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
[log in to unmask]
------------------------
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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