06 Aug 2020

Summary

The BDA supports all efforts to improve child health in the UK through active promotion of breastfeeding. There is a view that this work could be strengthened by changing the way we work with companies who manufacture breastmilk substitutes (BMS). The BDA Board of Directors have discussed this issue and agreed that we should no longer accept some types of sponsorship from BMS divisions of companies. This is in the context of guidance from the Baby Friendly Initiative (BFI) which outlines that staff should not be encouraged or enabled to attend study days sponsored by BMS product divisions of companies. This policy provides more background on the decision and details what we are going to do.

The BDA believes that

  • The work done to protect infant health and promote breastfeeding is crucial and that we should support our members to adhere to schemes like BFI which work towards these aims. However, these schemes may be interpreted differently at a local level which can result in uncertainty. This is why the BDA will develop guidance for members in complying with the requirements of these schemes.

In addition, so that BDA members can access suitable CPD whilst complying with these requirements, we will no longer accept sponsorship for BDA events from BMS product divisions of companies.

  • This new policy applies to event sponsorship only and does not include other sponsorship such as advertising, corporate membership, consultancy and insight work or other projects. It includes all BDA-led conferences, seminars, study days and training courses, including specialist group and regional branch events.
  • No sponsorship for the promotion of BMS products will be accepted at such events. In this context, the BDA aligns with the UNICEF definition of BMS which is any product which replaces breast milk for children up to the age of three years, including FSMPs (complete clinical paediatric products, specialist formulas and feeds, as well as over the counter preparations).
  • BMS product divisions of companies and their representatives may be invited to speak at these events if the organising committee feel they require an update, but no sponsorship fee can be accepted. Any such presentations must focus on scientific updates only, and they would only be invited in order to present and take questions. Similarly, BMS product divisions of companies may be invited to provide information which the organising committee feel supports the delivery of the event learning objectives, but no sponsorship fee can be accepted.
  • Only BMS product divisions of companies are included in this new policy – providers of foods and FSMP products for children aged over three years and adults will continue to be invited to sponsor BDA events as these are not within the UNICEF definition of BMS. The BDA will maintain guidance for event organisers in this respect.
  • The BDA will still engage in dialogue with BMS product divisions of companies in order to influence and advocate, but these relationships will be outside of a sponsorship context.
  • This shift takes account of the reality of the current climate while also supporting members to access suitable CPD. We will monitor its impact to ensure the BDA is aware of any adverse clinical care issues.

Background

The BDA supports all efforts to improve breastfeeding rates in the UK through active promotion of breastfeeding, the provision of support and advice to parents, and adherence to national and international policies and practices that protect, support and promote breastfeeding1.

We also believe it is important for healthcare professionals to continue to be able to speak with and collaborate with company representatives from companies who manufacture breastmilk substitutes. These relationships can be managed to focus on issues such as product changes or product development, in a way that removes the potential for any impact on parents and babies.

There is a view that our work to protect breastfeeding could be strengthened by changing the way we work with companies who manufacture breastmilk substitutes (BMS). The World Health Organisation (WHO) and UNICEF2 argue that the promotion of BMS influences behaviour and encourages mothers not to breastfeed or to cease breastfeeding.

An international code exists3 to control this promotion, which has been added to on a number of occasions, but is not enshrined in UK law. There is significant food and labelling regulation in the UK which controls what BMS companies can say to parents and health workers, as well as the compositional criteria of BMS4. Most BMS product divisions of companies in the UK publish some information on their compliance with these rules.

In addition, a framework exists in UK healthcare settings to ensure that the protection of breastfeeding is a priority for all healthcare professionals. The ‘Baby Friendly Initiative’ (BFI) is in place in a high number of UK hospitals and its scope may include paediatric departments and neighbouring services. In order to maintain its accreditation, an NHS Trust or Board must have controls in place around the access BMS companies have to premises and staff, and how staff engage with BMS companies directly. Since late 2018, the NHS England 10-year plan mandates that all Trusts or Boards should go through an independent accreditation (such as BFI).

The BFI has provided guidance for healthcare professionals in accredited services around managing potential conflicts of interest in contact and relationships with BMS product divisions of companies5. This document sets out requirements with regard to:

  • Sponsored study days / events / meetings on public services premises,
  • Staff attending sponsored study days,
  • Individual staff engaging with the companies and
  • Awards and gifts.

The BDA is not eligible for BFI accreditation and the scheme is not designed for organisations like us. We have robust guidelines on how we work with commercial organisations6 and regularly review the approach. Infant feeding and BMS are sensitive issues with several parts of the membership and given these recent policy shifts, the BDA Board of Directors have held several discussions during 2019. Directors are aware of the challenges members may face, especially in accessing suitable CPD. In addition, they explored how the BDA can support members who may feel our commercial relationships impact their practice.

The BDA Board of Directors have carefully considered this loss of revenue, and the new approach will be effective as at March 2020*.  The Board of Directors have considered other options and agreed that this is an appropriate adjustment in the current context. They will review the issue again in 12 months’ time (end of 2020).