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LACTNET  July 1998, Week 5

LACTNET July 1998, Week 5

Subject:

Re: BMJ articles

From:

Roni Chastain <[log in to unmask]>

Reply-To:

Lactation Information and Discussion <[log in to unmask]>

Date:

Fri, 31 Jul 1998 07:59:05 EDT

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (292 lines)

Just received the new articles in BMJ and thought you would find this
interesting. Sorry it is so long.
Roni M. Chastain RN, LCCE, FACCE
Glen Cove, New York

News
UN amends policy on breast
feeding
Scott Gottlieb, New York
After decades of promoting breast feeding for infant
nutrition, the United Nations has issued recommendations intended to
discourage women infected
with HIV from breast feeding.
The UN directive advises that all HIV infected women should be informed of the
risks of breast
feeding before they decide whether to breast feed. The step is aimed at
preventing transmission of
HIV from mothers to babies in developing countries.
The guidelines were the result of several years of internal debate inside the
United Nations and, even
now, are the cause of dispute within the agency. UN officials said that they
were reluctant to issue a
blanket warning because the decision should be left to each mother and because
no simple message
could encompass the diversity of environments where women live.
In some cultures women may become stigmatised for not breast feeding, and the
safety of
alternatives such as formula feed varies within each country. In addition, UN
officials were concerned
that they would be sending out a double message--telling some women that
breast feeding is best for
their babies but telling others that it could kill their babies. The result
could be to discourage all
women from breast feeding.
In its directive, the United Nations said it decided to issue the warnings,
despite these worries,
because of soaring HIV infection rates in much of the world. In 13 countries
in sub-Saharan Africa,
at least 10% of all adults are infected with HIV, with a prevalence of 35% or
more in many capital
cities (4 July, p 11).
Dr Susan Holck, an expert on breast feeding at the World Health Organisation,
said that many
experts are also concerned that the directive could trigger a repeat of
decades past, when
international corporations promoted formula feed, and many babies died when it
was mixed under
insanitary conditions.
Last year, of the 600000 children in the world who became infected with HIV,
up to a third were
infected through breast feeding.


BMJ 1998;317:350 ( 1 August )

Letters
Marketing of breast milk substitutes
    Infant food manufacturers hope code will be implemented
properly
    Italy has initiatives regarding compliance with international
code
    Manufacturers have sponsored healthcare journals
Infant food manufacturers hope code will be implemented properly
EDITORIt is disappointing that the BMJ should give such prominence to Taylor's
paper1 as it is
based on a report of the Interagency Group on Breastfeeding Monitoring that
was first published
15 months ago. The paper is no more than a reworked presentation of less than
30% of the original
document, some of which had already been reported in the journal.2
The timing is also disappointing in view of the announcement by the World
Health Organisation in
January 1998 that it is to hold consultations on infant feeding, including an
initiative to identify,
examine, and overcome the main obstacles to implementing the international
code of marketing of
breast milk substitutes in all countries. The infant food industry is happy to
work with the WHO and
others, but in the past the Interagency Group on Breastfeeding Monitoring has
refused to meet with
us and has repeatedly refused to provide the information that would allow
companies to investigate
the alleged contraventions.
Taylor concludes that the survey methods used in this study were successful in
detecting violations of
the international code and recommends that the methodology should be used in
future monitoring.
Yet the protocol, results, and conclusions have been severely criticised for
using arbitrary definitions
(J Rey, personal communication) and flawed methodology.3 We also take issue
with many of the
alleged violations that relate to foods not covered by the code, such as
follow-on formulas (weaning
milks) and weaning foods. Local regulations and codes are also ignored, even
though the code states
that countries should develop their own controls as appropriate to their own
requirements.
In its January 1998 report to its executive board the WHO "urges that national
measures adopted to
give effect to the International Code include: clear definitions, which are
communicated to and
understood by all parties; transparent monitoring and reporting procedures to
determine whether
alleged violations contravene national measures; and a monitoring authority
established under
government responsibility." The infant food industry fully supports this
recommendation and the
current consultation process, which we trust will lead to proper
implementation of the code by all
countries, with effective, transparent and impartial monitoring of the code
under government
supervision.
Sarah Jacobs, Executive secretary.
Infant and Dietetic Foods Association, London WC2B 5JJ
Andrée Bronner, Secretary general.
International Association of Infant Food Manufacturers, 75001 Paris, France


Taylor A. Violations of the international code of marketing of breast milk
substitutes:
prevalence in four countries. BMJ 1998; 316: 1117-1119[Abstract/Full Text].
(11 April.)

Wise J. Baby milk companies accused of breaching marketing code. BMJ 1997;
314: 167
[Medline]

Rothman J. Monitoring, compliance and surveys. Marketing and Research Today
1998 May.


Italy has initiatives regarding compliance with international code
EDITORManufacturers of infant food violate the international code for the
marketing of breast milk
substitutes in many countries. 1 2 The code is meant to regulate the practices
of governments and
companies, but disciplines also the behaviour of health workers. Under article
7, companies should
not offer "financial or material inducements to promote products" and health
workers should not
accept such inducements, and this statement was reinforced by the World Health
Assembly in 1996.
Italy has a law based on the International Code and European Union directives.
The prevalence of
breast feeding, not well defined and probably including any breast feeding,
was about 67% at
1 month and 31% at 6 months of age in 1994,3 well below the WHO
recommendations for
exclusive breast feeding. At discharge from hospital, 68% of mothers are given
free samples of
formula.
A large survey, Paediatric Education Breastfeeding Research (funded by the
European Union in
1995 to assess knowledge, attitudes, and practices of paediatricians on breast
feeding), included in
its long questionnaire this item: "Do you think it is correct for
paediatricians to accept financial
support from companies for research or clinical activities?" A total of
842 questionnaires were given
out in 1996 at the annual congress of the Società Italiana di Pediatria. We
received 406 completed
questionnaires (48%); 319 responders (38%) answered that question. The table
shows the results.

View this table:
[in this window]
[in a new window]

Opinion of Italian paediatricians about financial support from baby food
companies
This represents the opinion of paediatricians who attend an annual congress,
answer questionnaires,
are interested in breast feeding, and know that there is an international
code. In addition, the question
(which we were not allowed to modify, as it was part of a multinational study)
addressed only
financial support for research or clinical activities; other types of
financial support, such as
participation in congresses, were not included. About two thirds of the
responders were hospital
paediatricians; they may be more likely than community paediatricians to know
the code as the law
has applied mostly in hospitals since 1995. The real level of awareness about
the code and the
attitude towards financial support from companies may be worse among
paediatricians. To tackle
this problem, the Associazione Culturale Pediatri, another association of
paediatricians, is developing
an internal code that will regulate the relation of individual associates and
groups who apply for or are
offered financial support from companies. The association will also update
annually a list of
companies with documented violations of the international code.
Susanna Centuori, Research fellow.
Adriano Cattaneo, Epidemiologist.
Riccardo Davanzo, Neonatologist.
Tea Burmaz, Research student.
Menuela Del Santo, Resident in paediatrics.
Unit for Health Services Research and International Cooperation, Istituto per
l'Infanzia, Via dell'Istria 65/1,
34100 Trieste, Italy

We thank Luis Ruiz, co-ordinator of PEBR, for the permission to publish these
preliminary results.


Taylor A. Violations of the international code of marketing of breast milk
substitutes:
prevalence in four countries. BMJ 1998; 316: 1117-1119[Abstract/Full Text].
(11 April.)

Costello A, Sachdev HS. Protecting breast feeding from breast milk
substitutes: the WHO
code is widely violated and needs monitoring and supporting. BMJ 1998; 316:
1103-1104
[Full Text].

Conti Nibali S, Castorina N, Pizzimenti G, Salomone L, Siracusano MF. La
pratica
dell'allattamento al seno in Italia. Medico e Bambino 1998; 17(1): 25-29.


Manufacturers have sponsored healthcare journals
EDITORBreast milk substitutes remain a major cause of childhood morbidity and
mortality in both
low and high income countries. 1 2 As Taylor points out,3 widespread breaching
of the international
code of marketing breast milk substitutes4 has prompted cautions about covert
endorsements by
healthcare professionals of such products.5 We are therefore concerned that
sponsorship of a recent
index supplement for the 1997 volume of the British Journal of Midwifery by a
company that
manufactures breast milk substitutes could be misconstrued as an overt
endorsement of such
products by healthcare organisations. This practice may in the long term be
counterproductive for
health education on breast feeding.
Maxwell Asante, Senior registrar.
Mayday University Hospital, Thornton Heath, Surrey CR7 7YE
Kathleen Asante, Midwife.
University Hospital of Lewisham, London SE13 6LH


Golding J, Emmett P, Rogers I. Breast feeding and infant mortality. Early
Human
Development 1997; 49(suppl): S143-S155[Medline].

Wilson A, Forsyth J, Greene S, Irvine L, Hau C, Howie P. Relationship of
infant diet to
childhood health: seven year follow up of cohort of children in Dundee infant
feeding study.
BMJ 1998; 316: 21-25[Abstract/Full Text]. (3 January.)

Taylor A. Monitoring the international code of marketing of breast milk
substitutes: an
epidemiological study in four countries. BMJ 1998; 316:
1117-1122[Abstract/Full Text].
(11 April.)

WHO. International code of marketing breast milk substitutes. Geneva: WHO ,
1981.

Costello A, Sachdev H. Protecting breast feeding from breast milk substitutes.
BMJ 1998;
316: 1103[Full Text]. (11 April.)

© British Medical Journal 1998
Send a response to this article
Other related articles in BMJ
PubMed citation
Related articles in PubMed
Download to Citation Manager
Search Medline for articles by:
 Jacobs, S. || Asante, K.
Alert me when:
 New articles cite this article

Other related articles in BMJ:
PAPERS
Relation of infant diet to childhood health: seven year follow
up of cohort of children in Dundee infant feeding study.
Andrea C Wilson, J Stewart Forsyth, Stephen A Greene,
Linda Irvine, Catherine Hau, and Peter W Howie
BMJ 1998 316: 21-25. [Abstract] [Full text]
PAPERS
Violations of the international code of marketing of breast milk substitutes:
prevalence in
four countries.
Anna Taylor
BMJ 1998 316: 1117-1122. [Abstract] [Full text]

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July 2007, Week 1
June 2007, Week 5
June 2007, Week 4
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June 2007, Week 1
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April 2007, Week 5
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April 2007, Week 1
March 2007, Week 5
March 2007, Week 4
March 2007, Week 3
March 2007, Week 2
March 2007, Week 1
February 2007, Week 4
February 2007, Week 3
February 2007, Week 2
February 2007, Week 1
January 2007, Week 5
January 2007, Week 4
January 2007, Week 3
January 2007, Week 2
January 2007, Week 1
December 2006, Week 5
December 2006, Week 4
December 2006, Week 3
December 2006, Week 2
December 2006, Week 1
November 2006, Week 5
November 2006, Week 4
November 2006, Week 3
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November 2006, Week 1
October 2006, Week 5
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October 2006, Week 1
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March 2006, Week 5
March 2006, Week 4
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February 2006, Week 4
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February 2006, Week 2
February 2006, Week 1
January 2006, Week 5
January 2006, Week 4
January 2006, Week 3
January 2006, Week 2
January 2006, Week 1
December 2005, Week 5
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December 2005, Week 3
December 2005, Week 2
December 2005, Week 1
November 2005, Week 5
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November 2005, Week 3
November 2005, Week 2
November 2005, Week 1
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October 2005, Week 4
October 2005, Week 3
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April 2005, Week 1
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March 2005, Week 4
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January 2005, Week 3
January 2005, Week 2
January 2005, Week 1
December 2004, Week 5
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December 2004, Week 3
December 2004, Week 2
December 2004, Week 1
November 2004, Week 5
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November 2004, Week 3
November 2004, Week 2
November 2004, Week 1
October 2004, Week 5
October 2004, Week 4
October 2004, Week 3
October 2004, Week 2
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September 2004, Week 5
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August 2004, Week 5
August 2004, Week 4
August 2004, Week 3
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June 2004, Week 5
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June 2004, Week 2
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April 2004, Week 5
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April 2004, Week 3
April 2004, Week 2
April 2004, Week 1
March 2004, Week 5
March 2004, Week 4
March 2004, Week 3
March 2004, Week 2
March 2004, Week 1
February 2004, Week 5
February 2004, Week 4
February 2004, Week 3
February 2004, Week 2
February 2004, Week 1
January 2004, Week 5
January 2004, Week 4
January 2004, Week 3
January 2004, Week 2
January 2004, Week 1
December 2003, Week 5
December 2003, Week 4
December 2003, Week 3
December 2003, Week 2
December 2003, Week 1
November 2003, Week 5
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November 2003, Week 3
November 2003, Week 2
November 2003, Week 1
October 2003, Week 5
October 2003, Week 4
October 2003, Week 3
October 2003, Week 2
October 2003, Week 1
September 2003, Week 5
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September 2003, Week 3
September 2003, Week 2
September 2003, Week 1
August 2003, Week 5
August 2003, Week 4
August 2003, Week 3
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August 2003, Week 1
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July 2003, Week 1
June 2003, Week 5
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June 2003, Week 3
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May 2003, Week 3
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April 2003, Week 3
April 2003, Week 2
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March 2003, Week 5
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March 2003, Week 3
March 2003, Week 2
March 2003, Week 1
February 2003, Week 4
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February 2003, Week 2
February 2003, Week 1
January 2003, Week 5
January 2003, Week 4
January 2003, Week 3
January 2003, Week 2
January 2003, Week 1
December 2002, Week 5
December 2002, Week 4
December 2002, Week 3
December 2002, Week 2
December 2002, Week 1
November 2002, Week 5
November 2002, Week 4
November 2002, Week 3
November 2002, Week 2
November 2002, Week 1
October 2002, Week 5
October 2002, Week 4
October 2002, Week 3
October 2002, Week 2
October 2002, Week 1
September 2002, Week 5
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August 2002, Week 5
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August 2002, Week 3
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July 2002, Week 1
June 2002, Week 5
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April 2002, Week 4
April 2002, Week 3
April 2002, Week 2
April 2002, Week 1
March 2002, Week 5
March 2002, Week 4
March 2002, Week 3
March 2002, Week 2
March 2002, Week 1
February 2002, Week 4
February 2002, Week 3
February 2002, Week 2
February 2002, Week 1
January 2002, Week 5
January 2002, Week 4
January 2002, Week 3
January 2002, Week 2
January 2002, Week 1
December 2001, Week 5
December 2001, Week 4
December 2001, Week 3
December 2001, Week 2
December 2001, Week 1
November 2001, Week 5
November 2001, Week 4
November 2001, Week 3
November 2001, Week 2
November 2001, Week 1
October 2001, Week 5
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October 2001, Week 3
October 2001, Week 2
October 2001, Week 1
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September 2001, Week 2
September 2001, Week 1
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August 2001, Week 3
August 2001, Week 2
August 2001, Week 1
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June 2001, Week 5
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June 2001, Week 2
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May 2001, Week 1
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April 2001, Week 4
April 2001, Week 3
April 2001, Week 2
April 2001, Week 1
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March 2001, Week 4
March 2001, Week 3
March 2001, Week 2
March 2001, Week 1
February 2001, Week 4
February 2001, Week 3
February 2001, Week 2
February 2001, Week 1
January 2001, Week 5
January 2001, Week 4
January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
December 2000, Week 4
December 2000, Week 3
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December 2000, Week 1
November 2000, Week 5
November 2000, Week 4
November 2000, Week 3
November 2000, Week 2
November 2000, Week 1
October 2000, Week 5
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October 2000, Week 3
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April 2000, Week 5
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April 2000, Week 3
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April 2000, Week 1
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March 2000, Week 3
March 2000, Week 2
March 2000, Week 1
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February 2000, Week 3
February 2000, Week 2
February 2000, Week 1
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January 2000, Week 4
January 2000, Week 3
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January 2000, Week 1
December 1999, Week 5
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April 1999, Week 1
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February 1999, Week 2
February 1999, Week 1
January 1999, Week 5
January 1999, Week 4
January 1999, Week 3
January 1999, Week 2
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December 1998, Week 4
December 1998, Week 3
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December 1998, Week 1
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November 1998, Week 3
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November 1998, Week 1
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March 1998, Week 5
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March 1998, Week 1
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January 1998, Week 3
January 1998, Week 2
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December 1997, Week 5
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September 1997, Week 5
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September 1997, Week 1
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August 1997, Week 3
August 1997, Week 2
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April 1997, Week 1
March 1997, Week 5
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March 1997, Week 3
March 1997, Week 2
March 1997, Week 1
February 1997, Week 4
February 1997, Week 3
February 1997, Week 2
February 1997, Week 1
January 1997, Week 5
January 1997, Week 4
January 1997, Week 3
January 1997, Week 2
January 1997, Week 1
December 1996, Week 5
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December 1996, Week 3
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December 1995, Week 5
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