Social ecology and the breast-milk substitutes code

Gretel H. Pelto's "Perspectives on Infant Feeding: Decision Making and Ecology" (Food and Nutrition Bulletin, vol. 3, no. 3) is a veiled apologia for bottle-feeding.

Few of us argue with a woman's right to make a non breast feeding choice based on her perception "of the relative merits and shortcomings of particular actions"- in other words, an informed choice. This has little to do either with a biological or an ecological perspective. It is plain and simple justice.

The rationale behind the new International Code on the Marketing of Breast-Milk Substitutes (I served as special adviser to UNICEF/WHO) is that the decision should be reserved exclusively for each new mother and should not be tampered with by others, especially those whose motives may be questionable or, at best, unclear.

Thus, the aggressive commercial promotion of breast-milk substitutes in competition with mother's milk land breastfeeding practice) is clearly intended to manipulate the "ecology." Under such a circumstance free, not to speak of informed, choice by mothers is obviously not possible. I have spent my career in advertising and marketing and I have never known a promotion effort or a promotion budget that was not intended to develop the business. And that includes so-called "educational" efforts. "Educational" or not, a manufacturer's energy and money are obviously aimed at business development-for that is the enterprise's purpose. The notion of any other would be enough to justify a shareholder rebellion.

Thus, the Code is intended to protect the mother's right to free choice from any untoward interference from enterprises whose primary aim is to promote a product.

It does not restrict the sale or distribution of the product, merely any possibility of undue influence on the mother's decision. That is a matter between her and the health professionals who should be in the best position to help her make it an informed decision. Even with health professionals, the Code seeks to restrain manufacturers from exercising undue "promotional" influence and for the same reason. Professionals should deliver their counsel to mothers on the basis of uncompromising professional responsibility, based on fact and science-and untrammeled.

In a real sense the Code seeks to preserve the "social ecology" of which Dr. Pelto writes and to prevent its spoliation by potentially dangerous practices.

Richard K. Manoff President, Manoff International, Inc.
Dr. Pelto replies:

I am frankly dumbfounded that Mr. Manoff sees my paper as a "veiled apologia for bottle-feeding." This misinterpretation is particularly mystifying in view of his understanding that "in a real sense the Code seeks to preserve the 'social ecology' of which Dr. Pelto writes...." The purpose of my article was to clarify the social ("ecological") context that the Code-or any other action to promote better infant feeding practices - must inevitably encounter.

If only the world were just, and an "informed choice" were a matter of "simple justice." The Code is a very significant step forward, but I am disturbed by the implication in Mr. Manoff's letter that promotional activities of manufacturers are the only barrier to the "mother's right to a free choice." The evidence is clear that decisions regarding infant feeding are constrained and influenced by many factors, including health-care practices, the status of women, and economic circumstances.

While it is often very useful, for the purpose of political mobilization, to focus on one factor, it is tactically naive to lose sight of the larger picture. It is also poor science. Manoff's interpretation of my argument is parallel to the case of someone deeply concerned about the role of saturated fat in heart disease encountering an analysis showing multiple factors in the epidemiology of the disease and charging that it is an apologia for heart disease.

Gretel H. Pelto