by Karen Gromada
April 07, 2009

If you’re a new parent or a health professional caring for new parents or their children, you’ve probably heard of the name Medela. Chances are breast pumps—not infant-feeding-bottle systems—come to mind when you hear the company’s name. However, Medela has recently come under scrutiny for its lack of compliance with the International Code of Marketing of Breast-Milk Substitutes. At the center of the controversy is Medela’s marketing of infant-feeding-bottle systems, which the company calls Breastmilk Bottle sets.

Fewer parents and health professionals are familiar with the International Code of Marketing of Breast-Milk Substitutes, which is also referred to as the Code or the International Code. (You may also hear some call it the WHO Code.) The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) prepared the Code for review and vote by the World Health Assembly (WHA) in 1981. Since then several subsequent WHAs have passed related resolutions that revised or amended the Code.

Those who have heard of the Code often think its aim is to ban breast milk substitutes, such as infant formula but that is not so. Rather, the Code focuses on the practices used to market breast milk substitutes/formula, other commercial “baby” foods, and feeding equipment that target infants and very young children in order to protect the health of these vulnerable populations. The idea is to allow parents to make valid informed infant-feeding decisions without the pressure of corporate product promotion “hype.”

Yes, promoting and supporting breastfeeding is an important aspect of this, but the Code recognizes the need for breast milk substitutes in certain situations. However, in spite of the growing body of research evidence reinforcing breastfeeding and human milk as normal feeding for human beings, mass production of breast milk substitutes during the last half century has resulted in marketing practices that have caused women to doubt both their ability to breastfeed and the value of their milk for their babies. (Unfortunately, Mother Nature never counted on the need for a marketing plan—or a marketing budget.)

So what has the Code and its concern with infant-feeding marketing practices got to do with Medela? The Code does not cover breast pumps or breast milk collection containers, so Breastmilk Bottles are not the issue. The scrutiny is the result of an advertising expansion in the last year of the collection container in conjunction with the company’s feeding nipple, creating an infant-feeding system. And the Code definitely does cover the marketing of “feeding bottles and teats (feeding-bottle-nipples)”.

In addition, the Code warns against marketing practices that idealize feeding a baby with any product, whether food or feeding equipment, that is not at breast. This is another area where criticism has been leveled at Medela. About the time the company expanded its pump rental program to include large retail outlets, such as Babies-R-Us (without employee “how to” training), it also introduced a “giveaway” as a promotional gimmick to market its Breastmilk Bottle plus nipple as an infant-feeding system. Although the promotion appears to have expired, consumers may still “join the community” to be notified of future promotions. Shades of infant formula company parent “clubs”!

According to a Medela position statement issued not long before the giveaway, the company has chosen to interpret the Code in its own way. A recent addendum to that position acknowledges that “although it is painful” for the company they still realize their “activities bring Medela in a conflict with the current interpretation of the WHO Code with regard to the marketing of bottles and teats.”

Since the company’s reiteration of its decision to continue with the direct marketing of the breast milk bottle and nipple as a feeding system, the International Lactation Consultant Association (ILCA) and its affiliate the United States Lactation Consultant Association (USLCA) published an updated advertising policy, informing its members that the Medela Code violations meant the company was not eligible to exhibit at the organization’s July conference nor to advertise in the Journal of Human Lactation. ILCA’s policy update applies to all of its state, regional and local affiliates. However, it also leaves many lactation consultants and breastfeeding advocates in a quandary as to how to handle the ethical issues of advising parents about product issues, handling independent or hospital rental/retail stations, accepting conference exhibit fees and so on.

A question many of us have is “Why?” Why push the envelope over what seems a minor, and easily fixable Code violation? And why now? Many wonder about the timing. Did the company wait until it had what it considered a solid “market share” of the breast pump rental and sale market? That thought has some smaller breast pump rental stations and retailers feeling rather beat up and used.

Again, why? I can’t say for sure, but a “chi-ching” is ringing in my ears…