Here it is in a nutshell.

Medela—a Swiss company that has sold breast pumps and accessories in the U.S. for over 25 years—recently started featuring pictures of bottles and nipples (or teats) in their advertisements for their “Breastmilk Bottle” sets.

The International Lactation Consultant Association (ILCA) thought that might violate the International Code of Marketing of Breast-milk Substitutes, which was adopted in 1981 by the World Health Assembly, the decision-making entity for the World Health Organization. So, they asked a third party expert (the National Alliance for Breast-Feeding Advocacy ([NABA]) to see if it did. Indeed, it did, said NABA. So, ILCA had no choice but to drop Medela as both an advertiser in the Journal of Human Lactation and as an exhibitor at ILCA’s annual conference.

And that’s it. Except that it means so much more than that.

As Babygooroo has reported here and here, the issues surrounding Medela’s advertising are many: the influence industry plays in professional medical associations; a long-held relationship, now damaged, between a company and breastfeeding advocates; the priority of marketing over ethics.

While Medela may be violating the International code, ILCA’s decision to drop them as advertisers and exhibitors is a touchy topic—after all, this is a company that has been known for its breastfeeding advocacy, its relationship with private practice lactation consultants and its years of breastfeeding and pumping research.

“Politically, who is kidding whom?” said Liz Brooks, ILCA secretary. “We know Medela has a long-standing presence in the breastfeeding community.”

Is it fair to paint Medela as a villain here? Surely they’re acting out of the best interests for breastfeeding promotion? What does Medela have to say for itself, anyway?

Good question. Attempts to interview a representative resulted in a referral to Medela’s Frequently Asked Questions, as well as the company’s Position Statement on the matter, which was released in December.

“Medela feels that it is very important to give mother access to the information and education on the proper use and benefits” of the company’s complete breastfeeding systems,” reads the statement from Medela president Carr Lane Quackenbush. “…However, these activities bring Medela in a conflict with the current interpretation of the WHO code…we believe our actions continue to support the WHO code’s intent to support breastfeeding and oppose breastmilk substitutes. However, we recognize and sincerely regret that our actions may be considered a WHO code violation.”

According to Medela’s FAQ, the company chose to use images of bottles and teats as a way to draw attention to the fact that their bottles have always been BPA-free. “We continue to share the common goal of helping mothers in their endeavor to breastfeed and provide the best nutrition to their babies,” the FAQ reads.

It goes on to suggest that the code’s restrictive nature is actually at fault, as it forbids companies like Medela from sharing information about the safety of their products.

Medela invests in research and development to “provide mothers the best products to make their breastfeeding experience as comfortable and efficient as possible,” reads the FAQ. “…The WHO code Interpretation prevents us from this pertinent information to mothers.”

Brooks called the company’s PR “smoke and mirrors.” The code, she says, is straightforward, “designed to regulate the marketing only of products” like bottles, nipples or teats, formula and early baby food, she says. “Pumps aren’t even covered in the code, (but) Medela has begun to market bottles and teats predominantly with their pumps.” To be clear: the code is not a restriction against the sale of such items and is not a commentary on companies’ best intentions; it purely addresses marketing. Read on to see what else Brooks had to say in a recent interview.

Babygooroo: According to the April newsletter of the International Baby Food Action Network, Medela has been “treading a fine line” for years in regards to the International Code of Marketing of Breast-milk Substitutes. Would you say it was a hard decision for ILCA to no longer allow Medela to exhibit at the annual conference or advertise in the Journal of Human Lactation?

Brooks: No, it wasn’t a hard decision. Our bylaws are very clear that we support the WHO code philosophically. Our bylaws give us a second, stricter layer of responsibility: we as an organization will not accept any money from an organization deemed to be in violation of the WHO code. That is clear. The problem for us organizationally is to come up with a system to make that decision without a conflict of interest…If someone comes to us and says, ‘Gee, we might be a bad guy but we want to (pay to) exhibit,’ that’s a textbook definition of a conflict of interest. There are established entities that interpret the WHO code… NABA did an analysis and said they were code-violative.

Why do you think Medela isn’t backing down? Is it not important enough to maintain their image as a breastfeeding-supportive company?

Brooks: I don’t know the answer. Clearly it was a decision they made knowing that the marketing practice they’re engaging in now doesn’t support the WHO code. When I get stopped by the troop on the highway because I’m speeding, and I say, ‘I was supporting the intent of the law; I was speeding just a little bit”—I still get a ticket. It surprises me that they were willing to poison many, many years of goodwill that was engendered in the last 25 years.

If Medela were to change their advertising practices, do you think it’s at all possible that there could be a relationship with them again?

Brooks: Oh, sure. That’s the reason that ILCA created this system, using NABA as our judge and jury…if Medela or any other company where to change their marketing practices, they could be re-evaluated.

Do you think most lactation consultants here will continue to have Medela brochures or equipment and offer them? Is there a feeling that lactation consultants will sort of turn their back on Medela?

Brooks: To paint it with a broad brush is inaccurate and a little fantastical. Lactation consultants are required to have full and honest discussions with mothers. They can discuss anything…There is no restriction on what can be discussed. That’s what we’re here for. There are lactation consultants in the world who are peeved that Medela isn’t following the WHO code because it’d be very easy for them to change. You should have an arm’s length, business-type relationship (with industry). It’s just a piece of equipment you have in your hospital. You shouldn’t have a cozy relationship with these companies.

The Journal of American Medical Association (JAMA) has an article out now that talks about the relationship between professional medical associations and industry. Is this a tricky issue for the ILCA? Is there a lot of assessment when it comes to advertisers and exhibitors?

Brooks: The JAMA editorial was very powerful. The good news for us as an organization is we’ve always done everything they recommend, save one practice….in our ILCA exhibit booths, we allow people to hand out little doo-hickeys (such as pens). JAMA allows advertisers in professional journals. We at ILCA have a second step, we won’t allow non-code compliant advertisers….We’ve been doing it that way for years and we’ve been in the black for years.