Another important aspect of the Code is that it has an international scope; it paints with a very broad brush.  In 3rd world coutries, is there sanitary water for cleaning pumps or bottles; if breastfeeding is not managed well while the baby is learning, will there be sanitary water (and means) for ABM?  Since the rhetorical answer is "probably not," I can't quite envision how the international code can be updated and still paint with the same broad brush.
Pamela wrote, "Where is the evidence to show that the use of bottles and teats to feed babies breastmilk really undermines breastfeeding? Is it the use of bottles and teats per se, or is it the contents of the bottles that cause the major negative effects on the health and well-being of babies and the adults they will become?"  I can't numerate how many babies I have seen, whose mothers come to me having already heard, "Your baby has nipple confusion because you've used a bottle."  Upon my assessment, most of these babes have a disorganized or dysfunctional suck, often significant oral weakness, most certainly NOT caused by the introduction of a bottle.  I applaud these mothers for feeding their babies while seeking additional help.  They already feel so guilty, and then to be accused that they were the cause... that's not okay.  Having worked side by side with an SLP for years now, I think that when a bottle nipple is necessary, it can be chosen to approximate a similar placement with breastfeeding.  Yes, a poor nipple choice can cause problems, but we're painting with a broad brush again.  I guess this comes full circle back to the Code and marketing; when companies claim their bottle is most like breastfeeding, or most trusted in  hospitals, it does not take into account the individuality of the baby's suck and can be detrimental to breastfeeding.  

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