ICDC Statement on the Food for Thought Report

Food for Thought – an independent assessment of the International Code of Marketing of Breastmilk Substitutes written by independent legal analyst, Angela Evans, was launched on March 23rd at the UN Foundation, under the auspices of the Breastfeeding Innovations Team. The report, while pointing out the low rate of full Code implementation among countries, calls for reform in relation to Code implementation. Suggestions include:

  • Code implementation needs to enable women to combine paid work and breastfeeding
  • Code compliance should be advanced in the context of the broad and growing “business and human rights” agenda
  • Establish an independent Ombudsman to monitor compliance and arbitrate disputes
  • Corporations that fully implement the Code should be publicly acknowledged as models of best practice
  • Re-evaluate whether bottles and teats should be subject to the Code when they are an essential part of sick newborn care and when they are included with breast pumps — an increasingly essential item if women are to continue breastfeeding after they return to work
  • Consider to what extent the Code is “crowding out” private sector investments in breastfeeding support and other areas of infant and child nutrition support and other areas of infant and child nutrition

The report has also made a number of references to IBFAN-ICDC’s global monitoring report “Breaking the Rules, Stretching the Rules”, and our monitoring methodology as well as writing style. While we appreciate the attention given to the International Code, we have addressed a few of our concerns in our statement below.

IBFAN-ICDC welcomes comments and critiques on our work on the International Code of Marketing of Breastmilk Substitutes (Code). We believe constructive criticisms facilitate discussion and open the gateway for improvement in an area of public interest work where, very often, one stands isolated and alone. We realise too that the approaches we take in holding corporations to account through Code implementation and Code monitoring do not gain favour from some quarters. These are factions who feel that we are hostile to business interest and thwarting aspirations of collective cooperation between key parties.

The divide in opinion is clear but there is space for disagreement – one that is conducted in a fair and respectful manner.

Until Food for Thought (FFT) report. This so-called “independent assessment” of the Code developed under the auspices of the industry-friendly Breastfeeding Innovations Team went on an overdrive to criticise IBFAN and specifically ICDC, the IBFAN programme office for Code implementation and Code monitoring. Particularly targeted was our flagship publication, Breaking the Rules, Stretching the Rules (BTR) global monitoring report which the author, Angela Evans, derided as containing “a patchwork of offending images of labels, advertising and promotional activities.”

Based on observations made to the author via series of conference calls with key voices from NGOS, companies, UN institutions and other related bodies (fn. 153), our approach was described as “warranted and effective by some” and “outdated and unhelpfully confrontational by others.” When a sister organisation asked the Breastfeeding Innovations Team (BIT), the principal backer of FFT for a list of people they interviewed for the FFT report, the request was declined on grounds of confidentiality. It is no secret that no IBFAN leader was approached for an interview.  Certainly not ICDC, despite being described as “the most prominent NGO actor in Code compliance monitoring” and “the only major centralised Code monitoring agency collecting and reporting on alleged Code violations …” (p. 50).

Choosing not to speak to ICDC or any IBFAN global leader is an indication of bias. The author has obviously decided, on the outset, that the IBFAN network and its advocacy-based culture shall be vilified as “hardline opposition” (p.60). The author’s conclusion that the BTR is “ultimately limited as an impartial, rigorous and widely accessible form of monitoring” (p.50) is unjustified. Apart from gleaning information we chose to place in the public realm, neither the author nor the people she interviewed knew about the impact we have achieved in shifting institutional and corporate policies as a result of our monitoring. Since no one in ICDC has ever spoken with the author or BIT, they lack the moral authority to judge us.  Interestingly, the FTT report did concede that companies can be deemed “Code violators” with far reaching reputational and financial consequences.” (Pg. 33) Which “Code violator” is the FTT report acting as mouth-piece for? What political edge is the author and BIT gaining from the attack on our work? Despite the overwhelming presence of images of breastfeeding women in different cultural settings in the report, we don’t think the report speaks for them.

If the report is indeed an independent analysis, the author should have taken the trouble to understand IBFAN’s institutional history, culture, mandate, resource and constraints. Its bare statement that IBFAN-ICDC aims to serve as a watchdog and voice of civil society concerns with a “vast international network” and that is an organisation “most capable of fulfilling this role” is at once complimentary, contrarian and confounding given other damning statements in the report.

By all means, the author and BIT can reach for a “wider range of modalities for approaching the private sector.” It can call for the “traditional binary between adversarial advocacy and collaboration” to give way to “more mixed, hybrid strategies of private sector engagement that are capable of producing meaningful change” (p. 64). The need to pull down IBFAN and ICDC, in particular, in the process shows a lack of appreciation and understanding for the bigger issues we had to grapple with in protecting infant and young child health.

The preceding paragraphs pertain to impertinence of the FTT report.  Content wise, the report lacks merit in many instances.  In particular, we take issue with the FTT report in the following five areas.

  1. Call for clarity on which WHA resolutions are relevant to the Code and the scope. (pp.14 -15)

The FTT report fails to consider recent publications from WHO on the Code which resolved many existing gaps and areas of controversy. These publications are accessible from the WHO website. The FTT report also ignores ICDC publications which explain the scope of the Code and how subsequent resolutions have clarified and extend on the Code.

  1. Criticism about the ban of all milks for children under three years. (pp. 18-20)

The scope of the Code is based on the provisions of Article 2 as clarified and extended by subsequent World Health Assembly Resolutions. The scope of the Code cannot be determined by unjustifiable grouses that “corporate actors have barely been able to accept the application of the Code to products for infants older than six to twelve months” or that the ban “could alter the negotiation dynamics between civil society and industry for the worse”. Even that it would “disincentives innovation and investment.” The Code, resolutions and the 2016 Guidance on ending the inappropriate marketing of foods for infants and young children are adopted for the protection of breastfeeding, and not the protection of corporate interest. This is where the FTT report appears to have lost its moral compass.

  1. Reassessing feeding bottles and teats (p. 25-28)

The FTT report opines that the advent of the modern-day breast pump has transformed the relationship between breastfeeding and the bottle. This begs the question whether women in resource poor settings who are shown in the report even have access to breast pumps, a device much glorified by companies selling feeding bottles and teats as it offers a back-door entry to mothers in richer settings.   The FTT report sees the combination of breastfeeding and bottle feeding as a pragmatic arrangement that allows a mother to retain her milk supply and continue breastfeeding for longer amidst work commitments.  It recommends a clarification and adjustment of the way feeding bottles and teats are subject to the Code.  The FTT report misses the point that the Code does not ban sale or usage, just promotion. While these devices are useful in some cases, it ignores the fact that breast pumps, feeding bottles and teats are marketed in way that induce women to use them unnecessarily, adversely affecting breastfeeding and maternal and infant health.

  1. Advocating a more pluralistic framework for assessment (p.41)

The FTT report advocates several methods of assessment over the binary determination of whether a company is “violating” the Code. This includes the use of a presumption against partnership rather than an automatic exclusion from partnerships for UN agencies and a scorecard method for civil society monitoring that could allow for a more nuanced range of reactions. (p.28).  It is not clear what the FTT report is getting at here but it reads like an excuse to provide companies that violate the Code with a soft landing even though the act in ways which not only violate the Code but which impinge on the rights of children to best attainable standard of health. Code violations are serious misdemeanors and should be treated as such.  Companies should not expect leniency when they misbehave in a systematic, continuous and systemic manner.    The warning (p. 48) that key actors may begin to consider Code’s provisions outdated and unworkable and therefore a risk for the Code’s traction flies in the face of all national Code based legislation and the fact that companies must comply with the sovereign laws of the countries they operate in. The mere suggestion that the Code’s normative primacy will be eroded sounds like a threat which should not be tolerated. The legitimacy of the Code and the many subsequent World Health Assembly Resolutions which affirm the Code as a tool for the protection of breastfeeding is reflected through the collective will of Member States, thus it cannot be opened up for challenge even though companies find it inconvenient.

  1. Re/mis-interpreting Code Article 11.3 (pp. 42-43)

The FTT report pontificates on the semantics of the “weakness in the Code’s wording” and attempts to argue that companies only need to ensure marketing practices conform to principles and aims of Code, but not necessarily the actual Code provisions per se. It also goes as far as to call upon civil society to influence private sector through “industry-facing guidance” and to explore ways to offer guidance and help to translate the Code into a business context, i.e. civil society should work closely together with companies/private sector to develop “common” understanding of compliance.  (Incidentally, ICDC has a publication targeted for regulators and company compliance staff.) The FTT report fails to explain why civil society should bear the responsibility to guide industry and why WHO, UNICEF, and their NGO partners should clearly and definitively set the parameters for corporate success.  Under accepted human rights framework, there is no duty on the part of civil society to guide industry.  Industry’s role is to comply with the Code – it’s never a question of how to go about it. So far what we have seen is clever manipulation of Code provisions so that business can go on as usual.  The Code is not rocket science despite some grey areas.  Compliance is a matter of “wanting to” and not about “not knowing what to do”. In fact, it is an insult to the legal and management experts on their payroll who are hired to manage risks and compliance to imply otherwise.

For the reasons stated above, we censure the author of the FTT report and its backers for irresponsibility.