Health advocates say it’s long been US policy to ‘bully’ other countries to protect interests of formula manufacturers.

Health advocates in the US have responded with outrage over recent reports saying that the US government intimidated countries into ditching a WHO resolution promoting breastfeeding.

US officials have since denied the claims, but health experts and advocates say the reports help illustrate a long-standing practice of the government placing the priorities of formula manufacturers before those of global health.

“It has long been US policy to bully other countries on behalf of its companies and against the interests of public and environmental health,” said Ted Greiner of the World Public Health Nutrition Association’s Executive Committee.

According to Greiner and other health advocates, there have been several instances dating back to the 1980s in which the US government has sought to pressure other countries or their own agencies regarding language or legislation promoting breastfeeding.

Most recently, anger erupted after the New York Times first reported on July 8 that the US delegation to World Health Assembly, the decision-making body of the World Health Organization (WHO), in May allegedly threatened Ecuador with trade sanctions and the withdrawal of military aid over a resolution it was set to introduce about breastfeeding.

According to the New York Times, Ecuador suddenly backed out of introducing the resolution after the US allegedly made the threats. Several other countries were also asked to put the resolution forward, but refused, the New York Times reported.

US officials reportedly took issue with two passages in the resolution. The first called on governments to “protect, promote and support breast-feeding”. The second called for stricter regulation of the promotion of certain food products that may adversely affect children’s health.

The resolution was ultimately adopted with much of the original language after Russia stepped in.

The US Department of State dismissed the reports as “false”, saying it “worked collaboratively” with the other countries as a “leading voice in negotiations that led to [the] adoption of the resolution by consensus”.

In a statement to Al Jazeera, a State Department official said: “The US shares a common objective with other countries to promote breastfeeding, as well as adequate and timely complementary feeding … The resolution as originally drafted would have run counter to that common objective.”

The official added that the US “does not shy away from expressing its disagreement when necessary”.

Caitlin Oakley, US Department of Health and Human Services (HHS), told Al Jazeera that the US “was fighting to protect women’s abilities to make the best choices for the nutrition of their babies”, arguing women who cannot or choose not to breastfeed “should not be stigmatized”. HHS added that at no time during the negotiations at the World Heath Assembly were threats of trade sanctions made in relation to the resolution.

But Greiner argued that allegations of US meddling can be traced back as far as 1981, when President Ronald Reagan “forced the US delegation to the World Health Assembly to cast the sole vote against” the International Code of Marketing of Breast-Milk Substitutes.

That code highlights the “superiority of breastfeeding” and restricts certain marketing of breastmilk substitutes.

According to a New York Times article at the time, the US government said despite its “interest in encouragement of breast-feeding”, the marketing restrictions would “run counter to our constitutional guarantees of free speech and freedom of information”.

But according to health groups, the Reagan administration was protecting the interests of the formula industry. The New York Times reported that two high-level health officials resigned over the decision.

‘Never been fully supportive’

Cecilia Tomori, an anthropologist at Durham University who researches breastfeeding trends, said the US “has never been fully supportive of health policies that protect breastfeeding and has always protected commercial interests”.

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“Formula companies were major drivers of the global decline of breastfeeding in the 20th century, and they continue to target and undermine breastfeeding in the most vulnerable communities around the world,” Tomori said.

Advocates also point to a 2012 letter sent by the US embassy in Hanoi to the Vietnamese National Assembly that expressed concern over proposed legislation that would have banned baby formula companies from advertising products for children under two years old.

“Several US companies have contacted the US Embassy regarding their serious concerns,” said the letter leaked to INFACT Canada, an NGO that works to end “unethical marketing” of infant formula. The letter added that the legislation “could have a significant negative impact on their business in Vietnam” and that the embassy shared the concerns of the companies.

Roger Mathison, a nutritionist based in Hanoi, said the incident was “an alarming example of a country representation where the interests of large corporations take control over political decisions”.

The US embassy in Hanoi had not responded to Al Jazeera’s request for comment at the time of publication.

Other letters provided to Al Jazeera by Mathison showed the US questioning the Thai government’s position on a similar marketing ban on breastmilk substitutes.

Both Vietnam and Thailand ultimately passed the bans.

Even at home, the US government has been accused of bowing to the influence of the infant formula industry.

According to a Washington Post article from 2010, HHS toned down a campaign about the risks of not breastfeeding children after lobbying efforts by the infant-formula industry.

The newspaper reported that some senior officials involved in an ad campaign said the toned-down version of the ads promoted breastfeeding while following the scientific evidence at the time. Others, however, told the Washington Post, that it wasn’t the first time the department “missed a chance to try to raise the breastfeeding rate”.

‘Worst attack on maternal health’

Over the past 40 years, WHO has consistently urged mothers to breastfeed their children, to protect them from diarrhoeal and respiratory diseases, while also reducing the mothers’ chances of getting ovarian cancer, breast cancer, and diabetes. Long breastfeeding durations are also linked to better academic performance.

According to the Centers for Disease Control and Prevention (CDC), nearly 83 percent of newborn babies in the US started out breastfeeding in 2014, up from 73 percent in 2004. But the percentage dropped to 24.9 percent when examining the rate of babies who are breastfed exclusively for up to six months. The World Health Assembly has called for at least a 50 percent rate of exclusive breastfeeding by 2025.

For its part, the CDC states on its website that “breastfeeding is the best source of nutrition for most infants”. The Office of Women’s Heath, which is under the HHS, states the benefits of breastfeeding on its site.

According to Lactation consultant Jacqueline Torres, “families should have access to the quality lactation education they desire without having infant formula be an option until they want it to be”.

She added: “Systemic breastfeeding advocacy is absolutely crucial in making that a global reality.”

Trump weighed in on the issue on Twitter, saying “The US strongly supports breastfeeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty.”

But many health advocates say the US approach is an “attack” on global maternal health.

“For the representatives of the US invited into that conversation to attempt to be a barrier to evidence-based infant feeding practice through breastfeeding is at best extreme negligence and at worst an attack on maternal-child health and wellbeing,” Torres said.