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Forget the WHO Code. It’s The Street Code That Undermines Mothers in Detroit

It’s the 33rd anniversary of the international effort to curb unethical infant formula marketing practices. But you wouldn’t know it from the streets of Detroit.

By: Kimberly Seals Allers

If you thought we were past the days of blatantly egregious infant formula marketing and that hospitals, doctor’s offices and subtle messaging and innuendo were the final frontiers of removing unethical marketing practices, I implore you to drive through the streets of Detroit. As you ride by store after store, you will see large colorful signs with oversized cans of infant formula on them, advertising free pizza, free diapers or the chance to win a free television if you just spend your WIC dollars at their store. Of course, the main WIC item being advertised is the powdered infant formula cans, but I’m sure they will take the money for your smaller priced items too.  This is street marketing at its worst.

Shouldn’t someone call the World Health Organization? Today marks the 33rd anniversary of the World Health Organization (WHO) adopting the International Code of Marketing of Breast-milk Substitutes. Since then the Code has been used a benchmark to end unsavory marketing practices.  More than 160 countries and territories (the U.S did not at the time) agreed to take steps to implement the Code, which specifically prohibits marketing formula directly to the public. The American Academy of Pediatrics adopted a policy stating that the Academy would terminate the support it received from any company which promoted its products (infant formula) directly to the public.

Not to rain on any anniversary parade, but the WHO code has its own problems, lack of enforcement being one of them, but also in far too many communities, WHO-compliant activism (or lactivism, depending on who you ask) just doesn’t reach the street level. And many communities, like Detroit, are infested with street-level infant formula marketing that is off the radar of established activist and monitoring circles but adversely impacting the most vulnerable infants. The prevalence of such an insidious marketing ploy was highlight in the recently released, micro-documentary by the Black Mothers Breastfeeding Association in Detroit.

“The WHO Code is great but it doesn’t reach the community level where the real abuses are taking place against those who are the under financial pressure and under-resourced, ” says Kiddada Green, founder and executive director of BMBFA.

Local retailers likely know nothing of the Code and local health authorities are not in the business of enforcement. But the consequences are too dangerous to ignore. When formula is advertised with perks, it creates the appearance that mothers who breastfeed are missing out on free items that their families need too. Free diapers, free wipes, free pizza for your dinner and maybe even a new TV.  Under new WIC regulations, breastfeeding mothers, get more food items than formula feeding mothers, but when you drive down the street and store after store offer necessities as freebies for making your infant formula purchases at their store, the message is clear: Formula feeding pays off.

That’s bad news for the public health of low-income communities where high rates of infant mortality linger. In Detroit, the African American infant mortality rate is 16% percent compared to 6% for white infants in the state.  High rates of Type II diabetes and childhood obesity haunt our communities. Breastmilk has been linked to reducing the risks of these illnesses.

And while the breastfeeding movement has waged an impressive onslaught against the free distribution of infant formula bags in hospitals (and rightfully so as hospitals are ground zero for infant feeding) , the reality is after a two or three day stay, the majority of a mother’s infant feeding experience happens in her community. Mothers’ in Detroit with a positive initial breastfeeding experience are discharged into a minefield of daily assaults of feeling like she is missing out on financial benefits for her family.

Women are consistently set up for failure when we focus on hospitals only and ignore the reality of their day-after-day community environment. This has to stop.

We cannot prey on the economic pressures of all mothers by aligning giveaways with fake milk that has been proven to increase the risk of diarrhea, ear infections and diabetes.  We cannot sell out our babies’ health for a pizza. Nor can we stand by while others with authority to stem this practice do and say nothing.

I’m talking about WIC. As part of WIC’s increased efforts to encourage breastfeeding nationally, there should be concerted effort to create simple marketing standards and let local retailers know that continuing such practices will prevent them from receiving WIC payments. I don’t expect a World Assembly-worthy document but simple guidelines by WIC could produce the one thing  that 160 countries and the 33 years of the WHO code has been unable to produce-teeth. Accountability and enforcement. This can be done with punitive measures and it can send powerful ripple effects in communities where retailers are heavily reliant on WIC customers for their business revenue.

 In California the local WIC has stepped in to end incentives for using infant formula. The state WIC program there implemented guidelines on what WIC authorized vendors can and cannot give out as incentives to WIC participants. California WIC also created a Local Vendor Liason position, putting manpower behind making quarterly store visits to ensure compliance. Every mother deserves what California mothers get–a fair shot.

The WHO Code was designed to protect the most vulnerable. But in America, the most vulnerable are often using WIC services–in fact, WIC currently serves 53% of all infants born in the U.S. Infant formula companies don’t have to resort to the infamous “nurse” uniforms, they simply get a WIC contract and WIC (at least in the state of Michigan) allows the unethical marketing on the street. This has to stop (calls and emails to Michigan WIC representatives were not returned).

We have tried to end unethical infant formula marketing from a top down, worldwide approach. Now, with the health of so many mothers and infants on the line, it is time for a street-up approach. The Motor City is a good place to start.

To watch BMBFA’s mini documentary, click here.

6 Responses to “Forget the WHO Code. It’s The Street Code That Undermines Mothers in Detroit”
  1. Alicia says:

    I agree with your position, but you might want to double check the stated numbers for infant mortality rates. It seems they should be .6% and 1.6% instead of 6% and 16%.

  2. Excellent! You’re exactly right. There are aspects of the Code I truly value but there are aspects and approaches for advocating for the Code that are lacking in certain contexts. Yes, it is a problem for formula brands to market directly through health care providers and that needs to be addressed, but that isn’t even the biggest struggle. Within the context of developed countries where the most vulnerable to predatory marketing still have access to safe and clean water, the issues really are more along the lines of free pizza. It isn’t the only way, of course, but involving WIC and putting an end to incentives tied to formula for WIC participants would be a huge step in respecting mothers and the challenges this particular vulnerable group face.

    Thank you for such a thoughtful post.


  3. Kelley says:

    Preach! A totally doable and NECESSARY thing. How to best pressure WIC?

  4. Great article. Thank you for exposing this exploitation by neighborhood stores in Detroit.

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