カテゴリー: WHOやユニセフの母乳育児支援

WHO(世界保健機関)ユニセフ(世界児童基金)「赤ちゃんにやさしい病院運動」

赤ちゃんにやさしい病院運動The Baby-Friendly Hospital InitiativeとはWHO(世界保健機関)ユニセフ(世界児童基金)による
・「産科施設や社会」が母子にやさしくなる環境を広めるための運動 
・母乳育児を支援することで、母乳で育てることのできない赤ちゃんも含めた、全ての赤ちゃんに人生で最高のスタートを与えることを可能にするための運動 です。

1981年 母乳代用品のマーケティングに関する国際規準(対象 企業、保健医療システム、政府)https://bonyuikuji.net/?p=317

1989年 母乳育児成功のための10か条(対象:産科医療や新生児ケアにかかわるすべての施設)https://jalc-net.jp/dl/10steps_2018_1989.pdf

1990年 母乳育児の保護・推進・支援のための
 イノチェンティ宣言(対象:社会、政府、国際機関、国際的な団体)https://bonyuikuji.net/?p=308

1991年 赤ちゃんにやさしい病院運動https://www.who.int/activities/promoting-baby-friendly-hospitals
 (最初に「赤ちゃんにやさしい病院」と認定された1つが 現 国立岡山医療センター)
2002年 乳幼児の栄養に関する世界的な運動戦略(対象 政府、国際組織、その他の関係団体、医療専門家の職能団体、支援団体などのNGO、営利企業、雇用主、教育当局、マスメディアなど)要旨 https://jalc-net.jp/dl/Global_Strategy.pdf日本語全訳 http://apps.who.int/iris/bitstream/10665/42590/49/9241562218-jpn.pdf
2005年 乳幼児の栄養に関するイノチェンティ宣言 2005年版(対象 全ての関係者、政府、「国際規準」の範囲に含まれる製品のすべての製造業者と販売業者、多国間および2国間関係機関と国際金融機関)(参加団体が9つに拡大)https://jalc-net.jp/dl/Innocenti2007.pdf

2018年 母乳育児がうまくいくための10のステップ(対象:産科医療や新生児ケアにかかわるすべての施設)https://jalc-net.jp/dl/10steps_2018_1989.pdf

母乳育児がうまくいくための 10 のステップ 「母乳育児成功のための 10 カ条」2018 年改訂版

ユニセフとWHOの共同宣言として1989年に発表された母乳育児成功のための10カ条が2018年に改訂され、NPO 法人日本ラクテーション・コンサルタント協会 翻訳 「母乳育児がうまくいくための 10 のステップ」が2018 年 9月に公開されました。

母乳育児がうまくいくための 10 のステップ
「母乳育児成功のための 10 カ条」2018 年改訂版

 WHO/UNICEF:The Ten Steps to Successful Breastfeeding, 2018

施設として必須の要件
 1a. 「母乳代用品のマーケティングに関する国際規準」と世界保健総会の関連決議を
    完全に順守する。
 1b. 乳児栄養の方針を文書にしスタッフと親にもれなく伝える。
 1c. 継続したモニタリングとデータ管理システムを確立する。
 2. スタッフが母乳育児を支援するための十分な知識、能力、スキルを持つようにする。

臨床における必須の実践
 3. 母乳育児の重要性とその方法について、妊娠中の女性およびその家族と話し合う。
 4. 出産直後からのさえぎられることのない肌と肌との触れ合い(早期母子接触)がで
  きるように、出産後できるだけ早く母乳育児を開始できるように母親を支援する。
 5. 母親が母乳育児を開始し、継続できるように、また、よくある困難に対処できるように
  支援する。
 6. 医学的に適応のある場合を除いて、母乳で育てられている新生児に母乳以外の飲食物を
  与えない。
 7. 母親と赤ちゃんがそのまま一緒にいられるよう、24 時間母子同室を実践する。
 8. 赤ちゃんの欲しがるサインを認識しそれに応えるよう、母親を支援する。
 9. 哺乳びん、人工乳首、おしゃぶりの使用とリスクについて、母親と十分話し合う。
 10. 親と赤ちゃんが継続的な支援とケアをタイムリーに受けられるよう、退院時に調整する。

        翻訳:NPO 法人日本ラクテーション・コンサルタント協会 2018年9月



母乳育児成功のための10ヵ条

産科医療や新生児ケアにかかわるすべての施設は以下の条項を守らなければなりません


1. 母乳育児についての基本方針を文書にし、関係するすべての保健医療スタッフに周知徹底しましょう
2. この方針を実践する為に必要な技能を、すべての関係する保健医療スタッフにトレーニングしましょう
3. 妊娠した女性すべてに母乳育児の利点とその方法に関する情報を提供しましょう
4. 産後30分以内に母乳育児が開始できるよう、母親を援助しましょう
5. 母親に母乳育児のやり方を教え、母と子が離れることが避けられない場合でも母乳分泌を維持できるような方法を教えましょう
6. 医学的に必要でない限り、新生児には母乳以外の栄養や水分を与えないようにしましょう
7. 母親と赤ちゃんが一緒にいられるように、終日、母子同室を実施しましょう
8. 赤ちゃんが欲しがるときに欲しがるだけの授乳を勧めましょう
9. 母乳で育てられている赤ちゃんに人工乳首やおしゃぶりを与えないようにしましょう
10. 母乳育児を支援するグループ作りを後援し、産科施設の退院時に母親に紹介しましょう
(WHO/UNICEF: The Ten Steps to Successful Breastfeeding,1989)



https://www.who.int/nutrition/bfhi/ten-steps/en/

The International Code of Marketing of Breastmilk Substitutes

Art. 1. Aim of the Code
Art. 2. Scope of the Code
Art. 3. Definitions
Art. 4. Information and education
Art. 5. The general public and mothers
Art. 6. Health care systems
Art. 7. Health workers
Art. 8. Persons employed by manufacturers and distributors
Art. 9. Labelling
Art. 10. Quality
Art. 11. Implementation and monitoring

The Member States of the World Health Organisation:

Affirming the right of every child and every pregnant and lactating woman to be adequately nourished as a means of attaining and maintaining health;

Recognising that infant malnutrition is part of the wider problems of lack of education, poverty, and social injustice;

Recognising that the health of infants and young children cannot be isolated from the health and nutrition of women, their socio-economic status and their roles as mothers;

Conscious that breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; that it forms a unique biological and emotional basis for the health of both mother and child; that the anti-infective properties of breast milk help to protect infants against disease; and that there is an important relationship between breastfeeding and child spacing;

Recognising that the encouragement and protection of breastfeeding is an important part of the health, nutrition and other social measures required to promote healthy growth and development of infants and young children; and that breastfeeding is an important aspect of primary health care;

Considering that when mothers do not breastfeed, or only do so partially, there is a legitimate market for infant formula and for suitable ingredients from which to prepare it; that all these products should accordingly be made accessible to those who need them through commercial or noncommercial distribution systems; and that they should not be marketed or distributed in ways that may interfere with the protection and promotion of breastfeeding;

Recognising further that inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries, and that improper practices in the marketing of breastmilk substitutes and related products can contribute to these major public health problems;

Convinced that it is important for infants to receive appropriate complementary foods, usually when the infant reaches four to six months of age, and that every effort should be made to use locally available foods; and convinced, nevertheless, that such complementary foods should not be used as breastmilk substitutes;

Appreciating that there are a number of social and economic factors affecting breastfeeding, and that, accordingly, governments should develop social support systems to protect, facilitate and encourage it, and that they should create an environment that fosters breastfeeding, provides appropriate family and community support, and protects mothers from factors that inhibit breastfeeding;

Affirming that health care systems, and the health professionals and other health workers serving in them, have an essential role to play in guiding infant feeding practices, encouraging and facilitating breastfeeding, and providing objective and consistent advice to mothers and families about the superior value of breastfeeding, or, where needed, on the proper use of infant formula, whether manufactured industrially or home prepared;

Affirming further that educational systems and other social services should be involved in the protection and promotion of breastfeeding, and in the appropriate use of complementary foods;

Aware that families, communities, women’s organisations and other nongovernmental organisations have a special role to play in the protection and promotion of breastfeeding and in ensuring the support needed by pregnant women and mothers of infants and young children, whether breastfeeding or not;

Affirming the need for governments, organisations of the United Nations system, nongovernmental organisations, experts in various related disciplines, consumer groups and industry to cooperate in activities aimed at the improvement of maternal, infant and young child health and nutrition;

Recognising that governments should undertake a variety of health, nutrition and other social measures to promote healthy growth and development of infants and young children, and that this Code concerns only one aspect of these measures;

Considering that manufacturers and distributors of breastmilk substitutes have an important and constructive role to play in relation to infant feeding, and in the promotion of the aim of this Code and its proper implementation;

Affirming that governments are called upon to take action appropriate to their social and legislative framework and their overall development objectives to give effect to the principles and aim of this Code, including the enactment of legislation, regulations or other suitable measures;

Believing that, in the light of the foregoing considerations, and in view of the vulnerability of infants in the early months of life and the risks involved in inappropriate feeding practices, including the unnecessary and improper use of breastmilk substitutes, the marketing of breastmilk substitutes requires special treatment, which makes usual marketing practices unsuitable for these products;

THEREFORE:

The Member States hereby agree the following articles which are recommended as a basis for action.

Article 1. Aim of the Code

The aim of this Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Article 2. Scope of the Code

The Code applies to the marketing, and practices related thereto, of the following products: breastmilk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, when marketed or otherwise represented to be suitable, with or without modification, for use as a partial or total replacement of breast-milk; feeding bottles and teats. It also applies to their quality and availability, and to information concerning their use.

Article 3. Definitions

For the purposes of this Code:

“Breastmilk substitute” means any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose.

“Complementary food” means any food, whether manufactured or locally prepared, suitable as a complement to breast milk or to infant formula, when either becomes insufficient to satisfy the nutritional requirements of the infant. Such food is also commonly called “weaning food” or “breastmilk supplement”.

“Container” means any form of packaging of products for sale as a normal retail unit, including wrappers.

“Distributor” means a person, corporation or any other entity in the public or private sector engaged in the business (whether directly or indirectly) of marketing at the wholesale or retail level a product within the scope of this Code. A “primary distributor” is a manufacturer’s sales agent, representative, national distributor or broker.

“Health care system” means governmental, nongovernmental or private institutions or organisations engaged, directly or indirectly, in health care for mothers, infants and pregnant women; and nurseries or childcare institutions. It also includes health workers in private practice. For the purposes of this Code, the health care system does not include pharmacies or other established sales outlets.

“Health worker” means a person working in a component of such a health care system, whether professional or nonprofessional, including voluntary, unpaid workers.

“Infant formula” means a breastmilk substitute formulated industrially in accordance with applicable Codex Alimentarius standards, to satisfy the normal nutritional requirements of infants up to between four and six months of age, and adapted to their physiological characteristics. Infant formula may also be prepared at home, in which case it is described as “home prepared”.

“Label” means any tag, brand, mark, pictorial or other descriptive matter, written, printed, stencilled, marked, embossed or impressed on, or attached to, a container (see above) of any products within the scope of this Code.

“Manufacturer” means a corporation or other entity in the public or private sector engaged in the business or function (whether directly or through an agent or through an entity controlled by or under contract with it) of manufacturing a product within the scope of this Code.

“Marketing” means product promotion, distribution, selling, advertising, product public relations, and information services.

“Marketing personnel” means any persons whose functions involve the marketing of a product or products coming within the scope of this Code.

“Samples” means single or small quantities of a product provided without cost.

“Supplies” means quantities of a product provided for use over an extended period, free or at a low price, for social purposes, including those provided to families in need.

Article 4. Information and education

4.1 Governments should have the responsibility to ensure that objective and consistent information is provided on infant and young child feeding for use by families and those involved in the field of infant and young child nutrition. This responsibility should cover either the planning, provision, design and dissemination of information, or their control.

4.2 Informational and educational materials, whether written, audio, or visual, dealing with the feeding of infants and intended to reach pregnant women and mothers of infants and young children, should include clear information on all the following points:

 

1. the benefits and superiority of breastfeeding;

2. maternal nutrition, and the preparation for and maintenance of breastfeeding;

3. the negative effect on breastfeeding of introducing partial bottle feeding;

4. the difficulty of reversing the decision not to breastfeed; and

5. where needed, the proper use of infant formula, whether manufactured industrially or home prepared.

 

When such materials contain information about the use of infant formula, they should include the social and financial implications of its use; the health hazards of inappropriate foods or feeding methods; and, in particular, the health hazards of unnecessary or improper use of infant formula and other breastmilk substitutes. Such materials should not use any pictures or text which may idealise the use of breastmilk substitutes.

4.3 Donations of informational or educational equipment or materials by manufacturers or distributors should be made only at the request and with the written approval of the appropriate government authority or within guidelines given by governments for this purpose. Such equipment or materials may bear the donating company’s name or logo, but should not refer to a proprietary product that is within the scope of this Code, and should be distributed only through the health care system.

 

Article 5. The general public and mothers

5.1 There should be no advertising or other form of promotion to the general public of products within the scope of this Code.

5.2 Manufacturers and distributors should not provide, directly or indirectly, to pregnant women, mothers or members of their families, samples of products within the scope of this Code.

5.3 In conformity with paragraphs 1 and 2 of this Article, there should be no point-of-sale advertising, giving of samples, or any other promotion device to induce sales directly to the consumer at the retail level, such as special displays, discount coupons, premiums, special sales, loss leaders and tie-in sales, for products within the scope of this Code. This provision should not restrict the establishment of pricing policies and practices intended to provide products at lower prices on a long-term basis.

5.4 Manufacturers and distributors should not distribute to pregnant women or mothers of infants and young children any gifts of articles or utensils which may promote the use of breastmilk substitutes or bottle feeding.

5.5 Marketing personnel, in their business capacity, should not seek direct or indirect contact of any kind with pregnant women or with mothers of infants and young children.
Article 6. Health care systems

6.1 The health authorities in Member States should take appropriate measures to encourage and protect breastfeeding and promote the principles of this Code, and should give appropriate information and advice to health workers in regard to their responsibilities, including the information specified in Article 4.2.
6.2 No facility of a health care system should be used for the purpose of promoting infant formula or other products within the scope of this Code. This Code does not, however, preclude the dissemination of information to health professionals as provided in Article 7.2.
6.3 Facilities of health care systems should not be used for the display of products within the scope of this Code, for placards or posters concerning such products, or for the distribution of material provided by a manufacturer or distributor other than that specified in Article 4.
6.4 The use by the health care system of “professional service representatives”, “mothercraft nurses” or similar personnel, provided or paid for by manufacturers or distributors, should not be permitted.

6.5 Feeding with infant formula, whether manufactured or home prepared, should be demonstrated only by health workers, or other community workers if necessary; and only to the mothers or family members who need to use it; and the information given should include a clear explanation of the hazards of improper use.

6.6 Donations or low-price sales to institutions or organisations of supplies of infant formula or other products within the scope of this Code, whether for use in the institutions or for distribution outside them, may be made. Such supplies should only be used or distributed for infants who have to be fed on breastmilk substitutes. If these supplies are distributed for use outside the institutions, this should be done only by the institutions or organisations concerned. Such donations or low-price sales should not be used by manufacturers or distributors as a sales inducement.

6.7 Where donated supplies of infant formula or other products within the scope of this Code are distributed outside an institution, the institution or organisation should take steps to ensure that supplies can be continued as long as the infants concerned need them. Donors, as well as institutions or organisations concerned, should bear in mind this responsibility.

6.8 Equipment and materials, in addition to those referred to in Article 4.3, donated to a health care system may bear a company’s name or logo, but should not refer to any proprietary product within the scope of this Code.
Article 7. Health workers

7.1 Health workers should encourage and protect breastfeeding; and those who are concerned in particular with maternal and infant nutrition should make themselves familiar with their responsibilities under this Code, including the information specified in Article 4.2.
7.2 Information provided by manufacturers and distributors to health professionals regarding products within the scope of this Code should be restricted to scientific and factual matters, and such information should not imply or create a belief that bottle feeding is equivalent or superior to breastfeeding. It should also include the information specified in Article 4.2.
7.3 No financial or material inducements to promote products within the scope of this Code should be offered by manufacturers or distributors to health workers or members of their families, nor should these be accepted by health workers or members of their families.

7.4 Samples of infant formula or other products within the scope of this Code., or of equipment or utensils for their preparation or use, should not be provided to health workers except when necessary for the purpose of professional evaluation or research at the institutional level. Health workers should not give samples of infant formula to pregnant women, mothers of infants and young children, or members of their families.

7.5 Manufacturers and distributors of products within the scope of this Code should disclose to the institution to which a recipient health worker is affiliated any contribution made to him or on his behalf for fellowships, study tours, research grants, attendance at professional conferences, or the like. Similar disclosures should be made by the recipient.

 

Article 8. Persons employed by manufacturers and distributors

8.1 In systems of sales incentives for marketing personnel, the volume of sales of products within the scope of this Code should not be included in the calculation of bonuses, nor should quotas be set specifically for sales of these products. This should not be understood to prevent the payment of bonuses based on the overall sales by a company of other products marketed by it.

8.2 Personnel employed in marketing products within the scope of this Code should not, as part of their job responsibilities, perform educational functions in relation to pregnant women or mothers of infants and young children. This should not be understood as preventing such personnel from being used for other functions by the health care system at the request and with the written approval of the appropriate authority of the government concerned.

Article 9. Labelling

9.1 Labels should be designed to provide the necessary information about the appropriate use of the product, and so as not to discourage breastfeeding.

9.2 Manufacturers and distributors of infant formula should ensure that each container has a clear, conspicuous, and easily readable and understandable message printed on it, or on a label which cannot readily become separated from it, in an appropriate language, which includes all the following points:

 

1. the words “Important Notice” or their equivalent;

2. a statement of the superiority of breastfeeding;

3. a statement that the product should be used only on the advice of a health worker as to the need for its use and the proper method of use;

4. instructions for appropriate preparation, and a warning against the health hazards of inappropriate preparation.

 

Neither the container nor the label should have pictures of infants, nor should they have other pictures or text which may idealise the use of infant formula. They may, however, have graphics for easy identification of the product as a breastmilk substitute and for illustrating methods of preparation. The terms “humanised”, “maternalised” or similar terms should not be used. Inserts giving additional information about the product and its proper use, subject to the above conditions, may be included in the package or retail unit. When labels give instructions for modifying a product into infant formula, the above should apply.

9.3 Food products within the scope of this Code, marketed for infant feeding, which do not meet all the requirements of an infant formula, but which can be modified to do so, Should carry on the label a warning that the unmodified product should not be the sole source of nourishment of an infant. Since sweetened condensed milk is not Suitable for infant feeding, nor for use as a main ingredient of infant formula, its label should not contain purported instructions on how to modify it for that purpose.

9.4 The label of food products within the scope of this Code should also state all the following points:

 

1. the ingredients used;

2. the composition/analysis of the product;

2. the storage conditions required; and

3. the batch number and the date before which the product is to be consumed, taking into account the climatic and storage conditions of the country concerned.

Article 10. Quality
10.1 The quality of products is an essential element for the protection of the health of infants and therefore should be of a high recognised standard.

10.2 Food products within the scope of this Code should, when sold or otherwise distributed, meet applicable standards recommended by the Codex Alimentarius Commission and also the Codex Code of Hygienic Practice for Foods for Infants and Children.

Article 11. Implementation and monitoring

11.1 Governments should take action to give effect to the principles and aim of this Code, as appropriate to their social and legislative framework, including the adoption of national legislation, regulations or other suitable measures. For this purpose, governments should seek, when necessary, the cooperation of WHO, UNICEF and other agencies of the United Nations system. National policies and measures, including laws and regulations, which are adopted to give effect to the principles and aim of this Code should be publicly stated, and should apply on the same basis to all those involved in the manufacture and marketing of products within the scope of this Code.

11.2 Monitoring the application of this Code lies with governments acting individually, and collectively through the World Health Organisation as provided in paragraphs 6 and 7 of this Article. The manufacturers and distributors of products within the scope of this Code, and appropriate nongovernmental organisations, professional groups, and consumer organisations should collaborate with governments to this end.

11.3 Independently of any other measures taken for implementation of this Code, manufacturers and distributors of products within the scope of this Code should regard themselves as responsible for monitoring their marketing practices according to the principles and aim of this Code, and for taking steps to ensure that their conduct at every level conforms to them.

11.4 Nongovernmental organisations, professional groups, institutions, and individuals concerned should have the responsibility of drawing the attention of manufacturers or distributors to activities which are incompatible with the principles and aim of this Code, so that appropriate action can be taken. The appropriate governmental authority should also be informed.

11.5 Manufacturers and primary distributors of products within the scope of this Code should apprise each member of their marketing personnel of the Code and of their responsibilities under it.

11.6 In accordance with Article 62 of the Constitution of the World Health Organisation, Member States shall communicate annually to the Director General information on action taken to give effect to the principles and aim of this Code.

11.7 The Director General shall report in even years to the World Health Assembly on the status of implementation of the Code; and shall, on request, provide technical support to Member States preparing national legislation or regulations, or taking other appropriate measures in implementation and furtherance of the principles and aim of this Code.

母乳代用品のマーケティングに関する国際規準

母乳代用品のマーケティングに関する国際規準*(全文はこちら )
International Code of Marketing of Breast-milk Substitutes

*「国際規準」のほか、一般的に「WHOコード」あるいは、「国際基準」とも呼ばれる

(1981.5.21 第34回世界保健総会にて採択)

目的

この「国際規準」の目的は、乳児に対する安全で十分な栄養の供給に寄与することである。そのために、母乳育児を保護・推進【注】し、「必要な場合には、適切な情報に基づき、公正妥当なマーケティングと支給を通じて母乳代用品が適切に用いられること」を保証する。

【注】現在の日本では母乳育児の利点の多くが子育て世代には広く知られており、9割以上の母親が母乳で育てたいと願っています。その願いをかなえるために環境を整える努力をするのは母親ではなく、社会の役割です。「母乳育児の推進」というと、母親に対して「母乳で育てるように推進」するかのように思われがちですが、母乳育児を推進する対象は母親ではなく、むしろ母親を取り巻く社会にあるといえます。この国際規準は国際的に通用するように作られており、企業、保健医療システム、および政府に適用されます。

この国際規準は、母乳で育つ赤ちゃんだけではなく、ミルクで育つ赤ちゃんも含めたすべての赤ちゃんの健康を守るために、世界保健総会で採択されました。国際規準は、女性の意志に反して母乳育児を強いることを目的にしていません。誰もが乳児の栄養法に関して偏りがない正確な情報を得て、必要と見なされたときに、可能な限り安全に使用されるよう保証するためのものです。すべてのお母さんには、十分で偏りのない情報を得た上で自分の家族にとって最適な栄養法を選択する権利があります。

母乳には免疫成分があるなどの利点があることは知られていますが、心地よく母乳をあげるにはコツがあり、産科施設の方針やその後の支援によって母乳育児がうまくいくかどうかの大半は左右されます。しっかり赤ちゃんに吸われたり、(それができない場合は)しぼって外に出したりすることが体へのサインとなり、母乳は作られます。何らかの理由で赤ちゃんがしっかり吸えなかったり、授乳回数が減ったりすると作られる量が減っていきます。こうした母乳分泌のしくみやうまくいくためのコツについての十分な情報が与えられる前に、乳児用ミルクの宣伝メッセージを受け取り、医療機関・医療施設で試供品を渡たされると、それをあげているうちに母乳が出なくなっていきます。そうなると、母乳で育てたいと思ってもうまくいかないだけでなく、お母さんが自分の体への自信をなくしてしまうリスクがあります。

また、商品を売るためのテレビCMや雑誌の広告などの影響力も無視できません。そのような影響からできるかぎりお母さんと赤ちゃんを守ろうというのがこの国際規準の目的です。

母乳代用品とは乳児用調整乳(乳児用ミルク)やフォローアップミルク、そのほかの母乳にとって代わる乳児用食品のことです。また、それだけでなく、哺乳びんや人工乳首のマーケティングも規制の対象としています。

つまり、母乳を代用するどのような製品も「母乳代用品」であり、国際規準はどのような代用品の広告もしてはいけないといっています。そして、十分で偏りのない情報提供を得たうえで、乳児用ミルクや哺乳びんを使うと決めた場合は、安心して安全に使えるように支援されることが大切です。

この国際規準が生まれた背景には、乳児用ミルクを製造する多国籍企業が、自社製品の販路拡大を求めて、発展途上国で、不適切な手段で粉ミルクを売り込んだという事実があります。医療施設の中で白衣を着た「ミルクナース」(セールス員)が、粉ミルクを必需品であり、母乳よりも優れたものであるかのように宣伝し、医療施設の中で試供品を配布しました。

お母さんたちは、試供品のミルクをあげているうちに母乳が出なくなり、赤ちゃんにはミルクが不可欠になってしまいました。しかし、十分な粉ミルクを買うお金がない家庭では、薄めて飲ませることになりました。また、粉ミルクを作る水が汚染されているような状況でも販売促進が行われました。そのため、多くの赤ちゃんが亡くなったり、病気になったりしました。
こうした歴史的な悲劇からの教訓からこの国際規準は生まれました。

1981年の決議に反対したのはアメリカのみで日本を含む3国は棄権しましたが、1994年の世界保健総会ではアメリカ・日本も含む全会一致で採決しています。

しかし、それ以降も規制されたはずの宣伝は続いています。1990年代の実話を元にした映画のサイトはこちら http://www.bitters.co.jp/tanovic/milk.html (「汚れたミルク:あるセールスマンの告発」)

時代の変遷に伴い、世界保健総会で内容の補強が行われており、その決議は「国際規準」と同じ効力を持っています。例えば2016年の世界保健総会で合意された「乳幼児食品の不適切な販売促進をやめる指針」は、政府のプログラム、NGO、企業による乳幼児食品(3歳まで対象)の販売促進に対しても適用されます。この国際規準はWHOに加盟する世界194か国中144か国が部分的あるいは完全に何らかの法律や条例として法制化されています(2022年WHO/ユニセフ報告書)。WHOとユニセフは、全加盟国に対し、国内法制を強化し「母乳代用品のマーケティングに関する国際規準」とその後の世界保健総会の関連決議を有効なものとするように勧告しています。
また、国連の子どもの権利委員会からの日本の第 4 回・第 5 回統合定期報告書に関する総括所見(2019年)でも、この「国際規準」を全面的に実施するように勧告されています。

 国際規準の主な内容(全文ではありません)

1. 消費者一般に対して、母乳代用品の宣伝・広告をしてはいけない。
2. 母親に試供品を渡してはならない。
3. 保健施設や医療機関を通じて製品を売り込んではならない。これには乳児用調整乳の無料提供、もしくは低価格での販売も含まれる。
4. 企業はセールス員を通じて母親に直接売り込んではならない。
5. 保健医療従事者に贈り物をしたり個人的に試供品を提供したりしてはならない。保健医療従事者は、母親に試供品を手渡してはならない。
6. 赤ちゃんの絵や写真を含めて、製品のラベル(表示)には人工栄養法を理想化するような言葉、あるいは絵や写真を使用してはならない。
7. 保健医療従事者への情報は科学的で事実に基づいたものであるべきである。
8. 人工栄養法に関する情報を提供するときは、必ず母乳育児の利点を説明し、人工栄養法のコストや不適切な使用法によるリスクを説明しなければならない。
9. 乳児用食品として不適切な製品、例えば加糖練乳を乳児用として販売促進してはならない。
10. 母乳代用品の製造業者や流通業者は、その国が「国際規準」の国内法制を整備していないとしても、「国際規準」を遵守した行動をとるべきである。

主な参考文献
IBFAN(2019)/母乳育児支援ネットワーク訳(2021)乳児の健康を守るために:保健医療従事者のための「母乳代用品のマーケティングに関する国際規準」ガイド母乳育児支援ネットワーク.
United Nations Convention on the Rights of the Child, Committee on the Rights of the Child. (2019) Concluding observations on the combined fourth and fifth periodic reports of Japan, 5 March 2019.
UNICEF/WHO (2009)赤ちゃんとお母さんにやさしい母乳育児支援 ベーシックコース, 医学書院.
Palmer, G.(2009)/本郷寛子,瀬尾智子訳(2015)母乳育児のポリティクス:おっぱいとビジネスとの不都合な関係,メディカ出版.
WHO (2016) Guidance on ending the inappropriate promotion of foods for infants and young children.
WHO/UNICEF/IBFAN.(2022) Marketing of breast-milk substitutes: national implementation of the international code, status report.
(2009年11月、2018年7月、2019年7月、2022年8月 一部改訂)

国際規準違反を報告するフォームはこちらから

国際規準違反報告フォーム

母乳代用品のマーケティングに関する国際規準」の違反を日本語で報告できます。乳児用食品国際行動ネットワーク(IBFAN)のメンバーグループである母乳育児支援ネットワークの有志が英語に訳してIBFANに届けます。

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最初は母乳だけ、その後も他の食べ物を補いながら母乳を与え続ける。金色のリボンは、 その「ゴールド スタンダード」、つまり理想のありようの象徴です。

WABA(世界母乳育児行動連盟)とユニセフが共同で提唱している「金色のリボン運動」に参加しています。

Facebook 母と子の育児支援ネットワーク(災害時の母と子の育児支援 共同特別委員会)

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