The UK Royal College of Paediatrics and Child Health (RCPCH) announced in October, 2016, its decision to continue to accept funding from manufacturers of breast milk substitutes (BMS). 1 This decision raises serious concerns about the college’s impartiality and sets a harmful precedent for other health professional organisations. In order to protect the credibility and the authority of professional organisations that contribute to the formulation of public policy, they need to adopt codes of conduct and practices that protect their independence from vested interests.
The RCPCH decision contravenes the spirit and aim of the International Code of Marketing of Breast-milk Substitutes (also known as the International Code), adopted by the World Health Assembly (WHA) in resolution WHA34.22, and subsequent relevant WHA resolutions. Other resolutions include WHA69.9,2 adopted in May, 2016, in which WHO’s Member States welcomed the new WHO Guidance on Ending Inappropriate Promotion of Foods for Infants and Young Children (also known as the Guidance).
The RCPCH decision creates clear competing interests. The International Code (article 7.3) and associated resolutions (WHA49.15 and WHA58.32) prohibit the acceptance by health workers of financial or material inducements (including contributions to fellowships and research grants for health workers, as well as contributions toward their participation in study tours or attendance at professional conferences) and call for avoidance of conflicts of interests. Additionally, recommendation 6 of the Guidance unequivocally states “…health professional associations should not…accept equipment or services from companies that market foods for infants and young children, accept gifts or incentives from such companies” or “allow such companies to sponsor meetings of health professionals and scientific meetings”.3 The prohibition on acceptance of any funding or other services, gifts, and incentives is unconditional. As such, the RCPCH’s decision is in direct violation of the Guidance.
The RCPCH states that it has safeguards in place and will conduct an internal due diligence process regarding potential donors.1 Factors to be considered in assessing the acceptability of funding include the reputation and credibility of the donor, its product impact and reputation, as well as the extent to which the donor’s corporate policies and practices are aligned with the goals, visions, and values of the RCPCH. The RCPCH also states that it supports the International Code. The due diligence process would therefore need to ensure compliance of potential donors with the International Code. However, we firmly believe that health professional associations are not in a position, nor are they qualified, to assess and determine which companies comply with international policy and guidance documents related to the International Code.
Acceptance of funding or other incentives, however conditional, creates a sense of obligation and loyalty to the company in question. This is exactly what health professional associations, including the RCPCH, should avoid. They have a moral obligation to protect themselves and their members from inappropriate promotion of BMS in all forms, however indirect, and from resulting competing interests in health-care settings. Furthermore, health professional associations have a moral obligation to respect and protect women’s and children’s rights to be free from all forms of inappropriate marketing practices.
Notably, the RCPCH sets an unfortunate precedent for other national paediatric associations. WHO strongly encourages its Member States to support and abide by the International Code and WHA resolutions. We are acutely aware of and deeply concerned about the continued inappropriate promotion of BMS in health facilities, and the effect this has on breastfeeding practices and infant deaths. The 2016 Lancet Series on breastfeeding highlights that the BMS industry is likely to be worth upward of US$70 billion by 2019.4 By contrast, improving breastfeeding practices would annually save the lives of 820 000 children under the age of five, prevent thousands of women dying of breast and ovarian cancer, cut rates of obesity and type 2 diabetes, and improve performance on intelligence tests in people who were breastfed.5 The role and responsibilities of health professional associations, both globally and nationally, are pivotal to worldwide efforts to stop health systems from being conduits for marketing of BMS, even inadvertently.
The RCPCH has forfeited an opportunity to be a standard bearer and champion for children and young people globally and to exemplify implementation of the WHO International Code and Guidance. Instead, RCPCH is sending a strong message to its members and others worldwide that benefitting from funding from BMS manufacturers is acceptable. Unless this decision is reversed, the statement by its president that the RCPCH supports “WHO Guidance…on the marketing of breast milk substitutes”6 and considers the promotion of BMS over breastfeeding unacceptable, is clearly misleading and contradictory.
The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the views, decisions, or policies of WHO. We declare no competing interests.
- Thornton, J. Paediatricians vote for college to continue accepting funds from infant formula companies. BMJ. 2016; 355: i5827
- WHO sixty-ninth WHA. Ending inappropriate promotion of foods for infants and young children. WHA69.9. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R9-en.pdf; May 28, 2016. ((accessed Jan 30, 2017).)
- WHO sixty-ninth WHA. Maternal, infant and young child nutrition: guidance on ending the inappropriate promotion of foods for infants and young children. A69/7 Add.1. http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_7Add1-en.pdf; May 13, 2016. ((accessed Jan 30, 2017).)
- Rollins, NC, Bhandari, N, Hajeebhoy, N…, and on behalf of The Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices?. Lancet. 2016; 387: 491–504
- Victora, CG, Bahl, R, Barros, AJ…, and for The Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387: 475–490
- Modi, N. The RCPCH and funding from infant formula companies. BMJ Blogs. Oct 31, 2016; http://blogs.bmj.com/bmj/2016/10/31/neena-modi-the-rcpch-and-funding-from-infant-formula-companies/. ((accessed Jan 30, 2017).)