I agree with Tony: there are currently two actions that each of us should support to make progress in this field, but I would formulate them slightly differently.
1. Advocate to have the International Code incorporated into national laws is fine, but advocacy alone seems insufficient in many countries. In the European Union, for example, national advocacy is ineffective because
national laws are moulded based on directives of the European Commission, and the industry lobby concentrates its efforts in Brussels. Pressure, therefore, should be exerted where decisions are taken. Also, advocacy by NGOs (like Ibfan) alone seems too weak compared to the pressure exerted by industry, at both national and supra-national levels. NGOs and other groups interested in such advocacy should form a coalition, or a network, and seek also the support of interested parents and their associations. Ideally, professional associations should also be involved in the coalition; their resistance should be bent first. Finally, having a better law may not be enough because the marketing departments of Big Formula will sooner or later find ways to circumvent new laws. To conclude, advocacy sounds like a complex action with uncertain temporary results.
2. Have hospitals and clinics adopt the Baby Friendly initiatives is also fine, but again insufficient if pursued in isolation. To create health services that are marketing-proof, the simple application of a number of steps may be ineffective if health professionals are not aware of the subtleties of marketing. In my experience, current courses for BFHI accreditation, with barely one hour on the International Code, may not achieve a sufficient level of such awareness. Supplementary courses, followed by refresher workshops with a problem-learning approach, may be needed. Also, health professionals may become more sensitive to the effects of marketing if they are regularly reminded by mothers that marketing undermines breastfeeding. Hence the need to run in parallel some form of education of new mothers, for example during antenatal care.
All actions above would be tremendously facilitated if paediatric associations took side for the International Code against industry. As health professionals taking care of infants and children, one of our first priorities should be to keep hammering the secretariat of the associations we belong to requesting to sever their links with industry.
Adriano Cattaneo
Adriano Cattaneo is a retired epidemiologist. Until recently he was the coordinator of the WHO Collaborating Centre for Maternal and Child Health in Trieste, Italy. He is particularly interested in infant and young child feeding and is a member of IBFAN. adriano.cattaneo AT gmail.com
