Understanding the Ethical Imperatives of the International Code of Marketing of Breast-Milk Substitutes
In today’s world, where marketing strategies can heavily influence parental choices, it is paramount that midwives and healthcare professionals advocate for ethical practices, particularly concerning breastfeeding and breast-milk substitutes. The International Code of Marketing of Breast-Milk Substitutes (referred to as the Code) sets the standard for ethical guidelines that ensure the health and well-being of infants and their mothers, promoting informed choices without commercial bias.
Key Principles of the International Code
The International Code comprises critical rules designed to protect breastfeeding. Here are the tenets every midwife should uphold:
- No advertising of breast-milk substitutes, feeding bottles, or pacifiers to the public.
- No free samples for mothers, as this could influence their feeding choices.
- No promotions of these products within health services or via healthcare professionals.
- No donations of free or subsidized breast-milk substitutes in the healthcare system.
- No direct or indirect contact between industry representatives and mothers to avoid unnecessary influence.
- No gifts or personal samples accepted by health workers to maintain professional boundaries.
- No idealised claims on product labels that misrepresent the benefits of formula feeding.
- Information shared with health workers must be strictly scientific and fact-based.
- Discussions about artificial feeding should include benefits of breastfeeding and the inherent risks associated with formula feeding.
- Unsuitable products, such as sweetened condensed milk, must not be promoted for infant feeding.
Governments endorsing the Code are encouraged to integrate its provisions into national legislation. Yet, in many regions, laws are inadequately enforced, leaving room for marketing tactics that undermine public health (4). For instance, a BMJ report highlighted a case in the United Kingdom where companies exploited legislative gaps to market products indirectly, using midwives to influence families in-store (5).
The Impact of Commercial Milk Formula (CMF) Marketing on Breastfeeding
It is no secret that CMF marketing has a detrimental impact on breastfeeding rates. The industry often capitalises on maternal anxiety and self-doubt to promote its products, creating a narrative that undermines women’s confidence in their ability to breastfeed (4, 6). A 2023 Lancet series reaffirmed that despite the well-documented benefits of breastfeeding, aggressive marketing strategies contribute to the rise in commercial formula sales (7).
Breastfeeding challenges, such as ineffective latch and nipple pain, can prompt mothers to seek alternatives, often influenced by the notion that formula is the solution (8). This problem is exacerbated by misleading marketing tactics that idealise formula feeding as easier or superior to breastfeeding.
The Role of Midwives in Upholding the Code
Midwives are at the forefront of providing support and guidance to breastfeeding mothers. According to the ICM Essential Competencies for Midwifery Practice, midwives are responsible for promoting early initiation of breastfeeding and exclusive breastfeeding for the first six months, while allowing mothers to exercise their feeding choices.
Midwives’ Responsibilities Under the International Code
To ensure adherence to the Code, midwives must be vigilant in distinguishing between genuine education and disguised marketing campaigns. Here’s a concise overview of what midwives should and shouldn’t do:
| Midwives should not: | Midwives should: |
|---|---|
| Advertise breast-milk substitutes or related products. | Provide individualized, evidence-based information about breastfeeding. |
| Idealise formula feeding in comparison to breastfeeding. | Support and promote the benefits of breastfeeding. |
| Encourage formula feeding without a medical need. | Offer guidance on safe formula use when necessary. |
| Accept free samples or promotional materials. | Facilitate access to unbiased, educational resources. |
As reliable healthcare professionals, midwives must closely monitor the unethical marketing tactics of CMF companies and ensure they provide accurate, evidence-based support for breastfeeding, including helping parents who choose to use formula.
For further development, the WHO and UNICEF offer training resources through their course “Introduction to the International Code of Marketing of Breast-Milk Substitutes (2nd Edition),” which is invaluable for midwives and health providers looking to enhance their understanding and commitment to ethical standards.
Conclusion
In an era where commercial interests can often overshadow health mandates, the importance of adhering to the International Code of Marketing of Breast-Milk Substitutes is more crucial than ever. By remaining steadfast in their commitment to ethical practices, midwives can significantly influence maternal choices, bolster breastfeeding rates, and protect infants’ health. They must be the champions of evidence-based practice, ensuring that their support for breastfeeding is unwavering and free from commercial influences.
