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

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