Breastfeeding: It's your right!

World Breastfeeding Week 1st-7th August 2000

Author: Tessa Martyn (MSc RM), Health Campaigns Co-ordinator, Baby Milk Action

September 2000

A Baby Milk Action briefing. This article first appeared in RCM Midwives Journal, August 2000.

Contents

• Introduction
• WHO/UNICEF International Code of Marketing of Breast-milk Substitutes and subsequent relevant Resolutions
• Convention on the Rights of the Child
• ILO Maternity Protection Convention No. 103
• What is the midwives' role in this?
• Conclusion
• Useful information
• References

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Introduction

Each year, in August (1st - 7th) over 120 countries celebrate World Breastfeeding Week (WBW). This initiative, now in it's 9th year, is co-ordinated by the World Alliance for Breastfeeding Action (WABA). WABA, with its secretariat in Penang, Malaysia, is a global network of individuals and organisations which aims to protect, support and promote the right to breastfeed. WBW is "an opportunity for groups worldwide to take specific actions that will raise public awareness about breastfeeding and reap support for it" (Amin 1996).

Starting in 1992 with the Baby Friendly Hospital Initiative a different theme has been chosen each year to highlight various aspects of breastfeeding.This year the theme for WBW is: "Breastfeeding - it's your right!", and WABA aims to:

• raise awareness about the fact that breastfeeding is a right;
  
  
• stimulate a shift in public thinking so that this right is respected, protected, facilitated and fulfilled at household, community and government levels throughout the world, and
  
  
• provide information about international formal and legal mechanisms and their status at the national level.

Human rights are those basic standards without which people cannot live in dignity. The right to food is a basic human right and breastfeeding is the most beneficial way of fulfilling an infant's right to food for about the first 6 months. The World Health Assembly (WHA) and UNICEF (Lhotska and Armstrong 1999) recommends exclusive breastfeeding for about the first six months, and then continued, with appropriate complementary foods introduced, up until 2 years of age and beyond.

Breastfeeding, as the physiological norm, provides optimal nutrition for the vast majority of infants. There is now a huge body of research which demonstrates that artificial feeding is associated with a number of health disadvantages - not only for the infant but also for the mother .

There are many international instruments, such as declarations, conventions and recommendations which have legally or morally binding obligations once they have been ratified by a government. Several of these instruments, if implemented, help protect a woman's right to breastfeed, for example:

• The Innocenti Declaration Governments from around the world (including the UK) gave their support for numerous measures including the Ten Steps for Successful Breastfeeding in every maternity service; the WHO/UNICEF International Code of Marketing of Breast-milk Substitutes and subsequent relevant Resolutions (see below) and also to enact Ôimaginative legislation protecting the breastfeeding rights of working women'.
  
  
• The International Covenant on Economic, Social and Cultural Rights (CESCR). General Comment 12 on the Right to Adequate Food (Article 11) states: "measures may therefore need to be taken to maintain, adapt or strengthen dietary diversity and appropriate consumption and feeding-patterns, including breastfeeding..."
  
  
• The Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) This makes reference to the fact that women should have appropriate services in connection with pregnancy and lactation.

Three of the most important instruments are:

• The WHO/UNICEF International Code of Marketing of Breast-milk Substitutes and subsequent relevant Resolutions
  
  
• The Convention on the Rights of the Child
  
  
• The International Labour Organisation (ILO) Maternity Protection Convention No. 103

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WHO/UNICEF International Code of Marketing of Breast-milk Substitutes and subsequent relevant Resolutions

In 1981 the WHA in Geneva passed a Resolution to adopt the UNICEF/WHO International Code of Marketing of Breast-milk Substitutes, which was to be enacted by all governments "as a minimum requirement...in its entirety" (WHO 1981) Since 1981 eight further Resolutions have been passed. Both the 1981 Code and subsequent Resolutions have the same status and should be read as one. In this article the they are collectively referred to as Ôthe Code'.

In simple terms the aim of the Code is to ensure that all babies have the best possible start in life - "in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breast-milk substitutes, the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products" (WHO 1981, p.12).

The Code is a set of rules designed to regulate the marketing of all products which babies might be fed in the place of breastmilk, for example artificial baby milk, baby cereals, teas and juices. It also covers bottles and teats. The Code is not just for baby milk companies, it is also directed at health professionals (midwives), policy makers, citizens groups and indivduals.

The Code, if implemented, should enable a mother to make an informed decision about how she feeds her baby, and thus help protect a woman's right to breastfeed. If a mother makes her decision simply because she saw a glossy advert which told her that brand "X" was almost as good as breastmilk, or if she chooses a certain brand of milk because her local clinic had pens and posters from a particular baby milk company, then she has not made an informed decision. The Code allows baby milk companies to produce information, but only that which is factual and scientific. It forbids them from seeking direct contact with pregnant women and mothers - as they currently do in many countries.

The Code therefor protects a woman right to make a decision about how to feed her baby, in an environment that is free from commercial pressure and on the basis of full and accurate information. The Code also stresses health workers' responsibilities in encouraging and protecting breastfeeding. Information given by health professionals, and appropriate support for women, particularly from midwives in the early days postnatally, is crucial. That this is not happening in the UK at present is indicated by the results of the most recent national survey which found that, although the majority of women said that they wanted to breastfeed, a large proportion had given up after only 2 weeks. Only 1% of these mothers gave up because they had breastfed for as long as they had wanted to (Foster et al 1997). Therefore many women are not choosing to artificially feed, but instead are doing so by Ôdefault'.

The International Baby Food Action Network (IBFAN), of which Baby Milk Action is a member, is a global network of organisations and individuals - with over 150 groups in over 90 countries.

One of the key aspects of IBFAN's work is ensuring that the Code is translated into enforceable national legislation in as many countries as possible around the world. Governments have a moral obligation to enact this Code in national legislation. In the UK there is a law (The Infant formula and follow-on Regulations 1995), but it is weaker than the code, has a narrower scope and many loopholes. It is disappointing that the law is not stronger, especially since the UK has consistently endorsed the Code since 1981.

There is a group in the UK, the Baby Feeding Law Group, comprising health and consumer bodies, which is working to bring the UK legislation on infant feeding into line with the Code and Resolutions.

Convention on the Rights of the Child

The Convention on the Rights of the Child (CRC) was adopted by the United Nations General Assembly in November 1989, and marks the United Nation's move beyond the basic struggle for child survival to a rights-based approach. The CRC had been ratified by 191 countries including the UK by the end of 1997,and is 'the most universally embraced human rights instrument in history' (UNICEF, 1997).

Article 24 of the CRC states that it is the right of children to 'enjoy the highest attainable standard of health'. Governments who ratified the Convention have a legal obligation to fulfil their commitments regarding the CRC. For example, they should take measures to reduce child morbidity and mortality by ensuring that all sectors of society, particularly parents, 'have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding...' (UN, 1989).

According to UNICEF this means that: 'State Parties are placed under an obligation to ensure that the advantages of breastfeeding are universally understood and to take appropriate measures to achieve this goal. This can only be accomplished if the information reaching the general public, and parents in particular, is factual, objective, and not prepared with a view to persuading mothers to forgo or diminish breastfeeding and use an artificial product in the mistaken belief that it is equivalent to breastfeeding'. (UNICEF, 1998)

Additionally, the CRC Committee, along with UNICEF (UNICEF, 1997), has indicated that the Code should be viewed as a tool that will help governments fulfil their obligations under Article 24 of the CRC. Failure to provide adequate information, while at the same time allowing baby milk companies to distribute misleading information, could be construed as a failure to protect a child's rights to the highest attainable standard of health.

ILO Maternity Protection Convention No. 103

Many employed women around the world are still only entitled to a short period of paid maternity leave. Combined with unfavorable conditions at the workplace, this makes breastfeeding very difficult. Working women need paid maternity leave during the recommended 6 month period of exclusive breastfeeding. Once back at work they need adequate facilities for breastfeeding or expressing milk and paid Ônursing breaks' in order to continue breastfeeding.

In the UK, 19% of women surveyed (Foster et al 1997) stated that returning to work was a reason for stopping breastfeeding before their babies reached the age of three months, despite recommendations that babies should be exclusively breastfed for about six months.

In 1999, the International Labour Office (ILO) began a two-year process of revising its 1952 Maternity Protection Convention 103. Breastfeeding advocacy groups such as IBFAN and WABA lobbied for new standards which would enable a woman's right to breastfeed to be fulfilled. In June this year, a new Convention (that supersedes Convention 103) was adopted, which has provisions for 14 weeks statutory maternity leave, an increase from 12 weeks, and provisions necessitating adequate nursing breaks that will allow women to continue breastfeeding after their return to work. Although lobby groups had hoped for 26 weeks maternity leave, the new Convention is a welcome improvement on the previous one.

What is the midwives' role in this?

Midwives are in a prime position to safeguard a mother's right to breastfeed. Although at first glance the instruments mentioned in this article may seem of little relevance to midwives, they are actually working documents which have important implications for everyday practice. There are numerous actions which can be taken at various levels, from grassroots to policy making, to help bring these documents to life.

• As an individual, try to adopt work practices which are in line with the legal and moral obligations of the above instruments, in order to give mothers in your care the rights to which she is entitled.
  
  
• Find out more about the Baby Friendly Initiative in the UK and encourage your workplace to work towards Baby Friendly status.
  
  
• Join your national IBFAN group and find out more about the Code and how to report activities which undermine breastfeeding to the appropriate authorities.
  
  
• Campaign for facilities and paid time for breastfeeding or expressing milk in your workplace.
  
  
• Contact Yvette Cooper, Minister for Public Health, at the Department of Health, and ask what progress the Government is making in implementing the Code.
  
  
• Contact the Minister for Public Health and call for WBW to be celebrated in the UK.

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Conclusion

Every woman has the right to decide how she feeds her child, and midwives have a crucial role to play in enabling and supporting women in their chosen method of infant feeding. Breastfeeding is a right of mothers and is a fundamental component in assuring a child's right to food, health and care. Many international instruments exist which, if implemented would help secure this woman's right.

Useful information

UK IBFAN group:

Baby Milk Action, 23 St Andrew's Street, Cambridge, CB2 3AX Tel: 01223 464420
Email: info@babymilkaction.org

More information (including a copy of the 2000 WABA information leaflet on "Breastfeeding - it's your right!" - £1, and the WHO/UNICEF Code - £2.50) is available from: Baby Milk Action

WABA: email: secr@waba.po.my Website: http://www.waba.org.br

CRC NGO Liaison Office: email: dci-ngo.group@pingnet.ch

ILO (Conditions of Work Branch): email: dy@ilo.org Website: http://www.ilo.org

BFI: email: bfi@unicef.org.uk Website: http://www.babyfriendly.org.uk

References

Amin S (1995) Nurturing the Future: our first five years. WABA: Penang.

Foster K, Lader D, Cheesebrough S (1997) Infant Feeding 1995. Office of national Surveys: London.

Lhotska L, Armstrong H (1999) UNICEF's Recommended Length of Exclusive Breastfeeding. UNICEF, WABALINK 20/INSERT 3.

UN (1989) Convention on the Rights of the Child. UN: Geneva

UNICEF (1997) State of the World's Children 1997. Oxford University press: New York.

UNICEF (1997) UNICEF Responds to report on violations of breast-milk substitute Code. Press Release January 14th 1997

UNICEF (1998) Progress Report on the Baby Friendly Initiative. UNICEF: New York.

WHO (1981) WHO/UNICEF International Code of Marketing of Breast-milk Substitutes, WHO: Geneva