The Code addresses how certain products may be marketed.  The Code does not
say that a mother who decides to breastfeed is a better mother than a mother
who decides to pump or that children of mothers who can't face
breastfeeding, don't deserve their mothers' milk.  The Code has Nothing To
Do With That.
  
I'm not sure anyone says that, actually.  I know that when I meet a woman
who states that she plans to feed expressed breastmilk, (and it has
happened, though not often and they are usually reverse migrants who have
come home again from the US, go figure) I give her all the information at my
disposal on how to do that as cheaply and simply as possible because it
means her baby is likely to get her milk for longer.  I also know that if
she perceives me passing judgment on her, there is a danger that her
negative reaction to that, will be transferred to the whole question of what
to feed the baby.

Unless a mother states an intention to practice some kind of care that is in
conflict with existing laws here, I strive to remain non-judgmental because
of course I assume that she has her reasons for her decision. There is a
much better chance of her teaching me something by sharing those reasons if
I show her that I respect her and take her seriously.  I work in the public
sector, which is the only provider of maternity care, and in my role as a
staff midwife and public employee I have a duty to provide care to every
woman who needs it in our area.  In my role as a member of the mother to
mother breastfeeding organization it is different, because we only come into
contact with women who seek us out.  Hard for me to separate the roles
sometimes, because they do overlap, so I go with respecting women as the
bottom line, always. 

Where I live there is exactly one option for rental pumps and I refer
mothers to that business every single week, though with little joy.  I have
no financial relationship to the business whatsoever.  They happen to carry
one brand of pump, a brand that makes perfectly acceptable products, and the
business deals with technical problems with the products quickly and
satisfactorily.  The company is not compliant with the WHO Code at present.
I am dealing with that with the company directly but I don't have the option
of telling a mother who in fact needs a reliable pump that she should not
get one because of my beef with the company's marketing.   
Besides, the personal pump that is most sold here is made by another
well-known Code violator, so telling mothers to avoid patronizing one Code
violator in favor of another seems a bit meaningless.
For that matter, when we use breastmilk substitute at work, it invariably
comes from a prime Code violator.  Do I tell the mother her baby must starve
because we only have the wrong brand of formula?  Of course not.  Do we have
the package on display on the ward, or describe it by brand name when
discussing it with parents?  Again, no.  But it makes me no less persistent
in my opposition to the company's marketing policies.

The real sticky situation arises when an LC is forced by the structures in
the system in which she operates, to have a potential conflict of interest
every time a woman needs equipment.  I'm eternally grateful that I do not
have to assure any woman that my recommendation that she consider a pump, or
some other product that costs her money, is based on my opinion that the
equipment would be beneficial to her, and not on my need to break even which
is impossible based on consultation fees alone.  I have the greatest respect
and sympathy for those of you who face this every day in your work.

So, while we are in some cases forced to use products from companies we'd
rather not patronize, we must separate the needs of an individual woman here
and now from the need we have as a group to work to see to it that Code
compliance becomes the norm.  I would argue that we as a group have an
obligation not to become dependent on the good graces of any company, ever,
because management and marketing strategies can change and suddenly you are
in bed with someone you never meant to be.  It is entirely possible to have
a strictly business relationship to the supplier without needing to feel
affection for whoever their agents are, and in my experience it makes it
easier to see all the trees, as well as the tangled underbrush that is so
easy to stumble over, in the forest.

Rachel Myr
Kristiansand, Norway

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