h e a l t h p r o m o t i o n
Are you inadvertently assisting
baby formula companies by not knowing “the Code”?
Paul Daley Photo
The attitudes and practices of health care professionals can have a positive or negative effect on breastfeeding success.
Despite the compelling evidence on the
positive short and long term effects that breastfeeding has on the
health of mothers and infants, breastfeeding initiation, exclusivity
and duration according to the World Health Organization (WHO)
recommendations are not consistently practiced in Newfoundland and
Labrador (NL). Breastfeeding initiation rates for the province are
below the Canadian initiation rate of 87%.
There are wide regional variations within
Newfoundland and Labrador with breastfeeding initiation rates from
44-74%. Only 14% of women in the province breastfeed exclusively for the
recommended six months. The reasons why the province has the lowest
breastfeeding rates are complex, and improving these rates will require
a multifaceted long-term effort that includes physicians who care for
pregnant women and their families.
Local research has shown that the
attitudes and practices of health care professionals can have both a
positive or negative effect on breastfeeding intent and success.
Straightforward and simple efforts by physicians, especially with the
messages conveyed, can improve a woman’s success. For example, waiting
room formula sponsored posters or pamphlets may send subliminal and
unintended messages to patients.
The International Code of Marketing of
Breast-Milk Substitutes, commonly referred to as “the Code,” was
endorsed by the 34th Assembly of the World Health Organization in May
1981, for which Canada was a signatory. The Code aims to provide safe
and adequate nutrition for all infants and young children by
recommending minimum requirements for appropriate feeding practices. It
does not ban the sale of formula. Rather, the Code is a tool to support
mothers to make informed decisions about infant feeding based on
impartial and factual information that is free of commercial influences.
The Code includes a set of recommendations
to regulate the marketing of breastmilk substitutes (e.g., infant
formula), feeding bottles and artificial nipples. It also applies to any
foods marketed to infants under six months of age (e.g., cereals, teas,
juices) and any follow-up milks after six months that would replace
breastmilk. If babies are not breastfed, the Code recommends that they
are fed safely with the best available nutritional alternative.
The marketing and promotion of infant
formula can undermine breastfeeding and has contributed to a global
decline. A large provincial study on infant feeding (FiNaL Study) is
also researching the formula industry influence in Newfoundland and
Labrador. Anecdotal reports of breastfeeding mothers being sent free
formula packages and gifts are numerous.
Physicians can play an important role in
the promotion of breastfeeding as the normal and optimal way for mothers
to feed their infants and young children. Unfortunately, physicians are
frequently the target for much of the marketing of formula and related
products. There are, however, practical ways that physicians and their
office staff can counter the aggressive marketing and promotion of
infant formula in their practice setting. The flowing steps are
recommended by the Code:
Assist your patients to make informed
decisions about breastfeeding.
Display posters, pamphlets, DVDs and
local resources that promote breastfeeding as the norm for infant
Ensure that your office has a more
private and comfortable space for mothers to breastfeed, if
Eliminate the practice of accepting
free samples of formula or related products in your office.
Discontinue the practice of
distributing free formula and gift items (e.g., diaper bags,
pacifiers, DVDs) from formula companies to parents.
Ensure that your patient education
materials do not advertise breastmilk substitutes, bottles, or
artificial nipples, or display images of infants bottle-feeding.
Do not refer pregnant women to formula
company-sponsored infant feeding seminars, classes or websites.
Do not accept gifts (including writing
pads, weigh scale covers, pens, mouse pads, calendars, food) or
personal samples from companies manufacturing infant formula,
feeding bottles, or pacifiers.
Avoid conflicts of interest by
refusing to participate in formula industry- sponsored education
(e.g., receptions and dinners at local restaurants) and research
The Department of Health and Community
Services and the Baby-Friendly Council of Newfoundland Labrador have
information and resources available for physicians and their patients
that can be obtained free of charge by e-mailing your local
public health office.
More detailed information about the Code
can be found on
The International Baby Food Action Network website.
New Video Series to Promote
In March, the Baby-Friendly Council NL
launched the Newfoundland and Labrador Breastfeeds educational and
promotional video series. The videos feature local families, health
professionals, and media personalities and are intended to increase
awareness and promote breastfeeding. The videos may be used in prenatal
education and support programs, physician offices and waiting areas, and
secondary school programs throughout the province. To view the videos
Baby-Friendly Newfoundland & Labrador website.