One can continue to support the WHO Code, while recognizing that "today's"
world is different from the one we had in 1981 when it was written.

The Code is designed to curb the marketing of four product-types to the
general population.  Formula, bottles, teats, and foods to be "pushed" on
infants are NOT to be aggressively marketed directly to mothers.

Pumps are not now, and never were, one of the four product-types covered by
the WHO Code.  Which begs the question: why in the world would a pump
manufacturer risk the good will it enjoyed with mothers and the lactation
community, *just* to be able to push bottles-and-teats in its marketing
campaigns?  It was the marketing of those dang bottles that got them in
Code-hot-water .... not their pumps.  They had happily *sold* those
bottles-and-teats in a Code-compliant fashion for years.  Why did they feel
compelled to change?  But it doesn't really matter.  We can still, as
IBCLCs, continue to assist mothers who must use pumps (and -- gasp! --
bottles and teats) as they care for their individual newborns.  Because we
work one-on-one with dyads ... just as the Code envisioned.

There are many other "tensions" of which we IBCLCs must be cognizant.  Our
IBLCE Code of Ethics discusses avoiding real or imagined conflicts of
interest when we must discuss the use of equipment with mothers.  So
discussing the use of pumps -- even by companies that market in a
Code-compliant fashion -- is still territory to tread carefully.  Our
professional associations are also thinking about this:  IBLCE will soon
*not* approve CERPs provided by *any* manufacturer of durable medical
equipment -- and that means by any pump manufacturer, ven those who have
always been Code-compliant.   The JAMA editorial of April 1 2009 discusses a
"zero dollar tolerance"  for professional associations of health care
workers, in their collaborations with pharmaceutical and durable medical
equipment manufacturers.

Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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