Research has clearly identified breastmilk as the ideal nutrition for optimal growth and development, with numerous health-protecting qualities for both mother and infant widely established.¹

It is also recognised that there are circumstances where breastmilk substitutes are medically indicated or the preferred choice for families. Whilst the promotion of breastfeeding is an inherent and essential component of practice for midwives and nurses caring for families during early infancy and childhood, we also have a responsibility to provide evidence-based education and support to all families regardless of infant feeding method.

Understanding and complying with the regulation of marketing of breastmilk substitutes supports both a positive breastfeeding culture, and accurate, clear information regarding breastmilk substitutes for the families who use them.

The ANMF advocate for strategies that promote a positive breastfeeding culture, and also respect and support families regardless of infant and child feeding choice. To this end, the ANMF recently responded to a consultation on the re-authorisation of the Marketing in Australia of Infant Formulas: Manufacturers and Importers (MAIF) Agreement, which is due to expire in 2021.

The Australian Competition and consumer Commission (ACCC) were reviewing a request they had received for the current MAIF Agreement to be re-instated for a further 10 years. In Australia, the MAIF Agreement acts as a code of conduct for industries manufacturing breastmilk substitutes such as formula, regulating their ability to market their products and interact with the public and healthcare providers.

This Agreement was adopted in Australia in response to the World Health Organization (WHO) International Code of Marketing of Breastmilk Substitutes (The Code), which aimed to protect the provision of breastfeeding. The Code recognises that there is a legitimate market for breastmilk substitutes where infants don’t breastfeed but also seeks to ensure that breastmilk substitutes aren’t marketed or distributed in preference to breastfeeding.

Our response to the ACCC highlighted several issues with re-authorisation of the MAIF Agreement. These included:

• The inconsistency of re-instating the Agreement for 10 years with the recently released Australian National Breastfeeding Strategy (ANBS), 2019 and beyond, which identified an immediate review of the MAIF agreement as a priority action area;
• The inadequacy of the current Agreement, as it only partially adopts The Code and hasn’t been revised to include any subsequent World Health Assembly Resolutions such as those relating to advertising toddler milk;
• The widening gap between the Agreement and The Code enabling formula producers to access and market to the public and health professionals via social media platforms; and
• The ineffective complaints handling process when a company is in breach of the Agreement.

Breastfeeding education for health professionals is widely available however, education and understanding about the use and regulation of marketing of breastmilk substitutes is lacking. Midwives and nurses are in the optimal position to ensure that families receive accurate, evidence-based information on infant and child nutrition.

The ANMF argued in our submission to the ACCC that, for midwives and nurses to perform this role, governments need to invest in transparent, independent research and education on the composition and use of breastmilk substitutes, as well as implement tighter restrictions on their marketing by manufacturers.

Achieving the changes required to ensure the MAIF Agreement complies fully with The Code will take time. Despite this, nurses and midwives can promote a positive breastfeeding culture and still support the proper use of breastmilk substitutes, by understanding and adhering to The Code and promoting the ANBS.

So what can you do?

• follow the national Breastfeeding Friendly Health Initiative, and the WHO, 10 steps to successful breastfeeding;
• don’t support industry marketing or messages;
• don’t accept gifts, samples or resources from industry representatives;
• don’t support the use of any one breastmilk substitute brand over another;
• make sure breastmilk substitutes aren’t advertised in your organisation; and
• seek out research on the use of breastmilk substitutes, which isn’t influenced by manufacturers, to inform your practice.

If you identify a breach of the MAIF Agreement, you can make a complaint to the Australian Government Department of Health at: www1.health.gov.au, so we can all keep the infant formula manufacturers honest.

To read the ANMF submission to the ACCC go to: anmf.org.au/documents/submissions/ANMF_response_to_ACCC_re_INC_application_MAIF_agreement_30_November_2020.pdf

Reference
1 Department of Health. Breastfeeding. (2020) Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-brfeedindex.htm