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Are we asking the wrong people to comply with the International Code of Marketing of Breast-milk Substitutes?

The World Health Organization (WHO)'s International Code of Marketing of Breast-Milk Substitutes was adopted by the World Health Assembly in 1981 as a minimum requirement to ensure appropriate feeding of infants and young children. According to the WHO 's FAQs on the International Code:
The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.

In developing countries, the difference between being breastfed and being bottle fed truly is life or death. Around 1.4 million lives could be saved every year with improved breastfeeding . In the developed world, formula feeding isn't as likely to kill a child, but not breastfeeding does come with a whole host of health risks for both the baby and the mother. It can lead to deaths as well as increased health problems and increased health costs (whether you have a public system or a private insurance system, you do pay for other people's health care to some extent).

The power of bottle imagery

Bottle imagery is powerful. Everywhere you look you see babies being bottle fed. At the mall, on television, in magazines, on wrapping paper and gift cards, in children's books, in your doctor's office, at the pool, on the bus, at the park, at day care, and so on. In addition to just being what is considered "normal", the bottle industry and the infant formula industry are spending large sums of money to ensure that you see bottles everywhere. There are segments of the population in the United States where young adults have never seen a baby being breastfed and where they may not even know that breasts can be used to feed a baby.

The International Code was put into place partially to try to combat that bottle imagery. The Code sets restrictions on marketing and related practices of the following products:

  • breast-milk substitutes, including infant formula, other milk products, foods and beverages, including bottle-fed complementary foods

  • feeding bottles

  • teats, like bottle nipples and pacifiers

There are a number of restrictions covering a number of different stakeholders, but one in particular says that "there should be no advertising or other form of promotion to the general public of products within the scope of this Code."

I don't use Google Adsense to generate revenue on my blog because of the incredibly deceptive marketing practices that formula companies use on Google (e.g. tricking people into thinking they are getting breastfeeding help when they are really getting a formula ad).

I am a member of the BlogHer ads network.  Generally, I have been impressed with the way the program is run. Until recently, I was able to indicate certain categories of ads that I would not allow on my site. That changed and I now have to ask to have ads removed if I feel they are inappropriate. Unfortunately, since there is no option to preview the ads in advance of them showing up on my blog, this means that numerous visitors to my blog might see an offensive ad before I have the chance to remove it.

I do understand that bottles are sometimes used to feed breast milk. As a former pumping mom myself, I did allow a bottle ad on my blog in the past that specifically mentioned using the bottle for breast milk and that didn't point to any specific super powers of the bottle. I know that in theory it is a violation of the Code, but personally I didn't feel that it crossed the line. Others may disagree, but given all the extremely unethical and deceptive marketing practices by manufacturers of breast milk substitutes, I felt this one was acceptable.

But this week a line was crossed that I wasn't comfortable with. This time, the offending ad was an overt animated AVENT ad that said:
The AVENT Bottle
Clinically proven to reduce fussing in newborns
So everyone gets a good night's sleep
Click to find out how AVENT helps reduce fussing

If you click on it and scroll down to the fine print you would find out that these claims are in comparison with other bottles, not with breastfeeding. But most people don't click. They just see the images. See the words. And internalize that message. Bottles = better sleep. Buy AVENT = get sleep. Buy AVENT = happier baby. Cue the breastfeeding moms with colicy babies running out to the store to buy AVENT bottles instead of addressing the three known situations in the breastfed baby that may result in fussiness or colic. This is not about using a bottle to feed breast milk while you are at work (except maybe for moms on a night shift I guess). This is about blatantly advertising a bottle as the best alternative for nighttime sleep. A time when usually the mother would be right there with a boob on the ready.

So I blocked the bottle ad, but not before it was viewed 662 times. In addition, there was a link in the text links below the ads to a contest allowing moms to win $500. The text link, which showed up for a certain time period under all ads (not just the AVENT ad), must have been viewed thousands of times. I'm sorry.

Can we combat it with some breastfeeding imagery?

Advertising is powerful. Although there are numerous societal barriers to breastfeeding, the fact that people see babies bottle feeding everywhere and rarely see babies breastfeeding is a problem. I made $3.00 in return for 662 people being force fed bottle feeding imagery. It isn't worth it to me. To try to make it up to the world, I have replaced my BlogHer ads for a period of time with some beautiful breastfeeding imagery. I am also a big supporter of the Best for Babes campaign that is attempting to spread a positive message about breastfeeding and have a permanent link to their site in the right column.

But here is the problem. No one is making a profit from you using your breasts to feed your babies. At least not the type of profits made from bottles and formula. The government may save some money by virtue of having a healthier population, so they invest a bit in promoting breastfeeding. But the scant amount they can afford to spend is nothing in comparison with the abundance of funds breast-milk substitute manufacturers and distributors are willing to pour into advertising in order to increase their profits.

Encouraging people to make the healthier choice, in cases where the healthier choice doesn't make anyone any profits, needs to be regulated. This is why tobacco advertising is regulated. There are no anti-smoking companies to pour money into anti-tobacco advertising. Only the limited funds of the government and NGOs. So instead the government has to create balance in the message by regulating the way the message is communicated. This is what the International Code of Marketing of Breast-milk Substitutes is trying to do with regards to formula, bottles and the like.

Now to my point

The government has, in more than 60 countries, adopted the International Code of Marketing of Breast-milk Substitutes and made it law. Some countries have gone a step further. For example, as explained by UNICEF:
In Iran, the Government has taken control of the import and sale of breastmilk substitutes. Formula is available only by prescription, and the tins must carry a generic label - no brand names, pictures or promotional messages are allowed.

In India, legislation requires that tins of infant formula carry a conspicuous warning about the potential harm caused by artificial feeding, placed on the central panel of the label.

In the absence of legislation, the Code encourages manufacturers and distributors to comply with its provisions. Some do so voluntarily. Some pretend that they do, but instead blatantly lie, do not fully disclose ownership, or make other choices that compromise their compliance. Others just don't care at all about compliance and care only about profits.

So if governments are not legislating and we can't count on manufacturers and distributors to police themselves, whose assistance can we solicit to combat bottle imagery and increase breast feeding imagery?

To answer that question, we need to ask where the images are most pervasive. Sure, product labeling is part of the issue and health professionals are often accomplices. But I would like to think there is an opportunity to engage advertisers, broadcasters, and publishers and get them to help enforce the Code and concurrently ramp up breastfeeding imagery.

When I questioned why BlogHer continues to allow bottle and formula ads in violation of the Code, the reply I was given from the executive team and sales management was:
BlogHer does or would accept advertising for bottles, formula, and a variety of other products that might be polarizing in our community. That is why we have always and will continue to give every blogger the option to opt out of any ad featuring any product or service with which they disagree.

Is that good enough?

For me it isn't. This goes beyond something I disagree with or something that is not my cup of tea. It is about a practice that the United Nations attributes to millions of deaths each year. I know we can't count on the formula and bottle manufacturers to comply unless they have to.   So here I am, begging the advertising, broadcasting and publishing industry to do the right thing. To seek out ethical companies to work with. To ideally avoid all bottle imagery, but to at least not accept messages that deceive people into thinking that formula might be better or that a bottle might be better.

If BlogHer won't do that for me, will someone else? Are there any ethical blog advertising networks out there (the equivalent to ethical funds in the advertising world)?

I guess I could be altruistic and not have any advertising on my blog, but I tend to be a blue sky capitalist type and believe that I should be able to earn a living and make the world a better place at the same time. While I mull this over, enjoy the boobies that I put up in place of the BlogHer ads.

UPDATE: BlogHer agreed to create an opt-out category that would allow its bloggers to have Code compliant blogs. Thank you BlogHer!

Related reading:

« More on Health Care | Main | Societal Barriers to Breastfeeding »

Reader Comments (55)

I hate it when I read a nmagazine and there is a giant formila/bottle advertisement. They need to grow some ethics too...

September 14, 2009 | Unregistered Commenterslee

it all starts at the hospital. they have lactation consultants there, but they give you tons of formula swag. i was sent tons of formula in the mail after all 4 of my kids were born & i donated all of it. to think that a century ago this wasn't even an issue is mind-boggling.

September 14, 2009 | Unregistered Commentermommymae

Catherine Young, the original owner of "The Compleat Mother" magazine (http://www.compleatmother.com/) would be proud of your writing and your commitment to the health and future of the babies of the world. She died as a result of cancer that she solely connected to having been fed artificial baby milk as an infant. She went so far as to take Mead Johnson to court in an effort to get them to stop violating the "International Code of Marketing of Breast Milk Substitutes" but sadly lost.

Thank you for continuing to give her desire to see the ads and misrepresentation of choice a voice.

September 14, 2009 | Unregistered CommenterSam

I would think that each player in media systems has a role to play to ensure respect for those hard-fought but easy-to-implement standards. Thanks so much for continued to educate the blogging community. I am very offended by the role Nestle's advertising is playing in the blogosphere and join you in seeing a lot of room for education on that issue as well. You are a great leader and advocate!

September 14, 2009 | Unregistered CommenterDeb

@Deb: I agree about Nestle and have been fighting that fight on twitter today. I chose to post about Avent in this case because of the way its offensive ad invaded my blog, turning me into an unwilling ally.

September 14, 2009 | Unregistered Commenterphdinparenting

It's surreal how we can all walk through life and not even realize what we're seeing. Of course I know logically that I don't see breastfeeding images anywhere, but until you listed the bottle-imagery placement it hadn't clicked intellectually or emotionally.

I don't think I'll ever look at a bottle the same way again. Thank you.

September 15, 2009 | Unregistered CommenterJessica - This is Worthwhile

Since training as a bfing peer supporter and talking with other breastfeeding mothers and a lactation consultant, I have become incredibly aware of the pervasiveness of bottle imagery. Until the taboo about breasts is gone, the media will always have a problem depicting breastfeeding, even if it wants to. For example, babies on TV shows are almost always shown drinking from bottles. But if they did show breastfeeding, they would probably be inundated with complaints from prudes and bigots.
The UK is signed up to the International Code but we frequently contravene it. Advertisers aren't allowed to advertise formula milk for babies of under 6 months; they simply promote "follow-on" milk for six month old babies instead. It's a joke.

September 15, 2009 | Unregistered CommenterCave Mother

When I was a teenager, I went to a family reunion where one of my distant cousins was breastfeeding. That was the first time I had ever seen breastfeeding and it made me very uncomfortable. I didn't know where I should look - I didn't want to stare, but I didn't want to be conspicuously not-staring.

I have not seen anyone breastfeeding since, except on the internet.

How many babies given bottles have I seen? Between real life and media images, I must see at least a dozen a day. No wonder the bottle option is seen as "normal"!

What we women need to do is go out there and breastfeed in public. We need to be visible. We need to make it something that is so common that no one gives it a second thought. We may not be making money doing it, but this advertising strategy doesn't cost anything either. It's the only way that girls and other women will become comfortable enough with the image of breastfeeding to start doing it themselves.

September 15, 2009 | Unregistered CommenterSivana

My baby has not even been born yet, and I have been sent two packages containing formula samples/bottle samples (I must have signed up for something online somewhere). I have kept them because I think that maybe somewhere there is someone who could use them, and because I hate to waste anything, but I am planning to breastfeed and I'm not even considering formula feeding as an option.

A really interesting post! You've given me some inspiration for writing on my own site today, so thanks.

September 15, 2009 | Unregistered CommenterAssertagirl

I also wanted to add that when the Avent bottle ads were on my BlogHer banner I cringed every day, but felt helpless to do anything about it. I figured, "Well, at least it's just bottles and not the formula ads (which I opted out of)." Thanks for standing up and showing that we really CAN do whatever we want with the content of our blogs. Laying in bed last night I vowed that the next time bottle ads came up I would either a) take them down, or b) put big, fat, bold disclaimers and warnings about it with a link back to this post.

September 15, 2009 | Unregistered CommenterJessica - This is Worthwhile

I never really thought about how much bottle imagry we see on a daily basis. But it's so true. It's everywhere.

BTW I love the pics you posted. Better than BlogHer ads anytime.

September 15, 2009 | Unregistered Commenterandrea from the fishbowl

Love this post, and thank you for being a blogger with integrity.

September 15, 2009 | Unregistered CommenterShelly

Beautiful images! When my DS was born I refused to buy him any baby items with images of bottles or pacifiers on them. I did that even though I know that many breastfeeding mothers also give pacifiers, and even though DS ended up having lots of bottles (mostly of breastmilk) after I went back to work at 6 weeks. It is amazing how pervasive the images are, but I suppose you can't ban clothing companies from making clothes, bibs etc with pictures of bottles on them. (Or can you?)

September 15, 2009 | Unregistered CommenterChanna

Yes, yes, yes! We just cannot expect the advertising comapnies, the marketing companies, and the product makers to regulate themselves. They will put profit above all else every time. This is my problem with so-called "free market practices" and the idea that the markets will regulate themselves based on consumers desires, it just doesn't always work. Especially when they can shape the customer's desires with advertising and imagry. We need a government body to step in and say no, this is not healthy, we will stop it.

September 15, 2009 | Unregistered CommenterSummer

While I'm not a fan of comparisons of formula to the tobacco industry, I do see your quandry and also agree on the count of misleading marketing. I've always wondered what the profit margin on formula is. Anyways, I agree that there should be an ethical blog network to evaluate advertising for many reasons. Perhaps the demand would surprise the BlogHer executives and cause some change?

September 15, 2009 | Unregistered CommenterGayle

Gayle: I would never compare formula to tobacco, but I do think the tactics of the formula companies are similar to the tactics of the tobacco companies. And I hope you are right about incenting BlogHer to make some changes. They are a wonderful and progressive organization, but we are all works in progress!

September 15, 2009 | Unregistered Commenterphdinparenting

@Jessica: Did you opt out of individual formula ads? We used to be able to block whole categories (e.g. formula ads) and companies (e.g. Nestle), but that is not possible anymore. You now have to block individual ads after they have appeared on your site. That is what is causing me so much grief right now.

September 15, 2009 | Unregistered Commenterphdinparenting

Melissa posted an announcement on her blog at Stork Stories...Birth and Breastfeeding that the Healthy People's 2010 inititatives for breastfeeding didn't meet their goals so they are setting new goals for 2020. I think people have all the information they need to meet these goals if they would just grow some balls and make the changes needed. In advertising AND education. Perhaps if the President's Health Care Reform bill is passed the US will have a chance to meet these goals. But beyond that possibility someone has to stand up to all the barriers against them and demand the necessary changes get made. I hope this post goes far and wide to open up the eyes of anyone who wasn't already aware of the damaging effects of bottle advertising and imagery.

September 15, 2009 | Unregistered CommenterMelodie

[...] informative blog, PhD in Parenting, on Twitter, directing her followers to her recent post about her thoughts on BlogHer ads, bottle advertising, and her blog.  I learned a lot from her post, including the fact that there is an International Code of [...]

September 15, 2009 | Unregistered CommenterAssertagirl » My early e

I love the new images on your blog and the timely information. I'm not currently hosting ads on my blog but have been beginning to seek advertising for my radio show, with similar standards. Thanks for standing stall in support of breastfeeding.
PS If you need any other bf pics, I'd be happy to share.

September 15, 2009 | Unregistered CommenterKaren Angstadt

You really have put action behind conscience here--thank you. I hope you are able to find more ethical ad options and I second your feeling that it's a shame it has to be so difficult.

I think Cave Mother made a really good point in her comment that all of this also has to do with our society's feelings about breasts. We have such an over-sexed image of the female body that we are not able to see breasts as functional. In fact, I'm not sure how comfortable I am with the message Best for Babes is sending with that image of the gorgeous, slender, audience-facing "momma" nursing in the nude--it seems to be saying "Breastfeeding is sexy" and what I want it to say is "Breastfeeding is natural, healthful, relational . . . . a woman's body has worth outside of male pleasure and consumption!" Big fan of your "Breastfeeding is beautiful" pics.

September 15, 2009 | Unregistered CommenterPriscilla

@Assertagirl: Are there any women's shelters in your area? I've heard that mentioned as a good way for passing on formula you don't want to use.

September 15, 2009 | Unregistered CommenterSarah V.

I thank you too for your integrity. Formula advertising (and to a lesser degree bottle advertising) really upsets me. The new Nestle ads (Nothing else is breastmilk. Nothing else is Good Start.) are extremely powerful. I wish that the money and talent behind formula marketing could be spent on breastfeeding "marketing".

A group of my friends have been chatting about starting some kind of communal blog or newsletter, but the advertising has stymied us - we definitely want to block anything that goes against our parenting ethics.

I love the boobie pictures - they made me smile.

September 15, 2009 | Unregistered CommenterJuliette

@Sarah V. That is a good suggestion. I also mentioned to her over on her blog that donating it to the Food Bank would be a good idea.

September 15, 2009 | Unregistered Commenterphdinparenting

There is some great talent behind the http://www.bestforbabes.org/" rel="nofollow">Best for Babes campaign. Check it out if you haven't already.

September 15, 2009 | Unregistered Commenterphdinparenting

Dead on as usual. Thank you! I dream of a day that a breastfeeding women doesn't turn a room full of people into an uncomfortable and tense situation. I run a retail store, and have for the past 10 years. Never ONCE have a seen a women bf her baby. I do however, almost daily, see women whip out a bottle to feed. Now that I am a bf mother it saddens and troubles me that I so rarely see women bf'ing in public. That it is so tabboo--still. And that we let marketing and imagery dictate our rights and perception of normal.

September 15, 2009 | Unregistered CommenterRachael @ Warm Hearts

The mothers I work with in my public health job often refer to their choice of formula as "the formula that is closest to breast milk". Over the years, that has meant different things, depending on what marketing campaign is going on. A few years ago, it was the added DHA and ARA in the "lipil," "advanced," and "supreme" formulas. Now it's the added probiotics. Advertising is such a powerful force in society. I applaud you in your quest for ethical advertising. And I love the breastfeeding pictures!

September 15, 2009 | Unregistered CommenterChristina

I really liked this. And I love the pictures. Much better than the ads.

September 15, 2009 | Unregistered CommenterCapital Mom

This is one of several reasons I left BlogHer. Eventually I realized there were too many factors that were out of my hands if I was running network ads. Maybe you could pursue private ads? With as many readers and page views as you get, you could probably do nicely running private ads.

In the meantime, thank you for the introduction to Best for Babes! I've been reading through it off and on all day and I am super impressed!

September 15, 2009 | Unregistered CommenterMegan@SortaCrunchy

It's a great site. I spent a long time surfing it yesterday.

September 16, 2009 | Unregistered CommenterJuliette

Fantastic post, my friend. I'm super-psyched to soon be getting some more bfing in before my transplant. I'll be sure to take LOTS of photos for you. Just think of all the eyeballs on me, bald and nursing a 2.5 y/o; must make some heads just spin right off. xo

September 16, 2009 | Unregistered Commenterbitsofmyself.com

[...] Are we asking the wrong people to comply with the International Code of Marketing Breast-milk Substi... ~PhD in Parenting [...]

Lovely image. Although you know I disagree with you on some of these issues surrounding the WHO code, I still admire what you are doing here.

Have you heard of Natural Path Media? I am not a member, but perhaps their ethical standards in selecting ads is more in line with yours?

September 19, 2009 | Unregistered CommenterCandace

The best thing you can do is keep doing what your doing and continue to stick to your guns. Bravo.

September 20, 2009 | Unregistered CommenterMeghan

Very well put! This is what I was starting to touch on in my blog today, but there is really too much to cover at once. Future blog topic, I'm sure.

Ever notice that the only pictures of breastfeeding mothers we see in ads are in formula ads? I remember having a conversation with a friend of mine about how it always shows the mother up at night, in the sheer nightgown and breast exposed. There's that subtle message that breastfeeding=less sleep (after all, then you are the one that has to feed the baby, no one can help) and a play on that fear of being vulnerable and exposed. Not to mention that the louder message is that this formula is just as good as breastmilk, look, it even has "comfort proteins."

This extends to bottle ads. They're all supposed to be closer to breastfeeding, reduce colic and fussiness, etc. Perhaps this wouldn't be as much of an issue if there was as much money going into breastfeeding ads as there are into these ads.

September 24, 2009 | Unregistered CommenterRachel

I finally get around to coming to your blog, and I can't stop reading. MY GOD, I need to examine what's going on in my sidebar.... You are a force, my dear. Keep up the excellent writing.

September 29, 2009 | Unregistered CommenterHaley-O (Cheaty)

Wow. Makes me want to put some bf 'ads' up on my blog! ;p

September 30, 2009 | Unregistered CommenterAl_Pal

[...] regular reader of my blog, you will be aware that I used to have BlogHer ads on my website and that I took them down on September 14, 2009 because of my inability to keep manipulative bottle ads from .... While BlogHer would allow me to take down the ads that I found offensive, there was no way to [...]

This is an amazing piece and a terrific challenge to the blogging community. I've just spent 20 years pregnant/breastfeeding , and in that time had the opportunity to have my choices challenged by just about everyone, including my sisters in the Top-Free movement. It's really a long row to hoe.

I can say from experience, though, the marketing is VERY much more aggressive than it used to be. Particularly as the economy tightens down, advertising revenue becomes more important to families, and more cutthroat. I wonder why issues of 'equal time' aren't enforced in new media. There should be a place for rebuttal of all that stuff, wouldn't you think?

Thank you.

October 3, 2009 | Unregistered CommenterBrooke ... She Who

I just wanted to add my input regarding what to do with unsolicited "sample" formula and bottles. The bottles could be useful for pumped milk when a mom is sick and doesn't want to compromise the baby's health, but the formula really SHOULD be donated to a humane society shelter for puppies and kittens--sometimes the mother cat or dog is injured or killed and the puppies and kittens have no other option for nutrition--in a Women's Shelter, we can only hope the women are getting enough nutrition to be able to offer their children the imminently more suitable choice of breastmilk, so they shouldn't need the samples.

October 9, 2009 | Unregistered CommenterPaula

@Paula: I agree that bottles can be kept if the parents plan to use them at some point. However, there is no reason to stop breastfeeding your child if you are sick. In fact, it is important to continue to do so to benefit from the enhanced immune response that kicks in to fight illness when mom and/or baby are sick.

October 9, 2009 | Unregistered Commenterphdinparenting

Paula, regardless of how much nutrition women in a women's shelter are getting, many of them will be formula feeding and none of them are likely to be either relactating or travelling back through time to make a different choice with regard to how they feed their babies. We can wish that weren't so, we can even work hard to implement the changes in society that will mean that more of those women will be breastfeeding rather than formula-feeding, but at this point in time and for the foreseeable future lots of the women in shelters will be in the situation of formula-feeding and having difficulty getting hold of enough milk in their difficult circumstances, and they *will* need the samples.

BTW - since I'm posting on the subject, here's a problem that's been bugging me. What can a mother ethically do with baby bottles once the baby outgrows them?

As for puppies and kittens, I don't know if formula designed for humans would even be the most appropriate choice for them.

October 9, 2009 | Unregistered CommenterSarah V.

@Sarah V.: Aren't the bottles recyclable? We recycled ours when we were done with them.

October 9, 2009 | Unregistered Commenterphdinparenting

[...] Boycott and/or complain about formula advertising from Nestle and other companies when you see it in magazines, in Google ads, and other advertising. [...]

[...] those might be interpreted or internalized by readers. Just as I’ve called on the media to lay off the bottle imagery and told Elizabeth Pantley that I don’t like the unsafe co-sleeping images in her books, I [...]

[...] challenged BlogHer ads to allow bloggers to opt out of displaying ads for bottles on their sites she said: I do understand that bottles are sometimes used to feed breast milk. As a former pumping mom [...]

[...] it has chosen to ignore the WHO Code and push more bottle imagery and bottle messaging on moms (more on why bottle imagery and messaging is hurtful here). The result is that Medela is directly pushing bottles on moms and also doing so indirectly via [...]

[...] Similac, and Heinz continue to violate the code regularly, as do bottle manufacturers such as Avent, Medela and many others. Despite what they may tell you, these companies are more focused on [...]

[...] as I’ve said before, it may be more effective to express our concerns to the intermediaries that help formula companies spre....  So tell Babble that you do not think it is appropriate for them to have a Breastfeeding Concerns [...]

[...] That’s just a tiny tidbit from a brilliant post by Annie at PhD in Parenting called Are we asking the wrong people to comply with the International Code of Marketing of Breast-milk Sub... [...]

December 7, 2010 | Unregistered CommenterI’m Fully Indoctrinated

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