spring 2013

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.

Submitted Article

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 68% well 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:

  1. Assist your patients to make informed decisions about breastfeeding.

  2. Display posters, pamphlets, DVDs and local resources that promote breastfeeding as the norm for infant feeding.

  3. Ensure that your office has a more private and comfortable space for mothers to breastfeed, if requested.

  4. Eliminate the practice of accepting free samples of formula or related products in your office.

  5. Discontinue the practice of distributing free formula and gift items (e.g., diaper bags, pacifiers, DVDs) from formula companies to parents.

  6. Ensure that your patient education materials do not advertise breastmilk substitutes, bottles, or artificial nipples, or display images of infants bottle-feeding.

  7. Do not refer pregnant women to formula company-sponsored infant feeding seminars, classes or websites.

  8. 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.

  9. Avoid conflicts of interest by refusing to participate in formula industry- sponsored education (e.g., receptions and dinners at local restaurants) and research initiatives.

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 Breastfeeding

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 visit the Baby-Friendly Newfoundland & Labrador website.



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