Promoting Breastfeeding and Interaction of Pediatric Associations With Providers of Nutritional Products

Abstract

Pediatric associations have been urged not to interact with and not to accept support from commercial providers of breast milk substitutes (BMSs), based on the assumption that such interaction would lead to diminished promotion and support of breastfeeding. The leadership of seven European pediatric learned societies reviewed the issue and share their position and policy conclusions here. We consider breastfeeding as the best way of infant feeding and strongly encourage its active promotion, protection, and support. We support the World Health Organization (WHO) Code of Marketing of BMSs. Infant formula and follow-on formula for older infants should not be advertised to families or the public, to avoid undermining breastfeeding. With consistently restricted marketing of BMSs, families need counseling on infant feeding choices by well-informed pediatricians. Current and trustworthy information is shared through congresses and other medical education directed and supervised by independent pediatric organizations or public bodies. Financial support from commercial organizations for congresses, educational, and scientific activities of pediatric organizations is an acceptable option if scientific, ethical, societal, and legal standards are followed; any influence of commercial organizations on the program is excluded, and transparency is ensured. Public–private research collaborations for improving and evaluating pharmaceuticals, vaccines, medical devices, dietetic products, and other products and services for children are actively encouraged, provided they are guided by the goal of enhancing child health and are performed following established high standards. We support increasing investment of public funding for research aiming at promoting child health, as well as for medical education.

Global evidence of persistent violations of the International Code of Marketing of Breast‐milk Substitutes: A systematic scoping review

“…A person's understanding or perception of the products and the marketing may be as important as its occurrence and warrants review. Mothers (and other caregivers) have indicated confusion between BMS products being marketed (Barennes et al, 2008; Berry et al, 2010; Cattaneo et al, 2015) and health service and BMS industry interactions may be so normalized that the effect is not recognized (Bognar et al, 2020). It would be valuable to also collate the global research evidence on the effect of inappropriate marketing on family and national economics and environmental impact (Dadhich et al, 2021; Long et al, 2021; Smith, 2015; Walters et al, 2019) towards building the knowledge and developing coordinated multi‐faceted solutions.…”

“…Donations or low‐cost supplies of BMS to health services and in emergency situations, donated equipment to health care facilities, financial support for conferences, provision of education sessions, and other incentives are also prohibited, as these can all serve to build goodwill within the health system and with the public, increase the use and potentially expand the market of the products, while also creating conflicts of interest. Despite assertions by the industry that BMS companies are compliant with the Code (Nestlé, 2018) and commentary that marketing does not influence feeding practices (Bognar et al, 2020; Forsyth, 2013), numerous recent studies indicate that promotion through advertisement, gifts, sponsorship, cross‐promotion, and inappropriate labeling remains a problem with negative effects on infant feeding attitudes and behaviors (Berry et al, 2010; Boyle & Shamji, 2021; Ching et al, 2021; Hastings et al, 2020; Save the Children, 2018).…”

Allergy societies and the formula industry

“…However, the movement has not yet gained traction beyond the UK. For example, a large group of European paediatric societies made a public, formal decision to continue to accept sponsorship from formula companies last year, in defiance of WHO guidance 9 …”

Latin American Considerations for Infant and Young Child Formulae

“…The global paediatric community is a strong supporter of the International Code of Marketing of Breastmilk Substitutes ("Code of Marketing") and its goals to eliminate improper practices of marketing of BMS that may undermine breastfeeding [32,33]. Many paediatric organisations support that no direct marketing to consumers should occur for infant formula and for follow-up formula for older infants, which are generally presented with similar brand names and design as infant formulae, because improper marketing may mislead families to perceive formula feeding as equivalent to breastfeeding and hence may undermine breastfeeding [34]. Similarly, paediatric organisations oppose marketing to consumers for formula for special medical purposes for infants (e.g., special formula for treating cow's milk allergy, for preterm babies, etc.)…”