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Baby milk companies accused of breaching marketing code

Leading baby milk manufacturers are violating the international code on marketing breast milk substitutes, according to a damning report by a group of 27 religious and health organisations.

View larger version (94K): [in this window] [in a new window]   1.5 million deaths a year could be prevented by breast feeding OLIVER GARCIA/PANOS PICTURES

The World Health Organisation's international code of marketing of breast milk substitutes was adopted in 1981 to ensure safe and adequate infant nutrition by protecting and promoting breast feeding. A report by the Interagency Group on Breastfeeding Monitoring, which includes Unicef, Save the Children, and Voluntary Service Overseas, says that there is conclusive evidence that many infant formula manufacturers regularly breach this code.

The report, Cracking the Code, criticises Nestlé and Gerber of Switzerland, Mead Johnson and Wyeth of the United States, and Nutricia of the Netherlands (marketed as Cow and Gate in Britain). The research was immediately condemned by the International Association of Infant Food Manufacturers as biased in design and execution.

The research was carried out in Thailand, Bangladesh, South Africa, and Poland. A random sample of 800 pregnant women and mothers of infants under 6 months old and 120 health workers in each country were interviewed.

Women in all four countries were found to have received company sponsored information that broke the code by promoting artificial feeding without recognising breast feeding as the optimal form of infant nutrition. The results were highest in Poland, where one in three mothers had received such information-39% of it from Nutricia and 17% from Gerber. In South Africa 28% of mothers had received such information, with Nestlé supplying nearly half of it.

An example of information that breaks the code is a Nutricia leaflet "Mummy, I'm hungry," which was found in a facility in Poland (see picture). It contains pictures that idealise the use of breast milk substitutes, with the caption "Mummy, if I was given a particular formula milk, don't change it to a different one at home."

Women in all the countries studied had received free samples of products, most of them from within the healthcare system. The proportion ranged from 0.3% of mothers in Bangladesh to 26% of mothers in Thailand. Health workers also received samples of baby milk, other than for professional research or evaluation, in 50% of facilities in Thailand, 21% in Poland, and 20% in South Africa.

The report also details examples of unrequested visits from company staff to give product information to mothers, to give incentives to health workers to promote products, and to promote products outside healthcare facilities.

Dr John Seaman, senior policy adviser with Save the Children, said: "Bottle feeding is a problem in the developing world because the cost of a can of milk can be a month's disposable income, the instructions can't always be read and so babies can be underfed, and there often aren't the facilities to sterilise bottles and equipment." WHO estimates that some 1.5 million infant deaths every year could be averted though effective breast feeding.

A spokesman for Nestlé said: "We take this report seriously, but are concerned that its statistics are based on a subjective interpretation of the code. An early review of the allegations published in the report does not justify the author's claim that there is a "systematic" violation of the code." They added that if any breaches are confirmed they will be dealt with immediately.

Andrew Tomkins, professor of international child health at the Institute of Child Health in London, defended the research, saying that it used standardised methods and that the study design could not be faulted. "For the first time we have reliable, objective data on the scale of the problem. It is clear we have a totally unacceptable situation which needs radical solutions."

The Interagency Group on Breastfeeding Monitoring was set up after the Church of England decided in 1994 to suspend its support for a boycott of Nestlé until independent research had been carried out. The Church of England Synod will now consider whether to reinstate the boycott.

The Bishop of Coventry said: "Previously I felt we had to say that the jury was still out on this subject. But this report provides compelling evidence from countries around the world that the international code is still being violated."

The Royal College of Paediatrics and Child Health in London has come under renewed pressure to stop accepting donations from Nestlé. View larger version (101K): [in this window] [in a new window]   Polish leaflet breaks code Nestlé is one of the five companies featured in the report Cracking the Code, which criticises baby milk manufacturers for breaking the international code on marketing of infant formula. At the launch of the report Andrew Tomkins, professor of international child health at the Institute of Child Health in London and a member of the Royal College of Paediatrics and Child Health, strongly criticised the college's acceptance of money from Nestlé. He said: " I think it's now totally untenable for the royal college to accept money on this basis." Professor Tomkins said that the Institute of Child Health had decided not to accept money from baby milk manufacturers and urged other organisations to do the same. The Royal College of Paediatrics and Child Health receives £35 000 ($53 000) annually from Nestlé to help fund the activities of the research unit. The money was secured in July 1993 for four years. After criticism of its decision the college held a referendum of its 2265 members in 1995. The result was clearly in favour of continuing to accept the money-73.9% of the 64% of members who voted said yes and 26.1% said no. Dr Keith Dodd, honorary secretary to the college, said: "Given the clear cut result we agreed not to reopen this debate for five years." He added: "The Royal College of Paediatrics and Child Health believes that breast feeding is best for children and supports initiatives to promote breast feeding.

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