U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials  followed by a Tweet by President Trump that this was all ‘fake news’.



  • Consensus text proposed by Botswana, Ecuador, The Gambia, Ghana, Mozambique, Nepal, Pakistan, Panama, Senegal shared with Member States after the Member States meeting  14th May.
  • Draft Resolution proposed by the Russian Federation and published by WHO on 22nd May: (A71/A/CONF/4),  co-sponsored by Botswana, Canada, Gambia, Ghana, Mozambique, Nepal, Pakistan, Panama, Senegal, Sierra Leone, Thaïland and Zambia. This text is more or less the same as the Consensus Text.
  • CLICK HERE for DRAFT DECISION tabled by the US on the same day  and published 22nd May (A71/A/CONF/5) (CLICK HERE for previous US text that was circulating. The sentences about HIV and Code implementation – only the Code not the subsequent Resolutions – were removed).
  • CLICK HERE for the  Resolution that was adopted on dated 26th May, sponsored by Botswana, Canada, Gambia, Georgia, Ghana, Kenya, Mexico, Mozambique, Namibia,Nepal, Pakistan, Panama, Russian Federation, Senegal, Sierra Leone, Sri Lanka, Thailand and Zambia.(A71/A/CONF/4/Rev 1)
There has been global media coverage (Click here for some of the US coverage) about what happened at the 71st World Health Assembly in May.  Some of the coverage has become sidetracked into a debate about whether women should or should not breastfeed their babies.   Below are our thoughts on why this misses the point.
President Trump does seem to have a real dislike of breastfeeding, however the controversy is NOT really about breastfeeding – or about infant formula, which is a legitimate and necessary product for babies who are not breastfed. The debate at this time is about the trade of  ‘follow-on’ or ‘toddler’ formulas,  unnecessary products that target babies 6 -36 months and are aggressively and misleadingly promoted. These products are fuelling global formula sales (set to rise to $70bn by 2019) and exacerbating the obesity epidemic – while undermining breastfeeding  –  a lifeline for so many children and undermining the health safeguards that exist in many countries.
Unless there is a radical change of policy, the US has no intention of bringing in laws to control baby food marketing at home –  it never has.  This tactic of threatening less powerful countries has much more to do the corporate need to trade highly processed products globally with minimal restrictions  – forcing developing countries to welcome these products as somehow better than their own, and to abandon their traditional food cultures.
Why are WHA Resolutions important?:  Since 1981 (when the International Code of Marketing of Breastmilk Substitutes was adopted) the World Health Assembly has debated infant and young child feeding every two years and adopted 17 or so new Resolutions.  Click Here   The Assemblies and the Resolutions are important: they help Governments share their concerns and ensure that their regulations and policies keep pace with the new marketing tactics.
The  original draft Resolution that Ecuador planned to sponsor aimed to safeguard 5 critical areas – the Baby-friendly Hospital Initiative (BFHI), the implementation and monitoring of Code and relevant WHA resolutions,  the WHO Guidance on ending the Inappropriate Marketing of Foods for Infants and Young Children that had been adopted in 2016,  appropriate infant and young child feeding in emergencies and conflicts of interest in nutrition programmes.
What happened in May? Led by Ecuador, Member States had four meetings before the Assembly and arrived at a draft consensus text  by the 14th May along with a Rationale.  On the first day of the Assembly, it was clear that Ecuador was not able to sponsor the Resolution – some of us knew that this was because of US pressure  – others guessed.  Another country had to be found and quickly  to meet WHA rules and none of the original sponsors were prepared to  take the risk of US sanctions.  The  Russian Federation saved the day and agreed to table the text as a Draft Resolution with Botswana, Canada, Gambia, Georgia, Ghana, Mozambique, Nepal, Pakistan, Panama, Senegal, Sierra Leone, Thailand and Zambia as co-sponsors. (A71/A/CONF/4)

The same day, the USA proposed a single page Draft Decision (A71/A/CONF./5) This  focused on promotion of breastfeeding with no mention of the need for protection from harmful marketing.  Instead of ignoring the US proposal and if necessary calling for a vote on the Russia draft, Italy proposed a drafting committee.  From then on the only way was downhill.   Chaired by Thailand, two days of drafting followed with a large US delegation dominating the proceedings. IBFANers and other NGOs are not allowed to enter the drafting room but did their best to help Member States preserve as many safeguards as possible.

What was the outcome?  The re-drafted resolution that was eventually adopted (A71/A/CONF./4 REV. 1) did retain some of the original safeguards – largely because of the insistence of developing country delegates  – however  it is substantially weaker than the original text, contains very little about marketing and, not only that, it includes subtle flaws that could cause serious problems in the coming months when key decisions are taken at the global food standards setting body Codex Alimentarius Commission. (CLICK HERE for an explanation of what Codex is and why its important.)

Why did the US do this and why is it so worrying?

What happened at the Assembly is exactly what the US has been doing for years at Codex,  only this time in a more extreme way: CLICK HERE for our report of the meeting in Berlin in December 2017 and CLICK HERE for the Codex meeting in Rome last week. Since the arrival of President Trump the US position has moved on from lowering standards and the scientific evidence base point by point, to calling for the wholesale removal or re-evaluation of previous WHA Resolutions and recommendations from Codex texts: effectively removing essential safeguards that IBFAN, WHO and our partners have helped incorporate into the infant and young child feeding products standards over the last 20 years.  This is why health advocates are so worried.  As Ted McKinney, US -Under Secretary of State for Trade and Foreign Agricultural Affairs US, argued last week, national and regional concerns – whether products are safely and appropriately used – are not the ‘purview’ of Codex. What matters more to the US is that the corporations find the standards useful.

Why are the follow up and so called “Growing-up” formulas so problematic?

Follow-up formulas were invented for one reason –  to get round laws that – because of industry pressure – often only  cover products for babies up to 6 months.  The WHO guidance adopted in 2016 makes it clear that all formulas targeting babies 0-36 months function as breastmilk substitutes and that national controls should include controls on on their marketing. WHO recommends exclusive  breastfeeding for 6 months and continued breastfeeding alongside other foods for two years or more – however long the mother and baby dyad want.

Here are some examples of the misleading promotion that is being used to persuade governments to allow these products to be marketed.


This advert for health workers picked up in Botswana in 2016  shows Nestlé’s launch of its “growing up milk’  in Southern Africa. The brochure makes unsubstantiated and misleading claims, using bogus science,  that the formula will protect children from dirty water, exposure when travelling etc.  Nothing could be further from the truth. If a mothers stops breastfeeding her child to use these products, the risks to health will be greatly increased.

TV Adverts.  Here are some links to TV commercials for #3 milks in Hong Kong showing cross promotion. Growing up milks are products within the scope of the Code, as clarified by the 2016 WHO Guidance. The packaging of  #1 and #2 milks is very similar. By advertising #3 milk, they are at the same time exploiting a “loophole” to also advertise/promote #2 and #1, as packaging is almost identical. However, as clarified by the Guidance, even promoting #3 is a violation.

MJ Enfinitas


Translated phrases: “Enfinitas understands the natural needs of a baby, thus research is inspired by a mother’s love”, “researched and produced ‘original life nutrition combination’ – with lacto-ferrin, DHA, MFGM to help baby’s natural talent flourish…”, “the ‘original life nutrition’ is from the love of a mother”

See whole line of products (including #1 and #2 milks) here:




Wyeth Illuma


Translated phrases: “Illuma’s ‘human-body affinity’ (trademark) formula , an inspiration from breastmilk – a scientific research that enlightens the natural talent”

See whole line of products (including #1 and #2 milks) here: https://www.illuma.com.hk/product/tc/


Compilation of other reports by Mary Champney, HKI:

Key messages from the Save “Don’t Push It” report: general stats on global breastfeeding situation

  • Breastfeeding saves lives. It’s estimated that 823,000 child deaths could be prevented each year in low- and middle-income countries if breastfeeding were adopted at close-to-universal levels.
  • The risk of dying from pneumonia among infants under five months is about nine times greater among those not breastfed compared with those partially breastfed.
  • The lives and the health of millions of vulnerable children are at risk from the rapid growth of the market for baby milk formula.
  • The growth of the industry is no accident. While the need for certain infants to be formula-fed is recognised, much of the infant formula market growth stems from powerful marketing campaigns that have led mothers to limit or abandon breastfeeding.
  • Six companies today are among the leaders of the aggressive global promotion of milk formula and other foods for very young children – Nestlé, Danone, RB (who recently acquired Mead Johnson), Abbott, Friesland Campina and Kraft Heinz.
  • Evidence shows this aggressive marketing is driven from the most senior levels of the BMS companies.
  • While the problem is global, there is evidence that developing countries suffer most. In countries with limited access to sufficient, safe and affordable water and adequate sanitation, and with a high prevalence of acute respiratory infections, diarrhoea and measles, the consequences of a mother switching to infant formula can be a matter of life and death.
  • The market for infant formula and follow-on milk formulas is growing at eight times the pace of the global population. By 2019 that market will be worth more than $70 billion.


“Don’t Push It” Case study on Myanmar: company behavior in Low and middle income countries

  • Abbot advertising in Myanmar (Don’t push it, citing Alive & Thrive):  Abbott spent $486,460 on advertising its Gain IQ Similac brand, making it the biggest advertising spend in the country
  • Market analyst Euromonitor describes Myanmar as one of the “markets of the future”. According to Alive & Thrive, an initiative to strengthen maternal, infant and young child nutrition, companies spent $480,000 on advertising in Myanmar in the first six months of 2015.


From Changing Markets “Milking it” report executive summary: insights on Manufacturer behavior

  • In this report, we have reviewed over 400 products on sale in a variety of countries across the world from the top four infant formula manufacturers: Nestlé, Danone, Mead Johnson Nutrition and Abbott.
  • Manufacturers are marketing an increasing range of products for different age groups (1–12 months, 1–6 months, 1–3 months, etc.); products with additional nutrients, which are not required by law, in the race to get ‘closer than ever to breastmilk’ […] products claiming to solve general conditions […] and products with raw ingredients and flavours to cater for wider consumer preferences and concerns[…]


ARCH numbers (from our 2016 supplement in MCN): illustrative stats on availability and promotion

  • 68% percent of mothers who delivered their babies in private health facilities in Kathmandu Valley, Nepal received recommendations to use breastmilk substitutes
  • In Phnom Penh, Cambodia, 86% per cent of mothers reported observing a promotion for breastmilk substitutes.
  • In Dakar, Senegal Promotion of breastmilk substitutes outside health facilities was common with 41.0% having heard, seen or read product promotions since the birth of their youngest child.
  • Of a selection of stores selling infant and young child feeding products in each study site, just over a third of stores in Phnom Penh and Dakar had point of- sale promotions for breastmilk substitutes, while they were observed in less than 10% of stores in Kathmandu Valley and Dar es Salaam.
  • 113 different BMS products were available for sale in stores in Phnom Penh, from 25 different manufacturers.


Alison Stuebe’s blog on NYT story for Academy of Breastfeeding medicine: background info on US dairy interests and rise of GUM


  • The underlying issue is that we have a massive milk oversupply problem in the US. American milk consumption has plummeted, from 290 pounds per capita in 1950 to just 45 pounds per capita in 2014. Unloading all that milk has been a long-term project for the dairy industry. For example, with support from the Department of Agriculture, the National Dairy Board has worked tirelessly to inject cheese into every element of the American diet, tripling consumption between 1970 and 2007. In 2002, the USDA partnered with Pizza Hut to promote the “Summer of Cheese,” increasing cheese consumption by 102 million pounds.

Despite these efforts (and the associated obesity epidemic), we still have too much milk. In 2016, the Wall Street Journal reported that America’s dairy farmers dumped 43 million gallons of excess milk. When there’s not a market for fresh milk, it’s stored in other forms. Last week, it was reported that US cheese reserves are at their highest in a century, with 1.39 billion pounds in warehouses. As the director of market intelligence at the American Farm Bureau Federation told the Washington Post, “We’re producing more milk. It’s inevitable. That milk needs to get turned into something storable.”

What’s the fastest growing “something storable” in 2018? Baby formula – and in particular, a product called toddler milk. This product has been dubbed “The Hello Kitty of Packaged Food” for its runaway success in Asian markets. According to the European Food Safety Authority, these products offer no additional value to a balanced diet, and many are sweetened with sugar or corn syrup, potentially contributing to the global obesity epidemic. Toddler milk sales are expected to grow by 20% in developed countries from 2015 to 2020; in 2014, these milks comprised 39% of the baby milk retail market worldwide.

(CLICK HERE. for our Press Release describing what happened at the December Codex meeting,  HERE for another blog on John Bolton’s appointment and HERE for the 1978 Kennedy Hearings).

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