12 Apr Battle of Breastmilk vs. Formula Milk as Hong Kong awaits adoption of Code
After years of lobbying efforts by breastfeeding advocates, the Hong Kong SAR Government has recently decided to revive the stalled marketing code that gives effect to the International Code of Marketing of Breastmilk Substitutes (“Hong Kong Code”). The government plans to the Hong Kong Code into effect around mid-2017 after a lapse of 5 years and several rounds of consultations.
As was the case years before, critical discussions are currently underway within members of the Legislative Council (LegCo), as well as members from the public. Some LegCo members are supportive of enacting a Code that can prohibit promotion of formula milk and related products in order to curb marketing practices that undermine breastfeeding. Other lawmakers who are pro-trade, argue that the scope of restrictions should be narrowed down as the Code interferes with free market and undermine parents’ right to access to information on formula milk. In fact, such arguments are ungrounded as the Code does not restrict non-promotional information about the product and its proper usage, but instead, protects those who are fed on formula by ensuring that adequate and accurate information and instructions are provided. Policy makers who understand and agree with the purpose of the Code have stressed that there are adequate avenues to provide mothers who choose to feed their infants with formula milk with non-commercial information on infant feeding. Some even expressed their doubt in the effectiveness of a Code that has no “sanctions”, despite their support of the aim of the Code.
Battle of Breastmilk vs. Formula Milk
As breastfeeding advocates anxiously await the adoption of the voluntary Hong Kong Code, company affiliates are also ramping up their fight. Just last month (8 March), TVB, a major TV channel in Hong Kong aired a feature programme “Battle of Breastmilk vs. Formula Milk” during a prime-time TV talk show. Speakers included a well-known pediatrician, Dr. Li Kwok To, mothers, and a representative from the Hong Kong Infant and Young Child Nutrition Association (HKIYCNA).
In the programme, not only did the pediatrician omit to express his support for breastfeeding and warn the public of the various risks of formula feeding, he actually alluded that there is practically not much difference between breastfeeding and formula feeding. Li said, “Although the baby has these antibodies (from being breastfed), (it) does not mean he will not be sick. There is no need to be worried when feeding formula milk. There are a lot of immunisations for babies, so in general, all babies get sick less. It does not mean just because a baby is breastfed, there is no need for immunisations.”
Meanwhile, spokesperson of the HKIYCNA expressed support of restricting promotion of formula milk for 0 to 6 months only, but unabashedly expressed doubt and disagreement regarding the scope of the Hong Kong Code to also regulate breastmilk substitutes and complementary foods from 6 to 36 months or beyond, calling it “too strict”. This “selective” support of the Code, seems to be a “united” stance among manufacturers nowadays, especially in China as we have seen. They would pay lip-service to appear to support Code, but only recognising the need to ban promotion of formula during the 6-month exclusive breastfeeding period, and disregard the Code’s purpose to also protect sustained and continued breastfeeding (together with appropriate complementary feeding) up to 24 months or beyond.
The programme also discussed the plausible effect of the Code further stigmatising mothers who are formula feeding their babies, as there is already social rhetoric that deems mothers who feed formula to their babies as “lazy”. If the show is meant as an endorsement of the pro-formula camp, it backfired. Within two days after the programme was aired, the Hong Kong Communications Authority received 141 complaints from the public of its misleading and biased content leaning toward formula feeding, which severely undermines breastfeeding.
Are they pro-health or pro-industry?
In recent years, business interest organisations are forming rampantly to act as “fronts” to promote and advocate for industry interests in the realms of infant and young child nutrition policies. These associations often adopt “neutral-sounding” or even “pro-public health” names that conceal their direct links to formula companies, and work as independent organisations to influence policy making and public opinion on behalf of industry. The Hong Kong Infant and Young Child Nutrition Association (HKIYCNA) is one such organisation. HKIYCNA was represented in the TV programme as working to promote infant and young child nutrition when it is actually formed by seven major formula milk manufacturers in Hong Kong – Abbott, Danone (Nutricia), FrieslandCampina, Mead Johnson, Nestlé, Wyeth, and Snow Brand – to represent their interests.
The unsettling statements made by the paediatrician in the TV programme are indicative of his pro-industry stand which is not surprising as he is the chair of the Child Nutrition Advisory Group, which is sponsored by Wyeth, a position that is fraught with conflicts of interest because as a paediatrician, his role should and must be to promote breastfeeding. The International Code and subsequent relevant WHA resolutions contain clear provisions to prevent and safeguard against conflicts of interest to protect infant and young child nutrition from undue commercial influence.
ICDC has been working in the background to support the Code implementation process in Hong Kong for many years. As Hong Kong is the gateway to China, the biggest baby food market in the world, we do not foresee a smooth passage even if all evidence points to the urgent and dire need to hold companies (and those who work to promote their interests) accountable.
On 13 June 2017, the Department of Health in Hong Kong adopted the Hong Kong Code of Marketing of Formula Milk and Related Products and Foods for Infants and Young Children. The Hong Kong Code has an extensive scope and strong provisions banning promotion. Its main weakness lies in the fact that there are no sanctions attached to the voluntary Code. The Department of Health plans to conduct periodic surveys to evaluate overall trends but compliance with the Hong Kong Code would depend largely on the goodwill of manufacturers and distributors. Civil society groups will bear the burden of monitoring, naming and shaming.