According to a New York Times report, US officials did virtually everything in their power to fight a seemingly uncontroversial UN World Health Assembly resolution encouraging breastfeeding – including threatening Ecuador with trade measures and the cessation of vital military assistance.

The measure was meant to promote breastfeeding, and, crucially, to ensure governments combat misleading advertising of substitutes such as formula. First, officials sought to remove language calling for governments to “protect, promote and support breast-feeding,” and another establishing restrictions on the marketing of food products that can harm young children, according to the report by Andrew Jacobs. That measure would have aimed to step up enforcement of the International Code of Marketing of Breast-milk Substitutes. That agreement has been in place since 1981, but advocacy groups like Save the Children have said the code is routinely ignored by manufacturers.

When US officials were unsuccessful in removing these passages, the US delegation moved to threaten Ecuador, which was set to formally introduce the measure, according to diplomats and officials involved in the talks.

Ecuador backed down in the face of the threats, and at least a dozen other nations, mostly poor countries in Africa and Latin America, were scared off of sponsoring the measure instead, in the wake of the threats against Ecuador.

Patti Rundall, policy director of the organization Baby Milk Action, told the New York Times:

“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on the best way to protect infant and young child health.”

It was Russia who ultimately sponsored the resolution, and reportedly faced no threats from the US – although the American delegation then stalled the proceedings by introducing a competing one, before the original resolution was finally passed.

The Trump Administration’s Story

The Trump administration has since denied those allegations. A State Department official told NPR that “media reports suggesting the United States threatened a partner nation related to a World Health Assembly resolution are false.”

A tweet from Trump called the story “fake news” from the “failing NY Times.” As other official statements also emphasized, Trump pointed out that many women can’t breastfeed “because of malnutrition and poverty,” and highlighted the need to preserve access to formula.

A spokesperson for the Department of Health and Human Services also argued that the “resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children.”

But Lucy Sullivan, executive director of nutritional advocacy group 1,000 days, said to NPR:

“The existence of infant formula is not in question here. Neither is the availability of infant formula. What is in question here is the way that these products are promoted and pushed and marketed by these companies and how these companies are interfering in public health policy.”

Nothing in the resolution would have stopped mothers from seeking out formula. Trump and other administration officials have tried to reorient the conversation around whether or not their policies can be characterized as anti-breastfeeding. But this misses the point entirely. While the administration hasn’t actively campaigned against breastfeeding (and no one is arguing that they have), they apparently did not hesitate to use unethical tactics to support the rights of formula manufacturers to aggressively market a product that is harmful to children when used as a substitute for breastfeeding.

Sullivan added:

“The formula industry is a multibillion-dollar industry. The fact that the Trump administration would resort to bullying tactics on this seems to speak to their sort of allergies, their opposition, to anything that restricts the marketing of these products.”

The Science of Breastfeeding

The science leaves little room for debate. Both the World Health Organization and the American Academy of Pediatrics recommends that mothers exclusively breastfeed their children during their first six months – which scientists say will make infants six times more likely to survive. Currently, only 22 percent of US mothers follow this advice. Researchers have estimated that over 900 lives and $13 billion would be saved each year if that number increased to 90 percent. And the problem disproportionately affects lower income families. Formula is even distributed through the US government’s WIC, or food stamp, program.

Breast milk even offers targeted antibodies when a mother is exposed to an infection, which can stop babies from getting sick. Infants that consume breast milk are less likely to develop a host of diseases and infections, including everything from asthma to bad colds to childhood cancers, as well as obesity and diabetes.

The exceptions to this rule are extremely rare. Only mothers that have been diagnosed with a handful of diseases, such as HIV, or who are actively using illicit drugs, are advised not to breastfeed.

Baby Formula and Public Health

Formula marketing in poorer countries has long stirred up controversy, given the lack of access to healthcare and education, and the higher risk for certain health issues. This is why the international code was put in place to begin with. The move followed public outcry in the 1970s against Nestlé’s marketing of its formula as superior to breastmilk, despite evidence showing that babies were sickened or even killed as a result of formula feeding. Even as the benefits of breastfeeding were being confirmed by research, companies like Nestlé were pushing the notion that formula was an easier and more nutritious, not to mention more western and modern, solution.

In poor regions, mothers would reportedly overdilute their expensive formula, which they had been convinced was necessary for their child, to make it last longer, often using contaminated water. Even with quality water, this practice can stop children from absorbing the formula’s nutrients. At the time, one official from the United States Agency for International Development attributed one million infant deaths each year to unnecessary reliance on baby formula and the resulting malnutrition and diarrhea. Following public outcry culminating in a global boycott, the International Code of Marketing of Breast-milk Substitutes was put in place.

The code explicitly prohibits formula companies marketing their product directly to mothers or healthcare professionals, specifically forbids misinformation about the risks and benefits associated with formula, and puts restrictions on advertising and free samples.

But an investigation by The Guardian and Save the Children earlier this year found that Nestlé and other companies were still showering doctors, midwives, and other healthcare personnel in the Philippines with gifts, such as free trips to conferences, meals, entertainment tickets, and even gambling chips, in violation of not only the international code, but also local laws.

They discovered that representatives from Nestlé and three other companies were a “constant presence” in hospitals, handing out pamphlets on “infant nutrition” with coupons and brand promotion, masquerading as medical advice. The staff at these hospitals were found to be recommending specific brands of formula in lists of “essential purchases” given out to new mothers. They also used Facebook advertising targeting young mothers.

Violation of the code has not been limited to the Philippines. Prior investigations have found similarly illegal marketing practices in other parts of the world. These kinds of violations are why the new resolution was deemed necessary.

This context is key to understanding why the World Health Assembly resolution is important, and to grasping what it really means for the Trump administration to defend the rights of manufacturers to freely market baby formula. No one is trying to limit access to baby formula for mothers who need it. Instead, advocates are trying to regulate highly aggressive marketing strategies in parts of the world in which access to science-based health education is in short supply. The move fits with a broader pattern of Trump administration policies that put the needs of special business interests ahead of public well-being.

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