Jan - thanks for posting your take on the loss of David Clarke's position
as legal advisor on Code matters at UNICEF. I'm worried that you're not
worried. When I was in Penang recently I saw a draft letter that IBFAN
were considering sending to UNICEF expressing their concern and
disappointment, and perhaps you'd let us know whether the letter was
sent. Lactnetters would probably be reassured to see that IBFAN are doing
what they can to support the supporters of breastfeeding within UNICEF.
Personally I am not reassured by the ambiguous language employed by an
international agency which asserts that it is "increasing success in the
community by providing support for each new mother to make the best choices
in feeding her children". The meaning of this double-speak becomes clearer
when we realize that in the last eight years, since 1997, UNICEF has been
steadily withdrawing support for breastfeeding-related activities (the
Code, the goals of Innocenti, BFHI) and simultaneously directing its
funding, its attention and its language towards supporting and endorsing
"infant feeding" activities (HIV and Infant Feeding, Infant Feeding in
Emergencies, the Global Strategy on Infant and Young Child Feeding, a
Framework for Priority Action on HIV and Infant Feeding). A close scrutiny
of international policy documents will reveal that the language is
carefully chosen. "Infant feeding" does not always mean an inclusive
adjective-noun couplet embracing breastfeeding *and* formula feeding (now
called "replacement feeding" which sounds softer), but in some instances
"infant feeding" is also used instead of "not breastfeeding" but it has
such an innocuous ring to it that we may miss what is happening - as is no
doubt intended. As a small example, here are the current recommendations
on HIV and infant feeding:
"When replacement feeding is acceptable, feasible, affordable, sustainable
and safe, avoidance of all breastfeeding by HIV-positive mothers is
recommended."
"To minimize HIV transmission risk, breastfeeding should be discontinued as
soon as feasible ..."
"When HIV-positive mothers choose not to breastfeeding from birth, or stop
breastfeeding later, they should be provided with specific guidance and
support for at least the first 2 years of the child's life to ensure
adequate replacement feeding. Programmes should strive to improve
conditions that will make replacement feeding safer for HIV-positive mohers."
"HIV-positive mothers who breastfeed should be provided with specific
guidance and support when they cease breastfeeding ...."
"Whatever a mother decides, she should be supported in her choice."
"Assessments should be conducted locally to identify the range of feeding
options that are acceptable, feasible, affordable, sustainable and safe in
a particular context....
The following feeding options [are] currently recommended for infant
feeding by HIV-positive women ...
commercial infant formula
home-modified animal milk
exclusive breastfeeding
early breastfeeding cessation
wet-nursing by an HIV- woman
Expressing and heat-treating beast milk."
Note that five out of six of these options involve the mother abandoning
breastfeeding. In addition, current stress on promotion of maternal
infant-feeding choice provides a couple of comfortable loopholes for
national healthcare systems and international healthcare agencies to
snuggle into - 1) placing the infant feeding decision squarely on the
mother's shoulders absolves policy-makers (and through them, healthcare
workers) from any kind of responsibility or accountability for the health
consequences to the baby - particularly if the choice proves to be a poor
one and the baby becomes sick or dies, because after all, it was the mother
herself who made the choice - and 2) *not* legislating, implementing,
monitoring or enforcing the Code in many ways gives the mother *more* of a
choice, notwithstanding that both maternal choice *and* the right to trade
are in fact seriously interfering with infants' rights to the highest
attainable standard of health.
It's interesting to see that UNICEF is sending out a standardised reply to
queries about the loss of .David Clarke's post. Their plan is to
decentralize provision of legal assistance by developing a roster of
regional and global individuals able to provide legal "support", and leave
it up to country offices to gather expertise from local NGOs. Note,
however, that while support for implementation of the Code has been further
eroded, it is once again HIV (the new growth industry) which is receiving
the most attention:
>The organization is now dedicating
>significantly more attention and resources to nutrition for mothers and
>children and we are broadening our action on infant and young child feeding
>to include stronger and more comprehensive programmes around critical
>issues such as breastfeeding in emergencies and the feeding of children
>whose mothers are affected by HIV/AIDS. This is a positive trend and we
>expect it to continue.
Significantly more nutrition for mothers and children?? Now what does
*that* mean, I wonder ???? Does it mean more food supplements, vitamin
supplements, more free formula, the kind of packaged food like Plumpy-nut
distributed to the starving babies in Niger, involving more public-private
partnerships? Time will tell, but I am not optimistic. We have it on good
authority that malnutrition contributes to the death of millions of the
world's under-Fives. And that breastfeeding could go a long way
to reducing 60% of those deaths, comprising the single most effective
preventive tool. While pediatric HIV accounts for only 4% (of which
probably 1.3% occurs as a result of mixed breastfeeding, and approx 0.2%
would result from exclusive breastfeeding for even 3 months ...20 years
into the pandemic the research has yet to be done to show the numbers for
exclusive breastfeeding for six full months.....) Why then not provide
more resources to help more mothers breastfeed, more exclusively in the
first six months, and for a longer duration into young childhood??
Pamela Morrison IBCLC
Rustington, England
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------------------------
From: Jan Cornfoot <[log in to unmask]>
Subject: UNICEF & the WHO Code
Personally, I question the value of campaigns that rely on form letters and
information that appears sensational and short on facts.
Inundating UNICEF with accusations that they have withdrawn support for the
WHO Code *could* be quite wrong. (For WBW Anne Veneman said: >>
"UNICEF strives to create an environment that enables the best choices
in infant and young child feeding practices by supporting the breastfeeding
and complementary feeding efforts of partner countries and our NGO
colleagues at three levels: improving national regulation and oversight,
enhancing the knowledge and skills of health personnel, and increasing
success in the community by providing support for each new mother to make
the best choices in feeding her children".
They are dismantling/restructuring the position of the legal advisor based
in NY, but what else do we really know for fact?
Jan Cornfoot
Breastfeeding Advocate
IBFAN representative in Australia
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