STATE
OF THE CODE BY COUNTRY: WHERE IS CANADA?STATE
OF THE CODE BY COUNTRY: WHERE IS CANADA?
Every few years the International Baby Food
Action Network publishes the results of a survey of measures taken
by governments to implement the Code. Presented
in an easy to read chart format, the 1994 report card shows some
progress over previous reports. To date 11 countries have enacted
the code into legislation, encompassing all or nearly all of its
provisions. These include:
A significant number, 36, have legislated some but not all Code provisions (this excludes general food labelling laws). And another 13 have given effect to the Code through voluntary measures. The report notes that both laws and voluntary measures can be effective if properly monitored. Currently a full 19 countries have draft laws prepared awaiting final adoption by the legislative body. Others have taken some action to end the donation of free artificial feeding supplies to the health care system. A few, such as Germany, Ireland and Switzerland have endorsed industry drafted codes, weaker than the International Code and generally self monitored.
Considerable progress has been made by governments to end the distribution of free or low-cost supplies to the health care system. At the time of the report, 81 countries had taken some action to end the practice. Although Article 6 of the International Code intended to limit routine free supplies to hospitals, formula manufacturers refused to end this effective marketing route. This necessitated the strengthening of Article 6. In 1985 the World Health Assembly passes Resolution 39.28 urging member states to ensure that the small amounts of breast milk substitutes needed for the minority of infants who require them in maternity wards and hospitals are made available through the normal procurement channels and not through free or subsidized supplies. Even this amendment did not stop industry donated supplies. It was not until the Baby Friendly Hospital Initiative became reality in hospitals and maternities in many developing countries that this practice stopped. However, in industrialized countries free supplies persist.
Compared to progress in Code legislation in most European countries, North America lags well behind. No regulations exist restricting direct marketing to new mothers nor is there any legislation prohibiting promotion through the health care system. Since May of 1991 the European Commission adopted a "Commission Directive" on infant formula and follow-up formula. Member states had till June 1994 to implement this Directive. Importantly, the operative framework for the marketing rules that follow, "Whereas in an effort to provide better protection for the health of infants, the rules (....) laid down in this Directive should be in conformity with the principles and the aims of the International Code of Marketing of Breast-Milk Substitutes..." sets the International Code as the minimum standard.
The passage of the Directive represents a major breakthrough in the protection of breastfeeding and a credit to the hard work and lobbying efforts of European IBFAN groups (Baby Milk Action-UK, WEMOS-Netherlands, Geneva Infant Feeding Association-Geneva). To date almost all European Union Member States have implemented the European Directive into law. Of the 10 countries that have so far adopted laws, 5 have banned advertising of infant formula to the public. Others have banned free samples to parents and free or low cost supplies to institutions. The following are some examples:
A draft law before parliament forbids advertisements for infant formula to the public. Promotions are only allowed in special publications to the health care system and must be scientific and factual. Articles on free supplies are still ambiguous and clarification of these sections is being sought.
Advertisements of infant formulas is forbidden in publications to the general public. Such advertisements are allowed only in scientific publications and must be factual and scientific and should not give the impression that bottle feeding is better than or equal to breastfeeding. Manufacturers are not allowed to distribute samples of infant formula or engage in other sales inducements. Free supplies to hospitals are allowed only for infants who "have to be fed" with infant formula and must be supplied for the duration they are needed.
Advertisements for infant formula directed at the public are forbidden. Promotions are limited to special child care and scientific publications and must be factual and scientific. There may be no implications that bottle feeding is superior or equivalent to breastfeeding. Free samples and other sales inducements are forbidden. Free supplies are permitted only to certain institutions and only for those infants who "have to be fed" with formula and must be supplied for the entire duration of the need. The promotion of follow-up milks have similar restricted.
Why has Canada made no progress in Code regulation since the its passage in 1981? Ministers of Health have come and gone over the past 14 years but nothing has been done to regulate the International Code. Mme Marleau continues in the hardliner fashion of her predecessors, "Canada continues to support the approach that the Code should be implemented through education and health promotion rather that through legislation and regulation." Dr Warren Bell of Salmon Arm, BC expresses the frustration breastfeeding advocates and health care workers across Canada feel in a recent letter to Health Minister Mme Marleau, he writes,
Health professional like myself simply cannot comprehend how you can repeat such a response in the face of ever increasing formula marketing. Along with my two letters to you, I enclosed documents, actual promotional materials and critical reports indicating that the formula industry is in fact escalating its direct marketing campaign to consumers, ignoring "educational and health promotional" initiatives. These included print advertisements promoting Nestle's "Good Start" formula in the magazine Family Health, free samples from Ross enclosed with the video "For the Breastfeeding Mother", and information on the marketing "courses" for pregnant women created by Mead Johnson. In other words, the industry is proceeding full steam ahead in promotional campaigns and actions directed at pregnant or breastfeeding women which flaunt the spirit and letter of the Code. The Canadian government's approach to this matter is not working. It is simply giving free reign to the already profitable industry to advance sales by any means. Meanwhile, Canadian mothers are nursing for shorter periods of time now than five years ago, despite an aggressive pubic education campaign by many health and government agencies. (A recent study done in Vernon, BC again confirms this finding once again.) Canadian babies are getting sicker more often, and the Canadian health care system is spending unnecessary dollars on restoring them to health, dollars which we can ill afford to spend. I ask you, Mme Minister, to show me that the evidence I have submitted to you is false - to show me that the industry is not actually violating the Code, but complying with it. If you cannot, then I once again call upon you to set in motion regulations to formally commit this country to endorsement of the WHO Code. If you are not willing to do this, then I would ask you to explain to me and the many other concerned health professionals across this country why you, the Prime Minister, and your cabinet colleagues refuse to do so.
Let Diane Marleau, the Minister responsible for Health Canada know that Code violations are unacceptable to you. Send your letter and violations to:
The Honourable Diane Marleau
Health Canada
House of Commons
Ottawa, Ontario
K1A 0K9
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