Breaking the rules: What can be done

What Canada's government can do

It is essential that Canada's infant feeding policies as recommended in Nutrition for Healthy Term Infants be revised.

Criteria must be established to ensure that those with receive economic benefits from the infant formula and infant foods industries are prohibited from participating in the setting of infant feeding policies for Canada.

Provisions of the International Code of Marketing of Breast-Milk Substitutes must be integrated into any infant feeding policies for Canada. Requirements for the protection, promotion and support of breastfeeding are integral to the establishment of optimal infant feeding practices and the achievement of breastfeeding practices as recommended by the World Health Organization (WHO).

Infant feeding and breastfeeding practices are influenced by a multitude of factors -- social, scientific, economic and cultural. Thus consultations and contributions from a wide sector of those working on infant feeding should be included in the development of national policy and recommendations.

The global standards as set out by the WHO Expert Consultation on the recommended duration of exclusive breastfeeding must be included in Canada's infant feeding policies.

Canada must use its capacity to make exemptions under the free trade provisions for health. Abundant scientific evidence exists to assure Canada's right to establish marketing restrictions that are protective of infant and young child health. Such restrictions can be made under the sanitary and phytosanitary exemptions of trade agreements.

The Government of Canada must recognize that the right of optimal health for children and women supersedes the rights of the pharmaceutical-infant foods industries to undermine breastfeeding and subvert optimal infant feeding practices in Canada.

The provisions of the International Code are not superseded by trade agreements as the government claims. Scientific evidence overwhelmingly demonstrates the harm of artificial feeding both for children and for their mothers; harm both in the short term -- infectious diseases, atopy, allergy -- and in long term health -- chronic diseases, autoimmune diseases.

Health Canada can incorporate several provisions of the International Code into the Food and Drugs Act -- labelling provisions, marketing regulations; how hospitals relate to the infant formula/infant feeding products industries can be made a requirement of the Canada Health Act. The Canadian Food Inspection Agency can do much more to monitor and enforce existing regulations such as no health and nutrition claims for infant foods. Industry Canada can be much more proactive in enforcing regulations that prohibit misleading advertising claims.

What health professional associations can do

Health professional associations carry a special responsibility to ensure their practices and recommendations are independent and free of commercial influence. The International Code of Marketing makes it very clear that health care professionals have a special role in the protection of breastfeeding and should not be used as a vehicle for the marketing of products that come under its scope.

The professional associations must stop endorsement by association of products and practices that promote inferior infant feeding practices. They must stop accepting funds for conferences, social events, meals, publications, brochures, research, and any other perks that compromise their independence. Instead they must become proactive in eliminating these practices from their professional associations -- educate on the International Code; integrate provisions of the Code into their standards for practice and monitor their professional practices to ensure that they are in compliance.

What health care institutions can do

Hospitals -- maternity and birthing centres -- are uniquely recognized by the WHO as having major influence on infant feeding practices. It is in recognition of their unique role in the establishment and successful continuation of breastfeeding that WHO, UNICEF and international non-governmental partners such as the International Baby Food Action Network (IBFAN) and the World Alliance for Breastfeeding Action (WABA) developed the Ten Steps for the Protection, Promotion and Support of Breastfeeding, known as the Baby-Friendly Hospital Initiative (BFHI). Underlying the success of the BFHI is the need for Code compliance by maternity services in order to establish breastfeeding without the intervention of supplementary feeding, the mixed messages of artificial feeding, the free samples to create insecurity, and interference, and in the case of many Canadian hospitals the financial links of "donations" for the right to exclusive product arrangements and the rights to market to new mothers birthing in that institution. Although institutional practices have improved to support new mothers -- rooming-in, breastfeeding immediately after birth and no free samples -- much work still needs to be done to achieve full BFHI status.

What the public can do

Of importance is the need for public awareness and watchfulness of the practices of the infant foods industries. We all benefit from a healthier population when breastfeeding is optimally practised. Health care costs decline and we have a healthier, more cognitively able and more productive society. Members of the public can monitor, lobby, support and advocate for their communities and their governments to institute policies and practices and initiate programmes that create supportive environments.

What the infant foods industry must do

The International Code requires the manufacturers and distributors of the products that are covered -- infant formulas, teats and bottles, complementary foods when marketed before the age of six months -- to comply with its provisions regardless of measures taken by governments, and to monitor its practices to ensure that they are in compliance. Enough said!

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