Tag Archives | breastfeeding

El Código Internacional: ¿Sigue siendo relevante en la era de la información? {Parte 2}

We are proud to offer this Spanish translation to our popular post “The International Code: Is It Still Relevant in the Information Age? {Part 2}“.

Estamos orgullosos de presentar la segunda de dos entradas al blog sobre el Código Internacional de Comercialización de Sucedáneos de la Leche Materna (Puede leer la primera parte aquí). Este documento es vital para nuestro trabajo y es una pieza clave de apoyo a las familias que servimos. Después de nuestro post anterior, que era un “Código 101 de la OMS ” básico, la entrada de hoy cuestiona “¿Y ahora qué?”, ​​ Se discute cómo nuestras interpretaciones y aplicaciones del código tienen que cambiar con la llegada de nuevos estilos de marketing, incluido el uso de los medios sociales.

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

La mayoría de nosotros estamos familiarizados con las violaciones más comunes al código, publicidad directa en los medios impresos, muestras gratuitas en los hospitales y consultorios médicos, cupones para descuentos. Pero ¿qué pasa con los métodos de marketing que han surgido con el advenimiento de las redes sociales y el teléfono inteligente (smart phone) “siempre presente”?

¿Qué hay de nuevo?

Los mayores cambios en los últimos años han sido la explosión de los medios sociales y la ampliación del uso de los teléfonos inteligentes. Los medios sociales ocupan un estimado de 20% del tiempo que los estadounidenses gastan en línea en sus computadoras y el 30% de su tiempo en sus dispositivos móviles.

Las mujeres, y las personas de 18-34 años, son más propensas que otros grupos a visitar los sitios de medios sociales. Por ejemplo, las mujeres representan el 62% de todas las visitas de páginas en Facebook. Estas estadísticas sugieren que para muchas mujeres estadounidenses, los acontecimientos importantes de la vida como el embarazo, el parto y la maternidad están siendo influenciados por los medios de comunicación social. Y estas cifras crecen cada año. Según el informe de Nielsen, el tiempo que se gastó en los medios sociales en 2011 fue de 88 minutos al mes. En 2012, ese número había aumentado a 121 minutos.

De acuerdo con Nielsen: “Los días en que las empresas podían controlar muy bien los mensajes de la marca y su avance en los consumidores a lo largo de un línea de compra ordenada, hace tiempo que terminó. Los medios sociales han cambiado fundamentalmente la decisión del consumidor. Las decisiones de consumo y comportamientos cada vez están más impulsados por las opiniones, gustos y preferencias de una manera exponencial, grupo de amigos, compañeros y personas influyentes “.

sherylabrahamsComo resultado de estos cambios, la comercialización de los productos dentro del ámbito del código también ha cambiado. Sheryl Abrahams, una estudiante graduada en el Instituto Global de Lactancia Materna de Carolina, pensó que sería un buen proyecto de investigación averiguar cómo el código se está siguiendo, o no, en los campos de juego de los medios sociales. Sus resultados han sido publicados en el Journal of Human Lactation, agosto de 2012. Yo estaba haciendo mi propia investigación informal cuando tuve la oportunidad de hablar con ella en el otoño de 2011.

Los intereses comerciales tienen una presencia muy fuerte en los medios sociales: Varios fabricantes han establecido una presencia en Facebook y Twitter, incluyendo Gerber y productos PBM, el mayor fabricante de marcas de fórmulas en EE.UU., el cual ha lanzado páginas para sus diversos nombres: Bright Beginnings, Parent’s Choice, Vermont Organics y Member’s Mark. Earth’s Best, que fabrica fórmula, también tiene una página en Facebook. Todas estas páginas están configuradas para permitir comentarios de los miembros y permitir a los usuarios a darle “me gusta” o “seguir” a la página. Después, los usuarios quedan en el registro como “gustando” la página, un hecho que da motivo a sus  propios contactos de revisar estos sitios.

gerberLa página de Facebook de Gerber, en una sección dirigida a embarazadas, contiene un enlace a la información sobre una bolsa de regalo para cuando esté de alta del hospital, incluyendo un enlace para ver los hospitales participantes que están repartiendo la bolsa. También contiene biografías de dietistas registrados “expertos” que están a su disposición para responder a las preguntas publicadas. Hace un tiempo el sitio tenía un vínculo a cupones de fórmula.

Gerber, Parent’s Choice, Bright Beginnings y Member’s Mark de tiempo en tiempo patrocinan concursos de fotografías, en el que los usuarios envían fotos de sus hijos al sitio para oportunidades de ganar tarjetas de regalo y otros premios. Los usuarios a menudo tienen que  dar clic al “me gusta” o convertirse en un fan de la página para poder ganar. Estas fotos o las ganadoras, son publicadas en el sitio para que otros las puedan ver.

No hay datos sobre la superioridad de la leche materna en ninguna de estas páginas, excepto la página de Facebook de Earth’s Best, que son fabricantes de fórmula y alimentos complementarios. Ninguna de estas páginas contiene la lista completa de los avisos requeridos en el Código, como la información sobre los efectos adversos sobre la lactancia materna con la introducción parcial de la alimentación con biberón.

similacLuego están las “aplicaciones”. ¿No todas las mamás desean añadir una mayor previsibilidad a su vida? ¿Y quién no quiere ser una “madre fuerte”?

¿Qué tipo de información están estas madres recibiendo? Una de las seguidoras de Unlatched, una página de Facebook de apoyo a la lactancia, envió este correo electrónico que recibió cuando su bebé tenía 5 semanas de edad.

containterSe puede ver que la intención es promover un producto, no promover la lactancia materna. ¡Y usted puede conseguir fórmula GRATIS para que pueda empezar!

Otro aspecto de los medios de comunicación social son los blogs, “celebridades” en línea que las personas siguen y leen para obtener gran parte de su información. Para mi gran sorpresa, hay patrocinio de estos bloggers, se les paga para revisar productos y servicios. Muchas madres creen que estas son opiniones “independientes”, pero en realidad están muy sesgadas. La fuente de estos pagos es a través de terceros. Uno de estos terceros, se llama Collective Bias.

¿Y quiénes son estos clientes de Collective Bias? Su sitio web dice:

“Collective Bias es una empresa de marketing de contenido que asocia contenido social orgánico con historias reales para crear millones de impresiones, la unidad orgánica de SEO y en última instancia, las ventas de marcas y minoristas como Starbucks, Nestlé, Elmer’s y Walgreens.”

¿Quiénes son las personas que desean crear comunidades dedicadas a fomentar conversaciones compartidas, crear una plataforma que fomente la promoción en un diálogo orgánico. . . en última instancia, mejorar la lealtad y las VENTAS? Son las empresas multinacionales que ponen las ganancias por delante de la salud de millones de madres y bebés.

Las redes sociales se están utilizando en clara violación del Código Internacional.

Algunas prácticas, tales como la activación de contenido generado por usuarios, como fotos, vídeos, comentarios, endorso con un solo clic, y patrocinio a blogs de terceros, plantea cuestiones no previstas por el Código original.

Abraham concluye su investigación diciendo: “Las futuras revisiones del Código deberían considerar nuevas estrategias de marketing permitido por los medios sociales, incluyendo el uso de contenidos generados por usuarios, divulgación de patrocinio de críticos, bloggers y creadores de otros medios de comunicación y vínculos financieros que proporcionan educación a las madres y familias”.

Por lo tanto, ¿sigue siendo el Código relevante?

SÍ. El hecho de que la comercialización sea menos transparente y obvia que antes, no significa que nos vamos a rendir. Mientras a la Asamblea Mundial de la Salud puede que le tome un tiempo para aclarar las nuevas cuestiones que los medios sociales han generado para el Código, no tenemos que esperar hasta la próxima resolución. ¡Aun así, podemos y debemos hacer una diferencia! De hecho, propongo que, gracias a los medios de comunicación social, sea aún más fácil hacer que su voz se escuche.

¿Qué puede usted hacer?

  • ¡Ya hace mucho! Ayudar a las madres a amamantar es una gran manera de ayudar a derrotar a los intereses comerciales. Hable con las madres sobre los riesgos de los suplementos innecesarios y su impacto en la producción de leche incluyendo la dificultad de restablecer el amamantamiento
  • Familiarizarse con el Código. La Red Mundial de Grupos Pro Alimentación Infantil (IBFAN) es un recurso maravilloso y su sitio web contiene una gran cantidad de información.
  • Comprometerse a cumplir con las disposiciones del Código para “Trabajadores de la Salud” al hablar con las madres, profesionales de la salud, y cualquier persona involucrada con las madres y los bebés de la importancia del Código. Escribir cartas a revistas, páginas de Facebook y medios de comunicación que violan el Código. No aceptar comidas, regalos o patrocinio para su educación o conferencias que sean patrocinadas por compañías que violan el código.
  • Supervisar mediante la recopilación de muestras de revistas, exposiciones, tiendas, sitios web y consultorios médicos. Tome fotos de tiendas y exhibiciones en conferencias.
  • Informe violaciones a IBFAN o su red local “Vigilantes del Código” como la Alianza Nacional para la Defensa de la Lactancia Materna (NABA) o la Coalición para la acción en alimentación infantil (INFACT).
  • Asegúrese de no utilizar o proporcionar afiches, materiales educativos, libretitas, revistas, bolígrafos, imanes, etc. que le hayan obsequiado o que llevan el logotipo de los infractores del código.
  • Utilice los medios sociales, ¡tweet, post, me gusta y compartir!

benkenobiUsted puede hacer una diferencia. Tenemos que hacer una diferencia. Siempre me gusta contar la historia de los bebés del río cuando se habla del código, es una historia común que se aplica a muchos problemas de salud pública, pero creo que vale la pena repetirlo aquí. Es algo parecido a esto:

Un verano en un pueblo, la gente de la ciudad se reunieron para un picnic. Mientras compartían comida y conversación tranquilamente, alguien se dio cuenta de un bebé en el río, luchando y llorando. ¡El bebé se iba a ahogar! Alguien corrió a salvar al bebé. Entonces, se dieron cuenta de otro bebé gritando en el río, y sacaron a ese bebé. Pronto, vieron más bebés ahogándose en el río, y la gente del pueblo los sacaban tan rápido como podían. Tomó un gran esfuerzo, y comenzaron a organizar sus actividades con el fin de salvar a los bebés que llegaban por el río. Mientras todos estaban ocupados en las tareas de rescate para salvar a los bebés, dos personas del pueblo empezaron a correr por la orilla del río.

“¿A dónde van?”, Gritó uno de los rescatistas. “¡Los necesitamos aquí para ayudarnos a salvar a estos bebés!”

¡Vamos río arriba para detener a quien los está lanzando!”

El Código fue puesto en marcha para detener a los bebés de ser arrojados al río de la avaricia corporativa. Por favor ayude a detenerlos y a darle seguimiento y ojalá algún día todos nuestros países tengan una legislación gubernamental fuerte que pueda ayudarnos. Hasta entonces, no podemos renunciar y debemos seguir educándonos y a las madres que servimos para que no caigan presa de los intereses comerciales. Tienes una voz, utilízala.

 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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Parental Proximity: A Vital Aspect of Our Message

By Marianne Vanderveen-Kolkena, IBCLC 

In the year 1994, our third daughter was born. It was a beautiful home birth and we all felt blessed to be safely together. After a few days, however, I fell seriously ill with an old-fashioned disease: puerperal fever. It brought me to the hospital and I entered a world I had never been in before: the delivery ward. My stay awakened an awareness in me that has grown ever since: mothers should be central in the care of their infants, and healthcare providers ought to refrain from interfering with the essential process of secure attachment.

Skin to SkinStarted in 1994, my work as a volunteer breastfeeding counselor evolved to the private practice I have now as an International Board Certified Lactation Consultant in Assen, in the north of the Netherlands. As an ardent reader, my notion of “breastfeeding” has broadened immensely over the years. Breastfeeding is a dyadic, relation-building process of which a baby latching properly and taking in enough breastmilk is only a small part. This notion made me decide to take up a couple of translation projects besides my consultations. Many parents are desperate for good information, information that helps them to make choices that match their family values. Many parents intuitively know that being close to their infants is something they will all benefit from. Western societal habits, however, often hardly allow for that much needed proximity of primary attachment figures. Talking with parents, seeing how they are moved when I address the issue of how much their baby needs them and how much they have to offer, is very inspiring. My Dutch translation of Sleeping With Your Baby, written by James J. McKenna, led to beautiful responses from parents in the Netherlands: “Wonderful, to have this book now! I always knew it was a good thing to sleep together!” Mid April, the Dutch translation of Jill and Nils Bergman’s book Hold Your Prem will be published.

We all need a place where we can feel safe, so that we can develop physical and psychological stability in life. We do not only need that as a baby, but also as parents, in order to take care of our babies. I feel privileged to be able to professionally contribute in different ways to that sense of security!

SONY DSCMarianne Vanderveen-Kolkena started her breastfeeding work in 1994 with the Dutch breastfeeding association VBN. She became an IBCLC in 2008 and runs her private practice in Assen, the north of the Netherlands, Borstvoedingscentrum Panta Rhei. She still works with the VBN as editor for the brochure committee and gives presentations in different settings. She contributed to the Dutch national guideline on dealing with excessively crying babies, making a warm plea for responsive parenting, and was one of the two final editors of the Dutch National breastfeeding guideline. Marianne is a coworker of the biggest Dutch breastfeeding website, www.borstvoeding.com, advisor of ‘Het OuderSchap’, a Dutch organisation for parents (to be) and and an ILCA member.  All her practice and advocacy work focuses on the normalcy of breastfeeding, the importance of the mother-child relationship, the value of parental proximity in the early years and on language use that supports these aspects. She is preparing to study Anthropology at the University.

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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.

6

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.

12

Childbirth-Related Psychological Trauma: An Issue Whose Time Has Come

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

I first became interested in childbirth-related psychological trauma in 1990. Twenty-three years ago, it was not on researchers’ radar. I found only one study, and it reported that there was no relation between women’s birth experiences and their emotional health. Those results never rang true for me. There were just too many stories floating around with women describing their harrowing births. I was convinced that the researchers got it wrong.

To really understand this issue, I decided to immerse myself in the literature on posttraumatic stress disorder (PTSD). During the 1980s and 1990s, most trauma researchers were interested in the effects of combat, the Holocaust, or sexual assault. Not birth. But in Charles Figley’s classic book, Trauma and Its Wake, Vol. 2 (1986), I stumbled upon something that was quite helpful in understanding the possible impact of birth. In summarizing the state of trauma research in the mid-1980s, Charles stated that an event will be troubling to the extent that it is “sudden, dangerous, and overwhelming.” That was a perfect framework for me to begin to understand women’s experiences of birth. It focused on women’s subjective reactions, and I used it to describe birth trauma in my first book, Postpartum Depression (1992, Sage). {ed. note – this book is now in its 3rd edition and is titled Depression in New Mothers (Routledge, 2010).}

Photo by Tristan Wallace via Flickr Creative Commons

Photo by Tristan Wallace via Flickr Creative Commons

Since writing my first book, there has been an explosion of excellent research on the subject of birth trauma. The bad news is that what these researchers are finding is quite distressing:

High numbers of American women have posttraumatic stress symptoms (PTS) after birth.

Some even meet full criteria for posttraumatic stress disorder. For example, Lamaze International’s Listening to Mothers’ Survey II included a nationally representative sample of 1,573 mothers. They found that 9% met full-criteria for posttraumatic stress disorder following their births, and an additional 18% had posttraumatic symptoms (Beck, Gable, Sakala, & Declercq, 2011). These findings also varied by ethnic group: a whopping 26% of non-Hispanic black mothers had PTS. The authors noted that “the high percentage of mothers with elevated posttraumatic stress symptoms is a sobering statistic” (Beck, et al., 2011).

If the number of women meeting full-criteria does not seem very high to you, I invite you to compare it to another number. In the weeks following September 11th, 7.5% of residents of lower Manhattan met full criteria for PTSD (Galea et al., 2003).

Take a minute to absorb these statistics. In at least one large study, the rates of full-criteria PTSD in the U.S. following childbirth are now higher than those following a major terrorist attack.

In a meta-ethnography of 10 studies, women with PTSD were more likely to describe their births negatively if they felt “invisible and out of control” (Elmir, Schmied, Wilkes, & Jackson, 2010). The women used phrases, such as “barbaric,” “inhumane,” “intrusive,” “horrific,” and “degrading” to describe the mistreatment they received from healthcare professionals.

“Isn’t that just birth?” you might ask. “Birth is hard.” Yes, it certainly can be.

But see what happens to these rates in countries where birth is treated as a normal event, where there are fewer interventions, and where women have continuous labor support. For example, in a prospective study from Sweden (N=1,224), 1.3% of mothers had PTSD and 9% described their births as traumatic (Soderquist, Wijma, Thorbert, & Wijma, 2009). Similarly, a study of 907 women in the Netherlands found that 1.2% had PTSD and 9% identified their births as traumatic (Stramrood et al., 2011). Both of the countries reported considerably lower rates of PTS and PTSD than those found in the U.S.

How Does This Influence Breastfeeding?

Breastfeeding can be adversely impacted by traumatic birth experiences, as these
mothers in Beck and Watson’s study (Beck & Watson, 2008) describe:

“I hated breastfeeding because it hurt to try and sit to do it. I couldn’t seem to manage lying down. I was cheated out of breastfeeding. I feel that I have been cheated out of something exceptional.”

“The first five months of my baby’s life (before I got help) are a virtual blank. I dutifully nursed him every two to three hours on demand, but I rarely made eye contact with him and dumped him in his crib as soon as I was done. I thought that if it were not for breastfeeding, I could go the whole day without interacting with him at all.”

Breastfeeding can also be enormously healing, and with gentle assistance can work even after the most difficult births.

“Breastfeeding became my focus for overcoming the birth and proving to everyone else, and mostly to me, that there was something that I could do right. It was part of my crusade, so to speak, to prove myself as a mother.”

“My body’s ability to produce milk, and so the sustenance to keep my baby alive, also helped to restore my faith in my body, which at some core level, I felt had really let me down, due to a terrible pregnancy, labor, and birth. It helped build my confidence in my body and as a mother. It helped me heal and feel connected to my baby.”

What You Can Do to Help

There are many things that lactation consultants can do to help mothers heal and have positive breastfeeding experiences in the wake of traumatic births. You really can make a difference for these mothers.

  • Anticipate possible breastfeeding problems mothers might encounter. Severe stress during labor can delay lactogenesis II by as much as several days (Grajeda & Perez-Escamilla, 2002). Recognize that this can happen, and work with the mother to develop a plan to counter it. Some strategies for this include increasing skin-to-skin contact if she can tolerate it, and/or possibly beginning a pumping regimen until lactogenesis II has begun. She may also need to briefly supplement, but that will not be necessary in all cases.
  • Recognize that breastfeeding can be quite healing for trauma survivors, but also respect the mothers’ boundaries. Some mothers may be too overwhelmed to initiate or continue breastfeeding. Sometimes, with gentle encouragement, a mother may be able to handle it. But if she can’t, we must respect that. Even if a mother decides not to breastfeed, we must gently encourage her to connect with her baby in other ways, such as skin-to-skin, babywearing, or infant massage.
  • Refer her to resources for diagnosis and treatment. There are a number of short-term treatments for trauma that are effective and widely available. EMDR is a highly effective type of psychotherapy and is considered a frontline treatment for PTSD. Journaling about a traumatic experience is also helpful. The National Center for PTSD has many resources including a PTSD 101 course for providers and even a free app for patients called the PTSD Coach. In addition, the site HelpGuide.org also has many great resources including a summary of available treatments, lists of symptoms, and possible risk factors.
  • Partner with other groups and organizations who want to reform birth in the U.S. Our rates of PTS and PTSD following birth are scandalously high. Organizations, such as Childbirth Connection (take the opportunity to view their reports on the important issues regarding birth in the US HERE) , are working to reform birth in the U.S. 2013 may be a banner year for recognizing and responding to childbirth-related trauma. The new PTSD diagnostic criteria will be released in May in the DSM-5, and more mothers may be identified as having PTS and PTSD.

There has also been a large upswing in U.S. in the number of hospitals starting the process to become Baby Friendly, which will encourage better birthing practices. I would also like to see our hospitals implementing practices recommended by the Mother-friendly Childbirth Initiative.

There is also a major push among organizations, such as March of Dimes, to discourage high-intervention procedures, such as elective inductions.  And hospitals with high cesarean rates are under scrutiny. This could be the year when mothers and care providers stand together and say that the high rate of traumatic birth is not acceptable, and it’s time that we do something about it. Amy Romano, of Childbirth Connection,  describes it this way:

As we begin 2013, it is clear from my vantage point at the Transforming
Maternity Care Partnership that the transformation is underway. In Childbirth Connection’s nearly century-long history, we’ve never seen so much political will from leaders, so much passion from grassroots advocates, and so much collaboration among clinicians and other stakeholders. This new landscape presents many new opportunities for educators and advocates.  

There is much you can do to help mothers who have experienced birth-related trauma. Whether you join the effort to advocate for all mothers, or simply help one traumatized mother at a time, you are making a difference. Thank you for all you do for babies and new mothers.

Here are some helpful links to share with mothers:


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.

19

Nursing in Public: When Did It Become So Controversial?

Written by Robin Kaplan, M.Ed., IBCLC

When I look back at 2012 and recall the variety of breastfeeding stories that were covered by American media, I can’t help, but grimace and wonder,

“When did breastfeeding become so controversial?”

News story after news story depicts a breastfeeding mother being harassed for breastfeeding in public:

Charlotte Dirkes was asked to stop, cover up, or go somewhere else when she breastfed her 10-month old at a water park in Englewood, Colorado.

Tiffany Morgan was asked to stop breastfeeding her 6-month old, cover up, or leave Denny’s in Sedalia, Missouri.

Dawn Holland was asked to finish breastfeeding her 20-month old son in the bathroom of Applebee’s in Georgia.

Photo via Nurse-In @ Hollister Facebook Page

Photo via Nurse-In @ Hollister Facebook Page

Most recently, Brittany Warfield was screamed at and forced to leave a Hollister store in the Galleria Mall in Houston, Texas, when she breastfed her 7-month old, sparking a nurse-in across the United States and Canada of over 1,000 breastfeeding mothers, children, and friends on Jan 5th, 2013.

What ensued during this most recent nurse-in was truly shocking.

Three women participating in the Hollister nurse-in at Wilmington, Delaware’s Concord Mall were asked to remove their signs (written about normalizing nursing in public) and move to another part of the mall.  After taking down their signs, they continued to nurse in front of the Hollister store.  The mall’s security guards called the local police, who ended up not taking any action with the mothers once they showed them a copy of Delaware’s law that protects a woman breastfeeding in public.  The security officers took it upon themselves to continue to harass the mothers by threatening them with removal from the mall and then followed the mothers throughout the mall.

Photo via Nurse-In @ Hollister Facebook Page

Photo via Nurse-In @ Hollister Facebook Page

When other mothers heard about what happened at the mall, they posted on the Concord Mall’s Facebook page that they should be ashamed for calling the police when mothers were just feeding their babies.  In response, the Concord Mall responded that the breastfeeding was an ‘eyesore’ and that they ‘hope you guys don’t mind if I suck on my wife’s breasts in public.’

Since this Facebook exchange, The Concord Mall has disabled their Facebook Page (and denies that it ever had a Facebook page).  They also have apologized to the three mothers, yet the apology never admitted wrongdoing or that the women were treated improperly.

By the way, all of these harassment stories took place in states where breastfeeding women are protected by law to breastfeed in a public space.

While this type of harassment ruffles my IBCLC-feathers, it truly upsets me as an avid advocate for a breastfeeding mother’s right to meet her personal breastfeeding goals.  How can we expect mothers to breastfeed for any decent amount of time if they are relegated to their homes, cars, and public restrooms whenever their babies are hungry, just to avoid degradation and humiliation?

How can we, as mothers and IBCLCs, create the necessary change in our society where women will be able to feed their babies as nature intended?

I asked these questions to a group of mothers at my breastfeeding support group today, as well as of the followers on my business Facebook page, and their answers were honest and insightful.  Here’s what they had to say:

  • More women need to breastfeed in public so that people become desensitized to it, just like ‘we’ (Americans, in general) are desensitized to the sexualization of the breast and to violence on TV.
  • More breastfeeding on television shows and in movies, rather than always bottle feeding.
  • Public service announcements about how breastfeeding protects the health of the baby and of mom.
  • Have easier access to the laws that protect breastfeeding mothers, to use as a defense when asked to stop breastfeeding in public, cover up, or leave a public place.
  • In addition to the laws that protect a woman’s right to breastfeed in public, there is a need for laws that involve recourse for those who harass a woman for breastfeeding in public.

Fortunately, breastfeeding advocates are already thinking these same ideas!

Thanks to the Breastfeeding Law website, breastfeeding mothers can find all of the laws in the United States that protect their rights to breastfeed in public.

In California, on September 28, 2012, Governor Jerry Brown signed into law AB2386, which states that it is unlawful to engage in specified discriminatory practices in employment or housing accommodations on the basis of breastfeeding or medical conditions related to breastfeeding.  What this means for breastfeeding moms… they are now considered a ‘protected class’ of citizens and will receive a full spectrum of workplace discrimination protection.

In October, 2012, Best for Babes announced the launch of their Nursing in Public Harassment Hotline.  Now, breastfeeding mothers can report incidents of nursing in public harassment, document them, and receive guidance on how to deal with the situation and approach the offending institution.  The goal… to have enough documentation to influence policy makers to create laws that require enforcement of existing breastfeeding in public laws, the creation of laws that cover harassment and discrimination against breastfeeding in public, and educational and sensitivity trainings for employees.

Even MTV is changing their stance on breastfeeding.  While season 2 of Teen Mom removed scenes showing Kailyn Lowry breastfeeding, season 3 star, Katie Yeager, stated on Facebook and twitter that the show “will show me breastfeeding for a year.  I’m breaking the stigma and normalizing it again.”  That’s quite a commitment for a 16 year old!

For me, I plan to hand out a business card-sized copy of the California state laws that protect breastfeeding in public and prohibit discrimination in the workplace and housing to every breastfeeding mother I work with.  Hopefully having it in her wallet will provide some comfort that the law is on her side.  I also plan to submit an editorial to my local newspaper every time I hear a story about a mother being harassed for nursing in public.  I figure, it’s my job to educate my community about a mother’s right to feed her baby in public, without fear of persecution.  Lastly, I plan to promote Best for Babes Nursing in Public Harassment Hotline.  The more documentation they can collect, the better chance we have of creating a REAL change in our communities to help mothers meet their personal breastfeeding goals!

What plans do YOU have to create change in your communities for protecting a mother’s right to breastfeed in public?

RobinRobin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

18

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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New HIV and Breastfeeding Resource from the World Alliance for Breastfeeding Action (WABA)

By Pamela Morrison, IBCLC

Photo by  DFID - UK Department for International Development via Flickr Creative Commons

Photo by DFID – UK Department for International Development via Flickr Creative Commons

Have you gained the impression that maternal infection with the Human Immunodeficiency Virus (HIV) automatically rules out breastfeeding? Or that formula-feeding by HIV-positive mothers, whenever possible, is always recommended? If you have had access to different global World Health Organization (WHO) HIV and infant feeding recommendations over the years, do you find them confusing? If the answer to any one of these questions is Yes, then you are not alone.

Based on the huge amount of research conducted since the 1985 discovery that HIV could be transmitted in mothers’ milk, global guidance about breastfeeding in the context of HIV has been changing every few years. One of the spillover effects has been that IBCLCs and others who work with mothers and babies have frequently been exposed to outdated and/or myth-information.

However, IBCLCs can now feel more confident than ever before in supporting HIV-positive clients who express a desire to breastfeed. With certain safe-guards, including maternal adherence to antiretroviral (ARV) regimens which are mandatory in developed countries, the risk of transmission of HIV through breastfeeding can be reduced to virtually zero.

Originally conceived as a joint ILCA-WABA collaborative project, with a gestation period of over seven years, WABA marked World AIDS Day this December with the easy delivery of a new Comprehensive Resource entitled “Understanding International Policy on HIV and Breastfeeding” which can be downloaded HERE.

Intended for use by policy-makers, national breastfeeding committees, breastfeeding advocates, women’s health activists and others working for public health in the community, the Resource sets out why breastfeeding in the context of HIV has never been as safe as it is today. Recent research shows that HIV-positive mothers who receive effective ARVs, protecting their own health sufficiently to result in a near-normal life-span, can also expect that the risk of transmission of HIV to their babies during pregnancy, birth, and throughout the recommended period of breastfeeding, can be close to zero. As a consequence, today’s HIV-positive mothers are enabled to avoid both the stigma and the risks of formula-feeding because current HIV and infant feeding guidance is once again more closely aligned to WHO recommendations for their uninfected counterparts, in place over the last decade: exclusive breastfeeding for 6 months and continued breastfeeding with the introduction of age-appropriate complementary feeding for up to 2 years or beyond.

Building on current research, the 2010 global HIV and infant feeding guidelines and ARV recommendations for prevention of transmission of vertical HIV show that, for the first time, there is enough evidence to recommend ARVs while breastfeeding. Where ARVs are available, it is recommended that HIV-positive mothers breastfeed until their babies are 12 months of age. Furthermore, updated WHO programmatic advice issued earlier this year for ARVs for pregnant women and prevention of HIV infection in their infants has gone a long way towards clarifying many previously perceived ambiguities. Rather than different ARV regimens being decided on the basis of an individual HIV-positive mother’s disease progression, a clear recommendation is now made for provision of ARVs to all HIV positive pregnant women from the time that they are first diagnosed with HIV and continued for life.

With proper treatment, an infected mother’s viral load becomes undetectable, not only protecting her own health and survival, but also reducing to virtually zero the risk of her baby acquiring HIV through her breastmilk.

Thus, current guidance has enabled countries as diverse as South Africa and the United Kingdom to develop national recommendations which once again effectively support breastfeeding for all babies. The up-to-date guidelines simultaneously free health workers from having to tailor infant feeding advice to the HIV-status of their clients and lift from HIV-positive mothers the stigma attached to previous advice about formula-feeding. Most importantly, current guidance ensures the greatest likelihood of HIV-free survival for babies exposed to the virus.

Fully referenced throughout, the Resource’s six sections clarify many past misconceptions by helping to explain how they came about. They track the impact of HIV on women and their infants, review past and current research on transmission of the virus through breastfeeding, trace the evolution of past guidance, outline current policy and counselling recommendations and list easily accessed informational and training materials.

The Resource clarifies how, in a situation of competing infant feeding risks, breastfeeding can now be safely promoted and supported. It is hoped that this tool will enable all who work with HIV-positive mothers to confidently endorse current HIV and breastfeeding recommendations so that each individual child’s chance to survive and thrive can be maximized.

We hope that this document impacts practice and helps to support mothers with HIV all over the world. Please download your own copy of “Understanding International Policy on HIV and Breastfeeding” HERE

pmorrisonPamela Morrison’s interest in HIV and breastfeeding arose from having worked as a private practice IBCLC in a country where HIV-prevalence amongst pregnant women reached 25%, yet breastfeeding was both the cultural norm and a cornerstone of child survival. While in Zimbabwe, Pamela also worked as a BFHI Facilitator and Assessor, as well as serving on the Zimbabwe National Multi-sectoral Breastfeeding Committee and the national BFHI Task Force. She has also served on the World Alliance for Breastfeeding Action (WABA) Task Forces for Children’s Nutrition Rights, and for HIV and Infant Feeding, and the ILCA Ethics & Code Committee. After moving to England in 2005, she was employed until 2009 as a Consultant to WABA. She is currently the ILCA media representative on HIV, and continues to do volunteer work for WABA.

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Combining Work and Breastfeeding: Successful Strategies and Tools

By Wendy Wright, MBA, IBCLC

Photo by Jerry Bunkers via Flickr Creative Commons

Photo by Jerry Bunkers via Flickr Creative Commons

In May 2012, I had the opportunity to contribute “Pumping Strategies for the Working Mother” to Lactation Matters. We have had tremendous interest and discussion on this topic, so let’s explore the topic a bit further.

Over the past several years, I have helped hundreds of breastfeeding women in the work force and have found three tools that provide the most help to working mothers:

  1. Creating a breastfeeding calendar
  2. Hands on pumping
  3. Childcare provider education around breastmilk feeding

Creating a Breastfeeding Calendar

Most mothers intending to breastfeed have their due date and back to work date firmly in place on their calendars, so, what about adding other dates that can assist in scheduling and milk supply forecasting? At each Back-To-Work Breastfeeding class I teach we have an exercise where we pull out our calendars, and actually import important dates into them for enhancing breastfeeding success. Here are the dates I help women to import:

  • Due Date: We discuss the importance of being ready, finishing important work projects in plenty of time and handing off responsibilities so there are no last minute phone calls from the hospital.
  • 11-day Growth Spurt: Many new mothers are not aware of this growth spurt and often interpret it as “my baby is not getting enough milk.” By marking it on their calendar, they are more likely to remember being warned about this 11 day push to increase volume and take in stride with greater confidence in their breastfeeding abilities.
  • Three-week growth spurt: Initiating pumping after this growth spurt is a great way to minimize the breastfeeding burden on the mother during the first few weeks. I encourage mothers to allow their infants to “program” their milk supply for the first three weeks, until the growth spurt, and then take on pumping for storage and bottle introduction.
  • Initiate pumping (3 – 4 weeks): A great time to learn about the pump, work pumping into daily routine and begin milk storage for return to work.
  • Introducing a bottle (4 weeks): Breastfeeding should be well established by this point, and the return to work is on the horizon, bottles should be small and only once a day at most but again, once baby takes a bottle, mother’s confidence is enhanced as the return to work grows closer.
  • Return to work date: Other dates, if appropriate or helpful, can be incorporated here as well, such as: secure childcare, test childcare, practice days for returning to work or part time return to work days to get caught up on items missed during leave.
  • Three month growth spurt: Good to have this on the work calendar – mothers often become fearful about supply during this growth spurt, “How can I possibly pump that much?” Once they realize it is only temporary, breastfeeding confidence again return.
  • Introduction of solids (around 6 months): This is a great relief for fully breastfeeding, working mothers. Just knowing that if a meeting runs late or traffic is terrible, the baby can enjoy avocado or banana until the mother returns home tends to lessen stress around milk supply. Milk is of course still the primary source of nutrition yet the stress about exclusivity is reduced as solids are introduced.

Hands-On Pumping

Teaching hand expression and hands on pumping to mothers returning to work can ensure milk supply when the mother and baby are separated. Jane Morton, MD provides a helpful video and has found that adding breast massage and hands on pumping increased mothers’ average daily volumes by 48%.2 This additional pumped milk may make the difference in breastmilk exclusivity for the first six months of life especially once the stress and fatigue of returning to work set in for the very busy working mothers.

Child Provider Education Around Breastmilk Feeding

In California, by three months of age, 41% of mothers are breastfeeding, this means 59% are not. Due to this statistic, many of the care providers in our state have limited experience handling breastmilk. Here are some questions I arm my clients with as they select the care providers for their breastfed infants:

  • Are you familiar with the latest milk storage guidelines?
  • Will you refrigerate and reuse any leftover breastmilk? Let her know the re-use parameters you’re comfortable with, if any (for example, two hours).
  • Will you store a back up supply of my breastmilk in your freezer?
  • Do you require all parents to clearly label milk containers to avoid mix-ups?
  • Will you check with me before supplementing with formula?

I hope these three simple tools help the mothers you are working with ensure success as they return to work while breastfeeding. Anticipatory guidance with the calendar and careful childcare selection along with increasing parental confidence with enhanced breastmilk supply utilizing hands on pumping should help all mothers meet their breastfeeding goals.

References:

La Leche League’s, “The Breastfeeding Answer Book” (1997) by Nancy Mohrbacher,
IBCLC and Julie Stock, BA, IBCLC

Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhone WD. Combining hand
techniques with electric pumping increases milk production in mothers of preterm
infants. J Perinatol. 2009, July 2.

WEndy WrightWendy Wright, MBA, IBCLC spent 15 years in the biotech industry in the Bay Area and worldwide prior to breaking out on her own and founding Lactation Navigation in 2007. Wendy has a B.S. in Health Services Administration from the University of Arizona and an MBA with a Marketing emphasis from the University of Cincinnati. Wendy’s daughter is 13 and her son is five; both, of course, were breastfed! Lactation Navigation allows Wendy to combine skills learned in the corporate setting over the past 15 years with her love of breastfeeding. It allows her to spend time with her children and also with new mothers. It also encourages health and happiness for other families, and brings bottom-line profits to progressive companies.

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