PHM-Exch> FWHA2018 on Breast Feeding and the USA

[Claudio Schuftan]

From: Bev Snell <bev at burnet.edu.au>


This mornings MJA  (Medial Journal Australia) Insight included this piece.

It is copied here to save you looking for it.  Sorry - It is a bit long but
important


*MJA Insight*

*https://www.doctorportal.com.au/mjainsight/2018/28/big-formula-follows-big-tobacco-playbook/?utm_source=MJA+InSight&utm_campaign=bf6928be43-EMAIL_CAMPAIGN_2018_07_20_05_11&utm_medium=email&utm_term=0_7346f35e23-bf6928be43-42154993
<https://www.doctorportal.com.au/mjainsight/2018/28/big-formula-follows-big-tobacco-playbook/?utm_source=MJA+InSight&utm_campaign=bf6928be43-EMAIL_CAMPAIGN_2018_07_20_05_11&utm_medium=email&utm_term=0_7346f35e23-bf6928be43-42154993>*


*23 July 2018*

*Big Formula follows Big Tobacco Playbook*

*Authored by*

ALYCE WILSON
MARIAM TOKHI
LISA AMIR

Issue 28 / 23 July 2018 <https://www.doctorportal.com.au/mjainsight/2018/28>


BREASTFEEDING needs all the protection, promotion and support it can get.
Yet these three words were at the centre of a breastfeeding resolution
fiasco earlier this year. At the World Health Assembly in May, the United
States made deliberate attempts to dilute a resolution on
breastfeeding and specifically
sought to remove the wording that countries should “protect, promote and
support” breastfeeding
<https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html>.
The US threatened the original sponsor of the resolution, Ecuador, with
trade sanctions and military aid withdrawal if the resolution passed
unchanged. Fortunately, Russia stepped up to sponsor the resolution and it
passed largely unscathed.


The actions of the US have outraged the health sector, reminding us of the
risks of corporate interference in public health guidelines, policies and
programs. Media and commentators around the world have expressed surprise
at these actions, yet formula manufacturers have been active in
aggressively marketing the substitution of mothers’ milk with commercial
alternatives for many years <https://www.ncbi.nlm.nih.gov/pubmed/23034164>.


Rates of breastfeeding in Australia and internationally are low. The Australian
National Infant Feeding Survey in 2010
<https://www.aihw.gov.au/reports/mothers-babies/2010-australian-national-infant-feeding-survey/contents/table-of-contents>
found
that while over 90% of women initiate breastfeeding, only 15% exclusively
breastfeed their babies to 5 months. In low income and middle income
countries, less than 40% of infants under 6 months are exclusively breastfed
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract>.
In high income countries, there is a significant gap in breastfeeding
patterns between the rich and poor; breastfeeding rates show a clear
gradient with higher initiation and duration in higher income brackets
<https://www.mja.com.au/journal/2008/189/5/socioeconomic-status-and-rates-breastfeeding-australia-evidence-three-recent>
.


Australian guidelines <https://www.nhmrc.gov.au/guidelines-publications/n56>
 recommend that babies are exclusively breastfed to around 6 months of age
when solids are introduced and breastfeeding continued until the age of 12
months and beyond, if both mother and infant wish. We recognise that there
are certain circumstances when breastfeeding is not possible, and the safe
use of infant formula is essential. Establishing and continuing
breastfeeding may be challenging for many mothers and babies. New mothers
deserve encouragement and support to feed their babies. However, the
evidence is clear: breastfeeding is a far superior option on a number of
fronts and should be strongly promoted as such. Unfortunately, marketing
strategies used by the formula industry can weaken and distort this message.


Breastfeeding provides children with the best start in life and is a key
contributor to improved infant and maternal health outcomes. Authors of the
recent *Lancet *series
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract>
conducted
meta-analyses that indicated that breastfeeding provides children with
protection against infections and malocclusion, increases in intelligence
and likely reductions in overweight and diabetes. For nursing mothers,
there were benefits in terms of protection against breast cancer and
potential protection against ovarian cancer and type 2 diabetes.
Breastfeeding can also help with family planning with improved birth
spacing. The benefits for children in low and middle income countries are
significant. Diarrhoeal diseases and lung infections are among the major
causes of death in children under 5 years of age. Improving breastfeeding
rates could nearly halve diarrhoeal episodes and cut respiratory infections
by a third. Breastfeeding also has economic benefits, achieved not only
through health care cost reductions and lives saved but also through the
benefits of improved cognitive development leading to greater economic
productivity. Internationally, if all infants under 6 months of age were
exclusively breastfed, we could prevent 823 000 annual deaths in children
under 5 years and an estimated US$302 billion annually in economic losses
from cognitive deficits
<https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/abstract>
.


The pervasive marketing and availability of infant formula is a critical
factor in lagging breastfeeding rates. Big Formula operates in the same
playground as Big Tobacco. The aggressive tactics employed by the infant
formula industry to promote their products and expand their markets mirror
those used by the tobacco industry
<https://worldnutritionjournal.org/index.php/wn/article/view/155>. These
tactics include:

   - interfering with political and legislative processes;
   - overstating the economic importance of the industry;
   - manipulating public opinion to improve their appearance;
   - engineering support through “expert” front groups;
   - discrediting evidence-based science; and
   - intimidating governments with legal action.

The Hong Kong Infant and Young Child Nutrition Association (HKIYCNA)
appears to be a society of health professionals and claims to “improve the
nutritional wellbeing of infants and young children in Hong Kong”. Yet,
HKIYCNA is a front group for six baby food companies – Abbott, Danone,
FrieslandCampina, Mead Johnson, Nestle and Wyeth – and has openly lobbied
in opposition of the code on marketing of breast milk substitutes


With infant formula sales plateauing in high income countries
<https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html>,
we can expect to see increased lobbying efforts specifically targeting low
and middle income countries, which have been identified by infant formula
producers as key growth markets. Yet again, Big Formula is following in the
footsteps of Big Tobacco. Tobacco marketing has been reported to be
substantially
higher in low and middle income countries
<http://www.who.int/bulletin/volumes/93/12/15-155846/en/>, and the infant
formula industry will not be far behind. Research has shown that the marketing
of breast milk substitutes has a deleterious impact on the breastfeeding
practices <https://www.ncbi.nlm.nih.gov/pubmed/26314734> recommended by the
World Health Organization. Marketing in low and middle income countries is
less regulated than in high income countries and infant formulas are
directly marketed to consumers via the mass media and print advertisements;
with the use of internet marketing and social media on the rise.


Free samples, incentives and benefits are provided to health workers and
services to promote infant formula products. Misleading and even false
health claims have been used by the infant formula industry with attempts
to portray formula as “more modern” and “even better” than breast milk. The
billboard advertisement shown above suggests improved cognition with their
product “360° brain plus”. Earlier this year, Nestle came under fire for
violating breast milk substitute marketing guidelines
<https://www.scmp.com/news/world/europe/article/2131672/nestle-faces-fire-misleading-baby-milk-tactics-hong-kong-and>
with
products in Hong Kong and Spain advertised as having an “identical
structure” to breast milk and “inspired by human milk”.

The recent events at the World Health Assembly reveal the depth and extent
of interference that the infant formula industry is willing to take to
protect their $70 billion industry. Any health commitments which may limit
their ability to indiscriminately promote their products will be
challenged. Women and their families deserve better.


One approach may be to view breastfeeding through a food security lens. Food
security for infants and young children relies on high rates of
breastfeeding
<https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0029-6>.
Political attention and policy coordination may be strengthened by viewing
breastfeeding within a food security framework. A right-to-health approach
demands that women are given the best opportunity to breastfeed without the
undue influence of the industry.


Governments need to ensure <https://www.bmj.com/content/361/bmj.k2252>
responsible
advertising of infant formula, challenge countervailing narratives from the
industry, address globalised supply changes for breast milk substitutes and
have effective legislation in place to reprimand unacceptable behaviour.
Workplaces need to have supportive policies and practices that enable women
to return to work and continue breastfeeding. Women need to be supported at
all levels of society with structures in place and a culture that enables
them to breastfeed anywhere, anytime.


World Breastfeeding Week
<http://www.who.int/life-course/news/events/world-breastfeeding-week-2018/en/>
is
celebrated in the first week of August; and this year’s slogan is
“Foundation for life”. Let’s take this opportunity to provide babies and
their mothers with a supportive breastfeeding environment which indeed
enables them to provide a foundation for lifelong good health and wellbeing.


*Dr Alyce Wilson is an aspiring public health physician with a background
in public health nutrition. She works in research and international
development in maternal, child health and nutrition and lectures medical
students on nutrition.*

*Dr Mariam Tokhi is a GP and global public health researcher focusing on
women’s and children’s Health. She works in community medicine in
north-west Melbourne.*

*Associate Professor Lisa Amir is a GP and lactation consultant. She works
in breastfeeding medicine at the Royal Women’s Hospital in Melbourne and in
private practice. She is a Principal Research Fellow at the Judith Lumley
Centre, La Trobe University, Australia.*
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