UNICEF Executive Director Carol Bellamy's
Letter to the Editor on the subject of preventing the spread of HIV/AIDS
through breastfeeding
To the Editor:
Regarding your story "As UNICEF Battles Baby-Formula Makers, African
Infants Sicken" (Dec 5):
Your story - even the headline - wrongly implies that UNICEF has been
doing little to prevent mother-to-child transmission of HIV in Africa,
instead spending most of its time sparring with the infant formula industry.
Nothing could be further from the truth. Not only does your article
fail to acknowledge that UNICEF is leading the way in addressing mother-to-child
transmission, we were disappointed to find a number of other striking
omissions.
First and foremost, the article fails to present a full explanation
of why UNICEF so strongly supports breastfeeding. The simple fact is
that exclusive breastfeeding can save lives - as many as 1.5 million
a year, according to the World Health Organization. Yet the article
omits this fact and the large body of scientific evidence that backs
it up. The story also leaves out important research showing that formula-fed
infants are four to six times more likely to die of disease than breast-fed
infants (in part because formula must be mixed with potentially contaminated
water and because it does not build the immune system as well as breastmilk).
And while the article does mention that over the last twenty years as
many as 1.7 million children contracted HIV through breastfeeding and
died of AIDS, it does not mention that in the last ten years alone,
as many as 15 million young lives have been lost through lack of breastfeeding.
All these facts, thoroughly researched and proven, form the basis of
UNICEF's support for breastfeeding - not "politics and ideology,"
as the article asserts. The UNICEF approach to breastfeeding and HIV
reflects a 1997 joint policy with UNAIDS and WHO which was fundamentally
reaffirmed and elaborated on at a global meeting of scientists convened
by WHO just last month.
For these same reasons, UNICEF strongly supports the International
Code on the Marketing of Breast-Milk Substitutes. The Journal dismissed
this internationally recognized instrument as a "voluntary marketing
code devised by UNICEF" and WHO. But you neglected to say that
the Code was adopted by the World Health Assembly, the world's health
policy body, and that dozens of governments have implemented it, in
part or in whole, through national legislation. Indeed, where governments
have made it law, it carries both a legal and moral obligation.
The rise of HIV has made the picture more complex; of that we have
no illusions. The pandemic demands that all of us seek the most effective
ways to prevent the spread of HIV through breastmilk while at the same
time preventing the spread of other diseases that can result from a
rush to breastmilk substitutes. That is exactly what UNICEF's pilot
projects in eleven countries seek to do. Through voluntary and confidential
HIV testing and counseling, by supporting mothers in their feeding choices,
and, yes, by procuring and providing a free and lasting supply of formula
to women who make that choice, UNICEF is implementing a sophisticated,
serious and replicable approach to a difficult and paradoxical set of
challenges. Where we have made mistakes we have learned from them and
improved. But we have not shied away from these challenges, and we will
not give in to simplistic approaches that suggest that blanketing the
developing world with formula is good for children. The facts tell us
otherwise.
Even your detailed effort to reconstruct our past relations with formula
manufacturers who violate the Code leaves out a key fact: UNICEF has
never viewed formula in and of itself as a health risk or a "bad"
product. It is improper marketing of formula that makes it dangerous,
and we stand by our policy not to accept donations from companies that
have been found to violate the Code. At the same time, we believe that
the Code and subsequent WHA resolutions provide clear, actionable guidance
for companies wishing to make donations of formula for social welfare
purposes, and nothing in our policies or programs in the field prevents
a conscientious company that abides by the Code from acting in the best
interests of children.
In this regard it is worth pointing out that UNICEF is widely recognized
as having excellent relationships with the private sector. We are neither
afraid to stand up on behalf of children nor to partner on behalf of
children. In fact, UNICEF works in partnership with scores of companies
and over the last two years received in-kind donations valued at more
than $210 million.
In the end, our door remains open to discussions with formula manufacturers
who genuinely are committed to the best interests of children. But that
means recognizing that formula has serious limitations in the present
context, and that being a good corporate citizen means more than making
donations - it means being absolutely certain that your core business
does not hurt children in any way.
Carol Bellamy
Executive Director
UNICEF
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