Unicef accused of forming alliance with baby food industry
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7254.132 (Published 15 July 2000) Cite this as: BMJ 2000;321:132
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Editor - There has been a strong pressure by Baby food companies on
UNAIDS and UNICEF to take a lead in the Prevention of Maternal To Child
Transmission (MTCT) of HIV pilot projects in Africa . 1,2.
In the context of human rights (the right to live) counselling a
woman into knowing her HIV status, and then leaving the HIV positive woman
without a back-up support, Anti-retroviral treatment, prophylactics
against Tuberculosis or Pneumocystis carinii, socio-economic uplifted or
psychological support is inhumane.
The HIV positive woman is considered mechanical. There is only a
token assistance for these HIV positive women in the MTCT projects. The
socio-cultural and psychological component of the projects have been
completely forgotten.
She can and will die of AIDS, but the pilot projects believe that the
community, orphanage or yet another funded project can take her offspring.
She is left helpless and even the motherly human nature imbibed in her
culture i.e Breast-feeding; is denied to her before she dies. Total
disempowering a woman.
The additional risk of an HIV positive mother transmitting HIV is
15%, and that 85% of breast-fed infants will not necessarily be infected
with this route. In fact, only 30% of infants borne to HIV pregnant woman
in absence of short course AZT therapy will be infected either prenatal,
intranatal or postnatally through breast feeding.3 Exposing all the
infants born to HIV positive women to artificial formula exposes them (and
to those who will receive the message as spill over) to hazards of variois
diseases such as diarrhoea and pneumonia. These hazards are in no way less
fatal than AIDS itself. It is known that the risk of not breastfeeding in
the first 2 months of life carries a six fold increase risk from dying of
infectious diseases.4
Supplying artificial milk in these pilot projects, which are heavily
funded, is not ethical and sustainability cannot be assured. Moreover,
promoting formula in areas where there is no research to prove its
benefits is unethical. A pooled analysis on the effect of breastfeeding on
infant and child mortality due to infectious diseases in less developed
countries have clearly shown the over-whelming benefits of breast feeding.
4
The surge of orphans and street children, child sexual abuse and
similar social issues are related to the absence of the mother. It is
universally accepted and more so in Africa, that the mother is the one who
nurtures the baby.
The mother to child transmission (MTCT) programmes in Uganda and
Tanzania for example, concentrate on giving an extra short course of AZT
which decreases the rate of MTCT of HIV by 37% or nevirapine during
labour and a single dose to the neonate. The original ACTG 076 trial
conducted in Thailand used a longer course and was twice more effective
but is not used in Africa because of cost limitations. 5
The administration of these drugs is preceded by what is called VCT
(voluntary counselling and testing). This counselling is rather
directional. Breast-feeding is discouraged and infant formula promoted.
The HIV positive woman who is exposed to this new venture by enthusiastic
counsellor is obliged to accept alternative to breast feeding and is made
to believe that refraining from breast-feeding is a guarantee from
infecting the infant. This promotion involves supplying free replacement
formula to the project for 2 years as is the case in Uganda. During the
counselling the hazards of formula feeding are not clearly indicated.
In countries where safe drinking water is available to only 15-20% of
rural population, and the resources of counselling and repeated testing is
scare, this programme is not sustainable and ethical.
The UNICEF justifies the use of less effective short course therapy
for prevention of MTCT of HIV because of financial constraints, but
supplying formula is not considered financial constraint. Given that 85%
of infants will not be infected through Breast-feeding, then isn't
Breastfeeding a better option in terms of financial resources and human
rights?
Treatment of the mother with anti-retroviral drugs (ART) is also
argued to be expensive, and that these African countries do not have the
facilities to monitor and control the drug delivery. Why shouldn't UNICEF
consider the mother to have a right to live? They should be able to assist
in capacity building and equipping with facilities to monitor drug usage
for HIV/AIDS instead of supplying 2 years of less than optimal drugs for
MTCT and the provision of free formula.
The current pandemic of HIV in Africa has become a boon for Baby Milk
companies who have vested interests in the MTCT of HIV programmes. It is
even more shocking to note that UNICEF who has been a strong supporter of
breast-feeding is being bought away by these companies. 1,2.
Can the human rights observers see that this "disempowering of women"
and exploitation of Africa is not continued?
Dr. Karim P.Manji (breastfeeding supporter),
Senior Lecturer,
Muhimbili University College of Health Sciences,
P.O.Box 65001,
Dar-es-Salaam,
Tanzania
References
1. Rundell P. Partnership with TNCs-an attempt to compartmentalise
ethics? World Vision 2000; 10 (summer):10-15.
2. Yamey G. BMJ News 2000; 321:132.
3. Leroy V, Newell M L, Dabic F, Peckham C et al. International
multicentre pooled analysis of late post-natal mother to child
transmission of HIV-1 infection. Lancet 1998; 352:597-600
4. WHO collaborative Study team on the role of Breast-feeding on
prevention of Infant Mortality. Effect of Breastfeeding on Infant and
Child mortality due to infectious diseases in less developed countries: a
pooled analysis. The Lancet 2000; 355: 451-455
5. Centres for Diseases Control. Administration of zidovudine during
late pregnancy and delivery to prevent perinatal HIV transmission,
Thailand. 1996-1998. MMWR 1998; 7(8):151-154
Competing interests: No competing interests
Dear Sir, Madam
The article, " Unicef accused of forming alliance with baby
food industry" (BMJ 321 15 July) raises important issues
about the UN/NGO/Industry partnerships.
As members of the International Baby Food Action Network we
greatly appreciate the courage that UNICEF - more than any
other UN agency - has shown over the last two decades in
speaking out about
corporate practices which undermine infant health. A key
factor has been UNICEF's understanding of the influence that
inappropriate
sponsorship/partnerships can have. We are pleased that
Carol Bellamy, UNICEF Executive Director, has confirmed (BMJ
electronic responses 18 July 2000) that UNICEF will
continue to refuse donations from manufacturers of infant
formula which violate the International Code of Marketing
of Breast milk Substitutes and subsequent WHA resolutions,
but we do have other key concerns. For example,
1 What about manufacturers of other breastmilk
substitutes, bottles and teats or the new ‘medical’ foods?
All products which are promoted in ways which undermine
breastfeeding?
2 Are partnerships with corporations really the best way to
find appropriate solutions to HIV/AIDS? Surely the world
health community can research this problem without having to
beg from companies who will inevitably look for wealth
generating answers? There will never be a commercial
incentive to research exclusive breastfeeding, yet recent
research has shown that it may prove to be a more
appropriate way to combat HIV transmission.
3 How will UNICEF judge Code compliance of a partner or
other company? Even in the face of the most compelling
evidence, (ref BMJ 321 1 July ) companies will argue their
innocence. Rightly or wrongly, the public expects the UN
to provide an independent and authoritative view.
4 How will UNICEF protect its right to speak out? In
January this year at WHO's Executive Board meeting, IBFAN's
intervention included a comment exposing a report by a baby
food company which claimed that it followed the Code.
UNICEF (and other agencies) had been outspoken in its
criticism of the report and had given permission for its
critique to be made public WHO, which is actively pursuing
partnerships with industry (BMJ 320 20 may 2000), pressured
us to remove this section completely. We refused and said
that rather than edit it, we would hand it to Executive
Board members and the media. In the event the entire speech
was delivered as drafted. However, the critical piece about
the company was deleted from the provisional summary record.
If we are to have informed debates about issues which affect
public health so profoundly, surely all of us working in
the interests of public health should be encouraged to
express our concerns frankly? As corporate/NGO/UN
partnerships increase this is less and less likely to
happen.
Patti Rundall, Policy Director, Baby Milk Action
prundall@babymilkaction.org
Nancy Jo Peck, Scientific Advisor, Geneva Infant feeding Association
philipec@iprolink.ch
Competing interests: No competing interests
To the Editors and Readers of BMJ:
I write in reference to the article, “UNICEF accused of forming
alliance with baby food industry,” (BMJ, 14 July).
Let me get right to the crux of the matter: It is important that your
readers know that UNICEF does not accept donations from manufacturers of
infant formula whose marketing practices violate the International Code of
Marketing of Breast Milk Substitutes and subsequent WHA resolutions.
Moreover, UNICEF stands firmly behind the Code and will continue its long-
standing support for breastfeeding programs
world-wide.
It is true that over the past few months there has been considerable
discussion within UNICEF regarding our relationships with the corporate
community, including infant formula manufacturers. This internal
discussion emerged principally because UNICEF is one of the co-sponsoring
agencies of UNAIDS and has, at the request of the UN Secretary-General,
been among those involved in discussions with five large pharmaceutical
companies on the possibility of obtaining a variety of drugs to fight
HIV/AIDS at discounted prices on behalf of developing countries. One of
these companies is widely viewed as violating the Code.
Some inside and outside of UNICEF have misinterpreted our involvement
in these UNAIDS-led discussions as a sign that we are weakening our
support for breastfeeding and the Code. Nothing could be further from the
truth. In fact, UNICEF believes that in the face of AIDS our support for
breastfeeding must be strengthened, not diminished.
Nonetheless, where we think a company – any company – may offer a
compelling solution to a crucial child health problem such as HIV/AIDS, we
will not shy away from exploring how to get that company working on behalf
of children and women. At the same time, UNICEF will uphold its support
of the Code and will continue to publicly call violators of the Code to
account.
Are the issues complex? Yes. Is the growing calamity of HIV/AIDS
forcing us all to consider new approaches to our work? Absolutely.
That’s why the spirited debate within UNICEF. But regardless of our soul-
searching on how best to navigate through the sometimes conflicting policy
issues raised in part by AIDS, UNICEF remains resolutely committed to
breastfeeding and the many benefits it provides to both mother and child.
At the same time, UNICEF recognizes that mothers infected with HIV face an
agonizing dilemma on how best to feed their infants and strongly supports
the efforts of researchers to better understand this crucial area of
transmission.
Finally, as has been the case throughout the ten years since the
ratification of the Convention on the Rights of the Child, UNICEF will
strive to base its actions and programs on the best interests of the
child.
Sincerely,
Carol Bellamy
Executive Director
UNICEF
Competing interests: No competing interests
Infant Feeding Options revert to Breast Feeding offsprings of HIV infected mothers
Dear Editor,
It is now 10 years since the first trail of these articles was
produced.
It is heartening to note that the WHO has come with new
recommendations and rapid communications which were announced in November
2009 and recently published in February 2010.
The main discussion is still around infant feeding options. It is
well known that the criteria of AFASS (Affordable, Feasible, Acceptable,
Sustainable, Safe ) along with the additional criteria of having access to
health care that offers comprehensive health services.
The reverting back to recommend breast feeding for at least 12
months, with all other inricate ARV options to mother and baby, indicate
that the best nutrition for a baby is mother's milk, whether HIV or no
HIV.
Now than ever, WHO and UNICEF should not feel shy top acknowledge from
evidence that the so called AFASS does not exist in developing countires
and that we need to promote, protect, and encourage Breast Feeding.
Additionally, to implement the necessary legislations on the Breast Milk
Substitutes marketing and enforcing the regualtions on on the Code.
There is also need of the local communities to be able to bring fore
their experiences in order to druve the agenda of Breast Feeding.
Karim Manji
Competing interests:
None declared
Competing interests: No competing interests