The WHO Code, marketing, sponsorship, and why you should give a damn

keanuIt’s the WHO Code’s 33rd birthday, and we’re “celebrating” with a day of action to encourage healthcare facilities to be free of formula marketing. Here are some things may not know about the International Code of Marketing of Breast-milk Substitutes:

  1. Even though the United States helped spur the World Health Organization to action, giving birth to the Code, it’s still one of the only countries that has taken no action to adopt the Code. (President Clinton signed the World Health Assembly resolution 47.5 in 1994, reaffirming the Code, but no action has been taken to implement it in the United States.)
  2. The Code has nothing to do with restricting the availability of formula and other covered products to consumers, and everything to do with restricting how these things are marketed.
  3. You do not need to live or operate in a country that has adopted the Code in order to be a person, professional, organization or company that upholds it.
  4. IBCLCs and CLCs adhere to the principles and aim of the WHO Code as part of their codes of ethics and codes of professional conduct. That is, someone who is an IBCLC or CLC should not be helping to market anything covered under the Code. There are still gray areas and room for individual interpretation.
  5. The Code does not cover the marketing of pacifiers (except in countries that have created laws to that end), nor does it cover breast pumps. However, if you’re a company that manufactures breast pumps and bottles, and markets your bottles in a non-Code-compliant manner, you are a Code “violator.”

The WHO Code was created to protect breastfeeding, particularly for children in those areas for whom breastfeeding is a matter of life or death. So why should someone who lives in a country with clean water, sanitation services, relatively low rates of infant mortality, and plenty of money give a damn about the WHO Code? Well, why does anyone care about Wal-Mart’s business practices? Why do we arrange for boycotts of various products and companies on a regular basis? Why care about any business practices at all?

Some people don’t; I’m not here to make the case that people who don’t really care should. But I am suggesting that people who care about breastfeeding should care about the WHO Code. In the United States, being vigilant about the Code can be as simple as choosing where you spend your money (buy the Target brand milk storage bags instead of the Lasinoh or Medela ones) or choosing which products you suggest (Hygeia upholds the Code; Medela doesn’t).

It can get more complicated than that, and it requires bravery. At the recent La Leche League of the Minnesota and Dakotas conference, Nancy Mohrbacher talked about the WHO Code and the ethical dilemma she faced when her former employer, Ameda, was purchased by Evenflo (a Code violator). While Evenflo initially made the steps to become Code compliant, CEO turnover led to them reverting to non-compliant status, and Nancy Mohrbacher left her position. This had financial implications for her, but ethics are just that important.

We know that the marketing of infant formula works when it comes to negatively impacting breastfeeding. It’s just common sense: No one is going to spend money on marketing and free samples if it doesn’t lead to a return on their investment. This study in the Journal of Urban Health states:

Formula promotion materials are designed to sell formula to as many mothers as possible. The sooner a mother phases out breastfeeding, the more formula is purchased—creating an incentive for formula companies to undermine breastfeeding even as they state its benefits. Accordingly, although information on breastfeeding is usually included in these materials, the messages are mixed at best and emphasize the challenges of breastfeeding. A health provider who distributes materials that are ultimately designed to maximize formula sales is inadvertently strengthening the formula promotion message, potentially at the expense of patients’ plans to breastfeed.

One way that companies market themselves is through event sponsorship. For an investment that is usually relatively low, they’re able to gain media exposure, improve brand recognition and awareness, and increase sales, among many other metrics (here’s a look at how marketers measure the effectiveness of sponsorship). As far as brand recognition and awareness goes, what better way to get that than to have a well-respected person seen or photographed next to your logo? Medela recently sponsored a screening of Breastmilk The Movie, and Ricki Lake and Abby Epstein mugged for the camera in front of the Medela logo. [Edit: After being alerted to this sponsorship issue, The Breastmilk The Movie folks took down all images with the Medela logo—hooray!] Pictures like this can end up in newspapers, across social media, etc. at cost that is much less expensive than running an advertisement.

On a local level, I have been disappointed that Bump Club and Beyond Twin Cities has a relationship with Mead Johnson (makers of Enfamil), and the breastfeeding events are sponsored by WHO-Code violators Lasinoh and Evenflo. When Bump Club first moved into the Twin Cities, I was concerned about potential formula-company sponsorship, as the “parent” company in Chicago had the Similac logo plastered over the website and event invitations. It was said, at that time, that the Twin Cities branch did not accept sponsorship from formula companies. Obviously, this has changed.

I encourage anyone who works with any other organization, whether they are invited to speak at a conference or pay for a table at an event, to examine sponsorship if the organization has not made it clear that it honors the International Code of Marketing Breast-milk Substitutes. Some individuals (such as IBCLCs or CLCs) have a professional obligation to uphold the Code; others may wish to uphold it as a matter of personal ethics. It is your face and your reputation that will be used to sell the sponsors’ products.

NASCAR has standards as to who is allowed to have the privilege of paying hundreds of thousands of dollars to sponsor a race car. Shouldn’t we also have standards as to who should be allowed the privilege of that brand awareness, media exposure, and increased income when it comes to the health and well being of families and babies?



  1. I can't tell if the "I Support You" campaign is a formula ad or not. It does not suggest that I buy a particular brand of formula, but it does say that I should not believe that breastfeeding is more important than using formula. Does saying that breastmilk is better than formula imply that mothers who do not breastfeed are lesser people than mothers who do breastfeed? If it does, then wouldn't the WHO Code be unfair to mothers who can not breastfeed? Some IBCLCs and CLCs understand the importance of supporting all moms. They agree that sharing unused formula samples with those that could use them is more open-minded than throwing the samples out. Other Lactivists would rather dispose of the formula than use it, because of the WHO Code. At some point, doesn't supporting the WHO Code become being anti-mom?

  2. I'm not a WHO Code expert by any means, but from my perspective, the I Support You campaign itself doesn't violate the WHO Code. The recent organization of formula distribution and efforts to leave coupons could possibly constitute marketing, however. You don't need to be paid by a company to be doing its marketing (which is the whole point of this particular post).

    It would be the rare IBCLC, CLC, or lactivist/breastfeeding advocate who would rather throw away a formula sample than pass it along to someone who could use it. Donating your unused formula to a family in need absolutely doesn't violate the WHO Code. Neither does suggesting that someone use formula for a medical reason. Or suggesting formula at all. IBCLCs can provide pump rentals by Medela to moms or suggest products by other WHO-Code-violating companies if they're the best tool for the job. It's *promoting* and *marketing* it that is governed by the WHO Code.

    The only way to see the WHO Code as being anti-mom is to have a lack of understanding of what the WHO Code actually means, and maybe part of that is that some breastfeeding advocates don't know what it means.

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