I’d like you to watch this ad with a critical eye. [Transcript is appended.]
[If you know all about the Code and Innocenti and APMAIF already, skip down to the next iteration of the ad below!]
The WHO Code and the Innocenti Declaration
I’ve posted here a fair bit in the past on the World Health Organisation Code of Marketing of Breastmilk Substitutes.
I have not yet come across an infant formula company nor a business primarily engaged in feeding bottle and teat sales that is not a Code violator. Despite repeated exhortations by the World Health Assembly, and the Innocenti Declaration 2005, some countries who have on-paper ratified the Code have failed to enshrine it in law.
The countries that have comprehensively failed to enforce the WHO Code include Australia and the USA.
The Innocenti Declaration
The UNICEF Innocenti Research Centre is a UNICEF initiative based around sound, evidence-based advocacy for children and mothers worldwide. The 2005 Innocenti Declaration was the result of an assembly of policy-makers in Italy to assess progress and re-evaluate goals 15 years after the original Innocenti Declaration:
Guided by accepted human rights principles, especially those embodied in the Convention on the Rights of the Child, our vision is of an environment that enables mothers, families and other caregivers to make informed decisions about optimal feeding, which is defined as exclusive breastfeeding for six months followed by the introduction of appropriate complementary feeding and continuation of breastfeeding for up to two years of age or beyond. infants and young children.
The 2005 Innocenti Declaration includes this statement:
All governments [shall]:
[..] Implement all provisions of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assem- bly resolutions in their entirety as a minimum requirement, and establish sustainable enforcement mechanisms to prevent and/or address non-compliance. […]
The WHO Code is but one part of an international framework for breastfeeding support. There are many other aspects included in Innocenti’s breastfeeding support manifesto, including maternity leave, women’s empowerment, recognition of breastfeeding as the physiological norm, healthcare worker training, evidence-based information on the risks of artificial feeding, comprehensive support for women’s health and nutrition, independent co-ordination and monitoring of breastfeeding and breastfeeding support, the Baby-Friendly Hospital Initiative, positive media imagery, protection from environmental contamination, and breastfeeding support in disasters and in poverty reduction strategies. You can read a lot more about the issue at UNICEF: Celebrating the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding: Past Achievements, Present Challenges and Priority Actions for Infant and Young Child Feeding (1990 – 2005 ). It’s a great reference source if you’d like to start blogging or lobbying on supporting breastfeeding as a human right for women and children.
Failure to Regulate in the Australian Context
What do we have in Australia, instead of the WHO Code? A self-regulation agreement, the 1992 MAIF agreement (Marketing in Australia of Infant Formulas). The only signatories are a handful of large formula manufacturers (Heinz Wattie’s, Nestlé, Nutricia, Wyeth, Abbott, and SNOW). MAIF does not cover bottles and teats (which fall within the scope of the WHO Code), baby foods other than formula, retailers such as supermarkets and pharmacists, healthcare providers, or smaller formula manufacturers who have not signed on.
In practice, MAIF doesn’t stop your doctor distributing formula samples to pregnant women, it doesn’t stop ‘organic’ formula advertising, it doesn’t stop toddler milk co-branding and direct advertising, it doesn’t stop rampant formula and bottle advertising on “baby stuff” websites, it doesn’t stop your weekly flood of junkmail from being full of formula, bottle, and teat advertisements, it doesn’t stop your pharmacist from pushing formula and bottles under your nose when you drop in in late pregnancy for some haemorrhoid cream; all it stops is this handful of companies directly advertising infant formula to you – and there aren’t any legal penalties for breaches.
One-third of APMAIF’s funding comes from the formula companies themselves.
The overwhelming majority of breaches of the WHO Code reported to APMAIF are immediately dismissed as falling outside of its scope. Most of these relate to retailer activity. The Government’s excuse for excluding retailers from the agreement is that to do so would be “anti-competitive”. Since restrictions would affect all formula retailers in exactly the same way, this excuse is an utter nonsense.
Note, in particular, these two things about MAIF:
* only the formula company signatories are in any way affected by it;
* the advertising of bottles and teats, even if it includes language and images idealising bottle feeding and is very clearly banned by the WHO Code, is not covered.
The “Think Medela” Advertisement
Back to that ad, which
is was available at thinkmedela.com, and which I believe has played on US television. [Update 14 March 2009: the thinkmedela.com page is now re-directing to the main Medela page. You can (temporarily, probably) get a glimpse of it at the Google cache. Glitch or image management?]
[Update 20 March 2009: The advertisement on the Medela website has now been substantially edited, after complaints from the lactation community. This is the original version. ]
Shiny, isn’t it? Pretty. All full of love and gootchy-goo. Dig deeper.
The breastfeeding is a tiny part of this advertisement. It is shown in a private space, a home, with the mother’s breast mostly uncovered. No one else is present except the baby. Most of the advertisement is taken up talking about breastmilk, not about breastfeeding. The breastmilk is merely the product, a food. But here’s the money shot:
“When you choose to breastfeed, you’re doing what’s best for your baby. When you choose Medela breastfeeding products, you’re doing what’s best for you both.”
Medela is saying, directly, that breastfeeding is not best for women. It might be ok for babies, sure, because they get the breastmilk, but Medela is telling us loud and clear that pumping is better for mothers than breastfeeding is. No qualifications, no circumstances; just “pumping and bottle-feeding is best for women”, with a side serve of “and it’s just as good for babies”.
This isn’t just a WHO Code violation; it’s not true. And it’s a lie fed by all of our dysfunctional societal issues around breasts and breastfeeding and public feeding and mother-child attachment and women and the workplace. It’s fed by the huge pile of myths about how easy pumping is, and about how bottled stored breastmilk is just as good, and about how it’s vital to schedule feeds and “see how much babies are taking”, and about how babies don’t know when they’re hungry or thirsty or full or in need of comfort. The problem is, it isn’t just fed by those dysfunctions, it’s feeding back into them, reinforcing them.
These sorts of advertisements are part of the huge coercive societal mechanism denying support for mothers and children, part of the capitalist machine preventing women from being able to afford time with new babies, and keeping them being good little workers and consumers. I think it’s no coincidence that two countries with no moves towards a full legislative implementation of the Code, the USA and Australia, are also the only two industrialised countries in the world without mandatory paid maternity leave.
Words mean stuff. Marketing is powerful. Advertising works.
And it makes a whoooole lot of money.
Medela Bites Its Thumb At The WHO Code
In a position statement dated December 1, 2008 and published on February 11, 2009, the President of Medela, Carr Lane Quackenbush, announced the company’s intent to continue with an official policy of WHO Code violation. The position statement is titled “Medela Position on Marketing of Breastmilk Feeding Products to Mothers“. [emphases are mine]
Medela feels that it is very important to give mothers access to the information and education on the proper use and benefits of this complete feeding system, getting breastmilk from mom to baby. However, these activities bring Medela in a conflict with the current interpretation of the WHO Code with regard to the marketing of bottles and teats.
After a careful evaluation we believe our actions continue to support the WHO Code’s intent to support breastfeeding and oppose breastmilk substitutes. However, we recognize and sincerely regret that our actions may be considered as a WHO Code violation. This is painful for us given our common goals to support breastfeeding mothers. Medela will remain faithful to its Support Pledge and Destiny statement.
Anyone who believes the “painful” posing, raise your hand.
There’s no weaselly “current interpretation” or “may be considered” needed here. These particular advertisements have violated the Code since they started, and those violations are unambiguous.
Formal accounting of Medela’s violations
Medela’s Code breaches in Australia started at least six months ago, in Medela’s brochures claiming to be “breastfeeding guides”, but containing direct bottle and teat advertising. The brochures were distributed at an ABA conference.
They have been engaging in a vigorous bottle-and-teat giveaway programme in the USA, advertised through baby-stuff sites like this one:
The “click here” link goes to Medela’s own giveaway page, http://www.medelabreastfeedingus.com/free-bottle-offer-login, which is no longer active – and it seems Medela has deliberately excluded it from the Google cache and archive.org.
However, they can’t expunge it from the freebie sites out there, like freegrabber:
Another example of a Medela-sponsored and Code-violating bottle and teat giveaway is this one, but they’re everywhere.
Marsha Walker, Executive Director of the US National Alliance for Breastfeeding Advocacy (NABA( REAL, has formally summarised some of Medela’s Code violations. NABA receives and reports on Code violations in the US, just as INFACT Canada does in Canada and Baby Milk Action does in the UK. Quoted with permission:
Medela as a manufacturer and distributer of products within the scope of the Code has a responsibility to market those products within the guidelines specified in the Code. They are permitted to sell the products, these products can be pictured on their website but the language describing the products must not idealize them. The products can be included in pump packages but cannot be pictured on the packaging. The following violations of the Code have been incurred by Medela:
1. direct advertising to the public in American Baby magazine with a feeding bottle and nipple pictured. The picture of the feeding bottle and artificial nipple is a violation of the International Code Article 5.
2. Pictures of feeding bottles and artificial nipples on the packaging of pumps or other equipment is a violation of the International Code Article 5.
3. Language in the product description cannot idealize the use of the feeding bottle/nipple. Some of the materials intended for distribution to mothers contains language that idealizes the use of the bottle/nipple for feeding the baby in violation of Article 9.
4. Since Medela is a manufacturer and distributor of products – bottles and nipples – that come under the scope of the Code, they may not seek contact (Article 5.5) direct or indirect with pregnant women or wit h mothers of infants and young children. Their recent contest giving away of glass bottles and their offer to sign up mothers for more give aways violates the Code.
5. Their TV ad violates the Code with the picturing of the feeding bottles and nipples. [The soundtrack had not been analysed by NABA at the time of writing. ~lauredhel] […]
Pumps are not covered under the Code, so we may not like how pumps are being marketed but that does not violate the Code.
Moves toward organisational boycotts of Medela sponsorship and advertising are already happening, where existing Codes of Ethics are in place forbidding dealings with Code violators. In the past few weeks, La Leche League (LLL) has severed sponsorship arrangements with Medela, due to their Code of Ethics:
One of the major criteria for acceptance of funding from a commercial source is respect of the WHO International Code of Marketing of Breast-milk Substitutes. If an organization profits from undermining breastfeeding — and this undermining can be very subtle — their aims are incompatible with ours.
The International Lactation Consultant Association (ILCA) is also going about severing ties, in keeping with their By-Laws:
ILCA does not invest in, nor accept funding, donations, advertising nor sponsorship from, entities which do not comply with the International Code of Marketing of Breast- milk Substitutes and all subsequent WHA resolutions.
This also means that Medela cannot organise or contribute educational material to CERP-qualifying continuing education programmes for board-certified Lactation Consultants. From IBCLE’s information for Continuing Education Providers:
CERPs are not approved for programs organized by individuals or companies that manufacture, market or
distribute products within the scope of the WHO International Code of Marketing of Breast-milk Substitutes (e.g.
infant formula, bottles or teats); nor for programs where these companies or company personnel had input into
the choice of presenters or topics or the content of any presentation.
Medela is reaping what they have sown, here, and they knew damn well that this is what they were going to reap. These Codes of Ethics are out there in black and white, and they’ve been in place for years. Medela is deliberately biting its thumb not just at the World Health Organisation and UNICEF, but at all the volunteer and professional breastfeeding supporters out there doing their best to promote the health and well-being of mothers and babies worldwide. Because it doesn’t need them. It has Toys R Us and Babies Galore and BabyZone and morning television. And no-one can be bothered enforcing the Code, because large rich corporations won’t like it. Moves against rampant, unethical capitalism are unpopular with our government.
What You Can Do About It
So what can you do about marketing practices that violate the WHO Code?
* Lay complaints.
* Make a noise.
1. Lay complaints with APMAIF, if you’re in Australia. Yes, I know I said that complaints outside the scope of the Code are dismissed. However, those complaints are still recorded, broken down, and reported. The volume of complaints outside the scope of APMAIF but within the scope of the Code has seen the committee agitating for a revamped look at the WHO Code in the Australian context in the past. Additional pressure may help keep this issue at the forefront for them.
When you see breast pump companies advertising bottles and teats, idealising language in bottle and formula promotions, formula ads splashed all over your pharmacist’s junk mail, formula company branding on breastfeeding “educational” material, baby food jars marked as being suitable from four months, co-branded “toddler milk” giveaways at parenting expos, website advertisements for Avent and Dr Brown’s and Medela and Nestle – pop a complaint in the box. Here’s the MAIF Complaint Form.
2. Boycott. If you do need to express milk and you can’t hand-express, grab a pump from the company that doesn’t thumb its nose at the Code: Ameda. [NOTE: I have no commercial or other relationship with this company in any way, and information on Code compliance is based on the current information available to me. This may change at any time.]
If you buy through Mothers Direct, the Australian Breastfeeding Association will get their cut to improve their voluntary activities. The “Purely Yours” is the Ameda gear. It’s at least as good and a little less expensive than the Medela gear. Code violating breast pump companies to boycott include: Medela, Avent, Dr Brown’s, Pigeon, Tommee Tippee, Nuk, Chicco, and Cherub.
If you’re in a position to influence an institutional or organisational policy on products within the scope of the Code, educate yourself and your colleagues, and do what you can to ensure that you’re not inadvertently contributing to Code violations or inappropriately forming partnerships with Code-violating companies that may lead to conflicts of interest.
3. Make a noise. Learn more about the Code. Write a note to your local MP and to the Health Minister asking about their support for and commitment to the WHO Code. Ring up. Contact Medela, and to other companies who don’t bother with the Code. Tell them why you’re boycotting. Talk to your local shopkeepers, write to retailers promoting artificial feeding in your area. Donate to the ABA, which supports breastfeeding nationwide on a shoestring budget. Start conversations, and keep them going. There is plenty you can do. But it takes a lot of people to do it.
Transcript/description of Thinkmedela advertisement:
[A slim blonde woman is pushing a shopping trolley. She puts a quart of white liquid in her trolley. The pink label reads “Breastmilk”.]
Voiceover: The best thing for your baby can’t be found in a store. And it won’t be found on sale.
[a slim white early-30s woman with brown hair sits on a bus or train, reading a newspaper. There is a full-page advertisement on the back of the paper advertising the pink-labelled “Breastmilk” product. The ad reads: “Give your baby the best.”
A train passes by a large billboard advertising the product.]
Voiceover: But as a new mother, you’ll be able to find it everywhere you go.
[The brunette mum holds baby up and touches nose; she is then shown breastfeeding on a sofa, her breast mostly uncovered from the top. Her baby looks to be under six months of age.]
Voiceover: When you choose to breastfeeding, you’re doing what’s best for your baby. [Closeup of smiling baby.]
Voiceover: When you choose Medela breastfeeding products, you’re doing what’s best for you. [Closeup of hands putting breastpump parts aside, and screwing a feeding teat onto a bottle. Closeup of hands putting the feeding bottle into a shiny-clean fridge with other bottles of breastmilk. Another shot of smiling mother and baby playing.]
Voiceover: So when you’re ready to start thinking about breastfeeding, think Medela.
[Longer shot of mother and baby playing in the background, with Medela feeding bottles and a pump foregrounded.]
Voiceover: To learn more, visit thinkmedela.com.
 You can read the whole Code direct from the WHO, or go to IBFAN (the International Baby Food Action Network) for information on the issue of how breastfeeding is undermined by unethical marketing, the Code, and interpretation of the Code.
 Eye on the ball. If you’ve come in late to this conversation and you’re frothing at the gills, please read the links, and do a search on my previous posts on breastfeeding, feminism, and the Code. If you find yourself moved to rebut conversations on ethical marketing with statements including the strings “Makingmefeelguilty!”, “Freaspeach!”, “Justasgood!”, “Onlytryingtomakemoney!”, “Brownpaperbagsunderthecounter?!”, or “Crackednipplesteethnotenoughmilkdoctorsaid!”, please find a more appropriate forum. Above all, please remember that unless you are a formula or bottle manufacturer or retailer, or a healthcare or parenting information provider, the Code is not about you. Unless, perhaps, you’re looking for info on how to boycott and lay complaints about unethical companies.
If you are having difficulty breastfeeding and are looking for help, I suggest contacting the Australian Breastfeeding Association, La Leche League, or a local Internationally Board-Certified Lactation Consultant.
 If you do wish to wrangle with me, you are obliged to declare all interests of any kind, or the lack of them, up front. No fucking astroturfing.
 A Fightin’ Fourth Floating Footnote, as we’re now getting readers from all over, and reading the source links makes it clear that people really don’t know what the Code is. Please follow the links, particularly to IBFAN, and read the Code and its interpretation notes in full. After that, you will understand that the Code’s restrictions does NOT stop companies from making and selling pumps, bottles, and feeding teats. The Code’s restrictions do NOT stop you buying pumps and bottles and teats. They do NOT stop shops from stocking these items on shelves, they do NOT stop shopkeepers and healthcare workers from offering you fulll evidence-based information on these items, they do NOT restrict your access to these items in any way whatsoever. This is about advertising and promotions. Not about access to information and equipment.
If you think advertising is information, you have taken the blue pill. Or maybe two. Please exit by the purple door and enjoy your life in the Matrix.