In May, the government of Ecuador came to the World Health Organization (WHO) assembly with a resolution on breastfeeding. What worried the government of Ecuador, and many other governments of the Global South, is the behavior of large corporations — Nestlé in the lead. These corporations that sell infant formula have wanted to promote the use of substitutes to breast milk, especially in places such as Ecuador.
The month before — in April 2018 — the WHO and UNICEF jointly put out guidelines to support breastfeeding in health facilities. These “Ten Steps to Successful Breastfeeding” assist health care workers to encourage breastfeeding rather than to encourage the use of infant formulas. Breastfeeding babies in their first two years, say these UN agencies, would save the lives of more than 820,000 children under the age of five. “Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last well into adulthood,” said UNICEF’s executive director Henrietta H. Fore.
At the WHO Assembly, the United States government objected to the Ecuador proposal. The U.S. wanted the WHO to remove the statement “protect, promote and support breastfeeding” from the resolution. Why would the U.S. government oppose this statement? An employee of the Health and Human Services Department of the U.S. government told me bitterly that this has to do with corporate pressure. Corporations that make infant formula have long caviled at the restrictions they face in marketing their product.
Code of marketing breastmilk substitutes
These restrictions came from the May 1981 WHO-UNICEF International Code of Marketing Breastmilk Substitutes. That Code specifically prevents the aggressive marketing of infant formula by corporate representatives who masquerade as health care professionals (so-called ‘milk nurses’) and by the donation of samples to hook children. When the Code came before the World Health Assembly, the vote on it was 93 to 3. Two of the countries that voted against the Code — Bangladesh and Chad — said that they did not oppose the Code itself, but only wanted to extend the debate. The United States — the third country to vote against the Code — actually voted against it.
The U.S. representative to the Assembly in 1981, Gerald B. Helman, said that his government opposed the WHO’s “involvement in commercial codes.” What the U.S. did not want was for the multilateral agencies to get involved in the regulation of business. Echoing Helman, the International Council of Infant Food Industries said that the Code lacked “flexibility.” This means that the infant food corporations felt hemmed in by the regulations.
The WHO and the UNICEF took up discussion over the Code because of a scandal in the 1970s around Nestlé’s marketing practices. In 1974, the activist group War on Want produced a pamphlet “The Baby Killer,” which was on how Nestlé pushed its infant formula and how it denigrated breastfeeding. A Swiss group translated the report, with an inflammatory title — “Nestlé Toten Babies,” or “Nestlé Kills Babies.” Nestlé took the Swiss firm to court, which found the title libelous. The court case put on the table the issue of breastfeeding and corporate profit from the sale of infant formula.
The WHO and UNICEF responded in 1981 with their guidelines to clarify the terms of the debate from their standpoint. Dr. Torbjorn Mork of Norway, deputy chair of the WHO board, said at that time that the agency was looking at this not as an economic issue but as a public health issue that was important to children around the world and “thus to all future generations on our spaceship earth.”
The Code was not enough. Infant formula firms went around its regulations, creating infant cereals and offering free as well as subsidized breastmilk substitutes to hospitals. The World Health Assembly in 1984 and 1986 and then later had to close these loopholes. It has been a constant battle between the infant formula firms and the needs of families.
Between the bottle and the breast
In 1984, Professor Carolyn Campbell wrote an instructive paper in the International Journal of Health Services on the debate around breastfeeding and formula. What she found was that the debate itself had lost the focus on the well-being of children and their families.
On the one side, the corporations and the intellectuals of the free market made the case to substitute formula for breastmilk. There is money to be made in the selling of formula. Companies like Nestlé, which dominate the market, have long seen the massive profits from the discouragement of breastfeeding and the encouragement of infant formula. The only competition for the firm was the lactating mother. But she could easily be defeated, Campbell noted, by a kind of psychological war against women—providing free formula for a few weeks, making the case that breastfeeding is difficult, and encouraging caesarean births, all of these able to cut down on breast milk production “due to lack of sucking stimulus.”
There was little concern about the matter of health benefits from breastfeeding or of the lack of potable water with which to mix the formula. None of this mattered in the face of massive profits.
On the other side, Professor Campbell pointed out, were two different but related groups with agendas that were equally inimical to women. Liberal foundations such as Rockefeller and Carnegie encouraged breastfeeding as a method of birth control. Worries about population growth in the Global South fueled this policy. Cuts in social spending and in subsidies for basic goods, pushed by the IMF, had already led to anti-austerity or “IMF riots.” The push to cut back on the population in the Global South was linked to these cuts. It is why the U.S.-based Population Council and others joined in the campaign to encourage breastfeeding and to prolong postpartum amenorrhea.
The other groups that encouraged breastfeeding were those who participated in the myth of motherhood, who put pressure on women to be icons of a certain idea of being a mother. Rockefeller participated in this side of the argument as well. One of its documents noted that it would fund scientific child-rearing techniques in order to “bring the home into harmony with industrial conditions.”
Women did not drive this debate. As the American anthropologist Margaret Mead wrote as part of the 1970s debate, “Unfortunately, people are always taking an issue that relates to women and children and turning it into politics. Nobody cared in the least about them. They are into this with this multinational business and making the matter ideological instead of caring about the survival of children.” Or the ideas of the women, which should have been part of the debate.
It is plainly obvious that Trump’s government is deeply misogynistic. It is not going to allow women to drive this debate. But this is a long-term problem for U.S. policy making — a problem of being driven by corporations rather than by its own democracy. After the U.S. voted against the 1981 Code, both houses of Congress voted to override that vote. But this had no impact on the executive branch. The corporations had spoken. Their vote was more valuable.
This year, the U.S. bullied Ecuador for putting its resolution forward. The U.S. suggested that Ecuador would face other trade sanctions if it persisted. Russia entered the fray, sponsored the resolution and made sure that it got on the table. The WHO-UNICEF code is not a law. It is merely a guideline. Yet, it raised the ire of the United States, whose government took up the cudgels — once more — for giant corporations. As it always does, even when the lack of regulations — to follow the Swiss partner of War on Want — kills babies.