By Robert James Parsons

GENEVA (Reuters Health) - Two major reports severely criticizing the infant food industry's practices in the US and Canada were released here this week during the World Health Organization (news - web sites)'s annual general assembly of all member states, the World Health Assembly.

Two independent, not-for-profit non-governmental organisations based their critique on the WHO's International Code of Marketing of Breast-milk Substitutes. Voted at the 1981 WHA (with only the USA voting against it), the code was designed to foster breastfeeding and end misuse of infant formula that still, according to WHO and UNICEF (news - web sites) calculations, results in some 1.5 million infant deaths per year.

One report, "Selling Out Mothers and Babies: Marketing of Breast Milk Substitutes in the USA," was presented at the meeting by Barbara Heiser of the Maryland-based National Alliance for Breastfeeding Advocacy. According to Heiser, none of the WHO's code on breast milk substitutes has ever been written into legislation in the US. In 1998, according to the report, the US government spent almost $2 billion buying infant formula.

Assailing aggressive advertising campaigns influencing both mothers and health care professionals "to adopt the view... that formula is equivalent to breast milk and that formula-fed babies do just as well as breastfed ones," the report dubs breastfeeding "a dying culture." As proof, Hesier notes that exclusive breastfeeding, recommended by the WHO for the first six months after birth, drops off sharply after only two weeks. By six months, only one in eight mothers is still exclusively breastfeeding.

Elisabeth Sterken of Canada's Infant Feeding Action Coalition is author of the second of the two reports criticising North American breastfeeding policies. Titled "Out of the Mouths of Babes: How Canada's Infant Food Industry Defied WHO Rules and Puts Infant Health at Risk," Sterken and colleagues point out abuses arising from similarly aggressive campaigns in Canada. These involve direct mailings and free infant formula sample distribution, reinforced by indirect targeting through advertising in parent and baby magazines.

"It is virtually impossible," she told Reuters Health, "to escape being targeted [by infant formula companies] once you're pregnant."

David Clark, legal officer for UNICEF's Nutrition Division, speaking to Reuters Health, hailed the US report as "a very good study of how the companies ignore the fact that the WHO code applies to all countries." He stated that there are "all sorts of violations you wouldn't see in other parts of the world," adding, "Companies try to limit the scope of the code to the developing world. Mothers and babies in North America deserve the same protection as mothers and babies everywhere else."

Mead-Johnson, which with about two-thirds of the market in the US came under particular scrutiny in the US report, expressed concern that they might be in violation of the code. Pete Paradossi, spokesman for the company, told Reuters Health that, although he had not yet seen the report, Mead-Johnson paid careful attention to such assessments and, when violations were discovered, acted promptly to correct them.

Both reports call on government public health officials to put child and maternal health ahead of commercial considerations and implement the code as public health policy. This would mean severely limiting the market for manufacturers of infant formula and supplementary foods, since the underlying principle of the code is "Breast is best."

On Friday, a resolution of the currently running WHA, aiming to broaden the scope of the code by creating a Global Strategy on Infant and Young Child Feeding, was sent back to the drafting committee following reservations expressed by numerous member states. It was feared that without specific clarifications the resolution as worded could lead to conflicts of interest between public health ministries and industry in the course of the strategy's implementation.