Global Health Agencies and Breastfeeding

Global Health Agencies and Breastfeeding

Categories: Leader Today

Linda Smith

The World Health Organization

The World Health Organization (WHO) currently has 193 Member Nations and convenes the World Health Assembly (WHA) once a year ( Only nations are members of the WHO, and only nations send voting delegations to WHA meetings.

WHA Resolution

A World Health Assembly Resolution is a recommendation passed (after a great deal of discussion and negotiations) by a World Health Assembly. Resolutions are developed and passed with the intention and expectation that nations will implement the resolution by passing legislation (laws) in that country. Resolutions carry a high degree of moral authority—“we should do this”—but not legal authority. There’s no legal penalty for a nation to NOT implement a Resolution that they voted for, but the WHO monitors implementation of WHA Resolutions and expects nations to report on progress in implementing them. Resolution 34.22 (the International Code of Marketing of Breastmilk Substitutes) was passed in 1981 by 118 Member countries in favor, one against, and three abstentions. Since then, several Resolutions have expanded and filled in gaps in the initial Resolution (Code)’s language. When referring to the International Code, the proper term is

International Code of Marketing of Breastmilk Substitutes and Subsequent WHA Resolutions.

The United Nations

The United Nations (UN) currently has 193 Member States (nations) and convenes the General Assembly yearly (

A UN Convention

A UN Convention has the same legal standing for the nations that ratify it as a treaty: it is legally binding on the nations that ratify it. It is a very serious decision for a nation to ratify a UN Convention. The Convention on the Rights of the Child (CRC) is the most rapidly and widely ratified human rights treaty in history. The Convention to Eliminate All Forms of Discrimination against Women (CEDAW) is the only human rights treaty that affirms the reproductive rights of women and targets culture and tradition as influential forces shaping gender roles and family relations. The United States is the only nation that has not ratified the CRC, and one of only a few nations (others are Iran, Somalia, South Sudan, Sudan, Palau and Tonga) that has not ratified the CEDAW.

A UN Declaration

A UN Declaration brings global attention to an issue. Declarations are passed at the UN General Assembly by delegates of the member nations of the United Nations or at specially convened meetings of high-ranking global leaders. When a nation’s official representative votes for and signs the Declaration, it provides a legal basis for the nation to take substantive (legislative) action to work toward the Declaration’s goals.

The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding was produced and adopted by participants at the WHO/UNICEF policymakers’ meeting co-sponsored by the United States Agency for International Development (USAID) and the Swedish International Development Authority (SIDA) held at the Spedale degli Innocenti, Florence, Italy, on 30 July – 1 August 1990. The Declaration reflects the content of the original background document for the meeting and the views expressed in group and plenary sessions. The Declaration was endorsed by the UNICEF Executive Board, and by WHA Resolution 45.34. In November 2005, an update meeting was held in Florence, where delegates re-committed to the original Declaration and added more specific outcome measures.

The Millennium Development Goals (MDGs)

The Millennium Development Goals (MDGs) were adopted at the Millennium Summit in September 2000;

The Millennium Development Goals (MDGs) are the world’s time-bound and quantified targets for addressing extreme poverty in its many dimensions—income poverty, hunger, disease, lack of adequate shelter, and exclusion—while promoting gender equality, education, and environmental sustainability. They are also basic human rights—the rights of each person on the planet to health, education, shelter, and security.

The US Assistant Surgeon General Dr. Audrey Hart Nora signed the Innocenti Declaration of 1990, which made it possible for the US government —Department of Health and Human Services (DHHS)—to provide some funding for developing documents created by the US Breastfeeding Committee. That action also gives US government agencies justification in sending official representatives to meetings held by non-governmental organizations (NGOs) that exist to implement the Declaration. Like the WHA Resolutions, there’s no legal mandate for a nation to carry through on a UN Declaration, but there is strong moral and peer pressure to do so, and the UN monitors progress in implementing declarations. The USA and many other countries have prepared periodic reports on progress reaching the 2015 MDGs.

Non-governmental organizations

There are two types of non-governmental organizations (NGOs)

• Public interest NGOs known as “PINGOs”

PINGOs such as La Leche League International (LLLI) and the International Lactation Consultant Association (ILCA) have earned official recognition by the WHO and/or UN through a detailed, complicated, and rigorous process. PINGO’s are the “pure voice of the people” and presumably not swayed by political interests in individual countries. PINGOs that have earned recognition by the UN or WHO are considered to be highly qualified to speak and provide advice and input on various topics. LLLI, ILCA, International Baby Food Action Network (IBFAN), and World Alliance for Breastfeeding Action (WABA) are all PINGOs registered with the UN and WHO. PINGOs develop the language and format of Declarations, Conventions, and Resolutions, which is a long, tedious and often contentious process. They then work at the UN General Assembly, UN special meetings, and WHA meetings alongside national delegates to convince nations’ delegates that their points have merit; the nations may eventually bring them to a vote. Once a document is passed by the UN or WHO, the PINGO stays involved to monitor what nations actually DO about it, propose addendum documents, and track which countries are taking their legal or moral obligations seriously. PINGOs play an active role in encouraging nations to follow through on Declarations and other global commitments.

• Business interest NGOs known as “BINGOs”

These include think tanks funded by industry, and include “charitable arms” of commercial interests and others.

The Conflict of Interest Coalition

The Conflict of Interest Coalition is a broad international group of organisations working in various aspects of public health, including NCDs (non-communicable diseases), nutrition, and infant feeding. In their statement, the Coalition calls for a clear separation between public interest NGOs (PINGOs) and business interest NGOs (BINGOs). Public health policy should be decided by government, advised by health experts and NGOs working in the public interest. The CoaIition believes it is inappropriate to have commercial interests involved in the development of health policy.

Once health policy has been decided by government, with the advice of health experts and public interest groups, then business interests would be welcome to participate in the implementation of the plan.

“The policy development stage should be free from industry involvement to ensure a ‘health in all policies’ approach, which is not compromised by the obvious conflicts of interests associated with food, alcohol, beverage and other industries that are primarily answerable to shareholders.

‘These industries should, of course, be kept informed about policy development, through stakeholder briefings for example, but should not be in an influencing position when it comes to setting policy and strategies for addressing public health issues, such as NCD prevention and control.”

Legal obligations

There is no legal obligation for an NGO to adhere to any of these global policy documents. Nobody in the UN or WHO monitors the NGOs to see if they’re still interested in the documents or actually follows them internally, because membership in the UN and WHO is for nations, not organizations. But once an NGO puts its logo (and influence) into development of a UN or WHO document, it is expected to carry through in some robust manner. Most remain highly involved and influential over many years. The UN and WHO liaisons from ILCA, LLL, and other breastfeeding organizations have formed effective teams over the years.

NGOs choose their liaisons (delegates) very carefully, or should. Representing an NGO at the UN or WHO is no small spur-of-the-moment indulgence for a loyal member, because there’s an enormous amount of work and diplomatic correspondence that occurs between meetings. Ideally, the delegate develops trust and expertise over the years that serves both the UN/WHO and NGO, and like-minded NGOs and dedicated government representatives well.

The good news

Many of the individuals who serve as liaisons from one breastfeeding-related NGO are members of more than one NGO and/or have worked closely with other liaisons. (For example, I am ILCA’s official liaison to WHO for the Baby Friendly Hospital Initiative (BFHI) program; ILCA has other active liaisons for Baby Friendly purposes. As a liaison, I can speak officially for ILCA, and am responsible to the Board for reporting and communicating regularly as a requirement of my appointment. I’m also a member of LLLI, and IBFAN North America and stay in touch with many other liaisons as part of my role.)

The bad news

Occasionally an NGO’s Board of Directors or executive director (often a new person) doesn’t fully understand the importance of the organization’s status as an official NGO for the UN or WHO, and considers cutting funding for the delegate, and/or appoints someone with little or no expertise in international policy work but who happens to live near a UN or WHO event. That’s an unfortunate decision, because it tends to weaken the NGO’s “moral authority” and reputation at worldwide policy meetings. The same can be true of high-level national meetings where an NGO can send a delegate. Continuity, tenacity, diplomacy and tact are important characteristics of NGO delegates/liaisons. 

Future plans for LLLI

LLLI has continued its consultative status with the United Nations since 1979 and has plans to build a stronger relationship through the UN’s Economic and Social Council (ECOSOC). Due to an unfortunate inability to fully participate for a period of time, LLLI no longer holds NGO-status in the WHO.

Recognizing the importance these opportunities offer for furthering our mission and strengthening our impact and reputation in the world, the Board of Directors and the Executive Director are working to restore LLLI to its former position in WHO.

Healthy Documents

It is important for all those in leadership positions in LLLI and ILCA to maintain a broad view of the role of NGOs and policy documents/instruments on the national and global policy stage. In 2001, WABA compiled “Healthy Documents,” a source book of important documents and instruments that impact on peoples’health. (I helped write the section describing ILCA and lactation consultants.) Healthy Documents is now a website that is regularly updated and highly useful. LLLI and ILCA are original core partners of WABA.

Linda J. Smith, MPH, FACCE, IBCLC, FILCA is a lactation consultant, childbirth educator, author, and internationally known consultant on breastfeeding and birthing issues. Linda is ILCA’s liaison to the World Health Organization’s Baby Friendly Hospital Initiative and consultant to Infant Feeding Action Coalition (INFACT) Canada/IBFAN North America. As a La Leche League Leader and Lamaze-certified Childbirth Educator, she has provided education and support to diverse families over 40 years in nine cities in the USA and Canada. Linda was a founder of the International Board of Lactation Consultant Examiners (IBLCE), founder and past board member of ILCA, and is a delegate to the United States Breastfeeding Committee from the American Breastfeeding Institute. She owns the Bright Future Lactation Resource Center,