Safeguarding Breastfeeding: WHO's Model Policy Against Formula Industry Influence

The WHO’s model policy aims to eliminate sponsorship from commercial milk formula manufacturers to protect the integrity of healthcare advice and promote breastfeeding. By reducing conflicts of interest, the policy seeks to ensure healthcare professionals provide unbiased, evidence-based recommendations for infant feeding.

The World Health Organization (WHO), in collaboration with UNICEF, has long advocated for policies to support breastfeeding as a critical component of public health. In a continued effort to protect infant and young child feeding practices, the WHO has developed a model policy aimed at reducing the influence of manufacturers and distributors of commercial milk formula (CMF) on health professional associations (HCPAs). This initiative has been supported by a group of global experts including those from the University of Cape Town, Kumasi School of Medicine, and Queensland Children’s Hospital, among others, who have recognized the growing concern over conflicts of interest arising from corporate sponsorship. The primary issue is that companies marketing CMF often sponsor health professionals and scientific meetings, which the WHO argues undermines breastfeeding efforts and distorts the objectivity of healthcare advice. The potential for sponsorships to create conflicts of interest is particularly concerning because health professionals are trusted sources of information for parents and caregivers.

The Impact of Formula Marketing on Health Outcomes

Aggressive marketing tactics employed by CMF companies have been found to adversely affect infant feeding practices, pushing families towards formula feeding even when breastfeeding might be more appropriate. The WHO has highlighted how this undermines breastfeeding and contributes to negative health outcomes, not only for infants but also for women, who may face increased risks of non-communicable diseases when breastfeeding is abandoned prematurely. The inappropriate promotion of commercial milk formula has been a persistent issue despite longstanding efforts by WHO to curb it. As early as 1981, the WHO adopted the International Code of Marketing of Breast-Milk Substitutes to regulate the marketing of these products. In 2016, the World Health Assembly further called on Member States to prevent the promotion of CMF to healthcare professionals and their associations. Yet, sponsorships continue, fostering environments where conflicts of interest thrive.

Sponsorship Creates Conflicts of Interest in Healthcare

Sponsorship, in this context, is more than just a financial transaction; it establishes a relationship between companies and healthcare professionals that can subtly shift the attitudes of those in the healthcare system. Companies that provide financial or in-kind contributions to healthcare associations can foster goodwill, leading health professionals to develop more favorable views of these companies and their products. Studies have shown that healthcare workers exposed to corporate sponsorship are more likely to promote or recommend those products to their patients. These changes in behavior occur even when the healthcare professionals believe they are not influenced by the sponsorships or when they cannot recall the names of the sponsoring companies. The sponsorships can be so ingrained that they shift the balance of what healthcare professionals recommend—whether it's favoring formula feeding over breastfeeding or prescribing specialized CMF in cases where breastfeeding should be the first choice.

Damaging the Credibility of Healthcare Associations

The WHO’s concern is that these sponsorships, even if they seem innocuous, create conflicts of interest that undermine the independence and credibility of healthcare associations. When CMF companies sponsor scientific meetings, conferences, or provide gifts and in-kind support, they blur the line between independent scientific research and commercial interest. This not only damages the reputation of health professionals and their associations but also erodes public trust in healthcare advice. Furthermore, when healthcare associations are linked to these commercial interests, they may be excluded from participating in scientific discussions or editorial boards, reducing their influence in important healthcare debates. In some cases, health professionals may find themselves promoting products from these companies unconsciously, swayed by the subtle biases that develop through continued exposure to sponsorship.

Ending Sponsorship to Preserve Healthcare Integrity

In response to this growing concern, the WHO has proposed that healthcare associations commit to ending all forms of sponsorship from CMF manufacturers by a specific date. The policy outlines a range of activities that should no longer be accepted, including gifts, sponsored conference sessions, advertising in program booklets, financial support for scholarships, and the sale of exhibition space at events. This approach aims to eliminate the financial ties that can lead to conflicts of interest and compromise the integrity of healthcare advice. The WHO emphasizes that such measures are crucial to maintaining the objectivity and scientific credibility of healthcare professionals. It further stresses the need for individual declarations of conflicts of interest at conferences and other events to ensure transparency and accountability.

Protecting Public Health Through Independent Healthcare Advice

One of the major arguments in favor of ending CMF sponsorship is the long-term impact on public health. When healthcare professionals are free from commercial influence, they can provide unbiased, scientifically sound advice that supports optimal feeding practices, including breastfeeding. Breastfeeding has been proven to have numerous health benefits for both infants and mothers, including reduced risks of infection, improved cognitive development, and lower incidences of certain chronic diseases later in life. In contrast, formula feeding has been associated with poorer health outcomes and a higher risk of non-communicable diseases.

Ultimately, the WHO’s model policy seeks to realign the priorities of healthcare associations with the best interests of public health, rather than the commercial goals of formula manufacturers. By cutting ties with CMF companies, healthcare professionals can better support and promote breastfeeding, which remains the healthiest option for most infants. The WHO's efforts, backed by research from experts across various global institutions, aim to create a healthier, more transparent healthcare system that is free from the undue influence of corporate sponsorship and better equipped to protect infant health. This model policy is a step toward ensuring that healthcare professionals maintain their commitment to patient care and scientific integrity, unaffected by commercial interests.