David Clark: Defender of Human Rights and Breastfeeding

On September 10, I had the pleasure of interviewing my friend and colleague David Lawson Clark, the legal advisor for infant and young child nutrition and expert on the International Code of Marketing of Breast-milk Substitutes at UNICEF. A native of Scotland, David began his career as an attorney with the Scottish Development Agency and subsequently worked for the United Nations Interregional Crime and Justice Research Institute in Rome, Italy. Since 1995, David has assisted more than 60 countries in drafting legislation to implement the International Code of Marketing of Breastmilk Substitutes and has been instrumental in bringing a human rights-based approach to the protection, promotion, and support of breastfeeding. He has contributed to the development of international policy guidelines in the area of HIV and infant feeding and infant feeding in emergencies, and has provided guidance on issues around international trade agreements and intellectual property rights. David has written and contributed to many articles and publications on health and nutrition policy, developed courses and training materials on the implementation of the International Code and maternity protection, and has facilitated numerous workshops on the issue. (LGS refers to Dr. Laurence Grummer-Strawn and DC are the verbatim responses of David Clark)

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What You Don’t Know About the Codex Can Hurt You: How Trade Policy Trumps Global Health Governance in Infant and Young Child Nutrition

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.109 ◽

2021 ◽

Author(s):

Katheryn Russ ◽

Phillip Baker ◽

Michaela Byrd ◽

Manho Kang ◽

Rizki Nauli Siregar ◽

...

Keyword(s):

Public Health ◽

Child Nutrition ◽

Standard Setting ◽

World Health ◽

International Code ◽

Infant And Young Child ◽

Trade Politics ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Health Organization

Background: International food standards set by the Codex Alimentarius Commission (CAC), have become more prominent in international trade politics, since being referenced by various World Trade Organization (WTO) agreements. The new standing of the CAC imposes limits on domestic public health regulation. We show this includes implementation of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes. Methods: Using trade in commercial milk formulas (CMF) as a case study, we collected detailed data on interventions across various WTO bodies between 1995 and 2019. We used language from these interventions to guide data collection on member state and observer positions during the CAC review of the Codex Standard for Follow-up Formula (CSFUF), and during CAC discussions on the relevance of WHO policies and guidelines. Results: Exporting member states made 245 interventions regarding CMFs at the WTO, many citing deviations from standards set by the CAC. These did not occur in formal disputes, but in WTO Committee and Accession processes, toward many countries. In Thailand, complaints are linked to weakened regulation. Exporters also sought to narrow the CSFUF at the CAC in a way that is at odds with recommendations in the International Code. Tensions are growing more broadly within the CAC regarding relevance of WHO recommendations. Countries coordinated during WTO committee processes to advocate for reapportioning core WHO funding to the CAC and in order to further influence standard-setting. Conclusion: The commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC, and functions of the WTO. This poses serious concerns for countries’ abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.

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Who's keeping the code? Compliance with the international code for the marketing of breast-milk substitutes in Greater Glasgow

Public Health Nutrition ◽

10.1017/s1368980007441453 ◽

2007 ◽

Vol 10 (7) ◽

pp. 719-725 ◽

Cited By ~ 5

Author(s):

Rhona J McInnes ◽

Charlotte Wright ◽

Shogufta Haq ◽

Margaret McGranachan

Keyword(s):

Primary Care ◽

Breast Milk ◽

Infant Feeding ◽

Bottle Feeding ◽

Care Staff ◽

International Code ◽

Care Facilities ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Primary Care Staff

AbstractObjectiveTo evaluate compliance with the World Health Organization's International Code of Marketing of Breast-milk Substitutes in primary care, after the introduction of strict local infant feeding guidelines.DesignAn audit form was sent to all community-based health professionals with an infant feeding remit. Walking tours were conducted in a random sample of community care facilities.SettingGreater Glasgow Primary Care Division.Subjects(1) Primary-care staff with an infant feeding remit; (2) community health-care facilities.Main outcome measuresContact with manufacturers of breast-milk substitutes (BMS) and BMS company personnel, free samples or incentives, and advertising of BMS.ResultsContact with company personnel was minimal, usually unsolicited and was mainly to provide product information. Free samples of BMS or feeding equipment were rare but childcare or parenting literature was more prevalent. Staff voiced concerns about the lack of relevant information for bottle-feeding mothers and the need to support the mother's feeding choice. One-third of facilities were still displaying materials non-compliant with the Code, with the most common materials being weight conversion charts and posters.ConclusionsContact between personnel from primary care and BMS companies was minimal and generally unsolicited. The presence of materials from BMS companies in health-care premises was more common. Due to the high level of bottle-feeding in Glasgow, primary-care staff stated a need for information about BMS.

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Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices

Journal of Human Lactation ◽

10.1177/0890334419848728 ◽

2019 ◽

Vol 36 (1) ◽

pp. 175-186 ◽

Cited By ~ 1

Author(s):

Faith Agbozo ◽

Doris Ocansey ◽

Prosper Atitto ◽

Albrecht Jahn

Keyword(s):

Infant Feeding ◽

Staff Training ◽

Breastfeeding Initiation ◽

International Code ◽

Baby Friendly Hospital Initiative ◽

Cross Sectional ◽

Inadequate Knowledge ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Postpartum Mothers

Background: Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. Research aim: To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. Methods: In this cross-sectional, prospective, mixed-methods study ( N = 180), clinical staff ( n = 60), pregnant women ( n = 40), postpartum mothers ( n = 60), and mothers of babies in intensive care ( n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50–80%) signified noncompliance. Results: The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff’s inadequate knowledge about Baby-Friendly practices. Conclusions: Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.

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Marketing Breastfeeding Substitutes: A Discussion Document

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249239 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9239

Author(s):

Genevieve E Becker

Keyword(s):

Child Nutrition ◽

Health Workers ◽

Long Term Effects ◽

Policy Makers ◽

Health And Wellbeing ◽

Infant And Young Child ◽

Discussion Document ◽

Parental Confidence ◽

Breast Milk Substitutes ◽

Milk Substitutes

Marketing influences knowledge, attitudes, and decisions related to infant and young child nutrition, safety, development, parental confidence, and other aspects of health and wellbeing of the child. These attitudes and behaviours of parents, health workers, policy makers, and other influencers have short- and long-term effects on the child. There is an International Code of Marketing of Breast-Milk Substitutes. Is it time to have a code of marketing of breastfeeding substitutes?

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Media audit reveals inappropriate promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes in South-East Asia

Public Health Nutrition ◽

10.1017/s1368980016003591 ◽

2017 ◽

Vol 20 (8) ◽

pp. 1333-1342 ◽

Cited By ~ 7

Author(s):

Kristine Hansen Vinje ◽

Linh Thi Hong Phan ◽

Tuan Thanh Nguyen ◽

Sigrun Henjum ◽

Lovise Omoijuanfo Ribe ◽

...

Keyword(s):

Breast Milk ◽

East Asia ◽

Child Nutrition ◽

Market Size ◽

Milk Formula ◽

South East Asia ◽

International Code ◽

Editorial Content ◽

Breast Milk Substitutes ◽

Milk Substitutes

AbstractObjectiveTo review regulations and to perform a media audit of promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes (‘the Code’) in South-East Asia.DesignWe reviewed national regulations relating to the Code and 800 clips of editorial content, 387 advertisements and 217 Facebook posts from January 2015 to January 2016. We explored the ecological association between regulations and market size, and between the number of advertisements and market size and growth of milk formula.SettingCambodia, Indonesia, Myanmar, Thailand and Vietnam.ResultsRegulations on the child’s age for inappropriate marketing of products are all below the Code’s updated recommendation of 36 months (i.e. 12 months in Thailand and Indonesia; 24 months in the other three countries) and are voluntary in Thailand. Although the advertisements complied with the national regulations on the age limit, they had content (e.g. stages of milk formula; messages about the benefit; pictures of a child) that confused audiences. Market size and growth of milk formula were positively associated with the number of newborns and the number of advertisements, and were not affected by the current level of implementation of breast-milk substitute laws and regulations.ConclusionsThe present media audit reveals inappropriate promotion and insufficient national regulation of products under the scope of the Code in South-East Asia. Strengthened implementation of regulations aligned with the Code’s updated recommendation should be part of comprehensive strategies to minimize the harmful effects of advertisements of breast-milk substitutes on maternal and child nutrition and health.

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