Field Epidemiology

Breastfeeding Grand Rounds 2014

International Code of Marketing of Breastmilk Substitutes and Promoting and Supporting Exclusive Breastfeeding

Originally presented on August 7, 2014

David Clark, LLB
Nutrition Specialist & Legal Advisor

Tricia Cassi, BSS, IBCLC
WIC State Breastfeeding Coordinator
Vermont Department of Health – WIC

Ruth Lawrence, MD
Professor of Pediatrics and Obstetrics & Gynecology
University of Rochester School of Medicine & Dentistry

Mary Applegate, MD, MPH
Associate Dean for Public Health Practice
University at Albany School of Public Health

The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have emphasized the importance of maintaining the practice of breastfeeding as a way to improve the survival, health and development of infants, young children, and mothers.  Efforts to protect, promote and support breastfeeding and to overcome barriers to successful breastfeeding are a central part of the nutrition and maternal and child health programs of both these international organizations. 

Many factors influence the prevalence and duration of breast-feeding, both positively and negatively.   In 1974, the 27th World Health Assembly noted the general decline in breastfeeding in many parts of the world.  The decline was related to sociocultural and other factors, including the promotion of manufactured breastmilk substitutes, particularly in strongly free-market driven countries such as the United States.  The Assembly urged member countries “to review sales promotion activities on baby foods and to introduce appropriate remedial measures, including advertising codes and legislation where necessary." 

The 2014 edition of Breastfeeding Grand Rounds will explore the history and key provisions of the Code of Marketing of Breastmilk Substitutes.  The speakers will discuss the importance of the Code in promoting and protecting breastfeeding in the US and worldwide.  They will describe successful efforts in this country and elsewhere to promote and monitor adherence to the Code.  They will also talk about persistent barriers to Code implementation, as well as promising strategies for overcoming those challenges.

While overall breastfeeding rates have increased slightly in the US, research shows that the rates for those mothers continuing to breastfeed at 6 months or 1 year remain significantly lower despite a steady increase since 2000. There is a steep drop off in breastfeeding during the first month.  Mothers that make it through the first month are more likely to continue breastfeeding for additional months. 

These trends are evident among WIC participants as well.  WIC participants include 50-60% of all infants in New York State, and over 110,000 infants participate in WIC on a monthly basis.  Breastfeeding rates for this population are slowly increasing toward Healthy People 2020 goals, yet exclusive breastfeeding rates remain very low.  In the NYS WIC program, these rates have lagged behind the overall population. 

Effective and successful promotion and support for exclusive breastfeeding would impact positive health outcomes for WIC mothers and their infants.  Although breastfeeding promotion and support is challenging due in part to, WIC food packages that include free formula, WIC staff breastfeeding competencies,  and cultural/community infant feeding practices, several strategies shown to increase  exclusive breastfeeding rates have been identified. 

This webcast will highlight specific strategies that have resulted in improved exclusive breastfeeding rates at various NYS WIC agencies.  The program will explore practical strategies that result in successful outcomes when implemented during the prenatal period through the birth month. 

Target Audience
New York State WIC local agency staff, breastfeeding peer counselors, management staff, breastfeeding coordinators, dietitians, health care professionals and support staff.

Program Objectives
After watching this broadcast participants will be able to:

  1. List three major provisions of International Code of Marketing of Breastmilk Substitutes
  2. Describe the roles of UNICEF and of other international, national, statewide, and local authorities in promoting adoption of the code and in ensuring adherence to it
  3. List benefits for each of the following groups that comes from giving birth, being born, or providing care in a Code-compliant institution OR that derives from having Code-compliant institutions in one’s community
  4. Identify strategies for promoting and supporting exclusive breastfeeding among WIC participants.
  5. Describe types of system changes necessary to achieve culture shifts in early promotion and support of breastfeeding. 
  6. List staff breastfeeding competencies needed to fully support exclusive breastfeeding for WIC participants.

This program is sponsored by the New York State Department of Health and funded by the USDHHS/HRSA Maternal and Child Health Bureau.