This month, the World Health Assembly meeting in Geneva will vote on a proposed code to regulate the marketing of breast milk substitutes, worldwide.
The Post in its April 23 editorial ["Formual for Trouble"] concedes that "the proposed code, sanctioning interference in the domestic marketplace to restrict the promotion of a legal product, cuts across the grain of a free-enterprise society." For those who oppose it, the code goes far beyond: It arbitrarily restrains and prohibits legitimate commercial activities in clear violation of U.S. constitutional protection of freedom of expression and freedom of association.
Although the code's proponents argue that the anti-formula campaign is a "health issue," the medical premise underlying the code is fundamentally faulty. This premise has been nurtured by critics such as Dr. Derrick Jelliffe for UCLA, who is quoted by the activist group INFACT in its fund-raising letter: "Ten million Third World babies are starving because of the heartless, money-hungry actions of powerful multinational corporations."
Yet Newsweek, on Oct. 22, 1979, reported that Jelliffe "acknowledged that the number is a 'symbolic figure' that he customarily uses to underline what a huge problem malnutrition and disease represents."
The Post editorial makes a number of unfounded assumptions. The most important of these is that breast-feeding can be promoted by imposing severe restrictions on the marketing of infant formula. There is no sound evidence that infant formula marketing practices are causally related to mothers' decisions concerning breast-feeding. In the United States, where the infant formula market is well developed and highly competitive, breast-feeding has increased dramatically during the past decade. Of greater importance, the World Health Organization's own 1975-1977 study on breast-feeding involving interviews with nearly 23,000 mothers in nine diverse countries -- both developing and developed countries -- failed to show any causative relationship between commercial factors and breast-feeding decisions. In response to open-ended questioning about why mothers did not breast-feed or stopped breast-feeding, the study reported that insufficient milk, maternal illness, infant illness and a new pregnancy were mentioned frequently. Not once was any commercial factor mentioned. It is important to note that the WHO study was probably the most massive study of breat-feeding practices ever conducted.
The problems contributing to infant malnutrition and disease in the Third World are profound and cannot be dismissed by ascribing them to infant formula: poverty, pollution, poor sanitation and illiteracy will not be removed with a code. As The Wall Street Journal noted: "The critics fail to mention that the same contamined water that they fear gets mixed with formula was always mixed with traditional native weaning foods."
There are still those who believe that the infant formula companies should support the code if they care about babies' lives. The leading activist groups INFACT and the Interfaith Center for Corporate Responsibility, call the infant formula manufacturers "baby killers" and accuse them of having, by virtue of their opposition to the code, "declared war on babies."
In the context, it is essential to remind ourselves that infant formula is life-sustaining food. All agree that breast milk is preferred, but as the Committee on Nutrition of the American Academy of Pediatrics states: "When breast-feeding is unsuccessful, inappropriate or stopped early, infant formulas provide the best alternative for meeting nutritional needs during the first year."
Still the question persists: Why not support the code? Isn't the anti-formula campaign "in essance a health issue" to protect infants in the Third World, as The Post says? For anyone willing to read the fine print, there is substantial evidence to the contrary.
Article 5.1 of the code, for example, would prohibit any and all advertising and promotion to the public, regardless of its informational, educational or economic merit. Article 5.3 prohibits worldwide merit. Article 5.3 prohibits worldwide all "point of sale advertising -- special displays, discount coupons, premiums, special sales" at local supermarkets. Another provision of this code would prohibit sales incentive compensation, sales goals and bonuses related to sales for employes. Another would prohibit providing samples to doctors and prohibit doctors and hospitals from providing samples to the patients.
How can one really relate these sweeping prohibitions to polluted water in the Third World? For those who are skeptical about the intended scope of the code, it should be noted that proponents of the code very clearly state that this code should apply to the United States. tShould the code be adopted, it would take the form of an official recommendation of the World Health Assembly to every one of the 155 member countries as a "minimum requirement" and one to be implemented "in the entirety" in the form of "legislation, regulations or other suitable measures."
We recognize, of course that there are areas of many less developed countries in which poverty, poor sanitation, illiteracy and insufficient access to health care and advice introduce certain health risks. It is readily accepted the breast-feeding should be particularly encouraged in such areas. In this respect, our formal policy is designed to avoid discouragement of breast-feeding while encouraging the safe and appropriate use of our infant formulas. We carefully monitor the observance of these policies, and where violations have been found -- however small -- they have been swiftly corrected.
The WHO's proposed code contains, many unwanted restrictions and prohibitions that are unconstitutional, and it represents a dangerous precedent. Such arbitrary and supra-national attempts to regulate commence will be dignified and encouraged unless concerned individual and governments voice their objections now.
We believe that the United States should vote "no" on the proposed code.