Media rightly flags shocking U.S. move to undermine breastfeeding resolution

Following a story in The New York Times last week, there has been widespread news coverage of actions by American officials to undermine a resolution on breastfeeding at the recent World Health Assembly, held at the United Nations in Geneva in May. News stories highlighted that U.S. officials threatened to withdraw military aid and impose “punishing trade measures” on Ecuador, the original proponent of the resolution, and that the U.S. might even cut its contribution to the World Health Organization.

Other countries reportedly refused to sponsor the breastfeeding resolution for fear of retaliation by the U.S. government. Eventually Russia sponsored the resolution, an interesting political move, and it was not challenged by the U.S., even though American delegates tried to amend the text of the resolution until the bitter end. 

It’s worth noting how stunning all this is. Breastfeeding is a recognized human rights issue for mothers and babies alike and should be promoted as such.

Decades of research have underscored the health benefits of breastfeeding for mothers and babies alike. A host of U.S. government agencies, including the Office of the Surgeon General and the Department of Health and Human Services, are unequivocal in their evidence-based support of breastfeeding. More than 820,000 child deaths per year could be prevented if breastfeeding were adopted at near universal levels, according to 2016 research published in The Lancet.

Our governments have an obligation to help make this happen. 

Nonetheless, at the World Health Assembly, the U.S. delegation sought to water down global commitments to the promotion of breastfeeding. The delegates wanted to remove reference to most existing international standards, guidance and regulatory and enforcement mechanisms, all presumably to curry favor with the private sector. Corporations consistently engage in aggressive marketing practices designed to entice new mothers to use breast milk substitutes as an alternative to breastfeeding, and the global baby food market continues to grow. Recent research revealed that it is expected to be worth $70.6 billion by 2019. There is a clear need for breast milk substitutes for the minority of women who cannot breastfeed, and nobody is arguing against this, but their use should not be promoted for all new mothers. 

Most people have no idea what the World Health Assembly is nor how negotiations play out. The actions of the U.S. delegation may have been egregious, but they were not unusual. An editorial in The New York Times noted that the U.S. delegation to this year’s World Health Assembly also sought to derail other negotiations that might have negatively impacted commercial interests, and that previous administrations have engaged in similar tactics. 

Yet all of this usually flies under the radar. The level of media attention that followed the reporting by The Times is near unprecedented for the World Health Assembly. While most of the press has focused on the Trumpian nature of these actions, these behaviours run deeper than the current administration. The bigger picture is important here.

The World Health Assembly is, ultimately, a blend of the technical and political spheres. It’s a political forum where decisions about global health priorities are made by political leaders who balance evidence and priorities against the whole range of issues relevant to their country. And this includes trade, industry and all other competing interests.

Media attention to the Assembly is truly welcome: governments should be called out, people should be given information to understand the good and the bad of how global health negotiations work, especially when they take place behind closed doors. Ideally, global health priorities would be set by technical experts based only on the best available evidence. But global health does not occur in a vacuum. The politics that play out in global health are undeniable — “horse-trading” is widespread. The behaviour of the United States at the recent World Health Assembly is a particularly ugly manifestation of this reality.

We might be dismayed by the actions of the U.S. delegation, but we shouldn’t be surprised. We should be fired up, and we should use this emotion to hold our governments accountable for their actions, not only in our own countries but around the world. People’s lives are at stake.

Laura Ferguson is an assistant professor of preventive medicine at the University of Southern California and the associate director of the Program on Global Health & Human Rights at the USC Institute for Global Health.