999. Yes, that’s super impressive on its face. But consider this: the overall breastfeeding rate went from 58% to 78%. So that means African American mothers were within 4 percentage points of the overall hospital rate. A study found that, “Among a predominantly low-income and black population giving birth at a U.S. Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.” Disparity? Gone, baby, gone.

One Every 21 Seconds

In the climactic scene in Girl in the Café, Gina makes an impassioned speech to the
assembled world leaders (shortly before she is removed from the gathering), pleading with them to do something to help. She points out that one child dies of extreme poverty every three seconds. She snaps her fingers and says, “There’s one….and another…and another.”

We can make a similar statement. If we consider the WHO estimate of 1.5 million infant and child deaths annually, we can say that one child dies every 21 seconds due to lack of breastfeeding. “There’s one…and another…and another.” In the time it takes me to complete a 60-minute lecture, 171 children have died. With the U.S. ranking 41st in the world in infant mortality, this problem is not just “out there.” It is at our door as well.

We have made wonderful strides in 2012 in improving breastfeeding rates. It’s been an excellent year. Not surprisingly, there has also been a backlash. When people claim that this is matter of “upper-class white women” interfering needlessly in the lives of patients and trying to deny them “choice,” I hope you will see that they have truly missed the point. We need to continue to hold the line and remember what we are really fighting for. I long for the day when we can no longer say “there’s one…and another…and another.”

Wishing you a happy and healthy 2013. Thanks for fighting the good fight.


Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is Owner and Editor-in-Chief of Praeclarus Press. She is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is Editor-in-Chief of the journal, Clinical Lactation, a Fellow of the American Psychological Association, and is president elect of the APA Division of Trauma Psychology. This post is a preview of her editorial in the Vol 3-4 of Clinical Lactation. You can read more about Kathy at www.KathleenKendall-Tackett.com.

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World Wide Impact in 10 Minutes or Less: Using Social Media for Powerful Change

By Amber McCann, IBCLC

One week ago, Lactation Matters posted a blog entitled If YOU Don’t Advocate forMothers & Babies, Who Will? If there was any doubt that you, the Lactation Matters readers, were willing to step up to the plate, that doubt has been squashed. Within moments of the publishing the post, the initiative to use social media to ask the World Health Organization (WHO) and the Pan American Health Organization (PAHO) about their acceptance of money from major industry, including Swiftmoney Nestle, was gaining ground.

In response to the blog post, over 400 readers have joined a Facebook group, Friends of the WHO Code, to discuss advocacy and activism as it relates to the WHO Code and social media. Discussions this week have centered around gaining the attention of those involved in this situation and those who have the power to influence decisions. The group has worked hard to get the message out that that acceptance of funds that constitute a conflict of interest are unacceptable for an organization whose purpose is to protect the public health of the world. The group is primarily using Twitter as a means to connect and raise a tidal wave of support. And, it has been SUCCESSFUL!

Wednesday morning, those in the group noticed that the World Health Organization was responding to our questions with the following tweets:

In addition, WHO posted the following message on their Facebook page:

The conversation is beginning in the social media space and is a perfect example of how social media has the power to quickly bring all the players to the table. Although the World Health Organization has engaged in conversation with us, there is much work still to be done.

Do you have 10 minutes?

Would you join the conversation?

In a few short minutes, you can play a significant role in this initiative. Please consider taking 10 minutes and doing the following:

  1. Join the Friends of the WHO Code Facebook group
  2. Go to Twitter* and share the following tweets (just copy and paste!):

#WHOCode protects women&babies from predatory marketing. Shame @Nestle for trying to buy seat at the @PAHOWHO table #nonestle #breastfeeding

Tell @PAHOWHO to give back @Nestle $150K #nonestle #WHOCode #breastfeeding #conflictofinterest http://t.co/nnWJCIfX @WHO

We will not be bought! @PAHOWHO please return the money to @nestle . Stand up for mothers and babies. #WHOCode #breastfeeding #nonestle

If you’ve got more than 10 minutes, would you lend your expertise, insight, and skills to the movement?

Two thoughtful ladies responded to last weeks Call to Action with this quote from Margaret Meade:

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

The time is now.  Let’s change the world.

* If Twitter feels like another language to you, we understand. Check out the support from Birth Swell and Twitter’s Help Center.

Amber McCann, IBCLC is a  board certified lactation consultant in private practice with Nourish Breastfeeding Support, just outside of Washington, DC and the co-editor of this blog.  She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition to her work as the co-editor of Lactation Matters, the International Lactation Consultant Association’s official blog, she has written for a number of other breastfeeding support blogs including for HygeiaThe Leaky Boob, and Best for Babes. She also serves on the Social Media Coordinator for GOLD Conferences International and is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms.  When she’s not furiously composing tweets (follow her at @iamambermccann) or updating her Facebook page, she’s probably snuggling with one of her three children or watching terrible reality TV.

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If YOU Don’t Advocate for Mothers & Babies, Who Will?

Written by Jennie Bever Babendure, PhD, IBCLC

As IBCLCs, part of our Code of Professional Conduct  (IBLCE November 1st, 2011)calls on us to adhere to the World Health Organization’s (WHO) International Code of Marketing of Breast-Milk Substitutes and Subsequent Resolutions.  For those of us who hold this Code in high esteem, the news that WHO is accepting corporate funding and instant payday loans for its obesity initiative is enough to turn our stomachs many times over. According to the article, the Pan American Office of the WHO (based in Washington, D.C.) has begun to accept funding from fast food makers, among them the food giant and WHO Code violator Nestle.

As I struggled to reconcile the idea that an organization focused on world health would accept funding to fight obesity from the organizations that stand the most to gain from creating it, I began to feel crushing discouragement. How on earth can we, as a small band of mothers and breastfeeding professionals supporting the WHO Code, compete with multinational corporations with seemingly endless supplies of money? How can we succeed at supporting the WHO Code when the WHO is taking money from one of the worst offenders?

This is the point in the story when the hero has been soundly defeated. She goes back home with her eyes on the ground kicking stones in the path. She decides she will never win, so she might as well give up and just make noodles for the rest of her life (oh wait, I think that might be from one of my son’s favorite movies).

After a long night of frustration, writing, and a little alcohol, I chose to reframe the issue as a CALL TO ACTION. And if the WHO violating the WHO Code isn’t a call to action slapping me in the face, I don’t know what is!

But what can we do?

Most of us are doing our darndest to help mothers and babies start and continue breastfeeding in the face of tremendous marketing and cultural pressure to do otherwise. We stay awake nights worrying about how to best help a mother struggling with thrush or low supply, pour over research on tongue-tie and search the web for resources for new mothers. What more can we do?

The time has come for us to see our roles expand.  Our job as lactation professionals must not only be to provide individual breastfeeding support, but also to advocate for maternal and child health on a larger scale. If we don’t begin to protest the status quo and work to change the political and cultural barriers that mothers face in their attempts to reach their breastfeeding goals, we will be fighting the same battles for the next 100 years. The International Baby Food Action Network (IBFAN) has long been at this fight. They shouldn’t have to fight alone.

In many places, we are beginning to see policies and legislation changing. We need to harness that momentum to move the tide even further. Now more than ever, mothers and babies need us to advocate for them and they need us to empower them to demand change themselves. Not just in the clinic or hospital, but in the grocery stores and restaurants, in the hallways and on the floor of congress. When mothers and babies protest a mother being asked to leave for nursing in public, we need to show up. When our congressmen and women debate policies that impact breastfeeding, we need to show up. When a news station wants to run a story on breastfeeding, we need to show up. When the WHO takes money from Nestle, we need to show up!

For some, showing up means planning and attending nurse-ins and rallies, for others it is talking, blogging and posting information on the cultural and political barriers to breastfeeding on websites, twitter and Facebook pages. Still others have the ability to influence corporations and other organizations they are a part of by changing the way they do business, who they work with, and how they support their employees. Even beginning to have conversations with the mothers you work with about choosing to support companies that uphold the WHO Code can have an impact!

We can also leverage our resources by joining forces with other organizations working to improve maternal and child health. In addition to IBFAN and the World Alliance for Breastfeeding ActionNatasha K. Sriraman has written about the organization 1000 Days for the Academy of Breastfeeding Medicine.  With a goal of improving life by improving maternal and infant nutrition in the first 1000 days –pregnancy through the second birthday—1000 days seems like a natural ally of lactation consultants and maternal-child health advocates.  Working with like-minded organizations will increase our ability to impact policies and legislation that prevent corporations like Nestle from sabotaging breastfeeding in both developed and developing countries by marketing their products directly to mothers.

When I was younger, I was under the illusion that if something important were happening, someone else would take care of it. As I’ve gotten older I’ve realized that is rarely the case. When the WHO takes money from a formula company, something is terribly wrong. If we don’t do something about it, who will?

If you are interested, please consider joining the “Friends of the WHO Code” Facebook Group to discuss violations of the WHO Code, especially those on social media, and how we can empower lactation professionals, volunteers and mothers to stand up for its importance.

Jennie Bever Babendure, PhD, IBCLC: I am mother to 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates. For more research news and commentary, check out my blog at www.breastfeedingscience.com. I can be reached at jennie.bever@gmail.com.

16

IBCLCs Play a Critical Role in the US Best Fed Beginnings Program

By Debi Ferrarello, MSN, MS, IBCLC

The National Initiative for Children’s Healthcare Quality (NICHQ) launched it’s CDC-supported Best Fed Beginnings program with the ambitious goal of preparing 90 US hospitals for Baby-Friendly designation by September, 2014. The 90 hospitals were selected from 235 applicants and represent 29 states with dubious distinction of having the lowest breastfeeding rates and the highest rates of supplementation during the hospital stay. The 90 hospitals were further divided into three geographical cohorts of 30
hospitals each.

IBCLCs gathering at the recent NICHQ Region B conference in Baltimore.

Each hospital has a “core team” that includes a senior administrator, at least one physician, a nurse leader, a bedside nurse, a data manager, a team leader, a senior lactation consultant, and a mother who does not work for the hospital and has given recently given birth at the hospital. This model addresses administrative “buy-in” issues by requiring senior administrator participation. In fact, the senior administrators have their own track tailored especially for their needs. Since creating a community that supports breastfeeding is a goal of Baby-Friendly, involving a mother from the community makes so much sense!

Recently, hospital core teams from “Region B” gathered in Baltimore, MD for a two day learning session (and Baltimore’s famous crabcakes on our own!). National public health leaders such as CDC’s Laurence Grummer-Strawn and Charles Homer, MD, MPH, president of NICHQ and on faculty at Harvard University, kicked off the event and energized the crowd. Over the course of two days, participants learned more about why breastfeeding is so important, how hospital practices make a difference, and what teams can do to transform the culture. We heard specifics about Baby-Friendly designation directly from Trish Mac Enroe and Liz Westwater of Baby Friendly USA. ILCA members Lori Feldman-Winter, MD, MPH, IBCLC and Anne Merewood, PhD, IBCLC provided specific strategies for success. Pediatrician Sahira Long, MD, gave insights into providing culturally appropriate care. We learned Continuous Quality Improvement (CQI) techniques that are essential to measure our baseline, develop strategies for change and chart our progress as we strive to support breastfeeding from the prenatal period, throughout childbirth and the hospital stay, and into the postpartum period. Finally, we heard from hospitals in our region who have already become Baby-Friendly as they shared trials and triumphs that we could all relate to.

Each participating hospital made a “story board” or video about their hospital, their goals, their successes, and challenges. Pennsylvania Hospital Core Team members enjoyed seeing what others have done and were proud to share our history of “rooming-in” dating back to 1765! Debi Ferrarello, Susan Meyers, Brittany Stofko, Kelly Wade, Pam Powers, and Karen Anastasia in front of their hospital story board.

So what do IBCLCs need to know about this initiative? IBCLCs need to know that after years of pushing that boulder up the mountain alone, there is suddenly an army of folks pushing right along with us…And we need to welcome the newcomers to the task. We need to be prepared to graciously play support roles as leaders who may never before have considered breastfeeding suddenly “discover” it. Many of the hospital team leaders are IBCLCs, meaning that we need to quickly become experts in CQI tools that were never part of The Exam and develop the essential skills to effectively lead an interdisciplinary team through a complex and multi-layered transformation. This is challenging work, but then again, IBCLCs have always be up for a challenge!

Best Fed Beginnings brings opportunities for IBCLCs. In order to become Baby-Friendly, hospitals need to make sure that all of their nurses have at least 20 hours of breastfeeding education, including five hours of competency-based demonstration. IBCLCs can teach classes and conduct skills labs for the competency education. While hospitals are not required to employ IBCLCs for Baby-Friendly designation, many do hire IBCLCs to care for their patients, as well as to provide education for other staff members. And finally, as hospitals invest resources into breastfeeding support, the visibility of those with expertise in lactation care rises. IBCLCs become far more valuable in the eyes of the hospital and the community. This is all good for IBCLCs, and ultimately for mothers and babies!

Debi Ferrarello, MSN, MS, IBCLC is honored to lead the NICHQ Core Team for the nation’s first hospital—Pennsylvania Hospital in Philadelphia.  Over the years she has worked in private practice, co-founded the nonprofit communty-based Breastfeeding Resource Center with Colette Acker, IBCLC, and led hospital-based lactation programs.  She conducts breastfeeding-related research, writes and speaks about breastfeeding, and is passionate about breastfeeding as public health.  She currently serves on the board of the United States Lactation Consultant Association. 

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Interview with Trish MacEnroe of Baby Friendly USA

Lactation Matters recently caught up with Trish MacEnroe, Executive Director of Breastfeeding USA.  While the Baby Friendly Hospital Initiative is well established in many areas of the world, the number of facilities pursuing the designation has soared recently in the US.  Trish gives us a glimpse into the current trends.

1.      Can you give us a brief history of the Baby Friendly Hospital Initiative in the US?

The Baby-Friendly Hospital Initiative (BFHI) is an international recognition and quality improvement program that evaluates hospital practices to ensure the successful implementation of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) Ten Steps to Successful Breastfeeding and International Code of Marketing of Breast Milk Substitutes. In addition, the Baby-Friendly assessment serves as an external verification of the CDC’s mPINC survey and is a key strategy to sell my settlement for meeting Healthy People 2020 Goals for breastfeeding. At its core, this designation process involves significant quality improvement and organizational change that replaces long-standing practices with new evidence-based practices that have been proven to lead to better outcomes.

The Baby Friendly Hospital Initiative was launched globally in 1991.  In 1992, the US Department of Health and Human Services funded an Expert Work Group to consider how to implement the BFHI in the United States. In 1994, with support from the U.S. Committee for UNICEF, Wellstart International Screen Sharing developed the evaluation tools to implement the BFHI assessment process. At the request of the U.S. Committee for UNICEF, in January 1997, the Healthy Children Project, Inc. accepted responsibility for creating the organization to serve as the designating body for the BFHI in the United States. Since August 1997, Baby Friendly USA, Inc, a non-profit 501(c)(3) organization, is the US national authority for this global breastfeeding initiative.

Currently, 145 hospitals and birthing centers in 34 states are designated as Baby-Friendly Facilities in the United States. 23 hospitals were added in 2011 and 22 more have already received the designation in 2012. Another 675 are working towards designation. The Baby Friendly Hospital Initiative is growing rapidly in this country as more and more birthing facilities commit to becoming Baby Friendly.

 2.      How has the Surgeon General’s Call to Action impacted the practice?

The US Surgeon General acknowledged the benefits of the Baby-Friendly Hospital Designation in her Call to Action to Support Breast Feeding. Baby-Friendly USA, Inc. (BFUSA) is committed to advancing effective strategies that assist hospitals, breastfeeding coalitions, public health entities and funders to work collaboratively in implementing Action 7 of the Call to Action and improve outcomes.

Since the Surgeon General’s Call to Action, the number of local departments of health, breastfeeding coalitions and other community organizations (auto glass replacement houston shops) assisting hospitals in working to become Baby-Friendly designated has risen dramatically. While there is no direct evidence that it is specifically attributable, since the Call to Action was released 512 hospitals have officially begun work on the BFHI in the US.  My opinion is that the surge in hospital interest is the result of a combination of factors: a call to action from the highest levels of the US government, as well as some new funding opportunities to help hospitals change practices.

3. There has been news lately of the Latch On NYC  initiative to “lock up” formula in the hospital?  What is Baby Friendly USA’s stance on such practices?

Mayor Bloomberg and the NYC Department of Health and Mental Hygiene are to be commended for being proactive on a very important consumer protection issue.

Human milk fed through the mother’s own breast is the normal way for a human infant to be nourished.  Breastfeeding is the biological conclusion to pregnancy and an important mechanism for the continued normal development of the infant.  Naturally, things that occur outside the norm have side effects, including health consequences.  The “Latch-On NYC” campaign, which is voluntary for the facilities, asks that mothers be educated about the benefits of breastfeeding, which naturally includes the possible consequences of formula.  Some mothers will weigh the benefits and risks and compare them to other factors in their lives and decide that formula feeding is the best option for their circumstances.  When that occurs, their wishes should be respected.  This is very much in keeping with the tenants of the Baby-Friendly Hospital Initiative.

Another very important point that has been lost in the media frenzy around the Latch-On NYC campaign is that hospitals have standard policies that either limit access to (which is what Latch-On NYC calls for) or “lock up”  most of the products they use.  This is done for patient safety reasons as well as inventory control.  What we really should be asking is why is this not standard operating procedure for infant formula in all facilities throughout the US, and why has the suggestion of it stirred up such a controversy? It just makes good sense.

4.  What is your hope for BFUSA as we move forward in the US?

I can’t wait for the day that the last hospital in the US receives the Baby-Friendly designation.  My hope is that we effectively fulfill our vision of creating an American culture than values the enduring benefits of breastfeeding and human milk for mothers, babies, and society.

Trish MacEnroe is Executive Director of Baby-Friendly USA, treasurer of the NYS Breastfeeding Coalition, and former chair of the WIC Association of NYS. At Baby-Friendly USA, Trish has reorganized the Baby-Friendly designation process and created
tools to assist facilities pursuing designation. Previously, Trish worked for the WIC program, most recently as Director of the NYS WIC Training Center, and oversaw development of training programs for all aspects of WIC including the development of their Breastfeeding Peer Counselor website and curriculum. Trish received her Bachelor of Science degree in Food Science and Nutrition from the University of Rhode Island.

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