As UN leads global efforts to promote breastfeeding, national laws defeat the purpose
Breastfeeding is incorrectly thought of as a ‘third world issue’ but only six percent of European countries have comprehensive legislation.
After skimming through a UN report that highlights the status of global laws in 2016 to protect breastfeeding practices, a journalist friend of mine quipped that her headline would read ‘breastfeeding laws suck’. The World Breastfeeding Week observed last week focused primarily on generating awareness among mothers on the huge benefits of breastfeeding. However, global efforts to encourage breastfeeding have taken the hardest beating from national governments’ failure to tighten legislation against breast-milk substitutes.
Of 194 countries analysed in a UN report, 135 have in place some form of legal measure to crack down on baby food industry, while only 39 countries, including India, fully comply with the UN’s guidelines on laws regulating baby food marketing practices, according to the World Health Organization (WHO), the UN children's agency UNICEF and the International Baby Food Action Network (IBFAN).
The WHO, UNICEF and IBFAN's report titled Marketing of breast-milk substitutes: national implementation of the International Code 2016 shows that 49 countries, including US, New Zealand and Australia, have non-legal or no measures in place.
WHO in 1982 adopted the International Code of Marketing of Breast-Milk Substitutes to counter incorrect information on breastfeeding and aggressive marketing campaigns by the baby food industry through advertisements and unsubstantiated health claims.
The Code calls on countries to protect breastfeeding by stopping the inappropriate marketing of breast-milk substitutes (including infant formula), feeding bottles and teats. It bans all forms of promotion of substitutes — including advertising, gifts to health workers and distribution of free samples, bans labels making nutritional and health claims or including images that idealise infant formula and requires products to correctly inform consumers of the superiority of breastmilk over their own products.
Analysis of the report reveals the following:
— just over half the countries sufficiently prohibit advertising and promotion,
— fewer than half prohibit the provision to health facilities of free or low-cost supplies of breast-milk substitutes,
— just over half prohibit gifts to health workers or members of their families,
— only one-third explicitly cover products intended for children aged one year and up (many countries’ laws only cover ‘infant formula’ and ‘follow-up formula’),
— only one-third prohibit manufacturers and distributors from seeking direct contact with pregnant women and mothers, and
— fewer than half of the countries ban nutrition and health claims on designated products.
Breastfeeding is incorrectly thought of as a ‘third world issue’ but only six percent of the European countries have comprehensive legislation while most have very few laws.
On the other hand, 36 percent of South East Asian countries had implemented laws covering all the recommendations in the Code, followed by 30 percent of African countries; 29 percent countries in the Eastern Mediterranean region fully follow the Code.
Experts say that children who have been breastfed perform better on intelligence tests, are less likely to be overweight or obese, and less prone to diabetes later in life while mothers reduce their risk of developing breast and ovarian cancers.
A study in Lancet earlier in the year estimated that at current breastfeeding rates, more than 8,00,000 child deaths and 20,000 breast cancer deaths could be averted every year if more babies were breastfed to WHO recommended levels.
WHO and partners also estimate that global economic losses from lower cognition associated with not breastfeeding reached more than $300 billion in 2012, equivalent to 0.49 percent of the world’s gross national income.
Still, globally nearly two out of three infants under six months are not exclusively breastfed — a rate that has remained static in the last two decades — and only two out of three children between six months and two years of age receive any breast milk in low- and middle-income countries.
The film Tigers by Oscar-winning director Danis Tanovic, starring Emraan Hashmi in the lead role, took over a decade to make because the producers were jittery about the content. It is based on a true story of a former Nestlé baby milk salesman in Pakistan taking on the company for unethical practices. In the film, Tanovic changed the name of Nestlé to Lasta due to apprehensions of getting sued.
The baby food industry continues to grow in rich countries whereas in countries like India with strict legislation against marketing, sales have remained static. Currently, the industry rakes in sales of nearly $45 billion annually which is projected to rise by over 55 percent to $70 billion by 2019.
“We see this time and again: legal threats (by baby food companies), claims that regulations restrict trade, disinvestment and job losses if regulations are introduced, and increasingly attempts to partner with governments in health education and even in promoting breast feeding,” said Mike Brady of IBFAN.
“But there is a conflict of interest (in working with the government or the UN) here where they promote products that compete with breastfeeding,” he added.
The Codex Alimentarius Commission (the UN/FAO body) that sets global food standards for the quality, safety and labelling of food products often sees 40 percent of delegates at nutrition standard-setting meetings from the food or related industries, said Patti Rundall of IBFAN.
“Clever marketing should not be allowed to fudge the truth that there is no equal substitute for a mother’s own milk,” says UNICEF’s chief of nutrition Werner Schultink.
WHO and UNICEF recommend that babies are fed nothing but breast milk for their first six months, after which they should continue breastfeeding — as well as eating other safe and nutritionally adequate foods — until two years of age or beyond. WHO member states have committed to increase the rate of exclusive breastfeeding in the first six months of life to, at least, 50 percent by 2025 as one of a set of global nutrition targets. This seems to be a tall order for governments who are either business-friendly and recalcitrant to pass tough legislations or wary to make laws that would provoke legal action from powerful corporations.
Indian breastfeeding laws
India adopted the Infant Milk Substitutes, Feeding Bottles and Infant Foods (IMS) Act in 1992. Laws were further strengthened in 2003 and made applicable to the whole of India.
India is upheld as a model case in implementing the Code in the UN report.
The IMS Act, the violation of which is a criminal offence, comprehensively prohibits all forms of promotion of foods marketed for children up to two years of age, including products that are represented as a complement to breast milk. It bans sponsorship to health care professionals or their organisations, promotion of products through chemist shops and mandates that correct information be provided about infant feeding on products aimed at pregnant and lactating women.
At the 69th World Health Assembly (WHA) this year, corporations with the help of some rich countries, tried to water down a WHO resolution on infant and child feeding that tackled the marketing of baby foods and a new generation of processed, expensive, sweetened and flavored milks.
India had led a successful call with other countries that trade concerns must not take precedence over public health and child rights but that governments can take additional action to end inappropriate promotion of such foods.
The Resolution also states “reviews of Codex standards and guidelines should give full consideration to WHO guidelines and recommendations, including the International Code of Marketing of Breast-milk Substitutes and relevant WHA resolutions.”
Although India is much ahead in the game legislation-wise for reining-in the baby food industry, it has fallen woefully short in passing legislations and creating enabling structures for women to breastfeed at the workplace. This impinges significantly on consolidating strong breastfeeding rates. Generating awareness among mothers alone won’t suffice.
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