CASE STUDIES OF TWO SUCCESSFUL CAMPAIGNS

 I. Action on the International Code
II. Action on Innocenti Declaration
 
Conferences are held. Declarations made. Pledges of action promised.
 
Yet decades later these pledges remain only on paper. The failure to translate pledges into action is the most disturbing aspect of declarations. To give hope to those who feel deeply, their inability to act on their pledges, we have pleasure in showcasing the successful efforts of two organisations.

These examples of sustained, concerted action are in the area of children's health and they showcase the efforts of two organisations, the World Alliance for Breastfeeding Action (WABA) and the International Baby Food Action Network (IBFAN). WABA and IBFAN are working towards implementing the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (1990), and the WHO-UNICEF International Code on Marketing of Breastmilk Substitutes (1981).
 
These case studies describe briefly the circumstances under which the International Code was adopted, IBFAN's strategies in implementing it, and WABA's efforts and action programme towards realising the Innocenti Declaration.

I. ACTION ON THE INTERNATIONAL CODE
Background

The World Health Organization (WHO) adopted the International Code of Marketing of Breastmilk Substitutes on 21 May 1981. The aim of the International Code is "to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion and breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information". (1) Both WHO and UNICEF had stressed the importance of maintaining the practice of breastfeeding, and reviving the practice, where it is in decline as the best means of improving the health and nutrition of infants and young children. The 27th World Health Assembly (WHA), in 1974, noted the general decline in breastfeeding in many parts of the world, and urged "Member countries to review sales promotion activities on baby foods and to introduce appropriate remedial measures, including advertisement codes and legislation where necessary.(2)
 
The 31st World Health Assembly in May 1978 recommended "Member States should give priority to preventing malnutrition in infants and children by inter alia, supporting and promoting breastfeeding, taking legislative and social action to facilitate breastfeeding by working mothers, and "regulating inappropriate sales promotion of infant foods that can be used to replace breastmilk." (3)
 
As the Code was adopted as a recommendation, its implementation depended largely on three factors:

• Co-operation of the babymilk industry in adhering to the provisions of the Code;
   

• National governments' action in providing legal or other regulatory measures for the implementation of the Code;
  

• Non-governmental organizations (NGOs) watchdog activities to ensure its adherence.

Nine years after the WHA Meet in 1974

At the WHO/COMSEC/UNICEF Workshop on "Implementation of the International Code" held at Harare, Zimbabwe on 17-21 January 1983, participants presented the following problems in implementing the Code:

• There has been very little effort by commercial companies to adopt the Code as a voluntary measure. NGOs monitoring the industry's performance have reported that many marketing practices thought to be non-conducive to breastfeeding practices, continue.
  

• In many countries there is insufficient awareness of (i) the principles of good infant feeding practices, (ii) the effects of maternal nutrition; (iii) the issues which necessitate action to protect infants from malnutrition and diarrhoeal diseases; (iv) the existence of the Code, and its implications at the national level;
  

• Insufficient coordination and consultation on infant feeding between government and non-governmental organisations; inadequate planning and use of resources.
  

• Even where the Code may be adopted, its effects will be limited if related measures are not taken to improve the status of women and protection given in maternity.
  

• Many developing countries import infant formula. Although importation puts a heavy burden on foreign exchange, there are complex political and economic reasons why governments find it difficult to ban or control the import of infant feeds.

Code Advocacy

Thus the implementation of the International Code of Marketing of Breastmilk Substitutes is an important strategy of the global breastfeeding movement. The challenges posed by the baby food industry in the 1960s, '70s and '80s persist even in the 1990s, but with new and even more subtle ways of marketing. This has called for increased international cooperation to oppose the issue of commercial promotion of infant formulae, baby foods and drinks, cereals and other breastmilk substitutes. The International Baby Food Action Network (IBFAN) which spearheaded the campaign against breastmilk substitutes in early 1970s, is now convinced it is useless to merely promote breastfeeding without protecting women from the aggressive marketing of the baby food industry. IBFAN, in cooperation with other partners in the movement, has used three main strategies to protect breastfeeding through the Code - national legislation, monitoring of companies, and lobbying governments.
 
Legislation: Since the adoption of the International Code in 1981, the breastfeeding movement has sought to increase its implementation through legislation at country level by promoting a greater understanding of the International Code, especially among governments and health workers. During the 1990s, IBFAN, through its International Code Documentation Centre (ICDC) based in Penang, Malaysia, started undertaking Code implementation training for government officials and lawyers. IBFAN has so far conducted 17 training courses, and trained over 400 government participants and NGOs to enable governments to write and implement national laws regarding breastfeeding. ICDC has developed a Model Law for countries to follow, or adapt from, when drafting their own national legislation.
 
Today 24 countries have implemented most of the Code and WHA's subsequent resolutions by means of a law or decree while, 31 countries have enacted many of the Code's provisions as law, and 30 have drafts (4). This growth in country implementation reflects the very visible impact of Code advocacy work. The move into more professional training has given IBFAN the credibility and legitimacy similar to that of a training "institute", and to cooperate on a more "equal" basis with governments, ICDC also provides legal advisory services to governments in drafting national laws.

Monitoring: Monitoring the Code provides motivation for measures to restrict marketing and also exposes the extent to which industry is abiding by the International Code.
 
Through consistent monitoring, IBFAN has discovered many loopholes with the International Code and new ways in which industry is circumventing the Code in order to continue marketing its products and increase its market share.
 
IBFAN regularly publishes the results of the global monitoring projects in the form of two charts: State of the Code by Country and State of the Code by Company (SOCs). It is a very powerful and effective way of making the information on Code violations known worldwide and of keeping the companies in check. The SOCs are useful for NGOs as a popular mobilising tool in calling for more compliance from the industry, and in lobbying governments to strengthen measures to restrict marketing of baby foods at home.
 
Such monitoring results are even more important in the 1990s in the face of recent public relations efforts by the baby food industry to paint a perfect image of their company practices by showing governments' support for their "good behaviour".  Since 1998, Nestle has been lobbying numerous governments to sign certificates which allege that the company is abiding by the International Code. Governments who are not aware of the real situation, and where the marketing position of the company is big (e.g. opening a new factory and where economic leverage is great), are more likely to sign such a certificate. IBFAN works to counter such measures by sensitising participants at training courses about such tactics.
 
Lobbying: IBFAN's lobbying at the World Health Assembly since 1979, ensures that international standards to protect breastfeeding are not undermined by babymilk companies.
 
It is indeed a yearly battle of forces between resource poor members of civil society and powerful big business. The challenge for the NGOs is to identify and build relationships with the few strong and committed government delegates who will advocate on behalf of the breastfeeding movement.
 
The Code advocacy strategies set a useful example for other social movements looking for ideas on how to get international standards adopted and how to implement them nationally; how to monitor company practices in an effective way and; in general, how to deal with the greater challenges presented by globalisation and the growing position of power of multinational companies.

II. ACTION ON INNOCENTI DECLARATION 

The WHO/UNICEF Policy Makers' Meeting on Breastfeeding in the 1990s: a Global Initiative adopted the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding at Spedale degli Innocenti in Florence, Italy on 30 July - 1 August 1990.
 
A meeting was organised by UNICEF on 13 to 15 February 1991 at New York with 17 national and international groups to follow up on the Innocenti Declaration and strategies for a coordinated global effort to protect, promote and support breastfeeding. It focused on two issues:

• the body of international actions taken over the past decade; and
  

• new data and concerns about the tragic loss of life among infants from illnesses that could have been avoided by breastfeeding.

The meeting pointed out that it was clear the "bottle baby scandal" continued unabated and that global action of a new order was necessary to counter the forces that had undermined the breastfeeding culture.
 
It was also clear that the issue was universal, that the action taken should be unequivocal and the promoters of baby milk should initiate unilaterally action to stop any activities that would undermine breastfeeding.

The Birth of WABA
 
The idea of the World Alliance for Breastfeeding Action (WABA) was born on the evening of 14 February 1991 in a little restaurant in downtown New York, when some participants of the UNICEF Meeting gathered for dinner. Anwar Fazal, who thought of the idea of WABA and also 
the name, stated, "the UNICEF meeting showed us how much each group was doing. More importantly, it showed how much more needed to be done and that there was a real urgency for popular mobilisation on a scale we had never before dared to dream."
 
WABA was formed as an umbrella network of organizations and individuals who believe in breastfeeding and individuals who dedicate themselves to acting on this right. Pat Young of the US World Food Day Secretariat developed the first WABA brochure overnight and got it printed in record time. Inspired, Derrick Jelliffe wrote the song "The WABA Crawl" in calypso music. These are examples of the spirit that moved the pioneers of WABA. Since then there has been no looking back. 

How WABA Functions
 
WABA galvanised the power of citizens groups in open, light, participatory and action-oriented global mechanism to facilitate and encourage mass involvement of every sector committed to protecting, promoting and supporting breastfeeding. Among the key groups involved in the initiative from its inception were:

• American Public Health Association (APHA)
  

• La Leche League International (LLLI)
  

• International Baby Food Action Network (IBFAN)
  

• International Lactation Consultants Association (ILCA)
  

• Consumers International (CI)
  

• World Council of Churches (WCC)

Eminent scientists too were involved in WABA initiative, including, Professors Derrick and Patrice Jelliffe of the University of California, Dr. Michael Latham of Cornell University, Dr. Audrey Naylor of Wellstart International, USA, and Dr. Felicity Savage-King of the Institute of Child Health, London.
 
Partnerships were developed among mother support groups, researchers, trainers, health care professionals and development workers. WABA operates as a light, enabling structure, yet involves international experts, policy makers, grassroots activists, and the people forming a force with half a decade of successful programmes that have been felt worldwide.
 
WABA's Task Forces
 
WABA works with a participatory task force approach: eight important areas were identified for multiplying and linking. A volunteer coordinator was elected to facilitate each task force to identify and review existing activities, prioritise needs within the task force concerns and stimulating and coordinating action in response to these needs. Each task force is led by the network or individual with most expertise in the field and is challenged to organise value-added activities under the WABA umbrella.
 
The eight working areas and task forces formed were:

1. Social Mobilisation: to disseminate information, facilitate public debate, and build bridges between communities and potential allies;
   

2. Information Clearinghouse: to collect, disseminate, use and share information to support programmes; and to coordinate the dissemination of information produced by WABA task forces;
   

3. Research Groups and Briefing Papers: to stimulate and to support applied research important to the goals of WABA and as expressed in the Innocent Declaration;
   

4. Health Care Practices: to protect, promote and support breastfeeding according to the WHO/UNICEF Joint Statement on the Ten Steps to successful breastfeeding;
   

5. Education and Training: to coordinate and facilitate the education and training of personnel in the protection, promotion and support of breastfeeding;
   

6. Mother support groups: to train counsellors and expand the number of such groups, in order to create the appropriate support for a mother to initiate and sustain breastfeeding;
   

7. Women and Work: to develop strategies to address the special needs of working women through actions that assist women to integrate breastfeeding into their working lives;
   

8. Code Compliance: to bring about the implementation of the International Code of Marketing of Breastmilk Substitutes through training sessions etc.

Some task forces consist of entire networks like the Code Compliance Task Force composed largely of IBFAN members and the Mother Support Group Task Force made up mainly by La Leche League groups. Others, like the Health Care and the Women and Work Task Forces, are managed almost single-handedly by individuals with fulltime jobs. The eight task forces have grown at a different pace over five years and with differing degrees of intensity and global spread. At present, there are altogether six task forces with the addition of one on Children's Nutrition Rights. Task Force Nos. 1, 2 and 5 do not exist any more as these tasks are now undertaken by the WABA Secretariat.

STRATEGIES AND ACTIVITIES
 
There are five broad strategies employed by WABA in its task of protecting, promoting and supporting breastfeeding. They are: 1) Networking, 2) Capacity Building, 3) Advocacy, 4) Outreach, and 5) Media and Communications. See Chart on Framework of Mobilising Strategies. 

1) Networking

WABA's activities are based on principles of networking – of linking people and resources, of multiplying efforts, of sharing ideas, information, resources through sharing and disseminating information on current events, new research, campaign updates, available human and financial resources, etc. through various channels - via fax, email and letters - telephone conversations, newsletters, websites, internet discussion groups, bulletin boards, chats, etc. (see also Media and Communications)

The WABA website has been a key instrument to spread information on breastfeeding programmes and campaigns at the global level in a quick, attractive and effective way. It has received several awards for being among the best websites in several categories, including, "Best for the Breastfeeding Online Website" under the health category(1) . Email is currently the most frequently used means of communicating. However, regular mail/post, courier and the distribution of WABALINK, a quarterly newsletter continue to be very essential means of networking.
 
The WABA Steering Committee, which is the policy making board of WABA, meets once a year to review WABA's programmes, current global issues and challenges, and to decide on the future work plan. At programme level, a small work team tries to come together once a year to plan the World Breastfeeding Week Campaign – its goals, write documents and brainstorm on images that will help to launch the WBW campaign for that year. Some task forces also meet from time to time at specific events related to their task force issue or at an event where they want to advance their issue. WABA core participants also attend conferences or meetings of partners groups like IBFAN and La Leche League International. Such direct networking is very effective, it nurtures trust and cements relationships among the people who form the network.
 
The single, but very powerful networking event, which WABA organised in December 1996, was the Global Forum which brought together over 360 people from 86 countries to share information, research, experiences, new ideas, and to advance new policies, recommendations and a vision that helped to chart the way forward for the breastfeeding movement in the 21st century. It aimed to promote networking among existing participants in the network, as well as to bring on board people/allies from new/non-breastfeeding groups such as the women's, environmental and human rights movements.

2) Capacity building

WABA's main strategies/activities to build capacity among its network participants include: (a) the formation and networking functions of its task forces; (b) stimulating and sharing practical research (a function of the Research task force); (c) promoting the Baby-Friendly Hospital Initiative (BFHI); (d) the Global Participatory Action Research (GLOPAR) project; (e) the Women and Work programme (coordinated by the Women and Work Task Force and the WABA Secretariat); (f) conducting meetings, workshops and conferences around particular issues and/or skills; and (g) the Mother-Friendly Workplace Initiative (MFWI) seedgrants project (a component of the Women and Work programme).

3) Advocacy

World Breastfeeding Week is WABA's biggest, most influential and strategic advocacy programme that has raised global awareness on the issue of breastfeeding by involving thousands of individuals, groups, international organisations, governments and at least two United Nation agencies in the annual campaign. The other strategic programmes are the Baby-Friendly Hospital Initiative; the Ten Links for Nurturing the Future which was adopted at the WABA Global Forum in December 1996 in Bangkok, Thailand, and, the International Labour Organisation ILO Campaign for better maternity protection (which is a component of the Women and Work programme). Representation at conferences and meetings of partner groups as well as at important international events such as the United Nation's Conferences has also been a strategic advocacy activity of WABA and its partners. Representation involves all forms of networking, servicing an information booth or a display, and even lobbying of government delegates.

4) Outreach

WABA's outreach work with the launching of different themes for World Breastfeeding Week that would provide an entry point for the breastfeeding movement to link with other issue groups or social movements. WABA's outreach activities also includes representation at important international conferences such as the International Conference on the Year of the Family, the World Summit on Social Development, the International Conference on Population and Development, the Fourth World Conference on Women and the World Food Summit to build new alliances with other groups participating in these events.

5) Media & Communications

WABA has sought to manage a media and communications programme that is at the forefront of technology while at the same time, recognising the diverse nature of its network participants. It is simultaneously multi-media, multi-level and multi-directional. (See also Networking)
 
WABA tries to ensure all important documents and campaign materials are translated into three languages (English, French and Spanish) as far as possible. In fact, sensitivity to different language groups has been the strength of the breastfeeding movement as a whole.
 
The programme also looks at producing exhibits and various promotional materials like buttons, T-shirts, and stickers as a support to other strategic programmes.
 
A recent project has been the development of a book of images entitled Images of Breastfeeding Worldwide: a sourcebook for community action containing a collection of over 450 logos, pictures, drawings, illustrations, and graphics of breastfeeding mother and child which can be reproduced by national and local groups to produce their own popular educational materials. (5) This collection of images is contributed by numerous network partners from 87 organisations and committees participating in WABA reflecting the active participation of the many groups and individuals in the larger WABA network.
 
In WABA, all five strategies are employed, although some more often than others. Networking and Media and Communications, for instance, are part of the day-today tasks of the breastfeeding network. The other three strategies, Capacity Building, Advocacy and Outreach, are used at different periods. Some strategies are used at regular intervals, such as the annual WBW campaign; and other times only in response to certain situations or crisis like responding to bad press or lobbying at an important UN conference. Other strategies are employed continuously for a particular period of time until the results are achieved like advocacy for a specific cause such as the ILO Campaign, or building capacity to develop specialised skills among a selected group like training on code monitoring or implementation. Some others are used once in a while, such as when organising the WABA Global Forum.

CONCLUSION

This case study illustrates the importance of working towards ensuring that international declarations and UN instruments are implemented, so that they do not remain mere documents, filed away and forgotten. WABA and IBFAN are exemplary because their action and strategies in capacity building, monitoring, lobbying and advocacy, provide positive models, which can be quite easily adopted by other organisations. The success of WABA and IBFAN is also largely due to their sustained and concerted efforts. WABA has been active since the past 10 years and during this period built many contacts for partnership and managed to reach its message far and wide despite its limited financial resources. Even after 30 years of existence, IBFAN is not showing any signs of wavering. In fact, it is now more determined to find new strategies to combat the babyfood industry's subtle means of violating the International Code. We hope that these case studies will inspire similar actions to ensure that international declarations, conventions and other instruments are realised nationally and globally to improve the health and well-being of all peoples.

References

1. Article 1 of the International Code of Marketing Breastmilk Substitutes, 1981.
   

2. Resolution WHA 27.43. Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board, Volume II, 4th ed., Geneva, 1981. pp. 58.
   

3. Resolution WHA 31.47. Handbook of Resolutions and Decisions – Vol. II, 4th ed. Pp. 62.
   

4. State of the Code by Country. Penang: IBFAN, 2001.
   

5. Siew, Susan. Images of Breastfeeding Worldwide: a sourcebook for community action. Penang: WABA, 1999.

FRAMEWORK OF MOBILISING STRATEGIES OF THE BREASTFEEDING MOVEMENT

(Source: Amin, S. March 2000)

(1) WABA (1999) 'Another award for ORIGEM website' WABALINK, June 1999. Penang: WABA.

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