Can International Standards Prevent Corporate Malpractice? The Case of Baby Food

It is broadly recognised that marketing of breastmilk substitutes (baby food) impacts breastfeeding practices and infant mortality. In 1981, the World Health Assembly (WHA) adopted the International Baby Food Action Network (IBFAN)'s "International Code of Marketing of Breast-milk Substitutes", which bans all promotion of breastmilk substitutes, feeding bottles, and teats in all countries worldwide. Beyond direct advertising to the public, this code prohibits the provision of free baby food to members of the public or health facilities. Companies may only provide scientific and factual information to health workers and must disclose specific kinds of information and warnings on product labels. In countries in which such advertising and promotion practices are prohibited and breastfeeding is actively promoted, year-on-year increases in breastfeeding rates are achieved. In Brazil, where a strong law is rigorously enforced, rates of exclusive breastfeeding at 4 months of age have been increasing at 4% per year. This leads to reduced infant mortality and morbidity.

However, according to this article's author, who works with IBFAN, dedicated campaigning is often needed to stop industry from undermining this and other international codes of conduct. According to IBFAN's January 2004 report "Using International Tools to Stop Corporate Malpractice: Does it Work?" [PDF], the breastmilk substitute industry has argued that the code be deemed voluntary rather than binding. Its influence, says Brady, has extended to sponsorship of the research on which policy is based and the health worker bodies represented on government committees.

Brady cites data reinforcing the broad consensus that, when effective, such lobbying has direct impacts on women's behaviour and children's health. The IBFAN report includes case studies submitted by health advocates in Belgium, Bolivia, Brazil, India, Kenya, Mexico, and the UK. Belgium and the UK have apparently followed policies adopted by the European Union, which has introduced only some aspects of the code and WHA resolutions in regulations. As the report shows, concerted marketing activity over decades has created a situation in these 2 countries in which bottle-feeding is seen almost as a lifestyle - rather than a health - choice. In countries such as Bolivia and Kenya, industry has largely won out: Even though there is not a strong market (breastfeeding predominates), baby food marketing messages can lead mothers to doubt their ability to breastfeed. In Kenya, Brady claims, breastfeeding rates are declining.

In some cases, industry lobbying has been ineffectual; Brady attributes this failure to the work of NGOs in monitoring and exposing company marketing activities and in raising awareness of the need for strong measures. Summarising the conclusions of the IBFAN report, Brady stresses that, when "it comes to protecting the health and lives of infants...our strategy should include campaigning for and achieving science-based international standards; working for their implementation at national level; then resolutely monitoring them to ensure that they are followed; and ensuring that loopholes and weaknesses in the standards are effectively addressed".

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