Report Cards

• Article 6: Children have the right to live a full life and governments should ensure that children survive and develop healthily
• Article 24: Children have the right to nutritious food; governments must ensure parents and children are provided with basic knowledge of child health, nutrition, and among other things, the advantages of breastfeeding

Positive developments

NATIONAL: Plan to extend Paid Parental Leave scheme to 6 months

The Prime Minister Tony Abbott has indicated his intention to pursue an extension of the current Paid Parental Leave scheme, as promised in the lead up to the 2013 election. [3] Under the new policy, mothers would be eligible for full parental leave up to a period of 6 months, paid according to their actual wage. [4]

As stated by the policy document itself, this scheme would be consistent with WHO’s guidelines for exclusively breastfeeding and allow working mothers to exclusively breastfeed their children until they reach 6 months of age before returning to work. [5]

However, a number of MPs have stated their opposition to the policy as a result of economic concerns, [6] while the Opposition and public policy experts have labelled the policy as ‘unfair’ due to the increased amount available for high wage earners. [7]

NATIONAL: Support in Hospitals

In November 2012, the Standing Council on Health of the Council of Australian Governments agreed that all Australian jurisdictions support the WHO/UNICEF Baby Friendly Health Initiative (BFHI) and its ten steps to successful breastfeeding for health services. They encouraged all public and private hospitals to implement the ten steps to successful breastfeeding and to work towards or maintain their BFHI accreditation. [8]

SA: Child and Family Health Service gains full accreditation under the Baby Friendly Health Initiative

The South Australian Child and Family Health Service has become the first Australian community organisation to gain full accreditation under the Baby Friendly Health Initiative (“BFHI”). [9]

The health service, which operates at 120 sites across the state, is now recognised as being committed to making a significant difference to the promotion of breastfeeding and providing a supportive environment for parents and their children.

There are now 78 facilities across Australia which have been accredited by BFHI, catering for approximately 30% of all Australian births.

In this development, the South Australian state government and its health service are engaging in the CRC’s recommendation to promote the BFHI and encourage breastfeeding training for nurses.

However, it should be noted that no other government has yet established greater or compulsory breastfeeding training for nurses, which should be addressed expeditiously by the government.

VIC: New breastfeeding drop-in centres open as part of trial project

Five new breastfeeding drop-in centres have opened across Victoria, with 10 local councils taking part in the State Government’s trial $1.1 million program. [10]

As part of the program, new parents in the participating councils will receive home visits from specialist breastfeeding nurses [11] in a bid to promote breastfeeding among new mothers.

The Victorian Government is also developing a Victorian Breastfeeding Action Plan which will provide health services with strategies aimed at increasing breastfeeding rates. [12]

Access and community support are significant factors which assist mothers to breastfeed and continue breastfeeding their children. The opening of these centres is a positive development for the promotion of breastfeeding and should be expanded and supported.

Developments requiring further attention

NATIONAL: National Breastfeeding Strategy 2010 – 2015 funding and stakeholders

The National Breastfeeding Strategy has been endorsed as a positive development by the CRC, given that it aims to improve the health, nutrition and wellbeing of infants and young children as well as mothers by protecting, promoting, supporting and monitoring breastfeeding. [13]

However it is important that the government continue to adequately fund the policy in order to maintain its effectiveness.

Furthermore, the CRC has recommended industry representatives as stakeholders in the implementation of the strategy be removed, which has not yet occurred. [14]

Areas lacking progress

NATIONAL: Continued low rates of exclusive breastfeeding and lack of data

Since the release of the CRC’s recommendations in June 2012 there have been no further government-funded studies into the rates of breastfeeding in Australia.

As part of the National Breastfeeding Strategy 2010-2015, the Australian government pledged $1.5million funding towards research and improved data collection. However, this funding only included one nation-wide survey (the 2010 Australian National Infant Feeding Survey), in addition to review of guidelines for health care workers and an exploratory report into attitudes towards breastfeeding in the community. [15]

The 2010 Australian National Infant Feeding Survey, which was released in 2011 and showed only 15.4% of mothers exclusively breastfeed their infants up until 6 months of age, [16] therefore remains the most recent available data. The fact that Indigenous babies examined in that study were half as likely to be exclusively breastfed to around 4 months compared with non-Indigenous babies has also not been further reviewed. [17]

It is desirable that the government seek to more regularly fund research into rates of breastfeeding in Australia so as to monitor improvements and success of new initiatives in increasing rates to match the World Health Organisation’s and the CRC’s recommendations.

NATIONAL: Continued discrimination against breastfeeding women

Despite breastfeeding initiatives and health campaigns, many women continue to experience harassment and discrimination when attempting to breastfeed their children in public.

There have been a number of incidents over the past 12 months where mothers have complained that they were refused services or asked to leave shop premises when attempting to breastfeed, [18] contrary to anti-discrimination laws. Furthermore, TV presenter David Koch highlighted such attitudes after stating he believed breastfeeding should be ‘classy’ and ‘discreet’ when breastfeeding in public. Mothers groups and supporters staged a protest in response to comments, claiming that such comments indicated there was some form of ‘shame’ in breastfeeding [19] and that he had caused ‘more damage than you could realise’. [20]

Underlying negative attitudes towards breastfeeding are potentially damaging to any attempt to raise the national average of exclusive breastfeeding rates. The Australian government must engage in greater educational programs in order to promote the advantages and acceptability of breastfeeding children, both in private and in public. A number of other public personalities have spoken out on this issue, including Tara Moss [21] and Mia Freeman.

Negative developments

NATIONAL: Failure to wholly implement World Health Organisation International Code of Marketing of Breast-milk Substitutes

The implementation of the World Health Organisation’s International Code of Marketing of Breast-milk Substitutes (1981) (the International Code) in Australia is performed under the Manufacturers and Importers Agreement (the MAIF Agreement). This is a voluntary agreement to which most major Australian manufacturers and importers are signatory.

Recently the Department of Health and Ageing commissioned an independent report, ‘Review of the effectiveness and validity of the operations of the Marketing in Australia of Infant Formula: Manufacturers and Importers Agreement’ (the Review).

However, the Review is troubling in that it recommended no change to the voluntary industry self-regulatory model, no change to the scope of the MAIF, and no extension of the MAIF to retailers or pharmacists.

This means that five years on from the previous review, no significant action has been taken to implement the 2007 recommendation of the Australian Parliamentary Committee that the International Code be fully implemented in Australia. [22]

• a. Line extension marketing of toddler milks

In Australia, the ‘line extension marketing’ strategy is clearly implemented by many formula manufacturers, who use almost identical colouring and packaging of ‘toddler milks’ as on their infant formulas.

While infant formulas cannot be publically advertised as a result of the MAIF Agreement, toddler milks can, as they are not covered by the Agreement. By advertising toddler milk which has the same packaging as infant formula, consumers may be induced into either purchasing toddler milk as a substitute for breast-milk or associating the toddler milk advertisement and the brand with the infant formula product and purchasing it instead.

The government ignored the Review’s recommendation that:

Consideration should be given as to how to best restrict manufacturers’ labelling of toddler milk drinks with product identifiers resembling those of infant formula labels. Labelling of products should be sufficiently different to enable consumers to clearly and quickly distinguish between infant formula and toddler milk drinks. [23]

The government claims that the International Code does not support an extension of the advertising and other restrictions on manufacturers and importers to toddler milk. [24] However, WHO statements and resolutions state that toddler milks should be subject to similar restrictions as infant formulas where their marketing induces consumers to purchase infant formulas or use the product as infant formula. In July 2013, WHO stated that “…follow-up formula is unsuitable when used as a breast-milk replacement from six months of age onwards.” [25] It also confirmed that:

If follow-up formula is marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement for breast-milk, it is covered by the Code. In addition, where follow-up formula is otherwise represented in a manner which results in such product being perceived or used as a partial or total replacement for breast-milk, such product also falls within the scope of the Code. [26]

Research has shown that “consumers recall follow-on (toddler milk) advertising as advertising for infant formula”, [27] and that:

Australian infant formula manufacturers are using line extension marketing strategies, using similar packaging and the same brand and logo in their permitted infant food products to indirectly advertise infant formula. [28]

In order to abide by the CRC’s recommendations (and those of the Australian Parliamentary Committee in 2007 to fully implement the International Code), [29] the government should take immediate steps to prevent further line extension marketing by infant formula manufacturers to indirectly advertise infant formula to consumers through the guise of ‘toddler milks’.

• b. Need to extend the MAIF Agreement to complementary foods and infant feeding products

The government should extend the MAIF Agreement to cover foods described or sold as an alternative for human milk for the feeding of infants beyond the age of twelve months, retailers and pharmacies, and bottles, teats and complementary foods. [30]

WHO regulations and resolutions clearly state that complementary foods should not marketed in ways which undermine sustained breastfeeding [31] and that unrestricted marketing of feeding bottle and teats in particular is expressly prohibited by the International Code. [32]

While the MAIF Agreement does not cover or monitor these foods and items, the Australian government will continue to fail to implement the International Code and fail to adopt best practice breastfeeding policy.

• c. Failure to establish a monitoring mechanism

In the Concluding Observation, the CRC specifically recommended the establishment of a monitoring mechanism to give effect to the International Code. The previous Advisory Panel was already regarded by advocates as insufficient, being acomplaints-based system with no powers beyond voluntary agreement. However, the incoming Federal government has now gone so far as to dismantle the current Advisory Board without any replacement monitoring body or mechanism. This means that the industry is now almost entirely self-regulating, which is alarming and will undoubtedly result in problems in child safety in the future. [33]

The government must act immediately to prevent the total self-regulation of the infant formula industry, An independent body with enforcement powers and an active role in investigating and regulating the industry is necessary to give full effect to the International Code and ensure compliance . The government should also seek costings on the possibility of making the MAIF Agreement a mandatory obligation rather than voluntary. This would ensure compliance, enforcement and the protection and promotion of breastfeeding in Australia.

 

• Enactment of paid parental leave legislation to support exclusive breastfeeding by working mothers for young infants.
• That the government engage researchers to provide up to date data on breastfeeding on an annual basis.
• Removal of industry representatives as recognised stakeholders in the implementation of the National Breastfeeding Strategy.
• That breastfeeding is included in registered nurses’ training, potentially through the wider implementation of the Baby-Friendly Hospitals Initiative.

1. World Health Organisation, ‘Infant and young child feeding’ (Fact Sheet No.342, September 2013) http://www.who.int/mediacentre/factsheets/fs342/en/index.html (accessed 23 September 2013)
2. Australian Institute of Health and Welfare, ‘2010 Australian National Infant Feeding Survey’ (2011) p.vi
3. Jaqueline Maley, ‘Tony Abbott’s paid parental leave scheme to begin July 2015’, Sydney Morning Herald, 19 August 2013, http://www.smh.com.au/federal-politics/federal-election-2013/tony-abbotts-paid-parental-leave-scheme-to-begin-july-2015-20130818-2s4jc.html (accessed 1 October 2013); Michaela Whitbourn and Lucille Keen, ‘Coalition’s paid parental leave scheme unfair: experts’ Financial Review, 19 August 2013, http://www.afr.com/p/australia2-0/coalition_paid_parental_leave_scheme_26xeQB31RB1adtdLmSV8GO (accessed 1 October 2013)
4. Up to a maximum amount of $75,000, see The Liberal Party, ‘The Coalition’s Policy for Paid Parental Leave’ (August 2013) online at http://www.liberal.org.au/our-policies (accessed 1 October 2013) p.3
5. The Liberal Party, ‘The Coalition’s Policy for Paid Parental Leave’ (August 2013) online at http://www.liberal.org.au/our-policies (accessed 1 October 2013) p.4
6. Lauren Wilson, ‘Dennis Jensen ‘deeply troubled’ by Tony Abbott’s parental leave scheme’, The Australian, 17 September 2013, http://www.theaustralian.com.au/national-affairs/policy/dennis-jensen-deeply-troubled-by-tony-abbotts-parental-leave-scheme/story-fn59noo3-1226720818247 (accessed 1 October 2013)
7. Katie Cassidy, ‘Labor targets Coalition’s ‘unfair’ paid parental leave scheme; Abbott says Rudd ‘doesn’t get it’ ABC News Online, 20 August 2013, http://www.abc.net.au/news/2013-08-20/labor-targets-coalition-ppl–scheme/4899454 (accessed 1 October 2013)
8. Australian Government, Department of Health, http://www.health.gov.au/internet/main/publishing.nsf/Content/aust-breastfeeding-strategy-2010-2015#imp
9. UNICEF Australia, ‘UNICEF applauds Australian first in child and family health care’ (Media Release, 7 August 2013) http://www.unicef.org.au/Media/Media-Releases/July-2013-(1)/UNICEF-applauds-Australian-first-in-child-and-fami.aspx (accessed 24 September 2013)
10. ABC News, New centres offer breastfeeding support, 24 August 2012 http://www.abc.net.au/news/2012-08-24/new-centres-offer-breastfeeding-support/4220474 (accessed 23 September 2013)
11. Premier of Victoria, ‘First breastfeeding drop-in centre opens as part of $1.1 million Victorian Government trial project’ (Media Release, 23 August 2012) online at http://www.premier.vic.gov.au/media-centre/media-releases/4696-first-breastfeeding-drop-in-centre-opens-as-part-of-11-million-victorian-government-trial-project.html (accessed 8 October 2013)
12. Ibid
13. Australian Institute of Health and Welfare, A Picture of Australia’s Children 2012 p. 30
14. See the listing of MAIF company signatories on the Department of Health and Ageing website: http://www.health.gov.au/internet/publications/publishing.nsf/Content/review-effective-validity-maif~appendix-a updated 18 June 2012 (accessed 24 September 2013)
15. Department of Health, ‘Breastfeeding’, online at http://www.health.gov.au/breastfeeding updated 27 February 2013 (accessed 20 September 2013)
16. Australian Institute of Health and Welfare, ‘2010 Australian National Infant Feeding Survey’ (2011) p.vi
17. Australian Institute of Health and Welfare, A Picture of Australia’s Children 2012 p. 31 (19% of indigenous children are exclusively breastfeed to 4 months compared with 40% of non-indigenous children)
18. Natasha Christian and Kate Webber, ‘Breastfeeding mother in tears after being told to cover up’, The Observer 17 January 2013 http://www.gladstoneobserver.com.au/news/breastfeeding-mother-tears-after-being-told-cover/1721028/ (accessed 23 September 2013); James Dowling, ‘Eltham hairdresser refuses to serve breastfeeding mum’, Herald Sun, 20 May 2013 http://www.heraldsun.com.au/news/eltham-hairdresser-refuses-to-serve-breastfeeding-mum/story-fni0fiyv-1226647145686 (accessed 23 September 2013)
19. Lucy Carter, ‘TV host Koch targeted in breastfeeding protest’, ABC News Online, 22 January 2013 http://www.abc.net.au/news/2013-01-21/tv-host-targeted-in-breastfeeding-protest/4473302 (accessed 23 September 2013)
20. Megan Levy, ‘More damage than you could realise’: mothers protest against Koch breastfeeding comments, Sydney Morning Herald, http://www.smh.com.au/entertainment/tv-and-radio/more-damage-than-you-could-realise-mothers-protest-against-koch-breastfeeding-comments-20130121-2d1sw.html (accessed 24 September 2013)
21. UNICEF Australia, ‘Tara Moss calls for more support for mums and babies during World Breastfeeding Week’ (Media Release, 2 August 2012) http://www.unicef.org.au/Media/Media-Releases/August-2012/Tara-Moss-calls-for-more-support-for-mums-and-babi.aspx (accessed 24 September 2013)
22. J. Smith and M. Blake, ‘Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950 – 2010’, 37 (2013) 4 Australian and New Zealand Journal of Public Health, 338
23. Department of Health and Ageing, ‘Review of the effectiveness and validity of operations of the MAIF Agreement: Research Paper’, 13 June 2012, http://www.health.gov.au/internet/main/publishing.nsf/Content/1D0A31AAB8210156CA257B9E0023221B/$File/Review%20of%20MAIF%20Agreement%20-%20Final%20Research%20Paper%20120613.PDF (accessed 23 September 2013) rec.4
24. Department of Health and Ageing, ‘Advisory Panel on the Marketing in Australia of Infant Formula’, updated 8 July 2013 at http://www.health.gov.au/internet/main/publishing.nsf/Content/review-effective-infant-formula
25. World Health Organisation, ‘Information concerning the use and marketing of follow-up formula’, 17 July 2013, http://www.who.int/nutrition/topics/WHO_brief_fufandcode_post_17July.pdf p.1
26. World Health Organisation, ‘Information concerning the use and marketing of follow-up formula’, 17 July 2013, http://www.who.int/nutrition/topics/WHO_brief_fufandcode_post_17July.pdf p.3
27. B. Gunter, R. Dickinson, J. Matthews and J. Cole, ‘Formula manufacturers’ web sites: are they really non-compliant advertisements?’ 113 (2012) 1 Health Education 18-27
28. J. Smith and M. Blake, ‘Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950 – 2010’, 37 (2013) 4 Australian and New Zealand Journal of Public Health, 342.
29. Standing Committee on Health and Ageing, The Best Start: Report on the inquiry into the health benefits of breastfeeding (2007) recommendation 22
30. Particularly in cases where substitutes are marketed as a total breast-milk replacement, contrary to WHO recommendations that breastfeeding be continued until 2 years of age or beyond, with complementary foods.
31. Prohibited under World Health Assembly Resolution 49.15 (1996)
32. World Health Organisation, International Code of Marketing of Breast-milk Substitutes (1981) art. 2
33. Phillip Hudson, ‘Prime Minister Tony Abbott axes expert advice on firearms, infant formula, high-speed rail, housing, insurance and animal welfare’, Herald Sun, 7 November 2013 (online) at http://www.heraldsun.com.au/news/prime-minister-tony-abbott-axes-expert-advice-on-firearms-infant-formula-highspeed-rail-housing-insurance-and-animal-welfare/story-fni0fiyv-1226755751117 (accessed 9 January 2014)