“Food for Thought: an independent assessment of the International Code of Marketing of Breast-milk Substitutes”

The sheer ambition of the Sustainable Development Goals warrants an urgent reassessment of the major policies and instruments currently in place to end both child malnutrition and preventable newborn and child deaths by 2030. 

As breastfeeding rates impact both child malnutrition and survival, it is appropriate that the major initiatives that aim to increase breastfeeding rates are closely examined for their likely impact on the achievement of the new global goals.

An important new report offers an independent assessment of one of those initiatives - the International Code of Marketing of Breast-milk Substitutes - and makes several recommendations for ways to strengthen the Code’s contribution to the global goals.

The report was written by independent legal analyst, Angela Evans, and launched on March 23rd at the UN Foundation and on March 28th by webinar, both under the auspices of the Breastfeeding Innovations Team.* Kudos to Natalie Africa (UN Foundation) for hosting the event, to Pam Bolton for moderation, and to the expert commentary provided by France Begin (UNICEF), Altrena Mukuria (USAID/JSI), Briana Ferrigno (McCann Global Health), Laurence Grummer-Strawn (WHO), Chris Osa Isokpunwu (Nigerian Federal Ministry of Health), and Leon Mitoulas (Medela).

The report makes a strong case for reform. 

Despite the introduction of the Code almost forty years ago, very few countries have fully implemented it (39 of 194), the global rate of exclusive breastfeeding remains low at 40%, and only a minority of countries are “on-track” to achieve the global goal of 50% by 2025, according to the Global Nutrition Report. 

With female employment in the formal economy low and rising in many low and middle-income countries, downward pressure on breastfeeding rates will most likely continue, especially in the absence of workplace policies that offer paid family leave and make it easy for women to earn wages and breastfeed. It is important that implementation of the Code enables efforts for women to combine paid work and breastfeeding.

Further, with half of all child deaths now occurring among newborns, breastfeeding has an even greater role to play in achieving newborn survival goals. Implementation of the Code needs to facilitate efforts to increase access to breastmilk for newborns, especially the most vulnerable newborns at greatest risk of death, many of whom cannot breastfeed.  

In this complex environment, where breastfeeding is becoming more critical to the achievement of health goals and at the same time more challenging for women everywhere, the most effective breastfeeding policies and programs will be those that create a supportive environment where all mothers can exercise a genuine choice to breastfeed and provide breastmilk to their babies where breastfeeding is not an option, irrespective of their workforce status and/or any health challenges they or their babies are experiencing.

In this context, the report raises important new questions. Should future discussions about Code compliance be advanced in the context of the broad and growing “business and human rights” agenda? Should an independent Ombudsman monitor compliance and arbitrate disputes? Should corporations that fully implement the Code be publicly acknowledged as models of best practice? Should bottles and teats be subject to the Code when they are an essential part of sick newborn care and when they are included with breast pumps - an increasingly essential item if women are to continue breastfeeding after they return to work? And is there an"opportunity cost" to focusing so much attention on the Code, when other reforms may be more effective at increasing breastfeeding rates (e.g. six months paid parental leave, early breastfeeding initiation support)? Further, to what extent is the Code "crowding out" private sector investments in breastfeeding support and other areas of infant and child nutrition?

I commend the fresh perspectives and new insights contained in the report and hope that it provides a stimulus for a wider conversation about ways to improve the effectiveness of the International Code of Marketing of Breast-milk Substitutes in the context of broader efforts to support breastfeeding in the service of the new Sustainable Development Goals. 

You can find a copy of the report here and feel free to share it with your networks and on social media using #FoodforThought and #BreastfeedingInnovation.

*The Breastfeeding Innovations Team is a global network of more than 250 individuals and organizations committed to accelerating the development and adoption of the innovations with the greatest potential to increase access to breastmilk for babies, especially the most vulnerable. The Team works in support of the Sustainable Development Goals and the UN Secretary-General’s Every Woman, Every Child movement. You can join the Team here.