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What is the WHO Code and why is it important?

Defeating The Formula Death Star: Using Social Media to Advocate for the WHO Code Posted April 1st, 2013 by Jeanette McCulloch and Amber McCann As presented at the 8th Breastfeeding and Feminism Symposium: March 21, 2013 “Oh no. It looks like the Death Star.” – WHO Code advocate Last year, the world’s largest infant formula company, Nestle, rolled out a new center for managing its social media, described by Reuters as Nestle’s site for reaching consumers and “engaging with the online enemy.” Nestle’s new “digital acceleration center,” designed to both reach consumers and manage conflict, “looks like mission control” with walls of screens where red lights flash when online dissent is detected. Advocates for the fair marketing of formula were disheartened but not surprised to see this well-funded effort to reach mothers and diffuse controversy. How infant feeding choices are marketed matters. It matters enough that formula companies are reported to spend more than $50 million annually in the US alone. It matters enough that the World Health Organization developed an entire set of rules (known as the WHO Code) around how formula should – and should not – be marketed worldwide. Now, the efforts to ensure accurate information about feeding choices have moved online to social media. Those that defend those rules – WHO Code advocates – are working to ensure that those rules are upheld online. But defenders of the WHO Code are up against formula companies that are better-funded and are using the most up-to-date tools and strategies for reaching mothers using the Internet. Sound like David and Goliath? Once you see the technological power of the digital acceleration team, you will see why the online efforts of the formula companies feels like the Death Star of the Star Wars franchise fame. This “formula Death Star” is not going unchallenged. Using the incredible capacity of social media for the advocacy, education, and the mobilization of grassroots efforts, a rag-tag group of rebel forces–online WHO Code activists–are working to protect the WHO Code and breastfeeding families everywhere. What is the WHO Code? The International Code of Marketing of Breastmilk Substitutes (commonly called the WHO Code) was written with the goal of reducing the impact of marketing practices that aim to mislead new and expectant mother into believing that infant formula is nutritionally, immunologically, and otherwise comparable to breastmilk. Despite common misconceptions, the code DOES NOT limit access to or use of formula or related products. The code addresses marketing–and for good reason. When marketing spending on formula goes up, breastfeeding rates go down. The WHO Code was written and adopted in 1981 by the World Health Organization by a vote of 118 to 1 (the United States cast the lone dissenting vote). Thirty-two countries have adopted the code as national law, with 76 others adopting portions of it as law. Ethically and morally, the code should be considered worldwide, even where it has not yet been adopted as law. As providers who work with women, we believe in their capacity to make the best choices for their families, when presented with evidence-based information. If that’s our goal, we have two options: • We can increase marketing budgets for breastfeeding to the levels of formula companies. In the past years, they have spent at least $50 million..OR • We can uphold the WHO Code. We want to make abundantly clear that our support of the WHO Code comes from a desire to ensure ALL families have good information, not from any motivation to instill guilt or shame in families who use formula. The WHO Code does not limit options for mothers. It takes away the barriers to informed choice. As Bettina Forbes of Best for Babes puts it: “The only people who should feel guilty are those who know about the negative impact of formula marketing and do it anyway.” Meeting Us Where We Are Means Using Social Media Social media represents a revolution in communication that rivals the introduction of the printing press. For those of us of childbearing age, the notion of checking into Facebook on our iPhones, tweeting a photo of our dessert or going to Pinterest for a classic recipe instead of our family cookbooks, is second nature. Ninety-three percent of the “Millennial Generation” (those born after 1982 and who “get” technology because they grew up with it being an integral part of their lives) are communicating online, and in the United States, nearly 3 of 4 of them are using a social networking Website, such as Facebook, Twitter, or Pinterest. While the stereotype of the white, suburban mom certainly exists, we access social media widely, regardless of race, ethnicity, or socioeconomic status. We as mothers are the “power users” of social media…and marketers know it! These changes are having a significant impact on how we talk about, learn about, and share information around birth and breastfeeding. More than half of all women responding to one survey expressed their intention to share their birth experience, as it happens, on social media. Moreover, time online increases after the birth—44% of US women spend more time online after a new baby is born, and the likelihood that a new mother will seek breastfeeding information and support online is high. We Are Seeking Information About Health Care — Including Breastfeeding — Online Research tells us that health care providers continue to be the “first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the United States.” Eighty percent of U. S. Internet users have sought health care information online, and birth and related topics are an area of focus. We are using social media not only to seek information online, but we are also sharing our knowledge with others . . . and our iPhones make it as easy as sending a tweet or replying to a Facebook status update. The savvy marketers at corporations who produce infant formulas are fully aware of these changes. We argue that it is our responsibility, as advocates for breastfeeding families, to understand these changes. We know that there is POWER in using social media to reach and rise up and converse with mothers to affect change. Formula Companies Are Making Significant Investments In Social Media Savvy institutions understand what we’d teach in any “Social Media 101” presentation: social media is an unprecedented tool for listening to and engaging with an audience. Nestle has become a leading example of the use of social media both to reach consumers and to manage conflict and dissent. Nestle is the world’s largest food company and is also among the world’s most controversial corporations. Nestle was founded on the formulation of artificial infant milk. However, Nestle is not alone in its use of social media to reach parents. 10 out 11 infant formula brands commonly available in the United States, have a social media presence. Examples of their use included Facebook pages, Twitter accounts, YouTube channels, mobile apps, sponsored reviews on blogs, and interactive websites. How Do the TOP Breastfeeding Profiles Stack Up? Nestle and other formula companies have used large budgets to build their audiences. While overall marketing budgets are not generally available, at least $50 million was spent on formula advertising in 2004 and Nestle has been reported to have doubled their social media spending in recent years. Compare this to the resources of top breastfeeding organizations. La Leche League International, the breastfeeding advocacy organization with the most significant financial resources had total revenues of $1.5 million in 2011 and spent a little over $115,000 on “public relations, external relations, and advocacy.” Other organizations, like KellyMom, Best for Babes, and Breastfeeding USA have small budgets and rely largely on volunteer efforts. The result? Although all of these organizations make a significant impact on the women they reach, compare the total number of all of their followers on Facebook: about 145,000 as of this writing, to that of Gerber (the Nestle owned brand that manufactures Good Start formula) at more than five million followers. Nestle has used its significant financial resources to hire social media experts and develop tools that have made it a shining example of effective corporate social media strategy. Nestle’s “Digital Acceleration Team” has a trained staff that monitors every mention of Nestle’s brands across various social media platforms. Team members identify negative “emerging issues” by the volume of mentions and respond to those with a high level of engagement with a scripted playbook for team members. http://www.youtube.com/watch?v=ktsMa8hfgY0 The Formula Death Star, as it has become known to WHO Cde activists, can feel overwhelming, both because it limits our capacity to reach families and because it can feel impossible to influence change at the world’s largest food company. However, it is encouraging to remember that Nestle developed these tools in response to its inability to manage an onslaught of angry advocates and consumers. In 2010, Greenpeace activists were able to enact significant changes in how Nestle sources palm oil, thanks to a YouTube video spoof that garnered over 1.5 million views, along with a resulting social media campaign that netted more than 200,000 e-mail complaints. Policy change at Nestle, based on calls from all of us, is possible. Examples of Efforts to Support the WHO Code Online Although Nestle may have the Death Star, rebel forces are pulling together to provide much needed social media support for the WHO Code. A recent campaign demonstrates the power of social media to organize individuals, even without an official organizing body like Greenpeace. A blog post exposing that the Pan-American Health Organization — the regional representative in the Americas for the World Health Organization–accepted more than $150,000 in donations from Nestle sparked outrage among activists who were concerned that the fox was helping to buy the hen house. Within days, a private Facebook group was birthed and experienced rapid growth to 400 members, now at almost 1000 members as of this writing. Each day, members were given specific action steps, including suggested scripts for tweets directed at PAHO and WHO. Members shared impromptu trainings on Twitter use and etiquette, researched the money trail, and quickly developed strategy, including a decision to target WHO and call for a rejection of the Nestle funding. The result: A relatively small group of consumers and advocates, through the use of Facebook and Twitter alone, were able to force the World Health Organization to respond. More importantly, the group began to organize and mobilize motivated individuals (including breastfeeding professionals, volunteers, families, researchers, and advocates!) who will come to the next battle more organized and prepared to engage. How The Rebel Forces Can Defeat The Death Star As the Greenpeace example shows, social media provides all of us with a unique opportunities to influence how companies do business. With ongoing support to the rebel forces, much-needed pressure can be put on Nestle to change its policies; but this will not come without significant work. Some areas that need support: Ongoing consumer support and education around the WHO Code: In our experience, families generally are unaware of the WHO Code, or, if they have heard of it, they believe that it limits access to formula rather than limiting the marketing of breastmilk substitutes. The importance of the WHO Code needs to be distilled into social media-friendly images and infographics to build awareness and support for all future efforts. Ongoing education of maternal health advocates. The WHO Code is about more than just breastfeeding. Anyone concerned with infant and maternal health should be aware of and providing support for the adoptions and enforcement of the WHO Code worldwide. Bring even more social media savvy to the table. After Nestle’s run-in with Greenpeace, it brought in a top notch social media strategist to revamp its approach and provide training for its social media team. Nestle uses sophisticated tools to monitor and respond to issues. The Friends of the WHO Code–and any group hoping to use social media for impact–needs people on hand who are savvy in the use of social media and the funding for some basic tools to make the job collaborative. Keep doing what we know best. One the greatest results of the PAHO/WHO crisis was the assembly of a worldwide community with much work still to do. This and other groups need to use traditional community organizing strategies, incorporating social media to create a more level playing field. To learn more about what you can do to help promote the WHO Code through social media, join the group “Friends of the WHO Code” on Facebook. An earlier version of this post originally appeared in Science and Sensibility. You might also like: Read more: http://www.momsrising.org/blog/defeating-the-formula-death-star-using-social-media-to-advocate-for-the-who-code/#ixzz2PGC4jDLa

Too Few Breastfeeding Studies Done

Is the Medical Community Failing Breastfeeding Moms? By Lisa Selin DavisJan. 02, 20130 Share inShare2 Tamar Levine / Gallery Stock Email Print Share Facebook Twitter Tumblr LinkedIn StumbleUpon Reddit Digg Mixx Delicious Google+ Comment Follow @TIMEHealthland The doctor blamed it on the baby. “She’s not absorbing your milk,” he told Colleen Kelly, in the days after he daughter was born, as the baby lost too much weight and cried constantly. Lactation consultants said, “She’s not latching properly.” Kelly drove through rural Maine for hours to attend breast-feeding support groups and La Leche League meetings, yet the baby went from eight to six pounds and was diagnosed as “failure to thrive.” The baby’s kidneys were x-rayed and blood taken, but doctors found nothing wrong. Not once in her travels did someone suggest that perhaps the problem was Kelly herself, rather than her baby or her ability to latch on. She told doctors that her mother hadn’t been able to produce enough breast milk—could that be happening to her? No, they said. That was an old wives’ tale. But they never even looked at her breasts. “It was clear that none of the doctors or nurses knew enough about breast-feeding to figure out what was happening,” Kelly says. That’s because lactation is probably the only bodily function for which modern medicine has almost no training, protocol or knowledge. When women have trouble breast-feeding, they’re either prodded to try harder by well-meaning lactation consultants or told to give up by doctors. They’re almost never told, “Perhaps there’s an underlying medical problem—let’s do some tests.” (MORE: Breast-Milk Donors Come to the Rescue of a New Mom with Breast Cancer) When women have trouble breast-feeding, they are often confronted with two divergent directives: well-meaning lactation consultants urge them to try harder, while some doctors might advise them to simply give up and go the bottle-and-formula route. “We just give women a pat on the head and tell them their kids will be fine,” if they don’t breastfeed, says Dr. Alison Stuebe, an OB who treats breast-feeding problems in North Carolina. “Can you imagine if we did that to men with erectile dysfunction?” ED, she points out, is within the purview of many doctors’ services, and insurance will cover Viagra, but lactation dysfunction? It doesn’t even exist as a diagnosis, no accompanying health insurance code for which doctors can bill. Within the database of federally funded medical research, there are 70 studies on erectile dysfunction; there are 10 on lactation failure. No one argues that breast is best, but the truth is that breast-feeding is very difficult for many women, and for some, medical problems make it almost impossible without intervention. With the recent bans on giveaways of formula samples in some hospitals, it’s all the more important that the medical community have the tools and knowledge to help mothers breastfeed—or to figure out why they can’t. Until doctors and nurses are properly trained to help, women like Kelly will experience all of the pressure to breastfeed, with none of the support to figure out how. (MORE: 20 Ways To Make Breast-Feeding Easier) What do doctors learn about breast-feeding in medical school? “We learned that it’s what’s best for baby,” said my own pediatrician. “But that’s it.” They’re introduced to evidence that prolonged breast-feeding reduces the possibilities of obesity, SIDS and allergies, but the science of it, what’s happening at the anatomical level? Not so much. “It’s an hour, or a half a day, and [students] don’t remember anything,” says Dr. Todd Wolynn, a Pittsburgh pediatrician and executive director of the Breastfeeding Center of Pittsburgh. There were years, he says, when there was literally nothing said about breast-feeding at all. Why so little heed? “When most of the people who are currently leaders were in training, breast-feeding was really uncommon,” says Stuebe. Many teaching in medical schools today were raised in the better-living-though-chemistry age, when infant formula was thought to trump the attributes of breast milk. (Formula was certainly an improvement over the non-pasteurized cow’s milk that killed many infants at the turn of the 20th century, when breast-feeding was not in vogue). “It’s generational for doctors to think it would be necessary to know anything about breast-feeding.” It didn’t help that formula companies famously sidled up to doctors and nurses and insinuated themselves into hospital protocol; there’s a reason that, until the bans enacted in the last few weeks in some cities, new moms left the hospital with so much Similac swag. In addition, doctors practicing today don’t know where to place breast-feeding problems—breasts are attached to the women, so shouldn’t they be the province of OBs, say pediatricians. And OBs note that breast-feeding is for infants; shouldn’t the baby’s doctor handle it? This leaves breast-feeding problems either to the rare family physicians, or more commonly to lactation consultants who can assist with technical issues—improving the baby’s latch and such—but can’t write prescriptions, check hormone levels or offer a diagnosis. (MORE: Bloomberg’s Breast-Feeding Plan: Will Locking Up Formula Help New Moms?) That’s what a breast-feeding doctor—an OB, pediatrician or family physician with a subspecialty in breast-feeding medicine—would have done in Kelly’s case: a complete physical and medical history (yes, in fact, it is relevant if your mother couldn’t make milk) on mom and baby to see if any physical or anatomical factors were affecting supply. In the mother, they might check the shape of her breasts, to see if they were hypoplastic—a tubular shape that can indicate underdevelopment of the glandular tissue needed to make breast milk—or evaluate her hormone levels, ask if her breast size had increased during pregnancy. Perhaps they’d prescribe a galactogogue, a drug that promotes lactation. Today there are 88 physicians in the entire world who are fellows of the Academy of Breastfeeding Medicine, and have “demonstrated evidence of advanced knowledge and skills in the fields of breast-feeding and human lactation.” But Kelly’s doctors weren’t trained in human lactation, and they told her what many women with lactation failure have been told before: “We’ve never seen this before. You’re the only one.” Yet Kelly is clearly not alone. Dr. Amy Evans, a pediatrician and medical director of the Center for Breastfeeding Medicine in Fresno, CA, says that as many as five percent of all women have underlying medical conditions that prevent or seriously hinder lactation: hypoplasia, thyroid problems, hormonal imbalances, insufficient glandular tissue, among others. But even Dr. Wolynn, who is also a certified lactation consultant, seemed skeptical when I related Kelly’s tale—usually women struggle because they haven’t had enough support in the first few days after giving birth, in his experience. “Very few women really can’t breastfeed,” he said. “That’s very, very, uncommon.” It’s a “normal mammalian function,” he said. Almost everyone can do it. (MORE: Q&A With Breast-Feeding Mom Jamie Lynne Grumet) Because the complexities of lactation failure are so little studied and so often misunderstood, women can often feel that they are at fault, rather feeling like they are suffering from a medical issue for which they need and deserve professional help. Dr. Marianne Neifert writes in her article, Prevention of Breastfeeding Tragedies, “The bold claims made about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’” Luckily, doctors are beginning to take breast-feeding on. Wolynn, Evans and Stuebe are all fellows of the physicians’ organization Academy of Breastfeeding Medicine (ABM). At Wolynn’s practice, all six of the pediatricians on staff are also certified lactation consultants. ABM has developed 25 protocols to guide physicians in treating breast-feeding problems. They’ve successfully lobbied to include breast-feeding issues on the exams for the American Board of Obstetrics and Gynecology and the American Academy of Pediatrics. And the Affordable Health Care Act advises that, as of August 1, health insurance companies should provide “comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breast-feeding equipment.” Of course, we’re low on those trained providers, but there are more every day, as medical schools begin to adopt breast-feeding curricula. “It’s probably the most promising times we’ve seen,” says Wolynn. “We’re in the early phases of what I’m hoping in the next five to 10 years will be more appreciated and more considered a real subspecialty,” says Evans. “It’s a whole new area of medicine.” (MORE: Why Most Moms Don’t Reach Their Own Breast-Feeding Goals) Still, there’s work to be done. Health insurance companies need to reimburse doctors for the time they spend attending to breast-feeding issues, to cover galactogogues, and to cover donor breast milk for women with lactation failure. And if we’re going to remove formula samples for women to promote breast-feeding, we better come up with a plan to feed the babies of that 5% of women who can’t sustain them—with 4 million births a year, that’s 200,000 moms who need extra help. Doctors practicing today—especially those treating pregnant women and new mothers—need to know that lactation failure really does happen, and to be familiar with the potential causes of it, so that they can intervene early. Perhaps most importantly, we need to stop demonizing mothers who can’t breastfeed, guilting them into starving their kids with insufficient milk supplies rather than supplementing with formula. Yes, breast-feeding can help prevent SIDS, obesity, childhood leukemia, asthma, and lowered IQ…but none of those matter if your baby is failing to thrive because of malnutrition. In Kelly’s case, once the baby was admitted to the hospital, she began to use formula, fed through a syringe—she was told to avoid bottles because the baby would reject the breast. She stuck with formula, her baby gained weight, and today, “she’s happy, healthy and fine,” Kelly says. But her guilt and shame continued long after the baby recovered. It wasn’t until weeks later, in another doctor’s office, that Colleen happened upon an article that calmed her: some women, it said, can’t breastfeed, for physical reasons. If only her doctors had read that article, too. MORE: Can a Formula Company Really Promote Breast-Feeding and Fight Child Obesity? Read more: http://healthland.time.com/2013/01/02/is-the-medical-community-failing-breastfeeding-moms/#ixzz2GyaT1Ekh

My Breastfeeding Unsuccess Story

For many years I wanted to become a mother. I dreamt about staying home on a maternity leave and taking care of my newborn. I pictured myself sitting in the perfectly decorated nursery, with a celestial theme, and rocking my baby gently while I nursed him.

For years before this scenario could become a reality; I was working as a nurse. First, as a neonatal transport nurse, and then as a neonatal nurse practitioner. Many years were spent taking care of others' babies; both preemies and seriously ill term newborns. I felt that I had a calling to be a nurse; yet I was personally left feeling void without my own child.

After a first timester miscarriage two years prior; I became pregnant. Even though I was labeled advanced maternal age; I had a great pregnancy and thoroughly enjoyed impending motherhood. I took a several week long childbirth education class and learned all about being in labor. I feared the probable pain associated with delivery but still was very excited.  I neglected to take a breastfeeding class, in part because I had worked with many mothers of preemies, and had assisted many to provide the skin to skin technique. After all; breastfeeding is natural. There can't be that much to it that would make you need a class?  Oh, was I wrong and misinformed to say the least.

My son was born at very close to term. Brad came into this world via a stat-emergency cesarean section. His heartrate had dropped during my labor. My OB later discovered that Brad had an umbilical cord around his neck; known as a nuccal cord. Because of my age I was considered high-risk. So I had all the prenatal diagnostic tests while pregnant. Not that any results would alter my pregnancy, however, I am the type of personality that does better with prior information.  After Brad was born, the neonatologist discovered that Brad had an undiagnosed cleft palate. Funny; no family history so I never considered that one. I still attempted to breastfeed my newborn in the hospital; but he would never latch. So by the time I took him home from the hospital he was partially dehydrated with impending hyperbilirubinemia (jaundice). As we were being discharged a nurse handed me an unopened package that contained the Haberman Special Needs Nurser.
When we got home I proceeded to re-hydrate Brad, even going so far as to calculate out how many mL's per kilogram per day of fluid he was receiving. The neonatal nurse practitioner part of me was taking over. And, yes, I started a "chart" on Brad. I even counted his respirations. Signs of a nervous mom, or just a bad combination of mom/nurse? Thankfully Brad did well, although I needed to use formula because my milk never came in. Because my son wouldn't or couldn't latch; I knew to rent a hospital grade double electric breastpump. Because I didn't get support at that time from a Lactation Consultant; I didn't know how often to pump. Also, because I negelected to take a breastfeeding class; I was unaware of the need to pump frequently. That situation prompted me to go into a post partum depression, I had been a failure at having a vaginal birth and also a failure with breastfeeding.

Several great things have happened since that period in my life. I recovered from my PPD, my son Brad has thrived and grown into a fine, young man. Yes, he is handsome. But because of my ordeal I have now become a Certfied Childbirth Educator, first a Certified Lactation Counselor, and now a IBCLC (International Board Certified Lactation Consultant).
Last year I ventured into a private business known as BabyFirst Lactation & Childbirth. I truly recommend that all pregnant mothers take prenatal educational classes. I also recommend that breastfeeding is the absolute best way to nourish your baby. Breastfeeding is my passion and I desire to help you reach your personal breastfeeding goals.  ~Amy www.babyfirstlactation.com