By Constance Ching
Constance Ching is a Technical Consultant on Code Advocacy and Implementation to the Alive & Thrive regional program in Southeast Asia, and former Program Manager of IBFAN-ICDC.
It all started in a little apartment in Geneva. It was the 70s. The Baby Killer scandal and the Kennedy hearing got the public to raise eyebrows about harmful marketing tactics of infant formula companies and the effect on the global decline of breastfeeding.
In October 1979, WHO, together with UNICEF held a historic joint meeting with the participation of government delegates, NGOs, BMS industry and public health professionals. It was the first time NGOs and industry were invited as participants with equal status as government delegates. The meeting was instrumental to the subsequent adoption of the International Code of Marketing of Breast-milk Substitutes (the Code) in 1981 by the World Health Assembly.
The NGO participants, whom Annelies Allain endearingly referred to as “breastfeeding people,” needed a place to stay as hotels were expensive. Allain, who was living in Geneva at the time, offered her apartment for accommodation. She could not have imagined it then, but that kind gesture would lead her on a path to become the Director and Founder of the International Code Documentation Centre.
Her apartment became a place to strategize on how to deal with industry’s influence. Urged by the NGOs to join the fight against corporations putting profits before babies, Allain set up the Geneva Infant Feeding Association (GIFA) as the base to liaise with UN agencies, and, later, NGOs from around the world formed the International Baby Food Action Network (IBFAN) at the WHO/UNICEF joint-meeting. IBFAN, which now consists of over 200 public interest groups, works globally to improve the protection, promotion and support of breastfeeding and optimal infant feeding practices through universal and full implementation of the International Code and relevant WHA Resolutions.
A few years after the International Code was adopted, it became clear that many countries were not going to translate the Code into national legislation. It was – and still is – difficult for many reasons: doing so requires expertise in the fields of law, marketing and public health (breastfeeding), and the industry applies constant pressure to weaken the efforts. Some countries’ ministries of health endorsed the Code as health policy that is not legally enforceable; hence, it could not be used to hold companies accountable.
“The Code is not a text one can simply copy and paste into national law or regulation,” Allain said. “It requires understanding of the issue, for example, how marketing affects breastfeeding; it needs legal precision of terms, and understanding of the national juridical context.” She and her colleagues realized it was necessary to train government officials and lawmakers in marketing and in enforceable regulations.
With the help of the Dutch government, the International Code Documentation Centre (ICDC) was formally set up in 1991 to mark the 10th anniversary of the adoption of the Code. Working as part of IBFAN, ICDC was based in Penang, Malaysia, and its staff collected and analyzed drafts of legislation, codes and other regulatory measures that aimed to implement the Code at national level. It held the most comprehensive collection of national laws and other measures in the world. It also published handbooks and guidelines on legal drafting and Code implementation. Since 1985, ICDC started publishing regular reports to track Code implementation status of countries. It maintained a worldwide database on Code violations and, isnce the early 1980s, continuously published findings on IBFAN global Code monitoring, openly naming and shaming companies for unethical tactics.
Together with the IBFAN network, ICDC participated actively in the World Health Assembly, advising Member States while at the same time rallying support to advocate for stronger Code-related resolutions. Examples include the complete ban on free supplies after seven years of lobbying, expanding the scope of the Code to cover new formula products, restricting marketing practices that undermine exclusive breastfeeding for 6 months, and addressing conflicts of interest in nutrition programs and policy.
Mostly done in close collaboration with UNICEF, ICDC served as an international training unit to conduct courses on Code implementation and Code monitoring. From 1991 to 2019, the organization trained over 2,000 government officials from 148 countries in drafting and strengthening Code-based legislation, Code monitoring and Code advocacy.
In 2020, ICDC transitioned its Code monitoring tasks to IBFAN’s regional and country offices. Marked with the continued concern that globalization has made multinational companies stronger and ever more influential, the transition aimed to empower countries to take up an active role in a citizen movement that seeks to hold the business sector accountable to the health of mothers and children around the world, and the rights of all consumers.
Arendt, M., & Allain, A. (2019). Annelies Allain: Pioneer of the International Code of Marketing of Breastmilk Substitutes. Journal of Human Lactation, 35(1), 15-20.
Sokol, E. J. (1997). The Code Handbook: A Guide to Implementing the International Code of Marketing of Breastmilk Substitutes. International Code Documentation Centre.