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World Breastfeeding Week  

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 The history behind the Code

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   Before the industrial revolution: babies who were not breastfed by their mothers were wet nursed. There were some attempts at artificial feeding but most babies died.

  19th and early 20th centuries: doctors became interested in infant feeding, but many misunderstood how breastfeeding worked. Hospital protocols and medical advice caused and worsened breastfeeding problems. New processing methods to preservation milk led to surpluses which motivated European and North American companies to market milk for infants. These companies spread their promotion to the colonised world. In early 20th century Britain, advertising led to greater use of artificial-feeding products and increased infant deaths. Some doctors asked for warning labels on products.
 

Code Watch: 25 years of protecting breastfeeding

  1924 The American Medical Association set up a committee to investigate infant food advertising and proposed that this should be restricted to doctors only. “Our interest in this important phase of medical economics springs, not from any motives of altruism, philanthropy or paternalism, but rather from a spirit of enlightened self-interest and cooperation because [our] infant diet materials are advertised only to you, never to the public.” Mead Johnson 1924[1]  

        1939 Renowned paediatrician Dr Cicely Williams, states in a speech to the Singapore Rotary Club entitled
            ‘Milk and Murder’,  that deaths resulting from “..misguided propaganda on infant feeding should be regarded as murder.”
 

  1950s and 60s Worldwide expansion in distribution and marketing of powdered milk for infants. TV and radio spread the bottle-feeding message with frequent advertisements. Nestlé saleswomen in nurses’ uniforms (‘Milk Nurses’) gave out free samples and promoted artificial feeding in maternity wards and clinics. Health professionals noted increased rates of diarrhoea, infections, malnutrition and deaths of infants, bottlefed with artificial milks, in the developing world. Paediatrician, Dr Derrick Jelliffe, described this as ‘commerciogenic malnutrition’.  

 1970s The New Internationalist Magazine reports ‘The Baby Food Tragedy’ and called for a campaign to stop the promotion of baby milks, foods and feeding bottles. 

  1974 A UK Charity, ‘War on Want’, publishes ‘The Baby Killer’ which is widely translated. Nestlé takes legal action against the Swiss publishers. The case generates worldwide publicity and exposes Nestlé’s practices. The judge states that the company must change.  A boycott of Nestlé products is launched in the USA and spreads around the world. 

  1975 The Sisters of the Precious Blood (an order of Roman Catholic nuns) make a shareholder challenge of Bristol Myers’ unethical marketing practices. Bristol Myers undertake to change. 

  1977  The Government of Papua New Guinea legislates to control the sale of feeding bottles. This leads to a dramatic reduction in infant malnutrition and mortality. 

  1978/9 The US Senate holds a Committee of Inquiry into baby food marketing. WHO and UNICEF host a meeting and the process of creating an International Code begins.  

  1981 The Code is adopted by the 1981 World Health Assembly. In a sudden U-turn of policy, the USA votes against it.  

  1980s The companies make a few cosmetic changes but continue to flout the rules. Most governments fail to act and some bring in industry-drafted Codes. The Nestlé Boycott is suspended in 1984 when the company publicly promises to keep to the Code. In 1989 the boycott is resumed when monitoring reveals widespread violations, including flouting of the WHA Resolution banning free supplies. It continues in 2006.  

 1990 The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, an initiative of over 30 governments and 7 agencies, to bring back a global breastfeeding culture, is launched in Florence, Italy. Its four targets are:

§        Appoint a national breastfeeding committee and coordinator

§        Ensure the Ten Steps are practiced in maternity systems

§        Give effect to the Code and subsequent resolutions

§        Enact imaginative legislation to protect breastfeeding rights of working women

 The Innocenti Declaration’s four targets are endorsed in a WHA resolution (WHA 45.32). 

         1990 The Convention on the Rights of the Child includes parents’ right to knowledge of breastfeeding.  

         1992 The Baby Friendly Hospital Initiative (BFHI) launched to reform maternity facility practices. To gain BFHI status, the facility must implement The Ten Steps for Successful Breastfeeding and all relevant provisions of the International Code. 

         1990s into the 21st century

Code training, for government and health officials, NGOs and others, raises awareness and increases skills.

The eight Millenium Development Goals (MDGs) include that of reducing under five mortality by two thirds by 2015.  

   2000 The International Labour Organisation (ILO) adopts three Maternity Protection Conventions protecting maternity leave and breastfeeding breaks for all women in the workplace.  

   2002 The Global Strategy for Infant and Young Child Feeding builds on the Innocenti Declaration and calls on Governments to take urgent action to implement the Code.

  2005 The ‘Innocenti plus 15’ Celebration Meeting takes place in Florence , Italy  

   2006 The Innocenti Declaration 2005 is welcomed at the World Health Assembly (WHA59.21) and Member States are urged to renew their commitment to the Code and all subsequent relevant WHA Resolutions (12 to date)                  

[1] Apple Rima D, Mothers and Medicine A Social History of Infant Feeding 1890 -1950. University of Wisconsin Press,  p94 (1987).

 

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WABA: Protects, Promotes and Supports Breastfeeding Worldwide The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, promotion and support  of breastfeeding worldwide. WABA action is based on the Innocenti Declaration, the Ten Links for Nurturing the Future and the Global Strategy for Infant & Young Child Feeding. Its core partners are IBFAN, LLLI,  ILCA,  Wellstart International,  ABM and LINKAGES. Find out more at the WABA website.