Hi Lactnetters I have been watching lactnet for few weeks now, finding it a very intersting forum. I have recogized the names of a number of the women I have long held in high esteem by virtue of their work. (I was especially delighted to see that Dianne has been granted verb status!) I have noticed many similarites and some significant differences between the practices common to IBCLC's in Australia and those common in other places. Interestingly, 'listening' to those of you from north America has really helped me to understand and empathize with the concerns of my friend who has just had her first baby and, inspite of all her predictions is exclusively breast milk feeding. She is american and I have been able to put her extensive use of the pump and her reluctance to feed at the breast in public into a cultural context. Mothers in Australia generally only express if they must but I can see the time coming when the 'musts' will become more common - our new industrial relations laws have deregulated the labour market such that there is no longer any real protection of maternity leave. (And they call it "Work Choices" - don't get me started!)All that pumping just seems to me to make breastfeeding hard work. I am a breastfeeding counsellor with an organization that has many similarities to La Leche League. We are almost entirely made up of voluteers as our Code of Ethics precludes us from accepting renumeration for our counselling services. My first degrees were in arts and education and from there I have moved into graduate work in Applied Philosophy (Ethics). Last month, I wrote a proposal for a Doctoral project that examines the intersection between the promotion of breast milk substitutes, health promotion messages around breastfeeding and the ethics of advertising. I have supervisors lining up but I am still waiting for the administrative wheels to grind. I have a bit of a 'thing' about the WHO Code and am looking forward to speaking to the volunteers in our state about what has happened in Australia in the 25 years since the WHA delivered it. (It'll be a real short talk!) I had planned to 'lurk' for a bit longer but your discussion on ethics, advertising and health promotion has flushed me out. I am fascinated by the relationships between professionals, employers, clients and the wider society. So many of you seem to have really curly ethical situations to negotiate every day. I imagine that must be exhausting when all you really want to do is help mothers to do what they already really want to do and what should be a normal part of motherhood. In regard to the discussions about freebies offered to mothers in hospitals and at antenal breastfeeding classes, I would like to contribute the following and hope it will add to the debate. A professional's (and I asume we all agree that IBCLCs are professionals) obligations are primarily to her clients and to the society that bestows the status of professional upon her. Many professionals will also have contractual obligations (to employers often) but her primary obligations lie elsewhere. When professional and contractual obligations come into conflict, professional obligations should always win. We cannot contract out of our professional obligations. In a society where pharmaceutical companies advertise directly to consumers, anytime a connection is made between a health professional and a product, the consumer will see it as an endorsement. This relates to the question of antenatal gift packs I think. Since we all agree that 1)widespread artifical feeding does not serve our societies and 2) higher formula sales = lower breastfeeding rates (both in terms exclusivity and duration) LCs should not be seen to be associated with artificial infant feeding products. On a practical note, a glance the history if this practice reveals that ABM manufacturers used to dress their sales reps in nurses' uniforms and encourage mothers to visit them. The nurse's uniform gave the product a legitimacy it would not otherwise have had. The current practice of encouraging retailers to use LCs to give breastfeeding seminars is much the same. The LC, often unwittingly, legitimates the ABM prduct or brand just by her perceived association with it. I would suggest approaching the retailer with something like, 'I have a problem with my professional Code of Ethics. It says I can't be seen to endorse the brands or products of Who Code ABM manufacturers. What can we do to make this right?' Retailers often don't understand the issues and when they do they find they can be supportive - maybe by offering other kinds of gifts. As for the discussion about gift packs in hospitals - no brainer - if a mother is given one of these by a health professional, she will assume it is at least safe to use and probably that it is good for her baby - even healthy. This is what the companies that provide them know to be the case. That is why they spend so much on them and will fight (dirty!) to protect that avenue. (I have been reading about private investigators tailing vocal breastfeeding advocates in the early years of the Nestle boycott!!) I have to agree with Naomi and Rachel. This is unethical medical practice. I am not an IBCLC or a registered health professional but if I were I would be asking my registering body to lobby hospitals and goverments on my behalf. In the case of the IBLCE, since the Board has determined that it will not sanction members who find themselves in this employment situation, I would want the Board to be telling them that this common hospital practice is making it impossible for its members to practise in hosptitals and remain inside the parameters of ethical practice. The arguments about choice are red herrings. If people want to engage in arguments about choice, steer towards informed choice and suggest warning labels like those included on other pharmacological interventions and risky products. The arguments about free market economies are equally spurious. Regulation is required in the health sector because its consumers are vulnerable - because they are often unwell and because it is difficult to be adequately informed without the instruction of a health professional or an appropriate education. Lastly I think we should also bear in mind that ABM is a pharmacological intervention. The onus is on those who propose it to demonstrate its necessity, safety and efficacy. I haven't seen this done yet. Have you? Nina Berry Australia *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html