Ethics & the IBCLC

Ethics may not be the coolest topic ever but it's a part of the work we do every single day. It should be ingrained in all of our decisions, recommendations, and practices. Our ethics and integrity is meant to protect our patients, of course, but it also protects us as providers and our field. While the IBCLC certification has been around for 4 decades, it's still rather in its infancy. IBCLCs are not incorporated into every hospital, primary care clinic, and public health setting. Many consumers and other health care workers don't know who we are or what we do.

Acting with the upmost of integrity is crucial as we will build trust with our communities.

The Code of Professional Conduct for IBCLCs

https://iblce.org/wp-content/uploads/2017/05/code-of-professional-conduct.pdf

Has 3 main sections:

1. adhere “to the principles and aim of the International Code of Marketing of Breast-milk Substitutes”

2. uphold human rights as outlined in the “United Nations Convention on the Rights of the Child” & the “United Nations Convention on the Elimination of All Forms of Discrimination Against Women”
   

3. uphold the highest standards of ethical conduct as outlined in “Council of Medical Specialty Societies Code for Interactions with Companies”
   

What does this mean for you and for me?

With a huge increase of “influencers” working with pump companies, infant formula companies, bottle companies and more, we are seeing IBCLCs and other health care workers who have direct financial ties through affiliate links, coupon codes, and who receive products for free in exchange for reviews and feedback.

Is this ethical? Is this allowed for IBCLCs?

In short, no.

There are several documents and guides meant to help interpret and determine how this plays out in practice for providers and health care workers.

UNICEF has provided guidance for healthcare workers “to adhere to the International Code of Marketing of Breastmilk Substitutes (the Code), to protect breastfeeding and ensure that parents who formula feed have access to accurate and evidence-based information” https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2020/02/Health-Professionals-Guide-to-the-Code.pdf

There are key components of this guide which apply to IBCLCs and our relationships with companies, marketing, and sponsorship:

“Health workers are the ideal conduit for promoting company products. They are trusted and respected by the public and have easy access to virtually all new mothers and babies. The ‘halo effect’, in which mothers associate the company brand with a health worker, either through a recommendation or something as simple as a logo on a pen, is highly valued by companies.”

“A conflict of interest is any situation where an individual or organisation is in a position to derive a benefit which is at odds with the interests / purpose of their position or organisation. In this context, it is most usually seen when individual members of staff enter into a relationship with companies falling within the scope of the Code in order to gain some advantage for themselves or their service.”

“Maintain clear professional boundaries 18. You must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment.”

“Be impartial 58. You must ensure that your professional judgment is not influenced by any commercial considerations.”

“You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat, or refer patients.”

“not accept private financial benefits or favours, which could be interpreted as an attempt to gain preferential treatment, or present a conflict of interest”

Article 7 of the International Code of Marketing of Breast-milk Substitutes

In regards to health workers, states

“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.”

“Definitions

8. Promotion is broadly interpreted to include the communication of messages that are designed to persuade or encourage the purchase or consumption of a product or raise awareness of a brand… There does not have to be a reference to a brand name of a product for the activity to be considered as advertising or promotion.”

“17. Likewise, health workers, health systems, health professional associations and nongovernmental organizations should not:

• accept gifts or incentives from such companies”

UNICEF’S guide “What I Should Know About ‘the Code’ A guide to implementation, compliance and identifying violations”

“Health workers are required to encourage and protect breastfeeding and make themselves familiar with their responsibilities under the Code”

“The term “promotion” is crucial for understanding and implementing the Code. While there is no definition of “promotion” in the Code itself, the Guidance provides a broad interpretation of this term:

• Promotion includes the communication of messages that are designed to persuade or encourage the purchase or consumption of a product, or raise awareness of a brand.

• There does not have to be a reference to a product or brand name for the activity to be considered advertising or promotion.”

WHO Guidance on regulatory measures aimed at restricting digital marketing of breast-milk substitutes

“Recommendation 1.1. Regulatory measures should prohibit the use of digital marketing tools for the promotion of products within the scope of the Code, including, but not limited to, the following activities:

i. providing or disseminating any promotional content including advertising on social media platforms, streaming platforms, video-sharing platforms, gaming platforms or search engine platforms; in games, podcasts or video content; through websites, display advertisements, banner advertisements, pop-up advertisements, search engine advertising, dark posts, influencer marketing, affiliate marketing, email marketing, and other events hosted online or facilitated by digital technologies”

“Recommendation 4.2. Regulatory measures should prohibit any promotions of a food for infants and young children in digital environments that:

iii. conveys an endorsement or anything that may be construed as an endorsement by a professional”

So what does this mean if an IBCLC is in violation of the Code of Conduct?

It can mean that the provider may not have their certification renewed, they could face disciplinary action, or in some cases -like where I live in Oregon – the provider could lose their healthcare license. In Oregon, IBCLCs are licensed by the state and legally required to follow the Scope of Practice set forth by IBLCE which includes following the Code of Professional Conduct.

Additionally, these types of relationships with companies compromise your integrity and subtly build bias. Patients are compromised and, in my opinion, these types of relationships are completely unethical which casts a poor light on the entire profession.