[Ip-health] New York Times: U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials

Thiru Balasubramaniam thiru at keionline.org
Sun Jul 8 09:37:24 PDT 2018


U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials

By Andrew Jacobs

July 8, 2018

A resolution to encourage breast-feeding was expected to be approved
quickly and easily by the hundreds of government delegates who gathered
this spring in Geneva for the United Nations-affiliated World Health

Based on decades of research, the resolution says that mother’s milk is
healthiest for children and countries should strive to limit the inaccurate
or misleading marketing of breast milk substitutes.

Then the United States delegation, embracing the interests of infant
formula manufacturers, upended the deliberations.

American officials sought to water down the resolution by removing language
that called on governments to “protect, promote and support breast-feeding”
and another passage that called on policymakers to restrict the promotion
of food products that many experts say can have deleterious effects on
young children.


When that failed, they turned to threats, according to diplomats and
government officials who took part in the discussions. Ecuador, which had
planned to introduce the measure, was the first to find itself in the cross

The Americans were blunt: If Ecuador refused to drop the resolution,
Washington would unleash punishing trade measures and withdraw crucial
military aid. The Ecuadorean government quickly acquiesced.

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The showdown over the issue was recounted by more than a dozen participants
from several countries, many of whom requested anonymity because they
feared retaliation from the United States.

Health advocates scrambled to find another sponsor for the resolution, but
at least a dozen countries, most of them poor nations in Africa and Latin
America, backed off, citing fears of retaliation, according to officials
from Uruguay, Mexico and the United States.

“We were astonished, appalled and also saddened,” said Patti Rundall, the
policy director of the British advocacy group Baby Milk Action, who has
attended meetings of the assembly, the decision-making body of the World
Health Organization, since the late 1980s.

“What happened was tantamount to blackmail, with the U.S. holding the world
hostage and trying to overturn nearly 40 years of consensus on best way to
protect infant and young child health,” she said.

In the end, the Americans’ efforts were mostly unsuccessful. It was the
Russians who ultimately stepped in to introduce the measure — and the
Americans did not threaten them.

The United States ambassador to Ecuador, Todd C. Chapman, left, in Quito’s
historical center with a guide, center, and the undersecretary of state for
political affairs, Thomas A. Shannon.CreditJose Jacome/EPA, via Shutterstock

The State Department declined to respond to questions, saying it could not
discuss private diplomatic conversations. The Department of Health and
Human Services, the lead agency in the effort to modify the resolution,
explained the decision to contest the resolution’s wording but said H.H.S.
was not involved in threatening Ecuador.

“The resolution as originally drafted placed unnecessary hurdles for
mothers seeking to provide nutrition to their children,” an H.H.S.
spokesman said in an email. “We recognize not all women are able to
breast-feed for a variety of reasons. These women should have the choice
and access to alternatives for the health of their babies, and not be
stigmatized for the ways in which they are able to do so.” The spokesman
asked to remain anonymous in order to speak more freely.

Although lobbyists from the baby food industry attended the meetings in
Geneva, health advocates said they saw no direct evidence that they played
a role in Washington’s strong-arm tactics. The $70 billion industry, which
is dominated by a handful of American and European companies, has seen
sales flatten in wealthy countries in recent years, as more women embrace
breast-feeding. Overall, global sales are expected to rise by 4 percent in
2018, according to Euromonitor, with most of that growth occurring in
developing nations.

The intensity of the administration’s opposition to the breast-feeding
resolution stunned public health officials and foreign diplomats, who
described it as a marked contrast to the Obama administration, which
largely supported W.H.O.’s longstanding policy of encouraging

During the deliberations, some American delegates even suggested the United
States might cut its contribution the W.H.O., several negotiators said.
Washington is the single largest contributor to the health organization,
providing $845 million, or roughly 15 percent of its budget, last year.

The confrontation was the latest example of the Trump administration siding
with corporate interests on numerous public health and environmental issues.

In talks to renegotiate the North American Free Trade Agreement, the
Americans have been pushing for language that would limit the ability of
Canada, Mexico and the United States to put warning labels on junk food and
sugary beverages, according to a draft of the proposal reviewed by The New
York Times.

During the same Geneva meeting where the breast-feeding resolution was
debated, the United States succeeded in removing statements supporting soda
taxes from a document that advises countries grappling with soaring rates
of obesity.

The Americans also sought, unsuccessfully, to thwart a W.H.O. effortaimed
at helping poor countries obtain access to lifesaving medicines.
Washington, supporting the pharmaceutical industry, has long resisted calls
to modify patent laws as a way of increasing drug availability in the
developing world, but health advocates say the Trump administration has
ratcheted up its opposition to such efforts.

The delegation’s actions in Geneva are in keeping with the tactics of an
administration that has been upending alliances and long-established
practices across a range of multilateral organizations, from the Paris
climate accord to the Iran nuclear deal to Nafta.

Ilona Kickbusch, director of the Global Health Centre at the Graduate
Institute of International and Development Studies in Geneva, said there
was a growing fear that the Trump administration could cause lasting damage
to international health institutions like the W.H.O. that have been vital
in containing epidemics like Ebola and the rising death toll from diabetes
and cardiovascular disease in the developing world.

“It’s making everyone very nervous, because if you can’t agree on health
multilateralism, what kind of multilateralism can you agree on?” Ms.
Kickbusch asked.

A Russian delegate said the decision to introduce the breast-feeding
resolution was a matter of principle.

“We’re not trying to be a hero here, but we feel that it is wrong when a
big country tries to push around some very small countries, especially on
an issue that is really important for the rest of the world,” said the
delegate, who asked not to be identified because he was not authorized to
speak to the media.

He said the United States did not directly pressure Moscow to back away
from the measure. Nevertheless, the American delegation sought to wear down
the other participants through procedural maneuvers in a series of meetings
that stretched on for two days, an unexpectedly long period.

In the end, the United States was largely unsuccessful. The final
resolution preserved most of the original wording, though American
negotiators did get language removed that called on the W.H.O. to provide
technical support to member states seeking to halt “inappropriate promotion
of foods for infants and young children.”

The United States also insisted that the words “evidence-based” accompany
references to long-established initiatives that promote breast-feeding,
which critics described as a ploy that could be used to undermine programs
that provide parents with feeding advice and support.

Elisabeth Sterken, director of the Infant Feeding Action Coalition in
Canada, said four decades of research have established the importance of
breast milk, which provides essential nutrients as well as hormones and
antibodies that protect newborns against infectious disease.

A 2016 Lancet study found that universal breast-feeding would prevent
800,000 child deaths a year across the globe and yield $300 billion in
savings from reduced health care costs and improved economic outcomes for
those reared on breast milk.

Scientists are loath to carry out double-blind studies that would provide
one group with breast milk and another with breast milk substitutes. “This
kind of ‘evidence-based’ research would be ethically and morally
unacceptable,” Ms. Sterken said.

Abbott Laboratories, the Chicago-based company that is one of the biggest
players in the $70 billion baby food market, declined to comment.

Nestlé, the Switzerland-based food giant with significant operations in the
United States, sought to distance itself from the threats against Ecuador
and said the company would continue to support the international code on
the marketing of breast milk substitutes, which calls on governments to
regulate the inappropriate promotion of such products and to encourage

In addition to the trade threats, Todd C. Chapman, the United States
ambassador to Ecuador, suggested in meetings with officials in Quito, the
Ecuadorean capital, that the Trump administration might also retaliate by
withdrawing the military assistance it has been providing in northern
Ecuador, a region wracked by violence spilling across the border from
Colombia, according to an Ecuadorean government official who took part in
the meeting.

The United States embassy in Quito declined to make Mr. Chapman available
for an interview.

“We were shocked because we didn’t understand how such a small matter like
breast-feeding could provoke such a dramatic response,” said the Ecuadorean
official, who asked not to be identified because she was afraid of losing
her job.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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