What really happened with the breastfeeding scandal in Geneva

After the fire bombings leveled Tokyo in the Pacific War, my father-in-law watched his parents bury his infant sister, who starved to death. His mother, malnourished in her poverty, had no breast milk to give. Formula could have saved his sister’s life and his mother a lifetime of guilt.

It is a shocking and sad sign of our times that the Trump administration finds itself excoriated this week for taking a step toward helping poor women in similar situations.  

{mosads}U.S. delegates to the World Health Organization in Geneva three months ago stand accused of greedy motives for seeking to expand information about breastfeeding alternatives. They were accused of not caring about women and children. They were accused of threatening a poor country’s national security to funnel billions of dollars to U.S. corporations.

What really happened is that a U.S. delegation, including women who were experienced breastfeeding advocates and savvy negotiators, bested the entrenched interests of a powerful activist lobby in a fair fight and for good reasons. As the New York Times accurately reported, this “stunned” global health officials who had gotten all too accustomed to the status quo, including the previous U.S. administration’s reluctant acquiescence to the 2016 version of the resolution.

The trouble began when a small country made a negotiating faux pas. Ecuador decided to sponsor the biennial breastfeeding resolution that long had been informed by a cadre of breastfeeding activists seeking to ban baby formula.

A U.S. negotiator from the Department of Health and Human Services, said her colleagues reached out to their Ecuadorian counterparts months before the negotiation but they did not return any of the phone calls or emails. As the talks drew near, Washington asked its ambassador in Quito to deliver its concerns.

Complicating the Ecuadorian strategy was the fact that Vice President Mike Pence would be on his way to Quito in just a few weeks to sign an important deal that included military aid. Ecuador decided to drop sponsorship of the resolution.

Alma Golden, a pediatrician at the talks who spent years teaching and advocating on behalf of nursing infants, told me that Ecuador’s original draft was just too extreme. The USAID deputy assistant administrator spent years attending to indigent mothers. When mothers can’t breastfeed and don’t have formula, they turn to dangerous options such as rice water. One mother came to her with 7-month-old twins who were severely dehydrated, developmentally delayed, and had a horrifying skin condition. “Mothers have the right to know there are safe, healthy alternatives when they need them,” she said.

She called the resolution’s final text “balanced” — strongly endorsing breastfeeding and allowing countries to give mothers information about alternatives. 

Another U.S. negotiator told me she relied on infant formula when her son was born. A food industry standards expert, she said that trade and corporate considerations didn’t enter the U.S. negotiation; rather, it was about addressing the shortcomings of a 37-year-old WHO guidance on child nutrition.

That guidance, or code, virtually bans baby formula and dissemination of information about it. It originally was meant to correct far too little international emphasis on breastfeeding at the time.

The United States also targeted a WHO/UNICEF guide that says  “any promotion of complementary foods for infants less than 6 months of age is prohibited by the code.” That is the same complementary formula that kept the U.S. negotiator’s son alive, and that could have helped Dr. Golden’s patients.

Many assume that activists always have good intentions and governments never do. The reporter who broke the story likely thought the baby formula story fitted into his series of stories on corporate interests regarding obesity, trans fats, and sugary breakfast cereals; that may be why he missed the substantive debate. He is not alone, and his story hews to that of the United Kingdom-based Baby Milk Action version of events. The group’s leader, Patti Rundall, shares an anti-corporate worldview and is the only source named in the story.

Rundall said her goal at this year’s negotiation was to expand the code even further to include older children and to get WHO to pay for its enforcement in national laws and policies. She said the Americans thwarted 40 years of global consensus, but the facts don’t bear that out.

Not a single Western country has fully implemented the code, including the United Kingdom. After 40 years, only 35 countries have done so, and all of them are poor countries where women need information and access to nursing alternatives the most. Even with low compliance and lack of consensus for the code, nations have increased exclusive breastfeeding and rates doubled across 20 priority countries between 1990 and 2014.

Completing the triad of complaints was the disgruntled Ecuadorian negotiator, a colleague of the one who had refused to return American phone calls last spring. She told two American negotiators I interviewed that baby formula should be available only by a doctor’s prescription.

In the end, Russia took over sponsorship of the resolution and closed the deal. Five minutes into the final WHO ceremony, the final version was hailed with much applause as a great success. There is no indication it was a disappointment.

Moving forward, we can hope that this controversy will open up some space for more informed debate and less point-scoring in future deliberations. It is incumbent on people in the field to tell the story in all its complexity. Women and children deserve such attention because their issues, and their lives, are vitally important. And sometimes the guys in white hats are women from the U.S. government.

Susan Yoshihara, Ph.D., has taken part in United Nations negotiations on maternal and child health since 2006 as a delegation member and civil society participant. She is senior vice president for research at the Center for Family and Human Rights in Washington.