An international marketing code for formula milk, intended to foster global cooperation among governments, industry, and aid agencies, has instead been mired in three decades of often bitter dispute, claims a child nutrition expert in the Archives of Disease in Childhood.
As long as hostilities continue, improvements in maternal, infant, and child nutrition will be less likely, says Professor Stewart Forsyth, formerly of NHS Tayside.
Professor Forsyth has published widely on the benefits of breast feeding and collaborated with formula milk companies on research.
The Thirty Fourth World Health Assembly adopted the fourth draft of the International Code of Marketing of Breast Milk Substitutes in May 1981 as a minimum requirement to protect and promote appropriate feeding for infants and young children.
Although voluntary, the implementation of the 11 articles of the code, which range from marketing and distribution, through quality standards, to national government responsibilities, is closely monitored by the World Health Organization.
At the time of its inception, it was envisaged that the code would provide a framework for governments, UN bodies, aid agencies, specialists, consumer groups and industry to cooperate fully, says Professor Forsyth.
But instead, he writes: "There has been an unrelenting series of disputes, predominantly relating to alleged violations of the code, which have provoked high profile acrimonious exchanges, boycotts, and legal proceedings."
Crucially, there is a lack of official independent information on the validity or otherwise, of these claims and their outcomes, he adds.
The self regulatory national governance arrangements for the code have lacked transparency and clearly defined responsibilities, he contends.
"It is probably not surprising that each of the components of this self regulatory structure continue to manifest aspects of self interest, and this is likely to continue in the absence of an 'ombudsman' or independent body with the authority to arbitrate," he writes.
Self appointed monitoring groups, which have stepped into the breach, have been hampered by insufficient access to all the relevant information and an approach that is unlikely to inspire the confidence of all the players involved, he suggests.
International accountability also potentially lacks transparency and consistency, he contends, especially for issues that cross national and continental boundaries.
"The controversy that has bedevilled the code for 30 years is almost entirely limited to matters of interpretation and compliance," he writes. "However, because these issues have been so protracted it has led to an atmosphere of mistrust that has now become embedded between key agencies."
It is time to "replace current hostilities with effective national and international governance," he says.
Journal
Archives of Disease in Childhood